Chapter 25 - Physiological Adaptations of the Newborn

A patient gave birth to a healthy 3750 g infant. The nurse suggests that the patient place the infant to their 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 infant’s breathing pattern. What is a full-term newborn’s predominant breathing pattern?

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 which is the average range of expected apical pulse findings of a full-term, quiet, alert newborn?

a. 80 to 100 beats/min

b. 100 to 120 beats/min

c. 110 to 160 beats/min

d. 150 to 180 beats/min

c. 110 to 160 beats/min

A newborn is placed skin-to-skin with a parent, and a nurse evaluates the infant’s body temperature frequently. Maintaining the newborn’s body temperature is important to prevent which event from happening?

a. Respiratory depression

b. Cold stress

c. Tachycardia

d. Vasoconstriction

b. Cold stress

A Canadian patient of African ancestry notices some bruises on their newborn’s buttocks. They ask the nurse who spanked their newborn. The nurse explains that these marks are referred to as what?

a. Lanugo

b. Vascular nevi

c. Nevus flammeus

d. Congenital dermal melanocytosis

d. Congenital dermal melanocytosis

While examining a newborn, a nurse practitioner notes uneven skin folds on the buttocks and a click when performing the Ortolani manoeuvre. The nurse practitioner recognize these findings as an indication of what?

a. Polydactyly

b. Clubfoot

c. Hip dysplasia

d. Webbing

c. Hip dysplasia

A new mother states that their infant must be cold because the baby’s hands and feet are blue. The nurse explains that this is a common and temporary condition called

a. acrocyanosis.

b. erythema neonatorum.

c. harlequin colour.

d. vernix caseosa.

a. acrocyanosis.

A nurse assessing a newborn knows that the most critical physiological 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. What is the basis for the nurses’ response?

a. Infants can see very little until about 3 months of age.

b. Infants can track their parent’s eyes and distinguish patterns; they prefer complex patterns.

c. The infant’s eyes must be protected. Infants enjoy looking at brightly coloured stripes.

d. It’s important to shield the newborn’s eyes. Overhead lights help them see better.

b. Infants can track their parent’s eyes and distinguish patterns; they prefer complex patterns.

Newborns in whom cephalhematomas develop are at increased risk for

a. infection.

b. jaundice.

c. caput succedaneum.

d. erythema toxicum.

b. jaundice.

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. What should the nurse do?

a. Notify the pediatric health care provider immediately.

b. Move the newborn to an isolation nursery.

c. Document the finding as erythema toxicum.

d. Take the newborn’s temperature and obtain a culture of one of the vesicles.

c. Document the finding as erythema toxicum.

A patient is warm and asks for a fan in their room for comfort. The nurse enters the room to assess the mother and their infant and finds the infant unwrapped in the crib with the fan blowing over them on “high.” The nurse teaches 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. What is the basis of the nurse’s response?

a. The baby may lose heat by convection, which means that they will lose heat from their body to the cooler ambient air.

b. The baby may lose heat by conduction, which means that they will lose heat from their body to the cooler ambient air.

c. The baby may lose heat by evaporation, which means that they will lose heat from their body to the cooler ambient air.

d. The baby will get cold stressed easily and needs to be bundled up at all times.

a. The baby may lose heat by convection, which means that they will lose heat from their body to the cooler ambient air.

A first-time father is changing the diaper of his 1-day-old newborn. He asks the nurse, “What is this black, sticky stuff in the diaper?” What is the basis for the nurse’s response?

a. It is meconium and is a baby’s first stool.

b. It is a transitional stool.

c. It is a sign of internal bleeding.

d. Tell the parent not to worry about the colour of the stool.

a. It is meconium and is a baby’s first stool.

The transition period between intrauterine and extrauterine existence for the newborn

a. consists of four phases, two reactive and two of decreased responses.

b. is referred to as the newborn period and lasts from birth to day 28 of life.

c. applies to full-term births only.

d. varies by socioeconomic status and the mother’s age.

b. is referred to as the newborn period and lasts from birth to day 28 of life.

Which statement is an inaccurate description of the first phase of the transition period?

a. It lasts no longer than 30 minutes.

b. It is marked by spontaneous tremors, crying, and head movements.

c. It often includes the passage of meconium.

d. It may involve the infant suddenly sleeping briefly.

d. It may involve the infant suddenly sleeping briefly.

What should the nurse be aware of with regard to the respiratory development of the newborn?

a. The positive pressure created by crying aids in keeping the alveoli open.

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 positive pressure created by crying aids in keeping the alveoli open.

What should the nurse be aware of with regard to the newborn’s developing cardiovascular system?

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.

. What should the nurse know about variations in infants’ blood count to explain to new parents?

a. A somewhat lower than expected red blood cell (RBC) 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 protective?

a. Dilation of peripheral blood vessels

b. Shivering

c. Decreased respiratory rates

d. Flexed position

d. Flexed position

What would the nurse be aware of with regard to the functioning of the renal system in newborns?

a. The pediatric health care provider 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 pediatric health care provider.

d. Weight loss from fluid loss and other normal factors should be made up in 4 to 7 days.

a. The pediatric health care provider should be notified if the newborn has not voided in 24 hours.

What should the nurse be aware of with regard to the gastrointestinal (GI) system of the newborn?

a. The newborn’s 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. An active rectal “wink” reflex is a sign of good sphincter control.

d. Bacteria are already present in the infant’s GI tract at birth, because they travelled through the placenta.

c. An active rectal “wink” reflex is a sign of good sphincter control.

Which statement is true about jaundice?

a. Neonatal jaundice is not common, but kernicterus occurs frequently.

b. The appearance of jaundice during the first 24 hours indicates a pathological process.

c. Jaundice will most likely appear before discharge.

d. Breastfed babies have a lower incidence of jaundice.

b. The appearance of jaundice during the first 24 hours indicates a pathological process.

What is the term given to the cheeselike, whitish substance that fuses with the epidermis and serves as a protective coating for the fetus?

a. Vernix caseosa

b. Surfactant

c. Caput succedaneum

d. Acrocyanosis

a. Vernix caseosa

What marks on a baby’s skin may indicate an underlying problem that requires notification of a pediatric health care provider?

a. Congenital dermal melanocytosis spots on the back

b. Telangiectatic nevi on the nose or nape of the neck

c. Petechiae scattered over the infant’s body

d. Erythema toxicum anywhere on the body

c. Petechiae scattered over the infant’s body

What should a nurse practitioner do upon assessing unequal movement and uneven gluteal skin folds during the Ortolani manoeuvre?

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. Determine that the infant may have hip dysplasia.

c. Inform the parents that moulding has not taken place.

d. Suggest that, if the condition does not change, surgery to correct vision problems might be needed.

b. Determine that the infant may have hip dysplasia.

Why is the brain vulnerable to nutritional deficiencies and trauma in early infancy?

a. The infant has an incompletely developed neuromuscular system.

b. The infant has a primitive reflex system.

c. The infant experiences the presence of various sleep–wake states.

d. The infant experiences a cerebellum growth spurt.

d. The infant experiences a cerebellum growth spurt.

The nurse caring for the newborn should be aware that which sensory system is least mature at the time of birth?

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 centre in the medulla. The initiation of respiration then follows. Which contributes to the dynamic sequence of events that occur with the infants’ first breath?

a. Warm air temperature

b. Oxygen pressure increases

c. Carbon dioxide pressure decreases

d. Arterial pH decreases

d. Arterial pH decreases

A collection of blood between the skull bone and its periosteum is known as a cephalhematoma. What should the nurse be aware of with regard to cephalhematoma in order to reassure the new parents whose infant develops such a soft bulge?

a. It may occur with spontaneous vaginal birth.

b. It only happens as the result of a forceps or vacuum birth.

c. It is present immediately after birth.

d. It will gradually absorb over the first few months of life.

a. It may occur with spontaneous vaginal birth.

A nursing student is helping the postpartum unit nurse with morning vital signs. A baby born 10 hours ago by Caesarean section is found to have moist lung sounds. What is the best interpretation of these data?

a. The nurse should notify the pediatric health care provider stat for this emergency situation.

b. The newborn must have aspirated surfactant.

c. If this baby was born vaginally, it could indicate a pneumothorax.

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

d. The lungs of a baby born by Caesarean 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 nurse’s hands before touching the baby.

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

A first-time parent is concerned that their 3-day-old daughter’s skin looks “yellow.” In the nurse’s explanation of physiological jaundice, what fact should be included?

a. Physiological jaundice occurs during the first 24 hours of life.

b. Physiological jaundice is caused by blood incompatibilities between the mother and infant blood types.

c. The bilirubin levels of physiological jaundice peak between 60 to 72 hours of life.

d. This condition is also known as “breast milk jaundice.”

c. The bilirubin levels of physiological jaundice peak between 60 to 72 hours 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.

A nurse should immediately alert the pediatric health care provider when

a. the newborn is dusky and turns cyanotic when crying.

b. acrocyanosis is present at age 1 hour.

c. the newborn’s blood glucose level is 2.8 mmol/L.

d. the newborn goes into a deep sleep at age 1 hour.

a. the newborn is dusky and turns cyanotic when crying.

In administering vitamin K to the infant shortly after birth, a 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 colour and looser in consistency.

c. passed in the first 12 hours of life.

What are modes of heat loss in the newborn? (Select all that apply.)

a. Perspiration

b. Convection

c. Radiation

d. Conduction

e. Urination

B, C, D

b. Convection, c. Radiation, d. Conduction

Convection, radiation, evaporation, and conduction are the four modes of heat loss in the newborn.