Question 1

What infant response to cool environmental conditions is protective?
A) Dilation of peripheral blood vessels
B) Shivering
C) Decreased respiratory rates
D) Flexed position

Accepted Answer

The newborn's flexed position guards against heat loss because it reduces the amount of body surface exposed to the environment.The newborn's body is able to constrict the peripheral blood vessels to reduce heat loss.Newborns do not shiver.The respiratory rate may increase,not decrease,to stimulate muscular activity,which generates heat.

Question 2

Which of the following statements is an inaccurate description of the first phase of the transition period?
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.

Accepted Answer

The first phase is an active phase in which the baby is alert.Decreased activity and sleep mark the second phase.The first phase is the shortest,lasting less than 30 minutes.Such exploratory behaviours include spontaneous startle reactions.In the first phase the newborn also produces saliva.

Question 3

What should the nurse be aware of with regard to the respiratory development of the newborn?
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.

Accepted Answer

The first breath produces a cry.Newborns continue to expel fluid for the first hour of life.Newborns are preferential nose breathers.Seesaw respirations instead of normal abdominal respirations are not normal and should be reported.

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 which of the following ranges?
A) 80 to 100 beats/min
B) 100 to 120 beats/min
C) 110 to 160 beats/min
D) 150 to 180 beats/min

Accepted Answer

The average infant heart rate while awake is 110 to 160 beats/min.The newborn's heart rate may be about 85 to 100 beats/min while sleeping.The infant's heart rate typically is a bit higher when alert but quiet.A heart rate of 150 to 180 beats/min is typical when the infant cries.

Question 5

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.How would the nurse document this positive finding?
A) Tonic neck reflex
B) Glabellar (Myerson) reflex
C) Babinski reflex
D) Moro reflex

Accepted Answer

The characteristics displayed by the infant are associated with a positive Moro reflex.The tonic neck reflex occurs when the infant extends the leg on the side to which the infant's head simultaneously turns.The glabellar reflex is elicited by tapping on the infant's head while the eyes are open.A characteristic response is blinking for the first few taps.The Babinski reflex occurs when the sole of the foot is stroked upward along the lateral aspect of the sole and then across the ball of the foot.A positive response occurs when all the toes hyperextend,with dorsiflexion of the big toe.

Question 6

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.What is the best response by the nurse?
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 coloured stripes."
D) "It's important to shield the newborn's eyes. Overhead lights help them see better."

Accepted Answer

"Infants can track their parent's eyes and distinguish patterns; they prefer complex patterns" is an accurate statement.Development of the visual system continues for the first 6 months of life.Visual acuity is difficult to determine,but the clearest visual distance for the newborn appears to be 20 cm to 30 cm.Infants prefer to look at complex patterns,regardless of the colour.Infants prefer low illumination and withdraw from bright light.

Question 7

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?" What is the nurse's best response?
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."

Accepted Answer

"That's meconium,which is your baby's first stool.It's normal" is an accurate statement and the most appropriate response.TrAnsweritional stool is greenish brown to yellowish brown and usually appears by the third day after initiation of feeding."That meAnswer your baby is bleeding internally" is not accurate."Oh,don't worry about that.It's okay" is not an appropriate statement.It is belittling to the father and does not educate him about the normal stool patterns of his daughter.

Question 8

A new mother states that her infant must be cold because the baby's hands and feet are blue.What is the proper term for this common and temporary condition?
A) Acrocyanosis
B) Erythema neonatorum
C) Harlequin colour
D) Vernix caseosa

Accepted Answer

Acrocyanosis,or the appearance of slightly cyanotic hands and feet,is caused by vasomotor instability,capillary stasis,and a high hemoglobin level.Acrocyanosis is normal and appears intermittently over the first 7 to 10 days.Erythema toxicum (also called erythema neonatorum)is a trAnswerient newborn rash that resembles flea bites.The harlequin sign is a benign,trAnswerient colour change in newborns.Half of the body is pale,and the other half is ruddy or bluish red with a line of demarcation.Vernix caseosa is a cheeselike,whitish substance that serves as a protective covering.

Question 9

An African-Canadian 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 which of the following?
A) Lanugo
B) Vascular nevi
C) Nevus flammeus
D) Mongolian spots

Accepted Answer

A Mongolian spot is a bluish black area of pigmentation that may appear over any part of the exterior surface of the body.It is more commonly noted on the back and buttocks and most frequently is seen on infants whose ethnic origins are Mediterranean,Latin American,Asian,or African.Lanugo is the fine,downy hair seen on a term newborn.A vascular nevus,commonly called a strawberry mark,is a type of capillary hemangioma.A nevus flammeus,commonly called a port-wine stain,is most frequently found on the face.

Question 10

What is the most critical physiological change required of the newborn?
A) Closure of fetal shunts in the circulatory system
B) Full function of the immune defence system at birth
C) Maintenance of a stable temperature
D) Initiation and maintenance of respirations

Accepted Answer

The most critical adjustment of a newborn at birth is the establishment of respirations.The cardiovascular system changes markedly after birth as a result of fetal respiration,which reduces pulmonary vascular resistance to the pulmonary blood flow and initiates a chain of cardiac changes that support the cardiovascular system.The infant relies on passive immunity received from the mother for the first 3 months of life.After the establishment of respirations,heat regulation is critical to newborn survival.

Question 11

What should the nurse be aware of with regard to the newborn's developing cardiovascular system?
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).

Accepted Answer

The newborn's thin chest wall often allows the PMI to be seen.The normal heart rate for infants who are not sleeping is 110 to 160 beats/min.However,a crying infant temporarily could have a heart rate of 180 beats/min.Heart murmurs during the first few days of life have no pathological significance; an irregular heart rate past the first few hours should be evaluated further.Persistent tachycardia may indicate RDS; bradycardia may be a sign of congenital heart blockage.

Question 12

While examining a newborn,the nurse notes uneven skin folds on the buttocks and a click when performing the Ortolani manoeuvre.The nurse recognizes these findings as a sign that the newborn probably has which of the following?
A) Polydactyly
B) Clubfoot
C) Hip dysplasia
D) Webbing

Accepted Answer

The Ortolani manoeuvre is used to detect the presence of hip dysplasia.Polydactyly is the presence of extra digits.Clubfoot (talipes equinovarus)is a deformity in which the foot turns inward and is fixed in a plantar-flexion position.Webbing,or syndactyly,is a fusing of the fingers or toes.

Question 13

What should the nurse know about variations in infants' blood count to explain to new parents?
A) A somewhat lower than expected red blood cell ( RBC ) 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.

Accepted Answer

The WBC count is high the first day of birth and then declines rapidly.Delayed clamping of the cord results in an increase in hemoglobin and the RBC count.The platelet count essentially is the same for newborns and adults.Clotting is sufficient to prevent hemorrhage unless the vitamin K deficiency is significant.

Question 14

Which is true about the neonatal period?
A) It consists of four phases, two reactive and two of decreased responses.
B) It lasts from birth to day 28 of life.
C) It applies to full-term births only.
D) It varies by socioeconomic status and the mother's age.

Accepted Answer

The neonatal period is from birth to 28 days of age.The trAnswerition period has three phases: first reactivity,decreased response,and second reactivity.All newborns experience this trAnswerition regardless of age or type of birth.Although stress can cause variation in the phases,the mother's age and income level do not disturb the pattern.

Question 15

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 to prevent which of the following events from happening?
A) Respiratory depression
B) Cold stress
C) Tachycardia
D) Vasoconstriction

Accepted Answer

Loss of heat must be controlled to protect the infant from the metabolic and physiological effects of cold stress,and that is the primary reason for placing a newborn under a radiant heat warmer.Cold stress results in an increased respiratory rate and vasoconstriction.

Question 16

What would the nurse be aware of with regard to the functioning of the renal system in newborns?
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.

Accepted Answer

The frequency of voiding varies from 2 to 6 times per day during the first and second day.A newborn who has not voided in 24 hours may have any of a number of problems,some of which deserve the attention of the pediatrician.Formula-fed infants tend to void more frequently in the first 3 days; breastfed infants void less during this time because the mother's breast milk has not come in yet.Brick dust may be uric acid crystals; blood spotting could be caused by withdrawal of maternal hormones (pseudomenstruation)or a circumcision.The physician must be notified only if there is no apparent cause of bleeding.Weight loss from fluid loss might take 14 days to regain.

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.What should the nurse do?
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.

Accepted Answer

Erythema toxicum (or erythema neonatorum)is a newborn rash that resembles flea bites.This is a normal finding that does not require notification of the physician,isolation of the newborn,or any additional interventions.

Question 18

A woman gave birth to a healthy 3000 g 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,and this is period is referred to as which of the following?
A) Transition period
B) First period of reactivity
C) Organizational stage
D) Second period of reactivity

Accepted Answer

The first period of reactivity is the first phase of trAnswerition and lasts up to 30 minutes after birth.The infant is highly alert during this phase.The trAnswerition period is the phase between intrauterine and extrauterine existence.There is no such phase as the organizational stage.The second period of reactivity occurs roughly between 4 and 8 hours after birth,after a period of prolonged sleep.

Question 19

A patient 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.What is the nurse's best response?
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."

Accepted Answer

"Your baby may lose heat by convection,which meAnswer 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" is an accurate statement.Conduction is the loss of heat from the body surface to cooler surfaces,not air,in direct contact with the newborn.Evaporation is loss of heat that occurs when a liquid is converted into a vapour.In the newborn,heat loss by evaporation occurs as a result of vaporization of moisture from the skin.Cold stress may occur from excessive heat loss,but this does not imply that the infant will become stressed if not bundled at all times.Furthermore,excessive bundling may result in a rise in the infant's temperature.

Question 20

Part of the health assessment of a newborn is observing the infant's breathing pattern.What is a full-term newborn's predominant breathing pattern?
A) Abdominal with synchronous chest movements
B) Chest breathing with nasal flaring
C) Diaphragmatic with chest retraction
D) Deep with a regular rhythm

Accepted Answer

In normal infant respiration the chest and abdomen rise synchronously,and breaths are shallow and irregular.Breathing with nasal flaring is a sign of respiratory distress.Diaphragmatic breathing with chest retraction is a sign of respiratory distress.Infant breaths are not deep with a regular rhythm.

Quiz 24: Physiological Adaptations of the Newborn

What infant response to cool environmental conditions is protective?

Which of the following statements is an inaccurate description of the first phase of the transition period?

What should the nurse be aware of with regard to the respiratory development of the newborn?

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

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.How would the nurse document this positive finding?

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.What is the best response by the nurse?

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?" What is the nurse's best response?

A new mother states that her infant must be cold because the baby's hands and feet are blue.What is the proper term for this common and temporary condition?

An African-Canadian 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 which of the following?

What is the most critical physiological change required of the newborn?

What should the nurse be aware of with regard to the newborn's developing cardiovascular system?

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

What should the nurse know about variations in infants' blood count to explain to new parents?

Which is true about the neonatal period?

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 to prevent which of the following events from happening?

What would the nurse be aware of with regard to the functioning of the renal system in newborns?

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.What should the nurse do?

A woman gave birth to a healthy 3000 g 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,and this is period is referred to as which of the following?

Part of the health assessment of a newborn is observing the infant's breathing pattern.What is a full-term newborn's predominant breathing pattern?