Nokea
A full-term newborn weighs 3600 grams at birth. What would the nurse expect the newborn to weigh in grams 3 days later?
- A. 2900
- B. 3100
- C. 3300
- D. 3800
Correct Answer: C
Rationale: In the first 3 to 4 days of life, a newborn generally loses 5% to 10% of their birth weight, making 3300 grams the expected weight for a 3600-gram newborn.
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The nurse is measuring the vital signs of a calm, full-term newborn. Which finding is abnormal?
- A. An axillary temperature of 36.6?°C (98?°F)
- B. An apical pulse rate of 178 beats/minute
- C. Respirations of 35 breaths/minute
- D. Blood pressure of 80/50 mm Hg
Correct Answer: B
Rationale: The normal range for a newborn's pulse rate is 110 to 160 beats/minute. A pulse rate of 178 beats/minute is abnormal and should be reported.
What is the most appropriate nursing response to this mother?
- A. Tell me how many hours per day your baby sleeps.'
- B. It is normal for newborns to sleep most of the day.'
- C. Newborns generally sleep 12 to 15 hours per day.'
- D. You will find as the baby gets older, he sleeps less.'
Correct Answer: A
Rationale: The nurse should first clarify what the mother means by 'too much' sleep to provide accurate information and address concerns.
The nurse is aware that a full-term infant is born with which reflexes?
- A. Blinking
- B. Sneezing
- C. Gagging
- D. Sucking
- E. Pincer grasping
Correct Answer: A,B,C,D
Rationale: Blinking, sneezing, gagging, and sucking reflexes are present in the full-term newborn. Pincer grasp develops between 8 and 12 months.
The nurse reminds new parents that newborns must be protected from environments that are too cold or too hot because of which aspects of their physiology?
- A. Very little subcutaneous fat
- B. Low metabolic rates
- C. Ineffective sweat glands
- D. Small fluid reserves
- E. Low red blood cell counts
Correct Answer: A,C
Rationale: Newborns have very little subcutaneous fat and ineffective sweat glands, making them susceptible to thermal stress.
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
Correct Answer: B
Rationale: The rooting reflex causes the infant's head to turn in the direction of anything that touches the cheek in anticipation of food, aiding breastfeeding.