Chapter 16 Physiologic and Behavioral Adaptations of the Newborn

Chapter 16  Physiologic and Behavioral Adaptations of the Newborn

Complete Chapter Questions And Answers
 

Sample Questions

MULTIPLE CHOICE

1. A woman gave birth to a healthy 7-pound, 13-ounce 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.

ANS: B

Feedback
A
The transition period is the phase between intrauterine and extrauterine existence.
B
The first period of reactivity is the first phase of transition and lasts up to 30 minutes after birth. The infant is highly alert during this phase.
C
There is no such phase.
D
The second period of reactivity occurs roughly between 4 and 8 hours after birth, after a period of prolonged sleep.

DIF: Cognitive Level: Comprehension REF: 439
OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Planning

2. 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.

ANS: A

Feedback
A
In normal infant respiration, the chest and abdomen rise synchronously, and breaths are shallow and irregular.
B
Breathing with nasal flaring is a sign of respiratory distress.
C
Diaphragmatic breathing with chest retraction is a sign of respiratory distress.
D
Infant breaths are shallow and irregular.

DIF: Cognitive Level: Comprehension REF: 439
OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment

3. While assessing the newborn, the 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 140 beats/min.
d.
150 to 180 beats/min.

ANS: C

Feedback
A
The newborn’s heart rate may be about 85 to 100 beats/min while sleeping.
B
The infant’s heart rate typically is a bit higher when alert but quiet.
C
The average infant heart rate while awake is 120 to 140 beats/min.
D
A heart rate of 150 to 180 beats/min is typical when the infant cries.

DIF: Cognitive Level: Comprehension REF: 441
OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment

4. A newborn is placed under a radiant heat warmer, and the nurse evaluates the infant’s body temperature every hour. Maintaining the newborn’s body temperature is important for preventing:
a.
Respiratory depression.
b.
Cold stress.
c.
Tachycardia.
d.
Vasoconstriction.

ANS: B

Feedback
A
The primary reason for placing a newborn under a radiant heat warmer is to prevent heat loss and cold stress. Cold stress results in an increased respiratory rate and vasoconstriction.
B
Loss of heat must be controlled to protect the infant from the metabolic and physiologic effects of cold stress.
C
The primary reason for placing a newborn under a radiant heat warmer is to prevent heat loss and cold stress. Cold stress results in an increased respiratory rate and vasoconstriction.
D
The primary reason for placing a newborn under a radiant heat warmer is to prevent heat loss and cold stress. Cold stress results in an increased respiratory rate and vasoconstriction.

DIF: Cognitive Level: Comprehension REF: 443
OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment

5. 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.

ANS: D

Feedback
A
Lanugo is the fine, downy hair seen on a term newborn.
B
A vascular nevus, commonly called a strawberry mark, is a type of capillary hemangioma.
C
A nevus flammeus, commonly called a port-wine stain, is most frequently found on the face.
D
A Mongolian spot is a bluish black area of pigmentation that may appear over any part of the exterior surface of the body. It is more commonly noted on the back and buttocks and most frequently is seen on infants whose ethnic origins are Mediterranean, Latin American, Asian, or African.

DIF: Cognitive Level: Comprehension REF: 449
OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Diagnosis