Following a traumatic birth of a 10-pound infant, the nurse should assess:
a. gestational age status.
b. flexion of both upper extremities.
c. infant's percentile on growth chart.
d. blood sugar to detect hyperglycemia.
ANS: B
Large infants are at risk for shoulder dystocia, which may result in clavicle fracture or damage to the brachial plexus. Gestational age or the infant's growth chart percentile will not provide data about potential injuries from a traumatic birth. A large infant is at risk for hypoglycemia.
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