Question

A nurse is providing newborn nutrition education to new parents. The nurse will include which of the following as a sign (cue) of feeding readiness?

Answer 1

Correct Answers:

The infant brings their hand to their mouth.

Rationale :

🍼 Bringing the hand to the mouth is a classic early hunger cue and indicates the infant is ready to initiate feeding.

🍼 Other signs of feeding readiness include rooting, sucking motions, and lip smacking.

🍼 Grasp reflex or turning toward voices are developmental responses, but not direct indicators of hunger.

🍼 Recognizing early cues allows for easier, calmer feeding before the infant becomes distressed.

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Answer 2

Correct Answers:

Newborns receive passive immunity through the placenta and colostrum, but their own immune system is not fully functional until several months of age.

Rationale :

🧬 The newborn immune system is immature, especially the adaptive immune response, leaving infants vulnerable to infection.

🧬 Passive immunity from the mother via IgG (placenta) and IgA (colostrum) helps protect the infant in early months.

🧬 Innate immunity is present but less effective; full immune maturity develops over months to years.

🧬 Vaccines and breastfeeding play key roles in supporting immune development.

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Answer 3

Correct Answers:

Document the expected finding.

Rationale :

🫀 A newborn apical heart rate of 124 bpm is within the normal range (110–160 bpm).

🫀 No further intervention is needed—this is a routine, expected assessment finding.

🫀 Panic responses (NICU, emergency calls) are unnecessary and may alarm parents.

🫀 Always assess heart rate over a full minute for accuracy in neonates.

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Answer 4

Correct Answers:

Fold the top of the diaper underneath the cord.

Rationale :

🧷 Folding the diaper prevents it from rubbing against the cord stump, promoting dry healing and air exposure.

🧷 The stump should be kept dry and clean until it falls off, usually within 1–2 weeks.

🧷 Alcohol wipes and petroleum jelly are outdated or contraindicated unless instructed otherwise.

🧷 Air circulation speeds up cord separation and reduces infection risk.

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Answer 5

Correct Answers:

Placing your child on her back when sleeping will decrease the risk of SIDS.

Rationale :

🛏 The “Back to Sleep” campaign significantly reduced SIDS rates by promoting supine sleeping positions.

🛏 Babies should sleep on a firm mattress, without loose bedding, pillows, or stuffed animals.

🛏 No direct link exists between vaccines and SIDS.

🛏 Apnea is a risk factor, not the main cause.

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Answer 6

Correct Answers:

Tickle the outer edge of the sole of the newborn's foot moving up toward the toes.

Rationale :

👣 The Babinski reflex is elicited by stroking the lateral sole upward, causing the toes to fan—normal in infants.

👣 It helps assess neurologic development and disappears by age 1.

👣 Other reflexes include the Moro, stepping, and rooting, each with distinct triggers.

👣 An absent or diminished Babinski reflex may indicate neurological concern.

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Answer 7

Correct Answers:

60/min.

Rationale :

🌬 A normal newborn respiratory rate ranges from 30–60 breaths/min.

🌬 Breathing is often irregular, with pauses up to 20 seconds (periodic breathing) being normal.

🌬 Rates of 24 or >60 may indicate respiratory distress or transition issues.

🌬 Always observe both rate and effort when assessing neonates.

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Answer 8

Correct Answers:

Gluteal folds are asymmetrical.

Rationale :

🧍‍♂️ Asymmetrical gluteal or thigh folds are a key early sign of developmental dysplasia of the hip (DDH).

🧍‍♂️ Confirmatory assessments include the Ortolani and Barlow maneuvers.

🧍‍♂️ Inward foot, absent reflexes are not diagnostic for DDH.

🧍‍♂️ Early identification allows for Pavlik harness use to ensure proper hip development.

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Answer 9

Correct Answers:

A newborn who is 27 hours post-delivery and has not voided.

Rationale :

🚨 Newborns should void within the first 24 hours after birth; failure may indicate renal or urinary tract issues.

🚨 This is a priority intervention, requiring prompt provider notification.

🚨 Meconium delay can be normal up to 48 hours, and acrocyanosis is common in the first 24 hours.

🚨 Temperature of 37°C is within normal range for a neonate.

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Answer 10

Correct Answers:

Sucking on their fingers.
Smacking their lips.
Rooting.
crying.

Rationale :

✔️ Sucking on their fingers

👶 Newborns instinctively suck on fingers or hands as a self-soothing behavior and to indicate feeding readiness.

👶 It is an early hunger cue, suggesting the baby is becoming alert and looking to feed.

👶 Feeding now prevents crying and supports effective latch and breastfeeding success.

✔️ Smacking their lips

👄 Lip smacking is a subtle, early signal that a newborn is becoming hungry.

👄 It often accompanies rooting or sucking movements and appears before crying.

👄 Responding to this cue helps establish responsive feeding and reduces feeding stress.

✔️ Extending their tongue

👅 Tongue extension is a reflexive action that prepares the newborn for latching and sucking.

👅 It is a visible indicator of feeding readiness, especially in the early hunger stage.

👅 Often seen during quiet alert state, which is the best time to initiate breastfeeding.

✔️ Rooting

➡️ The rooting reflex is when the infant turns their head toward touch near the mouth, seeking a nipple to latch.

➡️ It is one of the most reliable and natural hunger cues in neonates.

➡️ It fades around 3–4 months, but is vital for early feeding initiation.

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QLexNursing

1 :
A nurse is providing newborn nutrition education to new parents. The nurse will include which of the following as a sign (cue) of feeding readiness?

2 :
Which of the following statements accurately describes a characteristic of the newborn immune system?

3 :
A nursery nurse is admitting a neonate and is performing the neonatal assessment. The apical pulse is auscultated with a rate of 124 bpm, after one full minute of listening. What is the next appropriate action should the nurse take?

4 :
A nurse is teaching a newborn's parent to care for the umbilical cord stump. Which of the following instructions should the nurse include?

5 :
A nurse is caring for a newborn whose mother voices concerns about sudden infant death syndrome (SIDS). The nurse should include which of the following statements in a discussion with the mother?

6 :
A nurse is caring for a newborn and assessing newborn reflexes. To elicit the Babinski reflex, the nurse should take which of the following actions?

7 :
A nurse is assessing a newborn 1 hour after birth. Which of the following respiratory rates is within the expected reference range for a newborn?

8 :
A nurse is assessing a newborn and evaluating for developmental dysplasia of the hip (DDH). What assessment finding would indicate DDH?

9 :
A nurse in the newborn nursery is caring for a group of newborns. Which of the following newborns requires immediate intervention?

10 :
The nurse is preparing to teach the postpartum mom about newborn feeding cues. Which of the following behaviors of the infant would be considered early hunger cues? Select all that apply.

QLexNursing

1 : A nurse is providing newborn nutrition education to new parents. The nurse will include which of the following as a sign (cue) of feeding readiness?

2 : Which of the following statements accurately describes a characteristic of the newborn immune system?

3 : A nursery nurse is admitting a neonate and is performing the neonatal assessment. The apical pulse is auscultated with a rate of 124 bpm, after one full minute of listening. What is the next appropriate action should the nurse take?

4 : A nurse is teaching a newborn's parent to care for the umbilical cord stump. Which of the following instructions should the nurse include?

5 : A nurse is caring for a newborn whose mother voices concerns about sudden infant death syndrome (SIDS). The nurse should include which of the following statements in a discussion with the mother?

6 : A nurse is caring for a newborn and assessing newborn reflexes. To elicit the Babinski reflex, the nurse should take which of the following actions?

7 : A nurse is assessing a newborn 1 hour after birth. Which of the following respiratory rates is within the expected reference range for a newborn?

8 : A nurse is assessing a newborn and evaluating for developmental dysplasia of the hip (DDH). What assessment finding would indicate DDH?

9 : A nurse in the newborn nursery is caring for a group of newborns. Which of the following newborns requires immediate intervention?

10 : The nurse is preparing to teach the postpartum mom about newborn feeding cues. Which of the following behaviors of the infant would be considered early hunger cues? Select all that apply.

1 :
A nurse is providing newborn nutrition education to new parents. The nurse will include which of the following as a sign (cue) of feeding readiness?

2 :
Which of the following statements accurately describes a characteristic of the newborn immune system?

3 :
A nursery nurse is admitting a neonate and is performing the neonatal assessment. The apical pulse is auscultated with a rate of 124 bpm, after one full minute of listening. What is the next appropriate action should the nurse take?

4 :
A nurse is teaching a newborn's parent to care for the umbilical cord stump. Which of the following instructions should the nurse include?

5 :
A nurse is caring for a newborn whose mother voices concerns about sudden infant death syndrome (SIDS). The nurse should include which of the following statements in a discussion with the mother?

6 :
A nurse is caring for a newborn and assessing newborn reflexes. To elicit the Babinski reflex, the nurse should take which of the following actions?

7 :
A nurse is assessing a newborn 1 hour after birth. Which of the following respiratory rates is within the expected reference range for a newborn?

8 :
A nurse is assessing a newborn and evaluating for developmental dysplasia of the hip (DDH). What assessment finding would indicate DDH?

9 :
A nurse in the newborn nursery is caring for a group of newborns. Which of the following newborns requires immediate intervention?

10 :
The nurse is preparing to teach the postpartum mom about newborn feeding cues. Which of the following behaviors of the infant would be considered early hunger cues? Select all that apply.