ATI RN
Nursing Care of the Newborn Questions
Question 1 of 5
The postpartum nurse notices that a new mother has her neonate unwrapped and undressed 'to check out the baby.' For which reason does the nurse conclude the neonate is at risk for cold stress?
Correct Answer: D
Rationale: The correct answer is D because cool and clammy skin is a sign of cold stress in neonates. When a neonate's skin is cool and clammy, it indicates that the baby is losing body heat and struggling to maintain a stable body temperature. Cold stress can lead to complications such as hypothermia and respiratory distress. A: Increased metabolic rate would actually help generate heat to combat cold stress. B: Respiratory rate dropping is not necessarily indicative of cold stress and may be a normal response to being undressed. C: Moving extremities about is a normal behavior and not necessarily a sign of cold stress.
Question 2 of 5
The nurse is providing care for a neonate during the fourth stage of labor. Which action does the nurse take during this stage?
Correct Answer: A
Rationale: The correct answer is A: Dry the neonate immediately. This is crucial during the fourth stage of labor to prevent hypothermia in the neonate. Drying the neonate helps maintain body temperature and reduce heat loss. Choice B is incorrect because a complete neonate assessment should be done within the first 1-2 minutes, not within 1 hour. Choice C is incorrect as obtaining neonate blood glucose levels is not typically done during the immediate post-birth period unless indicated. Choice D is incorrect as Apgar screening is typically done at 1 and 5 minutes after birth, not until the scores are 7.
Question 3 of 5
Postnatal nurses expressed concern about neonatal pain management during painful interventions. Using evidence-based practice from research performed by Thakkar, Arora, Das, Javadekar, and Panigrahi (2016), which method of pain control will be used for heel sticks?
Correct Answer: C
Rationale: The correct answer is C, a combination of stimulated sucking and receiving sucrose orally. Thakkar et al. (2016) found that this method effectively reduced pain response during heel sticks in neonates. Stimulated sucking triggers the release of endorphins, providing natural pain relief, while sucrose activates sweet taste receptors, further reducing pain perception. This dual approach addresses both physiological and psychological aspects of pain management in neonates. Choice A (anesthetic gel) may not be as effective for heel sticks as it takes time to work and may not provide comprehensive pain relief. Choice B (breastfeeding) may distract the neonate but does not directly address pain management. Choice D (en face positioning) may promote bonding but does not offer a specific pain management strategy. Overall, choice C is supported by research and provides a holistic approach to neonatal pain control during heel sticks.
Question 4 of 5
The nurse is explaining to the new breastfeeding mother the types of neonatal stools the mother can expect. Which examples does the nurse provide? Select all that apply.
Correct Answer: D
Rationale: The correct answer is D because in the early days after birth, newborn stools transition from meconium to a yellow, seedy consistency with a sour odor. This is known as transitional stool. Residual meconium is not passed as loose watery stool (A) but as a sticky, tar-like substance. Sticky, thick, black stools do not necessarily indicate blood (B) but could be meconium. Stools do not become drier and more formed (C) until later in the infant's life.
Question 5 of 5
In which condition is breastfeeding contraindicated?
Correct Answer: C
Rationale: The correct answer is C: Human immunodeficiency virus infection. Breastfeeding is contraindicated in this condition due to the risk of vertical transmission of the virus to the infant through breast milk. HIV can be present in breast milk, increasing the risk of infection to the baby. This is supported by guidelines from organizations such as WHO. Choices A, B, and D are incorrect: A: Triplet birth is not a contraindication for breastfeeding; it may require additional support but is not a direct contraindication. B: Flat or inverted nipples may pose initial challenges but can be addressed with proper latch techniques or the use of aids like nipple shields. D: Inactive, previously treated tuberculosis does not contraindicate breastfeeding as long as the mother has completed treatment and is not actively infectious.