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attachment -correct answer Process by which a parent comes to love and accept a child and a child comes to love and accept a parent. bonding -correct answer The process of attachment. mutuality -correct answer Infant behaviors and characteristics call forth a corresponding set of parental behaviors and characteristics. acquaintance -correct answer Process that occurs as parents interact with their newborn and maintain close proximity as they identify the infant as an individual and claim him or her as a member of the family. signaling behaviors -correct answer Infant behaviors such as crying, smiling, and cooing that initiate contact and bring the caregiver to the child. executive behaviors -correct answer Infant behaviors such as rooting, grasping, and postural adjustments that maintain contact. claiming -correct answer Process in which parents identify the new baby, first in terms of likeness to other family members, then in terms of differences, and finally in terms of uniqueness. en face (face to face) -correct answer Position used for mutual gazing in which the parent's face and the infant's face are approximately 30 cm apart and are on the same plane. entrainment -correct answer Newborns move in time with the structure of adult speech by waving their arms, lifting their heads, and kicking their legs, seemingly "dancing in time" to a parent's voice. biorhythmicity -correct answer Personal biorhythm developed by the infant; parents facilitate this process by giving consistent loving care and using their infant's alert state to develop responsive behavior, and thereby increase social interaction and opportunities for learning.
reciprocity -correct answer Type of body movement or behavior that provides the observer with cues. The observer or receiver interprets those cues and responds to them. synchrony -correct answer The "fit" between the infant's cues and the parents' response. transition to parenthood -correct answer Period from the decision to conceive through the first months of having a child. dependent (taking-in) -correct answer Phase of maternal adjustment that occurs during the first 24 hours (range of 1 to 2 days) when the woman focuses on herself and meeting basic needs with a reliance on others for comfort, rest, closeness, and nourishment. She is often talkative and desires to discuss her childbirth experience. dependent-independent (taking-hold) -correct answer Phase of maternal adjustment that begins on the second or third day postpartum and lasts for about 10 days to several weeks, during which the woman focuses on caring for her baby and becoming competent as a mother; she is eager to learn and to practice and may experience baby blues. interdependent (letting-go) -correct answer Phase of maternal adjustment during which the woman reasserts her relationship with her partner and resumes sexual intimacy. becoming a mother -correct answer Process of transformation and growth of the mother identity during which the woman learns new skills and increases her confidence in herself as she meets new challenges in caring for her child(ren). maternal sensitivity -correct answer The quality of a mother's sensitive behaviors that are based on her awareness, perception, and responsiveness to infant cues and behaviors. "pink" period -correct answer Period surrounding the first day or two of birth, characterized by heightened joy and feelings of well-being.
Which behavior illustrates engrossment? A. A father is sitting in a rocking chair, holding his new baby boy, touching his toes, and making eye contact. B. A mother tells her friends that her baby's eyes and nose are just like hers. C. A mother picks up and cuddles her baby girl when she begins to cry. D. A grandmother gazes into her new grandson's face, which she holds about 8 inches away from her own; she and the baby make eye-to-eye contact. -correct answer A. A father is sitting in a rocking chair, holding his new baby boy, touching his toes, and making eye contact. Engrossment refers to a father's absorption, preoccupation, and interest in his infant; choice B represents the claiming process phase I, identifying likenesses; choice C represents reciprocity; choice D represents en face or face-to-face position with mutual gazing. A woman expresses a need to review her labor and birth experience with the nurse who cared for her while in labor. This behavior is most characteristic of which phase of maternal postpartum adjustment? A. Taking-hold (dependent-independent phase) B. Taking-in (dependent phase) C. Letting-go (interdependent) D. Postpartum blues (baby blues) -correct answer B. Taking-in (dependent phase) Taking-in occurs in the first 1 to 2 days of recovery following birth; other behaviors exhibited include reliance on others to help her meet needs and being excited and talkative. Before discharge, a postpartum woman and her partner ask the nurse about the baby blues. "Our friend said she felt so let down after she had her baby and we have heard that some women actually become very depressed. Is there anything we can do to prevent this from happening to us or at least to cope with the blues if they occur?" The nurse could tell this couple: A. "Postpartum blues usually happen in pregnancies that are high risk or unplanned, so there is no need for you to worry." B. "Try to become skillful in breastfeeding and caring for your baby as quickly as you can." C. "Get as much rest as you can and sleep when the baby sleeps, because fatigue can precipitate the blues or make them worse."
D. "I will call your doctor before you leave to get you a prescription for an antidepressant to prevent the blues from happening." -correct answer C. "Get as much rest as you can and sleep when the baby sleeps, because fatigue can precipitate the blues or make them worse." Support and care of the postpartum woman and her newborn by her partner and family are the most effective prevention and coping strategies; feelings of fatigue from childbirth and meeting the demands of the newborn can accentuate feelings of depression. surfactant -correct answer Protein manufactured in type II cells of the lungs that reduces surface tension, thereby decreasing the pressure required to keep alveoli open with inspiration and preventing total alveolar collapse on exhalation; alveolar stability is maintained. thermoregulation -correct answer Maintenance of balance between heat loss and heat production. thermogenesis -correct answer Generation of heat. nonshivering thermogenesis -correct answer Heat production process unique to the newborn accomplished primarily by brown fat metabolism and secondarily by increased metabolic activity in the brain, heart, and liver. neutral thermal environment -correct answer Environment in which heat balance for the newborn is maintained; it is at the temperature that allows the newborn to maintain a normal body temperature to minimize oxygen and glucose consumption. convection -correct answer Flow of heat from the body surface to cooler ambient air. Two measures to reduce heat loss using this method are to keep the ambient air at 24C and wrap the infant who is in an open bassinet. radiation -correct answer Loss of heat from the body surface to a cooler, solid surface not in direct contact but in relative proximity. To prevent this type of heat loss, cribs and examining tables are placed away from outside windows, and care is taken to avoid direct air drafts.
vernix caseosa -correct answer White cheeselike substance that coats and protects the fetus's skin while in utero. milia -correct answer White facial pimples caused by distended sebaceous glands. jaundice -correct answer Yellowish skin discoloration caused by elevated serum levels of unconjugated (indirect) bilirubin. physiologic jaundice -correct answer Nonpathologic unconjugated hyperbilirubinemia that occurs in approximately 60% of term newborns. It appears after 24 hours of age and usually resolves without treatment. acute bilirubin encephalopathy -correct answer Acute manifestations of bilirubin toxicity that occur during the first weeks after birth; these can include lethargy, hypotonia, irritability, seizures, coma, and death. kernicterus -correct answer Irreversible, long-term consequences of bilirubin toxicity such as hypotonia, delayed motor skills, hearing loss, cerebral palsy, and gaze abnormalities. breast milk jaundice -correct answer Hyperbilirubinemia that can be manifested by breastfed newborns. Early onset, which begins in the first 2 to 5 days of age, is associated with ineffective breastfeeding. The etiology of the late-onset form, which can begin at age 5 or 10 days and persist for up to 12 weeks, is uncertain but could be related to factors found naturally in breast milk. meconium -correct answer Thick, dark green-black stool formed during fetal life and usually passed within 24 hours of birth. erythema toxicum (erythema neonatorum; flea bite dermatitis) -correct answer Sudden, transient newborn rash characterized by erythematous macules, papules, and small vesicles found anywhere on the body. hypospadias -correct answer Condition in which the urethral opening is located on the ventral side of the surface of the penis.
epispadias -correct answer Condition in which the urethral opening is located on the dorsal side of the surface of the penis. hydrocele -correct answer Accumulation of fluid in the scrotum, around the testes. Epstein pearls -correct answer Small whitish areas found on the gum margins and at the juncture of the hard and soft palates. cephalocaudal development -correct answer Head to rump development in the newborn. lanugo -correct answer Soft, downy hair on face, shoulders, and back. ecchymosis -correct answer Bruise. desquamation -correct answer Peeling of the skin that occurs in the term infant a few days after birth as vernix caseosa is removed; if present at birth, it may be an indication of postmaturity. port-wine stain (nevus flammeus) -correct answer Vascular lesion visible at birth as pink and flat but darkens with time, becoming red or purple and pebbly in consistency; it varies in size, shape, and location but is usually found on the neck and face. It does not blanch under pressure or disappear. strawberry hemangioma (nevus vascularis) -correct answer Birthmark consisting of dilated, newly formed capillaries occupying the entire dermal and subdermal layers with associated connective tissue hypertrophy; it is typically a raised, sharply demarcated bright or dark red, rough-surfaced swelling, usually found as a single lesion on the head. pseudomenstruation -correct answer Slightly blood-tinged mucoid vaginal discharge associated with an estrogen decrease after birth. prepuce -correct answer Foreskin.
state modulation -correct answer Ability of the newborn to respond to internal and external environmental factors by controlling sensory input and regulating the sleep-wake states, thereby making smooth transitions between states. habituation -correct answer Protective mechanism that allows the infant to become accustomed to environmental stimuli. It is a psychologic and physiologic phenomenon in which the response to a constant or repetitive stimulus is decreased. orientation -correct answer Quality of alert states and ability to attend to visual and auditory stimuli while alert. temperament -correct answer Individual variations in a newborn's primary reaction pattern. Magnet -correct answer Place infant in a supine position and apply pressure to soles of the feet with fingers when the lower limbs are semi-flexed; legs extend against examiner's pressure. Moro -correct answer Place infant supine on flat surface and make a loud abrupt noise; symmetric abduction and extension of arms, fingers fan out, thumb and forefinger form a C; arms are then adducted into an embracing motion and return to relaxed flexion and movement. Grasp -correct answer Place finger in palm of hand or at base of toes; infant's fingers curl around examiner's finger or toes curl downward. Truncal incurvation (Galant) -correct answer Place infant prone on flat surface, run finger down side of back first on one side and then down the other side 4 to 5 cm lateral to spine; trunk flexes and pelvis swings toward stimulated side. Glabellar (Myerson sign) -correct answer Tap over forehead, bridge of nose, or maxilla when eyes are open; blinks for first four or five taps. Babinski (plantar) -correct answer Use finger to stroke sole of foot beginning at heel, upward along lateral aspect of sole, then across ball of foot; all toes hyperextend, with dorsiflexion of big toe ("positive response").
Wink reflex -correct answer Anal sphincter responds to touch by opening and closing. cryptorchidism -correct answer Undescended testes. Rooting -correct answer Touch infant's lip, cheek, or corner of mouth with nipple or finger; turns head toward stimulus and opens mouth ready to take hold and suck. Tonic neck (fencing) -correct answer Place sleepy infant in a supine position, then turn head quickly to one side; arm and leg on side to which head is turned extend while opposite arm and leg flex. Stepping (walking) -correct answer Hold infant vertically, allowing one foot to touch table surface; infant alternates flexion and extension of feet. Extrusion -correct answer Touch or depress tip of tongue; tongue is forced outward. Crossed extension -correct answer Place infant in a supine position. Then extend one leg, press knee downward, and stimulate bottom of foot; opposite leg flexes, adducts, and then extends. A newborn, at 5 hours old, wakes from a sound sleep and becomes very active and begins to cry. Which signs, if exhibited by this newborn, indicate expected adaptation to extrauterine life? SATA A. Increased muscle tone B. Passage of meconium C. Heart rate of 160 beats/minute D. Respiratory rate of 24 breaths/minute and irregular E. Fine crackles on auscultation F. Expiratory grunting with nasal flaring -correct answer A. Increased muscle tone B. Passage of meconium C. Heart rate of 160 beats/minute
As part of a thorough assessment of a newborn, the pediatric nurse practitioner (PNP) should check for hip dislocation and dysplasia. Which technique does the PNP use? A. Check for syndactyly bilaterally B. Stepping or walking reflex C. Magnet reflex D. Ortolani maneuver -correct answer D. Ortolani maneuver Choices B and C are common newborn reflexes used to assess integrity of neuromuscular system; syndactyly refers to webbing of the fingers. When assessing a newborn after birth, the nurse notes flat, irregular, pinkish marks on the bridge of the nose, nape of the neck, and over the eyelids. The areas blanch when pressed with a finger. The nurse documents this finding as: A. Milia B. Nevus vasculosus C. Telangiectatic nevi D. Nevus flammeus -correct answer C. Telangiectatic nevi Telangiectatic nevi are also known as stork bite marks and can also appear on the eyelids; milia are plugged sebaceous glands and appear as white pimples; nevus vasculosus or a strawberry mark is a raised, sharply demarcated, bright or dark red swelling; nevus flammeus is a port-wine, flat red to purple lesion that does not blanch with pressure. Apgar score -correct answer Tool used to rapidly assess the newborn's transition to extrauterine life at 1 and 5 minutes after birth; it is based on five signs that indicate the newborn's physiologic state. 5 categories for Apgar scoring -correct answer 1. heart rate
- respiratory effort
- muscle tone
- reflex irritability
- color bulb syringe -correct answer Device used to suction mucus and secretions from the newborn's mouth and nose immediately after birth and when needed. thermistor probe -correct answer Automatic sensor usually placed on the upper quadrant of the abdomen immediately below the left or right costal margin; it is attached to the radiant warmer and monitors the newborn's skin temperature. eye prophylaxis -correct answer Instillation of antibiotic ointment into the eyes of a newborn after birth to prevent infection. ophthalmia neonatorum / neonatal conjunctivitis -correct answer Inflammation of the newborn's eyes caused by sexually transmitted bacteria (e.g., gonorrhea, chlamydia) acquired by the newborn during passage through the mother's birth canal. 0.5% erythromycin or 1% tetracycline ointment is usually instilled into the newborn's eyes within 1 to 2 hours after birth to prevent this infection. vitamin K -correct answer Medication administered intramuscularly to the newborn to prevent neonatal hemorrhagic disease; it is administered in a dose of 0.5 to 1 mg. new Ballard score -correct answer Tool used to assess and estimate a newborn's gestational age after birth; it involves assessment of the degree of the newborn's physical and neurologic maturity. appropriate for gestational age (AGA) -correct answer Term used to describe an infant whose birth weight falls between the 10th and 90th percentiles as a result of growing at a normal rate during fetal life regardless of length of gestation. large for gestational age (LGA) -correct answer Term used to describe an infant whose birth weight falls above the 90th percentile as a result of growing at an accelerated rate during fetal life, regardless of length of gestation.
blanch test -correct answer Test performed to distinguish cutaneous jaundice of the skin from normal skin color. It is performed by applying pressure with a finger over a bony area such as the nose, forehead, or sternum for several seconds to empty all capillaries in the spot. The area will appear yellow when the finger is removed if jaundice is present. transcutaneous bilirubinometry (TCB) -correct answer Device used for noninvasive monitoring of bilirubin via cutaneous reflectance measurements; it allows for repetitive estimation of bilirubin and works well on both dark-skinned and light-skinned newborns. thrush -correct answer Infection characterized by white plaques on cheeks or tongue that bleed if touched. hypoglycemia -correct answer Blood glucose concentration less than adequate to support neurologic, organ, and tissue function during the early newborn period; the precise level at which this occurs in every neonate is not known, though intervention is usually required if the blood glucose level falls below 40 to 45 mg/dL. bradypnea -correct answer Newborn respiratory rate of 30 breaths/minute or less. tachypnea -correct answer Newborn respiratory rate of 60 breaths/minute or more. handwashing (hand hygiene) -correct answer The most important single measure in the prevention of neonatal infection. phototherapy -correct answer Use of light energy to treat hyperbilirubinemia by converting unconjugated bilirubin to a conjugated form that can be excreted through the urine or feces. circumcision -correct answer Surgical procedure that involves removing all or part of the prepuce (foreskin) of the penis. A newborn male is estimated to be at 40 weeks of gestation following an assessment using the New Ballard Scale. New Ballard Scale findings consistent with this newborn's full-term status are: SATA A. Apical pulse rate of 120 beats/minute, regular, and strong
B. Popliteal angle of 160 degrees C. Weight of 3200 g, placing him at the 50th percentile D. Thinning of lanugo with some bald areas E. Testes descended into the scrotum F. Elbow does not pass midline when arm is pulled across the chest -correct answer D. Thinning of lanugo with some bald areas E. Testes descended into the scrotum F. Elbow does not pass midline when arm is pulled across the chest Thinning of lanugo with bald spots, absence of scarf sign, and descended testes are assessed with the New Ballard Scale and are consistent with full-term status; pulse and weight are not part of the New Ballard Scale; the popliteal angle for a full-term newborn is 100 degrees or less. The nurse evaluates the laboratory test results of a newborn who is 4 hours old. Which results require notification of the pediatrician? A. Hemoglobin 20 g/dL B. Hematocrit 54% C. Glucose 34 mg/dL D. White blood cell count 24,000/mm3 -correct answer C. Glucose 34 mg/dL Glucose should be 45 to 65 mg/dL; choices A, B, and D all fall within the expected reference range. A newborn male has been designated as large for gestational age. His mother was diagnosed with gestational diabetes late in her pregnancy. The nurse should be alert for signs of hypoglycemia. Which assessment finding is consistent with a diagnosis of hypoglycemia? A. High-pitched cry B. Jitteriness C. Hyperthermia D. Laryngospasm -correct answer B. Jitteriness
A. Confirm that the mother is hepatitis B positive before the injection is given B. Obtain parental consent prior to administering the vaccination C. Inform the parents that the next vaccine in the series needs to be given at 1 to 2 months D. Administer the injection into the vastus lateralis muscle E. Use a 1-inch 23-gauge needle F. Insert the needle at a 45-degree angle -correct answer B. Obtain parental consent prior to administering the vaccination C. Inform the parents that the next vaccine in the series needs to be given at 1 to 2 months D. Administer the injection into the vastus lateralis muscle Mother does not have to be hepatitis B positive for the vaccine to be given to her newborn; use a ⅝ inch 25-gauge needle and insert it at a 90 degree angle. A nurse is preparing to administer erythromycin ophthalmic ointment 0.5% to a newborn after birth. Which nursing actions are appropriate? SATA A. Administer the ointment within 30 minutes of the birth B. Wear gloves C. Cleanse the eyes if secretions are present D. Squeeze an ointment ribbon of 3 cm into the lower conjunctival sac E. Wipe away excess ointment after 1 minute F. Apply the ointment from the inner to outer canthus -correct answer B. Wear gloves C. Cleanse the eyes if secretions are present E. Wipe away excess ointment after 1 minute F. Apply the ointment from the inner to outer canthus Administer within 1 to 2 hours and squeeze a 1- to 2-cm ribbon of ointment into the lower conjunctival sac. Apgar score
1 minute after birth HR 160bpm Respiratory effort - good, crying vigorously Muscle tone - active movement, well flexed Reflex irritability - cries with stimulus to soles of feet Color - body pink, feet and hands cyanotic -correct answer 2, 2, 2, 2, 1 Score 9 Infant is having minimal to no difficulty adjusting to extrauterine life Apgar score 5 minutes after birth HR 102bpm Respiratory effort - slow, irregular with weak cry Muscle tone- some flexion of extremities Reflex irritability - grimace with stimulus to soles of feet Color - pale -correct answer 2, 1, 1, 1, 0 Score 5 Moderate difficulty adjusting to extrauterine life lobes -correct answer Structures in the breast that contain alveoli surrounded by myoepithelial cells. There are approximately 15 to 20 of these structures embedded in the fat and connective tissue in each female breast. alveoli -correct answer Milk-producing cells.
