During an assessment of the newborn, the nurse expects to see which finding when the anal area is slightly stroked?
a. Jerking of the legs
b. Flexion of the knees
c. Quick contraction of the sphincter
d. Relaxation of the external sphincter
ANS: C
To assess sphincter tone, the nurse should check the anal reflex by gently stroking the anal area and noticing a quick contraction of the sphincter. The other responses are not correct.
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