Newborn Passpoint Quiz
A primiparous client has just given birth to a term infant. Which topic should the nurse teach the client about first? sudden unexplained infant death syndrome (SUIDS) breastfeeding/chestfeeding newborn medications infant sleep-wake cycles
breastfeeding/ chestfeeding
At which time should the nurse anticipate assisting a client to breastfeed their neonate? during the neonate's first period of reactivity in about 2 hours, after the baby has been evaluated in about 4 hours, after the baby has had some sleep after the neonate's first period of reactivity
during the neonate's first period of reactivity
The parents of a child with colic are asked to describe the infant's bowel movements. Which description should the nurse expect? soft, yellow stools frequent watery stools ribbon-like stools foul-smelling stools
soft, yellow stools
At 24 hours of age, assessment of the neonate reveals the following: eyes closed, skin pink, no sign of eye movements, heart rate of 120 bpm, and respiratory rate of 35 breaths/min. What is this neonate most likely experiencing? drug withdrawal first period of reactivity a state of deep sleep respiratory distress
a state of deep sleep
A primiparous client who is beginning to breastfeed their neonate asks the nurse, "Is it important for my baby to get colostrum?" When instructing the client, the nurse would explain that colostrum provides the neonate with which factor? more fat than breast milk vitamin K, which the neonate lacks delayed meconium passage passive immunity from maternal antibodies
passive immunity from maternal antibodies
The nurse assesses a postterm neonate. Which finding is considered normal for a postterm infant? flattened nose small hands and feet red abdominal rash wrinkled, peeling skin
wrinkled, peeling skin
A nurse demonstrates infant bathing to a primiparous client. Which statement by the client indicates a need for additional teaching? "I'm going to bathe the baby in the kitchen because it's nice and warm there." "I have all kinds of pretty, scented soaps and lotions to bathe the baby with." "I'll sponge-bathe the baby until the cord area heals." "I'll wash the baby's eyes and face first."
"I have all kinds of pretty, scented soaps and lotions to bathe the baby with."
A nurse is teaching a client who gave birth to a full-term female neonate how to change the neonate's diaper. Which of the following statement by the client would indicate to the nurse that learning has taken place? "I will fold a cloth diaper so that a double thickness covers the front." "I will clean and dry the neonate's perineal area from front to back." "I will place a disposable diaper over a cloth diaper to provide extra protection." "I will position the neonate so that urine will fall to the back of the diaper."
"I will clean and dry the neonate's perineal area from front to back."
During a home visit to a primiparous client 1 week postpartum who is bottle-feeding her neonate, the client tells the nurse that her mother has suggested that she feed the neonate cereal so he will sleep through the night. What would be the nurse's best response? "It's permissible to give the baby cereal if it is thinned with formula." "The time for starting cereal varies, so check with your pediatrician." "It's better to continue feeding only formula until about 4 to 6 months of age." "If cereal is given too early in life, the undigested food can lead to a need for surgery."
"It's better to continue feeding only formula until about 4 to 6 months of age."
A nurse is administering vitamin K to a neonate following birth. The medication comes in a concentration of 2 mg/ml, and the ordered dose is 0.5 mg to be given subcutaneously. How many milliliters would the nurse administer? Record your answer using two decimal places. milliliters?
0.25
When performing a physical assessment on a postterm neonate, the nurse expects to find absent plantar creases. abundant subcutaneous fat. abundant lanugo. patchy fine hair distribution.
Abundant subcutaneous fat.
A nurse observes a family in the playroom. Which behavior would be considered an example of social affective play? An 8-year-old child is taking turns playing a handheld video game with another child. A 4-year-old child is listening to the parent's chest with a stethoscope. An infant is making happy noises in response to their parent speaking to them. A 2-year-old child is sitting in their parent's lap hugging a teddy bear.
An infant is making happy noises in response to their parent speaking to them.
While assisting a primiparous client with their first breastfeeding session, the nurse should instruct the client to perform which action in order to stimulate the neonate to open the mouth and grasp the nipple? Pull down gently on the neonate's chin and insert the nipple. Squeeze both of the neonate's cheeks simultaneously. Place the nipple into the neonate's mouth on top of the tongue. Brush the neonate's lips lightly with the nipple.
Brush the neonate's lips lightly with the nipple.
An infant diagnosed with Hirschsprung disease is scheduled to receive a temporary colostomy. When the nurse is initially discussing the diagnosis and treatment with the parents, which action by the nurse would be most appropriate? assessing the adequacy of their coping skills reassuring them that their child will be fine encouraging them to ask questions giving them printed material on the procedure
Encouraging them to ask questions.
A full-term neonate is admitted to the newborn nursery. When lifting the baby out of the crib the nurse notes the baby's arms move sideways with the palms up and the thumbs flexed. What should the nurse do next? Activate rapid response teams. Identify this reflex as a normal finding. Place the neonate on seizure precautions. Start supplemental oxygen.
Identify this reflex as a normal finding.
Which of the following should the nurse use to determine achievement of the expected outcome for an infant with severe diarrhea and a nursing diagnosis of Deficient fluid volume related to passage of profuse amounts of watery diarrhea? Moist mucous membranes. Passage of a soft, formed stool. Absence of diarrhea for a 4-hour period. Ability to tolerate intravenous fluids well.
Moist mucous membranes.
The nurse plans care for a neonate to prevent neonatal heat loss immediately after birth. What action should the nurse take to conserve heat and help the infant maintain a stable temperature? Nestle the neonate against the crib wall. Place the infant skin to skin with the birth parent. Bathe the neonate with warm water. Position the neonate lying in an open crib with a diaper on.
Place the infant skin to skin with the birth parent.
Which statement describes the rationale for administering vitamin K to every neonate? Neonates don't receive the clotting factor in utero. The neonate lacks intestinal flora to make the vitamin. It boosts the minimal level of vitamin K found in the neonate. The drug prevents the development of phenylketonuria (PKU).
The neonate lacks intestinal flora to make the vitamin.
A primiparous client with a neonate who is 36 hours old asks the nurse, "Why does my baby spit up a small amount of formula after feeding?" The nurse explains that the regurgitation is thought to result from which factor? an immature cardiac sphincter a defect in the gastrointestinal system burping the infant too frequently moving the infant during the feeding
an immature cardiac sphincter
When instilling erythromycin ointment into the eyes of a neonate 1 hour old, the nurse would explain to the parents that the medication is used to prevent which problem? chorioretinitis from cytomegalovirus blindness secondary to gonorrhea cataracts from beta-hemolytic streptococcus strabismus resulting from neonatal maturation
blindness secondary to gonorrhea
A nursery nurse just received the shift report. Which neonate should the nurse assess first? four-hour-old term neonate with jaundice two-day-old term neonate in an open bassinette six-day-old neonate in an isolette, whose gestational age assessment places him at 36 weeks' gestation twelve-hour-old term neonate who is small for gestational age
four-hour-old term neonate with jaundice
The client gives birth to a neonate who is given a score of 9 at 5 minutes on the Apgar rating system. How does the nurse interpret the neonate's physical condition? good fair poor critical
good
The health care provider (HCP) prescribes an intramuscular injection of vitamin K for a term neonate. The nurse explains to the mother that this medication is used to prevent which problem? hypoglycemia hyperbilirubinemia hemorrhage polycythemia
hemorrhage
After completing discharge instructions for a primiparous client who is bottle-feeding their term neonate, the nurse determines that the parent understands the instructions when the parent says they should contact the health care provider (HCP) if the neonate exhibits which sign or symptom? ability to fall asleep easily after each feeding spitting up a tablespoon of formula after feeding passage of a liquid stool with a watery ring production of one to two light brown stools daily
passage of a liquid stool with a watery ring
A mother is instructed to stimulate the rooting reflex when attempting to breast-feed her baby. Which action shows that the mother understands these instructions? turning the neonate's head to the side, causing the neonate to extend the extremities on that side. initiating the neonate's startle reflex to make sure the baby is aware. giving the neonate water to check for swallowing. stroking the neonate's cheek
stroking the neonate's cheek
The parent of a neonate scheduled for gastrointestinal surgery asks the nurse how newborns respond to painful stimuli. What is the nurse's best response? "Newborns cry and cannot be distracted to stop crying." "When faced with pain, newborns try to roll away from it." "Newborns typically move their whole body in response to pain." "Pain causes the newborn to withdraw the affected part."
"Newborns typically move their whole body in response to pain."
During a visit to the clinic, a mother who's breast-feeding her 2-month-old infant expresses concern over the infant's bowel movements. Which statement by the mother would lead the nurse to believe that the infant's bowel movements are normal? "The baby's stools are yellow and semi-formed." "The baby's stools are dark green and sticky." "The baby's stools are green and watery." "The baby's stools are bright yellow and soft."
"The baby's stools are bright yellow and soft."
While the nurse is conducting a teaching session on breast-feeding, a client asks why she should put her newborn to the breast within the first 30 minutes of birth. The nurse's best response will be? "The neonate will be responsive and eager to suck at this time." "Breast-feeding will inhibit prolactin production." "Your breasts will be firm and filled with colostrum at this time." "Breast-feeding will prevent the newborn from heat loss."
"The neonate will be responsive and eager to suck at this time."
The parents of a child with sickle cell disease ask the nurse why their child's hemoglobin was normal at birth but now the child has S hemoglobin. Which response by the nurse is appropriate? "The placenta prevents the passage of the hemoglobin S from the birth parent to the fetus." "The red bone marrow does not begin to produce hemoglobin S until several months after birth." "Antibodies transmitted from you to the fetus provide the newborn with temporary immunity." "The newborn has a high concentration of fetal hemoglobin in the blood for some time after birth."
"The newborn has a high concentration of fetal hemoglobin in the blood for some time after birth."
What information should the nurse include in a teaching plan for first-time parents of a bottle-feeding term newborn? Select all that apply. Fill the entire nipple of the bottle with formula. All term babies have well-developed sucking skills. Burp the baby after 2 oz (60 ml) of formula have been taken. Do not prop the bottle. The other parent can feed the baby the bottle whenever possible.
Fill the entire nipple of the bottle with formula. Do not prop the bottle. The other parent can feed the baby the bottle whenever possible.
While preparing to provide neonatal care instructions to a primiparous client who gave birth to a term neonate 24 hours ago, what should the nurse include in the client's teaching plan? Term neonates generally have few creases on the soles of their feet. Strawberry hemangiomas—deep, dark red discolorations—require laser therapy for removal. Milia are white papules from plugged sebaceous ducts that disappear by age 2 to 4 weeks. If erythema toxicum is present, it will be treated with antibiotic therapy.
Milia are white papules from plugged sebaceous ducts that disappear by age 2 to 4
While changing the neonate's diaper, the client asks the nurse about some red-tinged drainage from the neonate's vagina. Which response would be most appropriate? "It's of no concern because it's such a small amount." "The cause is usually related to swallowing blood during the birth." "Sometimes baby girls have this from hormones received from the birth parent." "This vaginal spotting is caused by hemorrhagic disease of the newborn."
Sometimes baby girls have this from hormones received from the birth parent."
A newly hired nurse on unit orientation prepares to administer vitamin K to a neonate. The nurse draws up 1 mg of vitamin K and prepares to administer a subcutaneous injection in the left, lateral anterior thigh. Which action by the nurse preceptor is best? Praise the nurse for accurately preparing to administer the injection. Stop the nurse and ask that the injection techniques be reevaluated. Distract the neonate by talking in a calm voice. Stop the nurse and instruct the nurse to administer the vitamin K using the Z-track method.
Stop the nurse and ask that the injection techniques be reevaluated.
The nurse in a postpartum couplet room is making rounds before ending the shift. Which finding(s) would indicate that the safety needs of the clients have been met? Select all that apply. infant lying on the abdomen security tags in place identification system on the birth parent and infant bulb syringe within sight someone in the room able to care for the infant infant in the parent's arms, both asleep.
security tags in place identification system on the birth parent and infant bulb syringe within sight someone in the room able to care for the infant
Which observation is expected when the nurse is assessing the gestational age of a neonate born at term? ear lying flat against the head absence of rugae in the scrotum sole creases covering the entire foot square window sign angle of 90 degrees
sole creases covering the entire foot
The newborn nurse has just received the shift report about a group of newborns and is to receive another admission in 30 minutes. To provide the safest care and plan for the new admission, the nurse should do which tasks in order of first to last? All options must be used. Click an option, hold and drag it to the desired position, or click an option to highlight it and move it up or down in the order using the arrows to the left. 1Review notes from the shift report, and prioritize all clients; make rounds on the most critical first. 2Move quickly from room to room, and assess all clients. 3Log on to the clinical information system, and determine if there are new prescriptions. 4Check the room to which the new client will be admitted to ensure all supplies and equipment are available.
Review notes from the shift report, and prioritize all clients; make rounds on the most critical first. Move quickly from room to room, and assess all clients. Log on to the clinical information system, and determine if there are new prescriptions. Check the room to which the new client will be admitted to ensure all supplies and equipment are available.
A breastfeeding primiparous client who gave birth 8 hours ago asks the nurse, "How will I know that my baby is getting enough to eat?" Which guideline should the nurse include in the teaching plan as evidence of adequate intake? six to eight wet diapers by the fifth day three to four transitional stools on the fourth day ability to fall asleep easily after feeding on the first day regain of lost birth weight by the third day
six to eight wet diapers by the fifth day
The nurse is preparing to administer vitamin K intramuscularly to a term neonate of a primipara who has just given birth. After explaining the purpose of the drug to the birth parent, which statement by the client indicates effective teaching? "Vitamin K will help my baby breathe easier." "Vitamin K will prevent my baby from becoming jaundiced." "Vitamin K will help my baby's blood to clot properly." "Vitamin K will prevent my baby from developing an infection."
"Vitamin K will help my baby's blood to clot properly."