Deck 23: Physiologic and Behavioral Adaptations of the Newborn

Question 1

The nurse caring for a newborn checks the record to note clinical findings that occurred before her shift.Which finding related to the renal system would be of increased significance and require further action?

A) The pediatrician should be notified if the newborn has not voided in 24 hours.
B) Breastfed infants will likely void more often during the first days after birth.
C) Brick dust or blood on a diaper is always cause to notify the physician.
D) Weight loss from fluid loss and other normal factors should be made up in 4 to 7 days.

Answer 1

The pediatrician should be notified if the newborn has not voided in 24 hours.

Question 2

A client is warm and asks for a fan in her room for her comfort.The nurse enters the room to assess the mother and her infant and finds the infant unwrapped in his crib with the fan blowing over him on high.The nurse instructs the mother that the fan should not be directed toward the newborn and that the newborn should be wrapped in a blanket.The mother asks why.How would the nurse respond?

A) "Your baby may lose heat by convection, which means that he will lose heat from his body to the cooler ambient air. You should keep him wrapped, and should prevent cool air from blowing on him."
B) "Your baby may lose heat by conduction, which means that he will lose heat from his body to the cooler ambient air. You should keep him wrapped, and should prevent cool air from blowing on him."
C) "Your baby may lose heat by evaporation, which means that he will lose heat from his body to the cooler ambient air. You should keep him wrapped, and should prevent cool air from blowing on him."
D) "Your baby will easily get cold stressed and needs to be bundled up at all times."

Answer 2

"Your baby may lose heat by convection, which means that he will lose heat from his body to the cooler ambient air. You should keep him wrapped, and should prevent cool air from blowing on him."

Question 3

Which statement best describes the transition period between intrauterine and extrauterine existence for the newborn?

A) Consists of four phases, two reactive and two of decreased responses
B) Lasts from birth to day 28 of life
C) Applies to full-term births only
D) Varies by socioeconomic status and the mother's age

Answer 3

Lasts from birth to day 28 of life

Question 4

While examining a newborn,the nurse notes uneven skinfolds on the buttocks and a clunk when performing the Ortolani maneuver.These findings are likely indicative of what?

A) Polydactyly
B) Clubfoot
C) Hip dysplasia
D) Webbing

Question 5

Which information about variations in the infant's blood counts is important for the nurse to explain to the new parents?

A) A somewhat lower-than-expected red blood cell count could be the result of a delay in clamping the umbilical cord.
B) An early high white blood cell (WBC) count is normal at birth and should rapidly decrease.
C) Platelet counts are higher in the newborn than in adults for the first few months.
D) Even a modest vitamin K deficiency means a problem with the blood's ability to properly clot.

Question 6

A new mother states that her infant must be cold because the baby's hands and feet are blue.This common and temporary condition is called what?

A) Acrocyanosis
B) Erythema toxicum neonatorum
C) Harlequin sign
D) Vernix caseosa

Question 7

A woman gave birth to a healthy 7-pound,13-ounce infant girl.The nurse suggests that the client place the infant to her breast within 15 minutes after birth.The nurse is aware that the initiation of breastfeeding is most effective during the first 30 minutes after birth.What is the correct term for this phase of alertness?

A) Transition period
B) First period of reactivity
C) Organizational stage
D) Second period of reactivity

Question 8

What is the correct term for the cheeselike,white substance that fuses with the epidermis and serves as a protective coating?

A) Vernix caseosa
B) Surfactant
C) Caput succedaneum
D) Acrocyanosis

Question 9

A newborn is placed under a radiant heat warmer.The nurse understands that thermoregulation presents a problem for the newborn.What is the rationale for this difficulty?

A) The renal function of a newborn is not fully developed, and heat is lost in the urine.
B) The small body surface area of a newborn favors more rapid heat loss than does an adult's body surface area.
C) Newborns have a relatively thin layer of subcutaneous fat that provides poor insulation.
D) Their normal flexed posture favors heat loss through perspiration.

Question 10

What is the most critical physiologic change required of the newborn after birth?

A) Closure of fetal shunts in the circulatory system
B) Full function of the immune defense system
C) Maintenance of a stable temperature
D) Initiation and maintenance of respirations

Question 11

A primiparous woman is watching her newborn sleep.She wants him to wake up and respond to her.The mother asks the nurse how much he will sleep every day.What is an appropriate response by the nurse?

A) "He will only wake up to be fed, and you should not bother him between feedings."
B) "The newborn sleeps approximately 17 hours a day, with periods of wakefulness gradually increasing."
C) "He will probably follow your same sleep and wake patterns, and you can expect him to be awake soon."
D) "He is being stubborn by not waking up when you want him to. You should try to keep him awake during the daytime so that he will sleep through the night."

Question 12

Which infant response to cool environmental conditions is either not effective or not available to them?

A) Constriction of peripheral blood vessels
B) Metabolism of brown fat
C) Increased respiratory rates
D) Unflexing from the normal position

Question 13

The parents of a newborn ask the nurse how much the newborn can see.The parents specifically want to know what type of visual stimuli they should provide for their newborn.What information provided by the nurse would be most useful to these new parents?

A) "Infants can see very little until approximately 3 months of age."
B) "Infants can track their parents' eyes and can distinguish patterns; they prefer complex patterns."
C) "The infant's eyes must be protected. Infants enjoy looking at brightly colored stripes."
D) "It's important to shield the newborn's eyes. Overhead lights help them see better."

Question 14

A first-time father is changing the diaper of his 1-day-old daughter.He asks the nurse,"What is this black,sticky stuff in her diaper?" What is the nurse's best response?

A) "That's meconium, which is your baby's first stool. It's normal."
B) "That's transitional stool."
C) "That means your baby is bleeding internally."
D) "Oh, don't worry about that. It's okay."

Question 15

An African-American woman noticed some bruises on her newborn daughter's buttocks.The client asks the nurse what causes these.How would the nurse best explain this integumentary finding to the client?

A) Lanugo
B) Vascular nevus
C) Nevus flammeus
D) Mongolian spot

Question 16

What marks on a baby's skin may indicate an underlying problem that requires notification of a physician?

A) Mongolian spots on the back
B) Telangiectatic nevi on the nose or nape of the neck
C) Petechiae scattered over the infant's body
D) Erythema toxicum neonatorum anywhere on the body

Question 17

While assessing the integument of a 24-hour-old newborn,the nurse notes a pink papular rash with vesicles superimposed on the thorax,back,and abdomen.What action is the highest priority for the nurse to take at this time?

A) Immediately notify the physician.
B) Move the newborn to an isolation nursery.
C) Document the finding as erythema toxicum neonatorum.
D) Take the newborn's temperature, and obtain a culture of one of the vesicles.

Question 18

Which information related to the newborn's developing cardiovascular system should the nurse fully comprehend?

A) The heart rate of a crying infant may rise to 120 beats per minute.
B) Heart murmurs heard after the first few hours are a cause for concern.
C) The point of maximal impulse (PMI) is often visible on the chest wall.
D) Persistent bradycardia may indicate respiratory distress syndrome (RDS).

Question 19

The nurse is assessing a full term,quiet,and alert newborn.What is the average expected apical pulse range (in beats per minute)?

A) 80 to 100
B) 100 to 120
C) 120 to 160
D) 150 to 180

Question 20

Part of the health assessment of a newborn is observing the infant's breathing pattern.What is the predominate pattern of newborn's breathing?

A) Abdominal with synchronous chest movements
B) Chest breathing with nasal flaring
C) Diaphragmatic with chest retraction
D) Deep with a regular rhythm

Question 21

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

A) Drying the baby after birth, and wrapping the baby in a dry blanket
B) Keeping the baby out of drafts and away from air conditioners
C) Placing the baby away from the outside walls and windows
D) Warming the stethoscope and the nurse's hands before touching the baby

Question 22

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

A) A cephalhematoma may occur with a spontaneous vaginal birth.
B) A cephalhematoma only happens as a result of a forceps- or vacuum-assisted delivery.
C) It is present immediately after birth.
D) The blood will gradually absorb over the first few months of life.

Question 23

Which statements describe the first stage of the neonatal transition period?

A) The neonatal transition period lasts no longer than 30 minutes.
B) It is marked by spontaneous tremors, crying, and head movements.
C) Passage of the meconium occurs during the neonatal transition period.
D) This period may involve the infant suddenly and briefly sleeping.
E) Audible grunting and nasal flaring may be present during this time.

Question 24

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

A) Newborn has to be footprinted.
B) As the skin dries, the creases will become more prominent.
C) Heel sticks may be required.
D) Creases will be less prominent after 24 hours.

Question 25

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

A) Infection
B) Jaundice
C) Caput succedaneum
D) Erythema toxicum neonatorum

Question 26

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?

A) To reduce the risk for jaundice
B) To reduce the risk of intraventricular hemorrhage
C) To decrease total blood volume
D) To improve the ability to fight infection

Question 27

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

A) Observed at age 3 days
B) Is residue of a milk curd
C) Passes in the first 12 hours of life
D) Is lighter in color and looser in consistency

Question 28

What are the various modes of heat loss in the newborn?

A) Perspiration
B) Convection
C) Radiation
D) Conduction
E) Urination

Question 29

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

A) Increased pressure in the right atrium
B) Increased pressure in the left atrium
C) Decreased blood flow to the left ventricle
D) Changes in the hepatic blood flow

Question 30

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

A) Vitamin K is important in the production of red blood cells.
B) Vitamin K is necessary in the production of platelets.
C) Vitamin K is not initially synthesized because of a sterile bowel at birth.
D) Vitamin K is responsible for the breakdown of bilirubin and the prevention of jaundice.

Question 31

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?

A) Physiologic jaundice occurs during the first 24 hours of life.
B) Physiologic jaundice is caused by blood incompatibilities between the mother and the infant blood types.
C) Physiologic jaundice becomes visible when serum bilirubin levels peak between the second and fourth days of life.
D) Physiologic jaundice is also known as breast milk jaundice.

Question 32

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

A) Vision
B) Hearing
C) Smell
D) Taste

Question 33

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

A) Enterohepatic circuit
B) Conjugation of bilirubin
C) Unconjugated bilirubin
D) Albumin binding

Question 34

Which statements regarding physiologic jaundice are accurate?

A) Neonatal jaundice is common; however, kernicterus is rare.
B) Appearance of jaundice during the first 24 hours or beyond day 7 indicates a pathologic process.
C) Because jaundice may not appear before discharge, parents need instruction on how to assess for jaundice and when to call for medical help.
D) Jaundice is caused by reduced levels of serum bilirubin.
E) Breastfed babies have a lower incidence of jaundice.

Question 35

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

A) Babinski
B) Tonic neck
C) Stepping
D) Plantar grasp

Question 36

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

A) The newborn's cheeks are full because of normal fluid retention.
B) The nipple of the bottle or breast must be placed well inside the baby's mouth because teeth have been developing in utero, and one or more may even be through.
C) Regurgitation during the first day or two can be reduced by burping the infant and slightly elevating the baby's head.
D) Bacteria are already present in the infant's GI tract at birth because they traveled through the placenta.

Question 37

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

A) Incompletely developed neuromuscular system
B) Primitive reflex system
C) Presence of various sleep-wake states
D) Cerebellum growth spurt

Question 38

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

A) Infant is dusky and turns cyanotic when crying.
B) Acrocyanosis is present 1 hour after childbirth.
C) The infant's blood glucose level is 45 mg/dl.
D) The infant goes into a deep sleep 1 hour after childbirth.

Question 39

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?

A) The nurse should immediately notify the pediatrician for this emergency situation.
B) The neonate must have aspirated surfactant.
C) If this baby was born vaginally, then a pneumothorax could be indicated.
D) The lungs of a baby delivered by cesarean section may sound moist during the first 24 hours after childbirth.

Question 40

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.

A) tonic neck
B) glabellar (Myerson)
C) Babinski
D) Moro

Question 41

The healthy infant must accomplish both behavioral and biologic tasks to develop normally. Behavioral characteristics form the basis of the social capabilities of the infant. Newborns pass through a hierarchy of developmental challenges as they adapt to their environment and caregivers. This progression in behavior is the basis for the Brazelton Neonatal Behavioral Assessment (NBAS). Match the cluster of neonatal behaviors with the correct level on the NBAS scale.

Ability to attend to visual and auditory stimuli while alert

A)Habituation
B)Orientation
C)Range of state
D)Autonomic stability
E)Regulation of state

Question 42

The healthy infant must accomplish both behavioral and biologic tasks to develop normally. Behavioral characteristics form the basis of the social capabilities of the infant. Newborns pass through a hierarchy of developmental challenges as they adapt to their environment and caregivers. This progression in behavior is the basis for the Brazelton Neonatal Behavioral Assessment (NBAS). Match the cluster of neonatal behaviors with the correct level on the NBAS scale.

Measure of general arousability

A)Habituation
B)Orientation
C)Range of state
D)Autonomic stability
E)Regulation of state

Question 43

The healthy infant must accomplish both behavioral and biologic tasks to develop normally. Behavioral characteristics form the basis of the social capabilities of the infant. Newborns pass through a hierarchy of developmental challenges as they adapt to their environment and caregivers. This progression in behavior is the basis for the Brazelton Neonatal Behavioral Assessment (NBAS). Match the cluster of neonatal behaviors with the correct level on the NBAS scale.

Ability to respond to discrete stimuli while asleep

A)Habituation
B)Orientation
C)Range of state
D)Autonomic stability
E)Regulation of state

Question 44

The healthy infant must accomplish both behavioral and biologic tasks to develop normally. Behavioral characteristics form the basis of the social capabilities of the infant. Newborns pass through a hierarchy of developmental challenges as they adapt to their environment and caregivers. This progression in behavior is the basis for the Brazelton Neonatal Behavioral Assessment (NBAS). Match the cluster of neonatal behaviors with the correct level on the NBAS scale.

How the infant responds when aroused

A)Habituation
B)Orientation
C)Range of state
D)Autonomic stability
E)Regulation of state

Question 45

During life in utero,oxygenation of the fetus occurs through transplacental gas exchange.When birth occurs,four factors combine to stimulate the respiratory center in the medulla.The initiation of respiration then follows.What are these four essential factors?

A) Chemical
B) Mechanical
C) Thermal
D) Psychologic
E) Sensory

Question 46

The healthy infant must accomplish both behavioral and biologic tasks to develop normally. Behavioral characteristics form the basis of the social capabilities of the infant. Newborns pass through a hierarchy of developmental challenges as they adapt to their environment and caregivers. This progression in behavior is the basis for the Brazelton Neonatal Behavioral Assessment (NBAS). Match the cluster of neonatal behaviors with the correct level on the NBAS scale.

Signs of stress related to homeostatic adjustment

A)Habituation
B)Orientation
C)Range of state
D)Autonomic stability
E)Regulation of state