Deck 23: The Physiologic Responses of the Newborn to Birth

Question 1

The nurse is planning the care of a 1-day-old infant. Which intervention would protect the newborn from heat loss by convection?
1) Drying the newborn thoroughly
2) Prewarming the examination table
3) Removing wet linens from the isolette
4) Placing the newborn away from air currents

Answer 1

4

Question 2

The mother of a 2-day-old infant newly diagnosed with sepsis asks why she could not detect the symptoms. What should the nurse reply to this mother?
1) "Your mothering skills will improve with time. You should take the newborn class."
2) "Newborns have immature immune function at birth, and illness is very hard to detect."
3) "Your baby did not get enough active acquired immunity from you during the pregnancy."
4) "The immunity your baby gets in utero does not start to function until 4 to 8 weeks of age."

Answer 2

2

Question 3

The new father asks what his baby will experience while sleeping and awake. How should the nurse respond?
1) "Babies have several sleep and alert states. Keep watching and you will notice them."
2) "Newborns have two stages of sleep: deep or quiet sleep and rapid eye movement sleep."
3) "You may have noticed that your child was in an alert awake state for an hour after his birth."
4) "Birth is hard work for babies; it takes them a week or 2 to recover and become more awake."

Answer 3

2

Question 4

A telephone triage nurse gets a call from a postpartum client who is concerned about jaundice in a 37-hour-old newborn. What information should the nurse gather first?
1) Skin color
2) Fluid intake
3) Bilirubin level
4) Stool characteristics

Question 5

The nurse is instructing the parents of a newborn about the number of wet diapers to expect each day. Which statement by the parents indicates that further education is necessary?
1) "Our baby was born with kidneys that are too small."
2) "Feeding our baby frequently will help the kidneys function."
3) "Kidney function in an infant is very different from in an adult."
4) "A baby's kidneys do not concentrate urine well for several months."

Question 6

The nurse is instructing a group of new parents about normal newborn behavior. Which attendee's statement indicates that teaching was effective?
1) "My baby will be able to hear very well immediately after birth."
2) "My baby will have difficulty seeing me close up right after delivery."
3) "My baby should be discouraged from sucking on a pacifier if being bottle fed."
4) "My baby should be trained to breastfeed by being encouraged to suck on a pacifier before feedings."

Question 7

The nurse notes that a 1-day-old infant's immunoglobulin M (IgM) antibodies are elevated. Which is the least likely cause for this elevation?
1) Placental leakage
2) Intrauterine exposure to syphilis
3) Intrauterine exposure to TORCH (toxoplasmosis, rubella, cytomegalovirus, herpesvirus hominis type 2 infection) syndrome
4) Maternal-fetal transfer of IgM while in utero

Question 8

A newborn weighing
8)8 lb is prescribed bottle-feedings every 3 hours to achieve the caloric intake of 120 calories/kg each day. How many calories should be in each ounce of feeding? (Calculate to the nearest whole number.)

Question 9

The nurse is planning an educational presentation on hyperbilirubinemia for nursery nurses. Which statement is most important to include in the presentation?
1) Antibiotics decrease the incidence of hyperbilirubinemia.
2) Total bilirubin is the sum of the direct and indirect levels.
3) Conjugated bilirubin is eliminated in the conjugated state.
4) Unconjugated bilirubin is neurotoxic and cannot cross the placenta.

Question 10

The nurse is reviewing the medical records of several newborns. Which infant requires immediate intervention?
1) 24-hour-old term male with total bilirubin level of 2
2) 3-day-old term bottle-fed female with bilirubin of 11
3) 2-week-old postterm breastfed male with bilirubin of 10
4) 12-hour-old preterm female exhibiting icterus and lethargy

Question 11

The nurse is teaching a group of new parents on ways to ensure body heat regulation of their newborns. Which diagram should the nurse use to explain the process of radiation?

Question 12

Nursing students describe actions while practicing physical assessment of a newborn using a model. Which nursing student's statement indicates the need for further teaching?
1) "I auscultated the infant's heart tones for 1 minute."
2) "I palpated peripheral pulses in all the newborn's extremities."
3) "I obtained a higher blood pressure on the legs than on the arms."
4) "I obtained the infant's heart rate by observing the cardiac monitor."

Question 13

The newborn at 24 hours of age has a red blood cell (RBC) count of
5)4 million per milliliter. Which entry should the nurse expect to find in the newborn's chart to explain this laboratory value?
1) Cord clamping delayed until pulsation ceased.
2) Infant is breastfed 15 to 20 minutes every 3 hours.
3) CBC drawn from the anterior surface of the left hand.
4) Placental abruption noted to be 80% at time of delivery.

Question 14

A newborn weighing
7)7 lb has an estimated bladder capacity of 20 mL. If 25 mL/kg of urine is expected to be produced each day, how many diaper changes will this baby need? (Calculate by rounding to the nearest whole number.)

Question 15

A new grandfather is marveling over his 12-hour-old newborn grandson. Which statement indicates that the grandfather needs additional education?
1) "I cannot believe he can already digest fats, carbohydrates, and proteins."
2) "It is amazing that his whole digestive tract moves things along at birth."
3) "Incredibly, his stomach capacity is already a cupful when he was born."
4) "He will lose some weight but then miraculously regain it by about 10 days."

Question 16

The home care nurse notes jaundice on the skin over the sternum of a 3-day-old infant. What should the nurse explain to the parents about this finding?
1) "The liver of an infant is not fully mature and does not conjugate the bilirubin for excretion."
2) "The yellow color of your baby's skin indicates that you are breastfeeding too often."
3) "This is an abnormal finding related to your baby's bowels not excreting bilirubin as they should."
4) "The infant received too many red blood cells after delivery because the cord was not clamped immediately."

Question 17

The nurse manager of the neonatal intensive care unit is preparing a handout for new parents. Which statement should the nurse include?
1) Neonates have a tendency to become dehydrated.
2) Sugar is always present in the urine of a newborn.
3) The kidneys are fully functional by 30 weeks' gestation.
4) Newborns can eliminate excess fluid as quickly as an adult.

Question 18

The nurse is teaching new parents how to dress their newborn. Which statements indicate that teaching has been effective? Select all that apply.
1) "Our baby will have a much faster rate of breathing if he is not dressed warmly enough."
2) "When we change the baby's diaper, we should change any wet clothing or blankets, too."
3) "It is important that we dry the baby off as soon as we give him a bath or shampoo his hair."
4) "We should make sure that we keep our home air conditioned so the baby does not overheat."
5) "If the baby's body temperature gets too low, he will warm himself up without any shivering."

Question 19

The nurse is assessing a newborn at 1 hour of age. Which finding requires an immediate intervention?
1) Mean blood pressure 55 mmHg
2) Pulse rate 145, systolic murmur heard
3) Pauses in respiration lasting 30 seconds
4) Respiratory rate 60, crackles present bilaterally

Question 20

A postpartum client calls the nursery to report that her 3-day-old newborn has passed a bright green stool. How should the nurse respond to the client?
1) "Your newborn has diarrhea."
2) "This is a normal occurrence."
3) "There may be a possible food allergy."
4) "Take your newborn to the pediatrician."