A nurse is caring for a newborn in the postpartum unit.
The parents express concern about their baby's weight loss of 5
Weight loss can be normal but 5
Weight loss occurs as a result of normal physiological processes such as fluid loss and adjusting to a new feeding pattern.
It's primarily due to the baby's inability to digest breast milk or formula initially.
Newborns lose weight because they have a higher metabolism than adults.
The Correct Answer is B
Choice A rationale
While weight loss is common, the rationale provided is too simplistic and doesn't explain the underlying physiological mechanisms. Newborns typically lose 5.
Choice B rationale
This is the correct scientific explanation. Weight loss in the first few days is primarily due to extracellular fluid shift (diuresis and evaporation), delayed onset of mature milk production, and the passage of meconium. This physiological weight loss is expected as the newborn transitions from the fluid-filled intrauterine environment and adjusts to an oral-feeding pattern.
Choice C rationale
This is generally inaccurate. The newborn's gastrointestinal system, while immature, is capable of digesting colostrum and breast milk/formula through enzymes like lactase and lipases. Initial weight loss is not primarily due to maldigestion, but rather limited intake before milk "comes in" and normal fluid loss mechanisms (insensible and urinary/stool).
Choice D rationale
While newborns have a relatively high basal metabolic rate (BMR) compared to adults due to a high ratio of surface area to mass and growth needs, this is a minor contributor to the initial acute weight loss. The primary reasons are related to fluid loss and nutritional transition, not excessive energy expenditure driving rapid weight decline. —.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
The transition of stool from black meconium to yellow, seedy, and loose is a key indicator of adequate breast milk intake and healthy intestinal function. By three to five days of life, an exclusively breastfed infant should have about three or more yellow, seedy stools per day, confirming effective transfer of nutrients and proper digestion of milk.
Choice B rationale
Newborns generally need to feed frequently, often every two to three hours (or eight to twelve times in 24 hours), especially during the initial weeks, because breast milk is easily and quickly digested. Sleeping for six hours without feeding, especially in the first few weeks, may indicate lethargy or inadequate calorie intake, not necessarily effective feeding.
Choice C rationale
While a good latch is essential for effective milk transfer, the duration of active feeding is typically longer than three to five minutes per breast, particularly when establishing a supply. Active, audible swallowing for 10 to 20 minutes per breast is a more reliable sign that the infant is taking in a sufficient volume of milk for proper growth and hydration.
Choice D rationale
A significant loss of birth weight (greater than 7-10 percent) suggests inadequate intake and is a sign of concern, not a positive indicator of feeding adequacy. Adequate intake is instead indicated by weight regain to birth weight by 10 to 14 days and a subsequent gain of about 15 to 30 g per day thereafter.
Correct Answer is D
Explanation
Choice A rationale
While encouraging early breastfeeding promotes bonding, provides optimal nutrition, and stimulates uterine involution, the immediate priority for a macrosomic infant, especially after a difficult delivery with an APGAR score of 7/9 (normal), is addressing the high risk of hypoglycemia due to hyperinsulinemia from maternal glucose exposure; therefore, metabolic stability precedes routine bonding.
Choice B rationale
Preparing for immediate transfer to the NICU is only warranted if the infant exhibits significant respiratory distress, persistent hypoglycemia refractory to intervention, or severe birth injuries like an unstable fracture or extensive nerve palsy; as the infant's APGAR scores (7/9) and stability suggest initial adequate transition, this action is premature without further assessment and intervention.
Choice C rationale
Documenting the birth weight of 4550 grams confirms the diagnosis of macrosomia (birth weight >4000 grams), which signals a high-risk status; however, simply continuing routine care ignores the well-established associated risks such as birth trauma (e.g., shoulder dystocia) and, most importantly, hypoglycemia (blood glucose <40-45 mg/dL), which requires immediate monitoring.
Choice D rationale
Monitoring blood glucose levels is crucial, as macrosomic infants are at high risk for hypoglycemia due to maternal diabetes leading to fetal hyperinsulinism, which continues after the umbilical cord is cut; initiating feedings as soon as possible provides a necessary glucose source to prevent or correct hypoglycemia and should be the primary action following stabilization.
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