Normal Newborn

Normal Newborn

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Multiple Choice

A nurse admits a newborn infant to the nursery. On assessment of the infant, the nurse palpates the anterior fontanel and notes that it feels soft. The nurse determines that this finding indicates:

• Dehydration

• A normal finding

• Increased intracranial pressure

• Decrease intracranial pressure

A normal finding

The anterior fontanel is normally 2-3 cm in width, 3-4 cm in length, and is diamond-like in shape. It can be described as soft, which is normal, or full and bulging, which could indicated increased intracranial pressure. Conversely, a depressed fontanel could mean that the infant is dehydrated.

Multiple Choice

A nurse in the delivery room assist with the delivery of a newborn infant. Following deliver, the nurse prevents heat loss in the newborn infant resulting from conduction by:

• Wrapping the newborn in a blanket

• Closing the doors to the delivery room

• Drying the newborn with a warm blanket

• Placing a warm pad on the crib before placing the newborn in the crib

Placing a warm pad on the crib before placing the newborn in the crib

Hypothermia caused by conduction occurs when the newborn infant is on a cold surface, such as a cold pad or mattress. Warming the crib pad will assist in preventing hypothermia by conduction. Evaporation of moisture from a set body dissipates heat along with the moisture. Keeping the newborn infant dry by drying the wet newborn infant at birth will prevent hypothermia via evaporation. Convection occurs as air moves across the newborn infant's skin from an open door and heat is transferred to the air. Radiation occurs when heat from the newborn infant radiates to a colder surface.

Multiple Choice

A nurse is preparing to assess the apical heart rate of a newborn infant. The nurse performs the procedure and notes that the heart rate is normal if which of the following is noted?

• A heart rate of 90 beats per minute

• A heart rate of 140 beats per minute

• A heart rate of 180 beats per minute

• A heart rate of 190 beats per minute

A heart rate of 140 beats per minute

The normal heart rate in a newborn infant is 110-160 beats per minute. Options 1, 2, and 4 are incorrect. Option 1 indicates bradycardia, and options 3 and 4 indicate tachycardia.

Multiple Choice

A childbirth educator tells a class of expectant parents the it is standard routine to instill a medication into the eyes of a newborn infant as a preventive measure against opthalmia neonatorum. The educator tells the class that the medication currently used for the prophylaxis of opthalmia neonatorum is:

• Vitamin K injection

• Penicillin ophthalmic eye ointment

• Neomycin ophthalmic eye ointment

• Erythromycin ophthalmic eye ointment

Erythromycin ophthalmic eye ointment

Ophthalmic erythromycin 0.5% ointment is a broad spectrum antibiotic and is used prophylactically to prevent ophthalmia neonatorum, an eye infection acquired from the newborn infant's passage through the birth canal. Infection from these organisms can cause blindness or serious eye damage. Erythromycin is effective against gonorrhea and Chlamydia. Vitamin K is administered to the newborn infant to prevent abnormal bleeding, and it promotes liver formation of the clotting factors II, VII,IX, and X. Options 2 and 3 are incorrect.

Multiple Choice

A nurse is preparing to assess the respirations of a newborn infant just admitted to the nursery. The nurs performs the procedure and determines that the respiratory rate is normal if which of the following is noted:

• A respiratory rate of 20 breaths per minute

• A respiratory rate of 40 breaths per minute

• A respiratory rate of 90 breaths per minute

• A respiratory rate of 100 breaths per minute

A respiratory rate of 40 breaths per minute

Normal respiratory rate varies from 30 to 60 breaths per minute when the infant is not crying. Respirations should be counted for 1 full minute to ensure an accurate measurement because the newborn infant may be a periodic breather. Observing and palpating respirations while the infant is quiet promotes accurate assessment. Palpation aids observation in determing the respiratory rate. Option 1 indicates bradypnea, and options 2 and 4 indicate tacypnea.