Chapter 14: Physiological and Behavioral Adaptations of the Newborn

A nurse has finished bathing a newborn. What is the priority action by the nurse to maintain thermoregulation? A. Dry the newborn thoroughly. B. Swaddle the newborn. C. Place a hat on the newborn. D. Place the newborn in a clean bassinet.

A. Dry the newborn thoroughly. This is priority to maintain the baby's thermoregulation to ensure that the infant is properly dry and heat is not lost through conduction.

A nurse is evaluating a newborn's laboratory results on day five. Which result is a concern to the nurse? A. 11.7 mg/dL B. 5 mg/dL C. 12 mg/dL D. 6 mg/dL

C. 12 mg/dL Result is not normal and should be reported.

What is the FIRST action in the sequence of events including internal and external stimuli that must happen in order for the infant to breathe upon a vaginal delivery? A. Increased blood flow to the lungs B. Surfactant secretion C. Chest squeeze D. First breaths

C. Chest squeeze This is the first external stimuli as the fetus moves through the birth canal. Pressure on the chest causes lung secretions and amniotic fluid to be squeezed out through the airway.

The nurse enters the room and notices that the room feels cold. The mother says, "He has been crying and kicking and now he seems very tired." What is the nurse's priority concern? A. The infant is overstimulated. B. The infant is hungry. C. Metabolic acidosis D. Metabolic alkalosis

C. Metabolic acidosis The infant may be fatigued from the efforts of kicking and crying in an attempt to raise his body temperature, leading to cold stress. This is the priority concern.

Normal physiological jaundice is assessed when the nurse observes which of the following? A. Lethargy, disinterest in feeding, and decreased urine output B. Serum conjugated bilirubin of 3.2 mg/dL C. Elevated unconjugated bilirubin at 12 hours of life D. Serum total bilirubin of 7.2 mg/dL on day four of life

D. Serum total bilirubin of 7.2 mg/dL on day four of life On day four of life, a serum total bilirubin above 5.8 mg/dL and less than 11.7 mg/dL is an indication of physiological jaundice.

The nurse admits a newborn to the admission nursery and prepares to bathe the baby for the first time after assessing which of the following? A. Drying of the umbilical cord B. Two hours since last eating C. Stable temperature for 2 hours D. Temperature 36.2°C axillary on radiant warmer

C. Stable temperature for 2 hours The baby's temperature should be stable for 2 hours prior to bathing.

A mother who is holding her 2-hour-old newborn says, "I don't think she likes breastfeeding, but last time, when we were in the delivery room, she did really well." Which is the nurse's best response? A. "After birth, babies go into a deep sleep, but when she wakes up, she'll be hungry." B. "Your milk isn't in yet. That is why she acts disinterested in eating." C. "You just need to wake her up so she'll be alert and ready to eat." D. "Let me help you get her to latch on. Once she takes hold, she'll be fine."

A. "After birth, babies go into a deep sleep, but when she wakes up, she'll be hungry." Babies go into a very deep sleep 39 to 60 minutes after birth and do not wake to eat, so the mother should be reassured.

What are the consequences of an increased metabolic rate in a newborn experiencing cold stress? (Select all that apply.) A. An increased need for oxygen B. A decrease in surfactant production C. Hyperglycemia D. Metabolic acidosis E. Jaundice

A. An increased need for oxygen As the infant tries to increase its body temperature the metabolic rate increases, which increases the need for oxygen. B. A decrease in surfactant production Cold stress leads to respiratory distress, which then causes a decrease in surfactant. D. Metabolic acidosis Metabolic acidosis is a result of rapid metabolism of brown fat.

The nurse needs to draw blood via heel stick for a newborn screening examination. How can the nurse use understanding of the newborn's heat production physiology to promote blood collection? A. By applying a warm pack to the heel before attempting to draw blood B. By wrapping the baby in a blanket with a hat C. By placing the baby under a radiant warmer D. By elevating the head of the bassinet

A. By applying a warm pack to the heel before attempting to draw blood Applying heat to the heel will promote circulation and increase blood flow to make drawing blood easier.

In a newborn infant, which of the following is the liver's job related to bilirubin? A. Changing unconjugated bilirubin to conjugated bilirubin B. Synthesis of vitamin K C. Removal of meconium D. Changing conjugated bilirubin to unconjugated

A. Changing unconjugated bilirubin to conjugated bilirubin The job is to remove the indirect unconjugated bilirubin from circulation and convert or conjugate it so that it can be excreted.

Which changes in newborn circulation does the nurse anticipate immediately after the first lusty cry, prior to clamping of the umbilical cord? (Select all that apply.) A. Closure of the ductus arteriosus B. Closure of the ductus venosus C. Closure of the foramen ovale D. Increased blood flow to the lungs E. Closure of the umbilical vessels

A. Closure of the ductus arteriosus With the first cry, as the lungs expand, the ductus arteriosus closes. C. Closure of the foramen ovale The foramen ovale closes with the first cry as pressure in the left atrium increases and pressure in the right atrium decreases. D. Increased blood flow to the lungs Blood flow to the lungs increases as a result of closure of the ductus arteriosus after the baby takes her first big breath of air with the lusty cry.

What nursing interventions will the nurse conduct to assist the newborn with the respiratory transition after birth? (Select all that apply.) A. Count respirations per minute. B. Suction the mouth and nose with the bulb syringe to clear mucus. C. Monitor respiratory effort. D. Observe the abdomen for breathing. E. Apply oxygen.

A. Count respirations per minute. This is a nursing intervention to assist the newborn with respiratory transition after birth. B. Suction the mouth and nose with the bulb syringe to clear mucus. This is a nursing intervention to assist the newborn with respiratory transition after birth. C. Monitor respiratory effort. This is a nursing intervention to assist the newborn with respiratory transition after birth. D. Observe the abdomen for breathing. This is a nursing intervention to assist the newborn with respiratory transition after birth.

A nurse is discussing interventions with parents for assisting the newborn with an immature immune system. What interventions should the nurse provide to protect their newborn? (Select all that apply.) A. Maintain strict hand washing for everyone who cares for the newborn. B. Screen all visitors for illness. C. Encourage parents to begin immunizations at 2 months of age. D. Protect the newborn from infection. E. Encourage parents to maintain hand hygiene.

A. Maintain strict hand washing for everyone who cares for the newborn. Intervention to protect the newborn with immune system transition after birth B. Screen all visitors for illness. Intervention to protect the newborn with immune system transition after birth C. Encourage parents to begin immunizations at 2 months of age. Intervention to protect the newborn with immune system transition after birth D. Protect the newborn from infection. Intervention to protect the newborn with immune system transition after birth E. Encourage parents to maintain hand hygiene. Intervention to protect the newborn with immune system transition after birth

Prior to delivery it is important to determine if the infant will need support for the initial transition to extrauterine life. Which infant may need assistance with this transition? (Select all that apply.) A. Premature infant B. Infant with shoulder dystocia C. Infant with meconium present at birth D. Infant with normal fetal heart rate E. Infant who was born via cesarean birth

A. Premature infant Infant may need assistance with the transition; have supplies and personnel on hand to provide support care. B. Infant with shoulder dystocia Infant may need assistance with the transition; have supplies and personnel on hand to provide support care. C. Infant with meconium present at birth Infant may need assistance with the transition; have supplies and personnel on hand to provide support care.

A nurse is precepting a new nurse on nursing interventions regarding the respiratory system and crying of the newborn after birth. Which statement by the nurse indicates safe teaching? A. "Prolonged crying is okay." B. "Short bursts of crying are okay." C. "It is best not to allow crying." D. "It is best to allow the newborn to soothe himself."

B. "Short bursts of crying are okay." Short bursts of crying is safe; it increases the depth of respirations, allowing the alveoli to open at birth.

A nurse is caring for a 2-hour-old infant whose skin has a yellow tint and an elevated total bilirubin. The nurse is concerned and calls the physician. Which method of communication should the nurse use? A. SOAP method B. C.U.S method C. Triage method D. STAT method

B. C.U.S method This is correct. This method identifies a Concern, about a situation the nurse is Uncomfortable about that identifies a Safety problem.

Which intervention is most effective for the nurse to perform to promote elimination of conjugated bilirubin? A. Administering IV fluid B. Encouraging frequent feeding C. Discouraging breastfeeding D. Administering packed blood cells

B. Encouraging frequent feeding Bilirubin is changed to a water-soluble form and excreted in the stool, so increased feeding will increase stooling.

Which statement about fetal circulation is true? A. Fetal circulation continues until adulthood. B. Fetal circulation is no longer effective at birth. C. Fetal circulation continues until after the stress of labor. D. Fetal circulation continues until red blood cells are broken down.

B. Fetal circulation is no longer effective at birth. This is correct; as the newborn starts breathing and the umbilical cord is cut, changes occur in the blood flow, pressure, and volume within the heart. Fetal circulation is no longer effective and the blood flows a new route.

A nurse understands which of the following assessment findings as priority to indicate that a newborn may be experiencing cold stress and burning brown fat to produce heat? (Select all that apply.) A. Hyperglycemia B. Metabolic acidosis C. Respiratory distress D. Hypoglycemia E. Metabolic alkalosis

B. Metabolic acidosis This is correct; metabolic acidosis results from the rapid metabolism of brown fat. C. Respiratory distress This is correct; an increased need for oxygen and a reduction in surfactant production lead to respiratory distress. D. Hypoglycemia This is correct; due to an increase in the use of stored glycogen, hypoglycemia is common.

A mother expresses concern regarding her newborn's sticky black stool. What is the nurse's best response? A. "We should get an x-ray." B. "We should be concerned." C. "This is normal meconium stool." D. "This is caused by overfeeding."

C. "This is normal meconium stool." This is normal and normally expelled within 24-48 hours after birth; meconium stool is the material from mucus, vernix, lanugo, hormones, and carbohydrates that accumulated in the bowel during fetal development.

A nurse is observing a mother whose infant has been crying. The mother has finished breastfeeding, burped the infant, and changed the diaper and the infant continues to cry. Which intervention should the nurse offer? A. "Try to burp him longer." B. "Try to feed him more." C. "Try to hold him close." D. "Try to place him in the bassinet."

C. "Try to hold him close." This is the best suggestion because the infant may be overstimulated, and close contact is preferred because this also promotes bonding.

The nurse is caring for an 18-hour-old newborn who has not voided for the first time yet. Which is the nurse's priority action? A. Notifying the provider immediately B. Pressing on the bladder to prevent urine retention C. Encouraging frequent breastfeeding D. Documenting and continuing monitoring

D. Documenting and continuing monitoring It is not unusual for a newborn to go as long as 24 hours without urinating, so the finding should be documented and the nurse should continue to monitor for the first void.

Which action does the nurse take to reduce the newborn's evaporative heat loss? A. Placing the newborn on a warm surface B. Keeping the room temperature warm C. Keeping the newborn away from cool objects D. Drying the infant thoroughly after birth

D. Drying the infant thoroughly after birth Drying the infant reduces the evaporative heat loss that occurs as a result of fluid evaporating off the baby's skin.

Immediately after the umbilical cord is cut, the newborn has a weak, shallow cry. Which is the nurse's priority action to promote breathing? A. Assessing vital signs B. Placing the newborn skin-to-skin with the mother C. Flicking the newborn's heels D. Drying the newborn vigorously

D. Drying the newborn vigorously When the infant is vigorously dried, the sensors in the skin are stimulated, which encourages the respiratory center to begin the first sequences of breathing.

Which newborn is at lowest risk for elevated unconjugated bilirubin levels? A. The newborn with significant bruising from a face presentation B. The premature newborn C. The newborn with O+ blood type, born to a mother with O- blood type D. The baby born at 41 weeks' gestation

D. The baby born at 41 weeks' gestation The baby born at 41 weeks' gestation does not have an increased risk of elevated bilirubin levels.