OB PrepU 17 Newborn Transitioning

What is the first action taken by a nurse caring for a newborn with suspected hypoglycemia?

Perform a heel stick to obtain a blood sample for testing for glucose level.

Feed the newborn some formula immediately.

Check the client's blood sugar by a venous blood draw.

Start an IV to provide intravenous glucose.

Perform a heel stick to obtain a blood sample for testing for glucose level.

Explanation:

If a newborn is noted to be jittery or exhibiting symptoms of hypoglycemia, the nurse should first do a heel stick to check the client's glucose level. After the glucose level is determined, then the nurse will determine what interventions to implement. A venous blood draw is not needed to check the newborn's glucose level.

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?

Put warming blanket over infant.

Recheck blood pressure in 15 minutes.

Document normal findings.

Report tachypnea.

Document normal findings.

Explanation:

These vital signs are within normal limits and should be documented. The heart rate should be 110 to 160 bpm; RR should be 30 to 60 breaths per minute. The axillary temperature can range from 97.7°F to 99.6°F (36.5°C to 37.5°C). Blood pressure should be 60-80/40-45 mm Hg. There is no need to contact the health care provider, recheck the blood pressure in 15 minutes, or place a blanket on the infant.

The nurse is conducting a newborn assessment and notes the head circumference is 35 cm. What is the largest measurement that the nurse will predict for the chest circumference in this newborn?

33

Explanation:

The chest circumference in a term newborn is usually 2 to 3 cm smaller than the head circumference.

35 cm - 3 cm = 32 cm

35 cm - 2 cm = 33 cm

Thus, the larger chest circumference is 33 cm.

A nurse is assessing a newborn's temperature. Which reading would the nurse document as normal?

37.0° C (98.6° F)

36.0° C (96.8° F)

38.0° C (100.4° F)

35.0° C (95.0° F)

37.0° C (98.6° F)

Explanation:

On average a newborn's temperature ranges from 36.5° C to 37.5° C (97.9° F to 99.7° F).

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

Longitudinal but no horizontal creases

Creases on two-thirds of the foot

Creases covering one fourth of the foot

Creases on two-thirds of the foot

Explanation:

As an infant matures in utero, sole creases become prominent to a greater amount. The term infant should have at least two-thirds of the foot covered by creases. These creases should be horizontal and not longitudinal, They should be in the ball of the foot before moving to the heel.

A nurse is assessing a neonate during the first 24 hours after birth. Which finding would the nurse recognize as normal?

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

positive Ortolani sign

enlarged labia with pseudomenstruation

heart rate of 90 to 100 beats/min

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

Explanation:

On average, a neonate's temperature ranges from 97.9° to 99.7° F (36.5° to 37.5° C). Although female neonates' labia often appear swollen, the discharge is white (physiologic leukorrhea). A positive Ortolani sign is noted if the hip is dislocated. The abdomen should be soft, round, and nondistended.

A nurse is assessing a newborn with the parents present. The nurse explains that which aspect of newborn behavior is an important indication of neurologic development and function?

crying response

reflex

voluntary movements

orientation to surroundings

reflex

Explanation:

The presence and strength of a reflex is an important indication of neurologic development and function. It is built into the nervous system and does not need the intervention of conscious thought to take effect. These reflexes end at different levels of the spine and brain stem, reflecting the function of the cranial nerves and motor system.

The nurse is caring for a newborn who has a large surface area to body mass ratio. What action will the nurse take to help this newborn regulate temperature?

Monitor the newborn's skin for changes related to fluid loss, such as turgor.

Educate the parents to rinse the newborn skin well after using soap.

Maintain accurate intake and output and monitor for dehydration.

Assure the newborn has a cap on the head and is kept covered.

Assure the newborn has a cap on the head and is kept covered.

Explanation:

Newborns have a large surface area to body mass ratio and are particularly susceptible to heat loss. The nurse will assure the newborn wears a cap on the head and is kept covered to avoid heat loss. The nurse would monitor intake and output but not related to temperature regulation. The skin of the newborn should be dried well after any liquid is noted (urine, cleansing wipes, etc.) to prevent temperature loss but not specifically because of the large surface area. The newborn's skin needs to be monitored but not specifically for temperature regulation.

The nurse is assessing a newborn, 4 hours old, weighing 9 lbs, 2 oz (4088 g). While doing the initial assessment the RN mentioned that the mother's history reveals gestational hypertension. Which assessment findings should the nurse prioritize as the newborn is continued to be monitored?

Frequent activity and jitteriness

Hypotonia and fever

Low temperature and hypertonia

Jitteriness and irritability

Jitteriness and irritability

Explanation:

Infants born to women gestational hypertension are at a greater risk for developing hypoglycemia. Early signs of hypoglycemia in the newborn include jitteriness, poor feeding, listlessness (not frequent activity), irritability, low temperature (not fever), weak or high-pitched cry, and hypotonia (not hypertonia).

A nurse who has worked in a nursery for 15 years informs the nursing student that feeding an infant early has advantages. The nurse describes which biggest advantage?

helps to ease the baby's hunger

allows the baby to sleep longer

allows the mother to see if the baby can tolerate formula

allows the baby to pass stools, which helps to reduce bilirubin

allows the baby to pass stools, which helps to reduce bilirubin

Explanation:

Newborns fed early pass stools sooner, which helps to reduce bilirubin. The other options might be helpful but are not the most important reason for feeding a newborn early.

A nurse is providing care to a 3-hour-old neonate. The nurse ensures that her hands are warm prior to touching the neonate to prevent heat loss by which mechanism?

conduction

convection

evaporation

radiation

conduction

Explanation:

Heat loss by conduction can occur when the nurse touches the newborn with cold hands. Conduction involves the transfer of heat from one object to another when the two objects are in direct contact with one another. Convection involves the flow of heat from the body surface to cooler surrounding air or to air circulating over a body surface. Radiation involves the loss of body heat to cooler, solid surfaces that are in proximity but not direct contact with the newborn. Evaporation involves the loss of heat when a liquid is converted to a vapor.

The heart rate of the newborn in the first few minutes after birth will be in which range?

180 to 220 bpm

110 to 160 bpm

120 to 130 bpm

80 to 120 bpm

110 to 160 bpm

Explanation:

During the first few minutes after birth, the newborn's heart rate is approximately 110 to 160 bpm. Thereafter, it begins to decrease to an average of 120 to 130 bpm.

Which statement is true regarding fetal and newborn senses?

A newborn does not have the ability to discriminate between tastes.

The rooting reflex is an example that the newborn has a sense of touch.

A newborn cannot see until several hours after birth.

A newborn cannot experience pain.

A fetus is unable to hear in utero.

The rooting reflex is an example that the newborn has a sense of touch.

Explanation:

The rooting reflex is an example of a newborn's sense of touch. Newborns experience pain, have vision, and can discriminate between tastes. The fetus can hear in utero.

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 have the ability to focus only on objects far away.

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

Newborns have the ability to focus on objects in midline.

Newborns cannot focus on any objects.

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

Explanation:

In regards to vision the newborn has the ability to focus on objects only in close proximity (8 to 30 cm away) and tracks objects in midline or beyond. Vision is the least mature sense at birth.

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.

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.

A newborn is passing greenish-black stool of tarry consistency. The nursing student correctly identifies this type of stool as:

transitional stool.

meconium stool.

stool of a formula-fed newborn.

stool of a breastfed newborn.

meconium stool.

Explanation:

Meconium is a newborn's first stool. It is composed of amniotic fluid, shed mucosal cells, intestinal secretions, and blood. Breastfed newborns will pass stools that are yellow-gold, loose, and stringy to pasty in consistency. A formula-fed newborn will have stools that are yellow, yellow-green, or greenish and loose, pasty, or formed in consistency based upon the type of formula.

Upon assessing the newborn's respirations, which finding would cause the nurse to notify the primary care provider?

coughing and sneezing in the newborn

short periods of apnea that last 10 seconds in a pink newborn

a respiratory rate of 15 breaths per minute with nasal flaring

a respiratory rate of 45 breaths per minute with acrocyanosis

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.

A nurse is preparing to place a skin temperature probe on a neonate who is lying on his back. To ensure an accurate reading, which location would be most appropriate to use for placement?

between the scapulae

above the left kidney

over the liver

at the nape of the neck

over the liver

Explanation:

A skin temperature probe should not be placed over a bony area or one with brown fat (such as between the scapulae, at the nape of the neck or above the kidneys) because it does not give an accurate assessment of the whole body temperature. To ensure the best accuracy, most temperature probes are placed over the liver when the newborn is supine or side-lying.

The nurse is preparing a teaching plan for new parents about why newborns experience heat loss. Which information about newborns would the nurse include?

enhanced shivering ability

expanded stores of glucose and glycogen

thick skin with deep lying blood vessels

limited voluntary muscle activity

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.

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?

yellowing of the soles of the feet

stools that are seedy and yellow

enlarged liver, palpable on examination

yellow-tinted skin on the head and face

yellow-tinted skin on the head and face

Explanation:

When the newborn's serum bilirubin level is 4 to 6 mg/dl (68.42 to 102.62 µmol/l) or higher, the newborn will exhibit jaundice. The appearance of jaundice (yellowing) will start on the head and face and move down the trunk. The stools of the newborn will not be yellow due to jaundice. The liver is overwhelmed by the large volume of red blood cells but is not physically enlarged.

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?

"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."

"The respiratory centers in the brain have not been stimulated when a newborn is delivered by a cesarean delivery."

"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."

Explanation:

The process of labor stimulates surfactant production, and much of the fetal lung fluid is squeezed out as the fetus moves down the birth canal. This so-called vaginal squeeze is an important way nature helps to clear the airway in preparation for the first breath. The vaginal squeeze also plays a role in stimulating lung expansion. The pressure of the birth canal on the fetal chest releases immediately when the infant is born. The lowered pressure from chest expansion draws air into the lungs.

A primiparous mother gave birth to an 8 lb 12 oz (3970 g) infant daughter yesterday. She is being bottle fed, is Rh positive, has a cephalohematoma, and received her hepatitis A vaccine last evening. Which factor places the newborn at risk for the development of jaundice?

Rh positive blood type

cephalohematoma

formula feeding

female gender

hepatitis A vaccine

cephalohematoma

Explanation:

Risk factors for the development of jaundice include bruising as seen in a cephalohematoma, male gender, and being breastfed. Blood type incompatibility is only an issue if the infant's blood type differs from the mother and the maternal blood type is not stated. Administering hepatitis A vaccine does not increase the risk of jaundice.

A nurse is teaching newborn care to students. The nurse correctly identifies which mechanism as the predominant form of heat loss in the newborn?

nonshivering thermogenesis

sweating and peripheral vasoconstriction

lack of brown adipose tissue

radiation, convection, and conduction

radiation, convection, and conduction

Explanation:

Heat loss in the newborn occurs primarily through radiation, convection, and conduction because of the newborn's large ratio of body surface to weight and because of the marked difference between core and skin temperatures. Nonshivering thermogenesis is a mechanism of heat production in the newborn. Lack of brown adipose tissue contributes to heat loss, particularly in premature infants, but it is not the predominant form of heat loss. Peripheral vasoconstriction is a method to increase heat production.

The nursing instructor is teaching a class on the physiologic prosperities involved with the birthing process. The instructor determines the session is successful when the students correctly match surfactant with which function?

It allows oxygen to move in the lungs.

It expands the lungs with breaths.

It keeps alveoli from collapsing with breaths.

It removes fluid from the lungs.

It keeps alveoli from collapsing with breaths.

Explanation:

The role of surfactant is to act on surface tension and assist in keeping the alveoli open in the lungs so the lungs do not collapse with the respiratory effort of the newborn. Surfactant does not expand the lungs, remove fluid from the lungs, or allow oxygen to move in the lungs.

A nurse is caring for a 5-hour-old newborn. The primary care provider has asked the nurse to maintain the newborn's temperature between 97.7° F and 99.5° F (36.5° C and 37.5° C). Which nursing intervention would be the best approach to maintaining the temperature within the recommended range?

Place the newborn skin-to-skin (kangaroo care) with the mother.

Use the stethoscope over the newborn's garment.

Delay weighing the infant, as the scales may be cold.

Place the newborn's crib close to the outer wall in the room.

Place the newborn skin-to-skin (kangaroo care) with the mother.

Explanation:

The nurse should place the newborn skin-to-skin (kangaroo care) with the mother. This is the best way to help maintain the newborn's temperature as well as promoting breastfeeding and bonding between the mother and newborn. The nurse can weigh the infant as long as a warmed cover is placed on the scale. The stethoscope should be warmed before it makes contact with the infant's skin, rather than using the stethoscope over the garment because it may obscure the reading. The newborn's crib should not be placed close to the outer walls in the room to prevent heat loss through radiation.

A 12-hour-old infant is receiving IV fluids for polycythemia. For which complication should a nurse monitor this client?

fluid overload

decreased level of consciousness

tachycardia

hypotension

fluid overload

Explanation:

The possibility of fluid overload is increased and must be considered by a nurse when administering IV therapy to a newborn. IV therapy does not significantly increase heart rate or change blood pressure, as well as the level of consciousness, unless fluid overload occurs.

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?

8 to 10

6 to 8

2 to 4

4 to 6

6 to 8

Explanation:

From birth to about 3 months of age, the newborn's kidneys are unable to concentrate urine and they will urinate frequently. Approximately 6 to 8 voidings per day is average and indicates adequate fluid intake.

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?

hyperthermia

cardiac murmur

hypoglycemia

tachypnea

tachypnea

Explanation:

The infant born from a cesarean birth has not had the opportunity to exit the birth canal and experience the squeezing of fluid from the lungs. The lungs have more amniotic fluid than the lungs of a baby from a vaginal birth and are at greater risk for respiratory complications, such as tachypnea. An infant born by cesarean birth is not at increased risk for hyperthermia, hypoglycemia, or a cardiac murmur.

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?

prolonged unsuccessful vaginal birth

inadequate suctioning of the mouth and nose of the newborn

lack of thoracic compressions during birth

loss of blood volume due to hemorrhage

lack of thoracic compressions during birth

Explanation:

A baby born by cesarean birth does not have the same benefit of the birth canal squeeze as does the newborn born by vaginal birth. This may result in the fluid in the lungs being removed too slowly or incompletely. Research findings support the need for thoracic compression to assist with the removal of the fluid and facilitate adequate breathing in the newborn.

The nurse is assessing the stools of a 36-hour-old neonate who is being breastfed. The nurse determines that the stools are within normal parameters based on which finding?

yellowy mustard color with seedy appearance

brownish black with a mucus-like appearance

tan in color with a firm consistency

greenish black with a tarry consistency

yellowy mustard color with seedy appearance

Explanation:

The evolution of a stool pattern begins with a newborn's first stool, which is meconium. Meconium is composed of amniotic fluid, shed mucosal cells, intestinal secretions, and blood. It is greenish black, has a tarry consistency, and is usually passed within 12 to 24 hours of birth. The first meconium stool passed is semi-sterile, but this changes rapidly with ingestion of bacteria through feedings. After feedings are initiated, a transitional stool develops, which is greenish brown to yellowish brown, thinner in consistency, and seedy in appearance. If breastfed, the stools will resemble light mustard with seed-like particles. If formula-fed, the stools will be tan or yellow in color and firmer. The neonate's stool should not appear brownish-black and mucous-like.

A nursing student will pick which value as a correct laboratory value for a newborn?

hematocrit (Hct) 40% (0.4)

platelet count 75,000/µL (75 ×109/L)

white blood cell (WBC) count 40,000/mm³ (40 ×109/L)

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

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

Explanation:

The normal laboratory values for a newborn include Hgb 16 to 18 g/dL (160 to 180 g/L), Hct 46% to 68% (0.46 to 0.68), platelet count 4,500,000/µL to 7,000,000/µL, (4,500 to 7,000 ×109/L) and WBC count 10 to 30,000/mm³ (0,1 to 30 ×109/L). From the values noted, only Hbg of 17 g/dL (170 g/L) is within normal range.

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.

Oxygen is exchanged in the lungs.

The oxygen in the blood decreases.

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

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 and increasing oxygen content in the blood are respiratory functions. The removal of the fluid from the alveoli occurs mainly during the birthing process and is completed by the lungs after birth.

A newborn's vital signs are documented by the nurse and are as follows: HR 144, RR- 36, BP- 128/78, and T- 98.6℉ (37℃). Which finding would be concerning to the nurse?

Temperature

Heart Rate

Blood Pressure

Respiratory Rate

Blood Pressure

Explanation:

The blood pressure of a newborn should be quite low—around 60-70 over 35 to 50. The heart rate and respiratory rate are both high, which are normal findings. The temperature falls within a normal range of 97.7℉ to 99.5℉ (36.5℃ to 37.5℃).

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?

Caput succedaneum

Increased intracranial pressure

Molding

Harlequin sign

Caput succedaneum

Explanation:

Caput succedaneum is swelling of the soft tissue of the scalp caused by pressure of the presenting part on a partially dilated cervix or trauma from a vacuum-assisted delivery. This finding is often of concern for the families. Reassure them that the caput will decrease in a few days without treatment. Increased intracranial pressure would involve the entire scalp and not just a small portion. There would also be other neurologic signs accompanying it. Molding is an elongated head shape caused by overlapping of the cranial bones as the fetus moves through the birth canal. This will also resolve in a few days without treatment. The Harlequin sign is characterized by a clown-suit-like appearance of the newborn where the skin is dark red on one side of the body and the other side is pale. This is a harmless condition which occurs most frequently with vigorous crying or with the infant lying on his or her side.

Eliminating drafts in the birth room and in the nursery will help to prevent heat loss in a newborn through which mechanism?

evaporation

conduction

radiation

convection

convection

lol the explanation was too long

The nurse explains to the parents of a 2-day-old newborn that decreased life span of neonatal red blood cells has contributed to which complication?

hyperbilirubinemia

polycythemia

respiratory distress syndrome

transient tachypnea of the newborn

hyperbilirubinemia

Explanation:

Neonatal red blood cells have a life span of 80 to 100 days and normally have a higher count at birth. This combination leads to increased hemolysis. Complications of this process include hyperbilirubinemia.

The nurse is caring for a newborn who was delivered via a planned cesarean birth. The nurse determines the infant requires closer monitoring than a vaginal delivery infant based on which factor?

Excessive fluid in the infant's lungs, making respiratory adaptation more challenging.

Fetal lungs are uninflated and full of amniotic fluid that must be absorbed.

Oxygen was cut off when the umbilical cord was clamped, resulting in decreased oxygen and increased carbon dioxide.

Much of the fetal lung fluid is squeezed out in cesarean birth.

Excessive fluid in the infant's lungs, making respiratory adaptation more challenging.

Explanation:

During a vaginal birth the infant is squeezed by uterine contractions, which squeeze fluid out of the lungs and prepare them for breathing. The infant who is born via cesarean 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, so there is a need to more closely assess a newborn after birth. The lungs should inflate once the baby is delivered and not wait until the amniotic fluid is absorbed. The umbilical cord is not clamped until the infant is out of the womb and starts to take its first breaths.

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."

"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."

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

Explanation:

During labor and delivery, the contractions provide pressure on the fetus. These forces "squeeze" the fetus's thoracic cavity. This aids the fetus in forcing the amniotic fluid from the lungs. The neonate born by cesarean does not have this experience, which may result in some initial periods of tachypnea and a need for oxygen supplementation. Maternal age and the uterine incision do not impact this phenomenon.

A mother is concerned because her 2-day-old newborn's birth weight was 8 lb (3584 g) and his current weight is 7 lb 8 oz (3360 g). What would be the nurse's response to the mother's concern?

"The newborn needs to be fed more frequently to stop this weight loss pattern."

"The weight loss may be indicative of some underlying health problem. I need to notify the doctor."

"The weight loss is a normal finding, since newborns lose 5% to10% of their birth weight in the first few days after birth."

"Although newborns lose some weight after birth due to poor nutrition, this amount is concerning."

"The weight loss is a normal finding, since newborns lose 5% to10% of their birth weight in the first few days after birth."

Explanation:

The normal weight loss of a newborn is 5% to10% of their birth weight, which means an average of 6 to 10 oz (168 to 280 g). This newborn's weight loss falls within the normal range. There is no need to increase the feeding frequency or notify the doctor and there is no indication of any underlying health problem.

The nurse is aware that the newborn's circulatory dynamics during transition can be positively affected by which action?

giving the infant oxygen as needed

clamping the cord immediately

clamping the cord at 1 minute

delayed umbilical cord clamping

delayed umbilical cord clamping

Explanation:

Early (before 30 to 40 seconds) or late (after 3 minutes) clamping of the umbilical cord changes circulatory dynamics during transition. Recent studies indicate that the benefits of delayed cord clamping include improving the newborn's cardiopulmonary adaptation; preventing iron deficiency anemia in full-term newborns without increasing hypervolemia-related risks and increased iron stores; increasing blood pressure; improving oxygen transport; and increasing red blood cell flow. Although a tailored approach is required in the case of cord clamping, current available data suggest that delayed cord clamping offers the newborn many physiological benefits, which include at least a 30 percent increase in blood volume for term infants and a 50 percent increase in preterm infants; improvement of systemic blood pressure; increase in the cerebral oxygen index; higher hemoglobin levels at 24 to 48 hours of age; and increased serum iron levels at 4 to 6 months.

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.

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

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.

Explanation:

If a nurse is concerned that the nostrils are patent in a newborn, the nurse will occlude the nares one at a time to see if the newborn can breath easily. The nurse would never place something like a swab into the nares to check patency due to potential trauma. Nasal flaring is an abnormal finding and indicates respiratory distress, not ease of breathing. Passing an NG tube is traumatic to the newborn and is not needed in most cases.

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?

Radiation

Conduction

Convection

Evaporation

Convection

Explanation:

There are four 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. The cold air blowing on the infant's skin will cause heat loss.

What is the best rationale for trying to decrease the incidence of cold stress in the neonate?

Evaporative heat loss happens when the neonate is not bundled and does not have a hat on.

It takes energy to keep warm, so the neonate has to remain in an extended position.

The neonate will stabilize his or her temperature by 8 hours after birth if kept warm and dry.

If the neonate becomes cold stressed, he or she will eventually develop respiratory distress.

If the neonate becomes cold stressed, he or she will eventually develop respiratory distress.

Explanation:

If cold stressed, the infant eventually will develop respiratory distress; oxygen requirements rise (even before noting a change in temperature), glucose use increases, acids are released into the bloodstream, and surfactant production decreases bringing on metabolic acidosis. A flexed position, not an extended position, keeps the neonate warm.

Which finding would alert the nurse to suspect that a newborn is experiencing respiratory distress?

respiratory rate of 50 breaths/minute

asymmetrical chest movement

acrocyanosis

short periods of apnea (less than 15 seconds)

asymmetrical chest movement

Explanation:

Chest movements should be symmetrical. Typical newborn respirations range from 30 to 60 breaths per minute. Acrocyanosis is a common finding in newborns and does not indicate respiratory distress. Periods of apnea of less than 15 seconds are considered normal in a newborn. However, if these periods last more than 15 seconds and are accompanied by cyanosis and heart rate changes, additional evaluation is needed.

A preterm infant is experiencing cold stress after birth. For which symptom should the nurse assess to best validate the problem?

hyperglycemia

apnea

metabolic alkalosis

shivering

apnea

Explanation:

Preterm newborns are at a greater risk for cold stress than term or postterm newborns. Cold stress can cause hypoglycemia, increased respiratory distress and apnea, and metabolic acidosis. Preterm infants lack the ability to shiver in response to cold stress.

A nurse is reviewing the history and physical examination findings of a postpartum woman and her female neonate. The neonate was healthy at birth but is now exhibiting signs of jaundice. Which factor(s) would the nurse assess to help identify the neonate suffers from jaundice? Select all that apply.

maternal gestational diabetes

use of oxytocin during labor

female gender of neonate

maternal TORCH infection

eastern European ethnicity

- use of oxytocin during labor

- maternal gestational diabetes

- maternal TORCH ifnection

Explanation:

Common risk factors for the development of jaundice include fetal-maternal blood group incompatibility, prematurity, asphyxia at birth, an insufficient intake of milk during breastfeeding, drugs (such as diazepam, oxytocin, sulfisoxazole/erythromycin, and chloramphenicol), maternal gestational diabetes, infrequent feedings, male gender, trauma during birth resulting in cephalohematoma, cutaneous bruising from birth trauma, polycythemia, previous sibling with hyperbilirubinemia, and intrauterine infections such as TORCH (toxoplasmosis, rubella, cytomegalovirus, herpes simplex, and other organisms).

New parents report to the nurse that their newborn has "crying jags" in the afternoon each day. They are worried that if they hold the newborn every time she cries, she will become spoiled. What advice would the nurse give these parents?

Crying indicates that the newborn has a need, so changing the diaper and feeding the infant should help.

Try walking with the newborn around the house then place her back in the crib to let her cry for a while.

Holding and comforting the newborn will not cause the infant to become spoiled.

Rocking the newborn may soothe her but the time needs to be limited to 30 minutes per session.

Holding and comforting the newborn will not cause the infant to become spoiled.

Explanation:

Newborns often have periods of crying; the parents should first check for a physical reason for crying such as hunger or a soiled diaper. If this is not the cause, then the parents need to try to soothe the newborn by holding, walking, rocking the newborn or even taking the infant for a ride in the car. Reassure the parents that they will not spoil the newborn by meeting its needs.

Which factors could increase the risk of overheating in a newborn? Select all that apply.

underdeveloped lungs

limited sugar stores

limited ability of diaphoresis

lack of brown fat

isolette that is too warm

- limited ability of diaphoresis

- isolette that is too warm

Explanation:

Limited sweating ability, a crib that is too warm or one that is placed too close to a sunny window, and limited insulation are factors that predispose a newborn to overheating. The immaturity of the newborn's central nervous system makes it difficult to create and maintain balance between heat production, heat gain, and heat loss. Underdeveloped lungs do not increase the risk of overheating. Lack of brown fat will make the infant feel cold because the infant will not have enough fat stores to burn in response to cold; it does not, however, increase the risk of overheating.

The nurse notes a newborn has a temperature of 97.0oF (36.1oC) on assessment. The nurse acts to prevent which complication first?

Seizure

Hypoglycemia

Respiratory distress

Cardiovascular distress

Respiratory distress

Explanation:

It takes oxygen to produce heat and an infant who has an episode of cold stress is at risk for respiratory distress. The infant needs to be warmed. The temperature should be in the range of 97.7°F to 98.6°F (36.5°C to 37°C). After respiratory distress sets in, it can be followed by seizures, cardiovascular distress, or hypoglycemia

A nurse is analyzing a journal article that explains the changes at birth from fetal to newborn circulation. The nurse can point out the closure of the ductus arteriosus is related to which event after completing the article?

higher oxygen levels at the respiratory centers of the brain

higher oxygen content of the circulating blood

drop in pressure in the neonate's chest

precipitous drop in blood pressure

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. A drop in the pressure results in a reversal of pressures in the right and left atria, causing the foramen ovale to close, which redirects blood to the lungs. A drop in blood pressure and higher oxygen levels at the respiratory centers of the brain do not result in the closure of the foramen ovale.

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.

formed in consistency

stringy to pasty consistency

completely odorless

firm in shape

yellowish gold color

- yellowish gold color

- stringy to pasty consistency

Explanation:

The stools of a breastfed newborn are yellowish gold in color. They are not firm in shape or solid. The smell is usually sour. A formula-fed infant's stools are formed in consistency, whereas a breastfed infant's stools are stringy to pasty in consistency.

A nurse is teaching a new mother about what to expect for bowel elimination in her newborn. Because the mother is breastfeeding, what should the nurse tell her about the newborn's stools?

Stools should be yellow-gold, loose, and stringy to pasty.

Stools should be greenish and formed in consistency.

Stools should be brown and loose.

Stools should be yellow-green and loose.

Stools should be yellow-gold, loose, and stringy to pasty.

Explanation:

The stools of a breast-fed newborn are yellow-gold, loose, and stringy to pasty in consistency. The stools of the formula-fed newborn vary depending on the type of formula ingested. They may be yellow, yellow-green, or greenish and loose, pasty, or formed in consistency, and they have an unpleasant odor.

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?

"Newborns weighing below 8 lb (3630 g) lack enough brown fat to produce heat."

"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."

"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."

Explanation:

Thermoregulation is difficult for newborns due to their inability to produce heat through muscle movement or shivering. They must rely on metabolizing brown fat. Placing a hat on the newborn can assist with thermoregulation. Newborns less than 8 lb (3630 g) still have brown fat. Windows can be problematic due to the potential for convective heat loss. Covering the newborn with heavy blankets is not recommended, because this can place the newborn at risk for sudden unexplained infant death (SUID).

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?

increased appetite

increase in the body temperature

lethargy and hypotonia

hyperglycemia

lethargy and hypotonia

The nurse should look for signs of lethargy and hypotonia in the newborn in order to confirm the occurrence of cold stress. Cold stress leads to a decrease, not increase, in the newborn's body temperature, blood glucose, and appetite.

What is the best way for the nurse to assess the newborn's heartbeat?

auscultating the apical pulse for 60 seconds

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

The best way for the nurse to assess the newborn's heart rate is to listen to the apical pulse for a full minute.

Which intervention would be the best way for the nurse to prevent heat loss in a newborn while bathing?

Limit the bathing time to 5 minutes.

Bathe the baby in water between 90 and 93 degrees.

Bathe the baby under a radiant warmer.

Postpone breastfeeding until after the initial bath.

Bathe the baby under a radiant warmer.

Bathing a newborn under a radiant warmer helps to prevent heat loss. To minimize the effects of cold stress during the bath, the nurse should also prewarm blankets, dry the child completely to prevent heat loss from evaporation, encourage skin-to-skin contact with the mother, promote early breastfeeding, used heated and humidified oxygen, and defer bathing until the newborn is medically stable. Limiting the length of time spent bathing the baby is secondary to maintaining the baby's body temperature. Having warm water is also important but is irrelevant if the baby is not kept warm under a warmer.

The nurse reads the laboratory report on a newborn (above). What action will the nurse take next?

Further assess the newborn for hypoglycemia.

Monitor the newborn's temperature.

Assess the newborn for elevated bilirubin levels.

Alert the provider that the newborn has elevated potassium.

Further assess the newborn for hypoglycemia.

A glucose level below 50 mg/dl (2.77 mmol/l), or 40 mg/dl (2.22 mmol/l) in some references, in a newborn needs further assessment and intervention. The laboratory report demonstrates a normal white blood cell count and potassium level for a newborn. There is no specific need to monitor the newborn's temperature related to the laboratory results.

A nurse is teaching a new mother about how newborns regulate their temperature. As part of the teaching, the nurse explains brown fat. Which information would the nurse include? Select all that apply.

Brown fat makes up 10% of a term newborn's body weight.

Brown fat is brown and rich in blood vessels and nerve endings.

The newborn keeps itself warm by oxidizing brown fat in response to exposure to the cold.

Only mature newborns have brown fat.

The most common places to find brown fat are the scapulae, neck, mediastinum, and areas near the kidneys and adrenals.

-Brown fat is brown and rich in blood vessels and nerve endings.

-The newborn keeps itself warm by oxidizing brown fat in response to exposure to the cold.

-Only mature newborns have brown fat.

-The most common places to find brown fat are the scapulae, neck, mediastinum, and areas near the kidneys and adrenals.

Brown fat, a special tissue found in mature newborns, helps to conserve or produce body heat by increasing metabolism as well as regulating body temperature similar to that of a hibernating animal. The greatest amounts of brown fat are found in the intrascapular region, the thorax, and behind the kidneys and makes up 2% to 6% of a term newborn's body weight. It is brown in color and rich in blood vessels and nerve endings. The newborn will oxidize the brown fat in response to exposure to the cold and help warm up their body.

The nurse is teaching a prenatal class and illustrating some of the basic events that will happen right after the birth. The nurse should point out which action will best help the infant maintain an adequate body temperature?

Bathe the infant immediately after birth.

Place the infant on the mother's abdomen after birth.

Wrap the infant in a warm, dry blanket.

Turn the temperature up in the birth room.

Wrap the infant in a warm, dry blanket.

Evaporation is one of the four ways a newborn can lose heat. As moisture evaporates from the body surface of the infant, the newborn loses heat. Wrapping the infant in a warm, dry blanket will allow the moisture to be absorbed, limiting heat loss from evaporation. Bathing the infant will only add to the evaporative heat loss. The newborn's skin is wet, so placing him on the mother' abdomen will not prevent evaporation and heat loss. Increasing the ambient temperature in the birth room does not address the evaporation problem.

The nurse is assessing an infant's reflexes. While eliciting a rooting reflex, the infant strongly sucks on the nurse's finger. How does the nurse interpret this finding?

The rooting reflex shows a strong sucking response.

The infant does not have a normal rooting reflex.

The infant displays a normal rooting reflex.

The rooting reflex was tested incorrectly.

The rooting reflex was tested incorrectly.

Gently stroking the newborn's cheek brings out the rooting reflex. The newborn would demonstrate this reflex by turning toward the touch with an open mouth. This infant demonstrates a positive suck reflex but does not display the rooting reflex because the test was performed incorrectly.

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:

the sleep state.

self-quieting ability.

social behavior.

motor maturity.

self-quieting ability.

Self-quieting ability refers to newborns' ability to quiet and comfort themselves. Assisting parents to identify consoling behaviors also helps. The sleep state is noted as an infant becoming drowsy and less attentive to the parents and his surroundings. Social behaviors are things such as cuddling and snuggling into the arms of the parents when the newborn is held. Motor maturity refers to posture, tone, coordination, and movements of the newborn.

At what point should the nurse expect a healthy newborn to pass meconium?

before birth

within 1 to 2 hours of birth

by 12 to 18 hours of life

within 24 hours after birth

within 24 hours after birth

The healthy newborn should pass meconium within 24 hours of life.

A newborn's primary method of heat production is through nonshivering thermogenesis. This process oxidizes which substance in response to cold exposure?

white fat

brown fat

muscles

nerves

brown fat

The newborn's primary method of heat production is through nonshivering thermogenesis, a process in which brown fat (adipose tissue) is oxidized in response to cold exposure. The brown color is derived from the fat's rich supply of blood vessels and nerve endings.

A new mother who is breastfeeding her son asks the nurse, "How do I know if my son is getting enough fluids?" Which response by the nurse would be most appropriate?

"Don't worry. He has a natural instinct that tells him when he needs to eat and drink."

"The best way is to check the number of diapers he wets. If he wets 6 to 8 times a day, he's getting enough."

"The amount of fluids is not important. It's the amount of calories he takes in that we watch."

"If you think he's not taking enough, give him 4 to 8 ounces of water each day in addition to what he breastfeeds."

"The best way is to check the number of diapers he wets. If he wets 6 to 8 times a day, he's getting enough."

Adequate fluid intake in a neonate is determined by the number of wet diapers or voidings he or she produces. On average, 6 to 8 voidings daily indicates adequate fluid intake. The neonate does not have a natural instinct to seek out additional fluid. Obtaining the necessary calories is important for weight gain, not fluid intake. There is no need to supplement feedings with additional water.

A nursing instructor informs students that recent research has shown that delayed cord clamping provides which advantages? Select all that apply.

improving the newborn's cardiopulmonary adaptation

preventing childhood anemia

increasing blood pressure

preventing childhood obesity

improving oxygen transport

increasing red blood cell flow

-improving the newborn's cardiopulmonary adaptation

-preventing childhood anemia

-increasing blood pressure

-improving oxygen transport

-increasing red blood cell flow

Recent studies show the benefits of delayed cord clamping as improving the newborn's cardiopulmonary adaptation, preventing childhood anemia without increasing hypovolemia-related risks, increasing blood pressure, improving oxygen transport, and increasing red blood cell flow. It does not help in preventing childhood obesity.

How long is the neonatal period for a newborn?

28 days

14 days

90 days

45 days

28 days

The neonatal period is the first 28 days of life.

The nurse has completed assessing the blood glucose levels of several infants who are 24 hours old. Which result should the nurse prioritize for intervention?

30 mg/dL (1.67 mmol/L)

53 mg/dL (2.94 mmol/L)

70 mg/dL (3.89 mmol/L)

90 mg/dL (5.00 mmol/L)

30 mg/dL (1.67 mmol/L)

Blood glucose levels less than 50 mg/dL (2.77 mmol/L) is indicative of hypoglycemia in a newborn infant and should be further evaluated and/or treated depending on the individual situation.

A nurse is observing the interaction between a new mother and the neonate. The nurse notes that the neonate moves the head and eyes to focus on the mother's voice and smile. The nurse interprets this as which behavioral response?

orientation

habituation

motor maturity

self-quieting behavior

orientation

The neonate is demonstrating orientation, the neonate's ability to respond to auditory and visual stimuli, as demonstrated by the movement of head and eyes to focus on that stimuli. Habituation is the ability to block out external stimuli after the newborn has become accustomed to the activity. Motor maturity depends on gestational age and involves evaluation of posture, tone, coordination, and movements. These activities enable newborns to control and coordinate movement. When stimulated, newborns with good motor organization demonstrate movements that are rhythmic and spontaneous. Self-quieting ability (also called self-soothing) refers to newborns' ability to quiet and comfort themselves.

A nurse is conducting a class for expectant parents about newborns and the changes that they experience after birth. The nurse discusses the neonatal period, describing it as which time frame?

first 28 days of life

first 2 months of life

first 3 weeks of life

first 36 days of life

first 28 days of life

The neonatal period is defined as the first 28 days of life. During this time period numerous physiologic changes occur as the infant adapts to the new environment.

A client gives birth to a baby at a local health care facility. The nurse observes that the infant is fussy and begins to move her hands to her mouth and suck on her hand and fingers. How should the nurse interpret these findings?

The infant is entering the habituation state.

The infant is attempting self-consoling maneuvers.

The infant is in a state of hyperactivity.

The infant is displaying a state of alertness.

The infant is attempting self-consoling maneuvers.

The hand-to-mouth movement of the baby indicates the self-quieting and consoling ability of a newborn. The other options are states of behavior of a newborn but are not applicable to this situation.

A newborn develops physiologic jaundice, and the mother asks the nurse why this happened. Which response by the nurse would be most accurate?

"Because his liver is a bit immature, the baby can't break down the bilirubin as fast as needed."

"There is some type of blood incompatibility between you and your baby that's causing the problem."

"Your baby must have a blocked duct near his liver that's preventing the bilirubin from being excreted."

"We really don't know why jaundice develops in some babies and not in others. We just know how to treat it."

"Because his liver is a bit immature, the baby can't break down the bilirubin as fast as needed."

The newborn has physiologic jaundice, which is related to decreased bilirubin conjugation. Newborns have relatively immature livers and cannot conjugate (break down) bilirubin as fast as needed. Bilirubin overproduction is responsible for causing jaundice associated with a blood incompatibility. Impaired bilirubin excretion, such as from an obstruction in the biliary tree, also can lead to jaundice. The causes of newborn jaundice are known; jaundice usually results from one of these three mechanisms.

A nurse is explaining to new parents about the numerous changes that occur shortly after birth to the newborn. When describing how the ductus arteriosus closes, the nurse explains that which factor is most important to assist in its closure?

oxygen

clamping the umbilical cord

start breastfeeding immediately

breathing

oxygen

The ductus arteriosus becomes functionally closed within the first few hours after birth. Oxygen is the most important factor in controlling its closure. Closure depends on the high oxygen content of the aortic blood resulting from aeration of the lungs at birth.

A nursing student is aware that fetal gas exchange takes place in which area?

uterus

placenta

lungs

bronchioles

placenta

Many different changes occur for the newborn to survive outside the uterus. One such change is that gas exchange that once took place in the placenta now will take place in the lungs.

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

24 hours after admission to the nursery

on admission to the nursery

4 hours after admission to the nursery

on admission to the nursery

Typically, a newborn's blood glucose levels are assessed with use of a heel stick sample of blood on admission to the nursery, not 4 or 24 hours after admission to the nursery. It is also not necessary or even reasonable to check the glucose level only after the newborn has been fed.

The nurse is teaching a new mother about the changes in her newborn's gastrointestinal tract. The nurse determines that additional teaching is needed when the mother makes which statement?

"The newborn's gut is sterile at birth."

"He needs to get food orally to make vitamin K."

"His stomach can hold approximately 10 ounces."

"The muscle opening that leads into the stomach is not mature."

"His stomach can hold approximately 10 ounces."

A newborn's stomach capacity is approximately 30 to 90 mL or 1 to 3 ounces. The gut is sterile at birth but changes rapidly depending on what feeding is received. Colonization of the gut is dependent on oral intake; oral intake is required for the production of vitamin K. The cardiac sphincter that leads into the stomach and nervous control of the stomach are immature.

The nurse is teaching new parents the best way to prevent hypothermia. Which mechanism would the nurse include when explaining about the newborn's primary method of heat production?

nonshivering thermogenesis

thermoconduction

thermoregulation

shivering thermogenesis

nonshivering thermogenesis

The newborn's primary method of heat production is through nonshivering thermogenesis, a process in which brown fat (adipose tissue) is oxidized in response to cold exposure. When the newborn is in a cold environment, the blood flow is increased through the brown fat, which warms the blood and in turn helps warm the infant.

The nurse is assessing a neonate as he transitions to extrauterine life. The nurse integrates understanding that which structure closes as a result of the neonate's first breath?

umbilical artery

ductus arteriosus

ductus venosus

foramen ovale

foramen ovale

Before birth, the foramen ovale allowed most of the oxygenated blood entering the right atrium from the inferior vena cava to pass into the left atrium of the heart. With the neonate's first breath, air pushes into the lungs, triggering an increase in pulmonary blood flow and pulmonary venous return to the left side of the heart. As a result, the pressure in the left atrium becomes higher than in the right atrium. The increased left atrial pressure causes the foramen ovale to close, thus allowing the output from the right ventricle to flow entirely to the lungs. The closure of the ductus arteriosus depends on the high oxygen concentration of the aortic blood that results from aeration of the lungs at birth. Closure of the ductus venosus occurs because shunting from the left umbilical vein to the inferior vena cava is no longer needed. The umbilical arteries and vein begin to constrict at birth because with placental expulsion blood flow ceases.

A nursing student correctly chooses which stage of behavioral adaptation in the infant to reinforce teaching about feeding, positioning for feeding, and diaper-changing techniques?

period of decreased responsiveness

second period of reactivity

first period of reactivity

There is no preferred time.

second period of reactivity

The second period of reactivity is the best time to teach about feeding, positioning for feeding, and diaper-changing techniques. It is also a good time for the parents to interact with the infant as well as examine the infant and ask questions.

The nurse is describing fetal circulation to new parents and how the circulation changes after birth. The nurse describes a structure that allows the pulmonary circulation to be bypassed, but that shortly after birth this structure should close. Which structure is the nurse describing?

ductus arteriosus

foramen ovale

ductus venosus

umbilical vessels

ductus arteriosus

During fetal life, the ductus arteriosus protects the lungs against circulatory overload by shunting blood into the descending aorta, bypassing the pulmonary circulation. The foramen ovale is located in the septum between the atria and allowed blood to flow from the right atrium directly the left atrium. The ductus venous allowed the majority of the blood to bypass the liver. The umbilical vessels carried oxygenated blood to the fetus and removed deoxygenated blood and waste products from the fetus.