ob test 2

The newborn's most dramatic and most rapid extrauterine transitions occur in four interdependent areas. What are they?

respiratory, circulatory, thermo-regulation and their ability to stabilize their blood glucose levels.

The newborn has been placed in skin-to-skin contact with his mother. A blanket covers all of his body except his head. His hair is still wet with amniotic fluid, etc. What is the most likely type of heat loss this baby may experience?

evaporation

Risk factors for pre-eclampsia?

(1) age < 20 yo or > 35 yo (2) history of previous or family history preeclampsia (mother/sister) (3) positive family history(DM, HTN, renal disease) (4) African american (5) multiple gestations (6) thrombocytosis (7) obesity (8) lower economic status (9) poor nutrition (10) use of ovulation drugs (11)chronic stress (12)chromosomal abnormalaties (13) primigravida status

A newborn has a heart rate of 90 beats per minute, a regular respiratory rate of 40 breaths per minute, tight flexion of the extremities, a grimace when stimulated, and acrocyanosis. The nurse assigns an Apgar score of:

7

A client expresses concern that her 2-hour-old newborn is sleepy and difficult to awaken. The nurse explains that this behavior indicates which of the following? A) Normal progression of behavior B) Probable hypoglycemia C) Physiological abnormality D) Inadequate oxygenation

A

A new mother asks the nurse, "Why has my baby lost weight since he was born?" The nurse integrates knowledge of which of the following when responding to the new mother? A) Insufficient calorie intake B) Shift of water from extracellular space to intracellular space C) Increase in stool passage D) Overproduction of bilirubin

A

A nurse is counseling a mother about the immunologic properties of breast milk. The nurse integrates knowledge of immunoglobulins, emphasizing that breast milk is a major source of which immunoglobulin? A) IgA B) IgG C) IgM D) IgE

A

A nurse is developing a teaching plan for the parents of a newborn. When describing the neurologic development of a newborn to his parents, the nurse would explain that the development occurs in which fashion? A) Head-to-toe B) Lateral-to-medial C) Outward-to-inward D) Distal-to-caudal

A

After the birth of a newborn, which of the following would the nurse do first to assist in thermoregulation? A) Dry the newborn thoroughly. B) Put a hat on the newborn's head. C) Check the newborn's temperature. D) Wrap the newborn in a blanket.

A

Twenty minutes after birth, a baby begins to move his head from side to side, making eye contact with the mother, and pushes his tongue out several times. The nurse interprets this as indicating which of the following? A) A good time to initiate breast-feeding B) The period of decreased responsiveness preceding sleep C) The need to be alert for gagging and vomiting D) Evidence that the newborn is becoming chilled

A

A nursing instructor is preparing a class on newborn adaptations. When describing the change from fetal to newborn circulation, which of the following would the instructor most likely include? (Select all that apply.) A) Decrease in right atrial pressure leads to closure of the foramen ovale. B) Increase in oxygen levels leads to a decrease in systemic vascular resistance. C) Onset of respirations leads to a decrease in pulmonary vascular resistance. D) Increase in pressure in the left atrium results from increases in pulmonary blood flow. E) Closure of the ductus venosus eventually forces closure of the ductus arteriosus

A,C,D,E

A newborn is experiencing cold stress. Which of the following would the nurse expect to assess? (Select all that apply.) A) Respiratory distress B) Decreased oxygen needs C) Hypoglycemia D) Metabolic alkalosis E) Jaundice

A,C,E

A new mother is changing the diaper of her 20-hour-old newborn and asks why the stool is almost black. Which response by the nurse would be most appropriate? A) "You probably took iron during your pregnancy." B) "This is meconium stool, normal for a newborn." C) "I'll take a sample and check it for possible bleeding." D) "This is unusual and I need to report this."

B

A nurse is reviewing the laboratory test results of a newborn. Which result would the nurse identify as a cause for concern? A) Hemoglobin 19 g/dL B) Platelets 75,000/uL C) White blood cells 20,000/mm3 D) Hematocrit 52%

B

A nursing student is preparing a presentation on minimizing heat loss in the newborn. Which of the following would the student include as a measure to prevent heat loss through convection? A) Placing a cap on a newborn's head B) Working inside an isolette as much as possible. C) Placing the newborn skin-to-skin with the mother D) Using a radiant warmer to transport a newborn

B

After teaching a class about hepatic system adaptations after birth, the instructor determines that the teaching was successful when the class identifies which of the following as the process of changing bilirubin from a fat-soluble product to a water-soluble product? A) Hemolysis B) Conjugation C) Jaundice D) Hyperbilirubinemia

B

After teaching a group of nursing students about a neutral thermal environment, the instructor determines that the teaching was successful when the students identify which of the following as the newborn's primary method of heat production? A) Convection B) Nonshivering thermogenesis C) Cold stress D) Bilirubin conjugation

B

Assessment of a newborn reveals rhythmic spontaneous movements. The nurse interprets this as indicating: A) Habituation B) Motor maturity C) Orientation D) Social behaviors

B

The nurse observes the stool of a newborn who has begun to breast-feed. Which of the following would the nurse expect to find? A) Greenish black, tarry stool B) Yellowish-brown, seedy stool C) Yellow-gold, stringy stool D) Yellowish-green, pasty stool

B

The nurse places a warmed blanket on the scale when weighing a newborn. The nurse does so to minimize heat loss via which mechanism? A) Evaporation B) Conduction C) Convection D) Radiation

B

The nurse is explaining how a newly delivered baby initiates respirations. Which statement explains this process? a.Drying off the infant b.Chemical, thermal, and mechanical factors c.An increase in the PO2 and a decrease in the PCO2 d.The continued functioning of the foramen ovale

B A variety of these factors are responsible for initiation of respirations. Tactile stimuli aid in initiating respirations but are not the main cause. The PO2 decreases at birth and the PCO2 increases. The foramen ovale closes at birth.

Which method of heat loss may occur if a newborn is placed on a cold scale or touched with cold hands? a.Radiation b.Conduction c.Convection d.Evaporation

B Conduction occurs when the infant comes in contact with cold objects. Radiation is the transfer of heat to a cooler object that is not in direct contact with the infant. Convection occurs when heat is transferred to the air surrounding the infant. Evaporation can occur during birth or bathing as a result of wet linens or clothes, or insensible heat loss.

Which organs are nonfunctional during fetal life? a.Eyes and ears b.Lungs and liver c.Kidneys and adrenals d.Gastrointestinal system

B Most of the fetal blood flow bypasses the nonfunctional lungs and liver. Near term, the eyes are open and the fetus can hear. Kidneys and adrenals function during fetal life. The fetus continuously swallows amniotic fluid, which is filtered through the kidneys. The gastrointestinal system functions during fetal life.

Which of the following would alert the nurse to the possibility of respiratory distress in a newborn? A) Symmetrical chest movements B) Periodic breathing C) Respirations of 40 breaths/minute D) Sternal retractions

D

During fetal circulation the pressure is greatest in the: a.left atrium. b.right atrium. c.hepatic system. d.pulmonary veins.

B Pressure in the fetal circulation is greatest in the right atrium, which allows right-to-left shunting that aids in bypassing the lungs during intrauterine life. The pressure increases in the left atrium after birth and will close the foramen ovale. The liver does not filter the blood during fetal life until the end. It is functioning by birth. Blood bypasses the pulmonary vein during fetal life.

Parents ask the nurse, What makes the opening between the baby's atriums close at birth? The nurse's response is that cardiovascular changes that cause the foramen ovale to close at birth are a direct result of: a. changes in the hepatic blood flow. b. increased pressure in the left atrium. c. increased pressure in the right atrium. d. decreased blood flow to the left ventricle.

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

A nurse is assessing a newborn who is about 4½ hours old. The nurse would expect this newborn to exhibit which of the following? (Select all that apply.) A) Sleeping B) Interest in environmental stimuli C) Passage of meconium D) Difficulty arousing the newborn E) Spontaneous Moro reflexes

B,C

A group of nursing students are reviewing the changes in the newborn's lungs that must occur to maintain respiratory function. The students demonstrate understanding of this information when they identify which of the following as the first event? A) Expansion of the lungs B) Increased pulmonary blood flow C) Initiation of respiratory movement D) Redistribution of cardiac output

C

The nurse is teaching a group of students about the similarities and differences between newborn skin and adult skin. Which statement by the group indicates that additional teaching is needed? A) The newborn's skin and that of an adult are similar in thickness. B) The lipid composition of the skin of a newborn and adult is about the same. C) Skin development in the newborn is complete at birth. D) The newborn has more fibrils connecting the dermis and epidermis.

C

While observing the interaction between a newborn and his mother, the nurse notes the newborn nestling into the arms of his mother. The nurse identifies this behavior as which of the following? A) Habituation B) Self-quieting ability C) Social behaviors D) Orientation

C

The nurse is explaining the risk of hypothermia in the newborn to a group of nursing students. Which should the nurse include as an explanation of hypothermia in the newborn? a. Newborns shiver to generate heat. b. Newborns have decreased oxygen demands. c. Newborns have increased glucose demands. d.Newborns have a decreased metabolic rate.

C In hypothermia, the basal metabolic rate (BMR) is increased in an attempt to compensate, thus requiring more glucose. Shivering is not an effective method of heat production for newborns. Oxygen demands increase with hypothermia. The metabolic rate increases with hypothermia

How can nurses prevent evaporative heat loss in the newborn? a.Placing the baby away from the outside wall and the windows b.Keeping the baby out of drafts and away from air conditioners c.Drying the baby after birth and wrapping the baby in a dry blanket d.Warming the stethoscope and nurses hands before touching the baby

C Wet linens or wet clothes can cause heat loss by evaporation. If the heat loss is caused by placing the baby near cold surfaces or equipment, it is termed a radiation heat loss. Heat loss by convection occurs when drafts come from open doors and air currents created by people moving around. Conduction heat loss occurs when the baby comes into contact with cold objects or surfaces.

When explaining how a newborn adapts to extrauterine life, the nurse would describe which body systems as undergoing the most rapid changes? A) Gastrointestinal and hepatic B) Urinary and hematologic C) Respiratory and cardiovascular D) Neurological and integumentary

C) Respiratory and cardiovascular

A nurse is assessing a newborn and observes the newborn moving his head and eyes toward a loud sound. The nurse interprets this as which of the following? A) Habituation B) Motor maturity C) Social behavior D) Orientation

D

After teaching new parents about the sensory capabilities of their newborn, the nurse determines that the teaching was successful when they identify which sense as being the least mature? A) Hearing B) Touch C) Taste D) Vision

D

The nurse institutes measure to maintain thermoregulation based on the understanding that newborns have limited ability to regulate body temperature because they: A) Have a smaller body surface compared to body mass B) Lose more body heat when they sweat than adults C) Have an abundant amount of subcutaneous fat all over D) Are unable to shiver effectively to increase heat production

D

The nurse is assessing the respirations of several newborns. The nurse would notify the health care provider for the newborn with which respiratory rate at rest? A) 38 breaths per minute B) 46 breaths per minute C) 54 breaths per minute D) 68 breaths per minute

D

The infants heat loss immediately at birth is predominantly from: a. radiation. b. conduction. c. convection. d. evaporation.

D Because the infant is wet with amniotic fluid and blood, heat loss by evaporation occurs quickly. Radiation occurs with the transfer of heat to a cooler object that is not in direct contact with the infant. Conduction occurs when the infant comes into contact with a cold surface. The crib should be preheated to prevent this from occurring. Convection occurs when heat is transferred to the air surrounding the infant.

1. A nursing student is helping the nursery nurse with morning vital signs. A baby born 10 hours ago via cesarean section is found to have moist lung sounds. Which is the best interpretation of this information? a.This is an emergency situation. b.The neonate must have aspirated surfactant. c.If this baby was born vaginally, it could indicate a pneumothorax. d.The lungs of a baby delivered by cesarean section may sound moist for 24 hours after birth.

D 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 birth. Remaining lung fluid will move into interstitial spaces and be absorbed by the circulatory and lymphatic systems. This is a common condition for infants delivered by cesarean section. Surfactant is produced by the lungs, so aspiration is not a concern. It is common to have some fluid left in the lungs; this will be absorbed within a few hours.

Which infant has the lowest risk of developing high levels of bilirubin? a. The infant who developed a cephalohematoma b. The infant who was bruised during a difficult birth c. The infant who uses brown fat to maintain temperature d. The infant who is breastfed during the first hour of life

D The infant who is fed early will be less likely to retain meconium and resorb bilirubin from the intestines back into the circulation. Cephalohematomas will release bilirubin into the system as the red blood cells die off. Bruising will release more bilirubin into the system. Brown fat is normally used to produce heat in the newborn.

A new mother reports that her newborn often spits up after feeding. Assessment reveals regurgitation. The nurse responds integrating understanding that this most likely is due to which of the following? A) Placing the newborn prone after feeding B) Limited ability of digestive enzymes C) Underdeveloped pyloric sphincter D) Relaxed cardiac sphincter

D) Relaxed cardiac sphincter

What are small unopened or plugged sebaceous glands that occur in a newborn's mouth and gums?

Epstein's pearls

A new mother asks the nurse why her baby's back and groin have a red and raised rash. Which of the following does the nurse correctly identify as the name of this condition?

Erythema toxicum

What time period is defined at the neonatal period?

First 28 days of life

Ophthalmia neonatorum is contracted when a mother has which sexually transmitted infection(s)?

Gonorrhea and Chlamydia

What pathologic events could alter a newborn's ability to generate heat?

Hypoxia, Acidosis, Hypoglycemia, Medication that blocks the release of norepinephrine

When newborns are exposed to a cool environment they require additional heat. They have several physiologic mechanisms that increase heat production or thermogenesis. What are they?

Increasing basic metabolic rate, Muscular activity,Chemical thermogenesis or Non Shivering Thermogenesis (Brown Fat Metabolism), Peripheral vagal constriction

When does Non Shivering Thermogenesis (Brown Fat Metabolism)occur?

Occurs when skin receptors perceive a drop in the environmental temperature and in response transmit sensations to stimulate the sympathetic nervous system.

Oxidation of fatty acids (triglycerides) depends on the availability of what?

Oxygen, Glucose, ATP

The New Ballard scoring system evaluates newborns on which 2 factors?

Physical maturity and neuromuscular maturity

The infant's temperature is 97.2°F (36.2°C) axillary an hour after birth. Which intervention is the appropriate for the nurse?

Place the infant under a radiant warmer or in a heated isolette.

A nurse determines that a newborn has a 1-minute Apgar score of 5 points. What conclusion would the nurse make from this finding?

The infant is experiencing moderate difficulty in adjusting to extrauterine life.

The nurse caring for a newborn has to perform assessment at various intervals. When should the nurse complete the second assessment for the newborn?

Within the first 2 to 4 hours, when the newborn reaches the nursery

Apgar scale

a standard measurement system that looks for a variety of indications of good health in newborns >7 excellent 4-6 moderately depressed 0-3 depressed

What is cold stress?

a term that describes excessive heat loss that leads to hypothermia and results from utilization of compensatory mechanisms to maintain neonates body temperatures

What are some complications of pre-eclampsia to the mother?

abrupto placenta chronic renal probems detached retina chronic HTN HELLP DIC

brown fat

also referred to as non-shivering thermogenesis, a highly dense and vascular adipose tissue that is unique to neonates

Which vital sign is not routinely assessed in a term, healthy newborn with 9/9 AGPARs?

blood pressure

Antidote for magnesium sulfate

calcium gluconate

What is the process of cold stress?

decrease of environmental temps lead to decrease in body temp leading to an increase in respiratory rate and heart rate leading to and increase in oxygen consumption, depletion of glucose and a decrease in surfactant which leads to respiratory distress

What are some factors that negatively affect thermoregulation?

decreased subcutaneous fat, decreased brown fat in preterm neonates, large body surface, loss of body heat from convection, radiation, conduction, and evaporation

Surfactant decreases or increases lung surface tension?

decreases lung surfactant

A decrease in the environmental temperature of 2' Celsius from 33' Celsius to 31' Celsius is a drop sufficient enough to?

double oxygen consumption of the term newborn. It takes even less of a temperature change for a preterm!

If the newborn shivers it means the newborn's metabolic rate has already?

doubled

What are some reasons preterm neonates are at a higher risk for thermoregulation problems?

higher body surface area to body mass ratio, higher metabolic rate, limited and immature thermoregulatory abilities, little to non brown fat

placenta previa

implantation of the placenta over the cervical opening or in the lower region of the uterus , partially of completely covers the cervix painless, bright red vaginal bleeding

Neonate's response to cold

increase in metabolic rate, increase in muscle activity, peripheral vascular constriction, and metabolism of brown fat

What stimulates increased cardiac output and contractility, relases surfactant, and promotes pulmonary fluid clearance?

increased levels of epinephrine and norepinephrine

Successful transition from fetal to postnatal circulation requires these four things?

increased pulmonary blood flow, removal of placenta, closure of the intracardiac (foramen ovale), and extracardiac shunts (ductus venous and ductus arteriosus)

How is heat produced from brown fat?

intense lipid metabolic metabolism of the brown fat

What is convection in relation to newborns?

loss of heat from the neonate's body surface to cooler air currents such as air conditioners or oxygen masks

What is evaporation in relation to newborns?

loss of heat that occurs when water on the neonate's skin is converted to vapors such as during bathing or directly after birth

Where is brown fat located?

neck, thorax, axillary area, interscapular areas, and around the adrenal glands and kidneys

an environment that maintains body temperature with minimal metabolic changes and/or oxygen consumption

neutral thermal environment

How are brown fat stores rapidly depleted?

periods of cold stress

What are some complications of pre-eclampsia to the fetus?

prematurity IUGR asphyxia

What are some risks factors for cold stress?

prematurity, SGA, hypoglycemia, prolonged resuscitation efforts, sepsis, neurological, endocrine, or cardio and respiratory problems

Who has limited brow fat or no brown fat at all?

preterm neonates

Nursing actions for cold stress?

prevent, skin to skin, swaddle, put cap on head, place in warmer, monitor temps, obtain heel stick to assess for hypoglycemia

What is radiation in relation to newborns?

transfer of heat from the neonate to cooler objects that are not in direct contact with the neonate such as the cold walls of the isolette or cold equipment near the neonate

What is conduction in relation to newborns?

transfer of heat to cooler surface by direct skin contact such as cold hands of caregivers or cold equipment