Deck 24: Physiologic Adaptations of the Newborn

Question 1

An African-American woman noticed some bruises on her newborn girl's buttocks. She asks the nurse who spanked her daughter. The nurse explains that these marks are called:

A)Lanugo.
B)Vascular nevi.
C)Nevus flammeus.
D)Mongolian spots.

Answer 1

Mongolian spots.

Question 2

With regard to the respiratory development of the newborn,nurses should be aware that:

A)The first gasping breath is an exaggerated respiratory reaction within 1 minute of birth.
B)Newborns must expel the fluid from the respiratory system within a few minutes of birth.
C)Newborns are instinctive mouth breathers.
D)Seesaw respirations are no cause for concern in the first hour after birth.

Answer 2

The first gasping breath is an exaggerated respiratory reaction within 1 minute of birth.

Question 3

While examining a newborn,the nurse notes uneven skin folds on the buttocks and a click when performing the Ortolani maneuver. The nurse recognizes these findings as a sign that the newborn probably has:

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

Answer 3

Hip dysplasia.

Question 4

While assessing the newborn,the nurse should be aware that the average expected apical pulse range of a full-term,quiet,alert newborn is:

A)80 to 100 beats/min.
B)100 to 120 beats/min.
C)120 to 160 beats/min.
D)150 to 180 beats/min.

Question 5

The nurse assessing a newborn knows that the most critical physiologic change required of the newborn is:

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

Question 6

By knowing about variations in infants' blood count,nurses can explain to their clients that:

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

Question 7

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 the newborn should be wrapped in a blanket. The mother asks why. The nurse's best response is:

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 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 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 prevent cool air from blowing on him."
D)"Your baby will get cold stressed easily and needs to be bundled up at all times."

Question 8

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?" The nurse's best response is:

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 9

A woman gave birth to a healthy 7-pound,13-ounce infant girl. The nurse suggests that the woman place the infant to her breast within 15 minutes after birth. The nurse knows that breastfeeding is effective during the first 30 minutes after birth because this is the:

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

Question 10

With regard to the newborn's developing cardiovascular system,nurses should be aware that:

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

Question 11

All of these statements describe the first phase of the transition period except:

A)It lasts no longer than 30 minutes.
B)It is marked by spontaneous tremors,crying,and head movements.
C)It includes the passage of meconium.
D)It may involve the infant suddenly sleeping briefly.

Question 12

What 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

A new mother states that her infant must be cold because the baby's hands and feet are blue. The nurse explains that this is a common and temporary condition called:

A)Acrocyanosis.
B)Erythema neonatorum.
C)Harlequin color.
D)Vernix caseosa.

Question 14

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:

A)Tonic neck reflex.
B)Glabellar (Myerson) reflex.
C)Babinski reflex.
D)Moro reflex.

Question 15

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.

Question 16

Part of the health assessment of a newborn is observing the infant's breathing pattern. A full-term newborn's breathing pattern is predominantly:

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

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. The nurse should:

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

Question 18

With regard to the functioning of the renal system in newborns,nurses should be aware that:

A)The pediatrician should be notified if the newborn has not voided in 24 hours.
B)Breastfed infants likely will 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.

Question 19

A newborn is placed under a radiant heat warmer,and the nurse evaluates the infant's body temperature every hour. Maintaining the newborn's body temperature is important for preventing:

A)Respiratory depression.
B)Cold stress.
C)Tachycardia.
D)Vasoconstriction.

Question 20

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. The nurse responds to the parents by telling them:

A)"Infants can see very little until about 3 months of age."
B)"Infants can track their parent's eyes and 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 21

One reason hyperthermia develops more rapidly in the newborn than in the adult is that sweat glands have not formed yet.

Question 22

The cheeselike,whitish substance that fuses with the epidermis and serves as a protective coating is called:

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

Question 23

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 anywhere on the body

Question 24

With regard to the gastrointestinal (GI) system of the newborn,nurses should be aware that:

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 25

The shivering mechanism of heat production is rarely functioning in the newborn. Nonshivering ____________________ is accomplished primarily by metabolism of brown fat,which is unique to the newborn,and by increased metabolic activity in the brain,heart,and liver.

Question 26

An examiner who discovers unequal movement or uneven gluteal skin folds during the Ortolani maneuver would then:

A)Tell the parents that one leg may be longer than the other,but they will equal out by the time the infant is walking.
B)Alert the physician that the infant has a dislocated hip.
C)Inform the parents and physician that molding has not taken place.
D)Suggest that,if the condition does not change,surgery to correct vision problems might be needed.

Question 27

The nurse caring for the newborn should be aware that the sensory system least mature at the time of birth is:

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

Question 28

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. Which is NOT one of these essential factors?

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

Question 29

A collection of blood between the skull bone and its periosteum is known as a cephalhematoma. To reassure the new parents whose infant develops such a soft bulge,it is important that the nurse be aware that this condition:

A)May occur with spontaneous vaginal birth.
B)Only happens as the result of a forceps or vacuum delivery.
C)Is present immediately after birth.
D)Will gradually absorb over the first few months of life.

Question 30

What are modes of heat loss in the newborn? Choose all that apply.

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

Question 31

All of these statements about physiologic jaundice are true except:

A)Neonatal jaundice is common,but kernicterus is rare.
B)The 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 it and when to call for medical help.
D)Breastfed babies have a lower incidence of jaundice.

Question 32

One reason the brain is vulnerable to nutritional deficiencies and trauma in early infancy is the:

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