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WorksheetsNewborn Care and Physiology
Total questions: 40
Worksheet time: 20mins
Immediately after birth, the nurse begins drying the newborn vigorously and removes the wet linens. When the infant remains slightly cyanotic and sluggish to cry, which additional intervention is appropriate based on safe newborn stimulation?
Rub or flick the soles of the newborn’s feet
Slap the newborn’s buttocks
Shake the newborn’s shoulders gently
Continue drying for several minutes without other stimulation
A student nurse continues to rub the newborn’s back for several minutes after the infant is pink, crying, and breathing regularly. The RN should intervene because:
Prolonged tactile stimulation is not recommended
Back rubbing should be replaced with slapping the buttocks
Stimulation should never be used after birth
Tactile stimulation should always last at least 10 minutes
After birth, the nurse explains to parents that blood is now flowing through the newborn’s lungs rather than bypassing them. This change occurs primarily because:
The foramen ovale opens more widely
Fetal shunts function more effectively
Pressure changes in the heart, lungs, and vessels cause functional closure of fetal shunts
The placenta increases its blood flow to the newborn
The nurse delays cord clamping for a brief period after birth at the provider’s request. Which hematologic effect is most directly influenced by the timing of cord clamping?
The newborn’s blood volume
The newborn’s platelet function
The newborn’s clotting factor production
The newborn’s blood type
A full-term newborn weighs 3.5 kg. Based on typical newborn blood volume of 80–85 mL/kg, the nurse estimates the infant’s total blood volume to be approximately:
100 mL
300 mL
450–300 mL
280–300 mL
The nurse is educating parents about fluid balance in their newborn. Which statement best explains why newborns are at higher risk for dehydration and acidosis?
Their kidneys are fully mature and excrete too much potassium
Their rate of metabolism is lower than adults
Their rate of fluid exchange and metabolism are higher, and their kidneys cannot concentrate urine
They produce more antidiuretic hormone (ADH) than adults
The nurse is planning care for a newborn, knowing they are prone to specific fluid-related problems. Which conditions is the newborn particularly at risk for due to fluid and electrolyte characteristics? Select all that apply.
Dehydration
Acidosis
Overhydration/fluid overload
Chronic hypertension
Hyperthyroidism
Parents plan to feed the baby store-bought cow’s milk. Which teaching point by the nurse is most accurate based on newborn GI function?
“Cow’s milk is ideal because your newborn has plenty of pancreatic lipase.”
“Your newborn has a deficiency in pancreatic lipase, which makes cow’s milk difficult to digest.”
“Cow’s milk is recommended because the stomach can hold over 200 mL.”
“Cow’s milk is safe if diluted with water.”
A nurse is preparing a feeding plan for a term newborn. Which information about stomach capacity is most relevant?
The newborn’s stomach can hold approximately 30 mL
The newborn’s stomach can hold approximately 90 mL
The newborn’s stomach is the same size as an adult’s
Stomach capacity is irrelevant when planning feedings
A newborn has not voided by 20 hours of life. Which action is most appropriate?
Reassure parents this is expected for the first 48 hours
Document as normal and continue routine care
Recognize that the first void is expected within 24 hours and continue to closely monitor
Restrict fluids until the newborn voids
The parent of a healthy newborn asks how often the baby will urinate. The nurse answers based on typical newborn patterns:
“Most newborns void 2–3 times per day.”
“Most newborns void 4–6 times per day.”
“Most newborns may void 10–20 times per day.”
“Most newborns void once every 48 hours.”
The nurse calculates urine output for a 3 kg newborn and finds it to be 1.5 mL/kg/hr. How should the nurse interpret this finding?
Below normal urine production
Within normal newborn urine production of 1–2 mL/kg/hr
Above normal, indicating fluid overload
Evidence of kidney failure
During discharge teaching, parents ask about their newborn’s pale complexion and sun exposure. Which statement by the nurse is most accurate regarding skin and melanin?
“Newborns have a high amount of melanin, which protects them from UV exposure.”
“Your baby has low melanin at birth, making them more susceptible to UV damage.”
“Melanin is not present in newborns until 6 months of age.”
“Newborns are immune to sun damage.”
The nurse explains musculoskeletal changes to a new parent. Which statement is accurate?
“Your baby’s skeleton is mostly ossified bone, just smaller.”
“The skeleton contains more cartilage than ossified bone and will rapidly ossify in the first year.”
“Muscle growth occurs primarily through hyperplasia (new muscle cells).”
“Bones do not change significantly during the first year of life.”
The nurse is teaching parents about their newborn’s immune protection. Which statement should be included?
“Skin and mucous membranes serve as the first line of defense against infection.”
“The first line of defense is antibody formation.”
“The newborn has no immune defenses until vaccines are given.”
“Breast milk does not influence immune protection.”
The nurse emphasizes to a breastfeeding parent that human milk provides passive immunity. Which immunologic benefit is correctly described?
Breast milk provides passive immunity through IgM only
Breast milk provides passive immunity, including IgG
Breast milk suppresses antibody formation
Breast milk replaces the need for any immunizations
A newborn shows an unusually high urine volume despite limited intake. Which endocrine characteristic contributes to the risk of dehydration?
Limited production of antidiuretic hormone (ADH)
Excessive ADH production
Excess thyroid hormone production
Fully mature adrenal function
The nurse is assessing a newborn’s neurologic status. Which finding is consistent with normal neurologic development at birth?
Fully integrated nervous system with no primitive reflexes
Presence of primitive reflexes and reliance on the autonomic nervous system
Absence of any reflexes at birth
Complete myelination of all motor pathways
Parents ask what their newborn can “see.” The nurse responds accurately by saying:
“Your baby’s pupils react to light, and reflexes like blinking are present, but tear production is minimal until 2–4 weeks.”
“Your baby cannot react to light at all yet.”
“Your baby has full visual acuity and tear production at birth.”
“Vision does not begin developing until 2–4 months.”
At 1 and 5 minutes after birth, the nurse assigns an Apgar score. When a student asks what the score is for, the nurse responds:
“It tells us exactly what resuscitation your baby needs.”
“It reflects the baby’s general condition but is not used to determine the need for resuscitation.”
“It is only used for research and has no clinical meaning.”
“It determines the baby’s gestational age.”
A newborn has a low Apgar score at 1 minute due to poor tone and reduced reflex irritability, but improves by 5 minutes. Which factors from the baby’s history could have contributed to the initial low score?
High birth weight alone
Maternal sedation during labor
Maternal high protein intake during pregnancy
Use of regional anesthesia only
Within the first hour after birth, a full-term newborn is wide awake, actively looking around, and latching effectively at the breast. This phase is best described as:
Period of deep sleep
First period of reactivity
Second period of reactivity
Transitional lethargy
A newborn is now 3 hours old and sleeping quietly after breastfeeding well at 45 minutes of life. The nurse recognizes this as:
The first period of reactivity
A normal sleep phase between the reactivity periods
Abnormal lethargy requiring evaluation
The second period of reactivity
At 6 hours of life, the newborn is alert and responsive again. The nurse documents this as:
Transition to preterm behavior
Second period of reactivity
Failure to thrive
Prolonged first reactivity
While assessing a newborn, the nurse notes a weak, groaning cry with grunting during expiration. What is the nurse’s priority interpretation?
This is a normal variation for a sleepy baby
This usually indicates a respiratory disturbance
This always indicates a neurologic emergency
This is diagnostic of colic
A newborn who was initially stable develops a high-pitched, shrill cry. The nurse interprets this as a potential sign of:
Increased intracranial pressure
Normal hunger
Sleepiness
Parental separation anxiety
The nurse is assessing parent–infant attachment during a feeding. Which behavior suggests healthy attachment?
Parents avoid eye contact and talk only to the nurse
Parents hold the infant stiffly at arm’s length
Parents call the infant by name and comment on whom the infant looks like
Parents refuse to hold the infant during feeding
When evaluating attachment behaviors, which observations would indicate positive bonding between parents and newborn? Select all that apply.
Parents reach out for the infant when the nurse enters with the baby
Parents speak to the infant and make direct eye contact
Parents avoid touching the infant’s body
Parents smile, stroke, or gently rock the infant
Parents express disgust about diaper changes
The nurse uses the New Ballard scale immediately after birth. This tool is most appropriate for:
Determining the Apgar score
Assessing gestational age between 20 and 44 weeks
Assessing respiratory distress
Diagnosing congenital anomalies
A newborn’s weight plots at the 5th percentile for gestational age. How should the nurse classify this infant?
Appropriate for gestational age (AGA)
Large for gestational age (LGA)
Small for gestational age (SGA)
Term by weight
A newborn is born at 39 weeks’ gestation. How should the nurse describe this infant’s maturity?
Preterm
Term
Postterm
Nonviable
The nurse is assessing a newborn’s vital signs. Which set falls within normal limits?
HR 130 bpm, RR 40/min
HR 90 bpm, RR 20/min
HR 160 bpm, RR 20/min
HR 100 bpm, RR 80/min
Before taking a rectal temperature on a newborn, which nursing action is essential?
Give a pacifier to reduce crying
Evaluate patency of the anus
Feed the newborn to calm them
Place the newborn prone for 20 minutes
During a HEENT exam, the nurse observes small white cyst-like spots on the newborn’s gums. Which interpretation is correct?
These are Epstein pearls and are a normal finding
These indicate oral thrush
These are neonatal teeth requiring urgent removal
These are a sign of vitamin deficiency
The nurse assesses the newborn’s mouth and checks for the sucking and rooting reflexes. The presence of these reflexes best indicates:
Adequate feeding readiness and neurologic function
Advanced motor development
Premature myelination
The need for supplemental formula
The parents ask why their newborn needs an eye ointment and a vitamin K injection shortly after birth. The nurse’s response should focus on:
Routine newborn care to prevent infection and support clotting
Controlling the baby’s crying
Improving the baby’s appetite
Enhancing the baby’s sleep patterns
The nurse is preparing teaching for parents on newborn screening. Which tests should the nurse expect to be completed before discharge?
Metabolic newborn screening and hearing screening
Metabolic newborn screening only
Hearing screening only
No screening is necessary if the baby appears healthy
During a breastfeeding class, a parent asks why breastfeeding is strongly encouraged. Which statement reflects a physiologic benefit for the newborn or parent?
“Breastfeeding has no effect on maternal health.”
“Breastfeeding may lower your risk of breast cancer.”
“Breastfeeding eliminates the need for all immunizations.”
“Breastfeeding is always more expensive than formula.”
The nurse is teaching key factors that promote breastfeeding success. Which concepts should be included? Select all that apply.
Correct positioning of the infant at the breast
Correct sucking technique
Rigid feeding schedule with long intervals between feeds
Early and frequent breastfeeding, ideally within the first hour
Promotion of skin-to-skin contact
The nurse is teaching parents about stimulating their newborn’s development. Which activity is most consistent with normal newborn preferences?
Bright neon-colored toys and loud electronic sounds
Human faces, black-and-white objects, human voice, and gentle touch
Complete absence of stimulation
Only mobile toys hung above the crib
