Professional Documents
Culture Documents
8th Edition
Pub Review
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.
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.
Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Pub Review 8-
2
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.
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
Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Pub Review 8-
3
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.
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.
DIF: Cognitive Level: Comprehension REF: Page 201 | Page 202 | Page 203
TOP: Integrated Process: Nursing Process: Assessment
MSC: Area of Client Needs: Health Promotion and Maintenance: Newborn Care
Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Pub Review 8-
4
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.
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.
Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Pub Review 8-
5
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.
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.
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.
13. Which of the following is the name of the suture separating the parietal bones at the top
center of a neonate’s head?
Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Pub Review 8-
6
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.
Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Pub Review 8-
7
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.
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.
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
Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Pub Review 8-
8
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.
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.
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.
Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Pub Review 8-
9
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.
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.
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
Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Pub Review 8-
1
0
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.
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.
Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Pub Review 8-
1
1
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.
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.
Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Pub Review 8-
1
2
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.
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.
Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Pub Review 8-
1
3
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.
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.
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.
Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Pub Review 8-
1
4
d. Topical and injected analgesia are available for this procedure.
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.
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.
Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Pub Review 8-
1
5
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.
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
Copyright © 2009 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.
Pub Review 8-
1
6
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.
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.
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-
1
7
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.