A nurse is preparing to assess a newborn who is postmature.
Which of the following findings should the nurse expect? (Select all that apply.)

Abundant lanugo

Positive Moro reflex

Vernix in the folds and creases

Short, soft fingernails

Cracked, peeling skin

Answer and Explanation

Correct Answer : B,E

Choice A rationale
Abundant lanugo, which is fine hair, is not typically seen in postmature babies. It is more common in babies who are born prematurely.
Choice B rationale
A positive Moro reflex is a normal finding in newborns, including those who are postmature, indicating a healthy neurological response.
Choice C rationale
Vernix, a white creamy substance that protects the baby’s skin in the womb, is usually absent or very scant in postmature babies.
Choice D rationale
Short, soft fingernails are not a specific sign of postmaturity. Newborns’ fingernails can vary, and they often grow quickly after birth.
Choice E rationale

Cracked, peeling skin is commonly seen in postmature babies. Their skin can often appear dry and wrinkled.

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Correct Answer is C

Explanation

Choice A rationale
Elevating the client’s legs is not the first action to take. While it can help with circulation, it does not directly address the issue of late decelerations.
Choice B rationale
Administering oxygen using a nonrebreather mask can be beneficial as it can increase the amount of oxygen available to the fetus. However, it is not the first action to take.
Choice C rationale
Placing the client in the lateral position is the correct action. This position can help improve placental blood flow and potentially improve the oxygen supply to the fetus.
Choice D rationale
Increasing the rate of maintenance IV infusion is not the first action to take. While it can help maintain hydration and blood pressure, it does not directly address the issue of late decelerations.

A. Monitor weight. B. Monitor I&O. C. Monitor axillary temperature. D. Monitor blood glucose levels.

Correct Answer is D

Explanation

Choice A rationale

Monitoring weight is important for a newborn who is small for gestational age (SGA), but it is not the priority intervention. Weight can provide information about the newborn’s growth and development, but it does not address immediate physiological needs.
Choice B rationale
Monitoring I&O (Intake and Output) is crucial in assessing the newborn’s hydration status and kidney function. However, it is not the priority intervention for an SGA newborn.
Choice C rationale
Monitoring axillary temperature is important to maintain the newborn’s thermal regulation. However, it is not the priority intervention. Newborns, especially those who are SGA, are at risk for hypothermia due to their high body surface area to volume ratio and lack of subcutaneous fat.
Choice D rationale
Monitoring blood glucose levels is the priority intervention for an SGA newborn. SGA newborns are at risk for hypoglycemia because they have fewer glycogen stores. Hypoglycemia can lead to serious complications such as seizures, hence the need for close monitoring

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A nurse is preparing to assess a newborn who is postmature. Which of the following findings should the nurse expect? (Select all that apply.)

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Naxlex Comprehensive Predictor Exams

Correct Answer is C

Explanation

A nurse is formulating a care plan for a newborn who is small for gestational age (SGA). Which of the following should be the priority intervention in the newborn’s care plan?

Correct Answer is D

Explanation

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A nurse is preparing to assess a newborn who is postmature.
Which of the following findings should the nurse expect? (Select all that apply.)