Chapter 25 Normal Newborn: Needs, Care, and Feeding

17) The nurse is teaching a prenatal class about feeding methods. A father-to-be asks the nurse which method, breast or formula, leads to the fastest infant growth and weight gain. Which response by the nurse is best? 1. "In the first 3 to 4 months, breastfed babies gain weight faster." 2. "In the first 3 to 4 months, there is no difference in weight gain." 3. "In the first 3 to 4 months, bottle-fed babies grow faster." 4. "In the first 3 to 4 months, growth isn't as important as your comfort with the method."

Answer: 1 Explanation: 1. Once feeding is established, breastfed babies tend to gain weight faster than do bottle-fed babies and have a leaner body at the end of the first year.

24) The nurse is completing the discharge teaching of a young first-time mother. Which statement requires immediate intervention? 1. "I will put my baby to bed with his bottle so he doesn't get hungry during the night." 2. "My baby will probably have a bowel movement each breastfeeding and will wet often." 3. "Nursing every 1 1/2 to 2 hours is normal, for a total of 8 to 12 feedings every day." 4. "I will drink yarrow tea from my grandmother to prevent my milk from coming in."

Answer: 1 Explanation: 1. Putting a baby to bed with a propped bottle is a choking hazard and should never be done.

14) A change in skin color requires further assessment of which of the following physiological functions? Select all that apply. 1. Oxygenation 2. Bilirubin levels 3. Glucose levels 4. Hematocrit 5. Blood pressure

Answer: 1, 2, 3, 4 Explanation: 1. Changes in skin color may indicate the need for closer assessment of temperature, cardiopulmonary status, hematocrit, glucose, and bilirubin. 2. Changes in skin color may indicate the need for closer assessment of temperature, cardiopulmonary status, hematocrit, glucose, and bilirubin. 3. Changes in skin color may indicate the need for closer assessment of temperature, cardiopulmonary status, hematocrit, glucose, and bilirubin. 4. Changes in skin color may indicate the need for closer assessment of temperature, cardiopulmonary status, hematocrit, glucose, and bilirubin. 5. Changes in skin color may indicate the need for closer assessment of temperature, cardiopulmonary status, hematocrit, glucose, and bilirubin.

1) Which of the following actions must a nurse perform before weighing the newborn during the admission procedure? Select all that apply. 1. Clean the scale 2. Take the infant's temperature 3. Cover the scale 4. Zero the scale 5. Wrap the infant tightly in a blanket to prevent heat loss

Answer: 1, 2, 3, 4 Explanation: 1. This action should be performed to prevent cross infection. 2. This action should be performed to monitor heat loss. 3. This action should be performed to prevent cross infection. 4. This action should be performed to ensure an accurate measurement.

6) The nurse tells the mother that the doctor is preparing to circumcise her newborn. The mother verbalizes concern that the infant will be uncomfortable during the procedure. The nurse explains to the mother that the physician will numb the area before the procedure. Additional methods of comfort often used during the procedure can include (select all that apply): 1. Non-nutritive sucking. 2. Stroking the head. 3. Swaddling. 4. Talking to the baby.

Answer: 1, 2, 4 Explanation: 1. This is an accepted method of soothing during the circumcision. 2. This is an accepted method of soothing during the circumcision. 4. This is an accepted method of soothing during the circumcision.

29) The nurse is caring for the newborn that is 30 minutes old. What signs would the nurse note in respiratory distress? Select all that apply. 1. Retractions 2. Respiratory rate of 68 3. Respiratory rate of 40 4. Grunting 5. Excessive mucous

Answer: 1, 2, 4, 5

28) The newborn is 2 hours old and is not at risk physiologically, what information should the nurse record in the newborn medical record? Select all that apply. 1. Parent-newborn interaction information 2. Labor and birth record 3. Lateness of provider because of sleeping in 4. Antepartum history 5. Condition of the newborn

Answer: 1, 2, 4, 5 Explanation: 1. This is part of the information needed in the medical record. 2. This is part of the information needed in the medical record. 4. This is part of the information needed in the medical record. 5. This is part of the information needed in the medical record.

4) Which of the following information is not recorded as a part of the initial newborn assessment? 1. Resuscitative measures required in the birthing area 2. Blood draw for PKU screening 3. Presence or absence of meconium-stained fluid 4. Parents' desires regarding circumcision for a male infant

Answer: 2 2. Blood is often drawn for laboratory testing, which should be recorded. However, blood draws for PKU screening must occur more than 24 hours after birth.

2) The nurse has received a shift change report on infants born within the last 4 hours. Which newborn should the nurse see first? 1. 37-week male, respiratory rate 45 2. 39-week female, pulse 150 3. Term male, grunting respirations 4. 39-week female, temperature 97.0°F

Answer: 3 3. Grunting respirations are an indication of respiratory distress. This infant needs further assessment and possibly intervention immediately.

21) A newborn appears pale and weak, and laboratory tests reveal the infant has iron deficiency anemia. The mother asks the nurse if it would better to breastfeed her infant or feed him a formula high in iron. What should the nurse's response be? 1. Breastfeed, because breast milk has higher levels of iron compared to formula 2. Breastfeed, because although breast milk has lower levels of iron compared to formula, it is more easily absorbed by the infant 3. Formula feed, because formula has higher levels of iron compared to breast milk 4. Formula feed, because although formula has lower levels of iron compared to breast milk, it is more easily absorbed by the infant

Answer: 2 2. Breast milk contains lower levels of iron compared to formula, but it is more easily absorbed by the infant, so it will be beneficial to the anemic infant to breastfeed if possible.

23) The nurse is assisting a mother to bottle feed her newborn, who has been crying. The nurse suggests that prior to feeding, the mother should: 1. Offer a pacifier. 2. Burp the newborn. 3. Unwrap the newborn. 4. Stoke the newborn's spine and feet.

Answer: 2 2. If a newborn has been crying prior to feeding, air might have been swallowed; therefore, the newborn should be burped before feeding. Time should be taken to calm the newborn prior to feeding.

11) The nurse is ready to perform a discharge assessment for a 2-day-old male infant 8-hours postcircumcision. Which of the following findings require immediate intervention? 1. The umbilical cord clamp has been removed. 2. The infant has had a dry diaper since the circumcision procedure. 3. The mother is ready to breastfeed on demand. 4. The infant maintains temperature when wrapped in a blanket.

Answer: 2 2. If the infant has not voided since the circumcision procedure, further assessment should be done to determine if a penile injury and/or edema is preventing urinary flow.

3) The nurse assesses the following in a sleeping 1-hour-old, 39-weeks'-gestation newborn. The assessment data that would be of greatest concern would be: 1. Skin temperature 97.6°F. 2. Respirations 68/min. 3. Blood pressure 72/44. 4. Heart rate 156 beats/min.

Answer: 2 2. Normal respiratory rate is 40 to 60 breaths/min. 68 could represent a less-than-expected transition.

18) The community nurse is working with women who are formula feeding their infants. Which statement indicates that the nurse's education session was effective? 1. "I should only use soy-based formula for the first year." 2. "I follow the instructions for mixing the powdered formula exactly." 3. "I can reuse one bottle for several feedings." 4. "The mixed formula can be left on the counter for a day."

Answer: 2 2. Powdered and concentrated formula must be mixed according to manufacturer's guidelines. Formula that is too concentrated can lead to excess sodium intake, which creates increased thirst and overfeeding.

20) The nurse is working with a new mother who delivered yesterday. The client has chosen to breastfeed her infant. Which demonstration of skill is the best indicator that the client understands breastfeeding? 1. The client puts the infant to breast when he is asleep to help wake him up. 2. The client takes off her gown to achieve skin-to-skin contact. 3. The infant is held so that he turns his head to access the nipple. 4. The infant is crying when he is brought to the breast.

Answer: 2 2. Skin-to-skin contact creates tactile sensations that increase the sucking of newborns.

26) A nurse is evaluating the diet plan of a breastfeeding mother and determines that her intake of fruits and vegetables is inadequate. The nurse explains that the nutritional composition of the breast milk can be adversely affected by this aspect of the mother's nutrition. Which of the following strategies should be recommended to the mother? 1. Stop breastfeeding. 2. Provide newborn supplements to the newborn. 3. Offer whole milk. 4. Supplement with skim milk.

Answer: 2 2. The mother may continue to breastfeed, but the caregiver may choose to prescribe additional vitamins for the newborn.

10) At birth, an infant weighed 8 pounds 4 ounces. Three days later, the newborn is being discharged. The parents note that the baby now weighs 7 pounds 15 ounces. What explanation should the nurse give for the change in this newborn's weight? 1. "His weight is excessive." 2. "His weight loss is within normal limits." 3. "His weight loss is less than expected." 4. "His weight loss is unusual."

Answer: 2 2. This newborn's weight loss is within normal limits. During the first 5 to 10 days of life, caloric intake often is insufficient for weight gain. Therefore, there might be a weight loss of 5 to 10 percent in term newborns.

16) The nurse is teaching an early-parenting class to families expecting their first child soon. A client asks the nurse if breast milk is really better than formula. The best response by the nurse is: 1. "Breast milk is the perfect food for human babies." 2. "Formula attempts to imitate the composition of breast milk." 3. "Breastfed babies grow faster because of breast milk." 4. "Formula is harder to digest than is breast milk."

Answer: 2 2. This statement best answers the question about whether breast milk or formula is best. Breast milk is the "gold standard" on which formula is based. Formula attempts to provide nutrition that is similar to breast milk; however, breast milk composition is different in many ways.

27) A nurse is conducting a breastfeeding assessment for a primipara mother. The infant has not yet learned how to latch on strongly, and the mother begins to get frustrated. In addition, the infant seems unsettled and uninterested in eating. The mother comments that she thinks her frustration is causing her milk to spoil. How should the nurse handle this statement? 1. Agree with the mother's statement and teach her relaxation techniques to reduce her frustration. 2. Assure the mother that there is no evidence that milk composition changes based on the mother's emotional state. The infant is fussy because he can sense the mother's frustration. 3. Tell the mother that the delayed let-down resulting from her frustration is causing the infant to suck in air rather than milk. 4. Remind the mother that spoiled milk will cause cramping in the infant's stomach, contributing to his fussy demeanor.

Answer: 2 2. Infants can sense the mother's emotions, so the mother should be taught relaxation techniques to reduce her frustration and enhance the feeding experience.

5) The parents of a newborn male ask the nurse if they should circumcise their son. The best response by the nurse is: 1. "Circumcision should be undertaken to prevent problems in the future." 2. "Circumcision might decrease the risk of developing a urinary tract infection." 3. "There can be complications associated with this procedure. What questions do you have?" 4. "Circumcision is painful and should be avoided unless you are Jewish."

Answer: 3 3. Asking this question allows the nurse to determine what the questions or concerns are and address them specifically.

22) A nurse is assisting a new mother to breastfeed. Place the steps in order for breastfeeding in a logical sequence. 1. Tickle the newborn's lips with the nipple. 2. Bring the newborn to breast. 3. The newborn opens mouth wide. 4. Have the newborn face the mother tummy-to-tummy. 5. Position the newborn so the newborn's nose is at level of the nipple.

Answer: 3, 5, 4, 2, 1

19) The client at 20 weeks' gestation has not decided on a feeding method for her infant. She asks the nurse for advice. The nurse presents information about the advantages and disadvantages of formula-feeding and breastfeeding. Which statements by the client indicate that the teaching was successful? 1. "Formula feeding gives the baby protection from infections." 2. "Breast milk cannot be stored; it has to be thrown away after pumping." 3. "Breastfeeding is more expensive than formula feeding." 4. "My baby has a lower risk of food allergies if I breastfeed."

Answer: 4 4. Breast milk provides newborns with immunoglobulins and reduces the risk of food allergies in children.

13) The nurse is instructing the parents of a newborn about car seat safety. Which statement indicates that the parents need additional information? 1. "The baby should be in the back seat." 2. "Newborns must be in rear-facing car seats." 3. "We need to read the owner's manual before using the car seat." 4. "How the straps go around the baby isn't that important."

Answer: 4 4. Car seats for infants are mandatory in most states. Straps must be snug around the baby in order to be effective in protecting the baby in case of a crash.

9) The nurse is teaching a parenting class for pregnant couples that will deliver soon. Which statement best indicates that additional information is needed? 1. "Baby girls sometimes have a little bloody mucus in their diapers as a reaction to the high estrogen level in the mother." 2. "Genitals of babies look swollen and enlarged at birth as a result of the hormones in the mother's circulation." 3. "We can call the nurse help line any time of day or night if we have questions about our baby after we get home." 4. "Car seats are installed the same way in different models of cars. Our friends can show us how to install it."

Answer: 4 4. Each model of car seat is installed differently in different makes of car. Directions for car seats should be followed carefully. Car dealerships often offer a car seat installation instruction service. A car seat that is installed incorrectly can be more dangerous than not using a car seat at all.

12) The nurse is planning home visits to the homes of new parents and their newborns. Which client should the nurse see first? 1. 3-day-old male who received a hepatitis B vaccine prior to discharge 2. 4-day-old female whose parents are both hearing-impaired 3. 5-day-old male with whitish adherent discharge on the circumcision site 4. 6-day-old female with greenish discharge from the umbilical cord site

Answer: 4 4. Greenish or malodorous discharge from the umbilicus is not an expected finding. This family should be seen first because they are experiencing a complication.

8) The nurse is working with new parents who have recently immigrated to the United States. The nurse is not familiar with the cultural background of the family. What statement is best? 1. "You appear to be Muslim. Do you want your son circumcised?" 2. "Let me explain how newborn care takes place here in the United States." 3. "Your baby is a U.S. citizen. You must be very happy about that." 4. "Could you explain what your preferences are regarding childbearing?"

Answer: 4 4. Sensitive, nonjudgmental exploration of the family's cultural beliefs regarding newborn care allows the nurse to gain valuable knowledge that will be applied when planning culturally competent care.

25) A nurse conducts an infant assessment on the second day after birth. A physical assessment of the newborn reveals the infant has dry lips and a dry oral cavity and has had only one wet diaper rather than the expected two. What is the primary nursing diagnosis for this infant? 1. Risk for imbalanced nutrition: less than body requirements related to mother's increased caloric need 2. Ineffective breastfeeding related to mother's lack of knowledge about breastfeeding techniques 3. Risk for infection related to impaired skin integrity 4. Imbalanced nutrition: less than body requirements related to dehydration as evidenced by dry mucus membranes and decreased urine output

Answer: 4 4. The infant is displaying signs of dehydration, which most often occurs when the infant is not receiving enough fluids through breastfeeding or bottle-feeding. Newborns require 140 to 160 mL/kg/day of fluids to prevent dehydration because the newborn has a decreased ability to concentrate urine and their overall metabolic rate is high.

15) The nurse is working with an adolescent mother and her newborn. As the nurse begins to gather the supplies needed to bathe the infant, the adolescent tells the nurse, "I'm really scared that I won't take care of my baby correctly. My mother says I'll probably hurt the baby because I'm too young to be a mother." The best response by the nurse is: 1. "You are very young, and parenting will be a challenge for you." 2. "Your mother was probably right. Be very careful with your baby." 3. "Mothers have instincts that kick in when they get their babies home." 4. "We can give the baby's bath together. I'll help you learn how to do it."

Answer: 4 4. This response is best because it both teaches the new mother skills she does not have and increases her confidence.

7) The nurse is discussing parent-infant attachment with a prenatal class. Which statement indicates that teaching was successful? 1. "I should avoid looking directly into the baby's eyes to prevent frightening the baby." 2. "My baby will be very sleepy immediately after birth, so he can go to the nursery." 3. "Newborns cannot focus their eyes, so it doesn't matter how I hold my new baby." 4. "Giving the baby his first bath can really give me a chance to get to know him."

Answer: 4 4. When parents give the first bath with the nurse, the nurse can point out behaviors and characteristics that help the parents understand their infant as unique and can model ways to respond to the baby's behavior.