A client is in active labor at 38 weeks' gestation with an uncomplicated pregnancy. She is admitted to the birthing center. After 9 hours of labor, the client has a spontaneous vaginal delivery of an infant boy.
HESI Healthy Newborn Case Study
A client is in active labor at 38 weeks' gestation with an uncomplicated pregnancy. She is admitted to
the birthing center. After 9 hours of labor, the client has a spontaneous vaginal delivery of an infant boy.
The nurse places the infant under a radiant warmer and starts to dry him quickly.
What is the rationale for these actions?
A. Heat production is increased through stimulation.
B. Convective heat loss from evaporation is reduced.
C. Newborns in an incubator are more difficult to access than those in a radiant warmer.
D. Bonding is promoted by enhancing the infant's appearance. - ANS B. Convective heat loss from
evaporation is reduced.
Rationale: Drying the infant quickly and placing him under a radiant warmer reduces heat loss through
evaporation and radiation. Although a radiant warmer allows healthcare personnel easy access to the
infant, that is not the reason for its use in this situation.
At 1 minute of age, the infant is alert and active, and has a strong cry. He has a heart rate of 172 and a
respiratory rate of 50. The infant's arms and legs are flexed, the color of his body is pink, and the color of
both feet is blue. The nurse continues a physical assessment of the infant looking for normal and
abnormal findings.
Which APGAR score should the nurse assign? (Enter numeric value only.) - ANS 9
Upon inspection of the umbilical cord, which finding should the nurse report to the healthcare provider
(HCP)?
A. The cord is covered with Wharton's jelly.
B. Pulsations are felt at the base of the cord.
C. One artery and one vein are present.
, D. The cord is glistening with a pearl-like coloring. - ANS C. One artery and one vein are present.
Rationale: Two arteries and one vein should be present.
The infant's head is molded from the vaginal delivery. Upon seeing the baby, the parent says, "Oh, he is
so beautiful, but something is wrong with his head."
How should the nurse respond?
A. No, nothing is wrong with his head. He really is a beautiful baby."
B. "Yes, it is misshaped, but we will show you how to change it over time."
C. "His head has been molded from delivery through the birth canal, which is normal."
D. "I know you are concerned. Would you like to talk further with the healthcare provider (HCP)?" - ANS
C. "His head has been molded from delivery through the birth canal, which is normal."
Rationale: Molding commonly occurs in babies delivered vaginally, and the head will become more
symmetrical over time.
Parents can be taught to change an infant's sleeping positions to correct a misshaped head, but this is
not the best response; Acknowledging the parent's feelings is a thoughtful response, but referral to the
HCP is not necessary.
The mother is offered the opportunity to breastfeed. After securing a comfortable position for herself
and the baby, she puts the infant to her breast. The baby latches onto the nipple, and with some
encouragement, he begins to nurse. After a time of family interaction, the client is taken to the
postpartum unit, and the infant is transferred to the transition care nursery.
The nurse discusses safety issues with the mother to ensure adequate understanding of safety measures
to prevent newborn abduction. The identification bands for both the baby and the mother are verified
upon admission to the nursery.
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