Newborn Adaptation – Flashcards
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Which is NOT a cause of jaundice in the newborn?
a) Bilirubin hyperexcretion
b) Bilirubin overproduction
c) Impaired bilirubin excretion
d) Decreased bilirubin conjugation
answer
Bilirubin hyperexcretion
Explanation: Overexcretion of bilirubin would not cause jaundice. Bilirubin overproduction, decreased bilirbuin conjugation, and impaired bilirubin excretion would cause hyperbilirubinemia, which leads to jaundice.
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At birth changes from fetal to newborn circulation must occur. What change causes the ductus arteriosus to close?
a) Drop in pressure in the neonate's chest
b) Higher oxygen levels at the respiratory centers of the brain
c) Higher oxygen content of the circulating blood
d) Increase in pressure in the left atrium of the heart
answer
Higher oxygen content of the circulating blood
Explanation: The first few breaths greatly increase the oxygen content of circulating blood. This chemical change (i.e., higher oxygen content of the blood) contributes to the closing of the ductus arteriosus, which eventually becomes a ligament.
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What is the term for a small collection of blood that forms underneath the skull as a result of birth trauma?
a) Caput succedaneum
b) Cephalhematoma
c) Vernix caseosa
d) Erythema toxicum
answer
Cephalhematoma
Correct
Explanation: Vernix caseosa is a thick white substance found on a newborn. Erythema toxicum is a newborn rash. Caput succedaneum is molding or edema.
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All of the following are signs of respiratory distress in the newborn EXCEPT
a) Grunting
b) Chest retractions
c) Coughing and a respiratory rate above 50
d) Nasal flaring
e) Central cyanosis
answer
Coughing and a respiratory rate above 50
Explanation: Coughing and sneezing are normal reflexes present in newborns. The expected respiratory rate of newborn is 30 to 60 breaths per minute.
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At what point should the nurse expect a healthy newborn to pass meconium?
a) Within 1 to 2 hours of birth
b) Before birth
c) Within 24 to 48 hours after birth
d) By 12 to 18 hours of life
answer
Within 24 to 48 hours after birth
Explanation: The healthy newborn should pass meconium by 48 hours of life.
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What should the nurse expect for a full-term newborn's weight during the first few days of life?
a) 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%.
b) Loss of 5% to 10% of birth weight in formula-fed and breastfed newborns
c) Loss of 5% to 10% of the birth weight in the first few days in breastfed infants only
d) An increase in 3% to 5% of birth weight by day 3 in formula-fed babies
answer
Loss of 5% to 10% of birth weight in formula-fed and breastfed newborns
Explanation: The nurse should expect the newborn who is breastfed or formula-fed to lose 5% to 10% of birth weight in the first few days of life.
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At birth there are multiple changes in the cardiac and respiratory systems. Which of the following is one of the changes to occur at birth in the cardiovascular system?
a) Oxygen is exchanged in the lungs
b) The oxygen in the blood decreases
c) Fluid is removed from the alveoli and replaced with air
d) Pressure changes occur and result in closure of the ductus arteriosus
answer
Pressure changes occur and result in closure of the ductus arteriosus
Explanation: The ductus arteriosus is one of the openings through which there was fetal circulation. At birth, or within the first few days, this closes and the heart becomes the source of movement of blood to and from the lungs. The exchange of oxygen in the lungs is not a function of the cardiovascular system; it is a function of the respiratory system. Again, the removal of fluid from the alveoli is not a function of the cardiovascular system. The oxygen content of the blood increases; it does not decrease. Therefore options A, B and D are incorrect.
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When assessing the newborn's umbilical cord, what should the nurse expect to find?
a) Two smaller arteries and one larger vein
b) One smaller artery and two larger veins
c) Two smaller veins and one larger artery
d) One smaller vein and two larger arteries
answer
Two smaller arteries and one larger vein
Explanation: When inspecting the vessels in the umbilical cord, the nurse should expect to encounter one larger vein and two smaller arteries. In 0.5% of births (3.5% of twin births), there is only one umbilical artery, which can be linked to cardiac or chromosomal abnormalities.
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The nurse is preparing a teaching plan for new parents about why newborns experience heat loss. Which of the following would the nurse include?
a) Limited voluntary muscle activity
b) Expanded stores of glucose and glycogen
c) Enhanced shivering ability
d) Thick skin with deep lying blood vessels
answer
Limited voluntary muscle activity
Explanation: Newborns have limited voluntary muscle activity or movement to produce heat. They have thin skin with blood vessels close to the surface. They cannot shiver to generate heat. They have limited stores of metabolic substances such as glucose and glycogen
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When assessing infant reflexes the nurse documents a startled response and extension of the arms and legs as which reflex?
a) Rooting
b) Moro
c) Fencing
d) Tonic neck
answer
Moro
Explanation: The moro reflex is also known as the startle reflex. When the infant is startled they extend their arms and legs away from the body. The fencing reflex is also called the tonic neck reflex and is a total body assessment. The rooting reflex assesses the infant's ability to "look" for food.
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Why should a nurse monitor a newborn after cesarean birth more closely than after a vaginal birth?
a) The baby will have more fluid in its lungs, making respiratory adaptation more challenging.
b) Fetal lungs are uninflated and full of amniotic fluid that must be absorbed.
c) The baby's lifeline to oxygen is cut off when the umbilical cord is clamped, resulting in oxygen levels falling and carbon dioxide rising.
d) Much of the fetal lung fluid is squeezed out as the fetus moves down the birth canal.
answer
The baby will have more fluid in its lungs, making respiratory adaptation more challenging.
Explanation: During a vaginal delivery the infant is squeezed by the uterine contractions. The infant who is born via c-section without labor first does not have the mechanical removal of the fluid from the lungs. This places the infant at increased risk for respiratory compromise. The need to more closely assess a newborn after delivery by cesarean section is not caused by the clamping of the umbilical cord. Amniotic fluid in the lungs of all newborns needs to be absorbed by the body. This is not just a need in an infant born by cesarean section.
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The nurse uses a radiant warmer to transport a newborn to reduce heat loss via which mechanism?
a) Convection
b) Conduction
c) Radiation
d) Evaporation
answer
Radiation
Explanation: Radiation involves loss of body heat to cooler, solid surfaces in close proximity but not in direct contact. Using a radiant warmer to transport a newborn reduces the risk of exposing the newborn to the cooler environment. Conduction involves the transfer of heat from one object to another when they are in direct contact with each other. Covering a surface that will come in contact with a newborn with a warmed blanket or cloth diaper helps minimize heat loss via conduction. Convection involves the flow of heat away from the body surface to cooler surrounding air. Keeping newborns out of drafts and minimizing the opening of portholes of an isolette helps to reduce heat loss via convection. Evaporation involves the loss of heat when a liquid is converted to a vapor. Drying a newborn immediately after birth and placing a cap on the newborn's head will help reduce heat loss via evaporation.
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A newborn's axillary temperature is 97.5 °F. He has a cap on his head. His T-shirt is damp with spit-up milk. His blanket is laid over him, and several children are in the room running around his bassinet. The room is comfortably warm, and the bassinet is beside the mother's bed away from the window and doors. What are the most likely mechanisms of heat loss for this newborn?
a) Convection and radiation
b) Conduction and evaporation
c) Conduction and radiation
d) Convection and evaporation
answer
Convection and evaporation
Explanation: Conductive heat loss occurs when the newborn's skin touches a cold surface, causing body heat to transfer to the colder object. Heat loss by convection happens when air currents blow over the newborn's body. 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. Heat loss also occurs by radiation to a cold object that is close to, but not touching, the newborn.
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A newborn is challenged to maintain an adequate body temperature. If a baby is placed too close to a cold air vent, the nurse can assume that the infant will lose heat by which mechanism?
a) Convection
b) Radiation
c) None. This will not cause the infant to lose body heat.
d) Conduction
answer
Convection
Explanation: There are 4 main ways that a newborn loses heat, Convection is one of the four and occurs when cold air blows over the body of the infant resulting in a cooling to the infant. Conductive heat loss occurs when the newborn's skin touches a cold surface, causing body heat to transfer to the colder object. Heat loss occurs by radiation to a cold object that is close to, but not touching, the newborn. 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. Option D is incorrect as the cold air blowing on the infant's skin will cause heat loss
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Which of the following is true regarding fetal and newborn senses?
a) A newborn does not have the ability to discriminate between tastes.
b) A fetus is unable to hear in utero.
c) A newborn cannot see until several hours after birth.
d) A newborn cannot experience pain.
e) The rooting reflex is an example that the newborn has a sense of touch.
answer
The rooting reflex is an example that the newborn has a sense of touch.
Explanation: Newborns experience pain, have vision, and can discriminate between tastes. The rooting reflex is an example of a newborn's sense of touch. The fetus can hear in utero.
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While teaching a newborn nutrition class to a group of pregnant women, the nurse encourages breast-feeding because it is a major source of which immunoglobulin?
a) IgG
b) IgE
c) IgA
d) IgM
answer
IgA
Explanation: The newborn largely depends on three immunoglobulins for defense: IgG, IgA, and IgM. A major source of IgA is human breast milk, so breast-feeding is believed to have significant immunologic advantages over formula feeding. IgG is the only immunoglobulin that crosses the placenta.
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A mother is concerned because her daughter has lost 8 ounces 3 days after birth. What response by the nurse is appropriate?
a) "Your baby is probably just dehydrated."
b) "Your baby needs to be checked for a viral illness."
c) "You need to give your baby formula since she has lost weight during breastfeeding."
d) "This is a normal and expected finding."
answer
"This is a normal and expected finding."
Correct
Explanation: The infant has a 5-10% loss of birth weight during the first few days of life as the body looses excess fluid and has limited food intake. You would not tell the new mother that her infant needs to be checked for a viral illness, this is inappropriate because if the infant were ill you would have no way of knowing if it was a viral or a bacterial disease process. Option C is incorrect as weight loss in a newborn is a normal finding. Option D is incorrect as a new breastfeeding mother should not supplement feedings with formula.
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You are the oncoming nursery nurse caring for a 3-hour-old newborn boy. You make your initial assessment and find the following: Respiratory rate 30 bpm, B/P 60/40 mm/Hg, heart rate 155, temperature (Axillary) 36.8 °C. You assess that the newborn is in a state of quiet alert. What would you do?
a) Call the physician
b) Inform the charge nurse
c) Document the data
d) Stimulate the newborn
answer
Document the data
Explanation: The normal respiratory rate is 30 to 60 breaths per minute and should be counted for a full minute when the infant is quiet. A newborn starts with a low blood pressure (60/40 mm/Hg) and a high pulse (120 to 160 bpm). Normal temperature range is between 97.7 °F (36.5 °C) and 99.5 °F (37.5 °C).
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Eliminating drafts in the delivery room and in the nursery will help to prevent heat loss in a newborn through which mechanism?
a) Evaporation
b) Convection
c) Radiation
d) Conduction
answer
Convection
Explanation: Convection refers to loss of heat from the newborn's body to the cooler surrounding air.
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If a newborn's skin is wet, the nurse can assume that the infant is in danger of what kind of heat loss?
a) Conduction
b) Radiation
c) Evaporation
d) None; wet skin will not cause an infant to lose heat.
answer
Evaporation
Explanation: Evaporation is one of the 4 ways a newborn can lose heat. As moisture evaporates from the body surface of the infant, the newborn loses heat. Option D is incorrect because when the newborn's skin is wet, heat is lost as the moisture evaporates. Conductive heat loss occurs when the newborn's skin touches a cold surface, causing body heat to transfer to the colder object. Heat loss occurs by radiation to a cold object that is close to, but not touching, the newborn.
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A newborn in the nursery has a temperature of 97.4F. What may happen first, if the infant continues to be cold stressed?
a) Respiratory distress
b) Cardiovascular distress
c) Hypoglycemia
d) Seizure
answer
Respiratory distress
Explanation: An infant who has an episode of cold stress is as risk for distress in the respiratory system. The infant needs to be warmed and monitored. If the infant is not warmed hypoglycemia, seizures and cardiovascular distress can occur, but they will not happen before the infant has respiratory distress.
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A mother points out to you that following three meconium stools, her newborn has had a bright green stool. You would explain to her that
a) this is most likely a symptom of diarrhea.
b) her child may be developing an allergy to breast milk.
c) her child will be isolated until the stool can be cultured.
d) this is a normal finding.
answer
this is a normal finding.
Explanation: Newborn stools typically pass through a pattern of meconium, green transitional, and then yellow.
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What is the primary mechanism for temperature regulation in a newborn infant?
a) External with blankets by the nursing staff
b) Brown fat store usage
c) Shivering and increased metabolic rate
d) Skin to skin contact with mother
answer
Brown fat store usage
Explanation: Brown fat stores are the stores used by the newborn infant to maintain warmth until feeding begins and the infant is able to maintain temperature without assistance. The infant's thermoregulatory system is not fully functional at birth. Infants cannot shiver to warm themselves. The use of external blankets as well as skin to skin contact with the mother assist in keeping the baby's temperature within the normal range, but they are not the primary mechanism for temperature regulation in the newborn infant.
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When describing the events that occur in a newborn when he or she experiences a cold environment, which of the following would the nurse identify as occurring first?
a) Increased release of norepinephrine
b) Breakdown of triglycerides
c) Increased blood flow through brown fat
d) Increased cardiac output
answer
Increased release of norepinephrine
Explanation: When the newborn experiences a cold environment, the release of norepinephrine increases. This in turn stimulates brown fat metabolism by the breakdown of triglycerides. Cardiac output increases, increasing blood flow through the brown fat tissue. Subsequently, this blood becomes warmed as a result of the increased metabolic activity of the brown fat.
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The nurse observes a newborn. He notes that the respiratory rate is 66, the nostrils flare out, and the newborn makes a grunting sound during respiration. What does the nurse conclude from these findings? The infant is:
a) Burning brown fat
b) Cold-stressed
c) In respiratory distress
d) Experiencing radiation heat loss
answer
In respiratory distress
Explanation: The assessment findings discussed are signs of respiratory distress. An infant with a respiratory rate of greater than 60 with noise requires further assessment by the RN. All newborns burn brown fat to produce heat for their bodies. This is not something the nurse can assess. The scenario described does not indicate that the newborn is cold-stressed nor experiencing radiation heat loss. Therefore options A, B and D are incorrect.
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Fill in the blank (with a number) question - Enter the answer in the space provided. Your answer should contain only numbers and, if necesary, a decimal point.
How long is the neonatal period for a newborn?
days
answer
28
Explanation: The neonatal period is the first 28 days of life.
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A male baby is born at 5:15 AM on a Wednesday. At 1:15 PM on the same day, the nurse notes yellow staining of the skin on the head and face of this infant. What does this finding likely indicate?
a) The infant has physiologic jaundice.
b) The nurse should not expect the yellow staining to occur on the trunk or extremities.
c) The infant has pathologic jaundice.
d) The unconjugated bilirubin levels in the infant are less than 4 mg/dL.
answer
The infant has pathologic jaundice.
Explanation: Bilirubin is released as blood cells are broken down in the body of the infant. The liver is immature and not able to break down the bilirubin and the infant demonstrates excessive bilirubin the blood by a yellow tinged skin. Elevated bilirubin levels in the first 24 hours of life are considered pathologic. Physiologic jaundice is characterized by jaundice that occurs after the first 24 hours of life (usually on day 2 or 3 after birth). Jaundice appears first on the head and face; then as bilirubin levels rise, jaundice progresses to the trunk and then to the extremities in a cephalocaudal manner. Hyperbilirubinemia, high levels of unconjugated bilirubin in the bloodstream (serum levels of 4 to 6 mg/dL and greater), can lead to jaundice .
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Upon assessing the newborn's respirations, when would the nurse need to notify the MD?
a) A respiratory rate of 15 breaths per minute with nasal flaring
b) A respiratory rate of 45 breaths per minute with acrocyanosis
c) Short periods of apnea that last 10 seconds in a pink newborn
d) Coughing and sneezing in the newborn
answer
A respiratory rate of 15 breaths per minute with nasal flaring
Explanation: Coughing and sneezing are normal reflexes present in the newborn. The respiratory rate of a newborn should be between 30 and 60 breaths per minute. Acrocyanosis can be a normal finding in a newborn and does not indicate respiratory distress. Short periods of apnea that last longer than 15 seconds in the absence of cyanosis can be normal. Nasal flaring is a sign of respiratory distress.
