1
Q
What is the most critical extrauterine adjustment a newborn must make after birth?
A
The establishment of respiratory function with the cutting of the umbilical cord.
2
Q
What three circulatory shunts in a newborn functionally close during the transition to extrauterine life?
A
The ductus arteriosus, ductus venosus, and foramen ovale.
3
Q
An Apgar score of 0 to 3 indicates what level of distress in a newborn?
A
Severe distress.
4
Q
An Apgar score of 4 to 6 indicates what level of difficulty for a newborn adapting to extrauterine life?
A
Moderate difficulty.
5
Q
What is the Apgar score for a newborn with a heart rate of 90/min?
A
1
6
Q
What is the Apgar score for a newborn who has a slow, weak cry?
A
1
7
Q
A newborn has some flexion of extremities. What is the Apgar score for muscle tone?
A
1
8
Q
What is the Apgar score for reflex irritability if a newborn only grimaces in response to stimulation?
A
1
9
Q
A newborn has a pink body but cyanotic hands and feet (acrocyanosis). What is the Apgar score for color?
A
1
10
Q
What is the primary purpose of a bulb syringe for a newborn assessment?
A
For suctioning excess mucus from the mouth and nose.
11
Q
What is the expected reference range for a newborn’s weight?
A
2,500 to 4,000 g (5.5 to 8.8 lb).
12
Q
What is the expected reference range for a newborn’s length?
A
45 to 55 cm (18 to 22 in).
13
Q
The expected reference range for a newborn’s head circumference is _____.
A
32 to 36.8 cm (12.6 to 14.5 in).
14
Q
A newborn’s chest circumference should be approximately _____.
A
30 to 33 cm (12 to 13 in).
15
Q
The New Ballard Score is used to assess a newborn’s _____.
A
Neuromuscular and physical maturity to estimate gestational age.
16
Q
A newborn is classified as Appropriate for Gestational Age (AGA) if their weight is between which percentiles?
A
Between the 10th and 90th percentile.
17
Q
A newborn is classified as Small for Gestational Age (SGA) when their weight is less than the _____ percentile.
A
10th.
18
Q
What classification is given to a newborn with a weight greater than the 90th percentile?
A
Large for gestational age (LGA).
19
Q
A newborn born prior to 37 0/7 weeks of gestation is classified as _____.
A
Preterm or premature.
20
Q
A newborn born after the completion of 42 weeks of gestation with evidence of placental insufficiency is classified as _____.
A
Postmature.
21
Q
What is the normal respiratory rate for a newborn?
A
30 to 60 breaths/min.
22
Q
Periods of apnea in a newborn lasting longer than _____ should be evaluated.
A
15 seconds.
23
Q
What are two clinical findings of respiratory distress in a newborn?
A
Grunting and nasal flaring.
24
Q
The normal heart rate for a newborn ranges from _____.
A
110 to 160/min.
25
Where should the stethoscope be placed to assess a newborn's apical pulse?
On the fourth or fifth intercostal space at the left midclavicular line.
26
What is the normal blood pressure range for a newborn?
60 to 80 mm Hg systolic and 40 to 50 mm Hg diastolic.
27
The normal temperature range for a newborn is _____.
36.5° C to 37.5° C (97.7° F to 99.5° F).
28
What is vernix caseosa?
A protective, thick, cheesy covering on a newborn's skin, often found in creases.
29
What are milia in a newborn?
Small raised pearly or white spots on the nose, chin, and forehead that disappear spontaneously.
30
Term: Mongolian spots
Spots of pigmentation that are blue, gray, brown, or black, commonly noted on the back and buttocks of newborns with dark skin.
31
What are telangiectatic nevi, or 'stork bites'?
Flat pink or red marks that easily blanch and are found on the back of the neck, nose, or eyelids, usually fading by the second year.
32
Term: Nevus flammeus
A port wine stain; a capillary angioma below the skin that is purple or red and does not blanch or disappear.
33
What is erythema toxicum (erythema neonatorum)?
A pink rash, often called newborn rash, that appears suddenly anywhere on the body of a term newborn during the first 3 weeks.
34
A newborn's head circumference should be how much larger than the chest circumference?
2 to 3 cm larger.
35
Bulging fontanels at rest can indicate what condition in a newborn?
Increased intracranial pressure, infection, or hemorrhage.
36
What might depressed fontanels indicate in a newborn?
Dehydration.
37
Term: Caput succedaneum
Localized swelling of the soft tissues of the scalp caused by pressure during labor, which can cross the suture line and resolves in 3 to 4 days.
38
How does a cephalohematoma differ from caput succedaneum?
A cephalohematoma is a collection of blood between the periosteum and skull bone that does not cross the suture line.
39
Low-set ears in a newborn can indicate what potential issues?
A chromosome abnormality, such as Down syndrome, or a kidney disorder.
40
Why is a nasal blockage dangerous for a newborn in the first 3 weeks of life?
Because newborns are obligate nose breathers and do not develop the response of opening the mouth to breathe until 3 weeks after birth.
41
Term: Epstein's pearls
Small whitish-yellow cysts found on the gums and at the junction of the soft and hard palates in a newborn.
42
A newborn should pass meconium within what timeframe after birth?
Within 24 to 48 hours.
43
How is the sucking and rooting reflex elicited in a newborn?
By stroking the cheek or edge of the mouth, causing the newborn to turn toward the side that is touched and start to suck.
44
To elicit the _____ reflex, the examiner places a finger in the palm of the newborn's hand.
Palmar grasp.
45
How is the Moro reflex elicited in a newborn?
By allowing the head and trunk in a semi-sitting position to fall backward to an angle of at least 30°.
46
The tonic neck reflex is also known as the _____ position.
Fencer.
47
How do you elicit the Babinski reflex in a newborn?
By stroking the outer edge of the sole of the foot, moving up toward the toes.
48
What is the expected response when eliciting the Babinski reflex in a newborn?
The toes will fan upward and out.
49
A newborn can typically focus on objects how far from their face?
8 to 12 inches.
50
When suctioning a newborn with a bulb syringe, which should be suctioned first: the mouth or the nose?
The mouth should be suctioned first to prevent aspiration.
51
What is the ideal method for promoting warmth and maintaining a stable newborn's body temperature?
Early skin-to-skin contact with a parent.
52
What are the three periods of reactivity a newborn passes through in the first 6 to 8 hours of life?
First period of reactivity, period of relative inactivity, and second period of reactivity.
53
For the results of a newborn metabolic screening to be accurate, the newborn must have received formula or breast milk for at least how long?
At least 24 hours.
54
When performing a heel stick on a newborn, the lancet should go no deeper than _____ to prevent necrotizing osteochondritis.
2.4 mm.
55
What is a 'passing' result for a critical congenital heart disease (CCHD) screening?
An oxygen saturation greater than 95% in either extremity, with less than a 3% difference between the lower and upper extremities.
56
What are two contraindications for circumcision?
Hypospadias/epispadias and a family history of bleeding disorders.
57
After a circumcision using a Gomco or Mogen clamp, what should be applied to the wound?
Sterile petroleum gauze to prevent infection and control bleeding.
58
A film of yellowish mucus can form over the glans by day two after a circumcision. What should the parent be taught to do?
Do not wash it off, as it is part of the healing process.
59
What action is a priority for a nurse to ensure newborn security?
Matching the parent's identification band with the newborn's band each time the newborn is given to the parents.
60
Heat loss resulting from direct contact with a cooler surface is known as _____.
Conduction.
61
Placing a newborn's bassinet out of the direct line of a fan or air conditioning vent prevents heat loss by _____.
Convection.
62
What type of heat loss occurs when a newborn is not dried completely after birth?
Evaporation.
63
Keeping a newborn away from cool windows or air conditioners prevents heat loss by _____.
Radiation.
64
To decrease the incidence of sudden unexpected infant death (SUID), newborns should be positioned _____ for sleep.
Supine ('safe sleep').
65
A newborn's diaper should be folded down and away from the umbilical stump to _____.
Allow the stump to air dry and prevent contamination.
66
Prophylactic eye care with _____ ointment is mandatory to prevent ophthalmia neonatorum.
Erythromycin.
67
Ophthalmia neonatorum is caused by which two organisms and can lead to blindness?
Neisseria gonorrhoeae or Chlamydia trachomatis.
68
Why is Vitamin K (phytonadione) administered to newborns?
To prevent hemorrhagic disorders, as it is not produced in the newborn's gastrointestinal tract until around day 7.
69
Where should a vitamin K injection be administered to a newborn?
Intramuscularly into the vastus lateralis.
70
For a newborn born to a parent infected with hepatitis B, what is given within 12 hours of birth?
Hepatitis B immunoglobulin and the hepatitis B vaccine.
71
What is a manifestation of cold stress in a newborn?
Skin pallor with mottling, cyanotic trunk, or tachypnea.
72
Interventions are indicated for at-risk newborns when their blood glucose levels are less than _____.
40 to 45 mg/dL.
73
Newborns who are breastfed or formula-fed should receive how much Vitamin D daily?
400 IU.
74
At what age are solids typically introduced to an infant's diet?
6 months of age.
75
What is colostrum?
The 'early milk' secreted during the first 1 to 3 days postpartum, which is rich in immunoglobulin A (IgA) for passive immunity.
76
To ensure a newborn receives adequate fat and protein, they should breastfeed for at least _____ minutes per breast.
15 to 20 minutes.
77
How can a parent break the suction from the nipple before removing a newborn from the breast?
By inserting a finger in the side of the newborn's mouth.
78
What are three hunger cues a newborn might exhibit?
Hand-to-mouth movements, sucking motions, and the rooting reflex.
79
To avoid nipple confusion, parents should not offer supplemental formula or pacifiers until breastfeeding has been established, typically for how long?
3 to 4 weeks.
80
Breast milk can be stored at room temperature for up to _____.
4 hours.
81
How long can breast milk be stored in the freezer compartment of a refrigerator?
Up to 6 months.
82
Why is thawing breast milk in a microwave contraindicated?
It destroys immune factors and lysozymes and can create hot spots that burn the newborn.
83
During bottle feeding, a newborn should be cradled in a semi-upright position at a _____ angle.
45°.
84
Why should a bottle never be propped for a feeding?
Due to the danger of aspiration.
85
Placing a newborn in the supine position for sleeping greatly decreases the risk of _____.
Sudden unexpected infant death (SUID).
86
Bathing by immersion should not be done until what two things have occurred?
The newborn's umbilical cord has fallen off and the circumcision has healed.
87
To prevent burns, the hot water heater should be set at _____ or less.
49° C (120.2° F).
88
How should a female newborn's vulva be washed to prevent infection?
By wiping from front to back.
89
Infants should be kept in a rear-facing car seat until what age?
Until age 2 or until the child reaches the maximum height and weight for the seat.
90
Parents should report a newborn temperature greater than _____ or less than _____ to the provider.
Greater than 38° C (100.4° F) or less than 36.5° C (97.9° F).
91
What is Neonatal Abstinence Syndrome (or Neonatal Opioid Withdrawal Syndrome)?
Withdrawal symptoms that occur when a parent uses drugs with addictive properties during pregnancy.
92
A key CNS finding of neonatal opioid withdrawal syndrome (NOWS) is a ____-pitched, shrill cry.
High.
93
What are the characteristic facial anomalies of Fetal Alcohol Syndrome (FAS)?
Small eyes, flat midface, smooth philtrum, and a thin upper lip.
94
What nursing intervention helps reduce self-stimulation in a newborn experiencing substance withdrawal?
Swaddling the newborn with legs flexed.
95
Respiratory distress syndrome (RDS) in newborns is a result of a deficiency of what substance in the lungs?
Surfactant.
96
What are the hallmark signs of RDS in a newborn?
Tachypnea, nasal flaring, expiratory grunting, and retractions.
97
What lung surfactant medication is administered to premature newborns with RDS?
Beractant, calfactant, or lucinactant.
98
Term: Apnea of prematurity
A pause in respirations of 20 seconds or greater, resulting from immature neurological and chemical mechanisms.
99
Term: Retinopathy of prematurity
A disease caused by abnormal growth of retinal blood vessels, often associated with oxygen administration to the newborn.
100
What is necrotizing enterocolitis (NEC)?
An inflammatory disease of the gastrointestinal mucosa due to ischemia, resulting in necrosis and perforation of the bowel.
101
A common complication for a large for gestational age (LGA) newborn is _____ due to high insulin reserves and insufficient glucose reserves at birth.
Hypoglycemia.
102
What is a characteristic physical finding of a postmature infant's skin?
Peeling, cracked, dry, and leathery skin.
103
What is the primary sign of newborn sepsis?
Temperature instability.
104
A flaccid arm with the elbow extended, hand rotated inward, and an absent Moro reflex on the affected side suggests what birth injury?
Erb-Duchenne paralysis (brachial plexus injury).
105
How is physiologic jaundice different from pathologic jaundice?
Physiologic jaundice appears after 24 hours of life and is benign, while pathologic jaundice appears before 24 hours of age and is the result of an underlying disease.
106
What is kernicterus?
An irreversible, chronic result of bilirubin toxicity causing permanent brain damage.
107
What is a key nursing intervention for a newborn receiving phototherapy?
Maintain an eye mask over the newborn’s eyes for protection.
108
While under phototherapy, a newborn should be repositioned every _____ to expose all body surfaces to the light.
2 hours.
109
The stools of a newborn undergoing phototherapy may appear _____ and _____.
Loose and green.
110
How should a nurse care for the protruding membrane in a newborn with spina bifida?
Protect the membrane with a sterile covering and plastic to prevent drying.
111
The 'sun-setting' sign, where the whites of the eyes are visible above the iris, is common in newborns with what condition?
Hydrocephalus.
112
A newborn with Tetralogy of Fallot who is in respiratory distress should be placed in what position?
Knee-chest position.
113
The Guthrie test is a neonatal screening for _____.
Phenylketonuria (PKU).
114
What is the most critical extrauterine adjustment for a newborn?
The establishment of respiratory function with the cutting of the umbilical cord.
115
The three circulatory shunts that functionally close during a newborn's transition to extrauterine life are the ductus arteriosus, ductus venosus, and _____.
foramen ovale
116
At what two-time intervals is an Apgar score assigned to a newborn?
At 1 minute and 5 minutes of life.
117
An Apgar score of 0 to 3 indicates what level of distress in a newborn?
Severe distress.
118
What Apgar score range indicates that a newborn is having minimal or no difficulty adapting to extrauterine life?
A score of 7 to 10.
119
In Apgar scoring, what score is given for a heart rate that is slow, and less than 100/min?
A score of 1.
120
In Apgar scoring, what score is given for muscle tone if the newborn is flaccid?
A score of 0.
121
In Apgar scoring, what is the term for a newborn having a pink body but cyanotic hands and feet, and what score does it receive?
Acrocyanosis, which receives a score of 1 for color.
122
What is the expected reference range for a newborn's weight in grams?
2,500 to 4,000 g (5.5 to 8.8 lb).
123
What is the expected reference range for a newborn's length in centimeters?
45 to 55 cm (18 to 22 in).
124
The expected reference range for a newborn's head circumference is _____.
32 to 36.8 cm (12.6 to 14.5 in)
125
A newborn's chest circumference should be within what expected range?
30 to 33 cm (12 to 13 in).
126
The New Ballard Score is a newborn maturity rating scale used to assess neuromuscular and _____ maturity.
physical
127
A newborn is classified as 'Appropriate for gestational age' (AGA) when their weight is between which two percentiles?
The 10th and 90th percentile.
128
How is a 'Small for gestational age' (SGA) newborn classified based on weight percentile?
Weight is less than the 10th percentile.
129
A newborn is defined as 'Large for gestational age' (LGA) when their weight is greater than the _____ percentile.
90th
130
What is the definition of a low birth weight (LBW) newborn?
A weight of 2,500 g or less at birth.
131
A newborn born prior to 37 0/7 weeks of gestation is classified as _____.
Preterm or premature
132
A postmature newborn is born after 42 weeks of gestation with evidence of what condition?
Placental insufficiency.
133
What is the normal respiratory rate range for a newborn?
30 to 60 breaths/min.
134
Short periods of apnea in a newborn are considered normal if they last less than how many seconds?
Less than 15 seconds.
135
What is the normal heart rate range for a newborn?
110 to 160/min.
136
What is the normal range for a newborn's blood pressure?
60 to 80 mm Hg systolic and 40 to 50 mm Hg diastolic.
137
What is the normal temperature range for a newborn in Celsius and Fahrenheit?
36.5° C to 37.5° C (97.7° F to 99.5° F).
138
What physiological condition can occur if a newborn becomes chilled (cold stress)?
Oxygen demands can increase and acidosis can occur.
139
Term: Vernix caseosa
Definition: A protective, thick, cheesy covering on a newborn's skin, with amounts varying, but more present in creases and skin folds.
140
Term: Milia
Definition: Small raised pearly or white spots on the nose, chin, and forehead of a newborn that disappear spontaneously.
141
Term: Mongolian spots
Definition: Spots of pigmentation (blue, gray, brown, or black) commonly noted on the back and buttocks of newborns, especially those with dark skin.
142
Term: Telangiectatic nevi (stork bites)
Definition: Flat pink or red marks that easily blanch and are found on the back of the neck, nose, upper eyelids, and middle of the forehead, usually fading by the second year.
143
Term: Nevus flammeus (port wine stain)
Definition: A capillary angioma below the skin surface that is purple or red, varies in size and shape, is commonly on the face, and does not blanch or disappear.
144
Term: Erythema toxicum (newborn rash)
Definition: A pink rash that appears suddenly anywhere on the body of a term newborn during the first 3 weeks, requiring no treatment.
145
A newborn's head should be how much larger than their chest circumference?
2 to 3 cm larger.
146
A head circumference greater than or equal to 4 cm larger than the chest circumference in a newborn can indicate what condition?
Hydrocephalus.
147
In a newborn, bulging fontanels at rest can indicate increased intracranial pressure, infection, or _____.
hemorrhage
148
A depressed fontanel in a newborn can be an indication of what condition?
Dehydration.
149
Term: Caput succedaneum
Definition: Localized swelling of the soft tissues of the scalp caused by pressure during labor; it can cross the suture line and resolves in 3 to 4 days.
150
Term: Cephalohematoma
Definition: A collection of blood between the periosteum and the skull bone that does not cross the suture line, resolving in 2 to 8 weeks.
151
Low-set ears in a newborn can indicate a chromosome abnormality, such as Down syndrome, or a _____ disorder.
kidney
152
Why is a nasal blockage a concern in a newborn?
Newborns are obligate nose breathers and do not develop the response of opening the mouth with a nasal obstruction until 3 weeks after birth.
153
Term: Epstein's pearls
Definition: Small whitish-yellow cysts found on the gums and at the junction of the soft and hard palates in a newborn, which disappear in a few weeks.
154
Within how many hours after birth should meconium be passed?
Within 24 to 48 hours.
155
A rust color in a newborn's urine for the first couple of days is produced by _____.
uric acid crystals
156
How is the sucking and rooting reflex elicited in a newborn?
By stroking the cheek or edge of the mouth, causing the newborn to turn the head toward the side that is touched and start to suck.
157
How is the palmar grasp reflex elicited?
By placing an examiner’s finger in the palm of the newborn’s hand, causing the newborn's fingers to curl around it.
158
How do you elicit the Moro reflex in a newborn?
Allow the head and trunk of the newborn in a semi-sitting position to fall backward to an angle of at least 30°.
159
To elicit the _____ reflex, the examiner turns the newborn's head quickly to one side, causing the arm and leg on that side to extend and the opposing limbs to flex.
tonic neck (fencer position)
160
How is the Babinski reflex elicited in a newborn?
By stroking the outer edge of the sole of the foot, moving up toward the toes, which causes the toes to fan upward and out.
161
A newborn's eyes are sensitive to light. At what distance can a newborn best focus on objects?
8 to 12 inches away from the face.
162
When suctioning a newborn with a bulb syringe, which should be suctioned first, the mouth or the nose, and why?
The mouth should be suctioned first to prevent aspiration as the nose is suctioned.
163
What is the ideal method for promoting warmth and maintaining a stable newborn's body temperature?
Early skin-to-skin contact with a parent.
164
What is the first period of reactivity in a newborn?
A period lasting 30 min after birth where the newborn is alert, exhibits exploring activity, makes sucking sounds, and has a rapid heart rate and respiratory rate.
165
When does the second period of reactivity typically occur in a newborn?
It usually occurs 2 to 8 hours after birth and can last from 10 minutes to several hours.
166
When is the newborn genetic screening (heel stick) typically performed?
24 hours following birth, after the newborn has received formula or breast milk for at least 24 hours.
167
All states mandate newborn genetic screening for what condition, a defect in protein metabolism?
Phenylketonuria (PKU).
168
During a newborn heel stick, the lancet should go no deeper than _____ to prevent necrotizing osteochondritis.
2.4 mm
169
Why should circumcision not be performed immediately following birth?
The newborn's level of vitamin K is at a low point, increasing the risk for hemorrhage.
170
A film of yellowish mucus can form over the glans of a circumcised penis by day two. What is the correct client education regarding this finding?
Do not wash it off.
171
What is the correct procedure for using a bulb syringe to suction a newborn?
Compress the bulb before insertion into one side of the mouth, aspirate the mouth first, then one nostril, then the second nostril.
172
What is the purpose of the two identification bands placed on a newborn immediately after birth?
It is a safety measure to prevent the newborn from being given to the wrong parents, switched, or abducted.
173
Term: Conduction (heat loss)
Definition: Loss of body heat resulting from direct contact with a cooler surface (e.g., cold scale, stethoscope).
174
Term: Convection (heat loss)
Definition: Flow of heat from the body surface to cooler environmental air (e.g., draft from a fan or vent).
175
Term: Evaporation (heat loss)
Definition: Loss of heat as surface liquid is converted to vapor (e.g., from amniotic fluid on the skin after birth).
176
Term: Radiation (heat loss)
Definition: Loss of heat from the body surface to a cooler solid surface that is close, but not in direct contact (e.g., a cold window).
177
To decrease the incidence of sudden unexpected infant death (SUID), newborns should be positioned _____ for sleep.
supine ("safe sleep")
178
The stools of breastfed newborns typically appear _____ and _____.
yellow and seedy
179
How should the newborn's diaper be positioned in relation to the umbilical stump?
The diaper should be folded down and away from the umbilical stump.
180
What prophylactic eye care is mandatory for newborns, and what does it prevent?
Instillation of antibiotic ointment (erythromycin) to prevent ophthalmia neonatorum.
181
Why is Vitamin K (phytonadione) administered to newborns?
To prevent hemorrhagic disorders, as Vitamin K is not produced in the newborn's gastrointestinal tract until around day 7.
182
Where should the Vitamin K injection be administered in a newborn?
Intramuscularly into the vastus lateralis muscle.
183
If a newborn requires both a Vitamin K and a hepatitis B injection, what is an important administration rule?
Do not give both injections in the same thigh.
184
What is the expected weight loss for a newborn immediately after birth?
Loss of 5% to 10% after birth (regain 10 to 14 days after birth).
185
For the first 3 months, a newborn requires approximately how many kcal/kg/day?
110 kcal/kg/day.
186
The early milk secreted from a postpartum client's breasts during days 1 to 3 is called _____, which provides passive immunity to the newborn.
colostrum
187
What are the four basic breastfeeding positions?
Football hold (under the arm), cradle (most common), modified cradle (across the lap), and side-lying.
188
How can a parent break the suction from the nipple before removing the newborn from the breast to prevent nipple trauma?
By inserting a finger in the side of the newborn’s mouth.
189
How long can breast milk be stored at room temperature?
Up to 4 hours.
190
How long can breast milk be stored in the freezer compartment of a refrigerator and in a deep freezer, respectively?
Up to 6 months in a refrigerator freezer and up to 12 months in a deep freezer.
191
Why is thawing breast milk by microwave contraindicated?
It destroys some immune factors and lysozymes and can lead to uneven heating, causing hot spots that can burn the newborn.
192
During bottle feeding, a newborn should be cradled in a semi-upright position at what angle to prevent aspiration?
A 45° angle.
193
To prevent the newborn from swallowing air during bottle feeding, the nipple should be kept _____.
filled with formula
194
What are the three main feeding-readiness cues exhibited by newborns?
Hand-to-mouth movements, sucking motions, and rooting.
195
Failure to thrive in a newborn is defined as slow weight gain, typically falling below the _____ percentile on the growth chart.
5th
196
How can parents help a newborn who gets their days and nights mixed up?
Bring the newborn into the center of action in the afternoon, bathe them before bedtime, and give the last feeding around 2300.
197
Bathing by immersion is not done until the newborn's umbilical cord has fallen off and what else has healed?
The circumcision, if applicable.
198
To prevent burns, a home's hot water heater should be set at or below what temperature?
49° C (120.2° F).
199
What is the proper way to cleanse the eyes of a newborn during a bath?
Use a clean portion of the washcloth with clear water for each eye, moving from the inner to the outer canthus.
200
How should the vulva of a female newborn be cleansed to prevent contamination?
By wiping from front to back.
201
To prevent a choking hazard, the slats on a newborn's crib should be no more than _____ apart.
5.7 cm (2.25 in)
202
What is the correct car seat safety recommendation for newborns?
Use an approved rear-facing car seat in the back seat, preferably in the middle, until age 2 or the child reaches the maximum height and weight for the seat.
203
Parents should report a newborn's temperature if it is greater than 38° C (100.4° F) or less than _____.
36.5° C (97.9° F)
204
Neonatal Abstinence Syndrome (withdrawal) is characterized by a CNS finding of a _____, shrill cry.
high-pitched
205
Fetal Alcohol Syndrome can cause specific facial anomalies, including small eyes, a flat midface, a smooth philtrum, and a _____ upper lip.
thin
206
In a newborn, interventions to raise blood glucose levels are usually indicated when glucose levels fall below _____ mg/dL.
40 to 45
207
Respiratory Distress Syndrome (RDS) in newborns occurs as a result of a deficiency in what substance?
Surfactant.
208
What are the five classic physical assessment findings of respiratory distress in a newborn?
Tachypnea, nasal flaring, expiratory grunting, retractions, and cyanosis.
209
The main priority in treating newborns who are preterm is supporting the _____ and _____ systems.
cardiac and respiratory
210
Term: Apnea of prematurity
Definition: A pause in respirations of 20 seconds or greater, resulting from immature neurological and chemical mechanisms in a preterm newborn.
211
Term: Retinopathy of prematurity
Definition: An eye disease caused by abnormal growth of retinal blood vessels, often associated with oxygen administration to the newborn.
212
Common complications for a Small for Gestational Age (SGA) newborn include perinatal asphyxia, meconium aspiration, _____, polycythemia, and instability of body temperature.
hypoglycemia
213
Uncontrolled maternal hyperglycemia during pregnancy is a leading risk factor for what type of newborn size classification?
Large for gestational age (LGA).
214
A postmature newborn's skin may appear peeling, cracked, and dry, with a _____ texture.
leathery
215
Term: Sepsis neonatorum
Definition: The presence of micro-organisms or their toxins in the blood or tissues of the newborn during the first month after birth.
216
In a newborn, an absence of the Moro reflex on one side can be a manifestation of what birth injury?
A fractured clavicle or a brachial plexus injury (Erb-Duchenne paralysis).
217
_____ jaundice appears before 24 hours of age or is persistent after day 14 and is the result of an underlying disease.
Pathologic
218
What is kernicterus?
An irreversible, chronic result of bilirubin toxicity causing permanent damage such as severe cognitive impairments and spastic quadriplegia.
219
What protective measure must be taken for a newborn's eyes during phototherapy?
An eye mask must be maintained over the newborn’s eyes.
220
During phototherapy, the newborn should be repositioned every _____ to expose all body surfaces to the lights and prevent pressure sores.
2 hours
221
What is the 'sun-setting sign' common in newborns with hydrocephalus?
The whites of the eyes are visible above the iris.
222
A newborn with Phenylketonuria (PKU) requires a specialized formula in which the amino acid _____ is removed or reduced.
phenylalanine
223
For a newborn with spina bifida, the nurse should protect the membrane with a sterile covering, position the newborn _____, and monitor for leakage of cerebrospinal fluid.
prone
224
What is the most critical extrauterine adjustment for a newborn?
The establishment of respiratory function with the first breath.
225
What three circulatory shunts functionally close during a newborn's transition to extrauterine life?
The ductus arteriosus, ductus venosus, and foramen ovale.
226
An Apgar score of 0 to 3 indicates what level of distress in a newborn?
Severe distress.
227
An Apgar score of 4 to 6 indicates what level of difficulty for a newborn?
Moderate difficulty.
228
An Apgar score of 7 to 10 indicates what level of difficulty for a newborn?
Minimal or no difficulty.
229
In Apgar scoring, what score is given for a heart rate that is absent?
0
230
In Apgar scoring, what score is given for a heart rate that is slow, less than 100/min?
1
231
In Apgar scoring, what score is given for an absent respiratory rate?
0
232
In Apgar scoring, what score is given for a slow, weak cry?
1
233
In Apgar scoring, what score is given for flaccid muscle tone?
0
234
In Apgar scoring, what score is given for some flexion of extremities?
1
235
In Apgar scoring, what score is given for no reflex irritability?
0
236
In Apgar scoring, what score is given for a grimace in response to stimuli?
1
237
In Apgar scoring, what score is given for a color of blue and pale?
0
238
In Apgar scoring, what score is given for a pink body with cyanotic hands and feet (acrocyanosis)?
1
239
Why are rectal temperatures avoided in newborns?
They can injure the delicate rectal mucosa.
240
An umbilical cord should contain how many arteries and veins?
Two arteries and one vein.
241
What is the expected reference range for a newborn's weight?
2,500 to 4,000 g (5.5 to 8.8 lb).
242
What is the expected reference range for a newborn's length?
45 to 55 cm (18 to 22 in).
243
What is the expected reference range for a newborn's head circumference?
32 to 36.8 cm (12.6 to 14.5 in).
244
What is the expected reference range for a newborn's chest circumference?
30 to 33 cm (12 to 13 in).
245
The _____ is a newborn maturity rating score used to assess neuromuscular and physical maturity.
New Ballard Score.
246
A newborn classified as appropriate for gestational age (AGA) has a weight between which percentiles?
The 10th and 90th percentile.
247
How is a small for gestational age (SGA) newborn classified based on weight percentile?
Weight is less than the 10th percentile.
248
How is a large for gestational age (LGA) newborn classified based on weight percentile?
Weight is greater than the 90th percentile.
249
What is the definition of a low birth weight (LBW) newborn?
A weight of 2,500 g or less at birth.
250
A newborn born prior to 37 0/7 weeks of gestation is defined as _____.
Preterm or premature.
251
A newborn born after the completion of 42 weeks of gestation with evidence of placental insufficiency is defined as _____.
Postmature.
252
What is the correct sequence for checking a newborn's vital signs?
Respirations, heart rate, blood pressure, and temperature.
253
What is the normal respiratory rate for a newborn?
30 to 60 breaths/min.
254
Periods of apnea lasting longer than _____ seconds in a newborn should be evaluated.
15 seconds.
255
What are two clinical findings of respiratory distress in a newborn?
Grunting and nasal flaring.
256
What is the normal heart rate range for a newborn?
110 to 160/min.
257
Where should the stethoscope be placed to assess a newborn's apical pulse?
On the fourth or fifth intercostal space at the left midclavicular line.
258
What is the normal blood pressure range for a newborn?
60 to 80 mm Hg systolic and 40 to 50 mm Hg diastolic.
259
What is the normal temperature range for a newborn?
36.5° C to 37.5° C (97.7° F to 99.5° F).
260
What can happen if a newborn becomes chilled (cold stress)?
Oxygen demands can increase and acidosis can occur.
261
What is the term for the bluish tint to a newborn's hands and feet?
Acrocyanosis.
262
The protective, thick, cheesy covering on a newborn's skin, especially in creases, is called _____.
Vernix caseosa.
263
Term: Milia
Small raised pearly or white spots on the nose, chin, and forehead of a newborn that disappear spontaneously.
264
Term: Mongolian spots
Spots of pigmentation that are blue, gray, brown, or black, commonly noted on the back and buttocks of newborns with dark skin.
265
Term: Telangiectatic nevi (stork bites)
Flat pink or red marks that easily blanch, found on the back of the neck, nose, or eyelids, and usually fade by the second year.
266
Term: Nevus flammeus (port wine stain)
A capillary angioma below the skin that is purple or red, varies in size, and does not blanch or disappear.
267
Term: Erythema toxicum (newborn rash)
A pink rash that appears suddenly anywhere on the body of a term newborn during the first 3 weeks.
268
A newborn's head should be how much larger than their chest circumference?
2 to 3 cm larger.
269
A head circumference greater than or equal to 4 cm larger than the chest can indicate what condition?
Hydrocephalus.
270
A head circumference less than or equal to 32 cm can indicate what condition?
Microcephaly.
271
What can bulging fontanels at rest indicate in a newborn?
Increased intracranial pressure, infection, or hemorrhage.
272
What can depressed fontanels indicate in a newborn?
Dehydration.
273
Term: Caput succedaneum
Localized swelling of the soft tissues of the scalp caused by pressure during labor, which can cross the suture line and resolves in 3 to 4 days.
274
Term: Cephalohematoma
A collection of blood between the periosteum and the skull bone that does not cross the suture line, resolving in 2 to 8 weeks.
275
Low-set ears in a newborn can indicate what potential issues?
A chromosome abnormality (such as Down syndrome) or a kidney disorder.
276
Why is a nasal blockage a concern in a newborn?
Newborns are obligate nose breathers and do not develop the response of opening the mouth until 3 weeks after birth.
277
Term: Epstein's pearls
Small whitish-yellow cysts on the gums and at the junction of the soft and hard palates, which are an expected finding.
278
How is the sucking and rooting reflex elicited?
By stroking the newborn's cheek or edge of the mouth.
279
How is the palmar grasp reflex elicited?
By placing an examiner’s finger in the palm of the newborn’s hand.
280
How is the plantar grasp reflex elicited?
By placing an examiner’s finger at the base of the newborn’s toes.
281
How is the Moro reflex elicited?
By allowing the head and trunk of the newborn in a semisitting position to fall backward to an angle of at least 30°.
282
What is the expected response for the tonic neck reflex (fencer position)?
The newborn’s arm and leg on the side the head is turned extend, and the opposing arm and leg flex.
283
How is the Babinski reflex elicited?
By stroking the outer edge of the sole of the foot, moving up toward the toes.
284
What is the expected response to the Babinski reflex in a newborn?
The toes will fan upward and out.
285
How is the stepping reflex elicited?
By holding the newborn upright with feet touching a flat surface.
286
What is the normal range for hemoglobin (Hgb) in a newborn?
14 to 24 g/dL.
287
What is the normal range for hematocrit (Hct) in a newborn?
44% to 64%.
288
What is the normal range for white blood cell (WBC) count in a newborn?
9,000 to 30,000/mm³.
289
What is the normal range for platelets in a newborn?
150,000 to 300,000/mm³.
290
What is a normal blood glucose range for a newborn?
Greater than 40 to 45 mg/dL.
291
When using a bulb syringe to suction a newborn, which area is suctioned first and why?
The mouth is suctioned first to prevent aspiration as the nose is suctioned.
292
During the first period of reactivity, how long does the period last and what is the expected heart rate?
It lasts 30 minutes after birth, with a heart rate as high as 160 to 180/min.
293
The second period of reactivity usually occurs how long after birth?
2 to 8 hours after birth.
294
For the newborn genetic screening (heel stick) to be accurate, the newborn must have received formula or breast milk for at least how long?
At least 24 hours.
295
When performing a heel stick, the lancet should go no deeper than _____ to prevent necrotizing osteochondritis.
2.4 mm.
296
Why should circumcision not be performed immediately following birth?
The newborn's level of vitamin K is at a low point, increasing the risk for hemorrhage.
297
What are two contraindications for circumcision?
Hypospadias/epispadias and a family history of bleeding disorders.
298
Following a circumcision with a Gomco clamp, what should be applied to the wound with each diaper change?
Sterile petroleum gauze.
299
A film of _____ mucus can form over the glans by day two after circumcision and should not be washed off.
yellowish.
300
How can a nurse verify the identity of a newborn before giving them to a parent?
By matching the parent’s identification band with the newborn’s band.
301
Term: Conduction (heat loss)
Loss of body heat resulting from direct contact with a cooler surface.
302
Term: Convection (heat loss)
Flow of heat from the body surface to cooler environmental air.
303
Term: Evaporation (heat loss)
Loss of heat as surface liquid is converted to vapor.
304
Term: Radiation (heat loss)
Loss of heat from the body surface to a cooler solid surface that is close, but not in direct contact.
305
What is the best method for promoting and maintaining a stable newborn's temperature?
Early skin-to-skin contact with the parent.
306
To decrease the incidence of sudden unexpected infant death (SUID), newborns should be positioned _____ for sleep.
Supine (on their back).
307
Meconium should be passed within the first _____ to _____ hours after birth.
24 to 48 hours.
308
How should the newborn's diaper be positioned in relation to the umbilical stump?
Folded down and away from the umbilical stump.
309
Why is prophylactic erythromycin ointment instilled in a newborn's eyes?
To prevent ophthalmia neonatorum, which can be caused by Neisseria gonorrhoeae or Chlamydia trachomatis and can lead to blindness.
310
Why is vitamin K (phytonadione) administered to newborns?
To prevent hemorrhagic disorders, as vitamin K is not produced in the newborn's gastrointestinal tract until around day 7.
311
Where should the vitamin K injection be administered in a newborn?
Intramuscularly into the vastus lateralis muscle.
312
The vitamin K and the hepatitis B injections should not be given in the _____.
same thigh.
313
A newborn is expected to lose what percentage of their birth weight immediately after birth?
5% to 10%.
314
Both breast milk and formula provide how many calories per ounce?
20 kcal/oz.
315
_____ is the early milk secreted from the breasts during postpartum days 1 to 3 and contains IgA, providing passive immunity.
Colostrum.
316
To prevent nipple trauma, how should a parent break the suction before removing the newborn from the breast?
By inserting a finger in the side of the newborn’s mouth.
317
What are three hunger cues in a newborn?
Hand-to-mouth movements, sucking motions, and rooting reflex.
318
How can breast milk be safely thawed to preserve immunoglobulins?
By thawing it in the refrigerator for 24 hours or holding it under lukewarm running water.
319
Why is thawing breast milk in a microwave contraindicated?
It destroys some immune factors and can create hot spots that burn the newborn.
320
During bottle feeding, a newborn should be held in what position?
In a semi-upright position (45˚ angle).
321
Why should a parent never prop a bottle for feeding?
Propping a bottle increases the danger of aspiration.
322
When should parents call the provider regarding their newborn's temperature?
If the temperature is greater than 38° C (100.4° F) or less than 36.5° C (97.9° F).
323
Bathing by immersion should not be done until the newborn's _____ has fallen off.
umbilical cord.
324
To prevent burns, the hot water heater should be set at or below what temperature?
49° C (120.2° F).
325
Until what age should infants be kept in rear-facing car seats?
Until age 2 or until they reach the maximum height and weight for the seat.
326
Fetal alcohol syndrome (FAS) can cause what characteristic facial anomalies?
Small eyes, a flat midface, a smooth philtrum, and a thin upper lip.
327
What is a characteristic CNS finding in a newborn experiencing neonatal abstinence syndrome (withdrawal)?
A high-pitched, shrill cry.
328
In a newborn, jitteriness, tremors, a weak cry, and hypothermia are potential signs of what condition?
Hypoglycemia.
329
Interventions to raise a newborn's blood glucose are usually indicated when levels fall below _____ to _____ mg/dL.
40 to 45.
330
Respiratory distress syndrome (RDS) in newborns occurs as a result of a deficiency in _____.
surfactant.
331
The main priority in treating newborns who are preterm is supporting which two body systems?
The cardiac and respiratory systems.
332
Term: Apnea of prematurity
A pause in respirations of 20 seconds or greater, resulting from immature neurological and chemical mechanisms.
333
Term: Necrotizing enterocolitis
An inflammatory disease of the gastrointestinal mucosa due to ischemia, resulting in necrosis and perforation of the bowel.
334
What is the term for the skin-to-skin contact encouraged with preterm infants to reduce stress?
Kangaroo care.
335
Common complications for a small for gestational age (SGA) newborn include perinatal asphyxia, meconium aspiration, and _____.
hypoglycemia.
336
Uncontrolled maternal hyperglycemia during pregnancy is the leading risk factor for what newborn condition?
Large for gestational age (LGA) or macrosomia.
337
A newborn born after 42 weeks of gestation with peeling, cracked, and leathery skin is described as ____.
postmature.
338
What is the term for the presence of micro-organisms or their toxins in the blood or tissues of a newborn during the first month?
Newborn sepsis (sepsis neonatorum).
339
_____ jaundice appears before 24 hours of age or is persistent after day 14 and is the result of an underlying disease.
Pathologic.
340
_____ jaundice is considered benign, resulting from normal newborn physiology, and appears 72 to 120 hours after birth.
Physiologic.
341
Term: Kernicterus
An irreversible, chronic result of bilirubin toxicity causing hypotonia, severe cognitive impairments, and spastic quadriplegia.
342
During phototherapy for hyperbilirubinemia, what protective measure must be taken for the newborn's eyes?
An eye mask must be maintained over the newborn’s eyes.
343
During phototherapy, how often should the newborn be repositioned?
Every 2 hours to expose all body surfaces to the lights.
344
A newborn with a cleft lip/palate should be fed in what position to decrease aspiration risk?
In the upright position.
345
A diagnosis of Phenylketonuria (PKU) requires a specialized formula in which the amino acid _____ is removed or reduced.
phenylalanine.
346
A newborn diagnosed with spina bifida should be positioned _____ to prevent trauma to the membrane.
prone.
347
In a newborn with Down syndrome, what is the term for the deep crease across the center of the palm?
Simian crease.
OB Proctor Exam ATI
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