Chapter 23 The Physiologic Responses of the Newborn to Birth

Chapter 23  The Physiologic Responses of the Newborn to Birth

Complete Chapter Questions And Answers
 

Sample Questions

1) The nurse is assessing a newborn at 1 hour of age. Which finding requires an immediate intervention?
1. Respiratory rate 60, crackles present bilaterally
2. Pulse rate 145, systolic murmur heard
3. Mean blood pressure 55 mmHg
4. Pauses in respiration lasting 30 seconds
Answer: 4
Explanation: 1. This respiratory rate is normal; crackles are commonly heard in the first few hours after birth as the infant reabsorbs the fluid in the lungs present at birth.
2. This pulse rate is normal. Systolic murmurs are very unlikely to indicate serious pathology and are usually caused by incomplete closure of the ductus arteriosus or foramen ovale.
3. This is a normal finding in an infant at 1 hour of life.
4. Pauses in respirations greater than 20 seconds are considered episodes of apnea and require further intervention.
Page Ref: 428
Cognitive Level: Application
Client Need&Sub: Health Promotion and Maintenance
Standards: QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Assessment/Coordination of care
Learning Outcome: LO 23.1-Explain the respiratory and cardiovascular changes that occur during the newborn’s transition to extrauterine life and during stabilization in determining the nursing care of the newborn.
MNL LO: Explain cardiopulmonary changes that occur during transition from intrauterine to extrauterine life.

2) The newborn at 24 hours of age has a red blood cell count of 5.4 million per mL. Which of the following entries would the nurse expect to find in the newborn’s chart?
1. Cord clamping delayed until pulsation ceased
2. CBC drawn from the anterior surface of the left hand
3. Placental abruption noted to be 80 percent at time of delivery
4. Infant is breastfed 15 to 20 minutes every three hours
Answer: 1
Explanation: 1. Delayed cord clamping can cause an increase of up to 61 percent, resulting in a slightly higher-than-average red blood cell count.
2. Venous blood has lower red cell counts than do capillary blood samples.
3. Maternal or fetal blood loss cause hypovolemia and low red blood cell counts (less than 5.2 million per mL).
4. Breastfeeding does not impact red cell counts in the first day of life.
Page Ref: 430
Cognitive Level: Analyzing
Client Need&Sub: Health Promotion and Maintenance
Standards: QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Assessment/Coordination of care
Learning Outcome: LO 23.2-Identify the differences in fetal and adult hemoglobin and why this is important in the transition to extrauterine life.
MNL LO: Examine ongoing assessments of the newborn following the initial transition to extrauterine life.
3) The nurse is teaching new parents how to dress their newborn. Which statements indicate that teaching has been effective? Select all that apply.
1. “We should make sure that we keep our home air-conditioned so the baby doesn’t overheat.”
2. “It is important that we dry the baby off as soon as we give him a bath or shampoo his hair.”
3. “When we change the baby’s diaper, we should change any wet clothing or blankets, too.”
4. “If the baby’s body temperature gets too low, he will warm himself up without any shivering.”
5. “Our baby will have a much faster rate of breathing if he is not dressed warmly enough.”
Answer: 2, 3, 4, 5
Explanation: 1. Babies need to be kept warm. Cold ambient temperatures will increase the oxygen consumption of a newborn and can lead to respiratory distress.
2. Drying a wet baby prevents evaporation, one mechanism of heat loss.
3. Changing wet clothing or blankets immediately prevents evaporation, one mechanism of heat loss.
4. Nonshivering thermogenesis is the mechanism used by newborns to warm themselves.
5. A neonate with a low body temperature will increase oxygen consumption, which can lead to respiratory distress.
Page Ref: 431-433
Cognitive Level: Analyzing
Client Need&Sub: Health Promotion and Maintenance
Standards: QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential VII: Clinical prevention and population health | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Evaluation/Health teaching and health promotion
Learning Outcome: LO 23.3-Relate the process of thermogenesis in the newborn and the major mechanisms of heat loss to the challenge of maintaining newborn thermal stability.
MNL LO: Determine the daily routine care required for a newborn.

4) The nurse is planning the care of a 1-day-old infant. Which of the following nursing interventions would protect the newborn from heat loss by convection?
1. Placing the newborn away from air currents
2. Pre-warming the examination table
3. Drying the newborn thoroughly
4. Removing wet linens from the isolette
Answer: 1
Explanation: 1. Placing the newborn away from air currents reduces heat loss by convection.
2. Pre-warming the examination table reduces heat loss by conduction.
3. Drying the newborn thoroughly immediately after birth or after a bath will prevent heat loss by evaporation.
4. Removing wet linens that are not in direct contact with the newborn from the isolette reduces heat loss by radiation.
Page Ref: 432-433
Cognitive Level: Analyzing
Client Need&Sub: Health Promotion and Maintenance
Standards: QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Planning/Coordination of care
Learning Outcome: LO 23.3-Relate the process of thermogenesis in the newborn and the major mechanisms of heat loss to the challenge of maintaining newborn thermal stability.
MNL LO: Implement strategies for promoting newborn health and parental teaching.