#3 OB EAQ Normal Newborn

The nurse is planning to use a newborn's foot to obtain blood for the required newborn metabolic testing. Which part of the foot is the best site to use for the puncture? 1. Big toe 2. Foot pad 3. Inner sole 4. Outer heel

4. Outer heel (The outer heel is well perfused and heals quickly. The big toe, foot pad, and inner sole are all inappropriate sites from which to obtain a blood specimen from a newborn.)

The nurse is caring for a newborn with caput succedaneum. The nurse is able to differentiate caput succedaneum from cephalhematoma because of what characteristic of the scalp edema in caput succedaneum? 1. Becomes ecchymotic 2. Crosses the suture line 3. Increases after several hours 4. Is tender in the surrounding area

2. Crosses the suture line (Scalp edema that crosses the suture line is the clinical finding that differentiates between these two conditions. With caput succedaneum the swelling crosses the suture line, whereas in cephalhematoma it does not. Bruising may occur in either condition. The swelling diminishes; if the swelling increases, the newborn will need to be observed for signs of increased intracranial pressure. Pain is not associated with either condition)

A nurse identifies a right cephalhematoma on an otherwise healthy 1-day-old newborn. What should the nurse teach the parents at the time of discharge? 1. To space feedings at every 3 hours 2. How to assess the fontanels for tenseness 3. How to monitor their child for signs of jaundice 4. To record the number of wet diapers during the first 24 hours

3. How to monitor their child for signs of jaundice (Bilirubin is a yellow pigment derived from the hemoglobin released with the breakdown of red blood cells as the hematoma resolves. Signs of jaundice should be reported. Spacing feedings every 3 hours, assessing the fontanels, and recording the number of wet diapers in the first 24 hours are not specific for a healthy neonate with a cephalhematoma.)

What does an Apgar score recorded 5 minutes after birth assist the nurse in evaluating when caring for the newborn? 1. Gestational age of the newborn 2. Effectiveness of the birthing process 3. Possibility of respiratory distress syndrome 4. Adequacy of the transition to extrauterine life

4. Adequacy of the transition to extrauterine life (The score at 5 minutes indicates the adequacy of the cardiac and respiratory systems' response to the environment. The Dubowitz score is related to gestational age. The score represents the neonate's response to the environment and is not related to the actual process of labor and birth. The Apgar score is not a diagnostic tool for respiratory distress syndrome.)

Which finding in a newborn whose temperature over the last 4 hours has fluctuated between 98.0° F (36.7° C) and 97.4° F (36.3° C) would be considered critical? 1. Respiratory rate of 60 breaths/min 2. White blood count greater than 15,000 mm3 3. Serum calcium level of 8 mg/dL (2 mmol/L) 4. Blood glucose level of 26 mg/dL (1.4 mmol/L)

4. Blood glucose level of 26 mg/dL (1.4 mmol/L) (Instability of the newborn's temperature is an indication of hypoglycemia. A glucose level below 30 mg/dL (1.7 mmol/L) does not provide enough energy to maintain the body temperature at a normal level. A serum calcium level of 8 mg/dL (2 mmol/L), respiratory rate of 60 breaths/min, and a white blood cell count greater than 15,000 mm3 are all normal findings and do not affect body temperature.)

A mother and her newborn have just been transferred to the postpartum unit from labor and delivery. Which infant safety education should be provided as soon as mom and baby are settled into their room? Select all that apply. 1. "Wash your hands before touching the newborn." 2. "Send the newborn to nursery to be monitored during the night." 3. "All client identification bands should remain in place until discharge." 4. "Do not let anyone remove the infant from your sight while you are in the hospital." 5. "Check the identification of staff, and if there is a question of validity, call the nursing station."

1,3,5 1. "Wash your hands before touching the newborn." 3. "All client identification bands should remain in place until discharge." 5. "Check the identification of staff, and if there is a question of validity, call the nursing station." (Mothers, significant others or persons of the mother's choice, and the infant must continue to wear identification bands during the entire hospital stay. These bands show which baby belongs to which mother. The mother should call the nursing station to verify any person appearing to be staff if she has any question about who the person is. Proper identification must be worn by staff at all times. Washing hands before touching the newborn will decrease the chance of infectious transfer of microorganisms to newborn. Safety is the most important concern. There may be times when procedures, assessments, showering, and other activities involve the newborn being taken from the mother's room. Only well-identified staff members caring for the client should be allowed to take the infant out of the mother's sight. It is not necessary to send the newborn to the nursery during the night; the mother may keep the baby at her side during this time.)

The nurse in the birthing room is assessing a newborn. Which characteristic would be assigned an Apgar value of 2? 1. A strong cry 2. A heart rate of 90 beats/min 3. Slight flexion of legs and arms 4. Pink body and blue extremities

1. A strong cry (A strong cry indicates effective respiratory function and is assigned a value of 2. If flexion of the arms and legs is slight and movement is diminished, a value of 1 is assigned. A value of 1 is assigned when the body is pink and the extremities are blue. The heart rate should be more than 100 beats/min; therefore a pulse of 90 beats/min is assigned a value of 1.)

A client has delivered her infant by cesarean birth. The nurse monitors the newborn's respiration closely, because infants born via the cesarean method are prone to atelectasis. Why does this occur? 1. The ribcage is not compressed and released during birth. 2. The sudden temperature change at birth causes aspiration. 3. There is usually oxygen deprivation after a cesarean birth. 4. There is no gravity during the birth to promote drainage from the lungs.

1. The ribcage is not compressed and released during birth. (The release following compression of the chest during a vaginal birth is the mechanism for expansion of the newborn's lungs; because this does not occur during a cesarean birth, lung expansion may be incomplete, and atelectasis may result. Temperature change is not implicated in aspiration. The infant is monitored closely to prevent oxygen deprivation. The newborn's head may be held lower than the chest to allow gravity to promote drainage from the lungs after a cesarean birth.)

A newborn is admitted to the nursery. The newborn weighs 10 lb, 2 oz (4592 g), which is 2 lb (907 g) more than the birthweight of any of the neonate's siblings. Which intervention should the nurse implement in relation to this baby's birth weight? 1. Document the findings 2. Delay starting oral feedings 3. Perform serial glucose readings 4. Place the newborn in a heated crib

3. Perform serial glucose readings (A large newborn may be the result of gestational diabetes; it is necessary to check the neonate for hypoglycemia, because maternal glucose is no longer available. The nurse should do more than document the findings; the primary healthcare provider should be notified after the serial glucose readings are taken. Placing the infant in a heated crib is indicated if the temperature is low and the newborn needs additional warmth. The infant may be hypoglycemic and require the glucose in an oral feeding immediately.)

The most appropriate method for a nurse to evaluate the effects of the maternal blood glucose level in the infant of a diabetic mother is by performing a heel stick blood test on the newborn. What specifically does this test determine? 1. Blood acidity 2. Glucose tolerance 3. Serum glucose level 4. Glycosylated hemoglobin level

3. Serum glucose level (Obtaining a blood glucose level is a simple, cost-effective method of testing newborns for suspected hypoglycemia. Although the acidity of the blood will indicate whether the newborn has metabolic acidosis as a result of hypoglycemia, it is more important to determine whether the newborn has hypoglycemia so it can be corrected before acidosis develops. The glucose tolerance test and glycosylated hemoglobin level test are not used in newborns.)