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Hockenberry & Wilson: Wong’s Essentials of Pediatric Nursing,

8th Edition

Pub Review

Chapter 8: Health Promotion of the Newborn and Family

MULTIPLE CHOICE

1. Which of the following is the most critical physiologic change required of the newborn?
a. Closure of fetal shunts in the heart
b. Stabilization of fluid and electrolytes
c. Body-temperature maintenance
d. Onset of breathing
ANS: D
d. The onset of breathing is the most immediate and critical physiologic change required
for transition to extrauterine life. Factors that interfere with this normal transition
increase fetal asphyxia, which is a condition of hypoxemia, hypercapnia, and acidosis.
This affects the fetus’s adjustment to extrauterine life.
a, b, and c. These are important changes that must occur in the transition to extrauterine
life, but breathing and the exchange of oxygen for carbon dioxide must come first.

DIF: Cognitive Level: Comprehension REF: Page 198


TOP: Integrated Process: Nursing Process: Problem Identification
MSC: Area of Client Needs: Health Promotion and Maintenance: Newborn Care

2. Which of the following is a function of brown adipose tissue (BAT) in the newborn?
a. Provides ready source of calories in the newborn period
b. Insulates the body against lowered environmental temperature
c. Protects the infant from injury during the birth process
d. Generates heat for distribution to other parts of body
ANS: D
d. Brown fat is a unique source of heat for the newborn. It has a larger content of
mitochondrial cytochromes and a greater capacity for heat production through intensified
metabolic activity than does ordinary adipose tissue. Heat generated in brown fat is
distributed to other parts of the body by the blood.
a. It is effective only in heat production.
b. The newborn has a thin layer of subcutaneous fat, which does not provide for
conservation of heat.
c. Brown fat is located in superficial areas such as between the scapulae, around the neck,
in the axillae, and behind the sternum. These areas would not protect the infant from
injury during the birth process.

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TOP: Integrated Process: Nursing Process: Problem Identification

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MSC: Area of Client Needs: Health Promotion and Maintenance: Newborn Care

3. Which of the following characteristics is representative of the neonate’s gastrointestinal


tract?
a. Stomach capacity is approximately 90 ml.
b. Peristaltic waves are relatively slow.
c. Overproduction of pancreatic amylase occurs.
d. Intestines are shorter in relation to body size.
ANS: A
a. Infants require frequent small feedings because their stomach capacity is
approximately 90 ml.
b. Peristaltic waves are rapid.
c. A deficiency of pancreatic lipase limits the absorption of fats.
d. Infant’s intestines are longer in relation to body size than those of an adult.

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TOP: Integrated Process: Nursing Process: Planning
MSC: Area of Client Needs: Health Promotion and Maintenance: Newborn Care

4. Which of the following terms is used to describe the newborn’s first stool?
a. Meconium
b. Transitional
c. Miliaria
d. Milk stool
ANS: A
a. Meconium is composed of amniotic fluid and its constituents, intestinal secretions,
shed mucosal cells, and possibly blood. It is the newborn’s first stool.
b. Transitional stools usually appear by the third day after the beginning of feeding. They
are usually greenish brown to yellowish brown, thin, and less sticky than meconium.
c. Miliaria are distended sweat glands that appear as minute vesicles, primarily on the
face.
d. Milk stool usually occurs by the fourth day. The appearance varies depending on
whether the neonate is breast-fed or formula fed.

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TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance: Newborn Care

5. In term neonates, the first meconium stool should occur within how many hours of birth?
a. 6 to 8
b. 8 to 12
c. 12 to 24
d. 24 to 48
ANS: D

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d. The first meconium stool should occur within the first 24 to 48 hours. It may be
delayed up to 7 days in very low–birth-weight infants.
a, b, and c. Although it may occur earlier, the expected range is the first 24 to 48 hours of
life.

DIF: Cognitive Level: Comprehension REF: Page 200


TOP: Integrated Process: Nursing Process: Problem Identification
MSC: Area of Client Needs: Health Promotion and Maintenance: Newborn Care

6. Which of the following is characteristic of a neonate’s vision at birth?


a. Ciliary muscles are mature.
b. Blink reflex is absent.
c. Tear glands function.
d. Pupils react to light.
ANS: D
d. Although at birth the eye is still structurally incomplete, the pupils do react to light.
a. The ciliary muscles are immature, limiting the eyes’ ability to focus on an object for
any length of time.
b. The blink reflex is responsive to minimal stimulus.
c. The tear glands do not begin to function until age 2 to 4 weeks.

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TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance: Newborn Care

7. The Apgar score of a neonate 5 minutes after birth is 8. Which of the following is the
nurse’s best interpretation of this?
a. Resuscitation is likely to be needed.
b. Adjustment to extrauterine life is adequate.
c. Additional scoring in 5 more minutes is needed.
d. Maternal sedation or analgesia contributed to the low score.
ANS: B
b. The Apgar reflects the newborn’s status in five areas: heart rate, respiratory effort,
muscle tone, reflex irritability, and color. Scores of 7 to 10 indicate an absence of
difficulty adjusting to extrauterine life. Scores of 0 to 3 indicate severe distress, and
scores of 4 to 6 indicate moderate difficulty.
a. The Apgar score is not used to determine the newborn’s need for resuscitation at birth.
c. All infants are rescored at 5 minutes.
d. The infant does not have a low score.

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TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance: Newborn Care

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8. The nurse is presenting an in-service session on assessing gestational age in newborns.
Which of the following information should be included?
a. The infant’s length and weight are the most accurate indicators of gestational
age.
b. The infant’s Apgar score and the mother’s estimated date of confinement (EDC)
are combined to determine gestational age.
c. The infant’s posture at rest and arm recoil are two physical signs used to
determine gestational age.
d. The infant’s chest circumference compared to the head circumference is the
determinant for gestational age.
ANS: C
c. With the infant quiet and in a supine position, the degree of flexion in the arms and
legs and the arm recoil can be used to help determine gestational age.
a and d. Length, weight, and the chest/head circumference reflect the infant’s size and
weight, which vary according to race and gender. Birth weight alone is a poor indicator
of gestational age and fetal maturity.
b. The Apgar score is an indication of the infant’s adjustment to extrauterine life, and the
mother’s EDC is of no importance in determining gestational age.

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TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance: Newborn Care

9. The nurse is assessing a 3-day-old, breast-fed newborn who weighed 7 pounds, 8 ounces
at birth. The infant’s mother is now concerned that the infant weighs 6 pounds, 15
ounces. The most appropriate nursing intervention is which of the following?
a. Recommend supplemental feedings of formula.
b. Explain that this weight loss is within normal limits.
c. Assess child further to determine cause of excessive weight loss.
d. Encourage mother to express breast milk for bottle feeding the infant.
ANS: B
b. The neonate normally loses about 10% of the birth weight by age 3 or 4 days. The birth
weight is usually regained by the tenth day of life.
a, c, and d. Because this is an expected occurrence, no further action is needed. The
mother should be taught about normal infant feeding and growing patterns.

DIF: Cognitive Level: Application REF: Page 205


TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Health Promotion and Maintenance: Newborn Care

10. Why are rectal temperatures not recommended in the newborn?


a. They are inaccurate.
b. They do not reflect core body temperature.
c. They can cause perforation of rectal mucosa.
d. They take too long to obtain an accurate reading.

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ANS: C
c. Rectal temperatures are avoided in the newborn. If done incorrectly, the insertion of a
thermometer into the rectum can perforate the mucosa.
a and b. Rectal temperatures, if taken correctly, are considered an accurate reflection of
core body temperature. The inherent risks and intrusive nature limit the use.
d. The time it takes to determine body temperature is related to the equipment used, not
only the route.

DIF: Cognitive Level: Comprehension REF: Page 205


TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance: Newborn Care

11. The nurse should expect the apical heart rate of a stabilized neonate to be in which of the
following ranges?
a. 60 to 80 beats/min
b. 80 to 100 beats/min
c. 120 to 140 beats/min
d. 160 to 180 beats/min
ANS: C
c. The pulse rate of the newborn varies with periods of reactivity. Usually the pulse rate is
between 120 and 140 beats/min.
a and b. This is too slow for a neonate.
d. This is too fast for a neonate.

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TOP: Integrated Process: Nursing Process: Problem Identification
MSC: Area of Client Needs: Health Promotion and Maintenance: Newborn Care

12. Which of the following is most descriptive of the shape of a newborn’s anterior fontanel?
a. Circle
b. Triangle
c. Square
d. Diamond
ANS: D
d. The anterior fontanel is diamond shaped and measures from barely palpable to 4 to 5
cm.
a and c. Neither of the fontanels is this shape.
b. This is the shape of the posterior fontanel.

DIF: Cognitive Level: Comprehension REF: Page 207


TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance: Newborn Care

13. Which of the following is the name of the suture separating the parietal bones at the top
center of a neonate’s head?

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a. Frontal
b. Coronal
c. Sagittal
d. Occipital
ANS: C
c. The sagittal suture separates the parietal bones on top of the infant’s head.
a. The frontal suture separates the frontal bones.
b. The coronal suture is said to “crown the head.”
d. There is no occipital suture. The lambdoid suture is at the margin of the parietal and
occipital bones.

DIF: Cognitive Level: Comprehension REF: Page 207


TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance: Newborn Care

14. In a neonate’s eyes, strabismus is a normal finding because of:


a. congenital cataracts.
b. lack of binocularity.
c. absence of red reflex.
d. inability of pupil to react to light.
ANS: B
b. Newborns are unable to focus their eyes on an object. Binocularity does not develop
until age 3 to 4 months.
a, c, and d. These are not normal findings and need further evaluation.

DIF: Cognitive Level: Comprehension REF: Page 208


TOP: Integrated Process: Nursing Process: Problem Identification
MSC: Area of Client Needs: Health Promotion and Maintenance: Newborn Care

15. Which of the following describes the respirations of a newborn?


a. Irregular, abdominal, 30 to 60 breaths/min
b. Regular, abdominal, 25 to 35 breaths/min
c. Regular, noisy, 35 to 45 breaths/min
d. Irregular, quiet, 45 to 55 breaths/min
ANS: A
a. The respirations of a normal newborn are irregular and abdominal, with a rate of 30 to
60 breaths/min.
b and c. Newborn respirations are irregular. Pauses in respiration less than 20 seconds in
duration are considered normal.
d. The newborn is an abdominal breather with a wider range of respiratory rates.

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TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance: Newborn Care

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16. When doing the first assessment of a male neonate, the nurse notes that the scrotum is
large, edematous, and pendulous. This should be interpreted as:
a. a normal finding.
b. a hydrocele.
c. an absence of testes.
d. an inguinal hernia.
ANS: A
a. A large, edematous, and pendulous scrotum in a term infant, especially in those born in
a breech position, is a normal finding.
b. A hydrocele is fluid in the scrotum, usually unilateral, which usually resolves within a
few months.
c. The presence or absence of testes would be determined on palpation of the scrotum and
inguinal canal. Absence of testes may be an indication of ambiguous genitalia.
d. An inguinal hernia may be present at birth. It is more easily detected when the child is
crying.

DIF: Cognitive Level: Comprehension REF: Page 210


TOP: Integrated Process: Nursing Process: Problem Identification
MSC: Area of Client Needs: Health Promotion and Maintenance: Newborn Care

17. Stroking the neonate’s cheek along the side of the mouth causes the infant to turn the
head toward that side and begin to suck. This is which of the following reflexes?
a. Perez
b. Sucking
c. Rooting
d. Extrusion
ANS: C
c. This is a description of the rooting reflex, which usually disappears by age 3 to 4
months but may persist for up to 12 months.
a. The Perez reflex involves stroking the infant’s back when prone; the child flexes
extremities, elevating head and pelvis. It disappears at age 4 to 6 months.
b. The infant begins strong sucking movements in response to circumoral stimulation.
The reflex persists throughout infancy, even without stimulation.
d. Infants force their tongues outward, when the tongue is touched or depressed. This
reflex usually disappears by age 4 months.

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TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance: Newborn Care

18. Which of the following statements best represents the first stage of the first period of
reactivity in the neonate?
a. Begins when the infant awakes from a deep sleep
b. Ends when the amount of respiratory mucus has decreased
c. Is an excellent time to acquaint the parents with the infant

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d. Is an excellent time for mother to sleep and recover
ANS: C
c. During the first period of reactivity, the infant is alert, cries vigorously, may suck the
fist greedily, and appears interested in the environment. The neonate’s eyes are usually
wide open, suggesting that this is an excellent opportunity for mother, father, and child to
see each other.
a. This is when the second period of reactivity begins.
b. This describes the end of the second period of reactivity.
d. The mother should sleep and recover during the second stage, when the infant is
sleeping.

DIF: Cognitive Level: Application REF: Page 211


TOP: Integrated Process: Nursing Process: Implementation
MSC: Area of Client Needs: Health Promotion and Maintenance: Newborn Care

19. The nurse observes that a new mother avoids making eye contact with her newborn. The
nurse should do which of the following?
a. Examine newborn’s eyes for ability to focus.
b. Assess for other attachment behaviors.
c. Recognize this as a common reaction in new mothers.
d. Ask mother why she won’t look at infant.
ANS: B
b. Attachment behaviors are thought to indicate the formation of emotional bonds
between the newborn and the mother. The mother’s failure to make eye contact with her
newborn may indicate difficulties with the formation of emotional bonds. The nurse
should perform a more thorough assessment.
a. Newborns do not have binocularity and cannot focus.
c. This is an uncommon reaction in new mothers.
d. This is a confrontational question that would put the mother in a defensive position.

DIF: Cognitive Level: Analysis REF: Page 215


TOP: Integrated Process: Nursing Process: Problem Identification
MSC: Area of Client Needs: Health Promotion and Maintenance: Newborn Care

20. At the time of birth, the grayish white, cheeselike substance that normally covers the
newborn’s skin is which of the following?
a. Miliaria
b. Meconium
c. Amniotic fluid
d. Vernix caseosa
ANS: D
d. This describes vernix caseosa.
a. Miliaria are distended sweat glands that appear as minute vesicles.
b. Meconium is the infant’s first stool.
c. Amniotic fluid is produced in utero.

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DIF: Cognitive Level: Comprehension REF: Page 217


TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance: Newborn Care

21. Which of the following are distended sebaceous glands that appear as tiny white papules
on cheeks, chin, and nose in the newborn period?
a. Milia
b. Lanugo
c. Mongolian spots
d. Cutis marmorata
ANS: A
a. This describes milia, which are common variations found in newborns.
b. Lanugo is fine downy hair.
c. Mongolian spots are irregular areas of deep blue pigmentation, usually in the sacral and
gluteal areas.
d. Cutis marmorata is transient mottling when the infant is exposed to decreased body
temperatures.

DIF: Cognitive Level: Comprehension REF: Page 217


TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance: Newborn Care

22. Where would nonpathologic cyanosis normally be present in the infant shortly after
birth?
a. Feet and hands
b. Bridge of nose
c. Circumoral area
d. Mucous membranes
ANS: A
a. Cyanosis of the feet and hands is termed acrocyanosis and is a usual finding in
newborns.
b, c, and d. These are signs of general cyanosis, which is a potential sign of distress or
major abnormality.

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TOP: Integrated Process: Nursing Process: Problem Identification
MSC: Area of Client Needs: Health Promotion and Maintenance: Newborn Care

23. What term describes irregular areas of deep blue pigmentation seen predominantly in
newborns of African, Asian, Native American, or Hispanic descent?
a. Acrocyanosis
b. Erythema toxicum
c. Mongolian spots
d. Harlequin color changes

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ANS: C
c. This describes Mongolian spots, which are common variations found in newborns of
African, Asian, Native American, or Hispanic descent.
a. Acrocyanosis is cyanosis of the hands and feet that is a usual finding in newborns.
b. Erythema toxicum is a pink papular with vesicles that may appear in 24 to 48 hours
and resolve after several days.
d. Harlequin color changes are clearly outlined areas of color change. As the infant lies
on a side, the lower half of the body becomes pink, and the upper half is pale.

DIF: Cognitive Level: Comprehension REF: Page 217


TOP: Integrated Process: Nursing Process: Problem Identification
MSC: Area of Client Needs: Health Promotion and Maintenance: Newborn Care

24. The nurse observes flaring of nares in a neonate. This should be interpreted as which of
the following?
a. Nasal occlusion
b. Sign of respiratory distress
c. Common response to sneezing
d. Snuffles of congenital syphilis
ANS: B
b. Nasal flaring is an indication of respiratory distress.
a. A nasal occlusion would prevent the child from breathing through the nose. Because
infants are obligatory nose breathers, this would require immediate referral.
c. Sneezing and thin white mucus drainage are common in newborns and are not related
to nasal flaring.
d. Snuffles are indicated by a thick, bloody, nasal discharge without sneezing.

DIF: Cognitive Level: Comprehension REF: Page 221


TOP: Integrated Process: Nursing Process: Problem Identification
MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

25. Which of the following findings in the neonate is considered abnormal?


a. Nystagmus
b. Profuse drooling
c. Dark green or black stools
d. Slight vaginal reddish discharge
ANS: B
b. Profuse drooling or salivation is a potential sign of a major abnormality. Infants with
esophageal atresia cannot swallow their oral secretions, resulting in excessive drooling.
a. Nystagmus is an involuntary movement of the eyes. This is a common variation in
newborns.
c. Meconium, the first stool of newborns, is dark green or black.
d. Pseudomenstruation may be present in normal newborns. This is a blood-tinged or
mucoid vaginal discharge.

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DIF: Cognitive Level: Comprehension REF: Page 218
TOP: Integrated Process: Nursing Process: Problem Identification
MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

26. Which of the following is the most important in the immediate care of the newborn?
a. Maintain patent airway.
b. Maintain stable body temperature.
c. Administer prophylactic eye care.
d. Establish identification of mother and baby.
ANS: A
a. Maintaining a patent airway is the primary objective in the care of the newborn. The
nurse uses a bulb syringe to clear the pharynx, followed by the nasal passages.
b. Conserving the infant’s body heat and maintaining a stable body temperature are
important, but a patent airway must be established first.
c and d. These are important functions, but physiologic stability is the first priority in the
immediate care of the newborn.

DIF: Cognitive Level: Analysis REF: Page 215


TOP: Integrated Process: Nursing Process: Planning
MSC: Area of Client Needs: Physiologic Integrity: Reduction of Risk Potential

27. The nurse is careful to place the incubator away from cold windows or air-conditioning
units. This is to conserve the neonate’s body heat by preventing heat loss through which
of the following methods?
a. Radiation
b. Conduction
c. Convection
d. Evaporation
ANS: A
a. Radiation is the loss of heat to a cooler solid object. The cold air from either the
window or the air conditioner will cool the incubator walls and subsequently the
newborn’s body.
b. Conduction involves the loss of heat from the body because of direct contact of the
skin with a cooler object.
c. Convection is the loss of heat similar to conduction, but aided by air currents.
d. Evaporation is the loss of heat through moisture. The infant should be quickly dried of
the amniotic fluid.

DIF: Cognitive Level: Application REF: Page 221


TOP: Integrated Process: Nursing Process: Implementation
MSC: Area of Client Needs: Health Promotion and Maintenance: Newborn Care

28. Vitamin K is administered to the neonate to:


a. prevent bleeding.
b. enhance immune response.

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c. prevent bacterial infection.
d. maintain nutritional status.
ANS: A
a. Vitamin K is administered to prevent hemorrhagic disease of the newborn. Vitamin K
is synthesized by the intestinal flora. Because the infant’s intestine is sterile and breast
milk is low in vitamin K, a supplemental source must be supplied.
b, c, and d. The purpose is not to enhance the immune response, prevent bacterial
infection, or maintain nutritional status. The major function of vitamin K is to catalyze
the liver synthesis of prothrombin, which is needed for blood clotting and coagulation.

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TOP: Integrated Process: Nursing Process: Implementation
MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic Therapies

29. In the newborn, intramuscular vitamin K is administered into which muscle?


a. Deltoid
b. Dorsogluteal
c. Vastus medialis
d. Vastus lateralis
ANS: D
d. The vastus lateralis is the traditionally recommended injection site.
a and b. These sites are not recommended for the vitamin K administration. The
ventrogluteal may be used as an alternative site to the vastus lateralis.
c. This site is not used for intramuscular injections.

DIF: Cognitive Level: Comprehension REF: Page 222


TOP: Integrated Process: Nursing Process: Implementation
MSC: Area of Client Needs: Physiologic Integrity: Pharmacologic Therapies

30. Recommendations for hepatitis B (HBV) vaccine include which of the following?
a. First dose is given between birth and age 2 days.
b. First dose is given between ages 12 and 15 months.
c. It is not recommended for neonates who are at low risk for hepatitis B.
d. It is not recommended for neonates whose mothers are positive for HBV surface
antigen.
ANS: A
a. To reduce the incidence of HBV in children and its serious consequences in adulthood,
the first of three doses is recommended soon after birth and before hospital discharge.
b. This is too late. The recommendation is for the first dose to be given soon after birth.
c. It is recommended for all infants.
d. Infants born to mothers who are HBV surface antigen positive should be given the
vaccine within 12 hours of birth. They also should be given hepatitis B immune globulin.

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TOP: Integrated Process: Nursing Process: Implementation

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MSC: Area of Client Needs: Health Promotion and Maintenance: Immunizations

31. A newborn is being discharged at age 48 hours. The parents ask how the infant should be
bathed this first week home. The nurse’s best recommendation is to bathe the newborn:
a. daily with mild soap.
b. daily with an alkaline soap.
c. two or three times this week with plain water.
d. two or three times this week with mild soap.
ANS: C
c. The newborn infant’s skin has a pH of approximately 5. This acidic pH has a
bacteriostatic effect. The parents should be taught to use only plain warm water for the
bath and to bathe the child no more than two or three times a week for the first 2 weeks.
a, b, and d. Soaps are alkaline. They will alter the acid mantle of the child’s skin,
providing a medium for bacterial growth.

DIF: Cognitive Level: Application REF: Page 225


TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Health Promotion and Maintenance: Newborn Care

32. The stump of the umbilical cord usually separates in how many days?
a. 3
b. 10 to 14
c. 16 to 20
d. 28
ANS: B
b. The average cord separates in 10 to 14 days.
a. This is too soon.
c and d. This is too late. The cord should be separated by these times.

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TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance: Newborn Care

33. The parents of a newborn plan to have him circumcised. They ask the nurse about pain
associated with this procedure. The nurse’s response should be based on the knowledge
that newborns:
a. experience pain with circumcision.
b. do not experience pain with circumcision.
c. quickly forget about the pain of circumcision.
d. are too young for anesthesia or analgesia.
ANS: A
a. Circumcision is a surgical procedure. The American Academy of Pediatrics has
recommended that, when circumcision is performed, procedural analgesia be provided.
b. Pain is associated with surgical procedures.
c. The infant experiences pain, which can be alleviated with analgesia.

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d. Topical and injected analgesia are available for this procedure.

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TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Physiologic Integrity: Basic Care and Comfort

34. Early this morning, a baby boy was circumcised by using the Plastibell method. The
nurse should tell the mother that the baby can be discharged after:
a. the infant voids.
b. receiving vitamin K.
c. yellow exudate forms over glans.
d. the Plastibell rim falls off.
ANS: A
a. The circumcision site is evaluated for excessive bleeding every 30 minutes for at least
2 hours. After these observations and voiding, the infant can be discharged.
b. The infant should have received vitamin K soon after delivery.
c. This normal yellow exudate will usually form on the second day after the circumcision.
Discharge can occur earlier.
d. The Plastibell rim will separate and fall off within 5 to 8 days. The infant should be
discharged before this.

DIF: Cognitive Level: Application REF: Page 228


TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Health Promotion and Maintenance: Newborn Care

35. The American Academy of Pediatrics recommends that the best form of infant nutrition
is:
a. exclusive breastfeeding until age 2 months.
b. exclusive breastfeeding until at least age 1 year.
c. commercially prepared infant formula for 1 year.
d. commercially prepared infant formula until age 4 to 6 months.
ANS: B
b. The American Academy of Pediatrics has reaffirmed its position that an infant be
breast-fed exclusively for the first year of life. This group also supports programs that
enable women to return to work and continue breastfeeding.
a. This is too short a period.
c and d. The recommendation is for breastfeeding, not commercial formula. If the mother
has stopped breastfeeding, then commercial formula, rather than whole milk, should be
used until age 1 year.

DIF: Cognitive Level: Comprehension REF: Page 229


TOP: Integrated Process: Nursing Process: Implementation
MSC: Area of Client Needs: Health Promotion and Maintenance: Newborn Care

36. Successful breastfeeding is most dependent on which of the following?

Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Pub Review 8-
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a. Mother’s socioeconomic level
b. Size of mother’s breasts
c. Mother’s desire to breastfeed
d. Birth weight of infant
ANS: C
c. The factors that contribute to successful breastfeeding are the mother’s desire to
breastfeed, satisfaction with breastfeeding, and available support systems.
a. This may affect the mother’s need to return to work and available support systems, but
with support, the mother can be successful.
b. This does not affect the success of breastfeeding.
d. Very low–birth-weight infants may be unable to breastfeed. The mother can express
milk, and it can be used for the child.

DIF: Cognitive Level: Application REF: Page 229


TOP: Integrated Process: Nursing Process: Planning
MSC: Area of Client Needs: Health Promotion and Maintenance: Newborn Care

37. A nursing intervention to promote parent-infant attachment would be which of the


following?
a. Delaying parent-child interactions until the second period of reactivity
b. Explaining individual differences among infants to the parents
c. Alleviating stress for parents by decreasing their participation in the infant’s care
d. Encouraging parents to hold child frequently unless he or she is fussy
ANS: B
b. Nurses can positively influence the attachment of parent and child by recognizing and
explaining individual differences to the parents. The nurse should emphasize the
normalcy of these variations and demonstrate the uniqueness of each child.
a. The nurse should facilitate parent-child interaction during the first period of reactivity.
c. Decreasing the parents’ participation in care will interfere with parent-infant
attachment.
d. The parents should be encouraged to hold the child when he or she is fussy and learn
how best to soothe their child.

DIF: Cognitive Level: Application REF: Page 234


TOP: Integrated Process: Nursing Process: Implementation
MSC: Area of Client Needs: Health Promotion and Maintenance: Newborn Care

38. A new mother wants to be discharged with her newborn as soon as possible. Before
discharge, the nurse should make certain that:
a. newborn has voided at least once.
b. newborn does not spit up after feeding.
c. jaundice, if present, appeared before 24 hours.
d. appointment is made for home care or a primary care practitioner office visit
within next 2 or 3 days.
ANS: D

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Pub Review 8-
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d. The American Academy of Pediatrics recommends that newborns discharged early
receive follow-up care within 48 hours of a short stay in either a primary practitioner’s
office or the home.
a. The child should void every 4 to 6 hours.
b. Spitting up small amounts after feeding is a normal occurrence in newborns. It would
not delay discharge.
c. Jaundice within the first 24 hours of life must be evaluated.

DIF: Cognitive Level: Application REF: Page 237


TOP: Integrated Process: Nursing Process: Evaluation
MSC: Area of Client Needs: Health Promotion and Maintenance: Newborn Care

39. Nursing interventions to maintain a patent airway in a neonate should include which of
the following?
a. Sleeping in the prone (on abdomen) position
b. Wrapping neonate as snugly as possible
c. Positioning neonate supine after feedings
d. Using bulb syringe to suction as needed, suctioning nose first, and then pharynx
ANS: C
c. This is the position recommended by the American Academy of Pediatrics to prevent
sudden infant death syndrome.
a. This is not advised because of the possible link between sleeping in the prone position
and sudden infant death syndrome.
b. The child can be wrapped snugly, but should be placed on side or back.
d. A bulb syringe should be kept by the bedside if necessary, but the pharynx should be
suctioned before the nose.

DIF: Cognitive Level: Application REF: Page 215


TOP: Integrated Process: Nursing Process: Implementation
MSC: Area of Client Needs: Health Promotion and Maintenance: Newborn Care

MULTIPLE RESPONSE

1. The nurse is teaching a class on breastfeeding to expectant parents. Select all of the
following that are contraindications for breastfeeding.
a. Human immunodeficiency virus (HIV) in mother
b. Mastitis
c. Inverted nipples
d. Maternal cancer therapy
e. Twin births
ANS: A, D
a and d. Both of these conditions place the infant at risk. HIV can be transmitted through
breast milk, as can be the metabolites of chemotherapy.
b, c, and e. These are not contraindications.

Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Pub Review 8-
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DIF: Cognitive Level: Comprehension REF: Page 230
TOP: Integrated Process: Teaching/Learning
MSC: Area of Client Needs: Health Promotion and Maintenance: Newborn Care

Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.