Question 1

The nurse assesses the following in a sleeping 1-hour-old, 39-weeks'-gestation newborn. The assessment data that would be of greatest concern would be:

Accepted Answer

A respiratory rate of 68/min in a newborn is significantly high and could indicate respiratory distress or other problems with the newborn's breathing. The other assessment data, although slightly outside of the normal range, are not as concerning as an elevated respiratory rate. A heart rate of 156 beats/min is within the normal range for a newborn, while a blood pressure of 72/44 and a skin temperature of 97.6°F are slightly low but not immediately concerning.

Question 2

The nurse has received a shift change report on infants born within the last four hours. Which newborn should the nurse see first?

Accepted Answer

The newborn with grunting respirations requires immediate evaluation as this could be a sign of respiratory distress and may require intervention to prevent further complications. The other infants may also need assessment, but they are not presenting with potentially life-threatening symptoms.

Question 3

Which of the following information is NOT recorded as a part of the initial newborn assessment?

Accepted Answer

The blood draw for PKU (Phenylketonuria) screening is not typically part of the initial newborn assessment. This screening usually occurs after the first 24 hours of life, not immediately after birth. The initial assessment focuses on the newborn's immediate health status, including resuscitative measures if needed, observation of meconium-stained fluid which can indicate fetal distress, and noting parental preferences for procedures like circumcision, which can impact immediate care plans.

Question 4

Which of the following actions must a nurse perform before weighing the newborn during the admission procedure?

Accepted Answer

The answer of Which of the following actions must a...

Question 5

The nurse is discussing parent-infant attachment with a prenatal class. Which statement indicates that teaching was successful?

Accepted Answer

Bathing a baby is an intimate activity that can promote bonding and attachment between the parent and the infant. It provides an opportunity for the parent to engage in gentle touch, eye contact, and communication, all of which are important for developing a strong emotional connection. Choices A, B, and C reflect misconceptions about newborn capabilities and behaviors that could interfere with bonding and attachment.

Question 6

The patient at 20 weeks' gestation has not decided on a feeding method for her infant. She asks the nurse for advice. The nurse presents information about the advantages and disadvantages of formula-feeding and breastfeeding. Which statements by the patient indicate that the teaching was successful?

Accepted Answer

Breastfeeding is associated with a lower risk of food allergies in infants due to the protective antibodies and other beneficial components found in breast milk. This statement indicates the patient understands one of the advantages of breastfeeding.

Question 7

The nurse is working with a new mother who delivered yesterday. The patient has chosen to breastfeed her infant. Which demonstration of skill is the best indicator that the patient understands breastfeeding?

Accepted Answer

Taking off her gown to achieve skin-to-skin contact is a key practice in successful breastfeeding, as it promotes bonding, stimulates the release of maternal hormones that support milk production, and helps to regulate the infant's body temperature, breathing, and heart rate.

Question 8

A newborn appears pale and weak, and laboratory tests reveal the infant has iron deficiency anemia. The mother asks the nurse if it would better to breastfeed her infant or feed him a formula high in iron. What should the nurse's response be?

Accepted Answer

Breastfeeding is the best choice for infants with iron deficiency anemia because although breast milk has lower levels of iron compared to formula, it is more easily absorbed by the infant. Breast milk also contains vitamin C, which helps with the absorption of iron. Additionally, breast milk provides a host of other nutritional benefits for the infant's overall health and development.

Question 9

The nurse is ready to perform a discharge assessment for a 2-day-old male infant that has been circumcised. Which of the following findings require immediate intervention?

Accepted Answer

A dry diaper since the circumcision procedure could indicate the infant is not urinating, which may be a sign of dehydration or urinary retention, both of which require immediate intervention.

Question 10

A change in skin color requires further assessment of which of the following physiological functions?

Accepted Answer

The answer of A change in skin color requires further...

Question 11

At birth, an infant weighed 8 pounds, 4 ounces. Three days later, the newborn is being discharged. The parents note that the baby now weighs 7 pounds, 15 ounces. What explanation should the nurse give for the change in this newborn's weight? "His weight loss is:

Accepted Answer

It is within normal limits for a newborn to lose up to 10% of their birth weight in the first few days after birth due to the loss of excess fluids. The weight loss of this newborn is less than 10% and therefore within normal limits.

Quiz 26: The Normal Newborn: Needs, Care, and Feeding