Deck 26: Physiologic Responses of the Newborn to Birth

Question 1

The mother of a 3-day-old infant calls the clinic and reports that her baby's skin is turning slightly yellow. What should the nurse explain to the mother?

A) Physiologic jaundice is normal, and peaks at this age.
B) The newborn's liver is not working as well as it should.
C) The baby is yellow because the bowels are not excreting bilirubin.
D) The yellow color indicates that brain damage might be occurring.

Answer 1

A

Question 2

A postpartum mother questions whether the environmental temperature should be warmer in the baby's room at home. The nurse responds that the environmental temperature should be warmer for the newborn. This response is based on which newborn characteristics that affect the establishment of thermal stability?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.

A) Newborns have less subcutaneous fat than do adults.
B) Infants have a thick epidermis layer.
C) Newborns have a large body surface to weight ratio.
D) Infants have increased total body water.
E) Newborns have more subcutaneous fat than do adults.

Answer 2

A, C, D

Question 3

Clinical risk factors for severe hyperbilirubinemia include which of the following?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.

A) African American ethnicity
B) Female gender
C) Cephalohematoma
D) Bruising
E) Assisted delivery with vacuum or forceps

Answer 3

C, D, E

Question 4

Marked changes that occur in the cardiopulmonary system at birth include which of the following?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.

A) Closure of the foramen ovale
B) Closure of the ductus venosus
C) Mean blood pressure of 31 to 61 m m H g in full-term resting newborns
D) Increased systemic vascular resistance and decreased pulmonary vascular resistance
E) Opening of the ductus arteriosus

Question 5

The nurse is caring for a newborn 30 minutes after birth. After assessing respiratory function, the nurse would report which findings as abnormal?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.

A) Respiratory rate of 66 breaths per minute
B) Periodic breathing with pauses of 25 seconds
C) Synchronous chest and abdomen movements
D) Grunting on expiration
E) Nasal flaring

Question 6

The nurse is assessing a newborn at 1 hour of age. Which finding requires an immediate intervention?

A) Respiratory rate 60 and irregular in depth and rhythm
B) Pulse rate 145, cardiac murmur heard
C) Mean blood pressure 55 m m H g
D) Pauses in respiration lasting 30 seconds

Question 7

Which of the following would be a newborn care procedure that will decrease the probability of high bilirubin levels?

A) Monitor urine for amount and characteristics.
B) Encourage late feedings to promote intestinal elimination.
C) All infants should be routinely monitored for iron intake.
D) Maintain the newborn's skin temperature at 36.5°C (97.8°F) or above.

Question 8

In utero, what is the organ responsible for gas exchange?

A) Umbilical vein
B) Placenta
C) Inferior vena cava
D) Right atrium

Question 9

The nurse has assessed four newborns' respiratory rates immediately following birth. Which respiratory rate would require further assessment by the nurse?

A) 60 breaths per minute
B) 70 breaths per minute
C) 64 breaths per minute
D) 20 breaths per minute

Question 10

A telephone triage nurse gets a call from a postpartum client who is concerned about jaundice. The client's newborn is 37 hours old. What data point should the nurse gather first?

A) Stool characteristics
B) Fluid intake
C) Skin color
D) Bilirubin level

Question 11

The nurse is teaching new parents how to dress their newborn. Which statements indicate that teaching has been effective?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.

A) "We should keep our home air-conditioned so the baby doesn't overheat."
B) "It is important that we dry the baby off as soon as we give him a bath or shampoo his hair."
C) "When we change the baby's diaper, we should change any wet clothing or blankets, too."
D) "If the baby's body temperature gets too low, he will warm himself up without any shivering."
E) "Our baby will have a much faster rate of breathing if he is not dressed warmly enough."

Question 12

At birth, an infant weighed 6 pounds 12 ounces. Three days later, he weighs 5 pounds 2 ounces. What conclusion should the nurse draw regarding this newborn's weight?

A) This weight loss is excessive.
B) This weight loss is within normal limits.
C) This weight gain is excessive.
D) This weight gain is within normal limits.

Question 13

The home care nurse is examining a 3-day-old infant. The child's skin on the sternum is yellow when blanched with a finger. The parents ask the nurse why jaundice occurs. What is the best response from the nurse?

A) "The liver of an infant is not fully mature, and doesn't conjugate the bilirubin for excretion."
B) "The infant received too many red blood cells after delivery because the cord was not clamped immediately."
C) "The yellow color of your baby's skin indicates that you are breastfeeding too often."
D) "This is an abnormal finding related to your baby's bowels not excreting bilirubin as they should."

Question 14

The nurse is planning care for a newborn. Which nursing intervention would best protect the newborn from the most common form of heat loss?

A) Placing the newborn away from air currents
B) Pre-warming the examination table
C) Drying the newborn thoroughly
D) Removing wet linens from the isolette

Question 15

The visiting nurse evaluates a 2-day-old breastfed newborn at home and notes that the baby appears jaundiced. When explaining jaundice to the parents, what would the nurse tell them?

A) "Jaundice is uncommon in newborns."
B) "Some newborns require phototherapy."
C) "Jaundice is a medical emergency."
D) "Jaundice is always a sign of liver disease."

Question 16

The pediatric clinic nurse is reviewing lab results with a 2-month-old infant's mother. The infant's hemoglobin has decreased since birth. Which statement by the mother indicates the need for additional teaching?

A) "My baby isn't getting enough iron from my breast milk."
B) "Babies undergo physiologic anemia of infancy."
C) "This results from dilution because of the increased plasma volume."
D) "Delaying the cord clamping did not cause this to happen."

Question 17

Which of the following is a benefit of delayed umbilical cord clamping for the preterm infant?

A) Fewer infants require blood transfusion for anemia
B) Fewer infants require blood transfusion for high blood pressure
C) Increase in the incidence of intraventricular hemorrhage
D) Increase in incidence of infant breastfeeding

Question 18

The nurse is planning an educational presentation on hyperbilirubinemia for nursery nurses. Which statement is most important to include in the presentation?

A) Conjugated bilirubin is eliminated in the conjugated state.
B) Unconjugated bilirubin is neurotoxic, and cannot cross the placenta.
C) Total bilirubin is the sum of the direct and indirect levels.
D) Hyperbilirubinemia is a decreased total serum bilirubin level.

Question 19

A 2-day-old newborn is asleep, and the nurse assesses the apical pulse to be 88 beats/min. What would be the most appropriate nursing action based on this assessment finding?

A) Call the physician.
B) Administer oxygen.
C) Document the finding.
D) Place the newborn under the radiant warmer.

Question 20

Which of the following is the primary carbohydrate in the breastfeeding newborn?

A) Glucose
B) Fructose
C) Lactose
D) Maltose

Question 21

During a home visit the mother of a 2 week old newborn is concerned that the baby always seems to be "wet" and wonders if this is normal. The newborn weighs 4 k g. How many m L of fluid should the nurse explain that the infant makes each day? (Round to the nearest whole number.)

Question 22

Which nonspecific immune mechanism helps the ability of antibodies and phagocytic cells to clear pathogens from an organism?

A) Complement
B) Coagulation
C) Inflammatory response
D) Phagocytosis

Question 23

The nurse is explaining the process of how a newborn adapts to breathing after delivery. In which order should the nurse review the following diagrams?
1.

2.

3.

4.

Question 24

At birth, a newborn weighs 8 pounds 4 ounces. When discussing the infant's weight over the next week, what is the maximum amount of weight the mother should expect that the infant will lose? (Calculate to the first decimal point.)

Question 25

Specific cellular immunity is mediated by T lymphocytes, which enhance the efficiency of the phagocytic response. What do cytotoxic activated T cells do?

A) Enable T or B cells to respond to antigens
B) Repress responses to specific B or T lymphocytes to antigens
C) Kill foreign or virus-infected cells
D) Remove pathogens and cell debris

Question 26

The nurse is teaching a group of new parents about newborn behavior. Which statement made by a parent would indicate a need for additional information?

A) "Sleep and alert states cycle throughout the day."
B) "We can best bond with our child during an alert state."
C) "About half of the baby's sleep time is in active sleep."
D) "Babies sleep during the night right from birth."

Question 27

A postpartum client calls the nursery to report that her 3-day-old newborn has passed a green stool. What is the nurse's best response?

A) "Take your newborn to the pediatrician."
B) "There might be a possible food allergy."
C) "Your newborn has diarrhea."
D) "This is a normal occurrence."

Question 28

The mother of a 2-day-old male has been informed that her child has sepsis. The mother is distraught and says, "I should have known that something was wrong. Why didn't I see that he was so sick?" What is the nurse's best reply?

A) "Newborns have immature immune function at birth, and illness is very hard to detect."
B) "Your mothering skills will improve with time. You should take the newborn class."
C) "Your baby didn't get enough active acquired immunity from you during the pregnancy."
D) "The immunity your baby gets in utero doesn't start to function until he is 4 to 8 weeks old."

Question 29

The student nurse notices that a newborn weighs less today compared with the newborn's birth weight three days ago. The nursing instructor explains that newborns lose weight following birth due to which of the following?

A) A shift of intracellular water to extracellular spaces.
B) Loss of meconium stool.
C) A shift of extracellular water to intracellular spaces.
D) The sleep-wake cycle.

Question 30

The nurse is teaching a newborn care class to parents who are about to give birth to their first babies. Which statement by a parent indicates that teaching was effective?

A) "My baby will be able to focus on my face when she is about a month old."
B) "My baby might startle a little if a loud noise happens near him."
C) "Newborns prefer sour tastes."
D) "Our baby won't have a sense of smell until she is older."

Question 31

A new father asks the nurse to describe what his baby will experience while sleeping and awake. What is the best response?

A) "Babies have several sleep and alert states. Keep watching and you'll notice them."
B) "You might have noticed that your child was in an alert awake state for an hour after birth."
C) "Newborns have two stages of sleep: deep or quiet sleep and rapid eye movement sleep."
D) "Birth is hard work for babies. It takes them a week or two to recover and become more awake."

Question 32

The student nurse notices that the newborn seems to focus on the mother's eyes. The nursing instructor explains that this newborn behavior is which of the following?

A) Habituation
B) Orientation
C) Self-quieting
D) Reactivity

Question 33

The parents of a newborn are receiving discharge teaching. The nurse explains that the infant should have several wet diapers per day. Which statement by the parents indicates that further education is necessary?

A) "Our baby was born with kidneys that are too small."
B) "A baby's kidneys don't concentrate urine well for several months."
C) "Feeding our baby frequently will help the kidneys function."
D) "Kidney function in an infant is very different from that in an adult."

Question 34

A new grandfather is marveling over his 12-hour-old newborn grandson. Which statement indicates that the grandfather needs additional education?

A) "I can't believe he can already digest fats, carbohydrates, and proteins."
B) "It is amazing that his whole digestive tract can move things along at birth."
C) "Incredibly, his stomach capacity was already a cupful when he was born."
D) "He will lose some weight but then miraculously regain it by about 10 days."

Question 35

The nurse is explaining the processes of infant heat loss to a new mother. Which diagram should the nurse use to describe the process of convection?

A)

B)

C)

D)

Question 36

The nurse is instructing a new mother on the amount and frequency of bottle-feeding for her newborn. The mother plans to use formula that is available in 6-ounce cans. If the infant ingests 25 m L for each of 8 feedings per day, how many cans of formula should the mother have available for a week? (Round to the nearest whole number.)

Question 37

A new mother is holding her 2-hour-old son. The delivery occurred on the due date. His Apgar score was 9 at both 1 and 5 minutes. The mother asks the nurse why her son was so wide awake right after birth, and now is sleeping so soundly. What is the nurse's best response?

A) "Don't worry. Babies go through a lot of these little phases."
B) "Your son is in the sleep phase. He'll wake up soon."
C) "Your son is exhausted from being born, and will sleep 6 more hours."
D) "Your breastfeeding efforts have caused excessive fatigue in your son."

Question 38

A newborn who has not voided by 48 hours after birth should be assessed for which of the following?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.

A) Restlessness
B) Pain
C) Kidney distention
D) Adequacy of fluid intake
E) Lethargy