a new mother is concerned about a mass on the newborns head the nurse assesses this to be a cephalohematoma based on which characteristics
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ATI Pediatrics Proctored Exam 2023 with NGN

1. What characteristic indicates that a mass on a newborn's head is a cephalohematoma?

Correct answer: A

Rationale: A cephalohematoma typically appears between the first and second days after birth, making choice A the correct answer. It results from blood vessel rupture between a cranial bone and the periosteal membrane. Choices B, C, and D are incorrect because the growth of the mass when the newborn cries, asymmetrical head appearance, or the mass being located on only one side of the head are not specific indicators of a cephalohematoma.

2. Mr. Lopez has a 7-year-old son with growth hormone (GH) deficiency. He shares with the nurse the desire of his son to play ball games. However, his wife feels the child will be in danger since he is smaller than the other children. In planning anticipatory guidance for these parents, the nurse should keep in mind which of the following?

Correct answer: A

Rationale: Children with GH deficiency may face challenges due to their size, but it is important to encourage their participation in activities like playing ball games to promote healthy self-esteem. Allowing the child to play can help in building confidence and a sense of accomplishment, which are essential for their overall well-being.

3. Which of the following signs is MOST indicative of inadequate breathing in an infant?

Correct answer: C

Rationale: Expiratory grunting is a significant sign of inadequate breathing and respiratory distress in infants. It indicates that the infant is struggling to exhale properly, which can be a sign of various respiratory issues, including lung problems or airway obstruction. Monitoring and recognizing this sign promptly can help in providing timely interventions to support the infant's breathing and prevent further complications.

4. When using the Ballard gestational assessment tool on a newborn, which of the following tests should be performed after the first hour of birth, allowing the newborn to recover from the stress of birth?

Correct answer: A

Rationale: The correct answer is Arm recoil. Arm recoil is slower in healthy but fatigued newborns after birth, making it best elicited after the first hour of birth when the baby has had time to recover from the stress of birth. This assessment helps evaluate neuromuscular maturity in newborns and is more accurate when performed after the initial recovery period. The other choices, Square window sign, Scarf sign, and Popliteal angle, are not specifically assessed using the Ballard gestational assessment tool and do not relate to the recovery period after birth.

5. Which of the following signs would you expect to see in a child with respiratory failure?

Correct answer: A

Rationale: In a child with respiratory failure, slow, irregular breathing is a common sign. Respiratory failure impairs the ability to exchange oxygen and carbon dioxide efficiently, leading to altered breathing patterns. Flushed skin, a strong cry, or unconsciousness may not be specific signs of respiratory failure and could be indicative of other conditions. Flushed skin may be a sign of fever or increased blood flow, a strong cry may indicate pain or distress, and unconsciousness can have various causes beyond respiratory failure.

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