ATI RN
Nursing Care of the Newborn and Family Questions
Question 1 of 5
When assessing the newborn for the presence of lanugo, where should the nurse look for it?
Correct Answer: D
Rationale: In assessing a newborn for the presence of lanugo, it is important to look for it on the newborn's back between the scapulae (shoulder blades). Lanugo is the fine, soft, downy hair that covers the body of a newborn. This location is where lanugo is commonly found in newborns and is a normal part of their development in utero. The other options are incorrect because: A) Lanugo is not typically found on the newborn's face. While some newborns may have fine hair on their face, this is usually not referred to as lanugo. B) Lanugo is not typically found on the newborn's extremities. The presence of lanugo on the extremities is less common compared to the back area. C) Lanugo is not typically found on the newborn's back near their buttocks. While newborns may have some hair in this area, true lanugo is more commonly found between the shoulder blades. Understanding the typical locations of lanugo on a newborn's body is essential for nurses and healthcare providers in providing comprehensive care for newborns. Recognizing normal variations in newborn appearance can help healthcare professionals assess the newborn's overall health and development accurately.
Question 2 of 5
The nurse knows that during the organizational process, the newborn will be rated as exceptionally good if they do what? Select all that apply.
Correct Answer: A
Rationale: In the organizational process after birth, a newborn will be rated as exceptionally good if they remain alert. This is because newborns who are alert are more likely to be responsive, have better feeding behaviors, and establish early bonding with their caregivers, promoting overall well-being. Being alert also indicates neurological maturity and readiness for interaction with the environment. Option B, highly irritable newborns with mood swings, is incorrect because these behaviors are signs of distress or immaturity rather than exceptional organization. Option C, demonstrating self-soothing and quieting techniques, while important, may not always indicate exceptional organization as it can vary among newborns. Option D, shutting down body responses to stimuli when drowsy, is also incorrect as it may indicate low arousal levels or neurological immaturity rather than exceptional organization. Educationally, understanding these behaviors helps nurses in assessing newborns' well-being and providing appropriate care and support. It also emphasizes the importance of promoting optimal newborn behavior for early bonding and development.
Question 3 of 5
The nurse provides discharge instructions to a parent about umbilical cord care. What statement by the parent indicates effective health teaching?
Correct Answer: C
Rationale: In this scenario, option C is the correct response as it demonstrates an understanding of proper umbilical cord care. Using water and mild soap for cleaning when the stump is dirty is the recommended method by healthcare providers to prevent infection while allowing the cord to dry and fall off naturally. Option A is incorrect as tub baths should be avoided until the stump has completely healed to reduce the risk of infection. Option B is incorrect since cleaning the stump with antiseptics daily can be too harsh and may delay the natural healing process. Option D is also incorrect because applying antibiotic ointment daily is not necessary and can lead to antibiotic resistance. Educationally, this question emphasizes the importance of providing accurate and evidence-based discharge instructions to parents regarding newborn care. It highlights the significance of promoting natural healing processes and preventing unnecessary interventions that could potentially harm the newborn's health. It also underscores the role of nurses in educating parents on best practices for neonatal care to ensure optimal outcomes for newborns and families.
Question 4 of 5
A 24-hour-old newborn male was circumcised 20 minutes ago. The nurse is doing 15-minute checks of the circumcision site. It appears that the newborn has had a bowel movement as meconium is leaking from the diaper leg. He is not crying and has just soothed from the last diaper check. What should the nurse do?
Correct Answer: D
Rationale: In this scenario, option D is the correct choice for the nurse to follow. Changing the newborn's diaper immediately, cleaning the meconium using water (and soap if needed), and refraining from changing the circumcision dressing until the next scheduled check is important. This approach ensures that the circumcision site is kept clean without excessive disturbance to the newborn, as frequent changes can increase the risk of infection and disrupt the healing process. Option A is incorrect because waiting an additional 10 minutes could lead to prolonged exposure of the circumcision site to meconium, potentially increasing the risk of infection. Option B is also incorrect as using packaged wipes may be too harsh for the delicate newborn skin, and immediate changes regardless of the scheduled checks may cause unnecessary disturbance. Option C is not the best choice as changing the dressing at the circumcision site immediately after cleaning the meconium may introduce unnecessary handling and increase the risk of infection. It is essential to follow a gentle and systematic approach to newborn care, considering their delicate skin and healing processes. The educational context here emphasizes the importance of proper wound care, infection prevention, and maintenance of newborn comfort and well-being in clinical practice.
Question 5 of 5
Treatment of neonatal jaundice depends on what factors? Select all that apply.
Correct Answer: C
Rationale: In the context of neonatal jaundice, the correct answer is C) age and weight of the infant. This is because the treatment of neonatal jaundice is tailored based on the age and weight of the newborn. These factors are crucial in determining the appropriate course of action as they influence the metabolism and clearance of bilirubin in the infant's body. Option A) degree of jaundice and Option B) bilirubin level are important factors to consider in assessing the severity of neonatal jaundice, but they alone do not determine the treatment approach. The age and weight of the infant play a significant role in guiding healthcare providers to decide on the most suitable treatment, whether it be phototherapy, exchange transfusion, or other interventions based on the individual needs of the baby. Option D) when jaundice began is also relevant in diagnosing the cause of neonatal jaundice, but it may not directly dictate the treatment plan as much as the infant's age and weight do. Understanding these distinctions is vital for nurses caring for newborns as it ensures that the treatment provided is both effective and safe for the infant. Educationally, this question highlights the importance of considering multiple factors when managing neonatal jaundice. It underscores the need for healthcare professionals, especially nurses, to have a comprehensive understanding of neonatal physiology and the impact of various variables on treatment decisions to provide optimal care for newborns and their families.