In preparing a family for discharge from the perinatal unit, which method of nail care does the nurse teach as the preferred method?

Correct Answer: B

Rationale: Several options exist for nail care to keep the infant from scratching her face. The nails can be cut, but there is a risk of damaging the delicate skin around the nail. This is best done while the baby sleeps. Letting the nails break off is not a good option, as the child may injure herself before they break. Covering the hands with mittens or a tee shirt is a possible option, but does not allow the child to suck on the fingers for self-soothing. The best option is to file the nails gently with a fine-grained emery board.

Correct Answer: C

Rationale: The extrusion reflex is elicited by touching the tip of the infant's tongue. The tongue should protrude outward. Palmar grasp is detected by placing a small object in the infant's hand. Stroking the side of the cheek should result in the rooting reflex. Turning the head and watching the position of the extremities is part of the tonic neck or fencing reflex.

Correct Answer: D

Rationale: In the context of pharmacology and nursing care of newborns, understanding infant behavior is crucial for providing optimal care. The correct answer, option D - Response to stimulation, is the best choice for assessing infant behavior. This is because a newborn's response to various stimuli can provide valuable insights into their neurological development, sensory processing, and overall well-being. Option A, Ease of learning to nurse, is incorrect because nursing ability is not a reliable indicator of infant behavior and may be influenced by factors like feeding techniques or maternal factors rather than the infant's behavior itself. Option B, Length of sleeping periods, is also incorrect as it only provides information on one aspect of infant behavior (sleep patterns) and does not give a comprehensive view of their overall behavior and responses. Option C, Presence of reflex activity, while important in assessing newborns, does not capture the full range of behaviors that can provide insight into their neurological functioning and responses to the environment. Educationally, understanding how to assess infant behavior accurately is essential for nurses caring for newborns as it can help in early identification of any neurological or developmental issues, guide appropriate interventions, and promote optimal growth and development in these vulnerable patients. By choosing the correct option, nurses can tailor their care based on the individual needs and responses of each newborn, ultimately improving outcomes and promoting overall health and well-being.

Correct Answer: D

Rationale: In understanding the difference in muscle tone between preterm and full-term newborns in pharmacology, it is crucial to grasp the developmental stages of fetal growth and the impact on neuromuscular maturity. The correct answer, D) flaccid, is indicative of the decreased muscle tone often seen in preterm newborns due to their limited time for in utero development. Preterm infants have immature nervous systems, leading to hypotonia or low muscle tone, which manifests as a lack of resistance to passive movement. Option A) firm is incorrect because firm muscle tone is typically associated with hypertonia, which is not a characteristic of preterm newborns. Option B) abnormal is too vague and does not specifically address the issue of muscle tone in preterm infants. Option C) normal is incorrect as preterm newborns do not exhibit normal muscle tone compared to full-term newborns. Educationally, this question highlights the importance of understanding the variations in neuromuscular development between preterm and full-term infants. Nurses caring for newborns need to recognize the implications of decreased muscle tone in preterm infants, as it can impact their ability to feed, maintain body temperature, and reach developmental milestones. This knowledge is essential for providing appropriate care and support to this vulnerable population.

Correct Answer: A

Rationale: Transient tachypnea of the newborn (TTN) is a common respiratory issue in neonates. The correct answer is A) failure to clear lung fluid by the usual mechanism. During birth, the normal process of clearing lung fluid is disrupted, leading to retention of fluid in the lungs and subsequent tachypnea. This condition usually resolves within a few days as the infant's lungs clear the fluid on their own. Option B) failure of the patent ductus arteriosus to close is not related to TTN. The patent ductus arteriosus is a blood vessel in the heart that shunts blood away from the lungs before birth but should close shortly after birth. Option C) insufficient surfactant production is more commonly associated with respiratory distress syndrome (RDS) rather than TTN. Surfactant is a substance that helps keep the lungs inflated and facilitates gas exchange. Option D) aspiration of meconium during birth can lead to meconium aspiration syndrome, which is a different respiratory condition from TTN. Meconium aspiration can cause airway obstruction and inflammation in the lungs. Educationally, understanding the pathophysiology of TTN is crucial for nurses caring for newborns. Recognizing the signs and symptoms of TTN and differentiating it from other neonatal respiratory conditions is essential for providing appropriate care and interventions to support the infant's respiratory function.