Nursing Application Exercises

Questions and Answers

What Apgar score range indicates severe distress in a newborn?

7 to 10

1 to 5

4 to 6

0 to 3 (correct)

Which of the following describes the heart rate score of 1 in the Apgar scoring system?

Slow, less than 100/min (correct)

Absent

Normal, between 100-140/min

Greater than 100/min

For the reflex irritability parameter, what score would indicate a grimace response?

Score of 3

Score of 1 (correct)

Score of 0

Score of 2

What defines the optimal response for muscle tone in the Apgar scoring system?

Well-flexed Signup and view all the answers

Which Apgar score would indicate moderate difficulty in adjusting to extrauterine life?

4 to 6 Signup and view all the answers

What is the normal range for a newborn's weight according to the expected reference ranges?

2,500 to 4,000 g (5.5 to 8.8 lb) Signup and view all the answers

Which of the following statements about the New Ballard Score is accurate?

It assesses both neuromuscular and physical maturity. Signup and view all the answers

What classification is used for a newborn whose weight is below the 10th percentile?

Small for Gestational Age (SGA) Signup and view all the answers

During a gestational age assessment, which neuromuscular maturity assessment evaluates how far a neonate's heels can reach their ears?

Heel to Ear Signup and view all the answers

Which of the following is NOT a criterion used in the assessment of physical maturity in the New Ballard Score?

Heart Rate Signup and view all the answers

What is the expected range for head circumference in newborns?

32 to 36.8 cm (12.6 to 14.5 in) Signup and view all the answers

What is the normal respiratory rate for a newborn?

30-60 breaths/min Signup and view all the answers

Which of the following is true regarding periods of apnea in newborns?

Short periods of apnea are typical and may occur. Signup and view all the answers

What is a significant concern if a newborn's respiratory rate falls below the normal range?

It may indicate a respiratory infection. Signup and view all the answers

In assessment, what should be noted if a newborn exhibits apnea during the evaluation?

It can be common and doesn't require action if brief. Signup and view all the answers

What range would be of immediate concern if a newborn's respiratory rate is observed?

60-80 breaths/min Signup and view all the answers

What should a caregiver monitor for if a newborn presents with unusual breathing patterns?

Cyanosis or changes in skin color Signup and view all the answers

Why is it important for healthcare providers to be aware of short periods of apnea in newborns?

To monitor for any signs of respiratory distress. Signup and view all the answers

Which behavioral response is NOT typically associated with newborn pain assessment?

Decrease in weight Signup and view all the answers

What vital sign change would most likely indicate a newborn is experiencing pain?

Increased blood pressure Signup and view all the answers

Which condition is indicated by skin changes such as pallor or flushing in newborns?

Pain response Signup and view all the answers

What is the appropriate axillary temperature range indicating normalcy in newborns?

36.5° C to 37.5° C Signup and view all the answers

What laboratory finding may indicate stress due to pain in newborns?

Hyperglycemia Signup and view all the answers

Which nursing action is critical for managing hypothermia in newborns?

Maintaining skin-to-skin contact Signup and view all the answers

Which of the following indicates a need for immediate resuscitation in a newborn?

Cyanosis in skin and mucous membranes Signup and view all the answers

What finding suggests increased intracranial pressure in a newborn?

Dilated pupils Signup and view all the answers

What is the average healthy temperature range for a newborn?

36.5° C to 37.5° C Signup and view all the answers

Which laboratory value indicates a possible risk for hypoglycemia in newborns?

Glucose below 40 mg/dL Signup and view all the answers

What should be done first when suctioning a newborn's airway?

Suction the mouth first Signup and view all the answers

Which of the following is the normal range for bilirubin in a newborn at 24 hours of age?

2 to 6 mg/dL Signup and view all the answers

In newborns, which condition is evaluated through a complete blood count (CBC)?

Anemia and polycythemia Signup and view all the answers

What is the expected RBC count range in newborns?

4.8 x 10⁶ to 7.1 x 10⁶ Signup and view all the answers

What action should be taken if a newborn's temperature is unstable?

Place the newborn in a radiant warmer Signup and view all the answers

What is the normal range for platelet count in newborns?

150,000 to 300,000/mm³ Signup and view all the answers

What is the expected Hct level for newborns?

44% to 64% Signup and view all the answers

Why is it important to determine the Rh status of the mother?

To evaluate risk for blood type incompatibility Signup and view all the answers

What is the expected finding regarding a female newborn's genitalia?

Labia majora are usually edematous and cover the labia minora. Signup and view all the answers

Which statement is accurate concerning the Babinski reflex in newborns?

Toes fanning upward and out is indicative of a positive Babinski reflex. Signup and view all the answers

Which finding is characteristic of a healthy male newborn's genitalia?

The urinary meatus should be at the penile tip. Signup and view all the answers

What is the expected behavior of a newborn when eliciting the rooting reflex?

The newborn will turn the head toward the side touched. Signup and view all the answers

How should the extremities of a newborn be assessed?

They should be symmetrical with full range of motion. Signup and view all the answers

What finding should be expected in the urine of a newborn during the first few days of life?

Rust color due to uric acid crystals. Signup and view all the answers

Which reflex typically disappears by 3 to 4 months but can last up to 1 year?

Rooting reflex. Signup and view all the answers

What characteristics should the spine of a newborn display?

Straight, flat, and midline. Signup and view all the answers

Which of the following is true regarding nail beds in a healthy newborn?

Nail beds should be pink with no extra digits present. Signup and view all the answers

Study Notes

Apgar Scoring

Apgar scores are assigned at 1 and 5 minutes after birth.
Scores indicate the newborn's adaptation to extrauterine life and the need for interventions.
Scoring ranges: 0 to 3 indicates severe distress, 4 to 6 indicates moderate difficulty, 7 to 10 indicates minimal or no difficulty.
Five parameters assessed: Heart Rate, Respiratory Rate, Muscle Tone, Reflex Irritability, Color.

Newborn Assessment

Expected reference ranges for healthy newborns:
- Weight: 2,500 to 4,000 g (5.5 to 8.8 lb).
- Length: 45 to 55 cm (18 to 22 in).
- Head Circumference: 32 to 36.8 cm (12.6 to 14.5 in).
- Chest Circumference: 30 to 33 cm (12 to 13 in).
Gestational age assessment performed within 48 hours helps predict morbidity and mortality.
New Ballard Score estimates gestational age based on neuromuscular and physical maturity.

Neuromuscular Maturity Assessment

Key parameters:
- Posture, Square Window, Arm Recoil, Popliteal Angle, Scarf Sign, Heel to Ear.
Each parameter scored on a scale from -1 to 5.

Physical Maturity Assessment

Key parameters:
- Skin texture, Lanugo presence, Plantar surface creases, Breast tissue amount, Eye and ear characteristics, Genital development.
Scoring similar to neuromuscular maturity.

Classification of Newborns

Appropriate for Gestational Age (AGA): Weight between the 10th and 90th percentiles.
Small for Gestational Age (SGA): Weight less than the 10th percentile.

Vital Signs in Newborns

Normal respiratory rate: 30-60 breaths/min; may include brief periods of apnea.

Anogenital Assessment

Anus should be patent; meconium passed within 24 to 48 hours.
Male genitalia: testicular descent, rugae on the scrotum.
Female Genitalia: edematous labia, blood-tinged discharge may occur due to maternal hormones.

Extremity Assessment

Assess movement, symmetry, and flexion of extremities.
Expected findings include well-lined soles and pink nail beds.

Reflexes

Positive Babinski: Toes fan outward; Negative: Toes curl downward.
Sucking and rooting reflexes present; expected to disappear by 3 to 4 months.

Diagnostic Procedures

Cord blood testing at birth for ABO and Rh status.
CBC for anemia, polycythemia, etc., in newborns at risk.

Expected Laboratory Values

Hemoglobin: 14 to 24 g/dL, Platelets: 150,000 to 300,000/mm³.
Glucose: greater than 40 to 45 mg/dL, WBC: 9,000 to 30,000/mm³.

Complications and Nursing Actions

Airway obstruction: suction mouth then nose using bulb syringe.
Hypothermia: Keep axillary temperature within 36.5° to 37.5°C; use radiant warmers.
Inadequate oxygen supply: Monitor respirations, temperature stabilization, oxygen administration if necessary.

Pain Assessment in Newborns

Use NIPS and CRIES scales to evaluate pain.
Behavioral responses include changes in sleep, feeding, irritability, and facial grimacing.
Physiological responses may include altered vital signs and skin changes.

Application Exercises

Familiarity with newborn classification and assessment is critical for nursing practice.
Understanding reflex responses helps ensure appropriate developmental milestones are being met.

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Description

Test your knowledge with these application exercises focused on newborn care and assessment. This quiz covers critical evaluations such as weight categorization and heart rate assessment in neonates. Ideal for nursing students looking to enhance their clinical skills.