Ch. 23 Physical biological Change Infant

A woman gave birth to a healthy 7-lb, 13-oz infant girl. The nurse suggests that the woman place the infant to her breast within 15 minutes after birth. The nurse knows that breastfeeding is effective during the first 30 minutes after birth because this is the:

a.

Transition period

b.

First period of reactivity

c.

Organizational stage

d.

Second period of reactivity

Part of the health assessment of a newborn is observing the infant’s breathing pattern. A full-term newborn’s breathing pattern is predominantly:

a.

Abdominal with synchronous chest movements

b.

Chest breathing with nasal flaring

c.

Diaphragmatic with chest retraction

d.

Deep with a regular rhythm

While assessing a newborn, a nurse should be aware that the average expected apical pulse range of a full-term, quiet, alert newborn is:

a.

80 to 100 beats/min

b.

100 to 120 beats/min

c.

120 to 160 beats/min

d.

150 to 180 beats/min

A newborn is placed under a radiant heat warmer. The nurse knows that thermoregulation presents a problem for newborns because:

a.

Their renal function is not fully developed, and heat is lost in the urine

b.

Their small body surface area favors more rapid heat loss than does an adult’s body surface area

c.

They have a relatively thin layer of subcutaneous fat that provides poor insulation

d.

Their normal flexed posture favors heat loss through perspiration

An African-American woman noticed some bruises on her newborn girl’s buttocks. She asks the nurse who spanked her daughter. The nurse explains that these marks are called:

a.

Lanugo

b.

Vascular nevi

c.

Nevus flammeus

d.

Mongolian spots

While examining a newborn, the nurse notes uneven skin folds on the buttocks and a clunk when performing the Ortolani maneuver. The nurse recognizes these findings as a sign that the newborn probably has:

a.

Polydactyly

b.

Clubfoot

c.

Hip dysplasia

d.

Webbing

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

a.

Acrocyanosis

b.

Erythema neonatorum

c.

Harlequin color

d.

Vernix caseosa

The nurse assessing a newborn knows that the most critical physiologic change required of the newborn is:

a.

Closure of fetal shunts in the circulatory system

b.

Full function of the immune defense system at birth

c.

Maintenance of a stable temperature

d.

Initiation and maintenance of respirations

A primiparous woman is watching her newborn sleep. She wants him to wake up and respond to her. The mother asks the nurse how much he will sleep every day. The nurse’s best response to her is:

a.

“He will only wake up to be fed, and you should not bother him between feedings.”

b.

“The newborn sleeps about 17 hours a day, with periods of wakefulness gradually increasing.”

c.

“He will probably follow your same sleep and wake patterns, and you can expect him to be awake soon.”

d.

“He is being stubborn by not waking up when you want him to. You should try to keep him awake during the daytime so that he will sleep through the night.”

The parents of a newborn ask the nurse how much the newborn can see. The parents specifically want to know what type of visual stimuli they should provide for their newborn. The nurse responds to the parents by telling them:

a.

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

b.

“Infants can track their parents’ eyes and can distinguish patterns; they prefer complex patterns.”

c.

“The infant’s eyes must be protected. Infants enjoy looking at brightly colored stripes.”

d.

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

While assessing the integument of a 24-hour-old newborn, the nurse notes a pink papular rash with vesicles superimposed on the thorax, back, and abdomen. The nurse should:

a.

Notify the physician immediately

b.

Move the newborn to an isolation nursery

c.

Document the finding as erythema toxicum

d.

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

A client is warm and asks for a fan in her room for her comfort. The nurse enters the room to assess the mother and her infant and finds the infant unwrapped in his crib with the fan blowing over him on “high.” The nurse instructs the mother that the fan should not be directed toward the newborn and that the newborn should be wrapped in a blanket. The mother asks why. The nurse’s best response is:

a.

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

b.

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

c.

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

d.

“Your baby will get cold stressed easily and needs to be bundled up at all times.”

A first-time father is changing the diaper of his 1-day-old daughter. He asks the nurse, “What is this black, sticky stuff in her diaper?” The nurse’s best response is:

a.

“That’s meconium, which is your baby’s first stool. It’s normal.”

b.

“That’s transitional stool.”

c.

“That means your baby is bleeding internally.”

d.

“Oh, don’t worry about that. It’s okay.”

The transition period between intrauterine and extrauterine existence for the newborn:

a.

Consists of four phases, two reactive and two of decreased responses

b.

Lasts from birth to day 28 of life

c.

Applies to full-term births only

d.

Varies by socioeconomic status and the mother’s age

All of these statements describe the first stage of the transition period except:

a.

It lasts no longer than 30 minutes

b.

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

c.

It includes the passage of meconium

d.

It may involve the infant suddenly sleeping briefly

With regard to the newborn’s developing cardiovascular system, nurses should be aware that:

a.

The heart rate of a crying infant may rise to 120 beats/min

b.

Heart murmurs heard after the first few hours are cause for concern

c.

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

d.

Persistent bradycardia may indicate respiratory distress syndrome (RDS)

17. By knowing about variations in infants’ blood counts, nurses can explain to their clients that:

a.

A somewhat lower than expected red blood cell count could be the result of delay in clamping the umbilical cord

b.

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

c.

Platelet counts are higher than in adults for a few months

d.

Even a modest vitamin K deficiency means a problem with the blood’s ability to clot properly

What infant response to cool environmental conditions is either not effective or not available to them?

a.

Constriction of peripheral blood vessels

b.

Metabolism of brown fat

c.

Increased respiratory rates

d.

Unflexing from the normal position

With regard to the functioning of the renal system in newborns, nurses should be aware that:

a.

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

b.

Breastfed infants likely will void more often during the first days after birth

c.

“Brick dust” or blood on a diaper is always cause to notify the physician

d.

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

All of these statements about physiologic jaundice are true except:

a.

Neonatal jaundice is common, but kernicterus is rare

b.

The appearance of jaundice during the first 24 hours or beyond day 7 indicates a pathologic process

c.

Because jaundice may not appear before discharge, parents need instruction on how to assess it and when to call for medical help

d.

Breastfed babies have a lower incidence of jaundice

The cheeselike whitish substance that fuses with the epidermis and serves as a protective coating is called:

a.

Vernix caseosa

b.

Surfactant

c.

Caput succedaneum

d.

Acrocyanosis

What marks on a baby’s skin may indicate an underlying problem that requires notification of a physician?

a.

Mongolian spots on the back

b.

Telangiectatic nevi on the nose or nape of the neck

c.

Petechiae scattered over the infant’s body

d.

Erythema toxicum anywhere on the body

One reason the brain is vulnerable to nutritional deficiencies and trauma in early infancy is the:

a.

Incompletely developed neuromuscular system

b.

Primitive reflex system

c.

Presence of various sleep-wake states

d.

Cerebellum growth spurt

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

a.

Chemical

b.

Mechanical

c.

Thermal

d.

Psychologic

A collection of blood between the skull bone and its periosteum is known as a cephalhematoma. In order to reassure the new parents whose infant develops such a soft bulge, it is important that the nurse is aware that this condition:

a.

May occur with spontaneous vaginal birth

b.

Only happens as the result of a forceps- or vacuum-assisted delivery

c.

Is present immediately after birth

d.

Will gradually absorb over the first few months of life

What are modes of heat loss in the newborn? Choose all that apply.

a.

Perspiration

b.

Convection

c.

Radiation

d.

Conduction

e.

Urination

A nurse is performing a blood glucose test every 4 hours on an infant born to a diabetic mother. This is to assess the infant’s risk of hypoglycemia. The nurse becomes concerned if the infant’s blood glucose concentration falls below ____________________ mg/dl.

One reason hyperthermia develops more rapidly in the newborn than in the adult is that sweat glands have not formed yet. Is this statement true or false?