A nurse is completing the admission assessment of a newborn.
Which of the following anatomical landmarks should the nurse use when measuring the newborn’s chest circumference?
Xiphoid process.
Fifth intercostal space.
Sternal notch.
Nipple line.
The Correct Answer is D
Choice A rationale
The xiphoid process is not the correct anatomical landmark for measuring chest circumference in newborns. It is located at the lower end of the sternum and does not provide a consistent measurement point.
Choice B rationale
The fifth intercostal space is not used for measuring chest circumference in newborns. This space is located between the ribs and is not a reliable landmark for consistent measurements.
Choice C rationale
The sternal notch is not the correct landmark for measuring chest circumference. It is located at the top of the sternum and does not provide a consistent measurement point.
Choice D rationale
The nipple line is the correct anatomical landmark for measuring chest circumference in newborns. This method ensures that the measurement is taken at a consistent and reproducible location, providing an accurate assessment of the chest size relative to growth and development standards.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["7"]
Explanation
The newborn’s Apgar score is 7.
Step 1: Heart rate of 110/min = 2 points.
Step 2: Slow, weak cry = 1 point.
Step 3: Flexed extremities = 1 point.
Step 4: Cries in response to suctioning of the nares = 2 points.
Step 5: Body pink in color with blue extremities = 1 point. Total Apgar score = 2 + 1 + 1 + 2 + 1 = 7.
Correct Answer is D
Explanation
Choice D rationale
The normal respiratory rate for a newborn is between 30 to 60 breaths per minute. A rate of 60/min is within this range.
Choice A rationale
A respiratory rate of 110/min is too high for a newborn and may indicate respiratory distress.
Choice B rationale
A respiratory rate of 100/min is also too high for a newborn and may indicate respiratory distress.
Choice C rationale
A respiratory rate of 24/min is too low for a newborn and may indicate respiratory depression.
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