You are receiving report from the nightshift nurse. Which newborn should you assess first?

Correct Answer: B

Rationale: The correct answer is B. Bilateral breath sounds and nasal flaring indicate respiratory distress, which is a priority assessment in a newborn. Nasal flaring suggests increased work of breathing, requiring prompt evaluation to prevent respiratory compromise. Choice A is incorrect as acrocyanosis is a common finding in newborns and not an urgent concern. Choice C is incorrect as breastfeeding is a normal activity for newborns. Choice D is incorrect as failing a hearing screen test does not present an immediate threat to the newborn's health.

Correct Answer: B

Rationale: The correct answer is B because in the case of a newborn with a congenital defect of the penis, the foreskin might be needed for future repairs to correct the defect. Removing the foreskin through circumcision could potentially limit surgical options and make it more challenging to address the underlying issue. It is essential to preserve as much tissue as possible to allow for optimal outcomes in any necessary corrective procedures. Choice A is incorrect as the risk of infection is not the primary reason for avoiding circumcision in this scenario. Choice C is incorrect as the visibility of the defect is not a determining factor in the decision. Choice D is also incorrect as there can be a valid medical rationale for circumcision in other cases, but in this specific situation, preserving the foreskin for potential future repairs is the most important consideration.

Correct Answer: C

Rationale: The correct answer is C because gestational age assessment helps identify infants at risk for problems like prematurity-related complications. It aids in providing appropriate care and monitoring for high-risk infants. Choice A is not patient-centered. Choice B is inaccurate as gestational age assessment is for clinical purposes, not insurance. Choice D is incorrect as hospitalization duration is determined by clinical condition, not just gestational age.

Correct Answer: A

Rationale: The correct answer is A because it acknowledges the mother's feelings and offers empathy, showing understanding and validating her concerns. It encourages open communication and allows the mother to express her emotions. Incorrect choices: B: This response generalizes all mothers and does not address the specific concerns of the new mother. C: While this choice attempts to reassure the mother, it minimizes her feelings and may come across as dismissive. D: This response is accusatory, blaming the mother for the baby's appearance and could potentially cause guilt and defensiveness.

Correct Answer: C

Rationale: The correct answer is C: contact the pediatric provider. In this scenario, the newborn's presentation with a hard ridged area, significant molding, and no sign of depression in the fontanels is concerning given the prolonged pushing, epidural anesthesia, and vacuum extraction during delivery. Contacting the pediatric provider is crucial as these findings may indicate potential issues such as cranial molding, head trauma, or skull fracture which require further evaluation and management. Monitoring the newborn, anticipating molding subsiding, inspecting fontanels, or considering findings within normal limits are not appropriate actions given the risk factors and concerning presentation. Contacting the pediatric provider ensures prompt assessment and appropriate intervention if necessary.