Deck 18: Nursing Care of a Family With a Newborn

Question 1

When caring for a newborn several hours after birth, what would the nurse assess as a normal newborn's respiratory rate?

A) 12 to 16 breaths/min
B) 16 to 20 breaths/min
C) 20 to 30 breaths/min
D) 30 to 60 breaths/min

Answer 1

30 to 60 breaths/min

Question 2

The nurse is assessing a term newborn. Which finding should the nurse expect when assessing the patterns of sole creases?

A) Creases on two thirds of the foot
B) Heel creases but no anterior creases
C) Longitudinal but no horizontal creases
D) Creases covering one fourth of the foot

Answer 2

Creases on two thirds of the foot

Question 3

During a home visit, a new mother is concerned that, after three meconium stools, her newborn has had a bright green stool. What should the nurse explain to the mother?

A) This is a normal finding.
B) This is most likely a symptom of diarrhea.
C) The baby may be developing an allergy to breast milk.
D) The child will need to be isolated until the stool can be cultured.

Answer 3

This is a normal finding.

Question 4

The nurse is planning to instruct a new mother on care of the newborn. Which instructions support the 2020 National Health Goals for the newborn? (Select all that apply.)

A) Place the infant on the back to sleep.
B) Wash the baby's hair at least once a week.
C) Continue to breastfeed the baby until age 6 months.
D) Bath the baby from the most soiled to the cleanest areas.
E) Do not provide the baby with a bottle while falling asleep.

Question 5

The nurse is caring for a newborn that weighed 7 lb 3 oz at birth. What action should the nurse take first based on this weight?

A) Plot the weight on a gestational age graph.
B) Ask for a physician to examine the newborn.
C) Draw additional blood work for cholesterol level.
D) Turn off the radiant heat warmer for physical assessment.

Question 6

The nurse documents that a newborn has a normal head-to-body proportion. What did the nurse document in the baby's medical record?

A) Head one half of total length
B) Head one sixth of total length
C) Head one fourth of total length
D) Head one eighth of total length

Question 7

The nurse completes a physical assessment of a newborn. Which finding should the nurse identify as being abnormal?

A) Abdomen slightly protuberant
B) Clear drainage at the base of the umbilical cord
C) Bowel sounds present at two to three per minute
D) Liver palpable 2 cm under the right costal margin

Question 8

Which assessment finding indicates to the nurse that a newborn has hip subluxation?

A) Inward rotation of the right foot
B) Inability of the right hip to abduct
C) Crying on straightening of the right leg
D) Drawing of the legs underneath while prone

Question 9

The nurse is inspecting a male newborn's genitalia. Which action should the nurse avoid when conducting this assessment?

A) Inspecting the genital area for irritated skin
B) Inspecting if the urethral opening appears circular
C) Palpating if testes are descended into the scrotal sac
D) Retracting the foreskin over the glans to assess for secretions

Question 10

The parents of a newborn are concerned that something is wrong with the newborn's eyesight. What should the nurse instruct the parents as being an expected finding in the newborn?

A) Produces tears when he cries
B) Follows a light to the midline
C) Has a white rather than a red reflex
D) Follows the finger a full 180 degrees

Question 11

A new mother is distraught because the baby has a white discharge coming from the breasts. What should the nurse explain to the mother about this discharge?

A) It is caused by exposure to cool air.
B) It is caused by the mother's hormones.
C) The baby may need chromosomal studies.
D) It is a sign that the baby has a pituitary tumor.

Question 12

The nurse assesses a newborn's Apgar score at birth and documents that it is normal. Which score did the nurse most likely record?

A) 1
B) 4
C) 8
D) 13

Question 13

When assessing a newborn's 5-minute Apgar score, how will the nurse determine reflex irritability?

A) Dorsiflexing a foot against pressure resistance
B) Raising the infant's head and letting it fall back
C) Tightly flexing the infant's trunk and then releasing it
D) Slapping the soles of the feet and observing the response

Question 14

What instructions should the nurse include when teaching a mother to care for her newborn's umbilical cord?

A) Keep it dry.
B) Cover it with dry gauze.
C) Wash it with soap and water.
D) Apply petroleum jelly to it daily.

Question 15

A patient who has just given birth to her first baby asks the nurse for help with breastfeeding. Which nursing diagnosis would be the most appropriate for the patient at this time?

A) Powerlessness
B) Health-seeking behaviors
C) Readiness for enhanced coping
D) Anxiety related to breastfeeding

Question 16

The nurse is visiting a new mother who has been home with a new infant for 4 days. Which observation indicates that the mother's home environment was inadequately assessed prior to being discharged from the hospital?

A) Baby has a changing area.
B) Kitchen has a refrigerator.
C) Windows are covered with screens.
D) Baby sleeps with the mother in bed.

Question 17

A newborn is prescribed to receive vitamin K (Aqua-Mephyton) 0.5 mg intramuscularly. What should the nurse do when providing this medication to the newborn?

A) Administer the medication in the deltoid muscle.
B) Administer the medication into the anterolateral muscle.
C) Provide the medication immediately before breastfeeding.
D) Notify the physician for swelling and irritation at the injection site.

Question 18

A new mother does not want the baby to return to the nursery because of the fear of someone taking the baby without her permission. What should the nurse explain to the mother to allay her fears?

A) Only people who are known to the staff are permitted in the nursery.
B) Keeping the baby in the mother's room at all times is the best approach.
C) Both the mother and infant have identification bands that need to match.
D) Security questions everyone before permitting them access to the hospital.