Chapter 17: The Newborn Flashcards

Question

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

Answer 1

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.

Answer 2

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.

Answer 3

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.

Answer 4

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.

Answer 5

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.

Answer 6

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.

Answer 7

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.

Answer 8

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.

Answer 9

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.

Answer 10

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.

Answer 11

B. Less than 15 seconds Rationale: Short periods of apnea lasting less than 15 seconds are considered normal in newborns.

Answer 12

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.

Answer 13

A. Chest movements should be symmetric Rationale: Respirations should not be labored, and chest movements should be symmetric in newborns.

Answer 14

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.

Answer 15

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.

Answer 16

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.

Answer 17

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.

Answer 18

D. Shallow and irregular breathing Rationale: Newborns typically exhibit shallow and irregular breathing during the first days of life.

Answer 19

D. It maintains alveolar stability Rationale: Surfactant production in the lungs is critical for maintaining alveolar stability, preventing alveolar collapse.

Answer 20

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.

Answer 21

B. Surfactant production Rationale: Surfactant production is crucial for maintaining alveolar stability and preventing alveolar collapse.

Answer 22

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.

Answer 23

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.

Answer 24

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.

Answer 25

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.

Answer 26

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.

Answer 27

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.

Answer 28

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.

Answer 29

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).

Answer 30

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.

Answer 31

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.

Answer 32

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.

Answer 33

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.

Answer 34

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.

Answer 35

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.

Answer 36

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.

Answer 37

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.

Answer 38

C. Increased heat loss Rationale: Newborns have a large surface area-to-body mass ratio, which results in increased heat loss.

Answer 39

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.

Answer 40

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.

Answer 41

D. Radiation Rationale: Radiation accounts for the highest percentage of heat loss in newborns, at 39%.

Answer 42

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.

Answer 43

C. 34% Rationale: Convection accounts for 34% of heat loss in newborns.

Answer 44

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.

Answer 45

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.

Answer 46

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.

Answer 47

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.

Answer 48

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.

Answer 49

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.

Answer 50

a. evaporation

Answer 51

a. by drying the baby immediately after delivery

Answer 52

b. convention

Answer 53

b. by keeping infants away from open windows and cold air sources

Answer 54

c. conduction

Answer 55

c. by warming surfaces and instruments prior to them touching the infant

Answer 56

d. radiation

Answer 57

d. by keeping babies away from unnecessary cooling devices and drafts

Answer 58

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.

Answer 59

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.

Answer 60

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.

Answer 61

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.

Answer 62

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.

Answer 63

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.

Answer 64

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.

Answer 65

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.

Answer 66

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.

Answer 67

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.

Answer 68

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.

Answer 69

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.

Answer 70

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.

Answer 71

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.

Answer 72

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.

Answer 73

B. Insensible loss Rationale: Insensible evaporative loss occurs from skin and respiration without the individual's awareness.

Answer 74

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.

Answer 75

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.

Answer 76

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.

Answer 77

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.

Answer 78

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.

Answer 79

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.

Answer 80

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.

Answer 81

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.

Answer 82

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.

Answer 83

D. Warmed transporter Rationale: Using a warmed transporter, which is an enclosed isolette on wheels, helps reduce heat loss during the transportation of newborns.

Answer 84

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.

Answer 85

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.

Answer 86

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.

Answer 87

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.

Answer 88

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.

Answer 89

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.

Answer 90

A. Encouraging frequent feedings Rationale: Frequent feedings promote gastrointestinal motility and stool excretion, aiding in the elimination of conjugated bilirubin through bile.

Answer 91

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.

Answer 92

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.

Answer 93

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.

Answer 94

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.

Answer 95

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.

Answer 96

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.

Answer 97

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.

Answer 98

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.

Answer 99

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.

Answer 100

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.

Answer 101

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.

Answer 102

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.

Answer 103

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.

Answer 104

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.

Answer 105

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.

Answer 106

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.

Answer 107

A. Decreased bilirubin conjugation Rationale: Hypothyroidism contributes to jaundice by decreasing the liver’s ability to conjugate bilirubin.

Answer 108

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.

Answer 109

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.

Answer 110

A. Aspirin C. Acetaminophen D. Sulfa antibiotics Rationale: Aspirin, acetaminophen, and sulfa antibiotics are known to impair bilirubin excretion.

Answer 111

B. Trisomy 21 Rationale: Trisomy 21 (Down syndrome) is a chromosomal abnormality associated with impaired bilirubin excretion.

Answer 112

A. Overproduction of bilirubin Rationale: TORCH infections can cause hemolysis, leading to overproduction of bilirubin.

Answer 113

D. Ensure frequent feedings to promote excretion Rationale: Frequent feedings promote gastrointestinal motility and bilirubin excretion through feces.

Answer 114

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.

Answer 115

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.

Answer 116

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.

Answer 117

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.

Answer 118

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.

Answer 119

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.

Answer 120

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.

Answer 121

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.

Answer 122

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.

Answer 123

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.

Answer 124

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.

Answer 125

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.

Answer 126

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.

Answer 127

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.

Answer 128

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.

Answer 129

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.

Answer 130

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.

Answer 131

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.

Answer 132

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.

Answer 133

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.

Answer 134

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.

Answer 135

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.

Answer 136

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.

Answer 137

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.

Answer 138

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.

Answer 139

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.

Answer 140

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.

Answer 141

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.

Answer 142

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.

Answer 143

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.

Answer 144

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.

Answer 145

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.

Answer 146

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.

Answer 147

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.

Answer 148

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.

Answer 149

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.

Answer 150

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.

Answer 151

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.

Answer 152

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.

Answer 153

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.

Answer 154

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.

Answer 155

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.

Answer 156

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.

Answer 157

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.

Answer 158

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.

Answer 159

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.

Answer 160

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.

Answer 161

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.

Answer 162

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.

Answer 163

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.

Answer 164

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.

Answer 165

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.

Answer 166

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.

Answer 167

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.

Answer 168

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.

Answer 169

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.

Answer 170

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.

Answer 171

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.

Answer 172

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.

Answer 173

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.

Answer 174

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.

Answer 175

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.

Answer 176

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.

Answer 177

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.

Answer 178

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.

Answer 179

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.

Answer 180

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.

Answer 181

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.

Answer 182

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.

Answer 183

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.

Answer 184

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.

Answer 185

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.

Answer 186

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.

Answer 187

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.

Answer 188

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.

Answer 189

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.

Answer 190

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.

Answer 191

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.

Answer 192

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.

Answer 193

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.

Answer 194

B) Conjugation

Answer 195

D) Are unable to shiver effectively to increase heat production

Answer 196

B) This is meconium stool, normal for a newborn.

Answer 197

A) Normal progression of behavior

Answer 198

A) Dry the newborn thoroughly.

Answer 199

B) Conduction

Answer 200

D) Sternal retractions

Answer 201

A) Head-to-toe

Answer 202

D) 68 breaths per minute

Answer 203

B) Yellowish-brown, seedy stool

Answer 204

A) Respiratory distress C) Hypoglycemia E) Jaundice

Answer 205

C) Initiation of respiratory movement

Answer 206

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.

Answer 207

B) Working inside an isolette as much as possible.