The nurse is performing an admission newborn physical exam with the parents. The nurse
assesses the pinna of the newborn's ears to be equal with the outer canthus of the eye. The
nurse would explain this finding to the parents to be:
a)The expected normal position
b)Possible chromosomal abnormality
c)Facial lag due to birth position
d)Indicative of prematurity - Answers a)The expected normal position
A 24-day old infant is placed in an incubator under the phototherapy lights with an elevated
bilirubin level. The infant has eye and genital coverine in place. What is th expected nursing
action in this situation?
a)Administer intravenous fluids via pump per doctors' orders
b)Tightly swaddle in baby blankets to maintain a normal temperature c)Change the newborn's
position every two hours, to expose all body parts d)Give the newborn oral rehydration therapy
after all feedings - Answers c)Change the newborn's position every two hours, to expose all
body parts
The nurse has just assisted new parents with bathing of the newborn. The nurse explains to the
birth partner that the newborn must remain under the radiant warmer after the bath. Which
assessment data indicates that this is required:
a)A heart rate of 12
b)Temperature 99.6ºF
c)Temperature 96.8ºF
d)Respiratory rate 50 - Answers c)Temperature 96.8ºF
The nurse is providing discharge teaching to new parents. The nurse should instruct the parents
to notify the healthcare provider if which occurs? Select All That Apply
, a)More than one episode of forceful vomiting
b)6-10 wet diapers per day
c)A bluish discoloration fo the skin with or without a feeding
d)Refusal of two feedings in a row
e)Development of eye drainage - Answers a)More than one episode of forceful vomiting
c)A bluish discoloration fo the skin with or without a feeding
d)Refusal of two feedings in a row
e)Development of eye drainage
The nurse has performed a gestational age assessment of an infant and estimates the infant to
be approximately 32 weeks gestation. Which set of physical characteristics are most likely to be
found?
a)Lanugo mainly gone, little vernix across the body
b)Prominent clitoris enlarging minora, lanugo abundant
c)Full areola, 5 to 10mm bud, pinkish-brown in color
d)Skin is pale, has cracking especially at wrists and ankles, no vessels - Answers b)Prominent
clitoris enlarging minora, lanugo abundant
The mother of a four-day-old term infant call the pediatrician and reports that her baby's skin is
turing slightly yellow. The nurse should explain to the mother that:
a)The yellow color indicates that brain damage may be occurring b)Physiologic jaundice is
normal and peaks at this age
c)The newborn's liver is not working as well as it should
d)The baby is yellow because the bowels are not absorbing bilirubin - Answers b)Physiologic
jaundice is normal and peaks at this age
As the nurse you are doing discharge teaching for a primiparous birth parent, who delivered a
term, AGA (average gestational age) healthy newborn. The parent asks about infant feedings,
and how they will know if the infant is getting enough to eat. The parent is chestfeeding and
bottle feeding. The nurse would teach the normal newborn expectations are: Select All That