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RN Nursing · Small for Gestational Age and Large for Gestational Age · Practice question

A nurse is assessing a post-term newborn immediately after birth. Which of the following clinical findings should the nurse prioritize as typical for a post-term infant? (Select all that apply.)

Answer & explanation

Correct: Dry, cracked, and peeling skin. · Thin, wasted appearance with decreased subcutaneous fat. · Wide-eyed, alert appearance. · Long fingernails and abundant scalp hair.

Post-term newborns (born after 42 weeks gestation) experience prolonged exposure to the intrauterine environment after the placenta begins to age and function less efficiently. This leads to a characteristic set of physical findings. Dry, cracked, and peeling skin results from the loss of the protective vernix caseosa and prolonged amniotic fluid exposure as the placenta deteriorates. A thin, wasted appearance with decreased subcutaneous fat occurs because the fetus begins metabolizing fat and glycogen stores when placental nutrient delivery becomes insufficient. A wide-eyed, alert appearance is classic for post-term infants and is thought to result from chronic mild hypoxia causing increased alertness. Long fingernails and abundant scalp hair develop because hair and nail growth continue throughout the extended gestational period. These four findings are hallmarks of post-term status. Jaundice appearing within the first 12 hours of life is considered pathological jaundice in any newborn, regardless of gestational age, and is most commonly associated with hemolytic disease such as Rh incompatibility or ABO incompatibility rather than post-term status specifically. Physiological jaundice typically appears after 24 hours. Therefore, early jaundice is not a typical or expected characteristic of post-term newborns and should not be included as a defining feature of this condition.

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