EAQs 6-10 Care of Newborn

EAQs 6-10 Care of Newborn How should the nurse assess a newborn's grasp reflex? - By pressing the examining fingers against the palms of the newborn's hands A client at 43 weeks' gestation has just given birth to an infant with typical postmaturity characteristics. Which postmature signs does the nurse identify? (Select all that apply.) - 1 Cracked and peeling skin 2 Long scalp hair and fingernails 5 Creases covering the neonate's full soles and palms A 7-lb newborn is admitted to the nursery with a prescription for intramuscular phytonadione (vitamin K, Aquamephyton) 1 mg. The nurse explains to the parents that this vitamin is administered to: - Promote clotting of the blood A nurse who is admitting a newborn to the nursery observes a fetal scalp monitor site on the scalp. For what complication should the nurse monitor this newborn? - Infection What should the nurse do when an apnea monitor sounds an alarm 10 seconds after cessation of respirations? - Use tactile stimuli on the chest or extremities Respiratory acidosis is confirmed in a neonate with respiratory distress syndrome when the laboratory report reveals: - An increased Paco 2 of 55 mm Hg Which characteristics should alert the nurse to conclude that a male newborn is a preterm infant? (Select all that apply.) - 1 Small breast buds 2 Wrinkled thin skin 5 Pinnae that remain flat when folded On the third postpartum day a mother visits the clinic and asks why her newborn's skin has begun to appear yellow. The nurse explains that the change in her infant's skin tone is the result of: - Breakdown of fetal red blood cells A client at 36 weeks' gestation exhibits oligohydramnios. What newborn complication should the nurse anticipate? - Intrauterine growth restriction (IUGR) A client has chosen not to have her son circumcised. What instruction should be included in discharge teaching for the care of an uncircumcised neonate? - Clean the penis with warm water at each diaper change. A nursing instructor provides education for the students on thermoregulation in the nursery. The students determine that in the healthy full-term neonate, heat production is accomplished by: - Metabolism of brown fat At 10 hours of age a newborn has a large amount of mucus in the nasopharynx and becomes cyanotic. What is the nurse's initial action? - Suctioning the mouth While a mother is inspecting her newborn she expresses concern that her baby's eyes are crossed. How should the nurse respond? - "This is expected. Your baby is trying to focus." A nurse is caring for a preterm neonate with physiological jaundice who requires phototherapy. What is the action of this therapy? - Breaks down the bilirubin into a conjugated form The mother of a newborn son tells the nurse that she is concerned about circumcision because of the pain involved. What is the nurse's best response? - "The health care provider will tell you how your baby's pain will be controlled." The nurse observes several dark round areas on a newborn's buttocks on a dark-skinned neonate. How should this observation be documented? - Mongolian spots -Mongolian spots are bluish-black areas of pigmentation commonly found on the back and buttocks of dark-skinned newborns; they are benign and fade gradually over time. While showing a new mother how to care for her infant's umbilical cord stump, the nurse explains that the stump is a potential source of infection because: - It contains exposed tissue and blood The health care provider hands a neonate to a nurse immediately after birth. What should the nurse do next for the newborn? - Dry and provide skin-to-skin contact with the mother -The priority is preventing heat loss; drying the newborn prevents heat loss through evaporation, and skin-to-skin contact with the mother provides a warm environment while promoting attachment. A 7-lb, 4-oz (3290-g) boy is admitted to the nursery and placed in a warm crib. The neonate begins to choke on mucus. How should the nurse suction him with a bulb syringe? - By suctioning the mouth before the nostrils The parents of a newborn ask the nurse about several areas of deep-blue coloring on their baby's lower back and buttocks. The nurse's response is based on the information that: - These areas usually are normal and will fade within the first year. A nurse is assessing a newborn for signs of hyperbilirubinemia (pathological jaundice). What clinical finding confirms this complication? - Jaundice that develops in the first 12 to 24 hours