A nurse is preparing to assess reflexes in a 3-day-old newborn who is currently asleep. Which reflex is most appropriately tested during the newborn's sleep state to evaluate neurological function?
Sucking reflex
Rooting reflex
Plantar grasp reflex (Babinski)
Moro (startle) reflex
The Correct Answer is C
A. Sucking reflex: The sucking reflex requires the newborn to be awake and alert to coordinate sucking motions, so it cannot be reliably assessed while the infant is asleep.
B. Rooting reflex: The rooting reflex also requires the newborn to be awake and responsive, as it depends on the infant turning the head toward a tactile stimulus near the mouth.
C. Plantar grasp reflex (Babinski): The plantar grasp reflex can be assessed even when the newborn is asleep, as it involves applying gentle pressure to the sole of the foot, causing toe flexion. It is a reliable indicator of neurological integrity in the sleeping state.
D. Moro (startle) reflex: The Moro reflex requires the infant to be awake and responsive to sudden stimuli or a gentle drop sensation, making it unsuitable for assessment during sleep.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","D"]
Explanation
A. The final booster dose is administered at 12 to 15 months of age: The Hib vaccine series is completed with a booster in the second year of life, which ensures long-term immunity against invasive Hib infections.
B. The vaccine is administered intramuscularly: Hib vaccine is given via IM injection, typically in the anterolateral thigh for infants or the deltoid for older children, which is important for proper absorption and immune response.
C. The first dose of this vaccine can be administered to a newborn immediately after birth: The Hib vaccine is not given at birth; the series begins at 2 months of age according to the recommended immunization schedule.
D. The vaccine reduces the risks for meningitis and epiglottitis: Hib vaccination protects against serious infections caused by Haemophilus influenzae type b, including meningitis, epiglottitis, and pneumonia, reducing morbidity and mortality.
E. An allergy to eggs is a contraindication to this vaccine: Egg allergy is not a contraindication for Hib vaccine; it is safe for children with this allergy.
Correct Answer is B
Explanation
A. Constantly reminding the child to stop scratching to prevent skin damage: Verbal reminders alone are ineffective in controlling pruritus in toddlers, as scratching is often involuntary and exacerbated by dry or irritated skin.
B. Applying topical moisturizers regularly to maintain skin hydration: Frequent use of emollients helps restore the skin barrier, reduces dryness, and prevents itching and flare-ups, which is a primary strategy in managing atopic dermatitis.
C. Administering oral antibiotics to prevent secondary infections from scratching: Antibiotics are only indicated if a secondary bacterial infection is present. Routine prophylactic use is unnecessary and does not prevent the initial skin irritation.
D. Preparing hot baths for the child to soothe the itching skin: Hot water can further dry and irritate the skin, worsening pruritus and increasing the risk of flare-ups. Lukewarm baths are recommended instead.
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