NCLEX QUESTION TRAINER EXPLANATIONS 2024 TEST 1

NCLEX QUESTION TRAINER EXPLANATIONS 2024 TEST 1 1. The nurse is caring for clients in the outpatient clinic. Which of the following messages should the nurse return FIRST? 1. A mother reports that the umbilical cord of her five-day-old infant is dry and hard to the touch. 2. A mother reports that the “soft spot” on the head of her four-day-old infant feels slightly elevated when the baby sleeps. 3. A mother reports that the circumcision of her 3-day-old infant is covered with yellowish exudate. 4. A father reports that he bumped the crib of his two-day-old infant and she violently extended her extremities and returned to them their previous position. Strategy: Determine the significance of each assessment and how it relates to a newborn. (1) expected outcome; falls off within 1-2 weeks; no tub baths until the cord falls off (2) correct–fontanelle should feel soft and flat; fullness or bulging indicates increased intracranial pressure (3) normal healing, don't remove exudate; clean with warm water (4) motor reflex is normal; disappears after 3-4 months