A woman gave birth to a newborn via vaginal delivery with the use of a vacuum extractor. The nurse would be alert for which of the following in the newborn?

Choice A rationale The application of a vacuum extractor cup creates negative pressure on the fetal scalp, specifically aiming to assist in delivery. A common and expected consequence of this suction is the formation of a caput succedaneum, which is a localized edematous swelling (serosanguinous fluid) of the soft tissues of the scalp, located above the periosteum. It is typically present at birth and crosses suture lines. Choice B rationale While severe, prolonged vacuum extraction or misuse can rarely lead to serious complications, central nervous system injury (e.g., intracranial hemorrhage) is not the most common or expected adverse effect. The nurse's initial alert should be for the most frequent and less severe, yet common, physiological responses to the procedure, such as scalp trauma. Choice C rationale Asphyxia (impaired gas exchange leading to hypoxemia and hypercapnia) is a complication that may necessitate the use of a vacuum extractor but is not a direct or most common result of the device's application. The procedure is intended to prevent or alleviate a prolonged labor that could lead to asphyxia. Choice D rationale Clavicular fracture is more commonly associated with shoulder dystocia or a difficult, manual breech delivery where lateral traction is applied to the baby's head or neck. While vacuum extraction carries risks, a clavicular fracture is not the typical or most anticipated trauma directly resulting from the suction on the scalp.