An infant is delivered with the use of forceps. What should the nurse assess for in the newborn?

Choice A rationale Forceps application during delivery applies pressure to the fetal head, potentially causing trauma to the facial nerve (Cranial Nerve VII) where it exits the stylomastoid foramen. This can result in Bell's palsy, characterized by unilateral facial muscle weakness or paralysis, leading to facial asymmetry, especially noticeable when the infant cries. Assessment involves observing for movement equality, symmetry of the nasolabial folds, and eyelid closure. This is a common consequence of mechanical trauma during assisted delivery. Choice B rationale A sacral hematoma involves a collection of blood typically associated with trauma to the sacral area, potentially from a fall or direct blunt force. While delivery can be traumatic, forceps application specifically focuses on the head for traction and rotation, making injury to the sacrum less directly linked to the instrument's primary action than facial trauma. Bruising in the sacral area might occur but a deep hematoma is not a typical forceps-specific injury. Choice C rationale Shoulder dislocation (or Dystocia) usually results from difficulty delivering the shoulders after the head, often due to a large fetus or a prolonged second stage. It is not a direct result of the application of obstetric forceps to the fetal skull. The primary injury concern with forceps is trauma to the head and face, whereas shoulder injuries, like a fractured clavicle or Erb's palsy, relate to excessive lateral traction on the head during delivery. Choice D rationale Loss of hair (alopecia) from the contact area with the forceps is a superficial effect sometimes seen, often presenting as a pressure necrosis or temporary ischemic injury to the hair follicles due to prolonged or excessive pressure. However, it is less clinically significant than potential nerve damage or soft tissue injury like facial palsy or bruising, making facial asymmetry (nerve damage) a higher priority assessment for forceps use.