Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
When a newborn takes its first breath, what physical changes occur in the heart to increase oxygenation of the body?
A. The ductus arteriosus expands to allow more blood to enter the lungs
This is not correct because the ductus arteriosus does not expand to allow more blood to enter the lungs. The ductus arteriosus is another fetal shunt that connects the pulmonary artery to the aorta. It allows blood to bypass the lungs and flow from the right ventricle to the aorta. After birth, when the baby starts to breathe air, the oxygen concentration in the blood increases and causes the ductus arteriosus to constrict and close. This increases blood flow to the lungs and decreases blood flow to the aorta¹².
B. The foramen ovale closes, preventing blood exchange from right to left in the heart
This is because the foramen ovale is a fetal shunt that allows blood to bypass the lungs and flow from the right atrium to the left atrium. After birth, when the baby starts to breathe air, the lungs expand and the pulmonary resistance decreases. This causes an increase in blood flow and pressure in the left atrium, which pushes the foramen ovale closed. This prevents blood from mixing between the right and left sides of the heart and allows oxygenated blood to circulate to the body¹².
C. The umbilical vein that carried oxygenated blood in utero becomes the ascending aorta entering the right atrium
This is not correct because the umbilical vein that carried oxygenated blood in utero does not become the ascending aorta entering the right atrium. The umbilical vein is a fetal vessel that carries oxygenated blood from the placenta to the fetus. It connects to either the portal vein or the ductus venosus, which then drains into the inferior vena cava. After birth, when the umbilical cord is clamped and cut, the umbilical vein collapses and becomes a fibrous cord called ligamentum teres hepatis¹².
D. The ductus venosus shunts oxygenated aortic blood to the lungs.
This is not correct because the ductus venosus does not shunt oxygenated aortic blood to the lungs. The ductus venosus is another fetal vessel that connects the umbilical vein to the inferior vena cava. It allows some of the oxygenated blood from the placenta to bypass the liver and enter directly into the systemic circulation. After birth, when the umbilical cord is clamped and cut, the ductus venosus closes and becomes a fibrous cord called ligamentum venosum¹².
This question is an excerpt from Nurse Dive's nursing test bank - Postpartum AMD Newborn Care Proctored Exam. Take the full exam now
Full Explanation
The foramen ovale closes, preventing blood exchange from right to left in the heart. This is because the foramen ovale is a fetal shunt that allows blood to bypass the lungs and flow from the right atrium to the left atrium. After birth, when the baby starts to breathe air, the lungs expand and the pulmonary resistance decreases. This causes an increase in blood flow and pressure in the left atrium, which pushes the foramen ovale closed. This prevents blood from mixing between the right and left sides of the heart and allows oxygenated blood to circulate to the body¹².
Choice A is not correct because the ductus arteriosus does not expand to allow more blood to enter the lungs. The ductus arteriosus is another fetal shunt that
connects the pulmonary artery to the aorta. It allows blood to bypass the lungs and flow from the right ventricle to the aorta. After birth, when the baby starts to breathe air, the oxygen concentration in the blood increases and causes the ductus arteriosus to constrict and close. This increases blood flow to the lungs and decreases blood flow to the aorta.
Choice C is not correct because the umbilical vein that carried oxygenated blood in utero does not become the ascending aorta entering the right atrium. The umbilical vein is a fetal vessel that carries oxygenated blood from the placenta to the fetus. It connects to either the portal vein or the ductus venosus, which then drains into the inferior vena cava. After birth, when the umbilical cord is clamped and cut, the umbilical vein collapses and becomes a fibrous cord called ligamentum teres hepatis.
Choice D is not correct because the ductus venosus does not shunt oxygenated aortic blood to the lungs. The ductus venosus is another fetal vessel that connects the umbilical vein to the inferior vena cava. It allows some of the oxygenated blood from the placenta to bypass the liver and enter directly into the systemic circulation. After birth, when the umbilical cord is clamped and cut, the ductus venosus closes and becomes a fibrous cord called ligamentum venosum.
Similar Questions
A new mother of a newborn girl calls the clinic in a panic, concerned about the blood-tinged soiled diaper. What is the best response from the nurse?
A. This can be from the sudden withdrawal of your hormones. It's not a cause for alarm.
This can be from the sudden withdrawal of your hormones. It's not a cause for alarm. This is because newborn female babies may have a little bloody vaginal discharge in their diapers due to the withdrawal of maternal hormones after delivery. This usually stops as the hormones return to normal levels.
B. The baby may have a problem; let's schedule an appointment.
This is wrong because the baby does not need an appointment for this condition.
C. For now, just watch her. If this continues, call us back.
This is wrong because the mother does not need to watch her baby for this condition.
D. This can be related to cleaning her perineal area; be more careful.
This is wrong because the blood is not related to cleaning her perineal area.
Full Explanation
This can be from the sudden withdrawal of your hormones. It's not a cause for alarm. This is because newborn female babies may have a little bloody vaginal discharge in their diaper due to the withdrawal of maternal hormones after delivery. This usually stops as the hormones return to normal levels¹².
Choice B is wrong because the baby does not need an appointment for this condition.
Choice C is wrong because the mother does not need to watch her baby for this condition.
Choice D is wrong because the blood is not related to cleaning her perineal area.
A nurse is caring for a newborn shortly after birth and places the newborn under a radiant warmer. Which of the following potential complications does this action help to prevent?
A. Cold stress
This action helps to prevent cold stress. This is because cold stress is a condition where the newborn's core temperature drops below 36.5°C and they use energy and oxygen to generate warmth. This can lead to hypoglycemia, metabolic acidosis, hypoxia, and an increased risk of infection. Placing the newborn under a radiant warmer provides thermal stability and prevents heat loss by radiation. Here is an image of a newborn under a radiant warmer.
B. Thermogenesis
This is wrong because thermogenesis is the process of heat production, not a complication.
C. Shivering
This is wrong because shivering is a mechanism of heat production in adults, not in newborns.
D. Brown fat production
This is wrong because brown fat production is a normal feature of newborns that helps them generate heat by lipolysis.
Full Explanation
This action helps to prevent cold stress. This is because cold stress is a condition where the newborn's core temperature drops below 36.5°C and they use energy and oxygen to generate warmth. This can lead to hypoglycemia, metabolic acidosis, hypoxia, and an increased risk of infection.
Placing the newborn under a radiant warmer provides thermal stability and prevents heat loss by radiation.
Choice B is wrong because thermogenesis is the process of heat production, not a complication.
Choice C is wrong because shivering is a mechanism of heat production in adults, not in newborns.
Choice D is wrong because brown fat production is a normal feature of newborns that helps them generate heat by lipolysis.
Here is an image of a newborn under a radiant warmer.
When planning the care for a client during the first 24 hours postpartum, the nurse expects to monitor the client's pulse and blood pressure frequently based on the understanding that the client is at risk for which condition?
A. Thromboembolism
This is wrong because thromboembolism is a blood clot that blocks a blood vessel, not a complication of bleeding.
B. Cervical laceration
This is wrong because cervical laceration is a tear in the cervix that can cause bleeding, but it is not a common cause of PPH.
C. Hemorrhoids
This is wrong because hemorrhoids are swollen veins in the anus or rectum that can cause bleeding, but they are not a common cause of PPH.
D. Hemorrhage
This is because postpartum hemorrhage (PPH) is severe bleeding and loss of blood after childbirth that can lead to death. The most common cause of PPH is the uterus not contracting properly after delivery. The nurse needs to monitor the client’s pulse and blood pressure frequently to detect signs of shock and blood loss.
Full Explanation
Hemorrhage. This is because postpartum hemorrhage (PPH) is severe bleeding and loss of blood after childbirth that can lead to death. The most common cause of PPH is the uterus not contracting properly after delivery. The nurse needs to monitor the client’s pulse and blood pressure frequently to detect signs of shock and blood loss.
Choice A is wrong because thromboembolism is a blood clot that blocks a blood vessel, not a complication of bleeding.
Choice B is wrong because cervical laceration is a tear in the cervix that can cause bleeding, but it is not a common cause of PPH.
Choice C is wrong because hemorrhoids are swollen veins in the anus or rectum that can cause bleeding, but they are not a common cause of PPH.
