A nurse is collecting data from a newborn 1 hr after delivery. Which of the following respiratory rates is within the expected reference range for a newborn?
22/min.
100/min.
48/min.
110/min.
The Correct Answer is C
Choice A rationale:
A respiratory rate of 22/min would be abnormally low for a newborn. The expected reference range for newborns is around 30-60 breaths per minute.
Choice B rationale:
A respiratory rate of 100/min would be abnormally high for a newborn. Such a high respiratory rate may indicate respiratory distress or other underlying issues and requires further evaluation.
Choice C rationale:
A respiratory rate of 48/min falls within the expected reference range for a newborn, which is around 30-60 breaths per minute. This rate suggests that the newborn's respiratory system is functioning within the normal range.
Choice D rationale:
A respiratory rate of 110/min would be abnormally high for a newborn. As mentioned earlier, the expected reference range for newborns is around 30-60 breaths per minute, making this rate concerning and necessitating further assessment.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale:
Iron will facilitate bone growth. This statement is not accurate in the context of feeding a newborn with iron-fortified formula. While iron is essential for overall growth and development, its primary role is not specifically related to bone growth. Instead, it plays a crucial role in the production of hemoglobin, which helps carry oxygen in the blood.
Choice B rationale:
Newborns do not metabolize iron adequately. This statement is the correct choice. Newborns have limited iron stores that are obtained from their mothers during pregnancy. As they grow, their iron requirements increase, but their ability to metabolize iron is not fully developed at
birth. Hence, iron-fortified formula is recommended to provide the necessary iron for the newborn's healthy development.
Choice C rationale:
The newborn's iron source will start to deplete. This statement is not accurate in the context of iron-fortified formula feeding. The newborn's initial iron source is the iron stores passed on by the mother during pregnancy. However, the iron-fortified formula is designed to supplement and fulfill the baby's iron needs, preventing depletion of iron stores.
Choice D rationale:
Iron will facilitate eyesight development. This statement is not entirely accurate. While iron is important for many bodily functions, including eye health, it is not specifically responsible for eyesight development in newborns. Visual development in newborns is influenced by various factors, but iron intake through formula feeding directly impacting eyesight is not a primary concern.
Correct Answer is A
Explanation
Choice A rationale:
The Moro reflex, also known as the startle reflex, is a normal reflex observed in newborns. To elicit this reflex, the nurse should perform a sharp hand clap or make a loud noise near the infant. This reflex is characterized by the baby's arms and legs extending outward, followed by a quick flexion, resembling a startle response. It is an important reflex to assess the newborn's neurological and motor development.
Choice B rationale:
Turning the newborn's head quickly to one side does not elicit the Moro reflex. This action may stimulate other reflexes, such as the tonic neck reflex, but it is not the appropriate method to assess the Moro reflex.
Choice C rationale:
Placing a finger at the base of the newborn's toes does not elicit the Moro reflex. This action is more related to testing the Babinski reflex, which involves the fanning and curling of the toes when the sole of the foot is stimulated.
Choice D rationale:
Holding the newborn vertically and allowing one foot to touch the crib surface does not elicit the Moro reflex. This action might elicit the stepping reflex, where the baby shows stepping movements as if walking when held in an upright position with their feet touching a surface.
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