Question 1

A nurse is administering vitamin K to an infant shortly after birth.The parents ask why their baby needs a shot.The nurse explains that vitamin K is

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 vital for clotting,so without it the infant is at increased risk of bleeding problems.It is not needed to produce red blood cells,platelets,or break down bilirubin.

Question 2

Cardiovascular changes that cause the foramen ovale to close at birth are a direct result of

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.It is higher during fetal life.Blood flow increases to the left ventricle after birth.The hepatic blood flow changes,but that is not the reason for the closure of the foramen ovale.

Question 3

What is a result of hypothermia in the newborn?

Accepted Answer

In hypothermia,the basal metabolic rate (BMR)is increased in an attempt to compensate,thus requiring more glucose.Shivering is not an effective method of heat production for newborns.Oxygen demands increase with hypothermia.The metabolic rate increases with hypothermia.

Question 4

The nurse needs to assess infants for the development of high levels of bilirubin.Which baby can the nurse check last?

Accepted Answer

The infant who is fed early will be less likely to retain meconium and reabsorb bilirubin from the intestines back into the circulation.Bruising,cephalhematomas,and prematurity increase the baby's risk of high bilirubin.

Question 5

To prevent heat loss from convection in a newborn,which action by the nurse is best?

Accepted Answer

Convection occurs when infants are exposed to cold air currents.Moving the baby out of the fan's air currents will reduce this loss.The warmer prevents heat loss from radiant heat loss.Drying the baby prevents evaporative heat loss.Warm blankets prevent conductive heat loss.

Question 6

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 greater,which occurs when the baby is approximately 3 days old.This finding is within normal limits for the newborn.Pathologic jaundice occurs during the first 24 hours of life.Pathologic jaundice is caused by blood incompatibilities,causing excessive destruction of erythrocytes,and 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 7

The nurse understands that respirations are initiated at birth as a result of

Accepted Answer

A variety of these factors are responsible for initiation of respirations.The PO₂decreases at birth and the PCO₂ increases.The foramen ovale closes at birth.Tactile stimuli aid in initiating respirations but are not the main cause.

Question 8

The hips of a newborn are examined for developmental dysplasia.Which sign indicates an incomplete development of the acetabulum?

Accepted Answer

Asymmetric thigh and gluteal creases may indicate potential dislocation of the hip.Positive Ortolani's sign yields a "clunking" sensation and indicates a dislocated femoral head moving into the acetabulum.During a positive Barlow test,the examiner can feel the femoral head move out of the acetabulum.If the hip is dislocated,the knee on the affected side will be lower.

Question 9

The nurse should alert the provider when

Accepted Answer

An infant who is dusky and becomes cyanotic when crying is showing poor adaptation to extrauterine life.The nurse needs to notify the provider.Acrocyanosis is an expected finding during the early neonatal life.A blood glucose of 45 mg/dL is within normal range for a newborn.Infants enter the period of deep sleep when they are about 1 hour old.

Question 10

An infant has an elevated immunoglobulin M (IgM)level.What action by the nurse is most appropriate?

Accepted Answer

An elevated level of IgM is associated with exposure to infection in utero because IgM does not cross the placenta.The nurse should take a set of vital signs and notify the provider so further investigation can occur.It is not related to breastfeeding or allergies.The information should be documented,but this is not the most important action.

Question 11

Nurses can prevent evaporative heat loss in the newborn by

Accepted Answer

Because the infant is wet with amniotic fluid and blood,heat loss by evaporation occurs quickly.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 termed a radiation heat loss.Conduction heat loss occurs when the baby comes in contact with cold objects or surfaces.

Question 12

The student nurse learns that in fetal circulation,the pressure is greatest in the

Accepted Answer

Pressure in fetal circulation is greatest in the right atrium,which allows a right-to-left shunting that aids in bypassing the lungs during intrauterine life.The pressure increases in the left atrium after birth and will close the foramen ovale.The liver does not filter the blood during fetal life until the end.It is functioning by birth.Blood bypasses the pulmonary vein during fetal life.

Question 13

A meconium stool can be differentiated from a transitional stool in the newborn because the meconium stool is

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,obstruction is suspected.It is dark in color and sticky and develops from matter in the intestines during intrauterine life.

Question 14

The student nurse learns that the process in which bilirubin is changed from a fat-soluble product to a water-soluble product is known as

Accepted Answer

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

Question 15

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

Accepted Answer

The condition will resolve itself within a few hours.For this common condition of newborns,surfactant acts to keep the expanded alveoli partially open between respirations.In vaginal births,absorption of remaining lung fluid is accelerated by the process of labor and delivery.Remaining lung fluid will move into interstitial spaces and be absorbed by the circulatory and lymphatic systems.There is no need to notify the pediatrician.Surfactant is produced by the lungs,so aspiration is not a concern.Pneumothorax is also not a concern.

Question 16

In which infant behavioral state is bonding most likely to occur?

Accepted Answer

In the quiet alert state,the infant is interested in his or her surroundings and will often gaze at the mother or father or both.In the drowsy state the eyes may remain closed.If open they are unfocused.The infant is not interested in the environment at this time.In the active alert state infants are often fussy,restless,and not focused.During the crying state the infant does not respond to stimulation and cannot focus on parents.

Question 17

Which statement is correct regarding the fluid balance in a newborn versus that in an adult?

Accepted Answer

Insensible water loss is greater in the infant due to the newborn's large body surface area and rapid respiratory rate.The infant's surface area is large compared to an adult's.Infants have a larger percentage of water to body mass.The filtration rate is less than in adults because the kidneys are immature in a newborn.

Question 18

While assessing the newborn,the nurse should be aware that the average expected apical pulse range of a full-term,quiet,alert newborn is ________ beats/min.

Accepted Answer

The average infant heart rate while awake is 120 to 160 beats/min.

Question 19

After giving birth the nurse suggests that the woman place the infant to her breast within 15 minutes.The nurse knows that breastfeeding is effective during the first 30 minutes after birth because this is the

Accepted Answer

The first period of reactivity is the first phase of trAnswerition and lasts up to 30 minutes after birth.The infant is highly alert during this phase.The trAnswerition period is the phase between intrauterine and extrauterine existence.There is no such phase as the organizational stage.The second period of reactivity occurs roughly between 4 and 8 hours after birth,after a period of prolonged sleep.

Question 20

When the newborn infant is fed,the most likely cause of regurgitation is

Accepted Answer

The underlying cause of newborn regurgitation is a relaxed cardiac sphincter.

Quiz 21: The Normal Newborn: Adaptation and Assessment