The nurse notices that a 37-week newborn who was born by spontaneous vaginal delivery 2 hours ago still has a thick white coating in his skin folds and hair.
What would be the most appropriate intervention?
To inform the NICU charge nurse to do a Ballard score as this would be unusual for a 37-week newborn.
Chart the white coating as milia and continue with the assessment.
Notify the doctor to get an order to swab the coating to test for infection.
Inform the parents that the coating is vernix which protects the baby's skin. Most of it will come off in the bath later and to just rub any excess into the baby's skin folds.
The Correct Answer is D
Choice A rationale
A Ballard score assesses neuromuscular and physical maturity and is used to estimate gestational age, which is already known to be 37 weeks. The thick white coating described is vernix caseosa, which is typically abundant in preterm and term newborns, thus its presence is not an unusual finding warranting NICU notification or a repeat gestational assessment.
Choice B rationale
Milia are tiny, white, benign cysts caused by retained keratin and sebum, commonly found on a newborn's nose, cheeks, and chin. They are distinct from the widespread, thick, white coating in skin folds and hair, which is characteristic of vernix caseosa, a protective material and not a localized skin finding like milia.
Choice C rationale
Vernix caseosa provides a natural antimicrobial barrier containing immunoglobulins and is not a sign of infection. It should not be swabbed for culture, as this is unnecessary and could disrupt the natural benefits it provides to the newborn's skin and immune defense, which is why a bath is usually delayed.
Choice D rationale
The thick white coating is vernix caseosa, a protective layer secreted by fetal sebaceous glands, composed of sebum, shed epithelial cells, and water. It moisturizes the skin, acts as a thermal insulator, and possesses antibacterial properties. Gentle rubbing into the skin after birth promotes its benefits and is acceptable, but it mostly absorbs or is removed with the first bath.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
Caput succedaneum, a common finding, is a localized, edematous swelling of the soft tissues of the scalp, which crosses suture lines. It results from pressure on the fetal head against the maternal cervix or bony pelvis during labor or delivery, and therefore it frequently occurs with spontaneous vaginal births.
Choice B rationale
Caput succedaneum is pitting edema or serosanguineous fluid above the periosteum, causing a diffuse swelling that typically resolves spontaneously and harmlessly within the first few days (often 24-48 hours) after birth, not over the first few months, which distinguishes it from a cephalohematoma.
Choice C rationale
This swelling is an extravasation of fluid and blood into the soft tissue of the scalp, which is above the periosteum. While the breakdown of red blood cells in the collection can contribute to jaundice, the cephalohematoma (bleeding under the periosteum) poses a higher and more substantial risk for hyperbilirubinemia.
Choice D rationale
Caput succedaneum is caused by venous and lymphatic congestion in the presenting part of the scalp due to pressure from the uterus, cervix, or maternal bony pelvis during labor. This common finding is non-pathologic and can occur with or without instruments during a spontaneous vaginal birth. —.
Correct Answer is A
Explanation
Choice A rationale
The number of wet diapers is a reliable indicator of sufficient fluid intake and renal perfusion, directly reflecting adequate milk transfer during breastfeeding. During the first week, an increase in wet diapers, reaching at least 6 to 8 wet diapers per day by day five, signifies successful hydration and effective latch and suck, ensuring the newborn receives necessary volume.
Choice B rationale
A newborn is expected to lose 5.
Choice C rationale
Newborns should feed on demand, typically 8 to 12 times in 24 hours or approximately every 2 to 3 hours initially, not sleeping for 6 hours between feedings. Prolonged periods of sleep, especially in the early weeks, can lead to hypoglycemia and insufficient milk intake, hindering effective weight gain and establishing milk supply.
Choice D rationale
In the first month, a breastfed newborn should typically have at least 3 to 4 breast milk stools per day, not just one, after the meconium phase is complete. Stools should transition from black (meconium) to green to a yellow, seedy consistency. One stool per 24 hours suggests inadequate intake or volume.
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