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CCNS Certified Clinical Nurse Specialist

Category - Neonatal

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A nurse is performing an admission assessment on a newborn infant with a diagnosis of spina bifida (myelomeningocele). A priority nursing assessment for this newborn is:

Pulse rate
Palpation of the abdomen
Specific gravity of the urine
Head circumference measurement

Explanation

Answer - D - A priority nursing assessment for this newborn is head circumference measurement. Newborn infants with spina bifida (myelomeningocele type) are at risk for hydrocephalus; therefore, the head circumference should be measured to obtain a baseline.

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CCNS Certified Clinical Nurse Specialist

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CCNS Certified Clinical Nurse Specialist

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