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A nurse is collecting data from a newborn who was delivered at 40 weeks of gestation. Which of the following is an expected finding when eliciting reflexes from the newborn?

A.

The newborn's legs flex at the knees and hips when pressure is applied to the soles of the newborn's feet.

B.

The newborn closes their eyes and keeps them closed when tapped on the forehead.

C.

The newborn's fingers curl around the nurse's finger when placed in the newborn's palm.

D.

The newborn turns their head away from the stimulus when their cheek is touched.

Answer and Explanation

The Correct Answer is C

Choice A rationale

 

The newborn's legs flexing at the knees and hips when pressure is applied to the soles indicates the stepping reflex, an expected response.

 

Choice B rationale

 

Newborns do not typically keep their eyes closed when tapped on the forehead; this is not an expected reflex response.

 

Choice C rationale

 

The palmar grasp reflex, where the newborn's fingers curl around the nurse's finger, is an expected and normal finding in newborns, indicating healthy neurological function.

 

Choice D rationale

 

The rooting reflex, where the newborn turns their head when their cheek is touched, is expected and demonstrates feeding readiness and normal neural development. .


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Correct Answer is C

Explanation

Choice A rationale

The newborn's legs flexing at the knees and hips when pressure is applied to the soles indicates the stepping reflex, an expected response.

Choice B rationale

Newborns do not typically keep their eyes closed when tapped on the forehead; this is not an expected reflex response.

Choice C rationale

The palmar grasp reflex, where the newborn's fingers curl around the nurse's finger, is an expected and normal finding in newborns, indicating healthy neurological function.

Choice D rationale

The rooting reflex, where the newborn turns their head when their cheek is touched, is expected and demonstrates feeding readiness and normal neural development. .

Correct Answer is A

Explanation

Choice A rationale

Positioning the newborn's car seat at a 45° angle helps to maintain an open airway and reduces the risk of the baby's head falling forward, which can obstruct breathing.

Choice B rationale

Placing the car seat in a forward-facing position is incorrect for a newborn. Newborns and infants should always be placed in a rear-facing car seat to protect their head, neck, and spine in the event of a crash.

Choice C rationale

Placing a rolled blanket behind the newborn's neck is not recommended as it can alter the position of the head and neck, potentially compromising the airway. Proper positioning is crucial to ensure safety and comfort.

Choice D rationale

The retainer clip should be positioned at the level of the newborn's armpits, not the umbilicus. Proper placement of the retainer clip ensures that the harness is secure and reduces the risk of injury in a collision.

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