practice questions: physiologic and behavioral adaptations of the newborn

A woman gave birth to a healthy 7-pound, 13-ounce infant girl. The nurse suggests that the woman place the
infant to her breast within 15 minutes after birth. The nurse knows that breastfeeding is effective during the
first 30 minutes after birth because this is the:
a. Transition period.
b. First period of reactivity.
c. Organizational stage.
d. Second period of reactivity.

b. First period of reactivity.

Part of the health assessment of a newborn is observing the infants breathing pattern. A full-term newborns breathing pattern is predominantly:
a. Abdominal with synchronous chest movements.
b. Chest breathing with nasal flaring.
c. Diaphragmatic with chest retraction.
d. Deep with a regular rhythm.

a. Abdominal with synchronous chest movements.

While assessing the newborn, the nurse should be aware that the average expected apical pulse range of a full-term, quiet, alert newborn is:
a. 80 to 100 beats/min.
b. 100 to 120 beats/min.
c. 120 to 160 beats/min.
d. 150 to 180 beats/min.

c. 120 to 160 beats/min.

A newborn is placed under a radiant heat warmer, and the nurse evaluates the infants body temperature every hour. Maintaining the newborns body temperature is important for preventing:
a. Respiratory depression.
b. Cold stress.
c. Tachycardia.
d. Vasoconstriction.

b. Cold stress.

An African-American woman noticed some bruises on her newborn girls buttocks. She asks the nurse who spanked her daughter. The nurse explains that these marks are called:
a. Lanugo.
b. Vascular nevi.
c. Nevus flammeus.
d. Mongolian spots.

d. Mongolian spots.

While examining a newborn, the nurse notes uneven skin folds on the buttocks and a click when performing the Ortolani maneuver. The nurse recognizes these findings as a sign that the newborn probably has:
a. Polydactyly.
b. Clubfoot.
c. Hip dysplasia.
d. Webbing

c. Hip dysplasia.

A new mother states that her infant must be cold because the babys hands and feet are blue. The nurse explains that this is a common and temporary condition called:
a. Acrocyanosis.
b. Erythema neonatorum.
c. Harlequin color.
d. Vernix caseosa.

a. Acrocyanosis.

The nurse assessing a newborn knows that the most critical physiologic change required of the newborn is:
a. Closure of fetal shunts in the circulatory system.
b. Full function of the immune defense system at birth.
c. Maintenance of a stable temperature.
d. Initiation and maintenance of respirations.

d. Initiation and maintenance of respirations.

The parents of a newborn ask the nurse how much the newborn can see. The parents specifically want to know what type of visual stimuli they should provide for their newborn. The nurse responds to the parents by telling them:
a. Infants can see very little until about 3 months of age.
b. Infants can track their parents eyes and distinguish patterns; they prefer complex patterns.
c. The infants eyes must be protected. Infants enjoy looking at brightly colored stripes.
d. Its important to shield the newborns eyes. Overhead lights help them see better.

b. Infants can track their parents eyes and distinguish patterns; they prefer complex patterns.

While evaluating the reflexes of a newborn, the nurse notes that with a loud noise the newborn
symmetrically abducts and extends his arms, his fingers fan out and form a C with the thumb and forefinger, and he has a slight tremor. The nurse would document this finding as a positive:
a. Tonic neck reflex.
b. Glabellar (Myerson) reflex.
c. Babinski reflex.
d. Moro reflex.

d. Moro reflex.

While assessing the integument of a 24-hour-old newborn, the nurse notes a pink, papular rash with vesicles superimposed on the thorax, back, and abdomen. The nurse should:
a. Notify the physician immediately.
b. Move the newborn to an isolation nursery.
c. Document the finding as erythema toxicum.
d. Take the newborns temperature and obtain a culture of one of the vesicles.

c. Document the finding as erythema toxicum.

A client is warm and asks for a fan in her room for her comfort. The nurse enters the room to assess the mother and her infant and finds the infant unwrapped in his crib with the fan blowing over him on high. The nurse instructs the mother that the fan should not be directed toward the newborn and the newborn should be wrapped in a blanket. The mother asks why. The nurses best response is:
a. Your baby may lose heat by convection, which means that he will lose heat from his body to the cooler ambient air. You should keep him wrapped and prevent cool air from blowing on him.
b. Your baby may lose heat by conduction, which means that he will lose heat from his body to the cooler ambient air. You should keep him wrapped and prevent cool air from blowing on him.
c. Your baby may lose heat by evaporation, which means that he will lose heat from his body to the cooler ambient air. You should keep him wrapped and prevent cool air from blowing on him.
d. Your baby will get cold stressed easily and needs to be bundled up at all times.

a. Your baby may lose heat by convection, which means that he will lose heat from his body to the cooler ambient air. You should keep him wrapped and prevent cool air from blowing on him.

A first-time father is changing the diaper of his 1-day-old daughter. He asks the nurse, What is this black, sticky stuff in her diaper? The nurses best response is:
a. That's meconium, which is your baby's first stool. Its normal.
b. That's transitional stool.
c. That means your baby is bleeding internally.
d. Oh, don't worry about that. Its okay.

a. That's meconium, which is your baby's first stool. Its normal.

The transition period between intrauterine and extrauterine existence for the newborn:
a. Consists of four phases, two reactive and two of decreased responses.
b. Lasts from birth to day 28 of life.
c. Applies to full-term births only.
d. Varies by socioeconomic status and the mothers age.

b. Lasts from birth to day 28 of life.

Which statement describing the first phase of the transition period is inaccurate?
a. It lasts no longer than 30 minutes.
b. It is marked by spontaneous tremors, crying, and head movements.
c. It includes the passage of meconium.
d. It may involve the infants suddenly sleeping briefly.

d. It may involve the infants suddenly sleeping briefly.

With regard to the respiratory development of the newborn, nurses should be aware that:
a. The first gasping breath is an exaggerated respiratory reaction within 1 minute of birth.
b. Newborns must expel the fluid from the respiratory system within a few minutes of birth.
c. Newborns are instinctive mouth breathers.
d. Seesaw respirations are no cause for concern in the first hour after birth.

a. The first gasping breath is an exaggerated respiratory reaction within 1 minute of birth.

With regard to the newborns developing cardiovascular system, nurses should be aware that:
a. The heart rate of a crying infant may rise to 120 beats/min.
b. Heart murmurs heard after the first few hours are cause for concern.
c. The point of maximal impulse (PMI) often is visible on the chest wall.
d. Persistent bradycardia may indicate respiratory distress syndrome (RDS).

c. The point of maximal impulse (PMI) often is visible on the chest wall.

By knowing about variations in infants blood count, nurses can explain to their clients that:
a. A somewhat lower than expected red blood cell count could be the result of delay in clamping the umbilical cord.
b. The early high white blood cell (WBC) count is normal at birth and should decrease rapidly.
c. Platelet counts are higher than in adults for a few months.
d. Even a modest vitamin K deficiency means a problem with the ability of the blood to clot properly.

b. The early high white blood cell (WBC) count is normal at birth and should decrease rapidly.

What infant response to cool environmental conditions is either not effective or not available to them?
a. Constriction of peripheral blood vessels
b. Metabolism of brown fat
c. Increased respiratory rates
d. Unflexing from the normal position

d. Unflexing from the normal position

As related to the normal functioning of the renal system in newborns, nurses should be aware that:
a. The pediatrician should be notified if the newborn has not voided in 24 hours.
b. Breastfed infants likely will void more often during the first days after birth.
c. Brick dust or blood on a diaper is always cause to notify the physician.
d. Weight loss from fluid loss and other normal factors should be made up in 4 to 7 days.

a. The pediatrician should be notified if the newborn has not voided in 24 hours.

With regard to the gastrointestinal (GI) system of the newborn, nurses should be aware that:
a. The newborns cheeks are full because of normal fluid retention.
b. The nipple of the bottle or breast must be placed well inside the baby's mouth because teeth have
been developing in utero, and one or more may even be through.
c. Regurgitation during the first day or two can be reduced by burping the infant and slightly
elevating the baby's head.
d. Bacteria are already present in the infants GI tract at birth because they traveled through the placenta.

c. Regurgitation during the first day or two can be reduced by burping the infant and slightly
elevating the baby's head.

Which statement describing physiologic jaundice is incorrect?
a. Neonatal jaundice is common, but kernicterus is rare.
b. The appearance of jaundice during the first 24 hours or beyond day 7 indicates a pathologic process.
c. Because jaundice may not appear before discharge, parents need instruction on how to assess it and when to call for medical help.
d. Breastfed babies have a lower incidence of jaundice.

d. Breastfed babies have a lower incidence of jaundice.

The cheeselike, whitish substance that fuses with the epidermis and serves as a protective coating is called:
a. Vernix caseosa.
b. Surfactant.
c. Caput succedaneum.
d. Acrocyanosis.

a. Vernix caseosa.

What marks on a babys skin may indicate an underlying problem that requires notification of a physician?
a. Mongolian spots on the back
b. Telangiectatic nevi on the nose or nape of the neck
c. Petechiae scattered over the infants body
d. Erythema toxicum anywhere on the body

c. Petechiae scattered over the infants body

An examiner who discovers unequal movement or uneven gluteal skin folds during the Ortolani maneuver would then:
a. Tell the parents that one leg may be longer than the other, but they will equal out by the time the infant is walking.
b. Alert the physician that the infant has a dislocated hip.
c. Inform the parents and physician that molding has not taken place.
d. Suggest that, if the condition does not change, surgery to correct vision problems may be needed.

b. Alert the physician that the infant has a dislocated hip.

One reason the brain is vulnerable to nutritional deficiencies and trauma in early infancy is the:
a. Incompletely developed neuromuscular system.
b. Primitive reflex system.
c. Presence of various sleep-wake states.
d. Cerebellum growth spurt.

d. Cerebellum growth spurt.

The nurse caring for the newborn should be aware that the sensory system least mature at the time of birth
is:
a. Vision.
b. Hearing.
c. Smell.
d. Taste.

a. Vision.

During life in utero, oxygenation of the fetus occurs through transplacental gas exchange. When birth occurs, four factors combine to stimulate the respiratory center in the medulla. The initiation of respiration then follows. Which is not one of these essential factors?
a. Chemical
b. Mechanical
c. Thermal
d. Psychologic

d. Psychologic

A collection of blood between the skull bone and its periosteum is known as a cephalhematoma. To reassure the new parents whose infant develops such a soft bulge, it is important that the nurse be aware that this condition:
a. May occur with spontaneous vaginal birth.
b. Happens only as the result of a forceps or vacuum delivery.
c. Is present immediately after birth.
d. Will gradually absorb over the first few months of life.

a. May occur with spontaneous vaginal birth.

A nursing student is helping the nursery nurses with morning vital signs. A baby born 10 hours ago by cesarean section is found to have moist lung sounds. What is the best interpretation of these data?
a. The nurse should notify the pediatrician stat for this emergency situation.
b. The neonate must have aspirated surfactant.
c. If this baby was born vaginally, it could indicate a pneumothorax.
d. The lungs of a baby delivered by cesarean section may sound moist for 24 hours after birth.

d. The lungs of a baby delivered by cesarean section may sound moist for 24 hours after birth.

Nurses can prevent evaporative heat loss in the newborn by:
a. Drying the baby after birth and wrapping the baby in a dry blanket.
b. Keeping the baby out of drafts and away from air conditioners.
c. Placing the baby away from the outside wall and the windows.
d. Warming the stethoscope and the nurses hands before touching the baby.

a. Drying the baby after birth and wrapping the baby in a dry blanket.

A first-time dad is concerned that his 3-day-old daughters skin looks yellow. In the nurses explanation of physiologic jaundice, what fact should be included?
a. Physiologic jaundice occurs during the first 24 hours of life.
b. Physiologic jaundice is caused by blood incompatibilities between the mother and infant blood
types.
c. The bilirubin levels of physiologic jaundice peak between the second and fourth days of life.
d. This condition is also known as breast milk jaundice.

c. The bilirubin levels of physiologic jaundice peak between the second and fourth days of life.

Cardiovascular changes that cause the foramen ovale to close at birth are a direct result of:
a. Increased pressure in the right atrium.
b. Increased pressure in the left atrium.
c. Decreased blood flow to the left ventricle.
d. Changes in the hepatic blood flow.

b. Increased pressure in the left atrium.

The nurse should immediately alert the physician when:
a. The infant is dusky and turns cyanotic when crying.
b. Acrocyanosis is present at age 1 hour.
c. The infants blood glucose level is 45 mg/dL.
d. The infant goes into a deep sleep at age 1 hour.

a. The infant is dusky and turns cyanotic when crying.

While assessing the newborn, the nurse should be aware that the average expected apical pulse range of a full-term, quiet, alert newborn is:
a. 80 to 100 beats/min.
b. 100 to 120 beats/min.
c. 120 to 160 beats/min.
d. 150 to 180 beats/min.

c. 120 to 160 beats/min.

In administering vitamin K to the infant shortly after birth, the nurse understands that vitamin K is:
a. Important in the production of red blood cells.
b. Necessary in the production of platelets.
c. Not initially synthesized because of a sterile bowel at birth.
d. Responsible for the breakdown of bilirubin and prevention of jaundice.

c. Not initially synthesized because of a sterile bowel at birth.

A meconium stool can be differentiated from a transitional stool in the newborn because the meconium stool is:
a. Seen at age 3 days.
b. The residue of a milk curd.
c. Passed in the first 12 hours of life.
d. Lighter in color and looser in consistency.

c. Passed in the first 12 hours of life.

The process in which bilirubin is changed from a fat-soluble product to a water-soluble product is known
as:
a. Enterohepatic circuit.
b. Conjugation of bilirubin.
c. Unconjugation of bilirubin.
d. Albumin binding.

b. Conjugation of bilirubin.

Which newborn reflex is elicited by stroking the lateral sole of the infants foot from the heel to the ball of the foot?
a. Babinski
b. Tonic neck
c. Stepping
d. Plantar grasp

a. Babinski

Infants in whom cephalhematomas develop are at increased risk for:
a. Infection.
b. Jaundice.
c. Caput succedaneum.
d. Erythema toxicum.

b. Jaundice.

Plantar creases should be evaluated within a few hours of birth because:
a. The newborn has to be footprinted.
b. As the skin dries, the creases will become more prominent.
c. Heel sticks may be required.
d. Creases will be less prominent after 24 hours.

b. As the skin dries, the creases will become more prominent.

What are modes of heat loss in the newborn (Select all that apply)?
a. Perspiration
b. Convection
c. Radiation
d. Conduction
e. Urination

b. Convection
c. Radiation
d. Conduction