The nurse is assessing a full-term African American newborn who is 18 hours old. Which assessment finding would the nurse document as normal for this newborn?
1. Lethargy.
2. Heart rate 115-120.
3. Bulging of the precordium.
4. Pale conjunctiva.
Correct Answer: 2
The infant should be easily aroused and alert. The heart rate of a newborn initially may be as high as 175-180 beats per minute but should decrease over the next 6 to 8 hours to about 115-120 beats per minute. Precordial bulging should always be evaluated and is never considered a normal finding. The skin should demonstrate perfusion with pink quality in the nail beds, mucous membranes, and conjunctiva regardless of the baby's race.
You might also like to view...
A nurse learns at report that a patient is a member of a Seventh-Day Adventist group. At mealtime, which trays should be served to this patient?
a. Corn flakes with whole milk, cranberry and orange juices, buttered muffin, and coffee b. Mixed salad with chunks of chicken, po-tato salad, orange juice, and a small apple c. Scrambled eggs and crisp bacon, melon slice, wheat toast, and hot tea d. Broiled flounder, scalloped potatoes, yel-low squash, green bean salad, rice pud-ding, and coffee
A PHN conducts an immunization clinic for measles. Which of the following is being imple-mented?
a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Health promotion
The client is prescribed warfarin 7.5 mg daily. The medication is supplied as 5 mg tablets. How many tablet(s) should the client receive?
a. 1/2 c. 2 b. 1 d. 1 1/2
A new mother asked the community/public health nurse what a nurse visiting her at home would do differently from what the nurses in the hospital had already done. Which of the following would be the best response from the nurse?
a. "All nurses try to help people stay well, but I can also help you assess your home for any dangers to the baby." b. "Hospital nurses and I all try to be helpful, but I can also tell you how to obtain excellent child care." c. "In the hospital, you had a nurse focus on your baby and another nurse focus on your care. I'll be focusing on both you and your baby." d. "The other nurses in the hospital focus on helping you and the baby get off to a great start. I'm going to repeat everything to be sure you really know it."