Chapter 19: Normal Newborn: Processes of Adaptation

At birth, which should the nurse do to prevent heat loss in the newborn? a. Dry the infant. b. Place the infant on a flat surface. c. Monitor the temperature. d. Rub the infant's back.

A Evaporation occurs when wet surfaces are exposed to air. As the surfaces dry, heat is lost. At birth the infant loses heat when amniotic fluid on the skin evaporates. Drying the infant helps prevent excessive heat loss.

When doing a newborn assessment on a 2-day-old infant, the nurse notices facial jaundice. The bilirubin level was assessed and found to be 6 mg/dL. The nurse understands that this jaundice will be classified as: a. Physiologic jaundice. b. Pathologic jaundice. c. Breastfeeding jaundice. d. True breast mild jaundice.

A With physiologic jaundice, the jaundice is not present during the first 24 hours of life. It appears on the second or third day and is considered a normal phenomenon. When jaundice is noted in the face only, the jaundice level can be estimated to be from 5 to 7 mg/dL.

Which of the newborns listed are at high risk for hypoglycemia? (Select all that apply). a. Preterm b. Small-for-gestational age c. Postterm d. Large-for-gestational age e. Average-for-gestational age f. Infants with infections g. Infants with cold stress

ABCDFG

Select the following situations that could accelerate fetal lung maturation. (Select all that apply). a. Intrauterine growth restriction b. Maternal hypertension c. Prolonged rupture of membranes d. Maternal diabetes e. Maternal administration of steroids

ABCE

Select the following that assist the newborn to initiate respirations. (Select all that apply). a. Decrease in oxygen b. Decrease in carbon dioxide c. Release of pressure on the chest at birth d. Rise in environmental temperature at birth

AC

The nurse is teaching the postpartum client about newborn transitional stools. Which should the nurse include in the teaching session with regard to transitional stools? (Select all that apply.) a. They are a greenish brown color. b. They are of a looser consistency. c. They have a tarlike consistency. d. They have a consistency of mustard. e. They are seedy, with a sweet-sour smell.

ANS: A, B Meconium stools are followed by transitional stools, a combination of meconium and milk stools. They are greenish brown and of a looser consistency than meconium. Stools that are tarlike are meconium stools. Infants fed with breast milk are seedy, with a sweet-sour smell; the meconium has the consistency of mustard.

Which newborn is at higher risk for developing hypoglycemia? (Select all that apply.) a. Post-term newborn b. 38 weeks' gestation newborn c. Small-for-gestational-age newborn d. Large-for-gestational-age newborn e. Term newborn born by cesarean birth

ANS: A, C, D Many newborns are at increased risk for hypoglycemia. In the preterm, late preterm (born between 34 weeks and 36 6/7 weeks of gestation), and small-for-gestational-age infant, adequate stores of glycogen or even fat for metabolism may not have accumulated. Stores may be used up before birth in the post-term infant because of poor intrauterine nourishment from a deteriorating placenta. Large-for-gestational-age infants and those with diabetic mothers may produce excessive insulin that consumes available glucose quickly. The newborn born at 38 weeks and the newborn born by cesarean at term have lower risk for hypoglycemia.

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

ANS: 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.

A newborn is admitted to the newborn nursery with hypothermia. Which complication should the nurse monitor related to hypothermia in the newborn? a. Hyperglycemia b. Metabolic acidosis c. Respiratory acidosis d. Vasodilation of peripheral blood vessels

ANS: B Cold stress can cause a significant rise in oxygen demands. Metabolism of glucose in the presence of insufficient oxygen causes increased production of acids. Metabolism of brown fat also releases fatty acids. The result can be metabolic acidosis, which can be a life-threatening condition. Cold stress causes hypoglycemia because glucose is being metabolized. Cold stress does not cause respiratory acidosis. As the infant's body attempts to conserve heat, vasoconstriction, not vasodilation, of the peripheral blood vessels occurs to reduce heat loss from the skin surface.

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

ANS: 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.

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

ANS: 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.

Which infant is at greater risk to develop cold stress? a. Full-term infant delivered vaginally without complications b. 36-week infant with an Apgar score of 7 to 9 c. 38-week female infant delivered via cesarean section because of cephalopelvic disproportion d. Term infant delivered vaginally with epidural anesthesia

ANS: B Preterm infants are at greater risk to develop cold stress because of thin skin, decreased subcutaneous fat, and poor muscle tone.

Which is the most likely cause of regurgitation when a newborn is fed? a. The gastrocolic reflex b. A relaxed cardiac sphincter c. An underdeveloped pyloric sphincter d. Placing the infant in a prone position following a feeding

ANS: B The underlying cause of newborn regurgitation is a relaxed cardiac sphincter. The gastrocolic reflex increases intestinal peristalsis after the stomach fills. The pyloric sphincter goes from the stomach to the intestines. The infant should be placed in a supine position.

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.

ANS: 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.

The process in which bilirubin is changed from a fat-soluble product to a water-soluble product is known as: a. albumin binding. b. enterohepatic circuit. c. conjugation of bilirubin. d. deconjugation of bilirubin.

ANS: C Conjugation of bilirubin is the process of changing the bilirubin from a fat-soluble to a water-soluble product. Albumin binding attaches something to a protein molecule. Enterohepatic circuit is the route whereby part of the bile produced by the liver enters the intestine, is resorbed by the liver, and then is recycled into the intestine. Unconjugated bilirubin is fat-soluble.

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.

ANS: 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.

A meconium stool can be differentiated from a transitional stool in the newborn because the meconium stool is: a. seen at 3 days of age. b. the residue of a milk curd. c. passed in the first 24 hours of life. d. lighter in color and looser in consistency.

ANS: C Meconium should be passed in the first 24 hours of life. Meconium stool is the first stool of the newborn. Meconium stool is made up of matter in the intestines during intrauterine life. Meconium is dark in color and sticky.

The nurse is preparing to administer a vitamin K injection to the infant shortly after birth. Which is important to understand about vitamin K? a. It is necessary for the production of platelets. b. It is important for the production of red blood cells. c. It is not initially synthesized because of a sterile bowel at birth. d. It is responsible for the breakdown of bilirubin and the prevention of jaundice.

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

A reported hematocrit level for a newborn vaginal birth is 75%. Based on this lab value, which complication is the newborn least at risk to develop? a. Hypoglycemia b. Respiratory distress c. Infection d. Jaundice

ANS: C The presence of polycythemia as indicated by this lab result could result in the infant being at risk to develop hypoglycemia, respiratory distress, and jaundice. Possible infection would be unrelated to this diagnostic value.

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 nurse's hands before touching the baby

ANS: 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.

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

ANS: 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.

During the first few minutes after birth, which physiologic change occurs in the newborn as a response to vascular pressure changes in increased oxygen levels? a. Increased pulmonary vascular resistance b. Decreased systemic resistance c. Decreased pressure in the left heart d. Dilation of pulmonary vessels

ANS: D Dilation of pulmonary vessels occurs in response to increased oxygen levels. Decrease in pulmonary vascular resistance occurs. Increase in systemic vascular resistance occurs. Increased pressure in the left heart occurs.

A multiparous patient arrives to the labor unit and urgently states, "The baby is coming RIGHT NOW!" The nurse assists the patient into a comfortable position and delivers the infant. To prevent infant heat loss from conduction, what is the priority nursing action? a. Dry the baby off. b. Turn up the temperature in the patient's room. c. Pour warmed water over the baby immediately after birth. d. Place the baby on the patient's abdomen after the cord is cut.

ANS: D Movement of heat away from the body occurs when newborns have direct contact with objects that are cooler than their skin. Placing infants on cold surfaces or touching them with cool objects causes this type of heat loss. The reverse is also true; contact with warm objects increases body heat by conduction. Warming objects that will touch the infant or placing the unclothed infant against the mother's skin (skin to skin) helps prevent conductive heat loss. Drying the baby off helps prevent heat loss through evaporation. Adjusting the temperature in the patient's room helps with heat loss through convection. Pouring warm water over a baby occurs with the first bath, which is conducted after the baby's temperature has stabilized. Pouring warm water over the baby prior to that time will increase heat loss through evaporation.

Which action by the nurse can cause hyperthermia in the newborn? a. Placing a cap on the newborn b. Wrapping the newborn in a warm blanket c. Placing the newborn in a skin to skin position with the mother d. Placing the newborn in the radiant warmer without attaching the skin probe

ANS: D Newborns may be overheated by poorly regulated equipment designed to keep them warm. When radiant warmers, warming lights, or warmed incubators are used, the temperature mechanism must be set to vary the heat according to the infant's skin temperature; this prevents too much or too little heat. Alarms to signal that the infant's temperature is too high or too low should be functioning properly. If the skin probe is not used, the alarms will not function properly. Putting a hat on the newborn, wrapping the newborn in a warm blanket, or placing the newborn skin to skin with the mother will not cause hyperthermia.

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.

ANS: 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

ANS: 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.

When caring for a newborn the nurse must be alert for signs of cold stress, which would include which of the following? a. Decreased activity level b. Increased respiratory rate c. Hyperglycemia d. Shivering

B Additional signs of cold stress include increased activity level, crying, basal metabolic rate (BMR), and heat production. Hypoglycemia occurs as glucose stores are depleted. Newborns are unable to shiver as a means to increase heat production; they increase their activity level instead.

The nurse helps a breastfeeding mother change the diaper of her 16-hour-old newborn after the first bowel movement. The mother expresses concern because the large amount of thick, sticky stool is dark green, almost black. She asks the nurse if something is wrong. The nurse should respond to this mother's concern by: a. Telling her not to worry because all breast-fed babies have this type of stool. b. Explaining that the stool is called meconium and is expected for the first few bowel movements of all newborns. c. Asking the mother what she ate at her last meal. d. Suggesting that the mother ask her pediatrician to explain newborn stool patterns to her.

B At this early age, this type of stool is typical of bottle- and breast-fed newborns. The mother's nutritional intake is not responsible for the appearance of meconium stool. The nurse is fully capable of and responsible for teaching a new mother about the characteristics of her newborn, including expected stool patterns.

If a nurse desires to promote infant-parent attachment, the best time to have the parents spend time with the infant is when the infant is going through which stage? a. Period of sleep b. Second period of reactivity c. Quiet sleep state d. Active sleep state

B During the second period of reactivity, the infant is alert and interested in feeding. It is a good time for the parents to get to know the infant. During the period of sleep, the quiet sleep state, and active sleep state, the infant is asleep and will not interact with the parents.

One reason that preterm infants are at higher risk for cold stress is the fact that they: a. Have a smaller surface area. b. Have a decreased amount of brown fat. c. Cannot nurse as effectively. d. Cannot buffer the acids in the body as well.

B The primary method of heat production in infants is the metabolism of brown fat to produce heat. Preterm infants may be born before stores of brown fat have accumulated.

Which of the following factors lead to the production of excessive amounts of bilirubin during the first week of life? (Select all that apply). a. Longer red blood cell life b. Liver immaturity c. Sterile intestines d. Trauma during birth

BCD

A new mother is bottle-feeding her newborn for the first time. The mother expresses concern to the nurse that the newborn is only drinking ½ ounce. The nurse can best answer the mother's concerns by stating: a. "Don't worry; the baby will drink more when he gets hungry." b. "Yes, he should be drinking more; let me try to feed him." c. "His stomach just holds about ½ ounce right now. By the end of the week it will have expanded and he will be drinking more." d. "Babies don't drink much at the first feeding, they are tired."

C At birth the stomach capacity of a newborn is about 6 mL but will expand to about 90 mL within the first week.

Vitamin K is given to the newborn to: a. Reduce bilirubin levels. b. Increase the production or red blood cells. c. Enhance ability of blood to clot. d. Stimulate the formation of surfactant.

C At birth the stomach capacity of a newborn is about 6 mL but will expand to about 90 mL within the first week.

A new mother expresses concern that her 18-hour-old son has only voided once since birth. The nurse's best response is: a. "We are aware of that and have notified the pediatrician." b. "How is he eating?" c. "Newborns don't void frequently for the first 2 days, but by the fourth day it will be about six times a day." d. "This may be a concern, so we will continue to monitor his voidings for the next 12 hours."

C It is appropriate to teach the mother about newborn characteristics. Newborns may not void at all for the first 24 hours; however, most will void once in the first 12 hours. Only one or two voidings may occur during the first 2 days of life. The infant voids at least six times a day by the fourth day.

The unit manager of the newborn nursery is orienting a group of student nurses. Infection control is one of the manager's major topics. When comparing infection control in a nursery with that in an adult medical unit, one major difference is that: a. All the clients in the nursery are usually in one room. b. The medical unit has many different organisms brought onto the unit. c. Newborns have a decreased ability to localize infections. d. Adults have a weaker immune system, which makes them more prone to developing infections.

C Newborns have a decreased ability to localize infections; therefore, they will develop sepsis. This fact makes infection control in a nursery extremely important.

The hematocrit for a newborn is 72%. The nurse is aware that this newborn is at risk for: a. Blood clots. b. Jaundice. c. Anemia. d. Leukocytosis.

C Newborns have a deficiency of vitamin K until intestinal bacteria that produce the vitamin are formed. Vitamin K is required for the production of certain clotting factors.