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 abnormal sound indicating the infant is attempting to increase end-expiratory pressure to maintain functional residual capacity and prevent alveolar collapse. This suggests respiratory distress, potentially from conditions like respiratory distress syndrome or pneumonia, and is a crucial unexpected finding requiring immediate assessment and intervention. Choice B rationale Clenched fists are a normal, common resting posture for neonates and young infants due to the dominant influence of flexor tone. This finding is considered normal and does not indicate an unexpected or pathological neurological or physical problem, so it would not be included as an unexpected finding during a routine physical examination. Choice C rationale Apnea in a neonate is defined as a cessation of breathing lasting 20 seconds or longer, or any duration accompanied by bradycardia (heart rate below 100 beats/min) or cyanosis. Episodes lasting longer than 20 seconds are a significant sign of immaturity or pathology, requiring further investigation and potential respiratory support. Choice D rationale Transient heart murmurs are common in the first 48 hours of life as the fetal shunts, particularly the ductus arteriosus, close, which usually causes a murmur over the base. A persistent or new loud murmur may be unexpected, but a murmur heard shortly after birth is often benign and expected due to the transition from fetal to pulmonary circulation. Choice E rationale The normal heart rate for a full-term sleeping neonate typically ranges from 80 to 160 beats/min. A heart rate of 100 beats/min is well within the acceptable lower limits of this normal range for a newborn who is asleep and at rest, thus making it an expected, non-pathological finding. Choice F rationale A persistent heart rate of 180 beats/min or more is considered tachycardia in a neonate, as the normal range is typically 110 to 160 beats/min when awake. Sustained tachycardia may indicate underlying conditions such as sepsis, fever, or congenital heart defects, and is an unexpected finding requiring immediate and thorough medical evaluation.