Question 1

Which intervention can nurses use to prevent evaporative heat loss in the newborn?

Accepted Answer

Because the infant is wet with amniotic fluid and blood,heat loss by evaporation quickly occurs.Heat loss by convection occurs when drafts come from open doors and air currents created by people moving around.If the heat loss is caused by placing the baby near cold surfaces or equipment,it is referred to as a radiation heat loss.Conduction heat loss occurs when the baby comes in contact with cold surfaces.

Question 2

How would the nurse optimally reassure the parents of an infant who develops a cephalhematoma?

Accepted Answer

The nurse should explain that bleeding between the skull and the periosteum of a newborn may occur during a spontaneous vaginal delivery as a result of the pressure against the maternal bony pelvis.Low forceps and other difficult extractions may result in bleeding.However,a cephalhematoma can also spontaneously occur.Swelling may appear unilaterally or bilaterally,is usually minimal or absent at birth,and increases over the first 2 to 3 days of life.Cephalhematomas gradually disappear over 2 to 3 weeks.A less common condition results in the calcification of the hematoma,which may persist for months.

Question 3

Which statements describe the first stage of the neonatal transition period?
(Select all that apply).

Accepted Answer

The first stage is an active phase during which the baby is alert; this stage is referred to as the first period of reactivity.Decreased activity and sleep mark the second stage,the period of decreased responsiveness.The first stage is the shortest,lasting less than 30 minutes.Such exploratory behaviors include spontaneous startle reactions.Audible grunting,nasal flaring,and chest retractions may be present; however,these behaviors usually resolve within 1 hour of life.

Question 4

What is the rationale for evaluating the plantar crease within a few hours of birth?

Accepted Answer

As the infant's skin begins to dry,the creases will appear more prominent,and the infant's gestation could be misinterpreted.Footprinting nor heel sticks will not interfere with the creases.The creases will appear more prominent after 24 hours.

Question 5

The condition during which infants are at an increased risk for subgaleal hemorrhage is called what?

Accepted Answer

Subgaleal hemorrhage is bleeding into the subgaleal compartment and is the result of the transition from a forceps or vacuum application.Because of the breakdown of the red blood cells within a hematoma,infants are at greater risk for jaundice.Subgaleal hemorrhage does not increase the risk for infections.Caput succedaneum is an edematous area on the head caused by pressure against the cervix.Erythema toxicum neonatorum is a benign rash of unknown cause that consists of blotchy red areas.

Question 6

The nurse is circulating during a cesarean birth of a preterm infant.The obstetrician requests that cord clamping be delayed.What is the rationale for this directive?

Accepted Answer

Delayed cord clamping provides the greatest benefits to the preterm infant.These benefits include a significant reduction in intraventricular hemorrhage,a reduced need for a blood transfusion,and improved blood cell volume.The risk of jaundice can increase,requiring phototherapy.Although no difference in the newborn's infection fighting ability occurs,iron status is improved,which can provide benefits for 6 months.

Question 7

How would the nurse differentiate a meconium stool from a transitional stool in the healthy newborn?

Accepted Answer

Meconium stool is usually passed in the first 12 hours of life,and 99% of newborns have their first stool within 48 hours.If meconium is not passed by 48 hours,then obstruction is suspected.Meconium stool is the first stool of the newborn and is made up of matter remaining in the intestines during intrauterine life.Meconium is dark and sticky.

Question 8

What are the various modes of heat loss in the newborn?
(Select all that apply).

Accepted Answer

Convection,radiation,evaporation,and conduction are the four modes of heat loss in the newborn.

Question 9

Which cardiovascular changes cause the foramen ovale to close at birth?

Accepted Answer

With the increase in the blood flow to the left atrium from the lungs,the pressure is increased,and the foramen ovale is functionally closed.The pressure in the right atrium decreases at birth and is higher during fetal life.Blood flow increases to the left ventricle after birth.The hepatic blood flow changes but is not the reason for the closure of the foramen ovale.

Question 10

The nurse is cognizant of which information related to the administration of vitamin K?

Accepted Answer

The bowel is initially sterile in the newborn,and vitamin K cannot be synthesized until food is introduced into the bowel.Vitamin K is necessary to activate blood-clotting factors.The platelet count in term newborns is near adult levels.Vitamin K is necessary to activate prothrombin and other blood-clotting factors.

Question 11

A first-time dad is concerned that his 3-day-old daughter's skin looks "yellow." In the nurse's explanation of physiologic jaundice,what fact should be included?

Accepted Answer

Physiologic jaundice becomes visible when the serum bilirubin reaches a level of 5 mg/dl or higher when the baby is approximately 3 days old.This finding is within normal limits for the newborn.Pathologic jaundice,not physiologic jaundice,occurs during the first 24 hours of life and is caused by blood incompatibilities that result in excessive destruction of erythrocytes; this condition must be investigated.Breast milk jaundice occurs in one third of breastfed infants at 2 weeks and is caused by an insufficient intake of fluids.

Question 12

Which component of the sensory system is the least mature at birth?

Accepted Answer

The visual system continues to develop for the first 6 months after childbirth.As soon as the amniotic fluid drains from the ear (in minutes),the infant's hearing is similar to that of an adult.Newborns have a highly developed sense of smell and can distinguish and react to various tastes.

Question 13

The process during which bilirubin is changed from a fat-soluble product to a water-soluble product is known as what?

Accepted Answer

Conjugation of bilirubin is the process of changing the bilirubin from a fat-soluble to a water-soluble product and is the route by which part of the bile produced by the liver enters the intestine,is reabsorbed by the liver,and is then recycled into the intestine.Unconjugated bilirubin is a fat-soluble product.Albumin binding is the process during which something attaches to a protein molecule.

Question 14

Which statements regarding physiologic jaundice are accurate?
(Select all that apply).

Accepted Answer

Neonatal jaundice occurs in 60% of term newborns and in 80% of preterm infants.The complication called kernicterus is rare.Jaundice in the first 24 hours or that persists past day 7 is cause for medical concern.Parents need to be taught how to evaluate their infant for signs of jaundice.Jaundice is caused by elevated levels of serum bilirubin.Breastfeeding is associated with an increased incidence of jaundice.

Question 15

Which newborn reflex is elicited by stroking the lateral sole of the infant's foot from the heel to the ball of the foot?

Accepted Answer

The Babinski reflex causes the toes to flare outward and the big toe to dorsiflex.The tonic neck reflex (also called the fencing reflex)refers to the posture assumed by newborns when in a supine position.The stepping reflex occurs when infants are held upright with their heel touching a solid surface and the infant appears to be walking.Plantar grasp reflex is similar to the palmar grasp reflex; when the area below the toes is touched,the infant's toes curl over the nurse's finger.

Question 16

The nurse should be cognizant of which important information regarding the gastrointestinal (GI)system of the newborn?

Accepted Answer

Avoiding overfeeding can also reduce regurgitation.The newborn's cheeks are full because of well-developed sucking pads.Teeth do develop in utero,but the nipple is placed deep because the baby cannot move food from the lips to the pharynx.Bacteria are not present at birth,but they soon enter through various orifices.

Question 17

The brain is vulnerable to nutritional deficiencies and trauma in early infancy.What is the rationale for this physiologic adaptation in the newborn?

Accepted Answer

The vulnerability of the brain is likely due to the cerebellum growth spurt.By the end of the first year,the cerebellum ends its growth spurt that began at approximately 30 weeks of gestation.The neuromuscular system is almost completely developed at birth.The reflex system is not relevant to the cerebellum growth spurt.The various sleep-wake states are not relevant to the cerebellum growth spurt.

Question 18

Under which circumstance should the nurse immediately alert the pediatric provider?

Accepted Answer

An infant who is dusky and becomes cyanotic when crying is showing poor adaptation to extrauterine life.Acrocyanosis is an expected finding during the early neonatal life and is within the normal range for a newborn.Infants enter the period of deep sleep when they are approximately 1 hour old.

Question 19

A nursing student is helping the nursery nurses with morning vital signs.A baby born 10 hours ago by cesarean section is found to have moist lung sounds.What is the best interpretation of these data?

Accepted Answer

Moist lung sounds will resolve within a few hours.A surfactant acts to keep the expanded alveoli partially open between respirations for this common condition of newborns.In a vaginal birth,absorption of the remaining lung fluid is accelerated by the process of labor and delivery.The remaining lung fluid will move into interstitial spaces and be absorbed by the circulatory and lymphatic systems.Moist lung sounds are particularly common in infants delivered by cesarean section.The surfactant is produced by the lungs; therefore,aspiration is not a concern.

Question 20

While evaluating the reflexes of a newborn,the nurse notes that with a loud noise the newborn symmetrically abducts and extends his arms,his fingers fan out and form a C with the thumb and forefinger,and he has a slight tremor.The nurse would document this finding as a positive _____ reflex.

Accepted Answer

The characteristics displayed by the infant are associated with a positive Moro reflex.The tonic neck reflex occurs when the infant extends the leg on the side to which the infant's head simultaneously turns.The glabellar (Myerson)reflex is elicited by tapping on the infant's head while the eyes are open.A characteristic response is blinking for the first few taps.The Babinski reflex occurs when the sole of the foot is stroked upward along the lateral aspect of the sole and then across the ball of the foot.A positive response occurs when all the toes hyperextend,with dorsiflexion of the big toe.

Quiz 23: Physiologic and Behavioral Adaptations of the Newborn