Name: Emma Hughes Date: 4/28/19 Unit 4 1. A nurse is caring for a newborn in the nursery. The newborn weighs 3,200 g and is in the 60 th percentile for weight. Apgar scores are 9 and 10 at 1 and 5 min of age. Vital signs are as follows: temperature 37.2 C (99.1) F) axillary, heart rate 160 beats/min, respiratory rate 48/min, length 50.8 cm )20 in), head circumference 35 cm (14 in), and chest circumference 33 cm (13 in). Which of the following is an appropriate classification for the newborn based on weight and gestational age?? A. LBW B. AGA C. SGA D. LGA 2. A nurse is collecting data from a newborn and observes small white bumps noted on the bridge of the noise. The nurse should document this finding as A. Erythema toxicum B. Epstein’s pears. C. Mongolian spots. D. Milia spots 3. A nurse is assisting a registered nurse with the care of a newborn following a low forceps vaginal delivery. Five minutes after birth, the newborn’s heart rate is 110 beats/min. Which of the following Apgar heart rate scores should the newborn receive? A. 0 B. 1 C. 2 D. 3 4. A nurse is checking the reflexes of a newborn. Which of the following should the nurse perform to elicit the startle reflex? A. Hold the newborn in a semi-sitting position, then allow the newborn’s head and trunk to fall backward. B. Make a loud noise such as clapping hands together over the newborn’s crib. C. Stimulate the pads of the newborn’s hands with a stroking touch. D. Stimulate the soles of the newborn’s feet on the outer lateral surface of each foot. 5. A nurse is assisting with the admission of a newborn to the nursery. Which of the following findings indicate that a newborn is experiencing difficulty adapting to extrauterine life? (Select all that apply.) _X_Grunting _X_Retractions _X_Nasal flaring ___Apnea for 10 sec periods ___Respiratory rate 55/min 6. A nurse is preparing to bathe a newborn and notices a bluish marking across the newborn’s lower back. Which of the following is the significance of the finding? A. The mark is frequently seen in dark-skinned newborns. B. The mark is abnormal and may indicate hyperbilirubinemia. C. The mark may be a forceps mark from an operative delivery. D. The mark is a sign of prolonged birth or trauma during delivery. 1 This study source was downloaded by 100000809642371 from CourseHero.com on 04-22-2022 20:51:02 GMT -05:00 https://www.coursehero.com/file/113287677/Unit-4-Study-Guidedocx/ Define Vocabulary Acrocyanosis: Cyanosis of the extremities Erythema Toxicum: Innocuous pink popular rash of unknown cause with superimposed vesicles; it appears within 24-48 hours after birth and resolves spontaneously within a few days Kernicterus: The yellow staining and degenerative lesions in basal ganglia associated with high levels of unconjugated bilirubin in newborns Molding: Shaping of the fetal head by overlapping of the cranial bones to facilitate movement through the birth canal during labor Physiologic Jaundice: A harmless condition caused by the normal reduction of red blood cells, occurring 48 or more hours after birth, peaking at the 5th or 7th day, and disappearing between the 7th and 10th day Gestational Age Assessment: Systems used to evaluate the newborn’s external physical characteristics and neurologic and/or neuromuscular development to accurately determine gestational age. These replace or supplement the traditional calculation from the women’s last menstrual period Vernix: A protective, cheeselike, whitish substance made up of sebum and desquamated epithelial cells that is present on the fetal skin Caput Succedaneum: Swelling or edema occurring in or under the fetal scalp during labor Fontanels: In the fetus, unossified space, or soft spot, consisting of a strong band of connective tissue lying between the cranial bones of the skull Lanugo: Fine, downy hair found on all body parts of the fetus, with the exception of the palms of the hands and the soles of the feet, after 20 weeks’ gestation Mongolian Spots: Flat, gray-blue in color, and can be small or large. They are caused by some pigment that didn’t make it to the top layer when the baby’s skin was being formed Respiratory Retractions: When the area between the ribs and in the neck skinks in when a person attempts to inhale Habituation: Infant’s ability to diminish innate responses to specific repeated stimuli Telangiectatic Nevi: Small clusters of pink-red spots appearing on the nape of the neck and around the eyes of newborns localized areas of capillary dilation Cephalohematoma: Subcutaneous swelling containing blood found on the head of a neonate several days after birth; it usually disappears within a few weeks to 2 months Gestational Age: Describes how far along the pregnancy; measured in weeks, from the first day of the woman’s last menstrual cycle to the current date Meconium Ileus: Bowel obstruction that occurs when the meconium in the child’s intestine is even thicker and thicker than normal, creating a blockage in part of the small intestines Petechiae: Pinpoint red lesions Serum Bilirubin: amount of bilirubin found in blood Orientation: Infants ability to respond to auditory and visual stimuli in the environment Circumcision: Surgical removal of the prepuce/foreskin of the penis Hypothermia: Body loses heat faster than it can produce heat Milia: Tiny white papules appearing on the face of a neonate as a result of unopened sebaceous glands; they disappear spontaneously within a few weeks Phototherapy: The treatment of jaundice by exposure to light Surfactant: A surface-active moisture of lipoproteins secreted in the alveoli and air passages that reduce surface tension of pulmonary fluids and contributes to the elasticity of pulmonary tissue Periods of Reactivity: Predictable patterns of neonate behavior during the first several hours after birth 2 This study source was downloaded by 100000809642371 from CourseHero.com on 04-22-2022 20:51:02 GMT -05:00 https://www.coursehero.com/file/113287677/Unit-4-Study-Guidedocx/ Powered by TCPDF (www.tcpdf.org)
