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A nurse is performing a newborn assessment and notes depressed fontanels. Which of the following is true regarding depressed fontanels in newborn assessment?

A.

Depressed fontanelles are only seen in premature newborns.

B.

Depressed fontanelles indicate infection.

C.

Depressed fontanelles are a sign of dehydration.

D.

Depressed fontanelles are a normal finding in newborns.

Answer and Explanation

The Correct Answer is C

Choice A rationale

 

Depressed fontanelles are not exclusive to premature newborns. They can occur in both premature and full-term infants and are not an indicator of prematurity.

 

Choice B rationale

 

Depressed fontanelles do not indicate infection. Infections in newborns typically present with other symptoms such as fever, irritability, and poor feeding.

 

Choice C rationale

 

Depressed fontanelles are a sign of dehydration in newborns. When a newborn is dehydrated, the fontanelles can appear sunken due to the lack of fluid in the body.

 

Choice D rationale

 

Depressed fontanelles are not a normal finding in newborns. Normally, fontanelles should be flat or slightly curved inward. A depressed fontanelle is a clinical sign that requires further evaluation and intervention.

 


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Correct Answer is A

Explanation

Choice A rationale

Drying the newborn’s skin thoroughly immediately after birth helps reduce heat loss by evaporation, which is a significant concern as wet skin can cause rapid heat loss.

Choice B rationale

Maintaining ambient room temperature at 24°C (75°F) helps prevent heat loss by convection but does not directly address evaporation.

Choice C rationale

Placing the newborn on a warm surface helps prevent heat loss by conduction but does not address evaporation.

Choice D rationale

Preventing air drafts helps reduce heat loss by convection but does not address evaporation.

Correct Answer is D

Explanation

Choice A rationale

Newborns are not born with fully developed immune responses. Their immune system is immature and continues to develop after birth. They rely on maternal antibodies for initial protection.

Choice B rationale

Newborns do not have a mature gut microbiome immediately after birth. The gut microbiome develops over time and is influenced by factors such as breastfeeding and exposure to the environment.

Choice C rationale

Newborns do not rely solely on their innate immune system. They receive passive immunity from maternal antibodies transferred through the placenta and colostrum, which provides initial protection against infections.

Choice D rationale

Newborns receive passive immunity through the placenta and colostrum, but their own immune system is not fully functional until several months of age. This passive immunity helps protect them from infections during the early months of life.

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