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A nurse is collecting data on a newborn who is 1 day old.Which of the following findings is a manifestation of dehydration?

A.

Presence of acrocyanosis.

B.

Capillary refill greater than 3 seconds.

C.

Voided four times in the past 24 hours.

D.

Flat soft anterior fontanel.

Answer and Explanation

The Correct Answer is B

Choice A rationale

 

Acrocyanosis is a common finding in newborns and is not a sign of dehydration. It usually resolves on its own.

 

Choice B rationale

 

A capillary refill time greater than 3 seconds can indicate dehydration in a newborn. It suggests poor perfusion and fluid status.

 

Choice C rationale

 

Voiding four times in the past 24 hours is within the normal range for a newborn and does not indicate dehydration.

 

Choice D rationale

 

A flat soft anterior fontanel is normal in newborns and does not indicate dehydration. A sunken fontanel would be a sign of dehydration.


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View Related questions

Correct Answer is D

Explanation

Choice A rationale

Applying a corticosteroid cream is not appropriate for acute perineal pain. It is more suitable for chronic inflammation or skin conditions.

Choice B rationale

Increasing fluid intake is beneficial for overall health, but it does not directly address acute perineal pain.

Choice C rationale

Catheterizing the bladder is not indicated for perineal pain unless there is a specific issue with urinary retention.

Choice D rationale

Offering an ice pack helps reduce swelling and numb the area, providing immediate relief for acute perineal pain. It is a standard intervention for postpartum perineal discomfort.

Correct Answer is A

Explanation

Choice A rationale

Warming the newborn’s heel for 5 to 10 minutes before the puncture increases blood flow, making it easier to collect a blood sample.

Choice B rationale

The outer aspect of the heel is the recommended site for puncture to avoid injury to the bone and nerves.

Choice C rationale

Leaving the heel open to the air after the puncture is not recommended as it can increase the risk of infection.

Choice D rationale

Applying an antiseptic after collecting the specimen is not necessary and can interfere with the blood sample.

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