ATI-MN ATI Maternal Newborn Exam - Set 5 - Part 3

Correct Answer: Feed the newborn breast milk or formula

Feeding the newborn breast milk or formula raises the blood glucose, and skin-to-skin contact helps stabilize both glucose and temperature. Option a is incorrect because a cool bath adds cold stress and further lowers glucose. Option b is incorrect because restricting intake would worsen the low blood glucose. Option c is incorrect because delaying feeding allows the glucose to fall further rather than correcting it.

Correct Answer: Respiratory distress syndrome

Rapid breathing with grunting, flaring, and retractions suggests respiratory distress syndrome, often from a lack of surfactant, and requires prompt support. Option a is incorrect because Mongolian spots are a skin finding unrelated to breathing. Option c is incorrect because jaundice involves yellow skin, not respiratory distress. Option d is incorrect because these labored breathing signs are abnormal, not normal newborn breathing.

Correct Answer: Cover the newborn's eyes with a mask

During phototherapy the nurse covers the newborn's eyes to protect them, keeps the newborn undressed for skin exposure, and repositions frequently for even treatment. Option b is incorrect because the newborn is repositioned regularly so all skin areas are exposed to the light. Option c is incorrect because lotions can absorb heat and cause burns under the lights. Option d is incorrect because the newborn is kept undressed so the light reaches the skin to break down bilirubin.

Correct Answer: It usually appears after the first day

Physiologic jaundice usually appears after the first twenty-four hours and is generally benign, unlike jaundice that appears very early and may signal a problem. Option a is incorrect because physiologic jaundice is often managed with feeding and phototherapy, not routine transfusion. Option b is incorrect because physiologic jaundice is a normal process, not a sign of infection. Option d is incorrect because jaundice within the first hours suggests a pathologic cause needing evaluation.

Correct Answer: Reduce environmental stimulation

A newborn in withdrawal is overstimulated, so the nurse reduces light and noise, swaddles with the legs flexed, and offers small frequent feedings to promote calming. Option a is incorrect because small frequent feedings, not large spaced ones, are better tolerated. Option b is incorrect because bright light adds stimulation that worsens irritability. Option c is incorrect because loud, active play increases stimulation and distress in these newborns.

Correct Answer: Temperature instability and poor feeding

Newborn sepsis often presents with subtle signs such as temperature instability, poor feeding, and lethargy, so these findings prompt cultures and prompt treatment. Option a is incorrect because eager feeding is reassuring, whereas poor feeding suggests sepsis. Option c is incorrect because steady weight gain reflects health rather than infection. Option d is incorrect because a strong cry is a sign of well-being, not sepsis.

Correct Answer: Stop the feeding and notify the provider

Excessive drooling and choking with feeding can indicate a tracheoesophageal fistula, so the nurse stops the feeding, keeps the head elevated, and notifies the provider. Option b is incorrect because continuing to feed risks aspiration when this anomaly is suspected. Option c is incorrect because lying flat increases the risk of aspiration and is avoided. Option d is incorrect because offering more volume increases the danger of choking and aspiration.

Correct Answer: A birth injury to the arm

Limited movement of one arm with an absent reflex on that side suggests a birth injury such as a fractured clavicle or nerve injury, which the nurse reports for evaluation. Option a is incorrect because a sleep position does not cause an absent reflex on one side. Option b is incorrect because this finding involves movement and reflexes, not skin pigmentation. Option d is incorrect because normal posture is symmetric, with both arms moving and reflexes present.

Correct Answer: Compress the bulb before inserting it

Parents compress the bulb before inserting it into the side of the mouth, then release it to draw out secretions, clearing the mouth before the nose. Option a is incorrect because inserting into the center of the mouth can trigger the gag reflex. Option c is incorrect because the mouth is suctioned before the nose to prevent aspiration. Option d is incorrect because releasing the bulb first would push air and secretions rather than removing them.

Correct Answer: Yellow and seedy in appearance

After the early dark meconium passes, the stools of a breastfed newborn become soft, yellow, and seedy, which is the expected normal appearance. Option a is incorrect because white, chalky stools are abnormal and may signal a liver problem that needs evaluation. Option b is incorrect because black, tarry meconium is normal only in the first days and should transition to yellow stools. Option c is incorrect because hard, formed pellets are not expected in a newborn and can suggest inadequate intake.