Test Bank Chapter 12 Newborn Assessment and Care Questions with Verified Answers,100%CORRECT

Test Bank Chapter 12 Newborn Assessment and Care Questions
with Verified Answers

MULTIPLE CHOICE

1. While inspecting a newborn’s head, the nurse identifies a swelling of the
scalp that does not cross the suture line. How would the nurse refer to this
finding when documenting?
a. Molding
b. Caput succedaneum
c. Cephalohematoma
d. Enlarged fontanelle
ANS: C
A cephalohematoma is caused by a collection of blood beneath the periosteum
of the cranial bone. It does not cross the suture line.
DIF: Cognitive Level: Comprehension REF: Page 283 OBJ: 1
TOP: Newborn Assessment—Head KEY: Nursing Process Step:
Implementation MSC: NCLEX: Physiological Integrity: Physiological
Adaptation

2. What is the nurse’s best response to a mother who is voicing concern about
the molding of her 2-day-old infant?
a. “Molding doesn’t cause any problems. Don’t worry about it.”
b. “Did you deliver vaginally or by cesarean section?”
c. “The baby’s head conformed to the shape of the birth canal. It will go away
soon.”
d. “A traumatic delivery can cause molding.”
ANS: C
The newborn’s head may be out of shape from molding. This refers to the
shaping of the fetal head to conform to the size and shape of the birth canal.

DIF: Cognitive Level: Application REF: Page 283 OBJ: 1
TOP: Newborn Assessment—Head KEY: Nursing Process Step:
Implementation MSC: NCLEX: Physiological Integrity: Physiological
Adaptation

3. What symptom assessed in the newborn shortly after delivery should be
reported?
a. Cyanosis of the hands and feet
b. Irregular heart rate
c. Mucus draining from the nose
d. Sternal or chest retractions

,ANS: D
Sternal retractions are evidence that the newborn is in respiratory distress and
should be reported immediately.

DIF: Cognitive Level: Analysis REF: Page 289 OBJ:
3 TOP: Newborn Assessment—Respiratory
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

, 4. When the newborn’s crib was moved suddenly, the nurse noticed that his legs
flexed and arms fanned out, and then both came back toward the midline.
How would the nurse interpret this behavior?
a. The Moro reflex
b. The grasp reflex
c. An abnormality of the musculoskeletal system
d. A neurological abnormality
ANS: A
The Moro reflex is a normal neonatal reflex. It is elicited when the infant’s crib is
jarred. The infant responds by drawing the legs up, fanning the arms, and then
bringing the arms to the midline in an embrace position.

DIF: Cognitive Level: Analysis REF: Page 282, Figure 12-3 | Page 284,
Table 12-1 OBJ: 2 TOP: Newborn Reflexes
KEY: Nursing Process Step: Data Collection
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

5. A first-time mother reports that she is experiencing difficulty breastfeeding
her newborn. Which neonatal reflex would the nurse teach the mother to
elicit to facilitate breastfeeding?
a. Sucking
b. Rooting
c. Grasping
d. Tonic neck
ANS: B
The rooting reflex causes the infant’s head to turn in the direction of anything
that touches the cheek in anticipation of food.

DIF: Cognitive Level: Application REF: Page 282 | Page 284,
Figure 12-1 OBJ: 2 TOP: Newborn Reflexes
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Physiological Adaptation

6. What will the nurse expect when assessing the anterior fontanelle of a
healthy, full-term newborn?
a. Depressed and sunken
b. Triangular shaped
c. Smaller than the posterior fontanelle
d. Open and diamond shaped
ANS: D
The anterior fontanelle is diamond shaped and located at the junction of the
two parietal and two frontal bones. It should not be raised or sunken, and it
closes between 12 and 18 months of age.

DIF: Cognitive Level: Comprehension REF: Page 283 | Page