Chapter 17: The Newborn Flashcards
Which fetal shunt closes within several minutes after birth?
a. Ductus Venosus
b. Foramen Ovale
c. Ductus Arteriosus
d. Foramen Venosus
b. Foramen Ovale
Which fetal shunt closes by 12 - 24 hours of age in a healthy, full-term newborn, with permanent closure occurring within 2 to 3 weeks?
a. Ductus Venosus
b. Foramen Ovale
c. Ductus Arteriosus
d. Foramen Venosus
c. Ductus Arteriosus
What triggers the functional closure of the foramen ovale at birth?
A. Increased left atrial pressure
B. Decreased left atrial pressure
C. Increased right atrial pressure
D. Decreased systemic vascular resistance
A. Increased left atrial pressure
Rationale: The foramen ovale functionally closes when the pressure in the left atrium becomes higher than in the right atrium due to increased pulmonary blood flow and venous return.
What event causes systemic vascular resistance to increase at birth?
A. Decrease in pulmonary vascular resistance
B. Clamping of the umbilical cord
C. Functional closure of the ductus arteriosus
D. Activation of the liver
B. Clamping of the umbilical cord
Rationale: Clamping of the umbilical cord increases systemic vascular resistance as the placental circulation is removed from the system.
Which fetal vessel becomes a ligament post-birth due to the activation of the liver?
A. Foramen ovale
B. Ductus arteriosus
C. Ductus venosus
D. Umbilical artery
C. Ductus venosus
Rationale: The ductus venosus shunted blood from the left umbilical vein to the inferior vena cava during fetal life and closes within a few days after birth as the liver takes over the function of the placenta.
What happens to the umbilical arteries and vein after birth?
A. They remain open to assist in circulation
B. They constrict and become ligaments
C. They become part of the systemic circulation
D. They enlarge and assist in oxygen exchange
B. They constrict and become ligaments
Rationale: The umbilical arteries and vein begin to constrict at birth because blood flow ceases with placental expulsion, and they become ligaments.
What happens to right-sided heart pressures after the foramen ovale closes?
A. They decrease
B. They increase
C. They remain the same
D. They fluctuate
B. They increase
Right-sided heart pressures decrease as pulmonary vascular resistance decreases and the foramen ovale closes, directing more blood flow to the lungs.
Which fetal structure allowed most of the oxygenated blood to pass from the right atrium to the left atrium before birth?
A. Ductus arteriosus
B. Ductus venosus
C. Umbilical vein
D. Foramen ovale
D. Foramen ovale
Rationale: The foramen ovale allowed most of the oxygenated blood entering the right atrium from the inferior vena cava to pass into the left atrium during fetal life.
What is the outcome of the closure of the foramen ovale on blood flow?
A. Separation of oxygenated and nonoxygenated blood
B. Mixing of oxygenated and nonoxygenated blood
C. Increased blood flow to the right atrium
D. Decreased blood flow to the left atrium
A. Separation of oxygenated and nonoxygenated blood
Rationale: The closure of the foramen ovale ensures that oxygenated blood from the lungs is separated from nonoxygenated blood, which is now directed entirely to the lungs.
Which structure becomes a ligament within a few days after birth due to the activation of the liver?
A. Foramen ovale
B. Ductus arteriosus
C. Umbilical artery
D. Ductus venosus
D. Ductus venosus
Rationale: The ductus venosus shunted blood during fetal life and becomes a ligament in extrauterine life as the liver becomes activated post-birth.
What facilitates the closure of the ductus arteriosus at birth?
A. Decrease in systemic vascular resistance
B. High oxygen content in aortic blood
C. Increase in pulmonary vascular resistance
D. Decrease in left atrial pressure
B. High oxygen content in aortic blood
Rationale: The high oxygen content of the aortic blood resulting from the aeration of the lungs at birth is critical in closing the ductus arteriosus.
What role did the foramen ovale play during fetal life?
A. Shunted blood from the left atrium to the right atrium
B. Shunted blood from the left umbilical vein to the inferior vena cava
C. Allowed deoxygenated blood to bypass the liver
D. Allowed oxygenated blood to pass from the right atrium to the left atrium
D. Allowed oxygenated blood to pass from the right atrium to the left atrium
Rationale: The foramen ovale allowed most of the oxygenated blood entering the right atrium to pass into the left atrium, facilitating systemic circulation during fetal life.
What change occurs in the ductus venosus post-birth?
A. It remains open
B. It becomes a ligament
C. It merges with the inferior vena cava
D. It enlarges to support liver function
B. It becomes a ligament
Rationale: The ductus venosus closes and becomes a ligament after birth as the liver activates and takes over functions previously managed by the placenta.
Which factor contributes most to the functional closure of the ductus arteriosus?
A. Increase in pulmonary blood flow
B. High oxygen content in aortic blood
C. Decrease in right atrial pressure
D. Activation of the liver
B. High oxygen content in aortic blood
Rationale: The high oxygen content of aortic blood resulting from lung aeration at birth is the primary factor in closing the ductus arteriosus.
What is the primary purpose of the ductus venosus during fetal life?
A. Shunts blood from the right atrium to the left atrium
B. Connects the pulmonary artery to the descending aorta
C. Bypasses the lungs entirely
D. Allows oxygenated blood from the umbilical vein to bypass the liver and flow directly to the inferior vena cava
D. Allows oxygenated blood from the umbilical vein to bypass the liver and flow directly to the inferior vena cava
Rationale: The ductus venosus directs oxygenated blood from the umbilical vein to the inferior vena cava, bypassing the liver during fetal life.
Where is the foramen ovale located?
A. Between the right and left atrium
B. Between the left atrium and left ventricle
C. Between the right ventricle and pulmonary artery
D. Between the aorta and pulmonary artery
A. Between the right and left atrium
Rationale: The foramen ovale is located between the right and left atrium and shunts blood to bypass the pulmonary circulation during fetal life.
What is the purpose of the ductus arteriosus during fetal life?
A. Connects the pulmonary artery to the descending aorta, bypassing the lungs
B. Shunts blood from the right atrium to the left atrium
C. Connects the umbilical vein to the inferior vena cava
D. Allows oxygenated blood to bypass the liver
A. Connects the pulmonary artery to the descending aorta, bypassing the lungs
Rationale: The ductus arteriosus connects the pulmonary artery to the descending aorta, bypassing the lungs, which are not yet functional during fetal life.
What happens to the foramen ovale after birth?
A. It remains open to allow blood flow between the atria
B. It closes functionally within minutes after birth
C. It connects the left atrium to the left ventricle
D. It becomes part of the aorta
B. It closes functionally within minutes after birth
Rationale: The foramen ovale closes functionally within minutes after birth, stopping the shunting of blood between the atria.
What anatomical structures are connected by the ductus venosus?
A. Right atrium and left atrium
B. Pulmonary artery and descending aorta
C. Umbilical vein and inferior vena cava
D. Right ventricle and left ventricle
C. Umbilical vein and inferior vena cava
Rationale: The ductus venosus connects the umbilical vein to the inferior vena cava during fetal life.
Why is the ductus arteriosus important during fetal circulation?
A. It shunts blood to the liver
B. It connects the left and right ventricles
C. It bypasses the non-functional fetal lungs by connecting the pulmonary artery to the descending aorta
D. It allows blood to flow directly from the aorta to the umbilical artery
C. It bypasses the non-functional fetal lungs by connecting the pulmonary artery to the descending aorta
Rationale: The ductus arteriosus allows blood to bypass the non-functional fetal lungs by connecting the pulmonary artery to the descending aorta.
Which fetal shunt closes due to increased left atrial pressure after birth?
A. Foramen ovale
B. Ductus arteriosus
C. Ductus venosus
D. Umbilical vein
A. Foramen ovale
Rationale: The foramen ovale closes due to increased left atrial pressure as blood flow through the lungs increases after birth.
What is the role of the ductus venosus in fetal circulation?
A. It connects the pulmonary artery to the descending aorta
B. It shunts blood from the right atrium to the left atrium
C. It allows blood to flow from the left ventricle to the aorta
D. It allows oxygenated blood to bypass the liver and flow directly to the inferior vena cava
D. It allows oxygenated blood to bypass the liver and flow directly to the inferior vena cava
Rationale: The ductus venosus bypasses the liver, allowing oxygenated blood from the umbilical vein to flow directly to the inferior vena cava during fetal life.
How does the ductus arteriosus assist in fetal circulation?
A. It bypasses the lungs by connecting the pulmonary artery to the descending aorta
B. It connects the right and left atrium
C. It allows oxygenated blood to flow directly to the inferior vena cava
D. It shunts blood to the liver
A. It bypasses the lungs by connecting the pulmonary artery to the descending aorta
Rationale: The ductus arteriosus connects the pulmonary artery to the descending aorta, bypassing the lungs which are not yet functional during fetal life.
What happens to the ductus venosus after birth?
A. It remains open to assist in circulation
B. It closes and becomes a ligament
C. It enlarges to increase blood flow to the liver
D. It connects to the umbilical artery
B. It closes and becomes a ligament
The ductus venosus closes after birth, and it becomes a ligament as the liver takes over functions previously managed by the placenta.
Which fetal shunt allows oxygenated blood from the umbilical vein to bypass the liver and flow directly to the inferior vena cava?
A. Foramen ovale
B. Ductus arteriosus
C. Ductus venosus
D. Umbilical vein
C. Ductus venosus
Rationale: The ductus venosus allows oxygenated blood from the umbilical vein to bypass the liver and flow directly to the inferior vena cava.
How long does it typically take for the foramen ovale to close functionally after birth?
A. Within minutes
B. Within hours
C. Within days
D. Within weeks
A. Within minutes
Rationale: The foramen ovale closes functionally within minutes after birth, shunting blood between the right and left atrium to bypass pulmonary circulation during fetal life.
What is the primary function of the ductus arteriosus during fetal life?
A. Shunts blood from the right atrium to the left atrium
B. Connects the pulmonary artery to the descending aorta, bypassing the lungs
C. Allows blood to bypass the liver
D. Connects the umbilical vein to the inferior vena cava
B. Connects the pulmonary artery to the descending aorta, bypassing the lungs
Rationale: The ductus arteriosus connects the pulmonary artery to the descending aorta, bypassing the lungs during fetal life.
When does the ductus arteriosus typically close in healthy, full-term newborns?
A. Within minutes after birth
B. Within hours after birth
C. By 12–24 hours after birth
D. By 2–3 weeks after birth
C. By 12–24 hours after birth
Rationale: The ductus arteriosus typically closes by 12–24 hours after birth in healthy, full-term newborns, with permanent closure occurring by 2–3 weeks.
Which fetal shunt closes with the clamping of the umbilical cord to several minutes after birth?
A. Ductus venosus
B. Foramen ovale
C. Ductus arteriosus
D. Umbilical vein
A. Ductus venosus
Rationale: The ductus venosus closes with the clamping of the umbilical cord to several minutes after birth, as it is no longer needed for shunting blood.
What is the consequence of the closure of the foramen ovale after birth?
A. Blood bypasses the liver
B. Blood flows directly from the right atrium to the left atrium
C. Blood bypasses the pulmonary circulation
D. Blood is directed to the lungs for oxygenation
D. Blood is directed to the lungs for oxygenation
Rationale: The closure of the foramen ovale directs blood to the lungs for oxygenation, ending its role of shunting blood between the atria to bypass pulmonary circulation.
What happens to the ductus arteriosus within the first few weeks after birth?
A. It remains patent
B. It redirects blood to the liver
C. It permanently closes
D. It becomes a functional part of the pulmonary circulation
C. It permanently closes
Rationale: The ductus arteriosus closes by 12–24 hours after birth and undergoes permanent anatomical closure by 2–3 weeks in healthy, full-term newborns.
Which fetal shunt plays a role in protecting the lungs against circulatory overload during fetal life?
A. Foramen ovale
B. Ductus arteriosus
C. Ductus venosus
D. Umbilical vein
B. Ductus arteriosus
Rationale: The ductus arteriosus protects the lungs against circulatory overload during fetal life by shunting blood from the pulmonary artery to the descending aorta.
What is the normal range of respiratory rate in a newborn after respirations are established?
A. 20 to 40 breaths per minute
B. 30 to 60 breaths per minute
C. 40 to 70 breaths per minute
D. 50 to 80 breaths per minute
B. 30 to 60 breaths per minute
Rationale: After respirations are established in the newborn, the normal respiratory rate ranges from 30 to 60 breaths per minute.
Which of the following is a sign of respiratory distress in a newborn?
A. Regular, deep breathing
B. Expiratory grunting
C. Symmetric chest movements
D. Short periods of apnea (less than 15 seconds)
B. Expiratory grunting
Rationale: Expiratory grunting is a sign of respiratory distress in a newborn. Other signs include cyanosis, tachypnea, sternal retractions, and nasal flaring.
How long should a normal apneic period last in a newborn?
A. More than 15 seconds
B. Less than 15 seconds
C. More than 30 seconds
D. Less than 30 seconds
B. Less than 15 seconds
Rationale: Short periods of apnea lasting less than 15 seconds are considered normal in newborns.
What variation in respiratory rate is observed in newborns based on their activity level?
A. More active newborns have a lower respiratory rate
B. Activity level does not affect respiratory rate
C. Less active newborns have a higher respiratory rate
D. More active newborns have a higher respiratory rate
D. More active newborns have a higher respiratory rate
Rationale: The respiratory rate of a newborn varies according to their activity level, with more active newborns having a higher respiratory rate on average.
What should be observed in newborns’ chest movements during respirations?
A. Chest movements should be symmetric
B. Chest movements should be asymmetric
C. Chest movements should be labored
D. Chest movements should be rapid
A. Chest movements should be symmetric
Rationale: Respirations should not be labored, and chest movements should be symmetric in newborns.
What does periodic breathing in a newborn entail?
A. Cessation of breathing that lasts 5 to 10 seconds without changes in color or heart rate
B. Cessation of breathing that lasts more than 15 seconds
C. Rapid breathing without pauses
D. Labored breathing with cyanosis
A. Cessation of breathing that lasts 5 to 10 seconds without changes in color or heart rate
Rationale: Periodic breathing is the cessation of breathing that lasts 5 to 10 seconds without changes in color or heart rate and may be observed in newborns within the first few days of life.
Which condition requires further evaluation in a newborn experiencing apneic periods?
A. Apneic periods lasting less than 15 seconds with no changes in color or heart rate
B. Periodic breathing lasting 5 to 10 seconds
C. Shallow and irregular respirations
D. Apneic periods lasting more than 15 seconds with cyanosis and heart rate changes
D. Apneic periods lasting more than 15 seconds with cyanosis and heart rate changes
Rationale: Apneic periods lasting more than 15 seconds with cyanosis and heart rate changes require further evaluation.
Which of the following is NOT a sign of respiratory distress in a newborn?
A. Cyanosis
B. Tachypnea
C. Symmetric chest movements
D. Sternal retractions
C. Symmetric chest movements
Rationale: Symmetric chest movements are a normal finding, whereas cyanosis, tachypnea, expiratory grunting, sternal retractions, and nasal flaring are signs of respiratory distress.
What should be closely monitored in newborns exhibiting periodic breathing?
A. Respiratory rate only
B. Changes in color or heart rate
C. Apneic periods longer than 5 seconds
D. Level of activity
B. Changes in color or heart rate
Rationale: Newborns exhibiting periodic breathing should be closely monitored for changes in color or heart rate to ensure there are no complications.
What type of breathing is commonly observed in newborns during the first days of life?
A. Regular and deep breathing
B. Regular and shallow breathing
C. Irregular and deep breathing
D. Shallow and irregular breathing
D. Shallow and irregular breathing
Rationale: Newborns typically exhibit shallow and irregular breathing during the first days of life.
What is the significance of surfactant production in the lungs of a newborn?
A. It increases the respiratory rate
B. It decreases the respiratory rate
C. It stabilizes the heart rate
D. It maintains alveolar stability
D. It maintains alveolar stability
Rationale: Surfactant production in the lungs is critical for maintaining alveolar stability, preventing alveolar collapse.
How does the respiratory rate of a newborn vary?
A. It remains constant regardless of activity level
B. It varies according to the newborn’s activity level
C. It decreases with increased activity
D. It increases only during sleep
B. It varies according to the newborn’s activity level
Rationale: The respiratory rate of a newborn varies based on their activity level; the more active the newborn, the higher the respiratory rate.
What is a critical factor in the newborn’s lungs for preventing alveolar collapse?
A. Regular breathing patterns
B. Surfactant production
C. Symmetric chest movements
D. High respiratory rate
B. Surfactant production
Rationale: Surfactant production is crucial for maintaining alveolar stability and preventing alveolar collapse.
Which characteristic is NOT typical of newborn respirations in the first days of life?
A. Regular and deep breathing
B. Shallow and irregular breathing
C. Periodic breathing
D. Respiratory rate of 30–60 breaths per minute
A. Regular and deep breathing
Rationale: Regular and deep breathing is not typical of newborn respirations; shallow and irregular breathing is common in the first days of life.
What should be monitored closely in newborns exhibiting periodic breathing?
A. Changes in color or heart rate
B. Increased respiratory rate
C. Symmetric chest movements
D. Surfactant production levels
A. Changes in color or heart rate
Rationale: Periodic breathing is normal, but it requires close monitoring for changes in color or heart rate to ensure no complications arise.
Which of the following is NOT a reason why newborns are predisposed to heat loss?
A. Abundant subcutaneous fat
B. Thin skin
C. Blood vessels close to the surface
D. Immature temperature regulation mechanisms
A. Abundant subcutaneous fat
Rationale: Abundant subcutaneous fat is not a factor that predisposes newborns to heat loss. In fact, newborns lack subcutaneous fat, which contributes to their vulnerability to heat loss.
What factors predispose newborns to heat loss?
A. Thick skin, abundant subcutaneous fat, blood vessels far from the surface, and mature temperature regulation mechanisms
B. Thin skin, lack of subcutaneous fat, blood vessels close to the surface, and immature temperature regulation mechanisms
C. Thick skin, lack of subcutaneous fat, blood vessels far from the surface, and immature temperature regulation mechanisms
D. Thin skin, abundant subcutaneous fat, blood vessels close to the surface, and mature temperature regulation mechanisms
B. Thin skin, lack of subcutaneous fat, blood vessels close to the surface, and immature temperature regulation mechanisms
Rationale: Newborns are predisposed to heat loss due to their thin skin, lack of subcutaneous fat, blood vessels close to the surface, and immature temperature regulation mechanisms.
Which environmental condition makes newborns extremely vulnerable immediately after birth?
A. Both underheating and overheating
B. Only underheating
C. Only overheating
D. Humidity changes
A. Both underheating and overheating
Rationale: Newborns are extremely vulnerable to both underheating and overheating due to their limited ability to regulate their body temperature.
Why is obtaining a stable body temperature critical for a newborn’s survival?
A. To promote rapid growth
B. To increase metabolic rate
C. To enhance immune function
D. To promote an optimal transition to extrauterine life
D. To promote an optimal transition to extrauterine life
Rationale: A stable body temperature is crucial for a newborn’s survival to ensure a smooth transition from the intrauterine to the extrauterine environment.
What is the recommended initial method for maintaining a newborn’s body temperature?
A. Wrapping the newborn in multiple blankets
B. Using a radiant warmer
C. Skin-to-skin contact with their mothers
D. Placing the newborn in an incubator
C. Skin-to-skin contact with their mothers
Rationale: Skin-to-skin contact is recommended as the initial method for maintaining a newborn’s body temperature and is also effective in promoting successful breastfeeding.
What is the normal range of a newborn’s body temperature?
A. 95.0°F to 97.0°F (35.0°C to 36.0°C)
B. 96.8°F to 98.6°F (36.0°C to 37.0°C)
C. 97.9°F to 99.7°F (36.6°C to 37.6°C)
D. 98.0°F to 100.0°F (36.7°C to 37.8°C)
C. 97.9°F to 99.7°F (36.6°C to 37.6°C)
Rationale: The average temperature range for a newborn is 97.9°F to 99.7°F (36.6°C to 37.6°C).
What is the process of maintaining the balance between heat loss and heat production in the body called?
A. Metabolism
B. Thermoregulation
C. Homeostasis
D. Temperature stabilization
B. Thermoregulation
Rationale: Thermoregulation is the process of maintaining the balance between heat loss and heat production to maintain the body’s core internal temperature.
Compared to adults, how do newborns tolerate environmental temperature changes?
A. Newborns tolerate a wider range of temperatures
B. Newborns and adults tolerate temperature changes similarly
C. Newborns tolerate a narrower range of temperatures
D. Newborns are less affected by temperature changes
C. Newborns tolerate a narrower range of temperatures
Rationale: Newborns are extremely vulnerable to both underheating and overheating and tolerate a narrower range of environmental temperatures compared to adults.
Which method is recommended as the first line of treatment for hypothermia in newborns?
A. Placing the newborn in an incubator
B. Wrapping the newborn in warm blankets
C. Using a radiant warmer
D. Skin-to-skin contact with their mothers
D. Skin-to-skin contact with their mothers
Rationale: Skin-to-skin contact is recommended as the first line of treatment for hypothermia in newborns.
Why are newborns more dependent on their environment for maintaining body temperature immediately after birth?
A. They transition from a warm, moist intrauterine environment to a colder, drier extrauterine environment
B. They have a high metabolic rate
C. They produce more body heat
D. They have developed thermoregulation mechanisms
A. They transition from a warm, moist intrauterine environment to a colder, drier extrauterine environment
Rationale: Newborns are more dependent on their environment for maintaining body temperature immediately after birth due to the transition from a warm, moist intrauterine environment to a colder, drier extrauterine environment.
What role does an appropriate thermal environment play in a newborn’s survival?
A. It promotes rapid weight gain
B. It enhances immune function
C. It reduces the need for feeding
D. It is essential for maintaining a normal body temperature
D. It is essential for maintaining a normal body temperature
Rationale: An appropriate thermal environment is essential for maintaining a normal body temperature, which is critical for the survival of the newborn.
What characteristic of newborn skin predisposes them to heat loss?
A. Thick skin with deep blood vessels
B. Lack of blood vessels
C. Thin skin with blood vessels close to the surface
D. Excessive subcutaneous fat
C. Thin skin with blood vessels close to the surface
Rationale: Newborns have thin skin with blood vessels close to the surface, which predisposes them to heat loss.
Why are newborns unable to produce heat by shivering?
A. They have mature temperature regulation mechanisms
B. They lack shivering ability until 3 months old
C. They have excessive metabolic substrates
D. They have a low surface area-to-body mass ratio
B. They lack shivering ability until 3 months old
Rationale: Newborns cannot produce heat by shivering because they lack the ability to shiver until they are about 3 months old.
Which metabolic substrates are limited in newborns, predisposing them to heat loss?
A. Protein and calcium
B. Sodium and potassium
C. Vitamins and minerals
D. Glucose, glycogen, and fat
D. Glucose, glycogen, and fat
Rationale: Newborns have limited stores of metabolic substrates such as glucose, glycogen, and fat, which predispose them to heat loss.
What is the consequence of newborns having a large surface area-to-body mass ratio?
A. Enhanced ability to conserve heat
B. Improved temperature regulation
C. Increased heat loss
D. Decreased skin permeability to water
C. Increased heat loss
Rationale: Newborns have a large surface area-to-body mass ratio, which results in increased heat loss.
Which posture is difficult for newborns to use to conserve heat?
A. Supine position
B. Sitting position
C. Standing position
D. Fetal position
D. Fetal position
Rationale: Newborns have little ability to conserve heat by changing posture, such as assuming the fetal position, which helps reduce heat loss.
What environmental factors influence the transfer of heat in newborns?
A. Temperature, air speed, and water vapor pressure or humidity
B. Light, sound, and air pressure
C. Oxygen levels, CO2 levels, and ventilation
D. Nutritional intake, hydration, and exercise
A. Temperature, air speed, and water vapor pressure or humidity
Rationale: The transfer of heat in newborns depends on the temperature of the environment, air speed, and water vapor pressure or humidity.
Which mechanism accounts for the highest percentage of heat loss in newborns?
A. Conduction
B. Evaporation
C. Convection
D. Radiation
D. Radiation
Rationale: Radiation accounts for the highest percentage of heat loss in newborns, at 39%.
How does the evaporation of amniotic fluid affect a newborn’s temperature shortly after birth?
A. Increases the newborn’s temperature
B. Decreases the newborn’s temperature
C. Has no effect on the newborn’s temperature
D. Stabilizes the newborn’s temperature
B. Decreases the newborn’s temperature
Rationale: The evaporation of amniotic fluid rapidly cools the newborn’s body, decreasing its temperature within minutes after birth.
What percentage of heat loss in newborns is due to convection?
A. 13%
B. 24%
C. 34%
D. 39%
C. 34%
Rationale: Convection accounts for 34% of heat loss in newborns.
What is a key nursing intervention to prevent heat loss in newborns?
A. Encouraging physical activity
B. Limiting fluid intake
C. Providing an appropriate thermal environment
D. Administering antibiotics
C. Providing an appropriate thermal environment
Rationale: Prevention of heat loss is a key nursing intervention, which involves providing an appropriate thermal environment to maintain the newborn’s body temperature.
Why are newborns predisposed to heat loss due to their skin characteristics?
A. Thick skin and deep blood vessels
B. Subcutaneous fat and low metabolic rate
C. Thin skin and blood vessels close to the surface
D. Mature temperature regulation mechanisms
C. Thin skin and blood vessels close to the surface
Rationale: Newborns have thin skin and blood vessels close to the surface, which predisposes them to heat loss.
What factor contributes to newborns’ inability to produce heat?
A. Lack of shivering ability and limited energy stores
B. Excessive voluntary muscle activity
C. Thick layer of subcutaneous fat
D. Ability to change posture to conserve heat
A. Lack of shivering ability and limited energy stores
Rationale: Newborns are unable to produce heat through shivering due to their lack of shivering ability until they are about 3 months old and their limited energy stores.
What characteristic of newborns leads to increased heat loss relative to body weight?
A. High metabolic rate
B. Small surface area-to-body mass ratio
C. Large body surface area relative to body weight
D. Excessive subcutaneous fat
C. Large body surface area relative to body weight
Rationale: Newborns have a large body surface area relative to their body weight, which contributes to increased heat loss.
What is a consequence of newborns’ lack of subcutaneous fat?
A. Enhanced ability to produce heat
B. Decreased heat loss
C. Limited insulation and increased heat loss
D. Improved temperature regulation
C. Limited insulation and increased heat loss
Rationale: The lack of subcutaneous fat in newborns means they have limited insulation, which increases their heat loss.
Which factor limits a newborn’s ability to communicate their temperature needs?
A. Limited energy stores
B. Large body surface area
C. Lack of shivering ability
D. Inability to adjust clothing or blankets
D. Inability to adjust clothing or blankets
Rationale: Newborns cannot adjust their own clothing or blankets and cannot communicate their temperature needs, making them dependent on caregivers to maintain their body temperature.
occurs when moisture from lungs and skin is lost to the air
a. evaporation
b. convention
c. conduction
d. radiation
a. evaporation
Which of the following is the correct way to prevent evaporation from occurring?
a. by drying the baby immediately after delivery
b. by keeping infants away from open windows and cold air sources
c. by warming surfaces and instruments prior to them touching the infant
d. by keeping babies away from unnecessary cooling devices and drafts
a. by drying the baby immediately after delivery
warm body heat is lost to a source of cooler air
a. evaporation
b. convention
c. conduction
d. radiation
b. convention
Which of the following is the correct way to prevent convection from occurring?
a. by drying the baby immediately after delivery
b. by keeping infants away from open windows and cold air sources
c. by warming surfaces and instruments prior to them touching the infant
d. by keeping babies away from unnecessary cooling devices and drafts
b. by keeping infants away from open windows and cold air sources
direct contact with a cooler object, pulling the body warmth away
a. evaporation
b. convention
c. conduction
d. radiation
c. conduction
Which of the following is the correct way to prevent conduction from occurring?
a. by drying the baby immediately after delivery
b. by keeping infants away from open windows and cold air sources
c. by warming surfaces and instruments prior to them touching the infant
d. by keeping babies away from unnecessary cooling devices and drafts
c. by warming surfaces and instruments prior to them touching the infant
heat lost to a cooler object such as a fan or air conditioner
a. evaporation
b. convention
c. conduction
d. radiation
d. radiation
Which of the following is the correct way to prevent radiation from occurring?
a. by drying the baby immediately after delivery
b. by keeping infants away from open windows and cold air sources
c. by warming surfaces and instruments prior to them touching the infant
d. by keeping babies away from unnecessary cooling devices and drafts
d. by keeping babies away from unnecessary cooling devices and drafts
Which method is effective in preventing heat loss through conduction when placing a newborn on a cold mattress?
A. Leaving the newborn uncovered
B. Using a warmed blanket to cover the cold mattress
C. Increasing the room temperature
D. Placing the newborn on a metal scale
B. Using a warmed blanket to cover the cold mattress
Rationale: Using a warmed blanket to cover a cold mattress helps prevent heat loss through conduction by creating a warm barrier between the newborn and the cold surface.
Why should cold objects be avoided when in contact with a newborn?
A. To prevent dehydration
B. To increase oxygen saturation
C. To prevent heat loss through conduction
D. To enhance metabolic rate
C. To prevent heat loss through conduction
Rationale: Cold objects should be avoided when in contact with a newborn to prevent heat loss through conduction.
What impact does touching a newborn with cold hands have on the newborn’s body temperature?
A. It increases the newborn’s body temperature
B. It causes heat loss through conduction
C. It stabilizes the newborn’s body temperature
D. It has no effect on the newborn’s body temperature
B. It causes heat loss through conduction
Rationale: Touching a newborn with cold hands causes heat loss through conduction as the cold hands transfer heat away from the newborn’s body.
What common practice helps prevent heat loss through conduction by maintaining direct contact between the newborn and the mother?
A. Skin-to-skin contact with the mother
B. Placing the newborn in an incubator
C. Wrapping the newborn in multiple blankets
D. Using a radiant warmer
A. Skin-to-skin contact with the mother
Rationale: Skin-to-skin contact with the mother helps prevent heat loss through conduction by maintaining direct, warm contact.
How can heat loss through conduction be prevented when handling a newborn?
A. Using a fan to circulate warm air
B. Increasing room temperature to 80°F (26.7°C)
C. Allowing the newborn to stay uncovered for a short period
D. Using a warmed cloth diaper or blanket to cover any cold surface touching the newborn
D. Using a warmed cloth diaper or blanket to cover any cold surface touching the newborn
Rationale: Using a warmed cloth diaper or blanket to cover any cold surface that touches the newborn helps prevent heat loss through conduction.
Which situation exemplifies heat loss through conduction in a newborn?
A. Placing the newborn on a cold metal scale
B. Wrapping the newborn in a warm blanket
C. Placing the newborn in a warm incubator
D. Using a radiant warmer
A. Placing the newborn on a cold metal scale
Rationale: Placing the newborn on a cold metal scale results in heat loss through conduction, as the newborn’s body surface comes into direct contact with the cold surface.
What is the primary mechanism of heat transfer involved in conduction?
A. Transfer of heat through air
B. Transfer of heat through radiation
C. Transfer of heat through convection
D. Transfer of heat from one object to another in direct contact
D. Transfer of heat from one object to another in direct contact
Rationale: Conduction involves the transfer of heat from one object to another when the two objects are in direct contact with each other.
What is the definition of convection in the context of newborn heat loss?
A. Transfer of heat from the body surface to another object in direct contact
B. Flow of heat from the body surface to cooler surrounding air or to air circulating over a body surface
C. Transfer of heat through radiation
D. Loss of heat through evaporation
B. Flow of heat from the body surface to cooler surrounding air or to air circulating over a body surface
Rationale: Convection involves the flow of heat from the body surface to cooler surrounding air or to air circulating over a body surface.
Which of the following is an example of convection-related heat loss in newborns?
A. A cool breeze flowing over the newborn
B. Placing the newborn on a cold mattress
C. Covering the newborn with a warm blanket
D. Skin-to-skin contact with the mother
A. A cool breeze flowing over the newborn
Rationale: A cool breeze that flows over the newborn is an example of convection-related heat loss.
What preventive measure can be taken to reduce heat loss through convection?
A. Placing the newborn on a metal scale
B. Using a radiant warmer
C. Keeping the newborn out of direct cool drafts such as open doors, windows, fans, and air conditioners
D. Leaving the newborn uncovered
C. Keeping the newborn out of direct cool drafts such as open doors, windows, fans, and air conditioners
Rationale: To prevent heat loss by convection, it is important to keep the newborn out of direct cool drafts in the environment.
How can working inside an isolette help prevent heat loss through convection?
A. It increases the humidity around the newborn
B. It minimizes the opening of portholes that allow cold air to flow inside
C. It exposes the newborn to warmer air currents
D. It reduces the need for clothing and blankets
B. It minimizes the opening of portholes that allow cold air to flow inside
Rationale: Working inside an isolette and minimizing the opening of portholes helps prevent cold air from flowing inside, reducing heat loss through convection.
Why should oxygen or humidified air be warmed before coming in contact with the newborn?
A. To increase oxygen saturation
B. To prevent heat loss through convection
C. To reduce the newborn’s metabolic rate
D. To enhance respiratory function
B. To prevent heat loss through convection
Rationale: Warming any oxygen or humidified air that comes in contact with the newborn helps prevent heat loss through convection.
What is an effective method to reduce the newborn’s exposed surface area and provide external insulation?
A. Using a fan to circulate warm air
B. Using clothing and blankets in isolettes
C. Placing the newborn in a cool room
D. Allowing the newborn to stay uncovered
B. Using clothing and blankets in isolettes
Rationale: Using clothing and blankets in isolettes is an effective means of reducing the newborn’s exposed surface area and providing external insulation.
How should a newborn be transported to the nursery to prevent heat loss through convection?
A. Carried in a caregiver’s arms
B. Placed on a metal scale
C. Transported in a warmed isolette
D. Wrapped in a single blanket
C. Transported in a warmed isolette
Rationale: Transporting the newborn to the nursery in a warmed isolette helps maintain warmth and reduces exposure to cool air, preventing heat loss through convection.
What is the primary mechanism of heat loss through evaporation?
A. Transfer of heat through direct contact
B. Flow of heat through air currents
C. Loss of heat when a liquid is converted to vapor
D. Transfer of heat through radiation
C. Loss of heat when a liquid is converted to vapor
Rationale: Evaporation involves the loss of heat when a liquid, such as amniotic fluid or sweat, is converted to vapor.
Which type of evaporative loss occurs without the individual’s awareness?
A. Sensible loss
B. Insensible loss
C. Radiative loss
D. Conductive loss
B. Insensible loss
Rationale: Insensible evaporative loss occurs from skin and respiration without the individual’s awareness.
How can heat loss through evaporation be prevented immediately after birth?
A. Placing the newborn on a cold surface
B. Leaving the newborn uncovered
C. Allowing amniotic fluid to evaporate naturally
D. Drying the newborn with warmed blankets and placing a cap on their head
D. Drying the newborn with warmed blankets and placing a cap on their head
Rationale: Drying the newborn with warmed blankets and placing a cap on their head immediately after birth helps prevent heat loss through evaporation.
What factors influence sensible evaporative heat loss?
A. Air speed and absolute humidity of the air
B. Room temperature and light intensity
C. Noise levels and air pressure
D. Oxygen saturation and CO2 levels
A. Air speed and absolute humidity of the air
Rationale: Sensible evaporative heat loss depends on the air speed and absolute humidity of the air.
When does evaporative heat loss occur in newborns?
A. When placed in a warm isolette
B. When covered with amniotic fluid or during bathing
C. When wrapped in warm blankets
D. When in skin-to-skin contact with the mother
B. When covered with amniotic fluid or during bathing
Rationale: Evaporative heat loss occurs when the newborn is covered with amniotic fluid or during bathing as the fluid evaporates into the air.
What is an effective measure to prevent heat loss through evaporation after bathing a newborn?
A. Leaving the newborn wet to air dry
B. Drying the newborn with a towel immediately after bathing
C. Placing the newborn in front of a fan
D. Using cold water for bathing
B. Drying the newborn with a towel immediately after bathing
Rationale: Drying the newborn immediately after bathing with a towel helps prevent heat loss through evaporation.
Why is it important to promptly change wet linens, clothes, or diapers in newborns?
A. To increase their comfort
B. To reduce the risk of infection
C. To reduce heat loss and prevent chilling
D. To enhance skin hydration
C. To reduce heat loss and prevent chilling
Rationale: Promptly changing wet linens, clothes, or diapers helps reduce heat loss through evaporation and prevents chilling.
What is the primary mechanism of heat loss through radiation?
A. Transfer of heat through direct contact
B. Flow of heat through air currents
C. Loss of heat when a liquid is converted to vapor
D. Loss of body heat to cooler, solid surfaces that are in proximity but not in direct contact
D. Loss of body heat to cooler, solid surfaces that are in proximity but not in direct contact
Rationale: Radiation involves the loss of body heat to cooler, solid surfaces that are nearby but not in direct contact with the newborn.
Which factor does NOT influence the amount of heat loss through radiation?
A. Humidity of the air
B. Size of the cold surface area
C. Surface temperature of the newborn’s body
D. Temperature of the receiving surface area
A. Humidity of the air
Rationale: The amount of heat loss through radiation depends on the size of the cold surface area, the surface temperature of the newborn’s body, and the temperature of the receiving surface area, but not the humidity of the air.
What example illustrates heat loss through radiation in a newborn?
A. Placing the newborn on a cold mattress
B. Drying the newborn after bathing
C. Placing a newborn in a single-wall isolette next to a cold window
D. Covering the newborn with a warm blanket
C. Placing a newborn in a single-wall isolette next to a cold window
Rationale: Placing a newborn in a single-wall isolette next to a cold window results in heat loss through radiation.
How can heat loss through radiation be prevented in newborns?
A. Leaving the newborn in a cool room
B. Keeping cribs and isolettes away from outside walls, cold windows, and air conditioners
C. Placing the newborn on a metal scale
D. Allowing the newborn to stay uncovered
B. Keeping cribs and isolettes away from outside walls, cold windows, and air conditioners
Rationale: To reduce heat loss through radiation, cribs and isolettes should be kept away from outside walls, cold windows, and air conditioners.
What type of warmer is recommended for transporting newborns to reduce heat loss?
A. Open bed with no heat source
B. Metal scale
C. Cold mattress
D. Warmed transporter
D. Warmed transporter
Rationale: Using a warmed transporter, which is an enclosed isolette on wheels, helps reduce heat loss during the transportation of newborns.
What is a radiant warmer, and how does it help in reducing heat loss in newborns?
A. An open bed with a radiant heat source above
B. A closed incubator with no heat source
C. A metal scale with warming capability
D. A warm blanket wrapped around the newborn
A. An open bed with a radiant heat source above
Rationale: A radiant warmer is an open bed with a radiant heat source above, which helps reduce heat loss and allows healthcare providers to perform procedures and treatments on the newborn.
Which practice helps reduce heat loss through radiation during procedures on newborns?
A. Placing the newborn on a metal scale
B. Allowing the newborn to stay uncovered
C. Placing the newborn next to a cold window
D. Using radiant warmers when performing procedures
D. Using radiant warmers when performing procedures
Rationale: Using radiant warmers when performing procedures on newborns helps reduce heat loss through radiation by providing a warm environment.
Which of the following statements accurately describes the newborn’s bilirubin metabolism after birth?
A. The placenta continues to aid the liver in bilirubin clearance until one week post-delivery.
B. The newborn’s liver must fully take over bilirubin metabolism immediately after birth.
C. Conjugated bilirubin is stored in the liver instead of being excreted.
D. Bilirubin metabolism is unnecessary in the newborn due to a reduced breakdown of red blood cells.
B. The newborn’s liver must fully take over bilirubin metabolism immediately after birth.
Rationale: After birth, the newborn’s liver assumes full responsibility for bilirubin metabolism as the placenta is no longer involved.
What process allows bilirubin to be excreted in the bile?
A. Bilirubin undergoes oxidation in the liver.
B. It is conjugated in the liver, becoming water-soluble.
C. Bilirubin is metabolized by the placenta before excretion.
D. Unconjugated bilirubin is directly excreted in bile.
B. It is conjugated in the liver, becoming water-soluble.
Rationale: Bilirubin is taken up by liver cells and converted into a water-soluble, conjugated form before being excreted in bile.
A newborn’s unconjugated bilirubin levels remain elevated after birth. Which physiological process is most likely impaired?
A. Breakdown of red blood cells
B. Bilirubin transport in plasma
C. Conjugation of bilirubin in the liver
D. Excretion of bile from the intestines
C. Conjugation of bilirubin in the liver
Rationale: The newborn’s liver may have difficulty conjugating bilirubin, preventing its conversion to the water-soluble form needed for excretion.
Which of the following contributes to the production of bilirubin in newborns?
A. Increased production of bile salts
B. Breakdown of maternal red blood cells
C. Breakdown of the newborn’s red blood cells
D. Insufficient bilirubin metabolism during pregnancy
C. Breakdown of the newborn’s red blood cells
Rationale: Bilirubin is produced as a byproduct of red blood cell breakdown, which occurs as the newborn transitions to extrauterine life.
A nurse is caring for a 2-day-old newborn with visible jaundice. Which action best supports bilirubin excretion?
A. Encouraging frequent feedings
B. Swaddling to conserve body heat
C. Initiating phototherapy immediately
D. Monitoring stool color and consistency
A. Encouraging frequent feedings
Rationale: Frequent feedings promote gastrointestinal motility and stool excretion, aiding in the elimination of conjugated bilirubin through bile.
What is the primary source of bilirubin production in the newborn?
A. Maternal bilirubin transfer through the placenta
B. Breakdown of fetal white blood cells
C. Conversion of heme from the gastrointestinal system
D. Hemolysis of erythrocytes after birth
D. Hemolysis of erythrocytes after birth
Rationale: The hemolysis of erythrocytes is the main source of bilirubin in newborns, as fewer RBCs are needed for extrauterine life.
Which of the following characteristics of indirect bilirubin differentiates it from direct bilirubin?
A. It is water-soluble and excreted in bile.
B. It is excreted unchanged through the kidneys.
C. It is directly processed by the gastrointestinal tract.
D. It is fat-soluble and requires enzymatic conversion in the liver.
D. It is fat-soluble and requires enzymatic conversion in the liver.
Rationale: Indirect bilirubin is fat-soluble and requires enzymes and proteins in the liver to convert it to water-soluble, conjugated bilirubin.
Which of the following processes occurs first in the metabolism of bilirubin in the newborn?
A. Bilirubin is excreted in the feces.
B. Unconjugated bilirubin is converted to conjugated bilirubin.
C. Heme from hemoglobin is converted to bilirubin.
D. Bilirubin enters the gastrointestinal system via bile/
C. Heme from hemoglobin is converted to bilirubin.
Rationale: The metabolism of bilirubin begins with the breakdown of heme in hemoglobin into bilirubin following RBC hemolysis.
Why is the conjugation of bilirubin critical for newborns?
A. Conjugated bilirubin is necessary for the oxygen transport system.
B. Conjugation allows bilirubin to become fat-soluble for energy storage.
C. Conjugation makes bilirubin water-soluble for excretion.
D. Conjugated bilirubin increases the breakdown of hemoglobin.
C. Conjugation makes bilirubin water-soluble for excretion.
Rationale: Conjugation in the liver converts fat-soluble, unconjugated bilirubin into water-soluble, conjugated bilirubin, allowing it to be excreted through bile and feces.
A nurse is assessing a newborn with elevated levels of indirect bilirubin. Which physiological process is most likely delayed?
A. Conjugation of bilirubin in the liver
B. Hemolysis of erythrocytes
C. Excretion of bilirubin by the kidneys
D. Entry of bilirubin into the gastrointestinal system
A. Conjugation of bilirubin in the liver
Rationale: Elevated indirect bilirubin suggests the newborn’s liver is not efficiently conjugating bilirubin to its direct, water-soluble form for excretion.
A nurse is caring for a 3-day-old newborn who appears slightly jaundiced and has a bilirubin level of 12 mg/dL. The nurse understands that which of the following factors contributes to increased bilirubin production in newborns?
A. Decreased breakdown of fetal red blood cells after birth
B. Immature liver metabolic pathways limiting bilirubin conjugation
C. Slower gastrointestinal motility in the first 24 hours after birth
D. Reduced production of bilirubin compared to adults
B. Immature liver metabolic pathways limiting bilirubin conjugation
Rationale: Newborns have increased bilirubin production due to polycythemia and increased RBC turnover. However, the immaturity of liver pathways limits the ability to conjugate bilirubin quickly, contributing to hyperbilirubinemia. Options A and D are incorrect because newborns experience increased, not decreased, RBC breakdown and higher bilirubin production compared to adults. Option C can contribute to jaundice but is not the primary factor.
Which of the following explains why bilirubin levels in newborns are significantly higher than in adults?
A. Newborns have increased RBC turnover and immature liver pathways.
B. Newborns have a faster rate of liver conjugation due to polycythemia.
C. Adult bilirubin production is suppressed by greater RBC stability.
D. Newborns excrete bilirubin at a higher rate due to rapid bile secretion.
A. Newborns have increased RBC turnover and immature liver pathways.
Rationale: Newborns produce bilirubin at a higher rate due to polycythemia (higher RBC count) and increased RBC turnover. Their liver pathways are immature, limiting their ability to conjugate and excrete bilirubin efficiently. Options A and D are incorrect as they misrepresent the newborn’s physiological processes. Option C is not directly relevant.
A nurse is educating a new mother about hyperbilirubinemia in newborns. Which factors increase the risk of elevated bilirubin levels? (SATA)
A. Immature liver metabolic pathways
B. Increased RBC turnover
C. Decreased bilirubin production in the first 14 days of life
D. Polycythemia in newborns
E. Rapid maturation of liver enzymes by 24 hours after birth
A. Immature liver metabolic pathways
B. Increased RBC turnover
D. Polycythemia in newborns
Rationale: Newborns are at risk for elevated bilirubin due to immature liver pathways, increased RBC turnover, and relative polycythemia, all of which contribute to higher bilirubin production. Option C is incorrect because bilirubin production is higher in newborns than in adults. Option E is incorrect because liver enzyme maturation is slow, not rapid, in the neonatal period.
A 2-day-old term newborn presents with visible jaundice, yellowing of the sclera, and a total bilirubin level of 16 mg/dL. Which of the following is the most concerning complication if this condition is left untreated?
A. Hypoglycemia
B. Bilirubin encephalopathy
C. Respiratory distress syndrome
D. Necrotizing enterocolitis
B. Bilirubin encephalopathy
Rationale: Extremely elevated bilirubin levels in the first week of life can lead to bilirubin encephalopathy, a permanent form of brain damage. The other options are not directly associated with untreated hyperbilirubinemia.
Which of the following factors places a newborn at increased risk for developing jaundice?
A. Female gender
B. Maternal hypertension during pregnancy
C. Trauma at birth resulting in cephalohematoma
D. Decreased red blood cell turnover
C. Trauma at birth resulting in cephalohematoma
Rationale: Birth trauma such as cephalohematoma increases the risk of jaundice due to increased bilirubin production from RBC breakdown. Female gender and maternal hypertension are not directly linked, and red blood cell turnover is typically increased in newborns, contributing to bilirubin production.
Which risk factors can lead to increased bilirubin levels in a newborn? (SATA)
A. Polycythemia
B. Breastfeeding
C. Hypothyroidism
D. Frequent feedings
E. TORCH infections
A. Polycythemia
B. Breastfeeding
C. Hypothyroidism
E. TORCH infections
Rationale: Polycythemia, breastfeeding (due to decreased bilirubin conjugation), hypothyroidism, and intrauterine infections such as TORCH can all contribute to increased bilirubin levels. Frequent feedings, however, aid in bilirubin excretion and are not a risk factor.
The nurse is explaining the classification of newborn jaundice to a parent. Which of the following is classified as impaired bilirubin excretion?
A. Polycythemia
B. Physiologic jaundice
C. Biliary atresia
D. Delayed cord clamping
C. Biliary atresia
Rationale: Impaired bilirubin excretion occurs in conditions such as biliary atresia, where bile cannot be excreted properly. Polycythemia and delayed cord clamping result in bilirubin overproduction, while physiologic jaundice is caused by decreased bilirubin conjugation.
A nurse is caring for a preterm newborn who is breastfed and has visible jaundice. Blood tests reveal elevated indirect bilirubin. The nurse should anticipate which of the following interventions?
A. Administer phototherapy
B. Begin iron supplementation
C. Increase the newborn’s caloric intake with formula supplementation
D. Administer intravenous antibiotics
A. Administer phototherapy
Rationale: Phototherapy is the treatment of choice for elevated indirect bilirubin levels. Increasing caloric intake may help in mild cases, but phototherapy is required when levels are high. Iron supplementation and antibiotics are not indicated for hyperbilirubinemia.
Which of the following are causes of bilirubin overproduction in newborns? (SATA)
A. Blood group incompatibility
B. Delayed cord clamping
C. Biliary obstruction
D. Cephalohematoma
E. Breast milk jaundice
A. Blood group incompatibility
B. Delayed cord clamping
D. Cephalohematoma
Rationale: Blood group incompatibility, delayed cord clamping, and cephalohematoma are all causes of bilirubin overproduction. Biliary obstruction is a cause of impaired excretion, and breast milk jaundice is related to decreased conjugation.
A newborn with visible jaundice is diagnosed with biliary atresia. Which of the following explains the pathophysiology of this condition?
A. Overproduction of bilirubin due to delayed cord clamping
B. Decreased bilirubin conjugation due to immature liver enzymes
C. Obstruction of bile flow preventing bilirubin excretion
D. Increased bilirubin due to cephalohematoma
C. Obstruction of bile flow preventing bilirubin excretion
Rationale: Biliary atresia causes an obstruction in bile flow, impairing bilirubin excretion. The other options describe different mechanisms of jaundice.
A newborn of Asian descent presents with visible jaundice on day 2 of life. Which of the following factors contributes to this newborn’s increased risk?
A. Polycythemia
B. Prematurity
C. Hypothyroidism
D. Ethnicity
D. Ethnicity
Rationale: Asian ethnicity is a known risk factor for jaundice. While polycythemia and prematurity are also risk factors, there is no indication of either in this scenario.
What is the primary mechanism of jaundice in hypothyroid newborns?
A. Decreased bilirubin conjugation
B. Overproduction of bilirubin
C. Impaired bilirubin excretion
D. Increased bilirubin reabsorption in the intestines
A. Decreased bilirubin conjugation
Rationale: Hypothyroidism contributes to jaundice by decreasing the liver’s ability to conjugate bilirubin.
Which of the following complications are associated with untreated hyperbilirubinemia in newborns? (SATA)
A. Bilirubin encephalopathy
B. Cerebral palsy
C. Hearing loss
D. Necrotizing enterocolitis
E. Brain damage
A. Bilirubin encephalopathy
B. Cerebral palsy
C. Hearing loss
E. Brain damage
Rationale: Untreated hyperbilirubinemia can result in complications such as bilirubin encephalopathy, cerebral palsy, hearing loss, and brain damage. Necrotizing enterocolitis is unrelated.
A newborn develops jaundice due to breast milk jaundice. What is the underlying cause?
A. Overproduction of bilirubin
B. Impaired bilirubin excretion
C. Decreased bilirubin conjugation
D. Increased RBC turnover
C. Decreased bilirubin conjugation
Rationale: Breast milk jaundice is caused by decreased bilirubin conjugation due to substances in the milk that inhibit the conjugation process.
Which of the following drugs can contribute to impaired bilirubin excretion in newborns?
A. Aspirin
B. Diazepam (Valium)
C. Acetaminophen
D. Sulfa antibiotics
E. Erythromycin
A. Aspirin
C. Acetaminophen
D. Sulfa antibiotics
Rationale: Aspirin, acetaminophen, and sulfa antibiotics are known to impair bilirubin excretion.
Which condition involves impaired bilirubin excretion due to a chromosomal abnormality?
A. Cephalohematoma
B. Trisomy 21
C. TORCH infection
D. Delayed cord clamping
B. Trisomy 21
Rationale: Trisomy 21 (Down syndrome) is a chromosomal abnormality associated with impaired bilirubin excretion.
A newborn with a history of TORCH infection is found to have elevated bilirubin levels. What is the likely cause of this newborn’s jaundice?
A. Overproduction of bilirubin
B. Impaired bilirubin excretion
C. Decreased bilirubin conjugation
D. Breast milk jaundice
A. Overproduction of bilirubin
Rationale: TORCH infections can cause hemolysis, leading to overproduction of bilirubin.
Which nursing action is most important when caring for a newborn with elevated bilirubin levels?
A. Monitor stool color and consistency
B. Swaddle the newborn to maintain warmth
C. Avoid exposing the newborn to sunlight
D. Ensure frequent feedings to promote excretion
D. Ensure frequent feedings to promote excretion
Rationale: Frequent feedings promote gastrointestinal motility and bilirubin excretion through feces.
Which newborn is at the highest risk for developing jaundice?
A. A term newborn with no complications who was breastfed within the first hour of life
B. A preterm newborn delivered via cesarean section with maternal gestational diabetes
C. A term newborn with delayed cord clamping and no evidence of bruising during birth
D. A term newborn born to a mother with blood type O and no evidence of hemolytic disease
B. A preterm newborn delivered via cesarean section with maternal gestational diabetes
Rationale: Prematurity, maternal gestational diabetes, and the likelihood of an immature liver place this newborn at the highest risk for jaundice. The other options either describe lower-risk scenarios or lack contributing factors.
A nurse is educating a parent about bilirubin metabolism in newborns. Which of the following explains the role of the liver in bilirubin excretion?
A. The liver stores bilirubin until it is needed for energy.
B. The liver breaks down conjugated bilirubin into its components.
C. The liver converts unconjugated bilirubin into conjugated bilirubin for excretion.
D. The liver absorbs bilirubin directly from the intestines for recycling.
C. The liver converts unconjugated bilirubin into conjugated bilirubin for excretion.
Rationale: The liver’s primary role in bilirubin metabolism is to convert unconjugated bilirubin (fat-soluble) into conjugated bilirubin (water-soluble), allowing it to be excreted via bile into the gastrointestinal system. The other options do not accurately describe the liver’s function in bilirubin metabolism.
A nurse is caring for a 36-hour-old newborn with visible jaundice. The newborn was delivered at 34 weeks’ gestation via vaginal birth and had significant bruising on the scalp due to vacuum-assisted delivery. Which of the following are likely contributing factors to the newborn’s jaundice?
A. Sepsis and immature liver
B. Blood incompatibility and prematurity
C. Delayed feeding and maternal diabetes
D. Bruising during birth and prematurity
D. Bruising during birth and prematurity
Rationale: Bruising during birth leads to increased red blood cell breakdown, and prematurity contributes to an immature liver, both of which increase the risk of jaundice. There is no evidence in the scenario to suggest blood incompatibility, sepsis, or maternal diabetes.
Which of the following are common causes of jaundice in newborns? (SATA)
A. Immature liver
B. Delayed feeding
C. Inadequate oxygenation at birth
D. Increased red blood cell breakdown
E. Sepsis
A. Immature liver
B. Delayed feeding
D. Increased red blood cell breakdown
E. Sepsis
Rationale: Jaundice in newborns is commonly caused by an immature liver, delayed feeding, increased red blood cell breakdown, and sepsis. Inadequate oxygenation is not a primary cause of jaundice but may contribute to other complications.
A nurse is teaching new parents about the importance of gut colonization in their newborn. Which statement by the parents demonstrates accurate understanding?
A. “Colonization of the gut happens before birth and helps with vitamin K production.”
B. “Our baby’s sterile gut will be colonized by bacteria after birth, which is necessary for vitamin K production.”
C. “Bacteria colonize the gut only if formula feeding is used.”
D. “Gut colonization is not necessary for digestion, but it does aid in immunity.”
B. “Our baby’s sterile gut will be colonized by bacteria after birth, which is necessary for vitamin K production.”
Rationale: A newborn’s gut is sterile at birth and becomes colonized by bacteria after delivery. This colonization is essential for the production of vitamin K, which plays a critical role in blood clotting, and for aiding digestion. Colonization depends on oral intake, regardless of whether it is breast milk or formula. Gut colonization is also critical for digestion and immunity.
A 2-day-old newborn is being assessed in the nursery. The nurse knows the newborn’s intestinal mucosal barrier is immature and is counseling the parents on protective measures. Which of the following should the nurse emphasize to reduce the risk of intestinal inflammation?
A. Provide exclusive breast milk feeding.
B. Delay initial feeding for 48 hours.
C. Use formula exclusively to promote faster colonization.
D. Supplement with vitamin K injections daily.
A. Provide exclusive breast milk feeding.
Rationale: Breast milk contains antibodies, viable leukocytes, and other protective substances that help strengthen the immature intestinal mucosal barrier, reducing the risk of inflammation. Delaying feeding would delay gut colonization, and formula lacks the immunologic properties of breast milk. Vitamin K injections are administered at birth but do not replace nutrition.
Which factors influence the colonization of the newborn’s gut after birth? (SATA)
A. Oral intake of breast milk or formula
B. Exposure to environmental microbes
C. Mechanical transfer from the mother
D. Delayed gut mucosal barrier maturation
E. Skin-to-skin contact with parents
A. Oral intake of breast milk or formula
B. Exposure to environmental microbes
C. Mechanical transfer from the mother
E. Skin-to-skin contact with parents
Rationale: Colonization of the newborn’s gut is influenced by oral intake, environmental exposure, mechanical transfer of microbes from the mother, and skin-to-skin contact. Delayed mucosal barrier maturation is a characteristic of the neonatal gut but does not directly influence colonization patterns.
Why is gut colonization important for the newborn?
A. It prevents the need for vitamin K supplementation.
B. It ensures proper digestion and prevents allergic reactions.
C. It aids in the production of vitamin K and supports immune defenses.
D. It speeds up the maturation of the mucosal barrier.
C. It aids in the production of vitamin K and supports immune defenses.
Rationale: Gut colonization is essential for the production of vitamin K and helps support the newborn’s immature intestinal defense system by strengthening the mucosal barrier against harmful substances.
A preterm newborn is being fed formula due to maternal breastfeeding challenges. The nurse explains that formula-fed infants are at increased risk for what complications related to gut colonization?
A. Inflammatory and allergic reactions
B. Delayed vitamin D synthesis
C. Impaired iron absorption
D. Faster development of the mucosal barrier
A. Inflammatory and allergic reactions
Rationale: Formula-fed infants lack the protective antibodies and leukocytes present in breast milk, which makes them more susceptible to inflammation and allergic reactions due to the immature mucosal barrier.
Which of the following are components of breast milk that protect the newborn’s mucosal barrier? (SATA)
A. Antibodies
B. Leukocytes
C. Toxins
D. Vitamin K
E. Substances that interfere with bacterial colonization
A. Antibodies
B. Leukocytes
E. Substances that interfere with bacterial colonization
Rationale: Breast milk provides antibodies, viable leukocytes, and other protective substances that strengthen the mucosal barrier and prevent harmful bacterial colonization. Toxins are not present in breast milk, and vitamin K is administered via injection.
When does bacterial colonization of the newborn’s gut typically occur?
A. Immediately at birth
B. Within 12 hours of birth
C. Within 24 hours of age
D. By the end of the first week of life
C. Within 24 hours of age
Rationale: Bacterial colonization of the gut typically occurs within 24 hours of age, facilitated by oral intake and exposure to environmental microbes.
A newborn is receiving formula feeds, and the parents are concerned about the baby’s intestinal health. What should the nurse recommend to support the newborn’s immature mucosal barrier?
A. Provide skin-to-skin contact with the baby frequently.
B. Switch to a breast milk-only diet immediately.
C. Avoid environmental exposure to reduce bacterial colonization.
D. Delay feeding until the mucosal barrier matures.
A. Provide skin-to-skin contact with the baby frequently.
Rationale: Skin-to-skin contact with the baby helps transfer maternal microbes, which can support gut colonization and immune defenses, even if the newborn is formula-fed.
Which processes facilitate the transfer of maternal microbes to the newborn after birth?
A. Suckling
B. Kissing
C. Caressing
D. Sterilizing feeding equipment
E. Cleaning the newborn’s skin frequently
A. Suckling
B. Kissing
C. Caressing
Rationale: Suckling, kissing, and caressing mechanically transfer maternal microbes to the newborn. Frequent cleaning and sterilization do not facilitate microbial transfer and may limit colonization.
Which newborn population is at highest risk for complications related to an immature intestinal mucosal barrier?
A. Term newborns fed breast milk
B. Preterm newborns fed formula
C. Term newborns receiving vitamin K supplements
D. Preterm newborns receiving mixed feedings
B. Preterm newborns fed formula
Rationale: Preterm newborns fed formula are at higher risk because they lack the protective antibodies and immune factors present in breast milk, and their mucosal barriers are less developed than term newborns.
Which of the following best explains why human breast milk supports neonatal intestinal defense?
A. It introduces environmental microbes for colonization.
B. It contains nutrients that accelerate gut maturity.
C. It provides antibodies and other substances that prevent harmful penetration.
D. It delays gut colonization to reduce the risk of infection.
C. It provides antibodies and other substances that prevent harmful penetration.
Rationale: Human breast milk contains antibodies, leukocytes, and other protective substances that strengthen the intestinal mucosal barrier and prevent harmful bacterial penetration.
A nurse is educating parents about the role of vitamin K in newborns. Which statement indicates the parents understand its importance?
A. “Vitamin K prevents intestinal infections in our baby.”
B. “It helps our baby’s immature liver produce antibodies.”
C. “It strengthens the gut lining to protect against harmful bacteria.”
D. “Vitamin K is needed for blood clotting and relies on gut bacteria for production.”
D. “Vitamin K is needed for blood clotting and relies on gut bacteria for production.”
Rationale: Vitamin K is essential for blood clotting and is synthesized by gut bacteria. It does not directly prevent infections or strengthen the gut lining.
A 24-hour-old newborn passes a greenish-black, tarry stool. The nurse should explain to the parents that this stool is:
A. An indication of gastrointestinal bleeding.
B. The first stool, called meconium, composed of amniotic fluid, mucosal cells, and intestinal secretions.
C. A sign of infection and should be reported to the healthcare provider immediately.
D. The result of delayed feeding and should be addressed with increased milk intake.
B. The first stool, called meconium, composed of amniotic fluid, mucosal cells, and intestinal secretions.
Rationale: The greenish-black, tarry stool passed within the first 12 to 24 hours is known as meconium, which consists of amniotic fluid, mucosal cells, and intestinal secretions. It is a normal finding in newborns and is not a sign of infection or bleeding.
Which of the following is true regarding a newborn’s stool pattern?
A. Meconium is the last stool passed and is composed of undigested breast milk.
B. Transitional stools occur after meconium and are usually greenish-brown to yellowish-brown in color.
C. Formula-fed newborns pass stools that are more liquid than those of breast-fed newborns.
D. A lack of stool passage for 48 hours after birth is normal and does not require intervention.
B. Transitional stools occur after meconium and are usually greenish-brown to yellowish-brown in color.
Rationale: Transitional stools occur after meconium and are typically greenish-brown to yellowish-brown in color. They are thinner and seedier in appearance. Formula-fed infants often pass firmer stools compared to breast-fed infants. Delayed stool passage for more than 48 hours requires assessment.
A breast-fed newborn passes stools that are yellow-gold, loose, and stringy in consistency. The nurse should explain that this is characteristic of:
A. Meconium stools.
B. Transitional stools.
C. Milk stools in a breast-fed infant.
D. Stools indicating gastrointestinal infection.
C. Milk stools in a breast-fed infant.
Rationale: Yellow-gold, loose, stringy stools are characteristic of milk stools in breast-fed infants. These stools have a sour smell, which is typical of breast milk digestion.
Which of the following are true regarding a newborn’s bowel elimination pattern? (Select all that apply.)
A. Meconium is passed within the first 12 to 24 hours of life.
B. Breast-fed newborns tend to have firmer stools than formula-fed infants.
C. Formula-fed infants typically have stools with a more unpleasant odor than breast-fed infants.
D. Early feeding helps newborns pass stools sooner, reducing the risk of bilirubin buildup.
E. Newborns may pass stools up to 10 times a day, especially if formula-fed.
A. Meconium is passed within the first 12 to 24 hours of life.
C. Formula-fed infants typically have stools with a more unpleasant odor than breast-fed infants.
D. Early feeding helps newborns pass stools sooner, reducing the risk of bilirubin buildup.
Rationale: Meconium is passed within 12 to 24 hours of birth. Formula-fed infants tend to have stools with a more unpleasant odor due to the digestion of formula. Early feeding promotes stool passage, which helps reduce bilirubin buildup. Breast-fed infants usually have softer stools compared to formula-fed infants. Stool frequency can vary widely between newborns.
A nurse is assessing a newborn who has passed several stools over the past 24 hours. The stools are yellowish-brown, seedy, and have a slightly sour smell. The nurse recognizes this as:
A. Meconium.
B. Transitional stools in a formula-fed infant.
C. A sign of gastrointestinal distress.
D. Milk stools in a breast-fed infant.
D. Milk stools in a breast-fed infant.
Rationale: Yellowish-brown, seedy, and slightly sour-smelling stools are characteristic of milk stools in a breast-fed infant. These stools are usually loose and soft.
Which of the following is the primary factor influencing the development of a newborn’s stool pattern?
A. The type of feeding (breast milk or formula).
B. Maternal diet during pregnancy.
C. The newborn’s gestational age at birth.
D. The infant’s weight at birth.
A. The type of feeding (breast milk or formula).
Rationale: The type of feeding, whether breast milk or formula, plays a significant role in determining the newborn’s stool characteristics, such as color, consistency, and frequency.
A nurse is teaching a parent of a newborn about bowel movements. The parent asks why their newborn’s stools are different from a friend’s baby who is also newborn. The nurse should explain that:
A. Stool patterns are primarily determined by the type of feeding the infant receives.
B. Stool patterns differ due to differences in gestational age at birth.
C. Stool patterns are influenced by the maternal diet during pregnancy.
D. Newborns typically have identical stool patterns regardless of feeding type.
A. Stool patterns are primarily determined by the type of feeding the infant receives.
Rationale: Stool patterns are primarily determined by the type of feeding the infant receives. Breast-fed and formula-fed infants typically have different stool characteristics, such as color, consistency, and frequency.
Which of the following are true regarding the stool patterns of breast-fed and formula-fed infants? (Select all that apply.)
A. Breast-fed infants typically have stools that are firmer and more odorous.
B. Formula-fed infants may have stools that are tan or yellow and firmer.
C. Both breast-fed and formula-fed infants can pass several stools daily.
D. Breast-fed infants may have stools that are yellow-gold, loose, and pasty.
E. Formula-fed infants typically have stools that are more frequent than breast-fed infants.
B. Formula-fed infants may have stools that are tan or yellow and firmer.
C. Both breast-fed and formula-fed infants can pass several stools daily.
D. Breast-fed infants may have stools that are yellow-gold, loose, and pasty.
Rationale: Formula-fed infants generally have firmer stools that can be tan or yellow. Both breast-fed and formula-fed infants may pass several stools per day. Breast-fed infants typically have yellow-gold, loose, and pasty stools. Breast-fed infants tend to have stools that are less firm than formula-fed infants.
Which of the following is a recommended intervention to help reduce the risk of bilirubin buildup in a newborn?
A. Delaying the first feeding to allow for proper digestion.
B. Early initiation of feedings to promote stool passage.
C. Limiting the frequency of feedings to reduce stool output.
D. Providing formula feedings exclusively to increase stool volume.
B. Early initiation of feedings to promote stool passage.
Rationale: Early initiation of feedings helps promote the passage of stools, which reduces the risk of bilirubin buildup. Delaying feedings or limiting their frequency may increase the risk of jaundice.
A nurse is assessing a 3-day-old newborn and observes the baby passing stools that are greenish-yellow in color. The nurse should interpret this as:
A. A sign of gastrointestinal infection.
B. The first stools passed, indicating meconium.
C. Transitional stools, which are normal for the third or fourth day after birth.
D. A sign of jaundice or bilirubin buildup.
C. Transitional stools, which are normal for the third or fourth day after birth.
Rationale: Greenish-yellow stools are indicative of transitional stools, which are typically passed between days 3 and 4 after birth. These stools are a normal part of the newborn’s stool pattern evolution and are not a sign of infection or jaundice at this stage.
A 2-day-old newborn passes black, tarry stools. The nurse should explain to the parents that this stool is:
A. A normal finding called meconium, which is passed within the first 12 to 24 hours.
B. An indication of abnormal gastrointestinal function.
C. A sign of blood in the stool, indicating potential bleeding.
D. A characteristic of transitional stools in a formula-fed newborn.
A. A normal finding called meconium, which is passed within the first 12 to 24 hours.
Rationale: Black, tarry stools are characteristic of meconium, the first stool passed by newborns within the first 12 to 24 hours. Meconium consists of amniotic fluid, shed mucosal cells, and intestinal secretions. It is a normal finding in the first few days of life.
Which of the following are true regarding the stool pattern of a newborn? (Select all that apply.)
A. Meconium is greenish-yellow in color.
B. Transitional stools are typically greenish-yellow and are passed by day 3 or 4.
C. After day 5, breastfed infants will pass yellow stools, while formula-fed infants pass yellow-brown stools.
D. Formula-fed newborns typically pass stools that are firmer and more formed than breastfed newborns.
E. Yellow stools are an indication of infection in newborns after day 5.
B. Transitional stools are typically greenish-yellow and are passed by day 3 or 4.
C. After day 5, breastfed infants will pass yellow stools, while formula-fed infants pass yellow-brown stools.
D. Formula-fed newborns typically pass stools that are firmer and more formed than breastfed newborns.
Rationale: Transitional stools are greenish-yellow in color and typically passed by days 3 or 4. After day 5, breastfed infants typically pass yellow stools, while formula-fed infants pass yellow-brown stools. Formula-fed infants generally have firmer stools compared to breastfed infants. Yellow stools after day 5 are normal, and do not indicate infection.
A 4-day-old newborn is being monitored for bowel elimination. The nurse notes that the baby’s stool is greenish-yellow and has a thin consistency. The nurse should document this as:
A. Meconium, indicating an abnormal stool pattern for the newborn’s age.
B. Transitional stool, which is a normal finding for a 3 to 4-day-old infant.
C. A sign of possible infection, requiring further evaluation.
D. Milk stool, indicative of a well-established feeding pattern.
B. Transitional stool, which is a normal finding for a 3 to 4-day-old infant.
Rationale: Greenish-yellow stools with a thin consistency are typical of transitional stools, which are common between days 3 and 4 of a newborn’s life. This is a normal part of the stool pattern evolution as the infant begins feeding and colonizing their gut.
Which of the following stool characteristics would the nurse expect in a 5-day-old breastfed infant?
A. Meconium (black, tarry).
B. Transitional stools (greenish-yellow).
C. Yellow stools (loose and stringy).
D. Yellow-brown stools (firm).
C. Yellow stools (loose and stringy).
Rationale: At day 5, breastfed infants typically pass yellow stools that are loose and stringy. This is the final stage of stool pattern development, known as milk stools, and is a normal finding for breastfed infants.
A nurse is assessing a 6-day-old newborn and notices that the baby has passed 2 wet diapers today. The nurse should:
A. Reassure the parents, as this is a normal finding for a 6-day-old infant.
B. Notify the healthcare provider about a possible concern for dehydration.
C. Suggest the parents reduce the number of feedings to prevent overhydration.
D. Encourage more frequent feedings, as the baby is not producing enough urine for this age.
B. Notify the healthcare provider about a possible concern for dehydration.
Rationale: By Day 5, it is expected for a newborn to pass 6 or more wet diapers per day. A newborn passing only 2 wet diapers by Day 6 could be a sign of dehydration or inadequate milk intake, and the nurse should notify the healthcare provider for further evaluation.
A nurse is educating new parents about newborn urination patterns. The nurse should explain that by Day 5, a healthy newborn typically produces:
A. 3–4 wet diapers per day.
B. 1–2 wet diapers per day.
C. 6 or more wet diapers per day.
D. No wet diapers, as the baby is still in the meconium stage.
C. 6 or more wet diapers per day.
Rationale: By Day 5, it is normal for a newborn to pass 6 or more wet diapers per day. This indicates adequate hydration and nutrition.
A nurse is caring for a 2-day-old newborn and notes that the baby has passed only 1 wet diaper so far. The nurse should:
A. Immediately notify the healthcare provider, as this indicates a significant problem.
B. Recommend starting supplemental feedings, as low urination could be related to inadequate milk intake.
C. Encourage the parents to wait 24 hours, as this is a normal finding for a 2-day-old newborn.
D. Document the finding and wait for the baby to urinate later in the day, as this is a typical pattern for this age.
B. Recommend starting supplemental feedings, as low urination could be related to inadequate milk intake.
Rationale: On days 1-2, it is normal for a newborn to pass only 1-2 wet diapers. However, since a low number of wet diapers could indicate insufficient milk intake, the nurse should recommend that the parents encourage more frequent feedings to ensure proper hydration.
At 4 days of age, a newborn has 3 wet diapers. The nurse should:
A. Notify the healthcare provider of oliguria.
B. Encourage the parents to continue breastfeeding, as 3 wet diapers is a normal finding.
C. Suggest using formula feeding instead, as the baby is not urinating enough.
D. Monitor the baby closely for signs of dehydration.
B. Encourage the parents to continue breastfeeding, as 3 wet diapers is a normal finding.
Rationale: At 3-4 days of age, it is normal for a newborn to pass 3-4 wet diapers per day. The nurse should reassure the parents that this is within the expected range for a 4-day-old infant. No further interventions are necessary unless other signs of dehydration are present.
Which of the following are normal findings regarding urination in a newborn from birth to 1 week? (Select all that apply.)
A. Day 1–2: 1-2 wet diapers.
B. Day 3–4: 5-6 wet diapers.
C. By Day 5: 6+ wet diapers.
D. By Day 5: Only 1-2 wet diapers are expected.
E. By Day 5: 3-4 wet diapers should be the minimum.
A. Day 1–2: 1-2 wet diapers.
C. By Day 5: 6+ wet diapers.
Rationale: On days 1-2, it is normal for a newborn to pass 1-2 wet diapers, and by Day 5, the expected number of wet diapers increases to 6 or more. A decrease in wet diapers or failure to meet these expectations may be a concern and warrant further evaluation.
A nurse is caring for a 3-day-old newborn. The baby responds to sound by turning toward it and demonstrates the ability to distinguish between sweet and sour flavors. The nurse should:
A. Document these as expected developmental milestones for a newborn.
B. Recognize that these findings are abnormal for a 3-day-old and report to the healthcare provider.
C. Immediately assess the baby for neurological abnormalities, as this may indicate sensory issues.
D. Assume the newborn’s hearing and taste capabilities will develop further over the next few weeks.
A. Document these as expected developmental milestones for a newborn.
Rationale: A 3-day-old newborn demonstrating an ability to respond to sound and distinguish between sweet and sour flavors is meeting expected sensory milestones. These are typical findings in newborns, as hearing and taste are well-developed shortly after birth.
Which of the following senses is least mature at birth in a newborn?
A. Taste
B. Smell
C. Touch
D. Vision
D. Vision
Rationale: Vision is the least mature sense at birth, as newborns can only focus on objects close to them (8-10 inches away) and have a visual acuity of 20/140. Visual development is dependent on proper nutrition and visual stimulation.
Which of the following are expected neurologic adaptations in a newborn? (Select all that apply.)
A. The newborn can distinguish between sweet and sour by 72 hours old.
B. The newborn’s vision is fully mature at birth and can focus on distant objects.
C. Newborns respond to tactile stimuli, indicating sensitivity to pain.
D. The newborn has well-developed hearing and responds to sounds by turning toward them.
E. Newborns have a complete complement of cortical and brain stem cells at birth.
A. The newborn can distinguish between sweet and sour by 72 hours old.
C. Newborns respond to tactile stimuli, indicating sensitivity to pain.
D. The newborn has well-developed hearing and responds to sounds by turning toward them.
Rationale: Newborns typically distinguish between sweet and sour tastes by 72 hours old, respond to tactile stimuli indicating pain sensitivity, and demonstrate well-developed hearing by turning toward sounds. Vision is less mature at birth, and brain development continues throughout the first year.
A nurse is assessing a 2-week-old infant and observes that the baby can track objects in the midline and beyond. The nurse should:
A. Notify the healthcare provider immediately, as this is abnormal for a 2-week-old.
B. Document this as an expected and normal developmental finding.
C. Suggest that the parents provide more visual stimulation to encourage further development.
D. Reassess the baby’s vision later in the day to ensure consistency.
B. Document this as an expected and normal developmental finding.
Rationale: The ability to track objects in the midline or beyond is an expected developmental milestone for a newborn. This indicates the maturation of the nervous system and is considered normal for a 2-week-old.
Which of the following best describes the typical progression of neurologic development in a newborn?
A. Development follows a proximal-distal pattern, with sensory capabilities maturing before motor functions.
B. Development follows a cephalocaudal pattern, with head control achieved before trunk and leg control.
C. Development is completely independent of sensory stimulation and nutrition.
D. Neurologic development is primarily governed by genetic factors with no environmental influence.
B. Development follows a cephalocaudal pattern, with head control achieved before trunk and leg control.
Rationale: Neurologic development follows a cephalocaudal (head-to-toe) and proximal-distal (center-to-outside) pattern. This means that head control and other upper body functions mature before the lower body, and sensory capabilities develop earlier than motor skills.
A nurse is educating new parents about their newborn’s sensory development. Which statement is most appropriate?
A. “Your baby can focus on objects across the room right now, but the vision will improve over time.”
B. “Your baby can distinguish between sweet and sour tastes at birth and will prefer sweet tastes.”
C. “Your baby can hear well at birth, and you can help by providing auditory stimulation.”
D. “Your baby’s ability to see distant objects will improve immediately after birth.”
C. “Your baby can hear well at birth, and you can help by providing auditory stimulation.”
Rationale: Newborns have well-developed hearing at birth and respond to sounds, which can be further stimulated by appropriate auditory experiences. The vision, however, is not fully developed at birth, and the baby can only focus on objects close to them.
Which of the following are true regarding sensory capabilities in a newborn? (Select all that apply.)
A. The newborn can distinguish between mother’s breast milk and milk from others by smell.
B. The newborn has no ability to distinguish between tastes at birth.
C. Newborns have an acute sense of hearing and respond to sounds by turning toward them.
D. Newborns can focus on distant objects immediately after birth.
E. Newborns can track objects in midline by 1 week of age.
A. The newborn can distinguish between mother’s breast milk and milk from others by smell.
C. Newborns have an acute sense of hearing and respond to sounds by turning toward them.
Rationale: Newborns can distinguish between their mother’s breast milk and others by smell and have an acute sense of hearing, responding to sounds by turning toward them. Newborns cannot focus on distant objects, and tracking objects in midline develops later.
Which of the following is an expected neurologic finding in a newborn?
A. Ability to fixate on distant objects immediately after birth.
B. Inability to hear sounds until 3 months of age.
C. Ability to fix and follow objects with alertness at 6 months.
D. Ability to distinguish between sweet and sour tastes within the first 72 hours.
D. Ability to distinguish between sweet and sour tastes within the first 72 hours.
Rationale: The newborn is able to distinguish between sweet and sour tastes by 72 hours old, which is an expected and normal developmental milestone. Vision and hearing are mature early, but the ability to fixate on distant objects and hearing is fully refined later in life.
Which of the following are true regarding the development of the newborn’s nervous system? (Select all that apply.)
A. The brain size increases threefold during the first year of life.
B. Myelination begins after birth and is completed by 6 months of age.
C. Neurologic development follows both cephalocaudal and proximal-distal patterns.
D. Sensory capabilities are fully developed at birth, with motor skills following later.
E. The newborn’s ability to focus on objects at birth is limited to a distance of 8 to 10 inches.
A. The brain size increases threefold during the first year of life.
C. Neurologic development follows both cephalocaudal and proximal-distal patterns.
E. The newborn’s ability to focus on objects at birth is limited to a distance of 8 to 10 inches.
Rationale: The brain size increases threefold during the first year of life. Neurologic development follows both cephalocaudal and proximal-distal patterns, with vision limited to 8 to 10 inches at birth. Myelination develops but is not completed by 6 months, and sensory capabilities mature more quickly than motor skills.
Which statement best describes the vision capabilities of a newborn?
A. The newborn can see objects across the room clearly.
B. The newborn can see well at birth but needs time to focus on objects.
C. The newborn can only focus on objects 8 to 10 inches away.
D. Vision is fully developed at birth, with clear acuity.
C. The newborn can only focus on objects 8 to 10 inches away.
Rationale: Newborns can only focus on objects that are 8 to 10 inches away, and their vision is not fully developed at birth. Visual acuity and depth perception improve over time with proper stimulation.
Which sensory capability is most developed in a newborn at birth?
A. Hearing
B. Vision
C. Smell
D. Taste
A. Hearing
Rationale: Newborns have well-developed hearing at birth and can recognize voices. While other senses are developing, hearing is the most mature sensory capability at birth.
Which of the following sensory characteristics are expected in a newborn? (Select all that apply.)
A. The newborn can track moving objects, but only at a short distance.
B. The newborn has a preference for sour and salty flavors.
C. The newborn can recognize its mother’s scent.
D. The newborn is nearsighted and cannot focus on distant objects.
E. The newborn responds positively to sweet flavors.
A. The newborn can track moving objects, but only at a short distance.
C. The newborn can recognize its mother’s scent.
D. The newborn is nearsighted and cannot focus on distant objects.
E. The newborn responds positively to sweet flavors.
Rationale: Newborns are nearsighted and can track moving objects at close distances. They can recognize their mother’s scent and respond positively to sweet flavors, demonstrating a preference for them.
A nurse is assessing a 2-day-old newborn and notices the baby tracks moving objects at a short distance and shows a preference for sweet flavors. The nurse should:
A. Report these findings as abnormal, as the newborn should not be able to track objects yet.
B. Document these findings as expected sensory responses at this age.
C. Reassess the newborn’s sensory capabilities and consult with the healthcare provider.
D. Assume that the newborn’s sensory capabilities will improve after the first week.
B. Document these findings as expected sensory responses at this age.
Rationale: The ability to track moving objects at a short distance and the preference for sweet flavors are normal sensory capabilities expected of a 2-day-old newborn.
A nurse is educating parents about their newborn’s sensory development. Which of the following statements is most accurate?
A. “Your baby will be able to recognize your voice by the time they are 1 month old.”
B. “Your baby will prefer salty and sour flavors right after birth.”
C. “Your baby will be able to focus on distant objects immediately after birth.”
D. “Your baby will recognize your scent right after birth.”
D. “Your baby will recognize your scent right after birth.”
Rationale: Newborns are sensitive to their mother’s scent, which is a well-developed sensory ability at birth. Other senses, like vision and taste, take time to mature.
Which of the following best describes the vision capabilities of a newborn?
A. The newborn can only focus on objects close to them, around 8 to 10 inches away.
B. The newborn has clear vision for distant objects immediately after birth.
C. The newborn’s vision is fully developed and similar to that of an adult.
D. The newborn can see clearly at various distances and track objects.
A. The newborn can only focus on objects close to them, around 8 to 10 inches away.
Rationale: Newborns are nearsighted and can only focus on objects that are about 8 to 10 inches away. Their vision develops over time and requires visual stimulation to improve.
Behavioral adaptation in the newborn after birth involves a progression of events triggered by:
A. Maternal hormones circulating in the newborn’s system.
B. The stimuli from the extrauterine environment.
C. The newborn’s initial feeding patterns.
D. The sensory capabilities of the newborn.
B. The stimuli from the extrauterine environment.
Rationale: Behavioral adaptation in the newborn is a defined progression of events triggered by stimuli from the extrauterine environment, which helps the baby adjust to life outside the womb.
Which of the following best describes the typical behavioral pattern observed in a newborn during the first hours after birth?
A. The newborn exhibits a predictable pattern of behavior with two periods of reactivity and a sleep phase.
B. The newborn remains quiet and alert throughout the first several hours of life.
C. The newborn demonstrates an irregular pattern of activity with no defined progression of events.
D. The newborn immediately becomes agitated and stays in a continuous sleep phase after birth.
A. The newborn exhibits a predictable pattern of behavior with two periods of reactivity and a sleep phase.
Rationale: Newborns typically exhibit a predictable behavioral pattern during the first hours of life, which includes two periods of reactivity separated by a sleep phase. This pattern is part of their adaptation to the extrauterine environment.
A nurse is observing a 2-hour-old newborn and notices that the baby is alert and responsive during the first period, followed by a sleep phase. After a short time, the baby becomes alert again. Which of the following actions should the nurse take?
A. Call the healthcare provider as this behavior is abnormal.
B. Administer calming medications to reduce the newborn’s alertness.
C. Move the newborn to a quieter room to encourage continuous sleep.
D. Monitor the newborn as this pattern is typical of early behavior after birth.
D. Monitor the newborn as this pattern is typical of early behavior after birth.
Rationale: The pattern of two periods of reactivity separated by a sleep phase is normal in newborns during the first several hours of life. No further intervention is necessary unless other signs of distress or abnormal behavior occur.
A nurse is observing a newborn in the first period of reactivity. The newborn is alert, moving, and showing sucking and rooting behaviors. The nurse should recognize that:
A. These behaviors indicate the newborn is experiencing stress and should be removed from the environment.
B. The newborn is preparing for the second period of reactivity and should be left alone to rest.
C. This is an ideal time to initiate breastfeeding as the newborn is likely to respond well.
D. The newborn is exhibiting abnormal behavior and should be closely monitored for complications.
C. This is an ideal time to initiate breastfeeding as the newborn is likely to respond well.
Rationale: The first period of reactivity is an ideal time for initiating breastfeeding, as the newborn exhibits sucking and rooting behaviors and may latch on effectively during this period.
Which of the following behaviors are characteristic of a newborn during the first period of reactivity? Select all that apply.
A. Increased muscle tone and motor activity.
B. Myoclonic movements and spontaneous Moro reflexes.
C. Deep sleep with reduced muscle tone.
D. Sucking and rooting behaviors.
E. Apnea and bradycardia episodes.
A. Increased muscle tone and motor activity.
B. Myoclonic movements and spontaneous Moro reflexes.
D. Sucking and rooting behaviors.
Rationale: During the first period of reactivity, the newborn exhibits increased muscle tone, motor activity, myoclonic movements, spontaneous Moro reflexes, and sucking and rooting behaviors. Apnea and bradycardia episodes are not characteristic of this phase.
Which of the following behaviors is most characteristic of a newborn during the first period of reactivity?
A. Lethargy and inability to respond to stimuli.
B. Alertness, myoclonic movements, and spontaneous Moro reflexes.
C. Continuous deep sleep with low muscle tone.
D. Immediate engagement in feeding after birth without alertness.
B. Alertness, myoclonic movements, and spontaneous Moro reflexes.
Rationale: During the first period of reactivity, the newborn is alert, moving, and demonstrates myoclonic movements, Moro reflexes, sucking motions, and rooting. Muscle tone and motor activity are heightened, and the newborn may show interest in feeding.
A nurse observes that a 1-hour-old newborn is alert and appears hungry, showing sucking and rooting behaviors. Which of the following actions should the nurse take at this time?
A. Offer the newborn the opportunity to latch and initiate breastfeeding.
B. Delay feeding to allow the newborn to rest.
C. Administer formula immediately due to the newborn’s apparent hunger.
D. Monitor the newborn closely and prepare to intervene if the alertness persists for too long.
A. Offer the newborn the opportunity to latch and initiate breastfeeding.
Rationale: The first period of reactivity provides an excellent opportunity to initiate breastfeeding, as many newborns exhibit rooting and sucking behaviors during this time.
During the first period of reactivity, what happens to the newborn’s respiration and heart rate?
A. Respiration and heart rate remain elevated throughout the entire period.
B. Respiration and heart rate gradually slow as the next period begins.
C. Respiration and heart rate fluctuate unpredictably.
D. Respiration and heart rate stabilize to normal levels immediately.
B. Respiration and heart rate gradually slow as the next period begins.
Rationale: During the first period of reactivity, respiration and heart rate are elevated but gradually begin to slow as the newborn transitions to the next period of reactivity.
Which of the following is an expected outcome during the first period of reactivity?
A. The newborn exhibits an immediate and strong latch to the breast.
B. The newborn remains inactive and sleeps through the period.
C. The newborn demonstrates irritability and crying that persists for several hours.
D. The newborn exhibits fine tremors of the extremities and increased muscle tone.
D. The newborn exhibits fine tremors of the extremities and increased muscle tone.
Rationale: Fine tremors of the extremities and increased muscle tone are characteristic of the first period of reactivity. The newborn may also exhibit sucking and rooting behaviors, with muscle tone and motor activity increased.
During the period of decreased responsiveness, the newborn’s:
A. Heart and respiratory rates increase as they become more active.
B. Muscle tone becomes increased, and the newborn shows interest in interacting.
C. Muscle tone relaxes, and there is a decrease in heart and respiratory rates.
D. Sensory systems are more alert and responsive to external stimuli.
C. Muscle tone relaxes, and there is a decrease in heart and respiratory rates.
Rationale: In the period of decreased responsiveness, the newborn’s muscle tone relaxes, and both heart and respiratory rates decrease as the newborn enters the sleep phase. There is less responsiveness to external stimuli.
A nurse notices that a 1-hour-old newborn is relaxed, with less frequent movement and no interest in sucking. The nurse should:
A. Immediately stimulate the newborn to promote sucking and activity.
B. Allow the newborn to rest undisturbed, recognizing that this is a normal phase of transition.
C. Assess the newborn for signs of distress or dehydration.
D. Provide formula feeding to stimulate the newborn’s interest in sucking.
B. Allow the newborn to rest undisturbed, recognizing that this is a normal phase of transition.
Rationale: The period of decreased responsiveness is a normal phase of transition, where the newborn is expected to rest, with less activity and no interest in sucking. This quiet time allows the newborn and mother to rest after the birthing process.
Which of the following are expected behaviors during the period of decreased responsiveness in a newborn? Select all that apply.
A. Jerky, frequent movements.
B. Decreased heart and respiratory rates.
C. Lack of interest in sucking.
D. Increased responsiveness to external stimuli.
E. Difficulty arousing the newborn from sleep.
B. Decreased heart and respiratory rates.
C. Lack of interest in sucking.
E. Difficulty arousing the newborn from sleep.
Rationale: During the period of decreased responsiveness, the newborn exhibits decreased heart and respiratory rates, no interest in sucking, and difficulty being aroused. Jerky movements and increased responsiveness to external stimuli are not characteristic of this phase.
Which of the following best describes the newborn during the period of decreased responsiveness?
A. The newborn is easily aroused and exhibits active sucking behaviors.
B. The newborn is alert and actively interacts with the environment.
C. The newborn demonstrates jerky movements and increased motor activity.
D. The newborn exhibits less frequent movements, relaxed muscles, and decreased responsiveness to stimuli.
D. The newborn exhibits less frequent movements, relaxed muscles, and decreased responsiveness to stimuli.
Rationale: During the period of decreased responsiveness, the newborn exhibits fewer movements, relaxed muscles, and a decreased responsiveness to stimuli. It is a quiet time when the newborn is difficult to arouse.
A nurse observes a newborn at 90 minutes of life. The baby is quiet, with no interest in sucking, relaxed muscles, and a decreased response to stimuli. The nurse should recognize that:
A. The newborn is entering the second stage of transition and is in a normal sleep phase.
B. The newborn is likely experiencing discomfort and should be assessed for complications.
C. The newborn is showing signs of overstimulation and should be immediately removed from the environment.
D. The newborn is exhibiting abnormal behavior and requires immediate intervention.
A. The newborn is entering the second stage of transition and is in a normal sleep phase.
Rationale: The newborn’s behavior is consistent with the second stage of transition, the period of decreased responsiveness, which is a normal phase after birth. During this phase, the newborn is quieter, less responsive, and has relaxed muscles.
During the period of decreased responsiveness, the newborn:
A. Exhibits increased motor activity and responsiveness to stimuli.
B. Remains alert and shows interest in sucking.
C. Has a decrease in heart and respiratory rates, with decreased responsiveness to external stimuli.
D. Continues to demonstrate jerky movements and increased muscle tone.
C. Has a decrease in heart and respiratory rates, with decreased responsiveness to external stimuli.
Rationale: During the period of decreased responsiveness, the newborn enters a sleep phase characterized by a decrease in heart and respiratory rates, less movement, and diminished responsiveness to stimuli. The newborn shows no interest in sucking during this phase.
The second period of reactivity in a newborn is characterized by:
A. Decreased heart and respiratory rates with a lack of interest in environmental stimuli.
B. Increased motor activity, muscle tone, and peristalsis, with the newborn showing interest in the environment.
C. A decrease in peristalsis and muscle tone with the newborn remaining quiet and unresponsive.
D. A significant drop in heart rate and respiratory rates while the newborn sleeps.
B. Increased motor activity, muscle tone, and peristalsis, with the newborn showing interest in the environment.
Rationale: The second period of reactivity is characterized by an increase in heart and respiratory rates, as well as an increase in motor activity, muscle tone, and peristalsis. The newborn becomes more interested in environmental stimuli during this phase.
Which of the following behaviors are typical of a newborn during the second period of reactivity? Select all that apply.
A. Increased motor activity and muscular coordination.
B. Decrease in peristalsis and bowel movements.
C. The newborn passes meconium or voids during this period.
D. Decreased heart and respiratory rates.
E. The newborn shows interest in environmental stimuli.
A. Increased motor activity and muscular coordination.
C. The newborn passes meconium or voids during this period.
E. The newborn shows interest in environmental stimuli.
Rationale: During the second period of reactivity, the newborn exhibits increased motor activity, increased peristalsis (resulting in passing meconium or voiding), and shows interest in the environment. Heart and respiratory rates increase during this phase, not decrease.
A 2-hour-old newborn is becoming more active, exhibiting increased motor activity, and showing interest in the surrounding environment. The nurse should:
A. Encourage the parents to engage with the newborn, as this is the second period of reactivity.
B. Limit interaction with the newborn to prevent overstimulation.
C. Monitor the newborn for signs of hypothermia as the activity level increases.
D. Provide the newborn with formula feeding immediately to promote growth.
A. Encourage the parents to engage with the newborn, as this is the second period of reactivity.
Rationale: The second period of reactivity is the ideal time for parents to interact with the newborn, as the baby is alert and interested in environmental stimuli. Encouraging the parents to engage during this period enhances bonding.
Which of the following would be an expected finding during the second period of reactivity?
A. The newborn demonstrates a lack of interest in feeding or environmental stimuli.
B. The newborn shows a decrease in motor activity, muscle tone, and peristalsis.
C. The newborn becomes more alert, exhibits increased muscle coordination, and shows interest in the environment.
D. The newborn remains in a state of deep sleep with no interest in interaction.
C. The newborn becomes more alert, exhibits increased muscle coordination, and shows interest in the environment.
Rationale: During the second period of reactivity, the newborn becomes more alert, exhibits increased muscle coordination, and shows an interest in environmental stimuli. This is the period when interaction with the parents is encouraged.
A nurse observes that a newborn is actively moving, with increased motor activity and muscle tone, and is showing interest in feeding. This newborn is likely in:
A. The first period of reactivity.
B. The second period of reactivity.
C. The sleep phase.
D. The transition phase.
B. The second period of reactivity.
Rationale: The second period of reactivity is characterized by the newborn awakening, showing interest in environmental stimuli, and becoming more active with increased motor activity, muscle tone, and coordination. This period lasts from 2 to 8 hours.
During the second period of reactivity, it is common for the newborn to:
A. Be non-responsive to environmental stimuli and have no interest in feeding.
B. Experience a decrease in heart and respiratory rates while resting.
C. Remain in deep sleep and exhibit no interest in interaction.
D. Pass meconium or void, and show increased motor activity.
D. Pass meconium or void, and show increased motor activity.
Rationale: The second period of reactivity is marked by increased motor activity, muscle tone, and peristalsis, which often leads to the passage of meconium or voiding. The newborn also becomes more alert and interested in feeding or environmental stimuli.
During the first period of reactivity, which of the following behaviors is most likely to be observed in a newborn?
A. The newborn is in a deep sleep with no interest in external stimuli.
B. The newborn exhibits an alert state, is active, and demonstrates a strong suck reflex.
C. The newborn shows no motor activity and is non-responsive.
D. The newborn is crying and exhibiting signs of discomfort.
B. The newborn exhibits an alert state, is active, and demonstrates a strong suck reflex.
Rationale: The first period of reactivity is characterized by the newborn being alert, active, and exhibiting a strong suck reflex. This is the period in which the newborn is most likely to interact with the environment and initiate feeding.
Which of the following behaviors are typical of the newborn during the second period of reactivity? Select all that apply.
A. The newborn exhibits increased alertness and responsiveness to stimuli.
B. The newborn remains in a deep sleep and is difficult to arouse.
C. The newborn may pass stool or void.
D. The newborn shows no interest in feeding or interaction.
E. The newborn demonstrates increased motor activity.
A. The newborn exhibits increased alertness and responsiveness to stimuli.
C. The newborn may pass stool or void.
E. The newborn demonstrates increased motor activity.
Rationale: The second period of reactivity is characterized by increased alertness, responsiveness, and motor activity. The newborn may also pass stool or void during this phase. Sleepiness and lack of responsiveness are typical of the sleep phase, not the second period of reactivity.
A nurse is assessing a 1-hour-old newborn and observes that the newborn is alert, actively moving, and demonstrating a strong suck reflex. The nurse should conclude that the newborn is in which stage of the reactivity cycle?
A. First period of reactivity
B. Sleep phase
C. Second period of reactivity
D. Transition phase
A. First period of reactivity
Rationale: The first period of reactivity occurs immediately after birth (birth to 30 minutes), during which the newborn is alert, active, and demonstrates a strong suck reflex, preparing for feeding.
Which of the following statements best describes the sleep phase following the first period of reactivity?
A. The newborn exhibits increased motor activity and responds to external stimuli.
B. The newborn becomes alert, responsive, and actively interacts with the environment.
C. The newborn demonstrates a strong suck reflex and may initiate breastfeeding.
D. The newborn is in a deep sleep with little to no motor activity or responsiveness to stimuli.
D. The newborn is in a deep sleep with little to no motor activity or responsiveness to stimuli.
Rationale: The sleep phase (30 minutes to 2 hours) is characterized by the newborn being in a deep sleep, with decreased motor activity and little responsiveness to stimuli.
A nurse notes that a newborn, 4 hours after birth, is awake, alert, and begins to pass meconium. The nurse should recognize that this behavior is typical of:
A. The first period of reactivity.
B. The sleep phase.
C. The second period of reactivity.
D. The transition phase.
C. The second period of reactivity.
Rationale: The second period of reactivity (2 to 8 hours after birth) is marked by increased alertness, responsiveness to stimuli, and physical activity, which may include passing meconium or voiding.
Which of the following is characteristic of the first period of reactivity in a newborn?
A. The newborn is in a deep sleep and does not respond to stimuli.
B. The newborn is alert, moving, and may show signs of hunger.
C. The newborn demonstrates a decrease in motor activity and responsiveness.
D. The newborn exhibits no interest in external stimuli or interaction.
B. The newborn is alert, moving, and may show signs of hunger.
Rationale: The first period of reactivity occurs within the first 30 minutes to 2 hours after birth. During this period, the newborn is alert, moving, and may show signs of hunger, which provides an opportunity to initiate feeding.
The period of decreased responsiveness occurs during which time frame after birth?
A. 1 to 4 hours after birth
B. 30 minutes to 2 hours after birth
C. Immediately after birth to 30 minutes
D. 8 to 12 hours after birth
B. 30 minutes to 2 hours after birth
Rationale: The period of decreased responsiveness occurs between 30 to 2 hours after birth. During this phase, the newborn enters a sleep-like state and shows decreased activity and responsiveness to stimuli.
Which of the following are characteristics of the second period of reactivity in newborns? Select all that apply.
A. Newborn awakens and shows an interest in environmental stimuli.
B. The newborn exhibits increased motor activity and muscle tone.
C. The newborn remains in a deep sleep, showing little to no movement.
D. The newborn may void or pass meconium.
E. The newborn demonstrates decreased interest in feeding.
A. Newborn awakens and shows an interest in environmental stimuli.
B. The newborn exhibits increased motor activity and muscle tone.
D. The newborn may void or pass meconium.
Rationale: The second period of reactivity, which occurs between 2 to 8 hours after birth, is marked by the newborn waking up and becoming more responsive to environmental stimuli. There is an increase in motor activity and muscle tone, and the newborn may pass meconium or void during this time.
A nurse is observing a 1-hour-old newborn who is alert, active, and appears hungry. The nurse recognizes that the newborn is most likely in which phase?
A. First period of reactivity
B. Period of decreased responsiveness
C. Second period of reactivity
D. Sleep phase
A. First period of reactivity
Rationale: The first period of reactivity is characterized by the newborn being alert, active, and showing signs of hunger. This period occurs during the first 30 minutes to 2 hours after birth.
After teaching a class about hepatic system adaptations after birth, the instructor determines that the teaching was successful when the class identifies which of the following as the process of changing bilirubin from a fat-soluble product to a water-soluble product?
A) Hemolysis
B) Conjugation
C) Jaundice
D) Hyperbilirubinemia
B) Conjugation
The nurse institutes measure to maintain thermoregulation based on the understanding that newborns have limited ability to regulate body temperature because they:
A) Have a smaller body surface compared to body mass
B) Lose more body heat when they sweat than adults
C) Have an abundant amount of subcutaneous fat all over
D) Are unable to shiver effectively to increase heat production
D) Are unable to shiver effectively to increase heat production
A new mother is changing the diaper of her 20-hour-old newborn and asks why the stool is almost black. Which response by the nurse would be most appropriate?
A) You probably took iron during your pregnancy.
B) This is meconium stool, normal for a newborn.
C) I’ll take a sample and check it for possible bleeding.
D) This is unusual and I need to report this.
B) This is meconium stool, normal for a newborn.
A client expresses concern that her 2-hour-old newborn is sleepy and difficult to awaken. The nurse explains that this behavior indicates which of the following?
A) Normal progression of behavior
B) Probable hypoglycemia
C) Physiological abnormality
D) Inadequate oxygenation
A) Normal progression of behavior
After the birth of a newborn, which of the following would the nurse do first to assist in thermoregulation?
A) Dry the newborn thoroughly.
B) Put a hat on the newborns head.
C) Check the newborns temperature.
D) Wrap the newborn in a blanket.
A) Dry the newborn thoroughly.
After teaching new parents about the sensory capabilities of their newborn, the nurse determines that the teaching was successful when they identify which sense as being the least mature?
A) Hearing
B) Touch
C) Taste
D) Vision
D) Vision
The nurse places a warmed blanket on the scale when weighing a newborn. The nurse does so to minimize heat loss via which mechanism?
A) Evaporation
B) Conduction
C) Convection
D) Radiation
B) Conduction
Which of the following would alert the nurse to the possibility of respiratory distress in a newborn?
A) Symmetrical chest movements
B) Periodic breathing
C) Respirations of 40 breaths/minute
D) Sternal retractions
D) Sternal retractions
A nurse is developing a teaching plan for the parents of a newborn. When describing the neurologic development of a newborn to his parents, the nurse would explain that the development occurs in which fashion?
A) Head-to-toe
B) Lateral-to-medial
C) Outward-to-inward
D) Distal-to-caudal
A) Head-to-toe
The nurse is assessing the respirations of several newborns. The nurse would notify the health care provider for the newborn with which respiratory rate at rest?
A) 38 breaths per minute
B) 46 breaths per minute
C) 54 breaths per minute
D) 68 breaths per minute
D) 68 breaths per minute
The nurse observes the stool of a newborn who has begun to breast-feed. Which of the following would the nurse expect to find?
A) Greenish black, tarry stool
B) Yellowish-brown, seedy stool
C) Yellow-gold, stringy stool
D) Yellowish-green, pasty stool
B) Yellowish-brown, seedy stool
A newborn is experiencing cold stress. Which of the following would the nurse expect to assess? (Select all that apply.)
A) Respiratory distress
B) Decreased oxygen needs
C) Hypoglycemia
D) Metabolic alkalosis
E) Jaundice
A) Respiratory distress
C) Hypoglycemia
E) Jaundice
A group of nursing students are reviewing the changes in the newborns lungs that must occur to maintain respiratory function. The students demonstrate understanding of this information when they identify which of the following as the first event?
A) Expansion of the lungs
B) Increased pulmonary blood flow
C) Initiation of respiratory movement
D) Redistribution of cardiac output
C) Initiation of respiratory movement
A nursing instructor is preparing a class on newborn adaptations. When describing the change from fetal to newborn circulation, which of the following would the instructor most likely include? (Select all that apply.)
A) Decrease in right atrial pressure leads to closure of the foramen ovale.
B) Increase in oxygen levels leads to a decrease in systemic vascular resistance.
C) Onset of respirations leads to a decrease in pulmonary vascular resistance.
D) Increase in pressure in the left atrium results from increases in pulmonary blood flow.
E) Closure of the ductus venosus eventually forces closure of the ductus arteriosus.
A) Decrease in right atrial pressure leads to closure of the foramen ovale.
C) Onset of respirations leads to a decrease in pulmonary vascular resistance.
D) Increase in pressure in the left atrium results from increases in pulmonary blood flow.
E) Closure of the ductus venosus eventually forces closure of the ductus arteriosus.
A nursing student is preparing a presentation on minimizing heat loss in the newborn. Which of the following would the student include as a measure to prevent heat loss through convection?
A) Placing a cap on a newborns head
B) Working inside an isolette as much as possible.
C) Placing the newborn skin-to-skin with the mother
D) Using a radiant warmer to transport a newborn
B) Working inside an isolette as much as possible.
