Wong s Essentials of Pediatric Nursing 10th Edition Hockenberry Rodgers Wilson (chapter 7) Maternal and Pediatric Nursing Care Clinical

Wong s Essentials of Pediatric Nursing 10th Edition Hockenberry Rodgers Wilson (chapter 7) Maternal and Pediatric Nursing Care Clinical Chapter 07: Health Promotion of the Newborn and Family Hockenberry: Wong’s Essentials of Pediatric Nursing, 10th Edition MULTIPLE CHOICE 1. Which 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 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. Closure of fetal shunts in the heart, stabilization of fluid and electrolytes, and body-temperature maintenance 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: Understand REF: p. 190 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance 2. Which 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 newborn from injury during the birth process d. Generates heat for distribution to other parts of body ANS: 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. It is effective in heat production only. The newborn has a thin layer of subcutaneous fat, which does not provide for conservation of heat. 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 newborn from injury during the birth process. DIF: Cognitive Level: Understand REF: p. 191 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance 3. Which characteristic is representative of the newborn’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 Newborns require frequent small feedings because their stomach capacity is approximately 90 ml. Peristaltic waves are rapid. A deficiency of pancreatic lipase limits the absorption of fats. Newborn’s intestines are longer in relation to body size than those of an adult. DIF: Cognitive Level: Understand REF: p. 191 TOP: Integrated Process: Nursing Process: Planning MSC: Area of Client Needs: Health Promotion and Maintenance 4. The nurse notes the first stool of a newborn is black and tarry. Which term is used to describe this type of stool? a. Meconium b. Transitional c. Miliaria d. Milk stool ANS: 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. 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. Miliaria are distended sweat glands that appear as minute vesicles, primarily on the face. Milk stool usually occurs by the fourth day. The appearance varies, depending on whether the neonate is breastfed or formula-fed. DIF: Cognitive Level: Remember REF: p. 191 TOP: Integrated Process: Nursing Process: Assessment MSC: Area of Client Needs: Health Promotion and Maintenance 5. A nurse notes that a 12-hour-old newborn has not had the first meconium stool. The nurse documents this finding and continues to monitor the newborn because, in term newborns, the first meconium stool occurs within how many hours of birth? a. 6 to 8 b. 8 to 12 c. 12 to 24 d. 24 to 48 ANS: 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 newborns. Although it may occur earlier, the expected range is the first 24 to 48 hours of life. DIF: Cognitive Level: Remember REF: p. 191 TOP: Integrated Process: Teaching/Learning MSC: Area of Client Needs: Health Promotion and Maintenance 6. A nurse is doing an assessment on a newborn. Which is characteristic of a newborn’s vision at birth and an expected finding during the assessment? a. Ciliary muscles are mature. b. Blink reflex is absent. c. Tear glands function. d. Pupils react to light. ANS: D