Deck 17: Physiological Transition of the Newborn

Question 1

The perinatal nurse explains the cardiopulmonary adaptations that occur in the neonate to a student nurse.Which of the following statements accurately describes the sequence of these changes?

A) "As air enters the lungs, the PO₂ rises in the alveoli, which causes pulmonary artery relaxation and results in an increase in pulmonary vascular resistance."
B) "As the pulmonary vascular resistance increases, pulmonary blood flow increases, reaching 100% by the first 24 hours of life."
C) "Decreased pulmonary blood volume contributes to the conversion from fetal to newborn circulation."
D) "Once the pulmonary circulation has been functionally established, blood is distributed throughout the lungs."

Answer 1

"Once the pulmonary circulation has been functionally established, blood is distributed throughout the lungs."

Question 2

A nurse assesses a 2-hour-old infant's temperature and notes it to be 97.7°F (36.5°C).What action by the nurse is most appropriate?

A) Document the findings and continue to monitor.
B) Ensure the baby is wearing a hat.
C) Place the baby in a pre-warmed incubator.
D) Tightly swaddle the baby.

Answer 2

Document the findings and continue to monitor.

Question 3

New parents are concerned that after initially breastfeeding their baby 2 hours after being born,she is sleeping soundly and will not awaken.What action by the nurse is most appropriate?

A) Call the rapid response team.
B) Document the neonate's behavior in the chart.
C) Reassure the parents that this is normal.
D) Stimulate the baby to wake her up.

Answer 3

Reassure the parents that this is normal.

Question 4

A healthy term infant is being discharged at 48 hours of age.When should the nurse instruct the mother to follow up with a bilirubin assessment?

A) Within 24 hours
B) Within 24-48 hours
C) Within 5 days
D) In 1 week

Question 5

A neonatal nurse who is caring for newborns suggests the best time for a mother to first attempt breastfeeding is during which of the following stages of activity?

A) First period of inactivity and sleep
B) First period of reactivity
C) Second period of inactivity and sleep
D) Second period of reactivity

Question 6

A nurse in the high-risk obstetrical unit monitors a student nurse preparing to give a patient a dose of betamethasone (Celestone).Which action by the student warrants intervention by the nurse?

A) Assesses the patient's lung sounds prior to administration
B) Draws up 12 mg in a syringe with a 20-gauge needle
C) Gently shakes the medication before drawing it up
D) Prepares to administer medication in the deltoid muscle

Question 7

The nurse caring for a woman about to deliver a baby at 33 weeks' gestation knows that what factor might have accelerated surfactant production?

A) Fetal hemolytic disorders
B) Incorrect dates
C) Maternal hypertension
D) Multiple gestation

Question 8

A nursing student asks the registered nurse why babies get dehydrated so easily.What response by the nurse is most accurate?

A) Babies are so tiny that a small water loss leads to big problems.
B) Infants tend to lose more water through insensible losses.
C) Because they don't drink much at a time, skipping a feeding is harmful.
D) Infants' long intestines have more surface area from which to lose water.

Question 9

A mother brings her 1-week-old baby to the clinic with complaints that the baby is not eating well.The mother is attempting to bottle feed about 120 mL every 2 hours.What action by the nurse is best?

A) Explain that this is too much volume at one time.
B) Have the mother demonstrate her feeding and burping technique.
C) Reassure the mother that the baby is eating fine.
D) Weigh the baby and plot her weight on a graph.

Question 10

A new mother with a 6-hour-old infant calls the nursing station complaining that her baby is so cold he is shivering.What action by the nurse is most appropriate?

A) Bring warm blankets to wrap the baby in.
B) Encourage the mother to feed him a warmed bottle.
C) Perform a thorough head-to-toe assessment.
D) Set the room temperature higher.

Question 11

A nurse suspects that an infant in the intensive care unit has had intrauterine exposure to one of the TORCH infections.What finding is indicative of in utero exposure to a TORCH infection?

A) Decreased IgA
B) Decreased IgG
C) Increased IgG
D) Increased IgM

Question 12

A mother-baby nurse assesses newborns for their risk of developing hypoglycemia.Which infant would the nurse assess as being at highest risk?

A) Asian ethnic background
B) Delayed feedings after birth
C) Infant with heat stress
D) Maternal use of terbutaline (Brethine)

Question 13

A woman gives birth to a healthy baby boy at 35 weeks' gestation.What factor regarding the development of the normal respiratory system should the nurse consider when performing an assessment of the neonate?

A) As the fetus approaches term, secretion of intrapulmonary fluid increases.
B) Lung expansion after birth suppresses the further release of surfactant.
C) Surfactant increases alveolar surface tension, allowing re-expansion after exhalation.
D) Surfactant production is sufficient to maintain alveolar stability by about 34 weeks.

Question 14

A nurse is assessing a newborn who is jittery,diaphoretic,and hypothermic,and has poor feeding.What laboratory value would the nurse correlate with this condition?

A) Bilirubin: 5 mg/dL
B) Blood glucose: 32 mg/dL
C) Hematocrit: 50%
D) White blood cell count: 25,000/mm3

Question 15

A term infant is 22 hours old,has a total serum bilirubin level of 13 mg/dL,and has visible jaundice.What action by the nurse is most appropriate?

A) Assure the parents that this is temporary.
B) Document the findings in the infant's chart.
C) Have the mother switch to bottle feeding.
D) Review the chart for history of a traumatic birth.

Question 16

The nursing professor is explaining to a class of students that which chemical factor in the blood directly leads to the initiation of respirations in the newborn?

A) Bilirubin
B) Carbon dioxide
C) High arterial pH
D) Low arterial pH

Question 17

A perinatal nurse has orders to administer betamethasone (Celestone)to the following women in preterm labor.For which patient should the nurse question this order?

A) Emergency cesarean section
B) Fetal cardiac abnormalities
C) Maternal diabetes
D) Severe preeclampsia/eclampsia

Question 18

What action by the nurse is most important to prevent hemorrhagic disease of the newborn?

A) Administer vitamin K₁ phytonadione (AquaMEPHYTON).
B) Assess daily hemoglobin and hematocrit levels.
C) Coordinate laboratory sticks to minimize blood loss.
D) Handle the infant gently to prevent injury.

Question 19

What action by the nurse is most important to prevent respiratory depression in a newly born infant?

A) Bathe the infant in warm water before giving to the mother.
B) Dress the infant in warm clothing and place in a warmer.
C) Dry the infant and place on the mother's bare chest.
D) Turn the delivery room temperature up to 85°F (29.4°C).

Question 20

The nurse is assessing the cardiovascular status of a newborn.Which of the following findings indicates adequate systemic circulation?

A) Capillary refill 2 seconds
B) Capillary refill 4 seconds
C) Pale mucous membranes in a dark-skinned baby
D) Truncal cyanosis

Question 21

The clinical nurse recalls that the newborn has mechanisms by which heat is lost following birth.Which of the following are examples of heat lost via convection?

A) Placed near an open window
B) Placed on a cold scale
C) Placed under a ceiling fan
D) Not dried adequately after birth
E) Placed in a warmer that is not yet warm

Question 22

The clinical nurse assesses kidney function in a newborn.Which of the following statements accurately describes the development of normally functioning kidneys in the newborn?

A) The glomerular filtration rate rapidly increases during the first 4 months of life.
B) The glomerular filtration rate is higher than that of the adult.
C) The kidneys are not mature and fully functional until after birth.
D) The nephrons are fully functional by 29 to 32 weeks of gestation.
E) Urine specific gravity in a neonate ranges from 1.002 to 1.010.

Question 23

A perinatal nurse assesses a term newborn for respiratory functioning.The nurse will document which of the following findings as normal for a neonate?

A) Breathing pattern that can be shallow, diaphragmatic, and irregular
B) Periodic episodes of apnea
C) Respiratory rate of 20-40 breaths/minute while sleeping
D) Respiratory rate of 60-80 breaths/minute
E) The neonate's lung sounds are moist during early auscultation

Question 24

A perinatal nurse suspects that a newborn may be experiencing polycythemia.What further assessments should be made to confirm this condition?

A) Heel stick for metabolic screen
B) Hematocrit level
C) Hemoglobin level
D) Respiratory rate
E) White blood cell count

Question 25

The perinatal nurse teaches new parents about the stages of infant behavior.What information does the nurse provide?

A) Excessive motor activity occurs in the wide-awake state.
B) Irregular respirations are common in REM sleep.
C) Jerking movements may accompany crying.
D) Stimulation decreases activity in the active alert state.
E) When stimuli are removed, the baby falls asleep.

Question 26

A pregnant woman at 25 weeks of gestation visits the prenatal clinic for a checkup.She asks the nurse how the baby is able to breathe on his own following childbirth.The nurse plans to explain the factors that influence the initiation of the newborn's first breath,including which of the following?

A) A quiet environment
B) Drastic change in temperature
C) Hypoxia
D) Initiation of breastfeeding
E) Recoil of the chest wall after delivery of the trunk

Question 27

What assessment finding indicates to the nurse that goals for the diagnosis of ineffective thermoregulation related to newborn's immature temperature regulatory system have been met?

A) Axillary temperature is 98.1°F (36.7°C).
B) Fluctuations in infant's temperature cease.
C) Baby stops shivering and falls asleep.
D) Rectal temperature is 101.0°F (38.3°C).

Question 28

The nursing instructor is explaining passive acquired immunity to a class of nursing students.What information does the professor include?

A) Cellular immunity is the mediator of passive acquired immunity.
B) Colostrum and breast milk are important sources of IgA.
C) IgG passes through the placenta before birth.
D) Most immunity is acquired in the first trimester.
E) Passive acquired immunity generally lasts 6 months.