1. A woman gave birth to a healthy 7-pound, 13-ounce infant girl. The nurse suggests that the client

place the infant to her breast within 15 minutes after birth. The nurse is aware that the initiation of

breastfeeding is most effective during the first 30 minutes after birth. What is the correct term for this

phase of alertness?

First Period of Reactivity

The first period of reactivity is the first phase of transition and lasts up to 30 minutes after birth. The

infant is highly alert during this phase. The transition period is the phase between intrauterine and

extrauterine existence. The second period of reactivity occurs approximately between 4 and 8 hours after

birth, after a period of sleep.

2. Part of the health assessment of a newborn is observing the infants breathing pattern. What is the

predominate pattern of newborns breathing?

Abdominal with synchronous chest movements

In a normal infant respiration, the chest and abdomen synchronously rise and infant breaths are shallow

and irregular. Breathing with nasal flaring is a sign of respiratory distress. Diaphragmatic breathing with

chest retraction is also a sign of respiratory distress.

3. The nurse is assessing a full term, quiet, and alert newborn. What is the average expected apical pulse

range (in beats per minute)?

120 to 160

The average infant heart rate while awake is 120 to 160 beats per minute. The newborns heart rate may

be approximately 85 to 100 beats per minute while sleeping and typically a little higher than 100 to 120

beats per minute when alert but quiet. A heart rate of 150 to 180 beats per minute is typical when the

infant cries.

4. A newborn is placed under a radiant heat warmer. The nurse understandsthat thermoregulation

presents a problem for the newborn. What is the rationale for this difficulty?

Newborns have a relatively thin layer of subcutaneousfat that provides poor insulation

The newborn has little thermal insulation. Furthermore, the blood vessels are closer to the surface of the

skin. Changes in environmental temperature alter the temperature of the blood, thereby influencing

temperature regulation centers in the hypothalamus.

5. An African-American woman noticed some bruises on her newborn daughters buttocks. The client

asks the nurse what causes these. How would the nurse best explain this integumentary finding to the

client?

Mongolian spot

A Mongolian spot is a bluish-black area of pigmentation that may appear over any part of the exterior

surface of the infants body and is more