Newborn Care Quiz: Essential Insights for Nursing Success

2/14/24, 1:29 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/52221757 1/57 Exit Performance Week 6 EAQ #1 Due Feb 20, 2024 by 8:30 am Passed 50 out of 57 questions answered correctly Completed on Feb 14, 2024 1:29 pm Incorrect (7) Report content error For which reason would the nurse perform nasal and oral suctioning of a newborn immediately after birth? To stimulate respiration

2/14/24, 1:29 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/52221757 2/57 Rationale Respiration in a newborn is stimulated by several chemical, mechanical, thermal, and sensory factors working together. Suctioning of the mouth and nose of the newborn stimulates the respiratory center. If cardiac activity is absent in the newborn, it can be stimulated by cardiopulmonary resuscitation. Thoracic squeezing in the newborn helps remove ﬂuid from the lungs; however, suction helps remove the secretions from the upper respiratory tract. Pulmonary blood ﬂow increases spontaneously once the newborn starts breathing. p. 460 Report content error Which assessment finding of the newborn would the nurse recognize as requiring further evaluation? Rationale To assist in stimulating cardiac activity To remove ﬂuid from the lungs To increase pulmonary blood ﬂow Heart rate of 85 beats/min while asleep Heart rate of 90 beats/min while feeding Heart rate of 140 beats/min while awake Heart rate of 170 beats/min when crying

2/14/24, 1:29 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/52221757 3/57 A heart rate of 90 beats/min while awake is low and should be reevaluated within 30 minutes to 1 hour, or when the activity of the infant changes. The heart rate in the term infant ranges from about 85 to 100 beats/min during deep sleep. The heart rate for a term infant ranges from 120 to 160 beats/min when awake. The heart rate can increase to 180 beats/min or higher when the infant cries. STUDY TIP: Record the information you find to be most diﬃcult to remember on 3" × 5" cards and carry them with you in your pocket or purse. When you are waiting in traﬃc or for an appointment, just pull out the cards and review again. This "found" time may add points to your test scores that you have lost in the past. p. 461 Report content error Which explanation correctly describes the crossed extension reﬂex of the newborn? Rationale It is a nonselective generalized response by the newborn after a knee-jerk stimulus. The trunk of the newborn is ﬂexed and the pelvis is swung toward the stimulated side. The infant simulates a walking response by alternating ﬂexion and extension of the feet. The newborn ﬂexes, adducts, and then extends the leg opposite to the stimulated leg.

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2/14/24, 1:29 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/52221757 4/57 Upon stimulating one leg of a newborn in the supine position, the newborn ﬂexes, adducts, and then extends the leg opposite to the stimulated leg, exhibiting a crossed extension reﬂex. A nonselective generalized response by a newborn after getting patellar or knee-jerk stimulus shows a deep tendon reﬂex. The truncal incurvation reﬂex is observed when the trunk of the newborn is ﬂexed and the pelvis is swung toward the stimulated side. A stepping reﬂex is achieved when the infant simulates a walking response by alternating ﬂexion and extension of the feet when held vertically over the arms. p. 477 Report content error Which health condition would the nurse anticipate in a preterm infant whose umbilical cord was clamped 3 minutes after birth? Rationale Clamping the umbilical cord after 2 minutes of birth refers to delayed clamping. Delayed clamping of the cord results in polycythemia (greater plasma volume) and improves hematocrit and iron status. Polycythemia is more commonly observed in preterm infants than in term infants. Epispadias is an abnormal position of the urethral opening and is a Epispadias Polydactyly Polycythemia Respiratory distress

2/14/24, 1:29 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/52221757 5/57 congenital abnormality that is not associated with the umbilical cord. Polydactyly is the presence of extra digits on the extremities and is a congenital abnormality. Respiratory distress is not related to delayed clamping of the umbilical cord. p. 462 Report content error Which condition would the nurse suspect to be the cause of ﬂushed skin in an infant? Rationale When an infant is hyperthermic (swaddled in too many blankets) they experience heat-losing mechanisms. This loss of heat from the infant’s body dilates the skin vessels, therefore causing the skin to appear ﬂushed and warm to touch. Loss of water and ﬂuids from the body occurs to prevent overheating complications, such as cerebral damage from dehydration or even heat stroke and death. Increased production of acids results in increased bilirubin levels, which leads to jaundice. If the infant has hypothermia they may appear pale and mottled because of vasoconstriction. p. 464 Loss of water and ﬂuids Increased acid production Hypothermia Hyperthermia

2/14/24, 1:29 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/52221757 6/57 Report content error Which factor affects blood pressure measurements in the newborn? Select all that apply. One, some, or all responses may be correct. Some correct answers were not selected Rationale Primary factors affecting BP values are gestational age, postconceptional age, and birth weight of newborn. The size of cuff, state of alertness, and newborn movement also affect the BP measurement. The gender of the newborn does not impact measurements. p. 461 Report content error Cuff size State of alertness Size of newborn Gestational age Gender of newborn

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2/14/24, 1:29 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/52221757 7/57 Which is the first sign a newborn may have an imperforate anus? Rationale A newborn with an imperforate anus would not be able to pass meconium, and it is regarded as the first indicator of this congenital condition. A newborn emitting a large amount of green, bilious vomit would have an intestinal obstruction or malrotation of the bowel. Forceful ejection of stool with a surrounding water ring indicates diarrhea in a newborn. If the newborn is passing meconium through the vagina or urinary tract, then it indicates a possible fistula in the rectal tract. p. 466 Inability to pass meconium Large amount of green, bilious vomit Forceful ejection of stool with a water ring Meconium passed through the urinary tract Correct (50) Report content error For which reason is vitamin K administered to newborns? It reduces bilirubin levels. It increases the production of red blood cells. It enhances the ability of blood to clot.

2/14/24, 1:29 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/52221757 8/57 Rationale Vitamin K is required for the production of certain clotting factors. Vitamin K does not reduce bilirubin levels. Vitamin K does not increase the production of red blood cells. Newborns have a deficiency of vitamin K until intestinal bacteria that produce vitamin K are formed and it helps prevent fatal bleeding in the newborn by helping the blood clot effectively. Vitamin K does not stimulate the formation of surfactant. p. 468 Report content error Which sensory system is least mature at the time of birth? Rationale The visual system continues to develop for the first 3 to 6 months. As soon as the amniotic ﬂuid drains from the ears (minutes), the infant’s hearing is similar to that of an adult. Newborns have a highly developed sense of smell. The newborn can distinguish and react to various tastes. Test-Taking Tip: If the question asks for an immediate action or response, It stimulates the formation of surfactant. Vision Hearing Smell Taste

2/14/24, 1:29 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/52221757 9/57 all the answers may be correct, so base your selection on identified priorities for action. p. 481 Report content error

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2/14/24, 1:29 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/52221757 10/57 In which range would the nurse expect the blood glucose to be in a healthy newborn during the first hours after birth? Rationale In most healthy term newborns, blood glucose levels stabilize at 50 to 60 mg/dL during the first several hours after birth. This is the normal plasma glucose level in the adult. A blood glucose level less than 40 mg/dL in the newborn is considered abnormal and warrants intervention. This infant can display classic symptoms of jitteriness, lethargy, apnea, feeding problems, or seizures. By the third day of life, the blood glucose levels should be approximately 60 to 70 mg/dL. Test-Taking Tip: Look for answers that focus on the client or that are directed toward the client’s feelings. p. 467 Report content error Which behavior by the infant would the nurse recognize as indicating respiratory distress? 80 to 100 mg/dL Less than 40 mg/dL 50 to 60 mg/dL 60 to 70 mg/dL Absent cry after birth

2/14/24, 1:29 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/52221757 11/57 Rationale The nurse would suspect that the newborn has diﬃculty breathing if a cry is absent after birth. Crying creates positive intrathoracic pressure, which helps draw air into the alveoli of lungs and promotes respiration. Hypoactive bowel sounds may indicate a gastrointestinal abnormality, but it is not related to respiration. Side-to-side head movement is common after birth, and it is not associated with breathing diﬃculties. Increased BP is a normal finding after birth and does not cause breathing diﬃculties. Test-Taking Tip: Choose the best answer for questions asking for a single answer. More than one answer may be correct, but one answer may contain more information or more important information than another answer. p. 460 Report content error Which newborn reﬂex is characterized by abrupt abduction and extension of the arms with the fingers fanned out while the thumb and forefinger form a C? Hypoactive bowel sounds Side-to-side head movement Elevated blood pressure (BP) Tonic neck reﬂex Moro reﬂex Cremasteric reﬂex

2/14/24, 1:29 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/52221757 12/57 Rationale These actions show the Moro reﬂex. The tonic neck reﬂex refers to the “fencing posture” a newborn assumes when supine and the head is turned to the side. The cremasteric reﬂex refers to retraction of the testes when the upper thigh is stroked. The Babinski reﬂex refers to ﬂaring of the toes when the sole is stroked. Test-Taking Tip: Relax during the last hour before an examination. Your brain needs some recovery time to function effectively. p. 475 Report content error Which phenomenon is characteristic of newborn respiration? Rationale Respirations in the newborn can be stimulated by mechanical factors such as changes in intrathoracic pressure resulting from the compression of the chest during vaginal birth. With birth, the pressure on the chest is Babinski reﬂex Crying increases the distribution of air in the lungs. Newborns expel all the ﬂuid from the respiratory system within a few minutes of birth. Newborns are instinctive mouth breathers. Seesaw respirations are expected the first hour after birth.

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2/14/24, 1:29 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/52221757 13/57 released, which helps draw air into the lungs. The positive pressure created by crying helps keep the alveoli open and increases distribution of air throughout the lungs. Newborns continue to expel ﬂuid for the first hour of life. Newborns are natural nose breathers; they may not have the mouth breathing response to nasal blockage for 3 weeks. Seesaw respirations instead of normal abdominal respirations are not normal and should be reported. p. 460 Report content error Which assessment finding would the nurse recognize as a sign of possible seizure activity? Rationale Tremors accompanied by ocular changes such as deviating or staring eyes are not a normal finding in newborns and are a sign of seizure activity. It is normal for a newborn to tremor when a sound is heard or when there is a slight motion. The tremors cease with gentle restraint of the extremity by the caregiver. It is normal for the tremors to stop when the extremity is ﬂexed passively by the caregiver. p. 475 Tremors are easily elicited by a sound or motion. Tremors cease with gentle restraint of the extremity. Tremors reduce or stop with passive ﬂexion. Tremors are accompanied by ocular changes.

2/14/24, 1:29 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/52221757 14/57 Report content error Which outcome on the respiratory function of the neonate is common after cesarean delivery? Rationale Before the onset of labor and during labor, a catecholamine surge promotes ﬂuid clearance from the lungs. This is absent during cesarean delivery when the mother does not go into labor. The full-term neonate born by cesarean delivery is likely to experience some retention of ﬂuid in the lungs, which generally clears without any deleterious effects. The neonate is more likely to develop transient tachypnea of the newborn (TTNB), not bradypnea, because of lower levels of catecholamines. Preterm or sick term infants may experience exhaustion from breathing as a result of absent or decreased surfactant in the lungs, which causes more pressure on the lungs. It is normal for all infants to experience periodic breathing, with pauses in respirations lasting less than 20 seconds during the active sleep cycle. STUDY TIP: You have a great resource in your classmates. We all have different learning styles, strengths, and perspectives on the material. Participating in a study group can be a valuable addition to your nursing school experience. Retention of ﬂuid in the lungs Incidence of transient bradypnea Exhaustion from the effort of breathing Episodes of periodic breathing

2/14/24, 1:29 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/52221757 15/57 p. 460 Report content error Which enzyme helps the newborn convert starch into maltose? Rationale The enzyme amylase is necessary to convert starch into maltose and is present in high amounts in colostrum. Mammary lipase in breast milk aids in the digestion of fats. The salivary glands produce amylase starting only at 3 months of age, so the newborn depends on the amylase available in colostrum. The newborn’s digestive system produces a high level of lactase, which aids in the digestion of lactose, a carbohydrate present in milk. STUDY TIP: Study goals should set out exactly what you want to accomplish. Do not simply say, "I will study for the examination." Specify how many hours, what day and time, and what material you will cover. p. 465 Amylase in colostrum Mammary lipase in breast milk Amylase in the salivary glands Lactase in the digestive system

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2/14/24, 1:29 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/52221757 16/57 Report content error Which reﬂex would the nurse document for a newborn who symmetrically abducts and extends his arms, fans his fingers and forms a C with the thumb and forefinger, and has a slight tremor following a loud noise? Rationale The characteristics displayed by the infant are associated with a positive Moro reﬂex. The tonic neck reﬂex occurs when the infant extends the leg on the side to which the infant’s head simultaneously turns. The glabellar reﬂex is elicited by tapping on the infant’s head while the eyes are open. A characteristic response is blinking for the first few taps. The Babinski reﬂex occurs when the sole of the foot is stroked upward along the lateral aspect of the sole and then across the ball of the foot. A positive response occurs when all the toes hyperextend, with dorsiﬂexion of the big toe. Test-Taking Tip: Avoid selecting answers that state hospital rules or regulations as a reason or rationale for action. p. 475 Positive tonic neck reﬂex Positive glabellar (Myerson) reﬂex Positive Babinski reﬂex Positive Moro reﬂex

2/14/24, 1:29 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/52221757 17/57 Report content error Which technique would the nurse use to assess the plantar reﬂex of an infant? Rationale The nurse would place a finger at the base of the infant’s toes to elicit the plantar reﬂex. The infant will curl the toes downward. The nurse checks the infant’s sucking reﬂex by touching the corner of the infant’s mouth with a finger. The infant turns the head toward the stimulus and opens his or her mouth. The nurse taps over the bridge of the nose when the infant is awake to assess the glabellar reﬂex. In response, the infant blinks for the first four or five taps. The nurse assesses the palmar reﬂex by placing a finger in the palm of the infant’s hand. The infant curls his or her fingers around the nurse’s fingers. p. 475 Report content error Touch the corner of the infant’s mouth with a finger. Tap over the bridge of the infant’s nose when awake. Place a finger at the base of the infant’s toes. Place a finger in the palm of the infant’s hand.

2/14/24, 1:29 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/52221757 18/57 In most healthy newborns, blood glucose levels stabilize at which level during the first hours after birth? Rationale In most healthy term newborns, blood glucose levels stabilize at 55 to 60 mg/dL during the first several hours after birth. A blood glucose level less than 40 mg/dL in the newborn is considered abnormal and warrants intervention. This infant can display classic symptoms of jitteriness, lethargy, apnea, feeding problems, or seizures. By the third day of life, the blood glucose levels should be approximately 60 to 70 mg/dL. Test-Taking Tip: Eat breakfast or lunch before an examination. Avoid greasy, heavy foods and overeating. This will help keep you calm and give you energy. p. 467 Report content error Which finding would the nurse expect when assessing a newborn male infant born at 39 weeks of gestation? 30 to 40 mg/dL 40 to 50 mg/dL 55 to 60 mg/dL 60 to 65 mg/dL Testes descended into the scrotum

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2/14/24, 1:29 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/52221757 19/57 Rationale A full-term male infant has both testes descended into his scrotum, and rugae appear on the anterior portion. A term infant’s good muscle tone results in a more ﬂexed posture when at rest. A full-term infant exhibits only a moderate amount of lanugo, usually on the shoulders and back. Preterm infants have an abundance of lanugo over the entire body. The muscle tone of a full-term newborn prevents him from being able to move his elbow past midline. Test-Taking Tip: Work with a study group to create and take practice tests. Think of the kinds of questions you would ask if you were composing the test. Consider what would be a good question, what would be the right answer, and what would be other answers that appear right but would in fact be incorrect. p. 472 Report content error Which clinical finding would the nurse recognize as a possible sign of cold stress in the newborn? Extended posture when at rest Abundant lanugo over his entire body Ability to move his elbow past his sternum Decreased activity level Increased respiratory rate Hyperglycemia

2/14/24, 1:29 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/52221757 20/57 Rationale In an infant who is cold, the respiratory rate increases in response to the increased need for oxygen. Signs of cold stress include increased activity level and crying (increased basal metabolic rate [BMR] and heat production). A cold infant is at risk for hypoglycemia, because the glucose stores are depleted. Newborns are unable to shiver as a means to increase heat production. p. 463 Report content error Which response would the nurse provide the mother of a 16- hour-old newborn who expresses concern about finding a large amount of thick, sticky, dark green, almost black stool during a diaper change? Rationale Shivering Reassure that breastfed babies have this type of stool. Explain that the stool is called meconium and is expected of all newborns for the first few bowel movements. Ask the mother what she ate at her last meal. Suggest that the mother ask her pediatric health care provider to explain newborn stool patterns to her.

2/14/24, 1:29 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/52221757 21/57 This type of stool ( meconium ) is typical of both bottle-fed and breastfed newborns. This type of stool is the first stool that all newborns have, not just breastfed babies. The mother’s nutritional intake does not cause meconium stool. The nurse is fully capable of and responsible for teaching the new mother about the characteristics of her newborn, including expected stool patterns. p. 466 Report content error Which clinical finding would the nurse attribute to a forceps- assisted birth? Rationale An infant who had a forceps-assisted birth is likely to have edema of the face and ecchymosis, or bruising. It is normal for the term infant to have erythematous, or red skin, for a few hours after birth. The skin gradually fades to its normal color. The skin often appears blotchy or mottled, especially over the extremities in a term infant. It is normal for the infant to have acrocyanosis, or cyanotic discoloration of the hands and feet. The discoloration is caused by vasomotor instability and capillary stasis and may appear intermittently over the first 7 to 10 days, especially with exposure to cold. Erythematous skin Blotchy or mottled skin Edema and ecchymosis Cyanotic discoloration

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2/14/24, 1:29 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/52221757 22/57 p. 469 Report content error Which assessment is the most important for the nurse caring for an infant after circumcision? Rationale The most important assessment by the nurse caring for a circumcised infant is to observe the infant for signs of hemorrhage. Infants can develop a coagulation deficiency from a lack of intestinal bacteria needed to synthesize the coagulation factor, vitamin K. The pain associated with circumcision may temporarily affect feeding, urination, or bowel movements. p. 469 Report content error Effective feeding Adequate urine output Passage of normal stool Excessive bleeding

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2/14/24, 1:29 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/52221757 23/57 Which behavior in the neonate would the nurse recognize as a symptom of thermogenesis? Rationale Thermogenesis is the process by which the neonate tries to generate heat in response to cold. The neonate increases muscle activity by crying and being restless in a quest to stay warm. The shivering mechanism is used to produce heat in adults; however, this mechanism is rarely operable in the newborn unless there is prolonged exposure to cold. The neonate assumes a position of ﬂexion, not extension, to conserve heat. This position reduces the amount of body surface exposed to the environment. The neonate with hyperthermia may develop pallor and seizures as a result of neurologic injury. p. 463 Report content error Which clinical finding would the nurse expect when examining a 36-week-old newborn male infant immediately after birth? Starts shivering incessantly Assumes position of extension Cries and appears restless Develops pallor and seizures Rugae covering the scrotal sac

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2/14/24, 1:29 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/52221757 24/57 Rationale After 35 weeks of gestation, the newborn’s body is covered with vernix caseosa, which resembles a cheesy white substance and is fused with the epidermis of the skin. It is formed to protect the fetus’ skin from the contents of the uterus. Rugae covering the scrotal sac are expected after 40 weeks; rugae appear on the anterior portion of the scrotal sac between 36 and 50 weeks. Postdate fetuses lose the vernix caseosa, and the epidermis may become desquamated. Desquamation (peeling) of the skin occurs a few days after birth. Erythema toxicum, a transient rash, usually appears in term neonates during the first 24 to 72 hours after birth. p. 469 Report content error Which scenario would the nurse recognize as increasing the likelihood of physiologic jaundice in a newborn? Desquamation of the epidermis Vernix caseosa covering the body Erythema toxicum Jaundice appeared within the first 24 hours of life. Jaundice appeared on the third day of life. The preterm infant is 12 hours old. The infant is bottle fed within the first 24 hours of life.

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2/14/24, 1:29 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/52221757 25/57 Rationale Physiologic jaundice can be seen in a large percentage of newborns, 60% of term babies and 80% of preterm babies, but it typically resolves without immediate intervention. Jaundice appearing within the first 24 hours of life is considered to be pathologic and requires further investigation. Prematurity increases the likelihood of pathologic jaundice. Bottle feeding decreases the likelihood of jaundice. Test-Taking Tip: Study wisely, not hard. Use study strategies to save time and be able to get a good night’s sleep the night before your examination. Cramming is not smart, and it is hard work that increases stress while reducing learning. When you cram, your mind is more likely to go blank during a test. When you cram, the information is in your short-term memory so you will need to relearn it before a comprehensive examination. Relearning takes more time. The stress caused by cramming may interfere with your sleep. Your brain needs sleep to function at its best. p. 468 Report content error Which health outcome is related to delayed cord clamping in the newborn? Improved iron levels Decreased risk of jaundice Decreased risk of polycythemia Risk of intraventricular bleeding

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2/14/24, 1:29 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/52221757 26/57 Rationale Delayed cord clamping expands the infant’s blood volume from the placental transfusion of blood to the newborn. It is reported to improve the infant’s iron status and decrease anemia for up to 6 months after birth. The delay in clamping leaves the infant with an increased risk of jaundice and may require phototherapy. Delayed clamping can also lead to polycythemia, but it is not harmful. Preterm infants are generally at a risk for intraventricular hemorrhage. This risk is significantly reduced when cord clamping is delayed. STUDY TIP: Answer every question. A question without an answer is the same as a wrong answer. Go ahead and guess. You have studied for the test, and you know the material well. You are not making a random guess based on no information. You are guessing based on what you have learned and your best assessment of the question. p. 462 Report content error Which finding in a newborn assessment would the nurse report to the primary healthcare provider during the first 2 days after birth? The neonate’s diaper has pink-tinged stains. The neonate’s urine is cloudy after the first voiding. The neonate voids eight times during the day. The neonate has not voided for 24 hours.

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2/14/24, 1:29 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/52221757 27/57 Rationale The nurse would notify the primary healthcare provider if the neonate has not voided for 24 hours . The neonate should be assessed for adequacy of ﬂuid intake, bladder distention, restlessness, and symptoms of pain. Pink- tinged stains on the diaper indicate the presence of uric acid crystals in the urine and is a normal finding during the first week; however, later on it can be a sign of inadequate intake. It is normal for the urine to appear cloudy after the first voiding because of the presence of mucus. Six to eight voids per day of pale, straw-colored urine indicate adequate ﬂuid intake; this frequency is not a cause for concern. p. 464 Report content error Which clinical finding would the nurse report to the provider when examining the external genitalia of a female infant? Rationale Fecal discharge from the vagina indicates a rectovaginal fistula. This finding should be reported to the provider for further evaluation. Slight bloody spotting, or pseudomenstruation, is normal and need not be reported. Nearly all female infants are born with hymenal tags. The nurse would report the absence of such tags, which can indicate vaginal Slight bloody spotting Presence of hymenal tag Mucoid vaginal discharge Fecal vaginal discharge

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2/14/24, 1:29 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/52221757 28/57 agenesis. The presence of mucoid vaginal discharge is a normal finding. The discharge occurs as a result of an increase in estrogen during pregnancy followed by a drop after birth. p. 472 Report content error Which action would the nurse take after finding unequal movement and uneven gluteal skinfolds during the Ortolani maneuver? Rationale The Ortolani maneuver is a technique for checking hip integrity. Unequal movement suggests that the hip is dislocated. The provider should be notified. Telling the parents that one of the infant’s legs might be longer than the other is an inappropriate statement that may result in unnecessary anxiety for the new parents. Molding refers to movement of the cranial bones and has nothing to do with the infant’s hips. The Ortolani maneuver is not a technique used to evaluate visual acuity in the newborn. This maneuver checks hip integrity. Tell the parents that one leg may be longer than the other, but they will equal out by the time the infant is walking. Alert the provider that the infant may have a dislocated hip. Inform the parents and provider that molding has not taken place. Suggest that if the condition does not change, surgery to correct vision problems might be needed.

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2/14/24, 1:29 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/52221757 29/57 Test-Taking Tip: Get a good night’s sleep before an examination. Staying up all night to study before an examination rarely helps anyone. It usually interferes with the ability to concentrate. p. 474 Report content error Which condition would the nurse suspect in a 1-week-old infant who displays symptoms of apnea, lethargy, jitteriness, and feeding problems? Rationale Apnea, lethargy, jitteriness, and feeding problems are the symptoms of hypoglycemia (less than 40 mg/dL blood glucose level). Therefore, the infant with a blood glucose level of 38 mg/dL (hypoglycemia) would have these symptoms. A heart rate of 120 beats/min, body temperature of 99.5° F, and BP of 80/40 mm Hg are normal values for a newborn and are not associated with the infant’s manifestations. Test-Taking Tip: On a test day, eat a normal meal before going to school. If the test is late in the morning, take a high-powered snack with you to eat 20 minutes before the examination. The brain works best when it has the glucose necessary for cellular function. Heart rate of 120 beats/min Body temperature of 99.5° F Blood glucose level of 38 mg/dL Blood pressure (BP) of 80/40 mm Hg

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2/14/24, 1:29 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/52221757 30/57 p. 467 Report content error Which recommendation would the nurse make to the parents about caring for an infant with respiratory distress and a murmur? Rationale Typically, the presence of a cardiac murmur in an infant has no pathologic significance. However, when murmurs are associated with other conditions that may cause apnea and cyanosis, such as respiratory distress, they are considered abnormal. In this case, the healthcare provider would evaluate the infant for a more serious condition. Feeding the infant with formula milk is not related to cardiac murmurs. Wrapping the infant in a thick blanket would prevent cold distress in the infant, but it would not affect the cardiac murmur. Although skin-to-skin contact is useful in enhancing thermoregulation in infants, it would not have any effect on a heart murmur. p. 461 "Switch to exclusive formula feedings." "Additional cardiac evaluation is necessary." "The infant should be wrapped in a thick blanket." "Maintain skin-to-skin contact with the mother."

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2/14/24, 1:29 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/52221757 31/57 Report content error

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2/14/24, 1:29 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/52221757 32/57 Which condition would the nurse suspect in an infant with bluish pigmentation on the back and buttocks? Rationale Bluish pigmented areas on the back are a sign of slate gray nevi (formerly known as Mongolian spots ), which are not dangerous and usually fade in a few months. The bluish pigmentation is a common finding in extrauterine life and does not indicate infection. Hypothermia does not cause pigmentation of the body, though it may cause shivering in the newborn. Polycythemia is the condition of accumulation of red blood cells on the face and gives a dark-red-colored tint on the face, but not a bluish pigmentation on the skin. Test-Taking Tip: Avoid choosing answers that use words such as always, never, must, all, and none . If you are confused about the question, read the choices, label them true or false, and choose the answer that is the odd one out (i.e., the one false one or the one true one). When a question is framed in the negative, such as "When assessing for pain, you should not, " the false option is the correct choice. p. 470 Report content error Infection Hypothermia Polycythemia Slate gray nevi

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2/14/24, 1:29 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/52221757 33/57 Which clinical finding is a sign of ineffective adaptation to extrauterine life when assessing a 24-hour-old breastfed newborn? Rationale The heart rate of a newborn should range from 120 to 160 beats/min, especially when active. The rate should be regular with sharp, strong sounds. Acrocyanosis is a normal finding in a newborn at 24 hours of age. The harlequin sign is a normal finding related to the immature neurologic system of a newborn. A 5% weight loss is acceptable in the newborn. p. 461 Report content error Which action would the nurse take after noting that an infant’s heart rate is 80 beats/min while sleeping? Apical heart rate of 90 beats/min, slightly irregular, when awake and active Acrocyanosis Harlequin color sign Weight loss representing 5% of the newborn’s birth weight Immediately wake the infant. Reassess the heart rate after 30 minutes. Advise the mother to stop breastfeeding.

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2/14/24, 1:29 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/52221757 34/57 Rationale The average heart rate of infants is 120 to 160 beats/min and varies based on the infant’s activity. When the infant is in a state of rest, such as sleeping, the heart rate decreases to 80 to 100 beats/min. The nurse would reassess the infant’s heart rate within 30 to 60 minutes if the heart rate is less than 100 beats/min. The nurse would not immediately wake the infant. The nurse would not advise the infant’s mother to stop breastfeeding as it is unlikely related to the variation in heart rate. Without a thorough assessment, the nurse would not conclude and inform the parents that the infant has bradycardia. Test-Taking Tip: After choosing an answer, go back and reread the question stem along with your chosen answer. Does it fit correctly? The choice that grammatically fits the stem and contains the correct information is the best choice. p. 461 Report content error Which cause would the nurse suspect in a 3-day-old infant with neutrophilia? Inform the parents that the infant has bradycardia. Epispadias Polydactyly Cephalhematoma Meconium aspiration syndrome

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2/14/24, 1:29 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/52221757 35/57 Rationale Meconium aspiration syndrome in newborns is associated with a rise in neutrophils as they are fighting off an infection. The rise in neutrophils is known as neutrophilia . Epispadias is a condition in which the urethral opening is located in an abnormal position; it is not associated with neutrophilia. Polydactyly is the presence of extra digits, and it does not cause neutrophilia. Cephalhematoma is the deposition of blood between a skull bone and its periosteum, and it is not associated with neutrophilia. p. 462 Report content error Which education would the nurse provide the parent of a breastfed newborn about expected stool appearance on the fourth day of life? Rationale The breastfed newborn passes pale yellow to golden stool on the fourth day. The stool is pasty in consistency with an odor similar to sour milk. The newborn’s first stool is meconium, which is viscous in its consistency and greenish-black in color. It contains amniotic ﬂuid, and its constituents include intestinal secretions, shed mucosal cells, and blood. The newborn Greenish-black stool with thick consistency Greenish-brown stool with thin consistency Pale yellow to brown stool with a firm consistency and foul odor Yellow to golden stool with pasty consistency and sour odor

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2/14/24, 1:29 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/52221757 36/57 passes transitional stool by the third day after initiation of feeding. Transitional stool appears greenish-brown to yellowish-brown in color. It is thinner and less viscous than meconium and may contain milk curds. By the fourth day, the newborn fed on formula milk passes pale yellow to light brown stool with a foul odor. p. 466 Report content error Which clinical condition would the nurse suspect in an infant with a sunken abdomen, bowel sounds heard in the chest, nasal ﬂaring, and grunting? Rationale The infant has a sunken abdomen (scaphoid) with bowel sounds heard in the chest. Nasal ﬂaring and grunting indicate respiratory distress. All of these symptoms indicate a diaphragmatic hernia. Epispadias, ruptured viscus, and Hirschsprung disease are not associated with these symptoms. Epispadias is a condition in which the urethral opening is located in an abnormal position. A ruptured viscus is caused by abdominal distention at birth resulting from abdominal wall defects. Hirschsprung disease is a congenital disorder that involves an imperforate anus. Epispadias Ruptured viscus Diaphragmatic hernia Hirschsprung disease

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2/14/24, 1:29 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/52221757 37/57 p. 466 Report content error Which response would the nurse provide to a client who says, "While crying, my baby often moves her hand toward her mouth and seems to be startled by the sound of the rattle"? Rationale Newborns adopt one of several ways to console themselves; making hand- to-mouth movements and becoming alert to voices, noise, and visual stimuli are common observations and indications of consoling. Hunger, seeking attention, and phonophobia are all common reasons for why the baby might cry. Test-Taking Tip: Notice how the subjects of the questions are related and, through that relationship, the answers to some of the questions may be provided within other questions of the test. p. 481 "Your baby is showing signs of hunger." "Your baby is consoling herself." "Your baby wants to interact with you." "Your baby is frightened by some noise."

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2/14/24, 1:29 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/52221757 38/57 Report content error Which assessment would the nurse perform to detect possible subgaleal hemorrhage in a newborn born by vacuum extraction? Rationale The nurse would obtain serial head circumference measurements for early detection of possible hemorrhage. Increasing head circumference may be an early sign of a subgaleal hemorrhage. The neonate with subgaleal hemorrhage will have tachycardia, not bradycardia. The nurse would inspect the back of the neck for increasing edema and a firm mass. If hematoma is present, it extends posteriorly, leading to a forward and lateral positioning of the neonate’s ears. p. 473 Report content error Measure serial head circumference. Monitor the neonate for bradycardia. Inspect the frontal aspect of the head. Look for backward positioning of the ears.

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2/14/24, 1:29 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/52221757 39/57 An infant communicating with the caregiver by crying and then being consoled is at which level of behavior? Rationale The infant is assessed to be at the third level of behavior, which is state regulation. The infant is able to react to stress by communicating with the caregiver by crying and then being consoled. At the first level, the infant is able to regulate the physiologic or autonomic system. The infant is not capable of regulating involuntary physiologic functions such as heart rate, respiration, and temperature. At the second level, the infant develops motor organization. The infant is able to regulate motor behavior, including controlling random movements, improving muscle tone, and reducing excessive activity. At the fourth level, the infant is able to attend to visual and auditory stimulation, stay alert for long periods, and engage in social interaction. p. 479 Report content error Regulation of physiologic functions Control of motor behavior Regulation of state Attention and social interaction

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2/14/24, 1:29 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/52221757 40/57 Which physiologic change is expected in neonates during the 2 to 8 hours after birth? Select all that apply. One, some, or all responses may be correct. Rationale The second period of reactivity occurs roughly 2 to 8 hours after birth. While assessing the neonate, the nurse would find a moderate-to-large amount of mucus in the mouth, and the infant would display increased muscle tone. The nurse is also likely to note brief periods of tachycardia that are associated with increased muscle tone, changes in skin color, and mucus production. Retractions of the chest are noted in the first stage of the transition period and usually cease within the first hour after birth. The nurse would note brief periods of tachypnea, not bradypnea, as a result of mucus production. STUDY TIP: Begin studying by setting goals. Make sure they are realistic. A goal of scoring 100% on all examinations is not realistic, but scoring an 85% may be a better goal. p. 459 Report content error Production of mucus Increased muscle tone Retractions of the chest Brief periods of bradypnea Brief periods of tachycardia

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2/14/24, 1:29 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/52221757 41/57 Which condition would the nurse suspect in an infant with a scaphoid abdomen, bowel sounds in the chest, and signs of respiratory distress? Rationale A scaphoid (or sunken) abdomen with bowel sounds heard in the chest and signs of respiratory distress are indications of diaphragmatic hernia in the infant. Fullness below the umbilicus can indicate a distended bladder. Abdominal distention at birth usually indicates a serious disorder caused by an abdominal wall defect. Distention that occurs after birth may be caused by gastrointestinal disorders or overfeeding. p. 466 Report content error Which measure would the nurse take to protect a newborn from heat loss? Select all that apply. One, some, or all responses may be correct. Distended bladder Abdominal wall defect Diaphragmatic hernia Gastrointestinal disorder Ensure that the infant is dried immediately after birth. Place the naked infant on a bare scale for accuracy.

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2/14/24, 1:29 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/52221757 42/57 Rationale Heat loss by evaporation is intensified if the newborn is not dried immediately after birth, which can lead to hypothermia. The naked infant is placed on the mother’s bare chest and covered with a warm blanket to reduce heat loss. The infant must be wrapped in a warm blanket; the head may be covered with a cap to conserve heat. The naked infant is weighed on scales with a protective cover to minimize conductive heat loss. The ambient temperature in the nursery is generally maintained at 22-26° C (72-78° F), and the infant lies in an open bassinet with a warm blanket and a cap. STUDY TIP: Becoming a student nurse automatically increases stress levels because of the complexity of the information to be learned and applied and because of new constraints on time. One way to decrease stress associated with school is to become very organized so that assignment deadlines or tests do not come as sudden surprises. By following a consistent plan for studying and completing assignments, you can stay on top of requirements and thereby prevent added stress. p. 463 Report content error Place the naked infant on the mother’s bare chest and cover him or her with a blanket. Ensure that the nursery temperature is 27° C (80.6° F). Wrap the infant, and cover the head with a cap.

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2/14/24, 1:29 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/52221757 43/57 Which inference would the nurse make for an infant born via cesarean delivery with a high respiratory rate and a bluish tint to the skin? Rationale Infants who are born through cesarean delivery are more likely to develop transient tachypnea. This condition is associated with ﬂuid retention in the lungs, which occurs as a result of the release of low levels of catecholamines. Low levels of catecholamines cause inadequate oxygenation and cyanosis in infants. The release of higher levels of catecholamines before the onset of labor promotes ﬂuid clearance from the lungs. The alveoli of the infant are lined with surfactant, a protein manufactured by cells in the lungs. Surfactant lowers surface tension and maintains alveolar stability. With increased levels of surfactant, the alveolar walls would become overly distended. With decreased levels of surfactant, more pressure would be required for inspiration, and the infant would get tired soon. Test-Taking Tip: Answer every question. A question without an answer is always a wrong answer, so go ahead and guess. p. 460 Low levels of catecholamines High levels of catecholamines Increased surfactant production Decreased surfactant production

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2/14/24, 1:29 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/52221757 44/57 Report content error

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2/14/24, 1:29 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/52221757 45/57 Which assessment finding would the nurse recognize as a normal reﬂex in the newborn? Select all that apply. One, some, or all responses may be correct. Rationale When eliciting the rooting reﬂex, the characteristic response is for the newborn to turn the head toward the stimulus and open his or her mouth. Extrusion is elicited by touching the newborn’s tongue, and the tongue is forced outward. The newborn should elicit symmetric abduction and extension of the arms and fingers forming a “C” with the Moro reﬂex. The Babinski reﬂex is elicited by stroking upward along the lateral aspect on the sole of the feet. The expected response is hyperextension of the toes with dorsiﬂexion of the big toe. The baby’s fingers should curl around the examiner’s fingers when eliciting the palmar reﬂex. p. 475 The newborn turns the head toward a stimulus with the mouth open when eliciting the rooting reﬂex. The newborn’s fingers fan out when the palmar reﬂex is checked. The newborn forces the tongue outward when the tongue is touched. The newborn exhibits symmetric abduction and extension of the arms, and fingers form a "C" when the Moro reﬂex is elicited. The newborn’s toes hyperextend with dorsiﬂexion of the big toe when the sole of the foot is stroked upward along the lateral aspect.

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2/14/24, 1:29 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/52221757 46/57 Report content error

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2/14/24, 1:29 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/52221757 47/57 Arrange the progression in which breastfeeding-associated jaundice develops. 1. 2. 3. 4. 5. Rationale Breastfeeding-associated jaundice begins at 2 to 5 days of age. The jaundice occurs as a result of ineffective breastfeeding, which leads to less caloric and ﬂuid intake. Insuﬃcient intake leads to dehydration. This leads to reduced hepatic clearance of bilirubin. The infant passes less stool because of decreased intake. As a result, bilirubin is reabsorbed from the intestine back into the bloodstream and must be conjugated again so it can be excreted. p. 468 Report content error The infant is not feeding effectively. The infant has less caloric and ﬂuid intake. The hepatic clearance of bilirubin is reduced. The infant is passing less stool. The bilirubin in the intestine is reabsorbed.

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2/14/24, 1:29 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/52221757 48/57 Arrange the steps in the order in which the nurse would perform the Barlow test and Ortolani maneuver. 1. 2. 3. 4. Rationale While performing the Barlow test, the nurse would place the middle finger over the infant’s greater trochanter and the thumb along the infant’s mid- thigh. The nurse would ﬂex the infant’s hip to 90 degrees and adduct it, followed by gentle downward pushing of the femoral head. If the hip is dislocated with this action, the femoral head will move out of the acetabulum. The nurse will feel a “clunk.” The nurse would then check the hip to determine if the femoral head can be returned into the acetabulum using the Ortolani test. The nurse would then abduct the infant’s hip and apply upward leverage. If the hip had previously dislocated, it returns to the acetabulum. The nurse will feel a “clunk.” p. 474 Place the thumb along the mid-thigh and the middle finger over the greater trochanter. Flex the hip to 90 degrees and adduct it. Push the femoral head gently downward. Abduct the hip and apply upward leverage.

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2/14/24, 1:29 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/52221757 49/57 Report content error Which clinical event would lead to an increased bilirubin level in the newborn? Select all that apply. One, some, or all responses may be correct. Rationale Delay in passage of meconium and delay in initiation of newborn feedings could lead to increased bilirubin levels as a result of increased enterohepatic circulation. Hemolytic disease of the newborn is cause by maternal/newborn blood incompatibility and increases the risk of increased bilirubin levels. An increase in bilirubin levels would be seen if cord clamping was delayed after birth. Hypoglycemia could lead to increased bilirubin levels as a result of alterations in hepatic function and perfusion. p. 468 Report content error Cord clamped immediately after delivery of the newborn First meconium passed after 24 hours Initiation of newborn feedings delayed after birth Hyperglycemia Hemolytic disease of the newborn

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2/14/24, 1:29 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/52221757 50/57 Which complication would the nurse anticipate in an infant experiencing cold stress? Rationale Cold stress may lead to metabolic acidosis. As a result, excessive fatty acids may be produced, which displaces the bilirubin from the albumin binding sites and leads to hyperbilirubinemia. In addition, cold stress may also result in excessive glycolysis. This, in turn, reduces the blood glucose levels and causes hypoglycemia instead of hyperglycemia. Because of the increased production of acids during cold stress, infants have respiratory acidosis rather than respiratory alkalosis. During cold stress, the metabolic rate usually increases rather than decreasing, to cause thermogenesis. p. 464 Report content error Which assessment finding would the nurse recognize as concerning in a neonate during the first hour after birth? Hyperglycemia Hyperbilirubinemia Respiratory alkalosis Decreased metabolic rate Rise of the abdomen with each inspiration Bluish discoloration of the hands and feet Transient periods of duskiness while crying

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2/14/24, 1:29 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/52221757 51/57 Rationale The nurse must report central cyanosis, or bluish discoloration of the lips and mucous membranes, which is abnormal and signifies hypoxemia. It may be caused by inadequate delivery of oxygen to the alveoli; poor perfusion of the lungs, which inhibits gas exchange; or cardiac dysfunction. During respiration, the rib cage of the neonate does not expand as it does in an adult. Abdominal breathing, or the simultaneous rise and fall of the chest and abdomen, occurs as a result of diaphragmatic contraction. Acrocyanosis, or the bluish discoloration of the hands and feet, is a normal finding during the first 24 hours after birth. The nurse may observe transient periods of duskiness when the neonate cries. This is common immediately after birth and is not a concerning finding. STUDY TIP: When forming a study group, carefully select members for your group. Choose students who have abilities and motivation similar to your own. Look for students who have a different learning style than you do. Exchange names, email addresses, and phone numbers. Plan a schedule for when and how often you will meet. Plan an agenda for each meeting. You may exchange lecture notes and discuss content for clarity or quiz one another on the material. You could also create your own practice tests or make ﬂash cards that review key vocabulary terms. p. 460 Report content error Discoloration of the mucous membranes

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2/14/24, 1:29 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/52221757 52/57 Which condition would the nurse recognize in a newborn with pale blue lips, feet, and palms 48 hours after birth? Rationale When pale blue discoloration of the lips, feet, and palms of the newborn persists for more than 24 hours after birth, it is referred to as central cyanosis. Central cyanosis can be the result of an inadequate supply of oxygen to the alveoli, poor perfusion of the lungs that inhibits gas exchange, or cardiac dysfunction. Because central cyanosis is a late sign of distress, newborns usually have significant hypoxemia when cyanosis appears. Acrocyanosis is a condition in which the infant shows bluish discoloration of the hands and feet for about 24 hours after birth and this is a normal finding. Because the newborn in this scenario shows bluish discoloration 48 hours after birth, it indicates central cyanosis and not acrocyanosis. If the newborn has polycythemia, the face would have a dark red complexion, but the newborn would not have pale blue lips, feet, and palms. Transient tachypnea is a condition in which the newborn has diﬃculty breathing as a result of obstruction of the nasal passage. p. 460 Report content error Acrocyanosis Polycythemia Central cyanosis Transient tachypnea

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2/14/24, 1:29 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/52221757 53/57 Which condition would the nurse suspect when observing mouth breathing in a 4-week-old infant? Rationale Newborns are generally nose breathers. After 3 weeks of age, newborns develop a reﬂex response that allows them to use their mouths for breathing at times of nasal obstruction. If the newborn has hypoxemia, the infant would breathe deeply through the nose and not through the mouth. Mouth breathing in infants is a normal finding and does not indicate a cardiac problem. If the infant has laryngeal obstruction, the infant would be unable to breathe. This is a life-threatening condition. Test-Taking Tip: Pace yourself while taking a quiz or examination. Read the entire question and all answer choices before answering the question. Do not assume that you know what the question is asking without reading it entirely. p. 460 Report content error Hypoxemia Cardiac disorder Nasal obstruction Laryngeal obstruction

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2/14/24, 1:29 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/52221757 54/57 Which clinical finding would the nurse expect to find while assessing a neonate during the first 30 minutes after birth? Rationale The first stage of the transition period lasts for up to 30 minutes after birth. During this period, fine crackles may be noted on auscultation. The newborn’s heart rate increases rapidly from 160 to 180 beats/min. After the first stage of the transition period, the neonate may maintain a baseline rate of 100 to 120 beats/min. Though bowel sounds are audible in the first 30 minutes, peristaltic waves may be noted over the abdomen only after the first 30 minutes. An irregular respiratory rate between 60 to 80 breaths/min may be noted during the first 30 minutes. After 30 minutes, respirations usually become rapid and shallow and reach up to 60 breaths/min. STUDY TIP: Avoid planning other activities that will add stress to your life between now and the time you take the licensure examination. Enough will happen spontaneously; do not plan to add to it. p. 459 Report content error The heart rate increases from 100 to 120 beats/min. Fine crackles may be present on auscultation. Peristaltic waves may be noted over the abdomen. Respirations are regular and shallow and may reach up to 60 breaths/min.

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2/14/24, 1:29 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/52221757 55/57 Which intervention would the nurse implement to prevent heat loss caused by evaporation in the infant? Rationale The infant loses heat as a result of the evaporation of moisture from the body. To prevent heat loss in the infant, the nurse should immediately dry the infant after the bath. Vasoconstriction of the skin may lead to acrocyanosis. Wrapping the infant in a cloth protects the infant from exposure to cold. The newborn is placed in the warm crib to minimize heat loss caused by conduction. Placing the crib away from windows helps prevent heat loss caused by radiation. Test-Taking Tip: Note the number of questions and the total time allotted for the test to calculate the times at which you should be halfway and three-fourths finished with the test. Look at the clock only every 10 minutes or so. p. 463 Report content error Wrap the infant in a cloth. Place the infant in a warm crib. Place the crib away from windows. Dry the infant immediately after the bath.

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2/14/24, 1:29 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/52221757 56/57 1 topics covered Chapter 23, Physiologic and Behavioral Ada… Lowdermilk: Maternity and Women's Health Care, 13th edition Proficient You Which assessment finding would help the nurse identify a congenital heart block in a newborn? Rationale The presence of persistent bradycardia in a newborn would help the nurse to detect the presence of congenital heart block. If the newborn displays signs of tachycardia, it can be an indication of hypovolemia, hyperthermia, or anemia. Pallor or pale coloring of the face in the newborn immediately after birth is a sign of marked peripheral constriction. Tachypnea in a newborn indicates inadequate clearance of lung ﬂuid, or it can be an indication of respiratory distress syndrome. p. 462 Tachycardia Pallor Tachypnea Bradycardia Novice Intermediate Proficient Questions answered 57

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2/14/24, 1:29 PM Elsevier Adaptive Quizzing - Quiz performance https://eaqng.elsevier.com/#/quizPerformance/52221757 57/57 Quiz me on this topic

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