Question 1

The nurse observes a mother bottle feeding her newborn and recognizes further teaching is needed when the mother does what?
A) Holds the bottle upright to fill the nipple
B) Holds the baby flat in her arms after the feeding
C) Feeds the baby until he stops sucking
D) Burps the baby halfway through the feeding

Accepted Answer

Holding the baby flat in the arms after feeding can increase the risk of choking and reflux. The correct position is to hold the baby upright or at a 45-degree angle for at least 30 minutes after feeding to allow for proper digestion and to prevent regurgitation.

Question 2

Immediately after the umbilical cord is cut,the newborn has a weak,shallow cry.Which is the nurse's priority action to promote breathing?
A) Assessing vital signs
B) Placing the newborn skin-to-skin with the mother
C) Flicking the newborn's heels
D) Drying the newborn vigorously

Accepted Answer

Drying the newborn vigorously is a standard initial step to stimulate breathing and alertness in a newborn immediately after birth. This action also helps to prevent hypothermia, which can result from being wet and exposed to cooler environments outside the womb.

Question 3

After a newborn has been bathed,which action performed by the nurse indicates a need for further teaching about maintaining the baby's thermoregulation?
A) The newborn is placed in a clean bassinet.
B) The newborn is thoroughly dried.
C) The newborn is dressed and swaddled in a blanket.
D) A hat is placed on the newborn's head.

Accepted Answer

Placing a newborn in a clean bassinet without ensuring the baby is properly warmed first can lead to heat loss. Proper thermoregulation techniques include drying the baby, dressing, swaddling in a blanket, and placing a hat on the baby's head to prevent heat loss through evaporation, conduction, and radiation.

Question 4

The nurse admits a newborn to the admission nursery and prepares to bathe the baby for the first time after assessing what?
A) Drying of the umbilical cord
B) Two hours since last eating
C) Stable temperature for 2 hours
D) Temperature 36.2°C axillary on radiant warmer

Accepted Answer

The newborn should have a stable temperature for at least 2 hours before the first bath to prevent hypothermia. It is also recommended to wait until the cord stump is dry before giving the first bath, but this is not listed as an option. The time since the last feeding and the temperature on the radiant warmer are not as relevant for determining when to give the first bath.

Question 5

The nurse reviews the laboratory results of a 1-hour-old newborn.Which finding does the nurse need to report to the provider immediately?
A) Elevated hemoglobin and hematocrit - 17 g/100 mL and 48%
B) Elevated white blood cell count - 17,000
C) Prolonged clotting time
D) Elevated bilirubin

Accepted Answer

Elevated bilirubin in a 1-hour-old newborn is a concerning finding and needs to be reported to the provider immediately as it can indicate the development of jaundice, which can lead to complications if left untreated. Elevated hemoglobin and hematocrit are within normal range for a newborn and are not concerning. An elevated white blood cell count may indicate infection but without other signs and symptoms, it may not require immediate reporting. Prolonged clotting time may also not require immediate reporting as it may be due to the normal physiological process of the newborn's blood clotting system adjusting after birth.

Question 6

The nurse encourages bonding when a baby is in which stage of the sleep-wake cycle?
A) Light sleep
B) Drowsy
C) Alert
D) Active alert

Accepted Answer

During the alert stage, babies are most receptive to interactions, making it an ideal time for bonding.

Question 7

The nurse is caring for an 18-hour-old newborn who has not voided for the first time yet.Which is the nurse's priority action?
A) Notifying the provider immediately
B) Pressing on the bladder to prevent urine retention
C) Encouraging frequent breastfeeding
D) Documenting and continuing monitoring

Accepted Answer

Newborns may not void immediately after birth; it can be normal for them to take up to 24 hours to have their first urination. The nurse's priority is to document the observation and continue to monitor the newborn's voiding patterns. Immediate intervention or concern is not typically warranted within the first 24 hours unless accompanied by other concerning symptoms.

Question 8

A mother says,"I changed his diaper,fed him,burped him,and he won't stop crying.I even tried playing music for him and shaking this toy for him.What am I doing wrong?" Which is the nurse's best response?
A) "Why don't you try feeding him a little bit more?"
B) "Here,I'll take him back to the nursery so you can rest."
C) "Are you sure you burped him enough?"
D) "He may be overstimulated.Try snuggling him close."

Accepted Answer

The nurse suggests that the baby might be overstimulated, so snuggling him close could help calm him down. Option A implies that the baby is hungry, which may not necessarily be the case. Option B suggests taking the baby away from the mother, which may not be what she wants. Option C assumes that the baby needs to be burped more, which may also not be the case.

Question 9

A mother who is holding her 2-hour-old newborn says,"I don't think she likes breastfeeding,but last time,when we were in the delivery room,she did really well." Which is the nurse's best response?
A) "After birth,babies go into a deep sleep,but when she wakes up,she'll be hungry."
B) "Your milk isn't in yet.That is why she acts disinterested in eating."
C) "You just need to wake her up so she'll be alert and ready to eat."
D) "Let me help you get her to latch on.Once she takes hold,she'll be fine."

Accepted Answer

Newborns often enter a deep sleep phase shortly after birth, which can make them seem uninterested in feeding. This is a normal pattern, and the baby will likely show interest in feeding once they wake up.

Question 10

When caring for a newborn born by Cesarean section,the nurse recognizes the increased risk for respiratory distress because the baby did not experience which external stimuli?
A) Chest squeeze
B) Stimulation of skin sensors
C) Cutting of the umbilical cord
D) Decreased pH

Accepted Answer

Babies born via Cesarean section miss the chest compression that occurs during vaginal delivery, which helps clear fluid from the lungs and can reduce the risk of respiratory distress.

Question 11

Which newborn is at lowest risk for elevated unconjugated bilirubin levels?
A) The newborn with significant bruising from a face presentation
B) The premature newborn
C) The newborn with O+ blood type,born to a mother with O- blood type
D) The baby born at 41 weeks' gestation

Accepted Answer

The baby born at 41 weeks' gestation is at the lowest risk for elevated unconjugated bilirubin levels compared to the other options. Significant bruising, prematurity, and blood type incompatibility are all risk factors for increased bilirubin levels, whereas a full-term baby (41 weeks) without these complications typically has the lowest risk.

Question 12

Normal physiological jaundice is assessed when the nurse observes what?
A) Lethargy,disinterest in feeding,and decreased urine output
B) Serum conjugated bilirubin of 3.2 mg/dL
C) Elevated unconjugated bilirubin at 12 hours of life
D) Serum total bilirubin of 7.2 mg/dL on day 4 of life

Accepted Answer

Normal physiological jaundice is a common condition in newborns and is related to the natural process of bilirubin production and metabolism in the first days of life. It is characterized by an elevation of unconjugated bilirubin, which peaks at around 72 hours of life and then declines. Serum total bilirubin levels of up to 12 mg/dL are considered normal in term infants. Therefore, a serum total bilirubin of 7.2 mg/dL on day 4 of life is within the expected range for physiological jaundice. Choices A, B, and C are incorrect because lethargy, disinterest in feeding, and decreased urine output may be signs of severe hyperbilirubinemia, which could lead to kernicterus if not promptly addressed. A serum conjugated bilirubin of 3.2 mg/dL is not an appropriate marker for physiological jaundice, and elevated unconjugated bilirubin levels at 12 hours of life may be a sign of pathologic jaundice, which requires further investigation and intervention.

Question 13

The nurse accepts a newborn from the provider after delivery.Which is the priority intervention?
A) Placing the infant skin-to-skin with the mother
B) Drying the newborn
C) Placing a hat on the baby's head
D) Placing the baby on the radiant warmer

Accepted Answer

Drying the newborn is the priority intervention immediately after birth to prevent hypothermia by evaporation. Newborns are wet with amniotic fluid and blood, and their large surface area to body weight ratio makes them prone to rapid heat loss.

Question 14

The nurse needs to draw blood via heel stick for a newborn screening examination.How can the nurse use understanding of the newborn's heat production physiology to promote blood collection?
A) By applying a warm pack to the heel before attempting to draw blood
B) By wrapping the baby in a blanket with a hat
C) By placing the baby under a radiant warmer
D) By elevating the head of the bassinet

Accepted Answer

Applying a warm pack to the heel before attempting to draw blood will promote vasodilation and blood flow to the area, making it easier to collect the sample. This is because newborns have limited ability to produce heat and maintain their body temperature, so their blood vessels can constrict in response to cold temperatures. Wrapping the baby in a blanket with a hat or elevating the head of the bassinet may help to maintain the baby's temperature, but will not necessarily promote blood collection. Placing the baby under a radiant warmer may actually cause the blood vessels to constrict further due to the heat source.

Question 15

The nurse notes a newborn's skin and sclera have taken on a yellow hue.Which finding does the nurse expect to see when reviewing the laboratory values?
A) Elevated red blood cell count
B) Elevated direct bilirubin
C) Elevated unconjugated bilirubin
D) Elevated serum albumin levels

Accepted Answer

The yellow hue of the skin and sclera in a newborn is indicative of jaundice, which is most commonly caused by elevated levels of unconjugated bilirubin. This occurs when the newborn's liver is not mature enough to process bilirubin effectively.

Question 16

What is the liver's job related to bilirubin?
A) Changing unconjugated bilirubin to conjugated bilirubin
B) Slowing the breakdown of red blood cells
C) Changing direct bilirubin to indirect bilirubin
D) Attaching bilirubin to albumin

Accepted Answer

The liver's job related to bilirubin is to change unconjugated bilirubin (which is not water-soluble and cannot be excreted in urine) to conjugated bilirubin (which is water-soluble and can be excreted in urine). This process is called conjugation and it allows the bilirubin to be eliminated from the body through the biliary system.

Question 17

Which intervention is most effective for the nurse to perform to promote elimination of conjugated bilirubin?
A) Administering IV fluid
B) Encouraging frequent feeding
C) Discourage breastfeeding
D) Administering packed blood cells

Accepted Answer

Encouraging frequent feeding is the most effective intervention to promote elimination of conjugated bilirubin. Breast milk contains substances that promote bowel movements and help eliminate bilirubin from the body. Discouraging breastfeeding would be counterproductive as it would delay the elimination of bilirubin. Administering IV fluid and Packed blood cells may be necessary for other reasons but are not directly related to promoting elimination of conjugated bilirubin.

Question 18

Which action does the nurse take to reduce the newborn's evaporative heat loss?
A) Placing the newborn on a warm surface
B) Keeping the room temperature warm
C) Keeping the newborn away from cool objects
D) Drying the infant thoroughly after birth

Accepted Answer

Drying the infant thoroughly after birth helps to reduce evaporative heat loss by removing moisture from the newborn's body surface. Placing the newborn on a warm surface, keeping the room temperature warm, and keeping the newborn away from cool objects are methods to reduce conductive and convective heat loss.

Quiz 15: Physiological and Behavioral Adaptations of the Newborn

The nurse observes a mother bottle feeding her newborn and recognizes further teaching is needed when the mother does what?

Immediately after the umbilical cord is cut,the newborn has a weak,shallow cry.Which is the nurse's priority action to promote breathing?

After a newborn has been bathed,which action performed by the nurse indicates a need for further teaching about maintaining the baby's thermoregulation?

The nurse admits a newborn to the admission nursery and prepares to bathe the baby for the first time after assessing what?

The nurse reviews the laboratory results of a 1-hour-old newborn.Which finding does the nurse need to report to the provider immediately?

The nurse encourages bonding when a baby is in which stage of the sleep-wake cycle?

The nurse is caring for an 18-hour-old newborn who has not voided for the first time yet.Which is the nurse's priority action?

A mother says,"I changed his diaper,fed him,burped him,and he won't stop crying.I even tried playing music for him and shaking this toy for him.What am I doing wrong?" Which is the nurse's best response?

A mother who is holding her 2-hour-old newborn says,"I don't think she likes breastfeeding,but last time,when we were in the delivery room,she did really well." Which is the nurse's best response?

When caring for a newborn born by Cesarean section,the nurse recognizes the increased risk for respiratory distress because the baby did not experience which external stimuli?

Which newborn is at lowest risk for elevated unconjugated bilirubin levels?

Normal physiological jaundice is assessed when the nurse observes what?

The nurse accepts a newborn from the provider after delivery.Which is the priority intervention?

The nurse needs to draw blood via heel stick for a newborn screening examination.How can the nurse use understanding of the newborn's heat production physiology to promote blood collection?

The nurse notes a newborn's skin and sclera have taken on a yellow hue.Which finding does the nurse expect to see when reviewing the laboratory values?

What is the liver's job related to bilirubin?

Which intervention is most effective for the nurse to perform to promote elimination of conjugated bilirubin?

Which action does the nurse take to reduce the newborn's evaporative heat loss?