OB EX.4 Newborn

Four main ways an infant looses heat

Convection Radiation Evaporation Conduction

The nurse is teaching nursing students about the risks that late preterm infants may experience. The nurse feels confident learning has taken place when the students make which statement? "A late preterm newborn may have more clinical problems compared with full-term newborns." "The late preterm infant is more mature and able to cope as well as a full-term infant." "Late preterm newborns have fewer clinical problems leading to shorter hospital stays." "Late preterm infant complications are considered minor compared to the preterm newborn."

"A late preterm newborn may have more clinical problems compared with full-term newborns."

When instructing a new mom on providing skin care to her newborn, which statement, made by the mother, indicates additional teaching is needed? " I will change my baby's diapers frequently." "I will give sponge baths until the umbilical cord falls off." "It is not necessary to give my baby a bath daily." "I can use talc powders to prevent diaper rash."

"I can use talc powders to prevent diaper rash."

A woman who is about to be discharged after a vaginal birth notices a flea-like rash on her newborn's chest that consists of tiny red lesions all across the nipple line. What is the best response from the nurse when explaining this to the woman? "It is an indication that the woman has mistreated her newborn." "It is a normal skin finding in a newborn." "It is a self-limiting virus that does not require treatment." "It is a sign of a group B streptococcus skin infection. "

"It is a normal skin finding in a newborn."

Upon entering the room of the newborn, the nurse notes the newborn is laying on the bed wearing only a diaper while the parents decide on an outfit for the newborn. What response by the nurse is of most importance? "Let me show you how to swaddle the baby while you select the outfit." "I can see you are eager to find the perfect outfit for your baby." "What questions do you have about fabrics that are close to the baby's skin?" "Have you decided on which outfit you will put on the baby to go home?"

"Let me show you how to swaddle the baby while you select the outfit."

A neonate born by cesarean birth required oxygen after the birth. The mother expresses concern because this was not a factor with her previous vaginal birth. What response by the nurse is most appropriate? "Neonates born by cesarean tend to need oxygen supplementation due to the rapid change in fetal circulation when the uterus was cut during the birth." "Normally, neonates born by cesarean do better after delivery since it is a much gentler birth." "Neonates born by cesarean do not benefit from the squeezing of the contractions, which helps to clear the lungs." "You are older now and that can impact how your neonate adapts to the birth process." "This is likely just coincidence."

"Neonates born by cesarean do not benefit from the squeezing of the contractions, which helps to clear the lungs."

Parents tell the nurse they have been told to keep their newborn away from windows. They do not understand why this is necessary. Which rationale will the nurse provide to the parents? "Windows can be drafty and placing the newborn by one can result in evaporative heat loss." "Newborns cannot shiver to produce heat and need to be kept away from sources of heat loss." "Newborns weighing below 8 lb (3630 g) lack enough brown fat to produce heat." "Covering the newborn with heavy blankets is the best way to keep your newborn warm."

"Newborns cannot shiver to produce heat and need to be kept away from sources of heat loss."

The primipara tells the nurse, "My baby jumps every time I pick her up. Is she afraid that I will drop her?" Which response by the nurse would be best? "Yes, she is afraid you will drop her." "No, it is the tonic neck reflex. It signifies handedness." "No, it is the Moro reflex. This reflex simulates the action of warding off an attacker." "No, it is the blink reflex. It is meant to protect the eyes."

"No, it is the Moro reflex. This reflex simulates the action of warding off an attacker."

A nurse is giving discharge education to a group of new parents before they are discharged home with their infants. What information will the nurse include in the teaching? "Place the newborn on the back to sleep and stomach to play." "Newborns can sleep on a couch to allow constant visual monitoring." "Change the newborn's diaper every four hours while awake." "You need to give your newborn a bath everyday."

"Place the newborn on the back to sleep and stomach to play."

A nursing instructor is teaching about changes the newborn must make to survive outside of the uterus. The instructor realizes that further teaching is needed when a student makes which statement? "The baby takes the first breath when the umbilical cord is clamped." "The baby takes the first breath when ready to leave the uterus." "The baby takes the first breath when stimulated by a slight slap." "The baby's lungs begin to function when the umbilical cord is clamped."

"The baby takes the first breath when ready to leave the uterus."

The student nurse is attending her first cesarean delivery and is asked by the mentor what should be carefully assessed in this infant. After responding "Respiratory status" the student is asked "Why?" What would be the best response? "The respiratory centers in the brain have not been stimulated when a newborn is delivered by a cesarean delivery." "There is more fluid present in the lungs at birth after a cesarean delivery than after a vaginal delivery." "Surfactant may be missing from the lungs depending on the newborn's gestational age." "A newborn delivered by cesarean has less sensory stimulation to breathe."

"There is more fluid present in the lungs at birth after a cesarean delivery than after a vaginal delivery."

A nurse teaches new parents how to soothe a crying newborn. Which statement by the parents indicates to the nurse the teaching was effective? "We will place our baby on the belly on a blanket on the floor." "We will hold feedings until our baby stops crying." "We will turn the mobile on that's hanging on our baby's crib." "We will vigorously rub our baby's back as we play some music."

"We will turn the mobile on that's hanging on our baby's crib."

A nurse is assessing a newborn and obtains the newborn's head circumference. The head circumference is 35 cm. The nurse then measures the newborn's chest circumference. Which chest circumference measurement would the nurse document as expected and within normal parameters?

33 cm

When teaching a class of new parents about the needs of their newborn, the nurse explains that the newborn's voiding is a good indicator that he or she is getting enough fluids. The nurse determines that the teaching was successful when the parents state which number of voidings per day is a good indicator of adequate fluids? 4 to 6 6 to 8 2 to 4 8 to 10

6 to 8

Normal hc of baby

A normal HC is 33 to 35.5 cm.

A newborn is receiving ampicillin and gentamicin every 12 hours. When would this client have his hearing screen performed? 1 day after birth Before discharge from the hospital After the newborn has completed the antibiotic therapy 1 month after discharge

After the newborn has completed the antibiotic therapy

The parents of a newborn male are questioning the nurse concerning the pros and cons of a circumcision. Which disadvantage should the nurse point out to these parents? Reduced risk of penile cancer Fewer complications than if done later in life Anesthetic may not be effective during the procedure Lower rate of urinary tract infections

Anesthetic may not be effective during the procedure

A woman in scrubs enters a mother's room while the nurse is completing an assessment. The woman states the doctor is in the nursery and has requested the infant be brought back for an examination. What will the nurse do? Call the nursery to confirm the doctor does indeed need this infant at this time. Ask how long the infant will be gone since her next feeding is in 30 minutes. Ask the woman to bring the infant back when the doctor finishes the examination. Ask to see the woman' hospital identification badge.

Ask to see the woman' hospital identification badge.

A 36-hour-old newborn is ready for discharge from the hospital and the nurse notices that the skin looks yellow. What action will the nurse take?

Assess the bilirubin level.

The parents of a newborn become concerned when they notice that their baby seems to stop breathing for a few seconds. After confirming the parents' findings which action should the nurse prioritize? Assess the newborn for signs of respiratory distress. Reassure the parents that this is an expected pattern. Notify the health care provider immediately. Tell the parents not to worry since his color is fine.

Assess the newborn for signs of respiratory distress.

Which intervention would be the best way for the nurse to prevent heat loss in a newborn while bathing? Postpone breastfeeding until after the initial bath. Bathe the baby in water between 90 and 93 degrees. Limit the bathing time to 5 minutes. Bathe the baby under a radiant warme

Bathe the baby under a radiant warmer.

When performing an assessment on a neonate, which assessment finding is suggestive of hypothermia? Hyperglycemia Metabolic alkalosis Bradycardia Shivering

Bradycardia

A breastfeeding mother wants to know how to help her 2-week-old newborn gain the weight lost after birth. Which action should the nurse suggest as the best method to accomplish this goal? Add cereal to the newborn's feedings twice a day. Weigh the infant daily to ensure that she is gaining 1.5 to 2 ounces (42.5 to 57 grams) per day. Recommend that the mother pump her breast milk and measure it before feeding. Breastfeed the infant every 2 to 4 hours on demand.

Breastfeed the infant every 2 to 4 hours on demand.

The nurse is assisting with the admission of a newborn to the nursery. The nurse notes what appears to be bruising on the left upper outer thigh of this dark-skinned newborn. Which documentation should the nurse provide? Congenital dermal melanocytosis (slate gray nevi) noted on left upper outer thigh. Mottling noted on left upper outer thigh. Harlequin sign noted on left upper outer thigh. Birth trauma noted on left upper outer thigh.

Congenital dermal melanocytosis (slate gray nevi) noted on left upper outer thigh.

A nurse is called into the room of one of the clients where the grandparents are visiting. The grandmother is visibly upset, and says "Just look at my grandson! His head is all soft and swollen here and it shouldn't be. The doctor injured him when he was born." The nurse assesses the newborn and finds an area of swelling about the size of a half-dollar at the center of the upper scalp. The nurse determines this finding is most likely which condition? Harlequin sign Increased intracranial pressure Caput succedaneum Molding

Caput succedaneum

A 30-minute-old newborn starts crying in a high-pitched manner and cannot be consoled by the mother. Which action should the nurse prioritize if jitteriness is also noted and the infant is unable to breastfeed? Assess for pain source. Assess the baby's temperature. Check blood glucose. Place child in a radiant warmer.

Check blood glucose.

The nurse is teaching a prenatal class illustrating the steps that are used to keep families safe. The nurse determines the session is successful when the parents correctly choose which precaution to follow after the birth of their infant? Send a family member to accompany the infant when leaving the room. Provide a list of approved visitors who came spend time with the infant. Check the name on the baby's identification bracelet. Check the identification badge of any health care worker before releasing baby from room

Check the identification badge of any health care worker before releasing baby from room.

The nurse walks into a client's room and notes a small fan blowing on the mother as she holds her infant. The nurse should explain this can result in the infant losing body heat based on which mechanism? Convection Radiation Evaporation Conduction

Convection

The nurse is preparing discharge instructions for the parents of a male newborn who is to be circumcised before discharge. Which instruction should the nurse prioritize? Notify the primary care provider if it appears red and sore. Cover the glans generously with petroleum jelly. Soak the penis daily in warm water. Cleanse the glans daily with alcohol.

Cover the glans generously with petroleum jelly.

The nurse is assessing a newborn who appears healthy and at term. Which assessment finding of the feet does the nurse predict to observe to confirm the status of at-term birth? Heel but no anterior creases Creases on two-thirds of the foot Creases covering one fourth of the foot Longitudinal but no horizontal creases

Creases on two-thirds of the foot

The nurse is assessing a newborn's vital signs and notes the following: HR 138, RR 42, temperature 98.7oF (37.1oC), and blood pressure 70/40 mm Hg. Which action should the nurse prioritize? Document normal findings. Recheck blood pressure in 15 minutes. Put warming blanket over infant. Report tachypnea.

Document normal findings.

When assessing the head of a newborn, the nurse notes that when pressing the skull, an indentation is made and then the area returns to normal after removing the pressure. What would the nurse do next? Assess the newborn's hearing. Measure the head circumference. Document this as a normal finding. Notify the health care provider.

Document this as a normal finding.

A nurse is observing a new parent bottle feeding the newborn. The nurse notices that the newborn begins to get fussy during the feeding. Which action by the nurse would be appropriate? Instruct the parent to stop feeding for a few minutes and then restart. Encourage the parent to burp the newborn to get rid of air. Suggest the parent stop the feeding because the newborn is full. Urge the parent to prop the bottle for the rest of the feeding.

Encourage the parent to burp the newborn to get rid of air.

Upon entering the room of the newborn and parents, the nurse notes the diapered newborn is undressed and laying on the foot of the bed while the parents plan which outfit to place on the baby. What is the priority for the nurse? Suggest the parents select an outfit that is not scratchy on the newborn's skin. Provide education on how to safely hold the newborn in the parents' arms. Explain the need to keep the newborn wrapped or dressed to prevent cold stress. Discuss the various types of fabric and materials used in newborn outfits and clothing.

Explain the need to keep the newborn wrapped or dressed to prevent cold stress.

The mother of a newborn observes a diaper rash on her newborn's skin. Which intervention should the nurse instruct the parent to implement to treat the diaper rash? Expose the newborn's bottom to air several times a day. Place the newborn's buttocks in warm water after each void or stool. Use products such as talcum powder with each diaper change. Use only baby wipes to cleanse the perianal area.

Expose the newborn's bottom to air several times a day.

The nurse is assessing reflexes in a newborn infant. What can the nurse do to elicit the rooting reflex? Startle the newborn by letting the head drop back slightly. Gently stroke the newborn's cheek. Place a gloved finger in the newborn's mouth. Turn the head to one side without moving the rest of the body.

Gently stroke the newborn's cheek.

Heat loss occurs by radiation

Heat loss occurs by radiation to a cold object that is close to, but not touching, the newborn

Infant vitals

HR= 110-160 bpm RR= 30-60 bpm Axillary temp= 97.6-99.6 BP= 60-80/40-45

A nurse is doing an admission assessment on a female infant born to a primipara. Which findings would warrant notification of the physician? Select all that apply. Scaphoid abdomen Heart rate of 150 Head circumference of 38 cm Episodic breathing Overlapping cranial sutures

Head circumference of 38 cm Scaphoid abdomen

The nurse is preparing the nursing care plan for a newborn who was born via a cesarean delivery. Which diagnosis should the nurse prioritize? Altered nutrition less than body requirement related to limited formula intake Ineffective thermoregulation related to heat loss to the environment Altered urinary elimination related to postcircumcision status Ineffective airway clearance related to mucus and secretions

Ineffective airway clearance related to mucus and secretions

A nurse is preparing to administer phytonadione to a newborn. After confirming the order, what will the nurse do next? Determine the newborn's weight. Administer the medication. Assess the newborn for bleeding. Identify the newborn.

Identify the newborn.

The nurse is preparing to administer the vitamin K injection to a newborn. Which action would be correct for this client? Using a 21-gauge needle Injecting at a 45-degree angle Injecting 1cc of medication Injecting the medication into the vastus lateralis

Injecting the medication into the vastus lateralis

A nurse does an initial assessment on a newborn and notes a pulsation over the anterior fontanel (fontanelle) that corresponds with the newborn's heart rate. How would the nurse interpret this finding? This finding is normal if the pulsation can also be palpated in the posterior fontanel (fontanelle). This is an abnormal finding and needs to be reported immediately. It is normal to feel pulsations that correlate with the newborn's heart rate over the anterior fontanel (fontanelle). If the fontanel (fontanelle) feels full, then this is normal.

It is normal to feel pulsations that correlate with the newborn's heart rate over the anterior fontanel (fontanelle).

A nursing student is preparing a class for new mothers about adaptations they can expect in their newborns. Which information about newborn vision should the student include in the presentation? Newborns cannot focus on any objects. Newborns have the ability to focus only on objects far away. Newborns have the ability to focus on objects in midline. Newborns have the ability to focus only on objects in close proximity.

Newborns have the ability to focus only on objects in close proximity.

The nurse is concerned that the nares of a newborn are not patent bilaterally. What can the nurse do to address this concern? Look for nasal flaring to indicate that the newborn is breathing out of both sides of the nostrils. Use a swab to explore the nares bilaterally for occlusions. Pass an NG tube down both sides of the nostrils to assess patency. Occlude the nares one at a time by applying pressure to each side to see if the newborn can breath comfortably.

Occlude the nares one at a time by applying pressure to each side to see if the newborn can breath comfortably.

A nurse is required to obtain the temperature of a healthy newborn who was placed in an open crib. Which is the most appropriate method for measuring a newborn's temperature? Tape electronic thermistor probe to the abdominal skin. Obtain the temperature rectally. Place electronic temperature probe in the midaxillary area. Obtain the temperature orally.

Place electronic temperature probe in the midaxillary area.

A nurse removes and discards a newborn's diaper before placing the newborn on the scales for a daily weight. The nurse realizes there are no clean diapers at the scale. The supply closet is located down the hallway. What will the nurse do? Wrap the newborn in a blanket and carry the newborn to get another diaper. Go get another pack of diapers from the supply closet to place at the scales. Place newborn in the bassinet and cover with blanket while obtaining diapers. Take a diaper from the newborn next in line to be weighed.

Place newborn in the bassinet and cover with blanket while obtaining diapers.

The parents of a 2-day-old newborn are preparing for discharge from the hospital. Which teaching is most important for the nurse to include regarding sleep? Place the infant on the back when sleeping. Newborns usually sleep for 16 or more hours each day. The infant may sleep through the night around 2 months of age. Caregivers need to sleep while the baby is sleeping.

Place the infant on the back when sleeping.

A laboring mother requests that she be allowed to participate in "kangaroo care" following the birth. The nurse understands that this involves what action? Allowing the mother to cut the cord of the newborn. Wrapping the newborn in a towel and placing it on the mother's abdomen. Laying the newborn in a radiant warmer for 30 minutes followed by the mother holding the newborn for 30 minutes. Placing the diapered newborn skin-to-skin with the mother and covering them both with a blanket.

Placing the diapered newborn skin-to-skin with the mother and covering them both with a blanket.

The nurse is assessing a newborn by auscultating the heart and lungs. Which natural phenomenon will the nurse explain to the parents is happening in the cardiovascular system? Fluid is removed from the alveoli and replaced with air. Pressure changes occur and result in closure of the ductus arteriosus. The oxygen in the blood decreases. Oxygen is exchanged in the lungs.

Pressure changes occur and result in closure of the ductus arteriosus.

A preterm infant will be hospitalized for an extended time. Assuming the infant's condition is improving, which environment would the nurse feel is most suitable for the child? Bring the child's open bassinet near the desk area so the infant sees people. Keep the environment free of color to reduce eye straining. Provide a mobile the child can see no matter how he or she is turned. Place the infant's Isolette near the window so the child can see outside.

Provide a mobile the child can see no matter how he or she is turned.

A preterm infant will be hospitalized for an extended time. Assuming the infant's condition is improving, which environment would the nurse feel is most suitable for the child? Place the infant's Isolette near the window so the child can see outside. Bring the child's open bassinet near the desk area so the infant sees people. Provide a mobile the child can see no matter how he or she is turned. Keep the environment free of color to reduce eye straining.

Provide a mobile the child can see no matter how he or she is turned.

A nurse is caring for a newborn with transient tachypnea. What nursing interventions should the nurse perform while providing supportive care to the newborn? Select all that apply. Provide oxygen supplementation. Observe respiratory status frequently. Ensure the newborn's warmth. Provide warm water to drink. Massage the newborn's back.

Provide oxygen supplementation. Observe respiratory status frequently. Ensure the newborn's warmth

The nursery nurse notes that one of the newborn infants has white patches on his tongue that look like milk curds. What action would be appropriate for the nurse to take? Report the finding to the pediatrician. Since it looks like a milk curd, no action is needed. Rinse the tongue off with sterile water and a cotton swab. Wipe the tongue off vigorously to remove the white patches.

Report the finding to the pediatrician.

the parent of a newborn asks why the fetus needed extra red blood cells. How will the nurse respond? "The extra oxygen available from the placenta is gone after birth, so the fetus stores extra blood cells for the newborn." "The fetus was in a low-oxygen environment before birth and needed the extra blood cells to carry the oxygen." "The bone marrow of the newborn is immature, which will make fewer blood cells as the newborn grows." "The red blood cells are what allowed the fetus to receive nutrition from the placenta."

The fetus was in a low-oxygen environment before birth and needed the extra blood cells to carry the oxygen."

The nurse observes a neonate born at 28 weeks' gestation. Which finding would the nurse expect to see? Creases appear on the interior two-thirds of the sole. The pinna of the ear is soft and flat and stays folded. The neonate has 7 to 10 mm of breast tissue. The skin is pale, and no vessels show through it.

The pinna of the ear is soft and flat and stays folded.

The nurse observes a neonate born at 28 weeks' gestation. Which finding would the nurse expect to see? The neonate has 7 to 10 mm of breast tissue. The skin is pale, and no vessels show through it. Creases appear on the interior two-thirds of the sole. The pinna of the ear is soft and flat and stays folded.

The pinna of the ear is soft and flat and stays folded.

The nurse is preparing new parents and their infant for discharge by answering questions and presenting basic discharge instruction. Which explanation should the nurse provide when questioned about the infant's yellow hue? Yellow is the normal color for some newborns. It's a mild reaction to the vitamin K injection. The infant needs to be in the sunlight to clear the skin. The tint is due to jaundice.

The tint is due to jaundice.

Babinski sign

The toes flex upward when sole of foot is stimulated, indicating motor nerve damage.

What is the best way for the nurse to assess the newborn's heartbeat? auscultating the apical pulse for 30 seconds and multiplying by 2 palpating the brachial pulse for 60 seconds palpating the femoral pulse for 30 seconds and multiplying by 2 auscultating the apical pulse for 60 seconds

auscultating the apical pulse for 60 seconds

What should the nurse expect for a full-term newborn's weight during the first few days of life? There is an increase in 3% to 5% of birth weight by day 3 in formula-fed babies. There is a loss of 5% to 10% of birth weight in formula-fed and breastfed newborns. A formula-fed newborn should gain 3% to 5% of the initial birth weight in the first 48 hours, but a breastfed newborn may lose up to 3%. There is a loss of 5% to 10% of the birth weight in the first few days in breastfed infants only.

There is a loss of 5% to 10% of birth weight in formula-fed and breastfed newborns.

The newborn should have the neurologic status evaluated to determine its maturity and to identify any potential problems. The nurse tests the newborn's Babinski sign. Which response would the nurse interpret as normal for the newborn? Newborn throws arms outward and flexes knees. Toes fan out when sole of foot is stroked. Newborn makes stepping motion. Newborn's toes curl over the nurse's finger.

Toes fan out when sole of foot is stroked.

kangaroo care

Treatment for preterm infants that involves skin-to-skin contact.

Which safety precautions should a nurse take to prevent infection in a newborn? Select all that apply. Cover jewelry while washing hands. Avoid using disposable equipment. Use sterile gloves for an invasive procedure. Avoid coming to work when ill. Initiate universal precautions when caring for the infant.

Use sterile gloves for an invasive procedure. Avoid coming to work when ill. Initiate universal precautions when caring for the infant.

A first-time mother informs the nurse that she is unable to breastfeed her newborn through the day as she is usually away at work. She adds that she wants to express her breast milk and store it for her newborn to have later. What instruction would be correct to offer the mother to ensure the safety of the stored expressed breast milk?

Use the sealed and chilled milk within 24 hours.

Following delivery, a newborn has a large amount of mucus coming out of his mouth and nose. What would be the nurse's first action? Suction the mouth and then the nose with a suction catheter. Place the newborn on its stomach with the head down and gently pat its back. Using a bulb syringe, suction the mouth then the nose. Suction the nose first and then the mouth with a bulb syringe.

Using a bulb syringe, suction the mouth then the nose.

A nurse is assessing a neonate during the first 24 hours after birth. Which finding would the nurse recognize as normal? enlarged labia with pseudomenstruation asymmetrical abdomen positive Ortolani sign body temperature of 97.9° to 99.7° F (36.5° to 37.5° C)

body temperature of 97.9° to 99.7° F (36.5° to 37.5° C)

As a part of the newborn assessment, the nurse examines the infant's skin. Which nursing observation would warrant further investigation? fine red rash noted over the chest and back blue or purplish splotches on buttocks bright red, raised bumpy area noted above the right eye small pink or red patches on the newborn's eyelids and back of the neck

bright red, raised bumpy area noted above the right eye

Correct order to bathe a baby

eyes face hair extremities diaper area

Which physical findings would the nurse observe in a newborn that would indicate that the newborn is full-term? Select all that apply. The newborn has a relaxed posture. Fingernails are present and extend to the end of the fingers. Creases on the feet cover 2/3 of the bottom of the feet. Labia minora are prominent upon observation. Pinnae are flexible with rapid recoil.

fingernails are present and extend to the end of the fingers. Pinnae are flexible with rapid recoil. Creases on the feet cover 2/3 of the bottom of the feet.

A 12-hour-old infant is receiving IV fluids for polycythemia. For which complication should a nurse monitor this client? decreased level of consciousness fluid overload tachycardia hypotension

fluid overload

A nursing student will pick which value as a correct laboratory value for a newborn? white blood cell (WBC) count 40,000/mm³ (40 ×109/L) platelet count 75,000/µL (75 ×109/L) hemoglobin (Hbg) 17 g/dL (170 g/L) hematocrit (Hct) 40% (0.4)

hemoglobin (Hbg) 17 g/dL (170 g/L)

The nurse is explaining to new parents that a potential complication of a cesarean birth is transient tachypnea of the newborn. The nurse explains that this is due to which occurrence? lack of thoracic compressions during birth inadequate suctioning of the mouth and nose of the newborn loss of blood volume due to hemorrhage prolonged unsuccessful vaginal birth

lack of thoracic compressions during birth

A woman who has given birth to a postterm newborn asks the nurse why her baby looks so thin with so little muscle. The nurse integrates understanding about which concept when responding to the mother? With postterm birth, the fetus uses stored nutrients to stay alive, and wasting occurs. The newborn was exposed to an infection while in utero. A postterm newborn has begun to break down red blood cells more quickly. The newborn aspirated meconium, causing the wasted appearance.

With postterm birth, the fetus uses stored nutrients to stay alive, and wasting occurs.

The nurse is explaining the care the newborn will be receiving right after birth to the parents. The nurse should point out the infant will receive an ophthalmic antibiotic ointment by approximately which time? Within 12 hours Within one hour Any time prior to discharge Within 72 hours

Within one hour

While assessing a newborn, the nurse notes that half the body appears red while the other half appears pale. The nurse interprets this finding as: erythema toxic. stork bites. congenital dermal melanocytosis (slate gray nevi). Within one hour

Within one hour

nursing instructor informs the student that which stimuli initiate respirations in the newborn? Select all that apply. decreased CO2 acidosis hypoxia hypercapnia alkalosis

acidosis hypoxia hypercapnia

What action by the nurse provides the neonate with sensory stimulation of a human face? having mothers look at the infant through the isolette's porthole assisting the mother to position the infant in an en face position teaching parents to maintain a distance of 18 inches (7 cm) from the baby's face encouraging the mother to view the baby through the isolette dome

assisting the mother to position the infant in an en face position

During the newborn's assessment, which finding would lead the nurse to suspect that a large-for-gestational-age newborn has experienced birth trauma? seizures asymmetrical movement feeble sucking temperature instability

asymmetrical movement

The nurse is reviewing the medical record of a newborn born 2 hours ago. The nurse notes that the newborn was born at 35 weeks' gestation. How would the nurse classify this newborn? late preterm very preterm postterm full term

late preterm

A 2-month-old infant is admitted to a local health care facility with an axillary temperature of 96.8° F (36° C). Which observed manifestation would confirm the occurrence of cold stress in this client? hyperglycemia increase in the body temperature lethargy and hypotonia increased appetite

lethargy and hypotonia old stress leads to a decrease, not increase, in the newborn's body temperature, blood glucose, and appetite.

A 35-year-old client has just given birth to a healthy newborn during her 43rd week of gestation. What should the nurse expect when assessing the condition of the newborn? tremors, irritability, and high-pitched cry meconium aspiration in utero or at birth yellow appearance of the newborn's skin seizures, respiratory distress, cyanosis, and shrill cry

meconium aspiration in utero or at birth

Which finding is indicative of hypothermia of the preterm neonate? regular respirations nasal flaring oxygen saturation of 95% pink skin

nasal flaring

Conducive heat loss

occurs when the newborn's skin touches a cold surface, causing body heat to transfer to the colder object

A nurse needs to monitor the blood glucose levels of a newborn under observation at a health care facility. When should the nurse check the newborn's initial glucose level? after the newborn has received the initial feeding on admission to the nursery 24 hours after admission to the nursery 4 hours after admission to the nursery

on admission to the nursery

At birth, the infant has dry, cracked skin, absence of vernix, lack of subcutaneous fat, fingernail extending beyond the fingertips, and poor skin turgor. Based on these findings, how would the nurse would classify this neonate? preterm postterm SGA LGA

postterm

A nurse is teaching newborn care to students. The nurse correctly identifies which mechanism as the predominant form of heat loss in the newborn? radiation, convection, and conduction sweating and peripheral vasoconstriction nonshivering thermogenesis lack of brown adipose tissue

radiation, convection, and conduction

nurse is explaining to a new mother that her newborn is susceptible to both dehydration and overhydration. The nurse integrates knowledge of which aspect as the underlying mechanism for this risk? Select all that apply. limited concentration ability decreased ability to produce urine reduced number of nephrons at birth reduced glomerular filtration rate immature acid-base regulation

reduced glomerular filtration rate limited concentration ability

When evaluating neurologic maturity to determine gestational age, the nurse understands that which activity is not part of the assessment? popliteal angle posture rooting square window

rooting

A nursing student observing newborns in the nursery is amazed that a crying infant put her fingers in her mouth, instantly stops crying, and then falls asleep. This behavior can best be explained as: self-quieting ability. motor maturity. the sleep state. social behavior.

self-quieting ability.

A nurse is performing a detailed assessment of a female newborn. Which observation(s) indicates a normal finding? Select all that apply. low-set ears enlarged fontanels (fontanelles) short, creased neck swollen genitals congenital dermal melanocytosis (slate gray nevi)

short, creased neck swollen genitals congenital dermal melanocytosis (slate gray nevi)

An infant born via a cesarean birth appears to be transitioning well; however, the nurse predicts that she will note which common assessment finding in this infant? tachypnea cardiac murmur hypoglycemia hyperthermia

tachypnea

The American Academy of Pediatrics and the American Dietetic Association recommend breastfeeding exclusively for how long? the first 28 days the first 3 months the first 4 months the first 6 months

the first 6 months

Evaporative heat loss happens when

the newborn's skin is wet. As the moisture evaporates from the body surface, the newborn loses body heat along with the moisture. The cold air blowing on the infant's skin will cause heat loss.

When assessing the newborn's umbilical cord, what should the nurse expect to find? two smaller arteries and one larger vein one smaller artery and two larger veins two smaller veins and one larger artery one smaller vein and two larger arteries

two smaller arteries and one larger vein

After completing an assessment of a newborn, the nurse determines that the newborn is small-for-gestational-age based on which weight assessment? weight of 2,800 g weight of 2,600 g weight of 3,000 g weight of 2,400 g

weight of 2,400 g

Root reflex

when baby's cheek is rubbed, it will automatically turn toward the stimuli

Convection

when cold air blows over the body of the infant resulting in a cooling to the infant

The nurse reviews the newborn's morning laboratory levels and notes a bilirubin level of 5.8 mg/dl (99.20 µmol/l). What will the nurse expect to assess in the newborn? enlarged liver, palpable on examination yellowing of the soles of the feet stools that are seedy and yellow yellow-tinted skin on the head and face

yellow-tinted skin on the head and face

The nurse is providing teaching to a new mother who is breastfeeding. The mother demonstrates understanding of teaching when she identifies which characteristics as being true of the stool of breastfed newborns? Select all that apply. stringy to pasty consistency yellowish gold color formed in consistency firm in shape completely odorless

yellowish gold color stringy to pasty consistency