A nurse is educating a student on the unexpected findings of neonates during a physical exam. What would the nurse include in the education? Select all that apply.

Choice A rationale An expiratory grunt is an unexpected and potentially concerning finding in a neonate, often indicating significant respiratory distress. This sound occurs as the infant attempts to increase positive end-expiratory pressure by closing the glottis before fully exhaling, which is a compensatory mechanism to keep alveoli open and improve oxygenation. Choice B rationale Clenched fists are a normal and common finding in a healthy neonate due to a strong palmar grasp reflex, which is a primitive reflex. This reflex is present at birth and usually diminishes by three to four months of age, and therefore, it is not an unexpected or abnormal finding during a routine physical examination of a newborn. Choice C rationale Apneic episodes lasting longer than 20 seconds are a significant and unexpected pathological finding, defined as abnormal in a newborn. Apnea is a common concern in preterm infants, but in a full-term newborn, prolonged cessation of breathing requires immediate investigation and intervention to prevent hypoxia and potential neurological injury. Choice D rationale A heart murmur over the base of the heart is an unexpected finding that requires further evaluation, although many neonatal murmurs are transient and functional. The nurse must document the location, timing, and characteristics of the murmur, as it may signify a congenital heart defect or a delay in the closure of fetal shunts. Choice E rationale A heart rate of 100 beats/min when sleeping is within the acceptable range for a neonate. The normal heart rate for a newborn at rest or sleeping can range from approximately 80 to 160 beats/min, but a typical average while sleeping may be slightly lower; therefore, this is considered a normal and expected finding. Choice F rationale A persistent heart rate of 180 beats/min or more is considered tachycardia in a neonate and is an unexpected and potentially dangerous finding. Tachycardia may be indicative of various underlying conditions such as fever, hypovolemia, infection, cardiac anomalies, or pain, and necessitates prompt assessment and intervention to determine the cause.