Nursing Care of the Newborn

Nursing Care of the Newborn Related

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The nurse is teaching a student nurse about some of the differences between a term and preterm infant. Which statement is most accurate?

  • A. Infants born at 32 weeks gestational age have sufficient alveolar stability to maintain adequate lung expansion.
  • B. Surfactant may need to be given to the infant born less than 34 to 36 weeks of age to assist with alveolar stability.
  • C. Women with gestational diabetes have larger babies; therefore, there are fewer issues with lung maturity when born preterm.
  • D. Mothers carrying multiples fetuses will increase the surfactant production naturally in utero.
Correct Answer: B

Rationale: The correct answer is B because infants born before 34 to 36 weeks gestational age may not have fully developed surfactant production, which is crucial for alveolar stability and lung expansion. Surfactant reduces surface tension in the alveoli, preventing their collapse. Without sufficient surfactant, preterm infants are at risk of respiratory distress syndrome.

Choice A is incorrect because infants born at 32 weeks may still have underdeveloped alveoli and insufficient surfactant production, leading to potential lung expansion issues.

Choice C is incorrect because the presence of gestational diabetes does not guarantee sufficient lung maturity in preterm infants. Lung maturity is more closely related to gestational age and surfactant production.

Choice D is incorrect because while carrying multiple fetuses can slightly increase surfactant production, it may not be sufficient for preterm infants born before 34 to 36 weeks, necessitating the need for exogenous surfactant administration.

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The postpartum nurse notices that a new mother has her neonate unwrapped and undressed 'to check out the baby.' For which reason does the nurse conclude the neonate is at risk for cold stress?

  • A. The neonate has an increased metabolic rate.
  • B. The neonate's respiratory rate has dropped.
  • C. The neonate is moving extremities about.
  • D. The neonate's skin is cool and clammy.
Correct Answer: D

Rationale: The correct answer is D because cool and clammy skin is a sign of cold stress in neonates. When a neonate's skin is cool and clammy, it indicates that the baby is losing body heat and struggling to maintain a stable body temperature. Cold stress can lead to complications such as hypothermia and respiratory distress.

A: Increased metabolic rate would actually help generate heat to combat cold stress.
B: Respiratory rate dropping is not necessarily indicative of cold stress and may be a normal response to being undressed.
C: Moving extremities about is a normal behavior and not necessarily a sign of cold stress.

Which step is most appropriate following delivery of a healthy newborn?

  • A. Assess the newborn's temperature rectally following delivery.
  • B. Place the newborn skin to skin in the mother's arms after the baby is dry.
  • C. Clothe the baby and place the newborn under the radiant warmer until the temperature is stable.
  • D. Wrap the baby in warm blankets; apply a cap to the bed and place open crib near the window.
Correct Answer: B

Rationale: Step 1: Placing the newborn skin to skin in the mother's arms helps with bonding, regulates the baby's temperature, and promotes breastfeeding initiation.
Step 2: Skin-to-skin contact supports the baby in transitioning to the outside world comfortably.
Step 3: Keeping the baby dry and close to the mother promotes a sense of security and comfort.
Step 4: This approach aligns with evidence-based practices for newborn care.

Summary:
A: Assessing the newborn's temperature rectally is not the immediate priority after delivery.
C: Placing the baby under the radiant warmer may disrupt bonding and delay skin-to-skin contact.
D: Wrapping the baby in warm blankets without skin-to-skin contact may lead to heat loss and hinder maternal-infant bonding.

The nurse knows that during the motoric process, the newborn will be rated poorly if they do what?

  • A. They have good reflexes.
  • B. They have hyper- or hypotonic movements.
  • C. They have good head control.
  • D. They have moderate activity levels.
Correct Answer: B

Rationale: Hyper- or hypotonic movements indicate poor motoric development.

A nurse is discharging parents and their new infant. When assisting the family to place the infant in a car seat, which observation leads the nurse to reinforce teaching?

  • A. The baby is wearing a sack-type sleeper.
  • B. The baby is wearing a single layer of clothes.
  • C. The parent checks the temperature of the car seat.
  • D. A rear-facing car seat is in the back seat.
Correct Answer: A

Rationale: Sack-type sleepers are not recommended for wearing in a child safety seat because the straps may not fit properly. The other observations are appropriate.

An infant has just been admitted to the newborn nursery after an uncomplicated delivery. Upon assessment, the nurse notes poor muscle tone and a temperature of 96°F axillary. What is the next course of action?

  • A. Obtain a blood glucose reading
  • B. Prepare for resuscitation needs
  • C. Call for a transfer to the neonatal intensive care unit
  • D. Place warm blankets around the newborn in the open crib
Correct Answer: A

Rationale: The correct next course of action is to obtain a blood glucose reading (Choice A). Poor muscle tone and low temperature in a newborn can be indicative of hypoglycemia, which is a common issue in infants. By checking the blood glucose level, the healthcare provider can determine if hypoglycemia is the cause of the symptoms. This action allows for prompt intervention if needed. Choices B, C, and D are incorrect as they do not address the potential underlying issue of hypoglycemia. Resuscitation needs (Choice B) should only be considered if the infant's condition deteriorates. Calling for a transfer to the neonatal intensive care unit (Choice C) may not be necessary if the issue can be managed in the nursery. Placing warm blankets (Choice D) may help with temperature regulation but does not address the root cause of the symptoms.

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