Chapter 17 Physiological Transition of the Newborn

Chapter 17  Physiological Transition of the Newborn

Complete Chapter Questions And Answers
 

Sample Questions

MULTIPLE CHOICE

1. A woman gives birth to a healthy baby boy at 35 weeks’ gestation. What factor regarding the development of the normal respiratory system should the nurse consider when performing an assessment of the neonate?
A.
As the fetus approaches term, secretion of intrapulmonary fluid increases.
B.
Lung expansion after birth suppresses the further release of surfactant.
C.
Surfactant increases alveolar surface tension, allowing re-expansion after exhalation.
D.
Surfactant production is sufficient to maintain alveolar stability by about 34 weeks.

ANS: D
As the fetus approaches term, there is a decrease in the secretion of intrapulmonary fluid, which assists in reducing the pulmonary resistance to blood flow and facilitates the initiation of air breathing. Lung expansion after birth stimulates the release of surfactant—a slippery, detergent-like lipoprotein. Surfactant causes decreased surface tension within the alveoli, which allows for alveolar re-expansion following each exhalation. Under normal circumstances, by the 34th to 36th week of gestation, surfactant is produced in sufficient amounts to maintain alveolar stability.

Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Nursing Process: Assessment
Difficulty: Easy

PTS: 1

2. A nurse in the high-risk obstetrical unit monitors a student nurse preparing to give a patient a dose of betamethasone (Celestone). Which action by the student warrants intervention by the nurse?
A.
Assesses the patient’s lung sounds prior to administration
B.
Draws up 12 mg in a syringe with a 20-gauge needle
C.
Gently shakes the medication before drawing it up
D.
Prepares to administer medication in the deltoid muscle

ANS: D
Betamethasone should not be administered in the deltoid muscle, as it can cause local atrophy. It needs to be given in a larger muscle. The other actions are appropriate for this medication.

Cognitive Level: Application/Applying
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
Integrated Process: Nursing Process: Implementation
Difficulty: Difficult

PTS: 1

3. A perinatal nurse has orders to administer betamethasone (Celestone) to the following women in preterm labor. For which patient should the nurse question this order?
A.
Emergency cesarean section
B.
Fetal cardiac abnormalities
C.
Maternal diabetes
D.
Severe preeclampsia/eclampsia

ANS: D
Betamethasone is contraindicated in women in whom there is a medical indication for childbirth (e.g., severe preeclampsia/eclampsia, cord prolapse, chorioamnionitis, abruptio placentae) and in women with systemic fungal infection.

Cognitive Level: Analysis/Analyzing
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Pharmacological and Parenteral Therapies
Integrated Process: Communication and Documentation
Difficulty: Difficult

PTS: 1

4. The perinatal nurse explains the cardiopulmonary adaptations that occur in the neonate to a student nurse. Which of the following statements accurately describes the sequence of these changes?
A.
“As air enters the lungs, the PO2 rises in the alveoli, which causes pulmonary artery relaxation and results in an increase in pulmonary vascular resistance.”
B.
“As the pulmonary vascular resistance increases, pulmonary blood flow increases, reaching 100% by the first 24 hours of life.”
C.
“Decreased pulmonary blood volume contributes to the conversion from fetal to newborn circulation.”
D.
“Once the pulmonary circulation has been functionally established, blood is distributed throughout the lungs.”

ANS: D
As air enters the lungs, the PO2 rises in the alveoli. This normal physiological response causes pulmonary artery relaxation and results in a decrease in pulmonary vascular resistance. As the pulmonary vascular resistance decreases, pulmonary blood flow increases, reaching 100% by the first 24 hours of life. The increased pulmonary blood volume contributes to the conversion from fetal to newborn circulation. Once the pulmonary circulation has been functionally established, blood is distributed throughout the lungs. The other explanations are inaccurate.

Cognitive Level: Comprehension/Understanding
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Teaching/Leaning
Difficulty: Moderate

PTS: 1

5. The nurse is assessing the cardiovascular status of a newborn. Which of the following findings indicates adequate systemic circulation?
A.
Capillary refill 2 seconds
B.
Capillary refill 4 seconds
C.
Pale mucous membranes in a dark-skinned baby
D.
Truncal cyanosis

ANS: A
On assessment, the systemic circulation is deemed adequate if the newborn exhibits a brisk capillary refill and stable blood pressure. Capillary refill in less than 3 seconds is considered adequate. A refill time greater than 4 seconds may be indicative of an underlying condition, such as sepsis, hypoxia, or cardiovascular or central nervous system compromise. A dark-skinned baby should have pink mucous membranes. Acrocyanosis is normal, but a cyanotic trunk is not.

Cognitive Level: Knowledge/Remembering
Content Area: Pediatrics/Maternity
Patient Needs: Physiological Integrity: Physiological Adaptation
Integrated Process: Nursing Process: Assessment
Difficulty: Moderate

PTS: 1