Question 1

The perinatal nurse explains the cardiopulmonary adaptations that occur in the neonate to a student nurse.Which of the following statements accurately describes the sequence of these changes? A) "As air enters the lungs, the PO₂ rises in the alveoli, which causes pulmonary artery relaxation and results in an increase in pulmonary vascular resistance." B) "As the pulmonary vascular resistance increases, pulmonary blood flow increases, reaching 100% by the first 24 hours of life." C) "Decreased pulmonary blood volume contributes to the conversion from fetal to newborn circulation." D) "Once the pulmonary circulation has been functionally established, blood is distributed throughout the lungs."

Accepted Answer

As air enters the lungs,the PO₂ rises in the alveoli.This normal physiological response causes pulmonary artery relaxation and results in a decrease in pulmonary vascular resistance.As the pulmonary vascular resistance decreases,pulmonary blood flow increases,reaching 100% by the first 24 hours of life.The increased pulmonary blood volume contributes to the conversion from fetal to newborn circulation.Once the pulmonary circulation has been functionally established,blood is distributed throughout the lungs.The other explanations are inaccurate.

Question 2

A nurse assesses a 2-hour-old infant's temperature and notes it to be 97.7°F (36.5°C).What action by the nurse is most appropriate?
A) Document the findings and continue to monitor.
B) Ensure the baby is wearing a hat.
C) Place the baby in a pre-warmed incubator.
D) Tightly swaddle the baby.

Accepted Answer

A normal axillary temperature for an infant is 97.7°-98.6° F (36.5°-37° C)within 2-3 hours after birth.The nurse should document the findings and continue to monitor per institutional policy.No further action is needed.

Question 3

New parents are concerned that after initially breastfeeding their baby 2 hours after being born,she is sleeping soundly and will not awaken.What action by the nurse is most appropriate?
A) Call the rapid response team.
B) Document the neonate's behavior in the chart.
C) Reassure the parents that this is normal.
D) Stimulate the baby to wake her up.

Accepted Answer

After the initial period of reactivity,the infant falls into a deep sleep from which she is difficult to arouse.The nurse should reassure the parents that this is normal.Documentation is important,but the nurse first needs to care for the parents and baby by giving the parents information on normal newborn behaviors.Calling the rapid response team and stimulating the baby are both unnecessary.

Question 4

A healthy term infant is being discharged at 48 hours of age.When should the nurse instruct the mother to follow up with a bilirubin assessment?
A) Within 24 hours
B) Within 24-48 hours
C) Within 5 days
D) In 1 week

Accepted Answer

Healthy term infants discharged between 48 and 72 hours should receive follow-up and bilirubin assessment within 5 days.

Question 5

A neonatal nurse who is caring for newborns suggests the best time for a mother to first attempt breastfeeding is during which of the following stages of activity?
A) First period of inactivity and sleep
B) First period of reactivity
C) Second period of inactivity and sleep
D) Second period of reactivity

Accepted Answer

The best stage for initiating breastfeeding is the first period of reactivity,which is the first period of active alert wakefulness that the infant displays immediately after birth.This first period of reactivity is an opportune time for the mother to initiate breastfeeding,if she wishes to do so.

Question 6

A nurse in the high-risk obstetrical unit monitors a student nurse preparing to give a patient a dose of betamethasone (Celestone).Which action by the student warrants intervention by the nurse?
A) Assesses the patient's lung sounds prior to administration
B) Draws up 12 mg in a syringe with a 20-gauge needle
C) Gently shakes the medication before drawing it up
D) Prepares to administer medication in the deltoid muscle

Accepted Answer

Betamethasone should not be administered in the deltoid muscle,as it can cause local atrophy.It needs to be given in a larger muscle.The other actions are appropriate for this medication.

Question 7

The nurse caring for a woman about to deliver a baby at 33 weeks' gestation knows that what factor might have accelerated surfactant production?
A) Fetal hemolytic disorders
B) Incorrect dates
C) Maternal hypertension
D) Multiple gestation

Accepted Answer

A fetus has produced sufficient surfactant for independent respiratory function by about gestational weeks 34 to 36.Hence,a baby born at 33 weeks' gestation is at risk for not having enough surfactant.Factors that can lead to increased surfactant production include mothers with White classification D,F,and R diabetes; maternal hypertension; and maternal heroin addiction.Fetal hemolytic disorders and multiple gestation are risk factors for decreased surfactant production.Incorrect dates may be important,but this is not a factor that leads to increased surfactant production.

Question 8

A nursing student asks the registered nurse why babies get dehydrated so easily.What response by the nurse is most accurate?
A) Babies are so tiny that a small water loss leads to big problems.
B) Infants tend to lose more water through insensible losses.
C) Because they don't drink much at a time, skipping a feeding is harmful.
D) Infants' long intestines have more surface area from which to lose water.

Accepted Answer

Babies' intestines are proportionally longer than adults'.This gives them more surface area from which to absorb nutrients,but also more surface area from which to lose water when they have diarrhea,leading to rapid dehydration.

Question 9

A mother brings her 1-week-old baby to the clinic with complaints that the baby is not eating well.The mother is attempting to bottle feed about 120 mL every 2 hours.What action by the nurse is best?
A) Explain that this is too much volume at one time.
B) Have the mother demonstrate her feeding and burping technique.
C) Reassure the mother that the baby is eating fine.
D) Weigh the baby and plot her weight on a graph.

Accepted Answer

At 1 week of age,an infant's stomach has a capacity of about 90 mL.Attempting to feed 120 mL is too much at one time.Weighing the baby and plotting her growth and having the mother demonstrate feeding and burping techniques are not incorrect,but the mother needs additional information to safely feed her baby.Simply reassuring the mother does not give her the information she needs to feed the baby appropriately.

Question 10

A new mother with a 6-hour-old infant calls the nursing station complaining that her baby is so cold he is shivering.What action by the nurse is most appropriate?
A) Bring warm blankets to wrap the baby in.
B) Encourage the mother to feed him a warmed bottle.
C) Perform a thorough head-to-toe assessment.
D) Set the room temperature higher.

Accepted Answer

Infants are unable to shiver to produce heat.They produce heat through a mechanism called nonshivering thermogenesis.A report by the mother of an infant shivering requires a thorough investigation and assessment for problems such as seizures.The other actions are not needed.

Question 11

A nurse suspects that an infant in the intensive care unit has had intrauterine exposure to one of the TORCH infections.What finding is indicative of in utero exposure to a TORCH infection?
A) Decreased IgA
B) Decreased IgG
C) Increased IgG
D) Increased IgM

Accepted Answer

Elevations in IgM can occur as a result of exposure to an intrauterine infection or one of the TORCH infections.

Question 12

A mother-baby nurse assesses newborns for their risk of developing hypoglycemia.Which infant would the nurse assess as being at highest risk?
A) Asian ethnic background
B) Delayed feedings after birth
C) Infant with heat stress
D) Maternal use of terbutaline (Brethine)

Accepted Answer

Several risk factors for hypoglycemia exist,including pre- or post-maturity,intrauterine growth restriction,large or small for gestational age,asphyxia,difficult transition at birth,cold stress,maternal diabetes or preeclampsia-eclampsia,terbutaline use,infection,and congenital malformations.

Question 13

A woman gives birth to a healthy baby boy at 35 weeks' gestation.What factor regarding the development of the normal respiratory system should the nurse consider when performing an assessment of the neonate?
A) As the fetus approaches term, secretion of intrapulmonary fluid increases.
B) Lung expansion after birth suppresses the further release of surfactant.
C) Surfactant increases alveolar surface tension, allowing re-expansion after exhalation.
D) Surfactant production is sufficient to maintain alveolar stability by about 34 weeks.

Accepted Answer

As the fetus approaches term,there is a decrease in the secretion of intrapulmonary fluid,which assists in reducing the pulmonary resistance to blood flow and facilitates the initiation of air breathing.Lung expansion after birth stimulates the release of surfactant-a slippery,detergent-like lipoprotein.Surfactant causes decreased surface tension within the alveoli,which allows for alveolar re-expansion following each exhalation.Under normal circumstances,by the 34th to 36th week of gestation,surfactant is produced in sufficient amounts to maintain alveolar stability.

Question 14

A nurse is assessing a newborn who is jittery,diaphoretic,and hypothermic,and has poor feeding.What laboratory value would the nurse correlate with this condition?
A) Bilirubin: 5 mg/dL
B) Blood glucose: 32 mg/dL
C) Hematocrit: 50%
D) White blood cell count: 25,000/mm3

Accepted Answer

This infant has signs of hypoglycemia,confirmed with a blood glucose level below 40 mg/dL (normal is 40-60 mg/dl).The other laboratory values are normal for a neonate.

Question 15

A term infant is 22 hours old,has a total serum bilirubin level of 13 mg/dL,and has visible jaundice.What action by the nurse is most appropriate?
A) Assure the parents that this is temporary.
B) Document the findings in the infant's chart.
C) Have the mother switch to bottle feeding.
D) Review the chart for history of a traumatic birth.

Accepted Answer

Jaundice that appears within the first 24 hours of life is considered pathological.Causes can include events that lead to excessive breakdown of RBCs,leading to increased bilirubin levels,such as polycythemia,traumatic birth,infection,metabolic disorders,and Rh incompatibility.The diagnosis is made when total serum bilirubin levels rise higher than 12.9 mg/dL in term infants and 15 mg/dL in preterm infants.The nurse should review the chart for evidence of a traumatic birth.The other actions are not warranted.

Question 16

The nursing professor is explaining to a class of students that which chemical factor in the blood directly leads to the initiation of respirations in the newborn?
A) Bilirubin
B) Carbon dioxide
C) High arterial pH
D) Low arterial pH

Accepted Answer

All newborns have a brief period of asphyxia during which they become hypoxic,leading to lowered pH.Subsequently carbon dioxide levels begin to rise and this stimulates the respiratory center in the brain to initiate respirations.

Question 17

A perinatal nurse has orders to administer betamethasone (Celestone)to the following women in preterm labor.For which patient should the nurse question this order?
A) Emergency cesarean section
B) Fetal cardiac abnormalities
C) Maternal diabetes
D) Severe preeclampsia/eclampsia

Accepted Answer

Betamethasone is contraindicated in women in whom there is a medical indication for childbirth (e.g.,severe preeclampsia/eclampsia,cord prolapse,chorioamnionitis,abruptio placentae)and in women with systemic fungal infection.

Question 18

What action by the nurse is most important to prevent hemorrhagic disease of the newborn? A) Administer vitamin K₁ phytonadione (AquaMEPHYTON). B) Assess daily hemoglobin and hematocrit levels. C) Coordinate laboratory sticks to minimize blood loss. D) Handle the infant gently to prevent injury.

Accepted Answer

Infants are given one dose of vitamin K₁ during initial care and assessment to prevent hemorrhagic disease of the newborn.Assessing laboratory values does not prevent a condition from occurring,but it might alert health-care providers to changes in status.Minimizing blood loss and gentle handling do not prevent hemorrhagic disease,although both are good ideas for other reasons.

Question 19

What action by the nurse is most important to prevent respiratory depression in a newly born infant?
A) Bathe the infant in warm water before giving to the mother.
B) Dress the infant in warm clothing and place in a warmer.
C) Dry the infant and place on the mother's bare chest.
D) Turn the delivery room temperature up to 85°F (29.4°C).

Accepted Answer

Cold stress can lead to respiratory depression.The nurse should immediately dry off a newly born infant and either place him in skin-to-skin contact with the mother or put him in a radiant warmer.

Question 20

The nurse is assessing the cardiovascular status of a newborn.Which of the following findings indicates adequate systemic circulation?
A) Capillary refill 2 seconds
B) Capillary refill 4 seconds
C) Pale mucous membranes in a dark-skinned baby
D) Truncal cyanosis

Accepted Answer

On assessment,the systemic circulation is deemed adequate if the newborn exhibits a brisk capillary refill and stable blood pressure.Capillary refill in less than 3 seconds is considered adequate.A refill time greater than 4 seconds may be indicative of an underlying condition,such as sepsis,hypoxia,or cardiovascular or central nervous system compromise.A dark-skinned baby should have pink mucous membranes.Acrocyanosis is normal,but a cyanotic trunk is not.

Quiz 17: Physiological Transition of the Newborn

The perinatal nurse explains the cardiopulmonary adaptations that occur in the neonate to a student nurse.Which of the following statements accurately describes the sequence of these changes?

A nurse assesses a 2-hour-old infant's temperature and notes it to be 97.7°F (36.5°C) .What action by the nurse is most appropriate?

New parents are concerned that after initially breastfeeding their baby 2 hours after being born,she is sleeping soundly and will not awaken.What action by the nurse is most appropriate?

A healthy term infant is being discharged at 48 hours of age.When should the nurse instruct the mother to follow up with a bilirubin assessment?

A neonatal nurse who is caring for newborns suggests the best time for a mother to first attempt breastfeeding is during which of the following stages of activity?

A nurse in the high-risk obstetrical unit monitors a student nurse preparing to give a patient a dose of betamethasone (Celestone) .Which action by the student warrants intervention by the nurse?

The nurse caring for a woman about to deliver a baby at 33 weeks' gestation knows that what factor might have accelerated surfactant production?

A nursing student asks the registered nurse why babies get dehydrated so easily.What response by the nurse is most accurate?

A mother brings her 1-week-old baby to the clinic with complaints that the baby is not eating well.The mother is attempting to bottle feed about 120 mL every 2 hours.What action by the nurse is best?

A new mother with a 6-hour-old infant calls the nursing station complaining that her baby is so cold he is shivering.What action by the nurse is most appropriate?

A nurse suspects that an infant in the intensive care unit has had intrauterine exposure to one of the TORCH infections.What finding is indicative of in utero exposure to a TORCH infection?

A mother-baby nurse assesses newborns for their risk of developing hypoglycemia.Which infant would the nurse assess as being at highest risk?

A woman gives birth to a healthy baby boy at 35 weeks' gestation.What factor regarding the development of the normal respiratory system should the nurse consider when performing an assessment of the neonate?

A nurse is assessing a newborn who is jittery,diaphoretic,and hypothermic,and has poor feeding.What laboratory value would the nurse correlate with this condition?

A term infant is 22 hours old,has a total serum bilirubin level of 13 mg/dL,and has visible jaundice.What action by the nurse is most appropriate?

The nursing professor is explaining to a class of students that which chemical factor in the blood directly leads to the initiation of respirations in the newborn?

A perinatal nurse has orders to administer betamethasone (Celestone) to the following women in preterm labor.For which patient should the nurse question this order?

What action by the nurse is most important to prevent hemorrhagic disease of the newborn?

What action by the nurse is most important to prevent respiratory depression in a newly born infant?

The nurse is assessing the cardiovascular status of a newborn.Which of the following findings indicates adequate systemic circulation?