NCLEX-PN
NCLEX Pediatric Questions Questions
Extract:
Question 1 of 5
During an assessment of the full-term,1-hour-old newborn the nurse obtains an apical HR of 120 bpm and auscultates a soft murmur at the left sternal border third intercostal space. In response to these assessment findings which action should be taken by the nurse?
Correct Answer: B
Rationale: An apical HR of 120 bpm (normal: 100–160 bpm) and a murmur at the sternal border (likely due to delayed foramen ovale closure) are normal findings. Documentation is sufficient. Reporting repositioning or stimulating crying is unnecessary.
Question 2 of 5
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Question 3 of 5
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Question 4 of 5
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Question 5 of 5
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