Chapter 27 Physiologic Responses of the Newborn to Birth My Nursing Test Banks

Olds Maternal-Newborn Nursing and Womens Health, 10e (Davidson)

Chapter 27 Physiologic Responses of the Newborn to Birth

1) The nurse is caring for a newborn 30 minutes after birth. After assessing respiratory function, the nurse would report which findings as abnormal?

Note: Credit will be given only if all correct and no incorrect choices are selected.

Select all that apply.

1. Respiratory rate of 66 breaths per minute

2. Periodic breathing with pauses of 25 seconds

3. Synchronous chest and abdomen movements

4. Grunting on expiration

5. Nasal flaring

Answer: 2, 4, 5

Explanation: 2. Periodic breathing with pauses longer than 20 seconds (apnea) is an abnormal finding that should be reported to the physician.

4. Grunting on expiration is an abnormal finding that should be reported to the physician.

5. Nasal flaring is an abnormal finding that should be reported to the physician.

Page Ref: 654, 655

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: V. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | AACN Essentials Competencies: IX. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1 Summarize the cardiopulmonary changes that must occur for the newborn to successfully transition to extrauterine life.

MNL LO: 4.1.1 Explain cardiopulmonary changes that occur during transition from intrauterine to extrauterine life.

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2) A 2-day-old newborn is asleep, and the nurse assesses the apical pulse to be 88 beats/min. What would be the most appropriate nursing action based on this assessment finding?

1. Call the physician.

2. Administer oxygen.

3. Document the finding.

4. Place the newborn under the radiant warmer.

Answer: 3

Explanation: 3. An apical pulse rate of 88 beats/min is within the normal range of a sleeping full-term newborn. The average resting heart rate in the first week of life is 110 to 160 beats/min in a healthy full-term newborn but may vary significantly during deep sleep or active awake states. In full-term newborns, the heart rate may drop to a low of 80 to 100 beats/min during deep sleep.

Page Ref: 655

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: V. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | AACN Essentials Competencies: IX. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1 Summarize the cardiopulmonary changes that must occur for the newborn to successfully transition to extrauterine life.

MNL LO: 4.1.1 Explain cardiopulmonary changes that occur during transition from intrauterine to extrauterine life.

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3) The nurse is assessing a newborn at 1 hour of age. Which finding requires an immediate intervention?

1. Respiratory rate 60 and irregular in depth and rhythm

2. Pulse rate 145, cardiac murmur heard

3. Mean blood pressure 55 mm Hg

4. Pauses in respiration lasting 30 seconds

Answer: 4

Explanation: 4. Pauses in respirations greater than 20 seconds are considered episodes of apnea, and require further intervention.

Page Ref: 654

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: V. B. 4. Communicate observations or concerns related to hazards and errors to patients, families, and the health care team. | AACN Essentials Competencies: IX. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1 Summarize the cardiopulmonary changes that must occur for the newborn to successfully transition to extrauterine life.

MNL LO: 4.1.1 Explain cardiopulmonary changes that occur during transition from intrauterine to extrauterine life.

4) The nurse has assessed four newborns respiratory rates immediately following birth. Which respiratory rate would require further assessment by the nurse?

1. 60 breaths per minute

2. 70 breaths per minute

3. 64 breaths per minute

4. 20 breaths per minute

Answer: 4

Explanation: 4. If respirations drop below 20 when the baby is at rest the primary care provider should be notified.

Page Ref: 655

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: V. B. 4. Communicate observations or concerns related to hazards and errors to patients, families, and the health care team. | AACN Essentials Competencies: IX. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management, and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings. | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1 Summarize the cardiopulmonary changes that must occur for the newborn to suc

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cessfully transition to extrauterine life.

MNL LO: 4.1.1 Explain cardiopulmonary changes that occur during transition from intrauterine to extrauterine life.

5) Marked changes occur in the cardiopulmonary system at birth include which of the following?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Closure of the foramen ovale

2. Closure of the ductus venosus

3. Mean blood pressure of 31 to 61 mmHg in full-term resting newborns

4. Increased systemic vascular resistance and decreased pulmonary vascular resistance

5. Opening of the ductus arteriosus

Answer: 1, 2, 4

Explanation: 1. Closure of the foramen ovale is a function of changing arterial pressures.

2. Closure of the ductus venosus is related to mechanical pressure changes that result from severing the cord, redistribution of blood, and cardiac output.

4. Increased systemic vascular resistance and decreased pulmonary vascular resistance; with the loss of the low-resistance placenta, systemic vascular resistance increases, resulting in greater systemic pressure. The combination of vasodilation and increased pulmonary blood flow decreases pulmonary vascular resistance.

Page Ref: 652, 653

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | AACN Essentials Competencies: IX. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | NLN Competencies: Context and Environment: Apply professional standards; show accountability for nursing judgment and actions; develop advocacy skills. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1 Summarize the cardiopulmonary changes that must occur for the newborn to successfully transition to extrauterine life.

MNL LO: 4.1.1 Explain cardiopulmonary changes that occur during transition from intrauterine to extrauterine life.

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6) The pediatric clinic nurse is reviewing lab results with a 2-month-old infants mother. The infants hemoglobin has decreased since birth. Which statement by the mother indicates the need for additional teaching?

1. My baby isnt getting enough iron from my breast milk.

2. Babies undergo physiologic anemia of infancy.

3. This results from dilution because of the increased plasma volume.

4. Delaying the cord clamping did not cause this to happen.

Answer: 1

Explanation: 1. At 2 months of age, infants increase their plasma volume, which results in physiologic anemia. This condition is not related to iron in the breast milk.

Page Ref: 656

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 2 Explain the differences in fetal and adult hemoglobin and why this is important in transition to extrauterine life.

MNL LO: 4.1.1 Explain cardiopulmonary changes that occur during transition from intrauterine to extrauterine life.

7) Which of the following is a benefit of delayed umbilical cord clamping for the preterm infant?

1. Fewer infants require blood transfusion for anemia

2. Fewer infants require blood transfusion for high blood pressure

3. Increase in the incidence of intraventricular hemorrhage

4. Increase in incidence of infant breastfeeding

Answer: 1

Explanation: 1. Clinical trials in preterm infants found that delaying umbilical cord clamping was associated with fewer infants who required blood transfusion for anemia.

Page Ref: 657

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | AACN Essentials Competencies: I. 3. Use skills of inquiry, analysis, and information literacy to address practice issues. | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 2 Explain the differences in fetal and adult hemoglobin and why this is important in transition to extrauterine life.

MNL LO: 4.1.1 Explain cardiopulmonary changes that occur during transition from intrauterine to

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extrauterine life.

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8) In utero, what is the organ responsible for gas exchange?

1. Umbilical vein

2. Placenta

3. Inferior vena cava

4. Right atrium

Answer: 2

Explanation: 2. In utero, the placenta is the organ of gas exchange.

Page Ref: 651

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | AACN Essentials Competencies: I. 3. Use skills of inquiry, analysis, and information literacy to address practice issues. | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 1 Summarize the cardiopulmonary changes that must occur for the newborn to successfully transition to extrauterine life.

MNL LO: 4.1.1 Explain cardiopulmonary changes that occur during transition from intrauterine to extrauterine life.

7

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9) A postpartum mother questions whether the environmental temperature should be warmer in the babys room at home. The nurse responds that the environmental temperature should be warmer for the newborn. This response is based on which newborn characteristics that affect the establishment of thermal stability?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Newborns have less subcutaneous fat than do adults.

2. Infants have a thick epidermis layer.

3. Newborns have a large body surface to weight ratio.

4. Infants have increased total body water.

5. Newborns have more subcutaneous fat than do adults.

Answer: 1, 3, 4

Explanation: 1. Heat transfer from neonatal organs to skin surface is increased compared to adults due to the neonates decreased subcutaneous fat.

3. Heat transfer from neonatal organs to skin surface is increased compared to adults due to the neonates large body surface to weight ratio.

4. Preterm infants have increased heat loss via evaporation due to increased total body water.

Page Ref: 657

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 3 Discuss the process of thermogenesis and the major mechanisms of heat loss in the newborn period.

MNL LO: 4.1.2 Describe thermoregulation in the newborn after birth.

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10) The nurse is teaching new parents how to dress their newborn. Which statements indicate that teaching has been effective?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. We should keep our home air-conditioned so the baby doesnt overheat.

2. It is important that we dry the baby off as soon as we give him a bath or shampoo his hair.

3. When we change the babys diaper, we should change any wet clothing or blankets, too.

4. If the babys body temperature gets too low, he will warm himself up without any shivering.

5. Our baby will have a much faster rate of breathing if he is not dressed warmly enough.

Answer: 2, 3, 4, 5

Explanation: 2. The newborn is particularly prone to heat loss by evaporation immediately after birth and during baths; thus drying the newborn is critical.

3. Changing wet clothing or blankets immediately prevents evaporation, one mechanism of heat loss.

4. Nonshivering thermogenesis (NST), an important mechanism of heat production unique to the newborn, is the major mechanism through which heat is produced.

5. A decrease in the environmental temperature of 2C is a drop sufficient to double the oxygen consumption of a term newborn and can cause the newborn to show signs of respiratory distress.

Page Ref: 658, 659

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 3 Discuss the process of thermogenesis and the major mechanisms of heat loss in the newborn period.

MNL LO: 4.1.2 Describe thermoregulation in the newborn after birth.

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11) The nurse is planning care for a newborn. Which nursing intervention would best protect the newborn from the most common form of heat loss?

1. Placing the newborn away from air currents

2. Pre-warming the examination table

3. Drying the newborn thoroughly

4. Removing wet linens from the isolette

Answer: 3

Explanation: 3. The most common form of heat loss is evaporation. The newborn is particularly prone to heat loss by evaporation immediately after birth (when the baby is wet with amniotic fluid) and during baths; thus drying the newborn is critical.

Page Ref: 658

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: V. B. 2. Demonstrate effective use of strategies to reduce risk of harm to self or others. | AACN Essentials Competencies: IX. 12. Create a safe environment that results in high quality patient outcomes. | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 3 Discuss the process of thermogenesis and the major mechanisms of heat loss in the newborn period.

MNL LO: 4.1.2 Describe thermoregulation in the newborn after birth.

12) The nurse is planning an educational presentation on hyperbilirubinemia for nursery nurses. Which statement is most important to include in the presentation?

1. Conjugated bilirubin is eliminated in the conjugated state.

2. Unconjugated bilirubin is neurotoxic, and cannot cross the placenta.

3. Total bilirubin is the sum of the direct and indirect levels.

4. Hyperbilirubinemia is a decreased total serum bilirubin level.

Answer: 3

Explanation: 3. Total serum bilirubin is the sum of conjugated (direct) and unconjugated (indirect) bilirubin.

Page Ref: 659

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 4 Discuss the reasons a newborn may develop hyperbilirubinemia and the nursing interventions that can decrease the probability or the severity of jaundice.

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13) A telephone triage nurse gets a call from a postpartum client who is concerned about jaundice. The clients newborn is 37 hours old. What data point should the nurse gather first?

1. Stool characteristics

2. Fluid intake

3. Skin color

4. Bilirubin level

Answer: 3

Explanation: 3. Jaundice (icterus) is the yellowish coloration of the skin and sclera caused by the presence of bilirubin in elevated concentrations. Inspection of the skin would be the first step in assessing for jaundice.

Page Ref: 660

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: V. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | AACN Essentials Competencies: IX. 12. Create a safe environment that results in high quality patient outcomes. | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4 Discuss the reasons a newborn may develop hyperbilirubinemia and the nursing interventions that can decrease the probability or the severity of jaundice.

14) The mother of a 3-day-old infant calls the clinic and reports that her babys skin is turning slightly yellow. What should the nurse explain to the mother?

1. Physiologic jaundice is normal, and peaks at this age.

2. The newborns liver is not working as well as it should.

3. The baby is yellow because the bowels are not excreting bilirubin.

4. The yellow color indicates that brain damage might be occurring.

Answer: 1

Explanation: 1. Physiologic jaundice occurs soon after birth. Bilirubin levels peak at 3 to 5 days in term infants.

Page Ref: 660

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4 Discuss the reasons a newborn may develop hyperbilirubinemia and the nursing interventions that can decrease the probability or the severity of jaundice.

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15) A newborn is determined to have physiological jaundice. The nurse explains the steps involved in conjugation and excretion of bilirubin to the parents. Which factors would the nurse include in the explanation?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. At birth, the newborns liver begins to conjugate bilirubin or convert it from a yellow lipid-soluble pigment to a water-soluble pigment.

2. Unconjugated bilirubin can leave the bloodstream and enter the tissues, causing a yellow hue to the skin and sclera.

3. Unconjugated bilirubin results from the destruction of white blood cells.

4. The infant is able to excrete conjugated bilirubin, but not unconjugated bilirubin.

5. The newborns liver has greater metabolic and enzymatic activity at birth than does an adult liver, increasing the newborns susceptibility to jaundice.

Answer: 1, 2, 4

Explanation: 1. Conjugation, or the changing of bilirubin into an excretable form, is the conversion of the yellow lipid-soluble pigment (unconjugated, indirect) into water-soluble pigment (excretable, direct).

2. Jaundice (icterus) is the yellowish coloration of the skin and sclera caused by the presence of bilirubin in elevated concentrations.

4. Unconjugated bilirubin is fat soluble, has a propensity for fatty tissues, is not in an excretable form, and is a potential toxin.

Page Ref: 659, 660

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4 Discuss the reasons a newborn may develop hyperbilirubinemia and the nursing interventions that can decrease the probability or the severity of jaundice.

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16) The visiting nurse evaluates a 2-day-old breastfed newborn at home and notes that the baby appears jaundiced. When explaining jaundice to the parents, what would the nurse tell them?

1. Jaundice is uncommon in newborns.

2. Some newborns require phototherapy.

3. Jaundice is a medical emergency.

4. Jaundice is always a sign of liver disease.

Answer: 2

Explanation: 2. Physiologic jaundice is a normal process that can occur after 24 hours of life in about half of healthy newborns. It is not a sign of liver disease. Physiologic jaundice might require phototherapy.

Page Ref: 657, 660

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4 Discuss the reasons a newborn may develop hyperbilirubinemia and the nursing interventions that can decrease the probability or the severity of jaundice.

17) Which of the following would be a newborn care procedure that will decrease the probability of high bilirubin levels?

1. Monitor urine for amount and characteristics.

2. Encourage late feedings to promote intestinal elimination.

3. All infants should be routinely monitored for iron intake.

4. Maintain the newborns skin temperature at 36.5C (97.8F) or above.

Answer: 4

Explanation: 4. Maintain the newborns skin temperature at 36.5C (97.8F) or above; cold stress results in acidosis.

Page Ref: 661

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: V. B. 2. Demonstrate effective use of strategies to reduce risk of harm to self or others. | AACN Essentials Competencies: IX. 12. Create a safe environment that results in high quality patient outcomes. | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4 Discuss the reasons a newborn may develop hyperbilirubinemia and the nursing interventions that can decrease the probability or the severity of jaundice.

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18) Clinical risk factors for severe hyperbilirubinemia include which of the following?

Note: Credit will be given only if all correct and no incorrect choices are selected.

Select all that apply.

1. African American ethnicity

2. Female gender

3. Cephalohematoma

4. Bruising

5. Assisted delivery with vacuum or forceps

Answer: 3, 4, 5

Explanation: 3. A clinical risk factor for severe hyperbilirubinemia includes cephalohematoma.

4. A clinical risk factor for severe hyperbilirubinemia includes bruising.

5. A clinical risk factor for severe hyperbilirubinemia includes assisted delivery with vacuum or forceps.

Page Ref: 661

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I. B. 1. Elicit patient values, preferences, and expressed needs as part of clinical interview, implementation of care plan, and evaluation of care. | AACN Essentials Competencies: IX. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4 Discuss the reasons a newborn may develop hyperbilirubinemia and the nursing interventions that can decrease the probability or the severity of jaundice.

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Copyright 2016 Pearson Education, Inc.

19) The home care nurse is examining a 3-day-old infant. The childs skin on the sternum is yellow when blanched with a finger. The parents ask the nurse why jaundice occurs. What is the best response from the nurse?

1. The liver of an infant is not fully mature, and doesnt conjugate the bilirubin for excretion.

2. The infant received too many red blood cells after delivery because the cord was not clamped immediately.

3. The yellow color of your babys skin indicates that you are breastfeeding too often.

4. This is an abnormal finding related to your babys bowels not excreting bilirubin as they should.

Answer: 1

Explanation: 1. Physiologic jaundice is a common occurrence, and peaks at 3 to 5 days in term infants. The reduction in hepatic activity, along with a relatively large bilirubin load, decreases the livers ability to conjugate bilirubin and increases susceptibility to jaundice.

Page Ref: 660

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4 Discuss the reasons a newborn may develop hyperbilirubinemia and the nursing interventions that can decrease the probability or the severity of jaundice.

20) Which of the following is the primary carbohydrate in the breastfeeding newborn?

1. Glucose

2. Fructose

3. Lactose

4. Maltose

Answer: 3

Explanation: 3. Lactose is the primary carbohydrate in the breastfeeding newborn and is generally easily digested and well absorbed.

Page Ref: 662

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | AACN Essentials Competencies: I. 3. Use skills of inquiry, analysis, and information literacy to address practice issues. | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and excellence in nursing. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 5 Delineate the functional abilities of the newborns gastrointestinal tract and liver.

MNL LO: 4.1.3 Discuss extrauterine gastrointestinal and genitourinary changes at birth.

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21) At birth, an infant weighed 6 pounds 12 ounces. Three days later, he weighs 5 pounds 2 ounces. What conclusion should the nurse draw regarding this newborns weight?

1. This weight loss is excessive.

2. This weight loss is within normal limits.

3. This weight gain is excessive.

4. This weight gain is within normal limits.

Answer: 1

Explanation: 1. This newborn has lost more than 10% of the birth weight; this weight loss is excessive. Following birth, caloric intake is often insufficient for weight gain until the newborn is 5 to 10 days old. During this time there may be a weight loss of 5% to 10% in term newborns.

Page Ref: 662

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: V. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | AACN Essentials Competencies: IX. 12. Create a safe environment that results in high quality patient outcomes. | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 5 Delineate the functional abilities of the newborns gastrointestinal tract and liver.

MNL LO: 4.1.3 Discuss extrauterine gastrointestinal and genitourinary changes at birth.

22) A new grandfather is marveling over his 12-hour-old newborn grandson. Which statement indicates that the grandfather needs additional education?

1. I cant believe he can already digest fats, carbohydrates, and proteins.

2. It is amazing that his whole digestive tract can move things along at birth.

3. Incredibly, his stomach capacity was already a cupful when he was born.

4. He will lose some weight but then miraculously regain it by about 10 days.

Answer: 3

Explanation: 3. The newborns stomach has a capacity of 22 mL to 27 mL by day 3 of life.

Page Ref: 662

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 5 Delineate the functional abilities of the newborns gastrointestinal tract and liver.

MNL LO: 4.1.3 Discuss extrauterine gastrointestinal and genitourinary changes at birth.

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23) A postpartum client calls the nursery to report that her 3-day-old newborn has passed a green stool. What is the nurses best response?

1. Take your newborn to the pediatrician.

2. There might be a possible food allergy.

3. Your newborn has diarrhea.

4. This is a normal occurrence.

Answer: 4

Explanation: 4. The newborns stools change from meconium (thick, tarry, black) to transitional stools (thinner, brown to green).

Page Ref: 667

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5 Delineate the functional abilities of the newborns gastrointestinal tract and liver.

MNL LO: 4.1.3 Discuss extrauterine gastrointestinal and genitourinary changes at birth.

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Copyright 2016 Pearson Education, Inc.

24) A newborn who has not voided by 48 hours after birth should be assessed for which of the following?

Note: Credit will be given only if all correct and no incorrect choices are selected.

Select all that apply.

1. Restlessness

2. Pain

3. Kidney distention

4. Adequacy of fluid intake

5. Lethargy

Answer: 1, 2, 4

Explanation: 1. A newborn who has not voided by 48 hours after birth should be assessed for restlessness.

2. A newborn who has not voided by 48 hours after birth should be assessed for pain.

4. A newborn who has not voided by 48 hours after birth should be assessed for adequacy of fluid intake.

Page Ref: 663

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: V. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | AACN Essentials Competencies: IX. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 6 Relate the development of the newborn kidney to the newborns ability to maintain adequate fluid and electrolyte balance.

MNL LO: 4.1.3 Discuss extrauterine gastrointestinal and genitourinary changes at birth.

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25) The parents of a newborn are receiving discharge teaching. The nurse explains that the infant should have several wet diapers per day. Which statement by the parents indicates that further education is necessary?

1. Our baby was born with kidneys that are too small.

2. A babys kidneys dont concentrate urine well for several months.

3. Feeding our baby frequently will help the kidneys function.

4. Kidney function in an infant is very different from that in an adult.

Answer: 1

Explanation: 1. Size of the kidneys is rarely an issue.

Page Ref: 663

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 6 Relate the development of the newborn kidney to the newborns ability to maintain adequate fluid and electrolyte balance.

MNL LO: 4.1.3 Discuss extrauterine gastrointestinal and genitourinary changes at birth.

26) The student nurse notices that a newborn weighs less today compared with the newborns birth weight three days ago. The nursing instructor explains that newborns lose weight following birth due to which of the following?

1. A shift of intracellular water to extracellular spaces.

2. Loss of meconium stool.

3. A shift of extracellular water to intracellular spaces.

4. The sleep-wake cycle.

Answer: 1

Explanation: 1. A shift of intracellular water to extracellular space and insensible water loss account for the 5% to 10% weight loss.

Page Ref: 662

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | AACN Essentials Competencies: IX. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 5 Delineate the functional abilities of the newborns gastrointestinal tract and liver.

MNL LO: 4.1.3 Discuss extrauterine gastrointestinal and genitourinary changes at birth.

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Copyright 2016 Pearson Education, Inc.

27) Which of the following would be considered normal newborn urinalysis values?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Color bright yellow

2. Bacteria 0

3. Red blood cells (RBC) 0

4. White blood cells (WBC) more than 4-5/hpf

5. Protein less than 5-10 mg/dL

Answer: 2, 3, 5

Explanation: 2. Bacteria value should be 0.

3. Red blood cells (RBC) should be 0.

5. Protein less than 5-10 mg/dL would be considered normal.

Page Ref: 663

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | AACN Essentials Competencies: I. 3. Use skills of inquiry, analysis, and information literacy to address practice issues. | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 6 Relate the development of the newborn kidney to the newborns ability to maintain adequate fluid and electrolyte balance.

MNL LO: 4.1.3 Discuss extrauterine gastrointestinal and genitourinary changes at birth.

28) The mother of a 2-day-old male has been informed that her child has sepsis. The mother is distraught and says, I should have known that something was wrong. Why didnt I see that he was so sick? What is the nurses best reply?

1. Newborns have immature immune function at birth, and illness is very hard to detect.

2. Your mothering skills will improve with time. You should take the newborn class.

3. Your baby didnt get enough active acquired immunity from you during the pregnancy.

4. The immunity your baby gets in utero doesnt start to function until he is 4 to 8 weeks old.

Answer: 1

Explanation: 1. The immune responses in neonates are usually functionally impaired when compared with adults.

Page Ref: 663

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

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Copyright 2016 Pearson Education, Inc.

Learning Outcome: 7 Describe basic newborn immunologic responses.

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Copyright 2016 Pearson Education, Inc.

29) Which nonspecific immune mechanism has the ability of antibodies and phagocytic cells to clear pathogens from an organism?

1. Complement

2. Coagulation

3. Inflammatory response

4. Phagocytosis

Answer: 1

Explanation: 1. Complement helps or complements the ability of antibodies and phagocytic cells to clear pathogens from an organism.

Page Ref: 664

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | AACN Essentials Competencies: I. Use skills of inquiry, analysis, and information literacy to address practice issues. | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 7 Describe basic newborn immunologic responses.

30) Specific cellular immunity is mediated by T lymphocytes, which enhance the efficiency of the phagocytic response. What do cytotoxic activated T cells do?

1. Enable T or B cells to respond to antigens

2. Repress responses to specific B or T lymphocytes to antigens

3. Kill foreign or virus-infected cells

4. Remove pathogens and cell debris

Answer: 3

Explanation: 3. Cytotoxic activated T cells kill foreign or virus-infected cells.

Page Ref: 664

Cognitive Level: Remembering

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | AACN Essentials Competencies: I. 3. Use skills of inquiry, analysis, and information literacy to address practice issues. | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 7 Describe basic newborn immunologic responses.

22

Copyright 2016 Pearson Education, Inc.

31) The student nurse notices that the newborn seems to focus on the mothers eyes. The nursing instructor explains that this newborn behavior is which of the following?

1. Habituation

2. Orientation

3. Self-quieting

4. Reactivity

Answer: 2

Explanation: 2. Orientation is the newborns ability to be alert to, to follow, and to fixate on complex visual stimuli that have a particular appeal and attraction. The newborn prefers the human face and eyes, and bright shiny objects.

Page Ref: 666

Cognitive Level: Understanding

Client Need/Sub: Psychosocial Integrity: Family Dynamics

Standards: QSEN Competencies: I. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | AACN Essentials Competencies: IX. 12. Create a safe environment that results in high quality patient outcomes. | NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe patient care. | Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 8 Explain the physiologic and behavioral characteristics of newborn neurologic functioning, patterns of behavior during the periods of reactivity, and possible nursing interventions.

MNL LO: 4.1.4 Explain neurologic adaptations to birth.

32) A new father asks the nurse to describe what his baby will experience while sleeping and awake. What is the best response?

1. Babies have several sleep and alert states. Keep watching and youll notice them.

2. You might have noticed that your child was in an alert awake state for an hour after birth.

3. Newborns have two stages of sleep: deep or quiet sleep and rapid eye movement sleep.

4. Birth is hard work for babies. It takes them a week or two to recover and become more awake.

Answer: 3

Explanation: 3. Teaching the parents how to recognize the two sleep stages helps them tune in to their infants behavioral states.

Page Ref: 665

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 8 Explain the physiologic and behavioral characteristics of newborn neurologic functioning, patterns of behavior during the periods of reactivity, and possible nursing interventions.

MNL LO: 4.1.4 Explain neurologic adaptations to birth.

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Copyright 2016 Pearson Education, Inc.

33) A new mother is holding her 2-hour-old son. The delivery occurred on the due date. His Apgar score was 9 at both 1 and 5 minutes. The mother asks the nurse why her son was so wide awake right after birth, and now is sleeping so soundly. What is the nurses best response?

1. Dont worry. Babies go through a lot of these little phases.

2. Your son is in the sleep phase. Hell wake up soon.

3. Your son is exhausted from being born, and will sleep 6 more hours.

4. Your breastfeeding efforts have caused excessive fatigue in your son.

Answer: 2

Explanation: 2. The first period of reactivity lasts approximately 30 minutes after birth. During this period the newborn is awake and active and may appear hungry and have a strong sucking reflex. After approximately half an hour, the newborns activity gradually diminishes, and the heart rate and respirations decrease as the newborn enters the sleep phase. The sleep phase may last from a few minutes to 2 to 4 hours.

Page Ref: 665

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 8 Explain the physiologic and behavioral characteristics of newborn neurologic functioning, patterns of behavior during the periods of reactivity, and possible nursing interventions.

MNL LO: 4.1.4 Explain neurologic adaptations to birth.

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Copyright 2016 Pearson Education, Inc.

34) The nurse is teaching a newborn care class to parents who are about to give birth to their first babies. Which statement by a parent indicates that teaching was effective?

1. My baby will be able to focus on my face when she is about a month old.

2. My baby might startle a little if a loud noise happens near him.

3. Newborns prefer sour tastes.

4. Our baby wont have a sense of smell until she is older.

Answer: 2

Explanation: 2. Swaddling, placing a hand on the abdomen, or holding the arms to prevent a startle reflex are other ways to soothe the newborn. The settled newborn is then able to attend to and interact with the environment.

Page Ref: 667

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 9 Describe the normal sensory/perceptual abilities and behavioral states present in the newborn period and the associated nursing care.

MNL LO: 4.1.4 Explain neurologic adaptations to birth.

35) The nurse is teaching a group of new parents about newborn behavior. Which statement made by a parent would indicate a need for additional information?

1. Sleep and alert states cycle throughout the day.

2. We can best bond with our child during an alert state.

3. About half of the babys sleep time is in active sleep.

4. Babies sleep during the night right from birth.

Answer: 4

Explanation: 4. Over time, the newborns sleep-wake patterns become diurnal, that is, the newborn sleeps at night and stays awake during the day.

Page Ref: 666

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 9 Describe the normal sensory/perceptual abilities and behavioral states present in the newborn period and the associated nursing care.

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Copyright 2016 Pearson Education, Inc.

MNL LO: 4.1.4 Explain neurologic adaptations to birth.

36) When providing anticipatory guidance to a new mother, what information does the nurse convey about the newborns neurologic and sensory/perceptual functioning?

Note: Credit will be given only if all correct and no incorrect choices are selected.

Select all that apply.

1. Newborns respond to and interact with the environment in a predictable pattern of behavior, reacting differently to a variety of stresses.

2. The usual position of the newborn is with extremities partially flexed, legs near the abdomen.

3. Newborns do not react to bright light, and their eye movements do not permit them to fixate on faces or objects until they are 3 months of age.

4. Newborns have the capacity to utilize self-quieting behaviors to quiet and comfort themselves.

5. The newborn is very sensitive to being touched, cuddled, and held.

Answer: 1, 2, 4, 5

Explanation: 1. Newborns respond to and interact with the environment in a predictable pattern of behavior that is shaped somewhat by their intrauterine experience.

2. Normal newborns are usually in a position of partially flexed extremities with the legs near the abdomen.

4. Self-quieting ability is the ability of newborns to use their own resources to quiet and comfort themselves.

5. The newborn is very sensitive to being touched, cuddled, and held; thus touch may be the most important of all of the senses for the newborn infant.

Page Ref: 664, 667

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: QSEN Competencies: I. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | AACN Essentials Competencies: IX. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | NLN Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 9 Describe the normal sensory/perceptual abilities and behavioral states present in the newborn period and the associated nursing care.

MNL LO: 4.1.4 Explain neurologic adaptations to birth.

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