Question 1

Infants in whom cephalhematomas develop are at increased risk for:

Accepted Answer

Cephalhematomas are characterized by bleeding between the bone and its covering,the periosteum.Because of the breakdown of the red blood cells within a hematoma,the infants are at greater risk for jaundice.Cephalhematomas do not increase the risk for infections.Caput is an edematous area on the head from pressure against the cervix.
Erythema toxicum is a benign rash of unknown cause that consists of blotchy red areas.

Question 2

One reason the brain is vulnerable to nutritional deficiencies and trauma in early infancy is the:

Accepted Answer

The vulnerability of the brain likely is to the result of the cerebellum growth spurt.The neuromuscular system is almost completely developed at birth.The reflex system is not relevant.The various sleep-wake states are not relevant.

Question 3

A collection of blood between the skull bone and its periosteum is known as a cephalhematoma.To reassure the new parents whose infant develops such a soft bulge,it is important that the nurse be aware that this condition:

Accepted Answer

Bleeding may occur during a spontaneous vaginal delivery as a result of the pressure against the maternal bony pelvis.The soft,irreducible fullness does not pulsate or bulge when the infant cries.Low forceps and other difficult extractions may result in bleeding.However,cephalhematomas can also occur spontaneously.The swelling may appear unilaterally or bilaterally and is usually minimal or absent at birth.It increases over the first 2 to 3 days of life.Cephalhematomas disappear gradually over 2 to 3 weeks.A less common condition results in calcification of the hematoma,which may persist for months.

Question 4

The nurse should immediately alert the physician when:

Accepted Answer

An infant who is dusky and becomes cyanotic when crying is showing poor adaptation to extrauterine life.Acrocyanosis is an expected finding during the early neonatal life.This is within normal range for a newborn.Infants enter the period of deep sleep when they are about 1 hour old.

Question 5

A meconium stool can be differentiated from a transitional stool in the newborn because the meconium stool is:

Accepted Answer

Meconium stool is usually passed in the first 12 hours of life,and 99% of newborns have their first stool within 48 hours.If meconium is not passed by 48 hours,obstruction is suspected.Meconium stool is the first stool of the newborn and is made up of matter remaining in the intestines during intrauterine life.Meconium is dark and sticky.

Question 6

Cardiovascular changes that cause the foramen ovale to close at birth are a direct result of:

Accepted Answer

With the increase in the blood flow to the left atrium from the lungs,the pressure is increased,and the foramen ovale is functionally closed.The pressure in the right atrium decreases at birth.It is higher during fetal life.Blood flow increases to the left ventricle after birth.The hepatic blood flow changes,but that is not the reason for the closure of the foramen ovale.

Question 7

In administering vitamin K to the infant shortly after birth,the nurse understands that vitamin K is:

Accepted Answer

The bowel is initially sterile in the newborn,and vitamin K cannot be synthesized until food is introduced into the bowel.Vitamin K is necessary to activate blood clotting factors.The platelet count in term newborns is near adult levels.Vitamin K is necessary to activate prothrombin and other clotting factors.

Question 8

The process in which bilirubin is changed from a fat-soluble product to a water-soluble product is known as:

Accepted Answer

Conjugation of bilirubin is the process of changing the bilirubin from a fat-soluble to a water-soluble product.This is the route by which part of the bile produced by the liver enters the intestine,is reabsorbed by the liver,and then is recycled into the intestine.Unconjugated bilirubin is fat soluble.Albumin binding is to attach something to a protein molecule.

Question 9

Nurses can prevent evaporative heat loss in the newborn by:

Accepted Answer

Because the infant is wet with amniotic fluid and blood,heat loss by evaporation occurs quickly.Heat loss by convection occurs when drafts come from open doors and air currents created by people moving around.If the heat loss is caused by placing the baby near cold surfaces or equipment,it is referred to as a radiation heat loss.Conduction heat loss occurs when the baby comes in contact with cold objects or surfaces.

Question 10

With regard to the gastrointestinal (GI)system of the newborn,nurses should be aware that:

Accepted Answer

Avoiding overfeeding can also reduce regurgitation.The newborn's cheeks are full because of well-developed sucking pads.Teeth do develop in utero,but the nipple is placed deep because the baby cannot move food from the lips to the pharynx.Bacteria are not present at birth,but they soon enter through various orifices.

Question 11

A nursing student is helping the nursery nurses with morning vital signs.A baby born 10 hours ago by cesarean section is found to have moist lung sounds.What is the best interpretation of these data?

Accepted Answer

The condition will resolve itself within a few hours.For this common condition of newborns,surfactant acts to keep the expanded alveoli partially open between respirations.In vaginal births,absorption of remaining lung fluid is accelerated by the process of labor and delivery.Remaining lung fluid will move into interstitial spaces and be absorbed by the circulatory and lymphatic systems.This is a particularly common condition for infants delivered by cesarean section.Surfactant is produced by the lungs,so aspiration is not a concern.

Question 12

The nurse caring for the newborn should be aware that the sensory system least mature at the time of birth is:

Accepted Answer

The visual system continues to develop for the first 6 months.As soon as the amniotic fluid drains from the ear (minutes),the infant's hearing is similar to that of an adult.Newborns have a highly developed sense of smell.The newborn can distinguish and react to various tastes.

Question 13

An examiner who discovers unequal movement or uneven gluteal skinfolds during the Ortolani maneuver would then:

Accepted Answer

The Ortolani maneuver is a technique for checking hip integrity.Unequal movement suggests that the hip is dislocated.The physician should be notified.

Question 14

Which newborn reflex is elicited by stroking the lateral sole of the infant's foot from the heel to the ball of the foot?

Accepted Answer

The Babinski reflex causes the toes to flare outward and the big toe to dorsiflex.The tonic neck reflex (also called the fencing reflex)refers to the posture assumed by newborns when in a supine position.The stepping reflex occurs when infants are held upright with their heel touching a solid surface and the infant appears to be walking.Plantar grasp reflex is similar to the palmar grasp reflex: when the area below the toes is touched,the infant's toes curl over the nurse's finger.

Question 15

During life in utero,oxygenation of the fetus occurs through transplacental gas exchange.When birth occurs,four factors combine to stimulate the respiratory center in the medulla.The initiation of respiration then follows.Which is not one of these essential factors?

Accepted Answer

Psychologic factor is not one of the essential factors in the initiation of breathing; the fourth factor is sensory.The sensory factors include handling by the provider,drying by the nurse,lights,smells,and sounds.Chemical factors are essential for the initiation of breathing.During labor,decreased levels of oxygen and increased levels of carbon dioxide seem to have a cumulative effect that is involved in the initiation of breathing.Clamping of the cord may also contribute to the start of respirations.Prostaglandins are known to inhibit breathing,and clamping of the cord results in a drop in the level of prostaglandins.Mechanical factors are also necessary to initiate respirations.As the infant passes through the birth canal,the chest is compressed.With birth the chest is relaxed,which allows for negative intrathoracic pressure that encourages air to flow into the lungs.The profound change in temperature between intrauterine and extrauterine life stimulates receptors in the skin to communicate with the receptors in the medulla.This also contributes to the initiation of breathing.

Question 16

The cheese-like,whitish substance that fuses with the epidermis and serves as a protective coating is called:

Accepted Answer

This protection,vernix caseosa,is needed because the infant's skin is so thin.Surfactant is a protein that lines the alveoli of the infant's lungs.Caput succedaneum is the swelling of the tissue over the presenting part of the fetal head.Acrocyanosis is cyanosis of the hands and feet that results in a blue coloring.

Question 17

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

Accepted Answer

The average infant heart rate while awake is 120 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 18

A first-time dad is concerned that his 3-day-old daughter's skin looks "yellow." In the nurse's explanation of physiologic jaundice,what fact should be included?

Accepted Answer

Physiologic jaundice becomes visible when the serum bilirubin reaches a level of 5 mg/dL or greater,which occurs when the baby is approximately 3 days old.This finding is within normal limits for the newborn.Pathologic jaundice occurs during the first 24 hours of life.Pathologic jaundice is caused by blood incompatibilities,causing excessive destruction of erythrocytes,and must be investigated.Breast milk jaundice occurs in one third of breastfed infants at 2 weeks and is caused by an insufficient intake of fluids.

Question 19

Which statement describing physiologic jaundice is incorrect?

Accepted Answer

Breastfeeding is associated with an increased incidence of jaundice.Neonatal jaundice occurs in 60% of newborns; the complication called kernicterus is rare.Jaundice in the first 24 hours or that persists past day 7 is cause for medical concern.Parents need to know how to assess for jaundice in their newborn.

Question 20

What marks on a baby's skin may indicate an underlying problem that requires notification of a physician?

Accepted Answer

Petechiae (bruises)scattered over the infant's body should be reported to the pediatrician because they may indicate underlying problems.Mongolian spots are bluish-black spots that resemble bruises but fade gradually over months and have no clinical significance.Telangiectatic nevi (stork bites,angel kisses)fade by the second year and have no clinical significance.Erythema toxicum is an appalling-looking rash,but it has no clinical significance and requires no treatment.

Quiz 22: Physiologic and Behavioral Adaptations of the Newborn