Page 850 - Saunders Comprehensive Review For NCLEX-RN

272. The nurse is assessing a newborn after circumcision and notes that the
circumcised area is red with a small amount of bloody drainage. Which
nursing action is most appropriate?
1. Apply gentle pressure.
2. Reinforce the dressing.
3. Document the findings.
4. Contact the primary health care provider (PHCP).
273. The nurse in a newborn nursery is monitoring a preterm newborn for
respiratory distress syndrome. Which assessment findings should alert the
nurse to the possibility of this syndrome? Select all that apply.
1. Cyanosis

2. Tachypnea

3. Hypotension
4. Retractions

5. Audible grunts

6. Presence of a barrel chest
274. The postpartum nurse is providing instructions to the mother of a newborn
with hyperbilirubinemia who is being breast-fed. The nurse should provide
which instruction to the mother?
1. Feed the newborn less frequently.
2. Continue to breast-feed every 2 to 4 hours.
3. Switch to bottle-feeding the infant for 2 weeks.
4. Stop breast-feeding and switch to bottle-feeding permanently.
275. The nurse is assessing a newborn who was born to a mother who is addicted
to drugs. Which findings should the nurse expect to note during the
assessment of this newborn? Select all that apply.
1. Lethargy

2. Sleepiness

3. Irritability
4. Constant crying

5. Difficult to comfort

6. Cuddles when being held

276. The nurse notes hypotonia, irritability, and a poor sucking reflex in a full-
term newborn on admission to the nursery. The nurse suspects fetal alcohol
syndrome and is aware that which additional sign would be consistent with
this syndrome?
1. Length of 19 inches
2. Abnormal palmar creases
3. Birth weight of 6 lb, 14 oz (3120 g)
4. Head circumference appropriate for gestational age
277. The nurse is creating a plan of care for a newborn diagnosed with fetal

850