Recommended Maternal and Newborn Success Questions Chapter 6: Newborn

1. Encourage the parents to bond with their baby. Babies are awake and alert for approximately 30 minutes to 1 hour immediately after birth. This is the perfect time for the parents to begin to bond with their babies.

A 40-week-gestation neonate is in the first period of reactivity. Which of the following actions should the nurse take at this time? 1. Encourage the parents to bond with their baby. 2. Notify the neonatalogist of the finding. 3. Perform the gestational age assessment. 4. Place the baby under the overhead warmer.

2. "It is recommended that babies receive only breast milk for the first 4 to 6 months of their lives." Explanation: 3. It is recommended that babies receive breast milk at all feedings. When formula feeds are substituted, breastfeeding success is often compromised. 4. Apple juice is added to the diet when recommended by the pediatrician; usually well after cereals have been introduced.

A breastfeeding mother mentions to the nurse that she has heard that babies sleep better at night if they are given a small amount of rice cereal in the evening. Which of the following comments by the nurse is appropriate? 1. "That is correct. The rice cereal takes longer for them to digest so they sleep better and longer." 2. "It is recommended that babies receive only breast milk for the first 4 to 6 months of their lives." 3. "It is too early for rice cereal, but I would recommend giving the baby a bottle of formula at night." 4. "A better recommendation is to give apple sauce at 3 months of age and apple juice 1 month later."

4. A statement from the American Academy of Pediatrics asserts that circumcision is optional. The AAP, although acknowledging that there are some advantages to circumcision, states that there is not enough evidence to suggest that all baby boys be circumcised.

A couple is asking the nurse whether or not their son should be circumcised. On which fact should the nurse's response be based? 1. Boys should be circumcised in order for them to establish a positive self-image. 2. Boys should not be circumcised because there is no medical rationale for the procedure. 3. Experts from the Centers for Disease Control and Prevention argue that circumcision is desirable. 4. A statement from the American Academy of Pediatrics asserts that circumcision is optional.

2. To provide heat production when the baby is hypothermic. Babies do not shiver. Rather, to produce heat they utilize chemical thermogenesis, also called nonshivering thermogenesis. BAT is metabolized during hypothermic episodes to maintain body temperature. Unfortunately, this can lead to metabolic acidosis.

A full-term neonate has brown adipose fat tissue (BAT) stores that were deposited during the latter part of the third trimester. What does the nurse understand is the function of BAT stores? 1. To promote melanin production in the neonatal period. 2. To provide heat production when the baby is hypothermic. 3. To protect the bony structures of the body from injury. 4. To provide calories for neonatal growth between feedings.

1. Remove wet blankets. When newborns are wet they can become hypothermic from heat loss resulting from evaporation. They may then develop cold stress syndrome

A full-term newborn was just born. Which nursing intervention is important for the nurse to perform first? 1. Remove wet blankets. 2. Assess Apgar score. 3. Insert eye prophylaxis. 4. Elicit the Moro reflex.

2. "It is recommended that powder not be put on babies." It is recommended that powders, even if advertised for the purpose, not be used on babies

A mother asks the nurse which powder she should purchase to use on the baby's skin. What should the nurse's response be? 1. "Any powder made especially for babies should be fine." 2. "It is recommended that powder not be put on babies." 3. "There is no real difference except that many babies are allergic to cornstarch so it should not be used." 4. "As long as you only put it on the buttocks area, you can use any brand of baby powder that you like."

2. "Babies usually breathe in and out through their noses so they can feed without choking." This statement provides the mother with the knowledge that babies are obligate nose breathers in order to be able to suck, swallow, and breathe without choking.

A mother asks whether or not she should be concerned that her baby never opens his mouth to breathe when his nose is so small. Which of the following is the nurse's best response? 1. "The baby does rarely open his mouth but you can see that he isn't in any distress." 2. "Babies usually breathe in and out through their noses so they can feed without choking." 3. "Everything about babies is small. It truly is amazing how everything works so well." 4. "You are right. I will report the baby's small nasal openings to the pediatrician right away."

2. "The medicine helps to prevent eye infections." This response gives the mother a brief scientific rationale for the medication administration.

A mother questions why the ophthalmic medication is given to the baby. Which of the following responses by the nurse would be appropriate to make at this time? 1. "I am required by law to give the medicine." 2. "The medicine helps to prevent eye infections." 3. "The medicine promotes neonatal health." 4. "All babies receive the medicine at delivery."

1. Assist the woman to breastfeed. Breastfeeding should be instituted as soon as possible to promote milk production, stability of the baby's glucose levels, and meconium excretion, as well as to stabilize the baby's temperature through skin-to-skin contact.

A mother, who gave birth 5 minutes ago, states that she would like to breastfeed. The baby's Apgar score is 9/9. Which of the following actions should the nurse perform first? 1. Assist the woman to breastfeed. 2. Assess the baby's blood pressures. 3. Administer the ophthalmic prophylaxis. 4. Take the baby's rectal temperature.

3. Cryptorchidism. Undescended testes—cryptorcidism— is an unexpected finding. It is one sign of prematurity.

A neonate is being admitted to the well-baby nursery. Which of the following findings should be reported to the neonatalogist? 1. Umbilical cord with three vessels. 2. Diamond-shaped anterior fontanelle. 3. Cryptorchidism. 4. Café au lait spot.

1. Baby is showing signs of hunger and frustration. Showing signs of hunger and frustration describes the active alert or active awake state.

A neonate is in the active alert behavioral state. Which of the following would the nurse expect to see? 1. Baby is showing signs of hunger and frustration. 2. Baby is starting to whimper and cry. 3. Baby is wide awake and attending to a picture. 4. Baby is asleep and breathing rhythmically.

1, 4, and 5 1. Babies do not starve themselves. If a baby refuses to eat, it may mean that the baby is seriously ill. For example, babies with cardiac defects often refuse to eat. 2. Newborns normally breathe irregularly. Apnea spells of 10 seconds or less are normal. 3. Newborns do not tear when they cry. If a baby does tear, he or she may have a blocked lacrimal duct. 4. Although babies who are in the deep sleep state are difficult to arouse, the deep sleep state lasts no more than an hour. If the baby continues to be nonarousable, the pediatrician should be notified. 5. A temperature above 100.4ºF is a febrile state for a newborn and the pediatrician should be notified.

A nurse is advising a couple of a newborn regarding when they should call their pediatrician. Which of the following responses show that the teaching was effective? Select all that apply. 1. If the baby repeatedly refuses to feed. 2. If the baby's breathing is irregular. 3. If the baby has no tears when he cries. 4. If the baby is repeatedly difficult to awaken. 5. If the baby's temperature is above 100.4ºF.

1. Put the car seat facing forward only after the baby reaches twenty pounds. It is unsafe for infants to be facing forward until they have reached 20 pounds, even if they are over 1 year of age.

A nurse is advising a mother of a neonate being discharged from the hospital regarding car seat safety. Which of the following should be included in the teaching plan? 1. Put the car seat facing forward only after the baby reaches twenty pounds. 2. The baby's car seat should be placed facing the rear in the front seat of the car. 3. A fist should fit between the straps of the seat and the baby's body. 4. Seat belt adjusters should always be used to support infant car seats

3. Call the doctor if greenish drainage appears The green drainage may be a sign of infection. The cord should become dried and shriveled.

A nurse is providing discharge teaching to the parents of a newborn. Which of the following should be included when teaching the parents how to care for the baby's umbilical cord? 1. Cleanse it with hydrogen peroxide if it starts to smell. 2. Remove it with sterile tweezers at one week of age. 3. Call the doctor if greenish drainage appears. 4. Cover it with sterile dressings until it falls off.

3. Swaddle baby in blanket. The baby's extremities are cyanotic as a result of the baby's immature circulatory system. Swaddling helps to warm the baby's hands and feet.

A nurse notes that a 6-hour-old neonate has cyanotic hands and feet. Which of the following actions by the nurse is appropriate? 1. Place child in isolette. 2. Administer oxygen. 3. Swaddle baby in blanket. 4. Apply pulse oximeter.

2. Baby with Apgar 9/9, weight 4660 grams. Although the Apgar score—9—is excellent, the baby's weight—4660 grams—is well above the average of 2500 to 4000 grams. Babies who are large-for-gestational age are at high risk for hypoglycemia

Four babies have just been admitted into the neonatal nursery. Which of the babies should the nurse assess first? 1. Baby with respirations 42, oxygen saturation 96%. 2. Baby with Apgar 9/9, weight 4660 grams. 3. Baby with temperature 97.8ºF, length 21 inches. 4. Baby with glucose 55 mg/dL, heart rate 121.

4. Small blood vessels that broke under the baby's scalp during birth. Cephalhematomas are subcutaneous swellings of accumulated blood from the trauma of delivery. The bulges may be one sided or bilateral and the swellings do not cross suture lines.

The mother notes that her baby has a "bulge" on the back of one side of the head. She calls the nurse into the room to ask what the bulge is. The nurse notes that the bulge covers the right parietal bone but does not cross the suture lines. The nurse explains to the mother that the bulge results from which of the following? 1. Molding of the baby's skull so that the baby could fit through her pelvis. 2. Swelling of the tissues of the baby's head from the pressure of her pushing. 3. The position that the baby took in her pelvis during the last trimester of her pregnancy. 4. Small blood vessels that broke under the baby's scalp during birth.

4. The nostrils flare whenever the baby inhales. Nasal flaring is a symptom of respiratory distress. Pseudostrabismus—eyes cross and uncross when they are open—is normal in the neonate because of poor tone of the muscles of the eye. 2. Ears positioned in alignment with the inner and outer canthus of the eyes is the normal position. In Down syndrome, ears are low set.

The nurse is assessing a neonate in the newborn nursery. Which of the following findings in a newborn should be reported to the neonatalogist? 1. The eyes cross and uncross when they are open. 2. The ears are positioned in alignment with the inner and outer canthus of the eyes. 3. Axillae and femoral folds of the baby are covered with a white cheesy substance. 4. The nostrils flare whenever the baby inhales.

1. Intracostal retractions. Intracostal retractions are a sign of respiratory distress.

The nurse is assessing a newborn on admission to the newborn nursery. Which of the following findings should the nurse report to the neonatalogist? 1. Intracostal retractions. 2. Caput succedaneum. 3. Epstein's pearls. 4. Harlequin sign.

3. 8 The baby's Apgar is 8.

The nurse notes that a newborn, who is 5 minutes old, exhibits the following characteristics: heart rate 108 bpm, respiratory rate 29 rpm with lusty cry, pink body with bluish hands and feet, some flexion. What does the nurse determine the baby's Apgar score is? 1. 6 2. 7 3. 8 4. 9

2. Grunting during expiration. Expiratory grunting is an indication of respiratory distress. Neonates are often mottled when chilled. Unless other signs or symptoms are present, it is a normal finding.

The nursery charge nurse is assessing a 1-day-old female on morning rounds. Which of the following findings should be reported to the neonatalogist as soon as possible? 1. Blood in the diaper. 2. Grunting during expiration. 3. Deep red coloring on one side of the body with pale pink on the other side. 4. Lacy and mottled appearance over the entire chest and abdomen.

0.25 mL

The pediatrician has ordered vitamin K 0.5 mg IM for a newly born baby. The medication is available as 2 mg/mL. How many milliliters (mL) should the nurse administer to the baby? ______ mL

Epstein's Pearls

Small, white blebs found along the gum margins and at the junction of the hard and soft palates; commonly seen in the newborn as a normal manifestation.

Cafe au lait spots

Smooth edged tan-to-brown pigmentations on the skin

Newborn Weight

2500-4000 g (5 lb. 8oz- 8 lb. 13 oz.)

1. Do nothing because this is a normal weight loss. The baby has lost less than 4% of its birth weight. The normal weight loss for babies is 5% to 10%.

A 2-day-old breastfeeding baby born via normal spontaneous vaginal delivery has just been weighed in the newborn nursery. The nurse determines that the baby has lost 3.5% of the birth weight. Which of the following nursing actions is appropriate? 1. Do nothing because this is a normal weight loss. 2. Notify the neonatalogist of the significant weight loss. 3. Advise the mother to bottlefeed the baby at the next feed. 4. Assess the baby for hypoglycemia with a glucose monitor.

4. If the baby has eyes and skin that are tinged yellow If the baby has yellow sclerae, the baby is exhibiting signs of jaundice and the pediatrician should be contacted.

A 2-day-old, exclusively breastfed baby is to be discharged home. Under what conditions should the nurse teach the parents to call the pediatrician? 1. If the baby feeds 8 to 12 times each day. 2. If the baby urinates 6 to 10 times each day. 3. If the baby has stools that are watery and bright yellow. 4. If the baby has eyes and skin that are tinged yellow

Harlequin Sign

A deep red color develops over one side of the body while the other remains pale. (lasts from 1-20mins, clinically insignificant)

Frank Breech Position

A position in utero where the legs are flexed at the hips and extend toward the shoulders.

Caput Succedaneum

Edematous swelling and ecchymosis of the presenting part of the head caused by birth trauma

1. Cephalohematoma. Red blood cells in the cephalhematoma will have to be broken down and excreted. The byproduct of the destruction—bilirubin—increases the baby's risk for physiological jaundice.

Four babies with the following conditions are in the well-baby nursery. The baby with which of the conditions is high risk for physiological jaundice? 1. Cephalohematoma. 2. Caput succedaneum. 3. Harlequin coloring. 4. Mongolian spotting.

3. 2-day-old baby who is breathing irregularly at 70 breaths per minute. Normal neonatal breathing is irregular at 30 to 60 breaths per minute. This baby is tachypneic.

Four newborns are in the neonatal nursery. Which of the babies should the nurse report to the neonatalogist? 1. 16-hour-old baby who has yet to pass meconium. 2. 16-hour-old baby whose blood glucose is 50 mg/dL. 3. 2-day-old baby who is breathing irregularly at 70 breaths per minute. 4. 2-day-old baby who is excreting a milky discharge from both nipples.

4. The neonate with respirations of 72 and heart rate of 166. The normal resting respiratory rate of a neonate is 30 to 60 and the normal resting heart rate of a neonate is 110 to 160.

Four newborns were admitted into the neonatal nursery 1 hour ago. They are all sleeping in overhead warmers. Which of the babies should the nurse ask the neonatalogist to evaluate? 1. The neonate with a temperature of 97.9ºF and weight of 3000 grams. 2. The neonate with white spots on the bridge of the nose. 3. The neonate with raised white specks on the gums. 4. The neonate with respirations of 72 and heart rate of 166.

2, 3, 4, and 5 2. The smell and/or the taste of the milk often will arouse a drowsy baby. 3. Drowsy babies will open their eyes when placed in the en face position and are interacted with. 4. Performing manipulations like diapering or playing pat-a-cake often will arouse a drowsy baby. 5. Performing manipulations like diapering or playing pat-a-cake often will arouse a drowsy baby.

It is time for a baby, who is in the drowsy behavioral state, to breastfeed. Which of the following techniques could the mother use to arouse the baby? Select all that apply. 1. Swaddle or tightly bundle the baby. 2. Hand express milk onto the baby's lips. 3. Talk with the baby while making eye contact. 4. Remove the baby's shirt and change the diaper. 5. Play pat-a-cake with the baby.

3. 3-day-old, breastfeeding every 4 hours, jittery. Babies who breastfeed fewer than 8 times a day are not receiving adequate nutrition. Jitters are indicative of hypoglycemia. Slight jaundice is within normal limits on day 2. The rash is a normal newborn rash— erythema toxicum. Crying, without other signs and symptoms, is a normal response by babies.

The following four babies are in the neonatal nursery. Which of the babies should be seen by the neonatalogist? 1. 1-day-old, HR 110 beats per minute in deep sleep. 2. 2-day-old, T 97.7ºF, slightly jaundiced. 3. 3-day-old, breastfeeding every 4 hours, jittery. 4. 4-day-old, crying, papular rash on an erythematous base.

1. Wash hands well before picking up the baby. Although this baby is being breastfed, he or she is still susceptible to illness. The best way to prevent transmission of pathogens is to wash hands carefully before touching the baby

The nurse is developing a teaching plan for parents who are taking home their 2-day-old breastfed baby. Which of the following should the nurse include in the plan? 1. Wash hands well before picking up the baby. 2. Refrain from having visitors for the first month. 3. Wear a mask to prevent transmission of a cold. 4. Sterilize the breast pump supplies for the first month.

4. Cerebral palsy. Cerebral palsy (CP) is a disorder characterized by motor dysfunction resulting from a nonprogressive injury to brain tissue. The injury usually occurs during labor, delivery, or shortly after delivery. Physical examination is required to diagnose CP. Blood screening is not an appropriate means of diagnosis.

The nurse is discussing the neonatal blood screening test with a new mother. The nurse knows that more teaching is needed when the mother states that which of the following diseases is included in the screening test? 1. Hypothyroidism. 2. Sickle cell anemia. 3. Galactosemia. 4. Cerebral palsy.

Cryptorchidism

Undescended testicles

1. Baby with seesaw breathing. Seesaw breathing is an indication of respiratory distress.

Which of the following full-term babies requires immediate intervention? 1. Baby with seesaw breathing. 2. Baby with irregular breathing with 10-second apnea spells. 3. Baby with coordinated thoracic and abdominal breathing. 4. Baby with respiratory rate of 52.