The nurse is conducting a body system assessment of the newborn. Which are abnormal findings that the nurse should report? (Select all that apply.)
A) Low-set ears
B) Yellow sclera
C) A doll's eye sign
D) Edema of the eyelids
E) Absence of the grasp reflex

Question

Quizplus · Accepted Answer

Low-set ears may indicate chromosomal abnormalities. The sclera should be white or bluish white. A yellow color indicates jaundice. Absence of reflexes may indicate a serious neurologic problem. The doll's eye sign is a normal finding in the newborn; when the head is turned quickly to one side, the eyes move toward the other side. Edema of the eyelids and subconjunctival hemorrhages (reddened areas of the sclera) result from pressure on the head during birth, which causes capillary rupture in the sclera.

The Nurse Is Conducting a Body System Assessment of the Newborn