20-25

An infant is to have an eye examination, and the nurse has just instilled a mydriatic agent into the infant's eyes. Which of the following indicate a potential complication? A:Tachycardia and restlessness B:Apnea and hypotension C:Periorbital edema and photophobia D:Lethargy

Correct:A A mydriatic agent, or agent that dilates the pupil of the eye, is an anticholinergic, meaning that it blocks acetylcholine in the central and peripheral nervous system. If systemic absorption occurs, other anticholinergic effects could be observed, including tachycardia and restlessness.

Which of the following findings should alert the nurse to a potential renal problem? A:Single umbilical artery B:History of polyhydramnios C:Bilious emesis D:Presence of sacral anomaly

Correct:A A single umbilical artery is concerning for renal abnormalities.

An infant is born with an amputated hand caused by amniotic bands. This defect is an example of which of the following? A:Sequence B:Disruption C:Deformation D:Malformation

Correct:B A disruption is an abnormality of morphogenesis caused by disruptive forces acting on the developing structures. Defects that result from amniotic bands are an example of disruption.

The initial blood culture report on an infant with suspected sepsis reveals coagulase-positive, gram-positive cocci. The most likely organism is: A:Escherichia coli. B:Staphylococcus aureus. C:Listeria monocytogenes. D:Staphylococcus epidermidis.

Correct:B Staphylococcus aureus is a gram-positive, coccus-shaped organism that is coagulase positive.

An infant is observed to have prominent epicanthal folds, a flat face, a protruding tongue, and a herniated umbilicus. What genetic disorder does this infant likely have? A:Trisomy 13 B:Trisomy 18 C:Trisomy 21 D:Turner syndrome

Correct:C Additional clinical features of trisomy 21 include brachycephaly with flattened occiput, low-set and malformed ears, generalized hypotonia, hyperflexibility of the joints, clinodactyly of the fifth fingers, wide spacing between the first and second toes, and loose skinfolds in the posterior neck.

During fetal development, failure of the urorectal septum to divide the cloaca into anterior and posterior portions results in which of the following congenital anomalies? A:Esophageal atresia B:Duodenal atresia C:Anorectal malformation D:Omphalocele

Correct:C Anorectal malformations can occur as an abnormal development of the urorectal septum, which results in incomplete separation of the cloaca. It does not result in esophageal or duodenal atresia or omphalocele because these defects have different embryologic origins.

The functional unit of the kidney is the: A:collecting duct. B:ureteric bud. C:nephron. D:Bowman capsule.

Correct:C The nephron is the functional unit of the kidney.

A 1-day-old term male infant presents with left-sided scrotal edema that is painful on examination and bluish in color. Which of the following radiologic studies should the nurse anticipate being included in the plan of care? A:Renal ultrasound B:Voiding cystourethrogram C:Scrotal ultrasound D:Spinal ultrasound

Correct:C This presentation is concerning for testicular torsion. The best evaluation tool in scrotal pathology is ultrasound. The other studies do not assist in the diagnosis of an acute scrotum.

A newborn infant with suspected trisomy 21 has a protruding tongue, hypotonia, and prominent epicanthal folds. After a karyotype is sent, what should be done next? A:Nothing because infants with trisomy 21 have few problems B:Orthopedic consult to assess for fractures/abnormalities C:Echocardiogram to assess for cardiac defects D:Neurology consult to assess for seizures

Correct:C Because up to 50% of infants with trisomy 21 have some form of congenital heart disease, an echocardiogram should be done as soon as possible after birth.

A primigravida reports fetal kicking in the lower abdomen. Which of the following statements should the nurse share with the mother regarding this event? A:Can be an indicator of placenta previa B:May be reflective of fetal distress C:Commonly occurs with breech presentation D:Represents need for a biophysical profile

Correct:C Breech presentation is the most common malpresentation, followed by shoulder dystocia. Mothers with breech fetuses often report fetal kicking in the lower abdomen. Fetal malpresentations are a significant cause of neonatal morbidity and mortality and place the infant at risk for umbilical cord prolapse, asphyxia, and neonatal head and neck trauma. Ultrasonography should be done to confirm the malpresentation.

Ganciclovir is associated with which of the following side effects? A:Sensorineural hearing loss B:Thrombocytosis C:Neutrophilia D:Neutropenia

Correct:D Two thirds of neonates treated with ganciclovir experience neutropenia.

An infant is to have an eye examination, and the nurse has just instilled a mydriatic agent into the infant's eyes. Which of the following indicate a potential complication? Curriculum for Neonatal Intensive Care Nursing. St. Louis, Elsevier Saunders, 2015, pp. 813-831. A:Tachycardia and restlessness B:Apnea and hypotension C:Periorbital edema and photophobia D:Lethargy

Correct:A A mydriatic agent, or agent that dilates the pupil of the eye, is an anticholinergic, meaning that it blocks acetylcholine in the central and peripheral nervous system. If systemic absorption occurs, other anticholinergic effects could be observed, including tachycardia and restlessness.

An infant is diagnosed with DiGeorge syndrome (22q11.2 deletion). What are some of the common anomalies associated with this syndrome? A:Microcephaly, polydactyly, cutis aplasia B:Coarctation of aorta, absent thymus, hypocalcemia C:Hypotonia, enlarged tongue, shortened palpebral fissures D:Rocker-bottom feet, cleft lip/palate, small size

Correct:B Infants with DiGeorge Syndrome (22q11.2 deletion) frequently have heart abnormalities, recurrent infection caused by problems with the immune system and absent thymus, and hypocalcemia, which can result in seizures. Many other problems also can occur with DiGeorge Syndrome, including breathing problems, renal issues, thrombocytopenia, and cleft palate.

An otherwise healthy-appearing term newborn has pustules localized to the axillae and groin. Laboratory analysis reveals gram-positive cocci and neutrophils. The lesions most likely represent: A:a benign newborn rash. B:Staphylococcus aureus infection. C:Candida diaper dermatitis. D:Staphylococcus epidermidis infection.

Correct:B Infectious pustulosis is usually caused by Staphylococcus aureus, a gram-positive coccus. Lesions are commonly found in the axillae, groin, and periumbilical area. Benign rashes, such as erythema toxicum and transient pustular melanosis, typically have a generalized distribution.

A 7-day-old infant with a postmenstrual age of 24 weeks has a history of hyperglycemia and is receiving steroids for treatment of hypotension. The nurse caring for the patient notices erosive skin lesions with serous drainage and crusting on the infant's back. Suspicion should be raised for infection with which of the following agents? A:Candida B:Parvovirus B19 C:Escherichia coli D:Staphylococcus epidermidis

Correct:A A gestational age of less than 26 weeks, hyperglycemia, and postnatal steroid therapy are risk factors for invasive fungal dermatitis caused by microorganisms such as Aspergillus or Candida species in the first 2 weeks of life. The characteristic lesions typically appear on dependent surfaces such as the back or abdomen.

What is a karyotype? A:A karyotype is a pictorial representation of an individual's chromosomes that can be used to look for abnormal numbers or structure of chromosomes. B:A karyotype is the degree to which an inherited trait is manifested in the person who carries the affected gene. C:A karyotype is a gene's observable characteristic in an individual. D:A karyotype is the functional unit of heredity.

Correct:A A karyotype is an image of one's chromosomes to look for abnormal numbers or structure of chromosomes.

A preterm infant with a birth weight of 1800 g was delivered to a mother who was not tested during pregnancy for hepatitis B surface antigen (HBsAg). A maternal blood sample was drawn at delivery for HBsAg determination. While the results are awaited, and within 12 hours of birth, the infant should receive hepatitis B vaccine. When should the nurse administer hepatitis B immune globulin? A:Within 12 hours of age if maternal status cannot be determined or if mother tests positive B:Within 7 days of age if the mother tests positive for HBsAg C:According to the recommendations for term infants D:At 1 month of age

Correct:A A preterm infant weighing less than 2000 g whose mother's hepatitis B surface antigen (HBsAg) status is unknown should receive hepatitis B immune globulin (HBIG, 0.5 ml) within the initial 12 hours after birth if the mother's status cannot be determined within 12 hours, because the vaccine has potentially decreased immunogenicity in these infants.

An infant is diagnosed with acute kidney injury. The nurse should anticipate which of the following clinical symptoms? A:Hyperkalemia B:Metabolic alkalosis C:Decreased serum blood urea nitrogen (BUN) D:Decreased serum creatinine

Correct:A Acute kidney injury (AKI) is associated with hyperkalemia. It is also associated with metabolic acidosis, not metabolic alkalosis.

An infant has been diagnosed with a genetic disorder. The mother of the infant does not exhibit the disorder but is a carrier. The mother's brother does have the disorder. What should the mother know about this disorder? A:It is considered an X-linked recessive disorder. B:It is considered an X-linked dominant disorder. C:It is considered an autosomal-recessive disorder. D:It is considered an autosomal-dominant disorder.

Correct:A An X-linked disorder is caused by an abnormal gene on the X chromosome. In X-linked recessive disorders male offspring are affected and carrier females transmit the disorder. In almost all cases, only male offspring have the disorder. The mother will require genetic counseling with subsequent pregnancies.

When assessing an infant who has Potter sequence, the nurse should expect which of the following findings? A:Arthrogryposis B:Pulmonary hyperplasia C:Prominent chin D:Narrow-set eyes

Correct:A Arthrogryposis is a common finding with Potter sequence.

The nurse is caring for an infant being cooled for hypoxic-ischemic encephalopathy. On morning rounds the attending physician says it is important to monitor the infant for subcutaneous fat necrosis. The nurse anticipates that an appropriate intervention would be to: A:monitor serum calcium levels. B:monitor complete blood count levels. C:monitor the infant for soft, mobile, gray nodules in the subcutaneous tissue. D:monitor the scalp for nodules presenting in a dermatomal pattern.

Correct:A Calcium levels should be monitored in infants with subcutaneous fat necrosis, because these are caused by the crystallization of the subcutaneous fat cells. Both hypercalcemia and hypocalcemia have been reported in these infants, and therefore the serum calcium should be closely monitored.

A 37-week male develops tachypnea and grunting at 6 hours of life. On chest radiograph the infant is found to have cardiomyopathy. What is the most likely maternal condition that results in cardiomyopathy? A:Diabetes B:Hypothyroidism C:Hemolysis, elevated liver enzymes, low platelet count (HELLP) syndrome D:Chronic hypertension

Correct:A Cardiomyopathy is estimated to occur in 25% to 75% of infants of diabetic mothers (IDMs). Maternal hyperglycemia results in increased fetal insulin production, which produces a hyperinsulinemic state in the fetus. This state promotes fetal growth, particularly in skeletal muscle and cardiac tissue. IDM with cardiomyopathy may be asymptomatic, but may present with respiratory distress or cardiac failure.

An infant is delivered to a mother with a history of oligohydramnios. The nurse should assess the infant carefully for which of the following conditions? A:Renal agenesis B:Esophageal atresia C:Anencephaly D:Omphalocele

Correct:A Fetal breathing, swallowing, and urination regulate the amniotic fluid volume. Amniotic fluid volume can be measured using ultrasonography and is reported as the amniotic fluid index, which is the summation of the measurement of the largest pocket of amniotic fluid in each quadrant. Oligohydramnios—low amniotic fluid volume—is associated with fetal anomalies, particularly of the renal and urinary system. Renal agenesis and urinary tract obstructions are commonly diagnosed if pregnancy affected by oligohydramnios. Polyhydramnios—the overproduction of amniotic fluid—is often a result of impaired swallowing, gastrointestinal anomalies and obstructions, or neurologic anomalies.

What is the diagnostic modality of choice for diagnosis of HIV-infected infants? A:HIV DNA or RNA polymerase chain reaction B:Enzyme-linked immunosorbent assay and western blot C:Culture D:CD4+ T-lymphocyte count

Correct:A HIV DNA or RNA polymerase chain reaction (PCR) has a high sensitivity and specificity. At birth, the sensitivity is <100%, but both DNA and RNA PCR have 100% sensitivity and specificity (ie, all cases are diagnosed without false positives).

A full-term infant received ampicillin and gentamicin for suspected sepsis. Before discharge, the infant fails hearing screening in both ears. What information should the nurse provide to the parents at this time? A:Further evaluation of auditory function will be necessary. B:Immediate treatment for permanent hearing loss is required. C:Failing the hearing screening is a temporary side effect of antibiotic therapy. D:The hearing screening will be repeated until the infant passes the test in at least one ear.

Correct:A Hearing screening aids in identifying infants at high risk for hearing loss. Infants who fail the screening should be referred for further evaluation.

The neonatal nurse is planning for the discharge of a full-term infant. What action is most appropriate when the nurse discovers that the hearing screening has not yet been completed? A:Perform the hearing screening before the infant's discharge. B:Perform the hearing screening only if the infant received antibiotic therapy. C:Inform the parents that hearing screening is necessary only for preterm infants. D:If there is a family history of hearing loss, refer the infant for outpatient testing.

Correct:A Hearing screening is recommended for all newborns. Failure on the hearing screening is an indication for referral for further evaluation

At 28 weeks' gestation, a mother reports decreased fetal movement and measures large for gestational date. An ultrasound reveals fetal ascites and pleural effusions. The nurse should expect the infant to present with which of the following conditions? A:Hydrops fetalis B:Trisomy 21 C:Congenital diaphragmatic hernia D:Duodenal atresia

Correct:A Hydrops fetalis is characterized by edema in multiple body cavities. Polyhydramnios and measuring large for gestational dates are often the first indicators of hydrops fetalis, with subsequent ultrasound revealing ascites, pleural effusion, pericardial effusion, or skin edema. Ultrasonography findings commonly associated with trisomy 21 include increased nuchal translucency, absent nasal bone, cardiac anomalies—specifically atrioventricular canal defect—and shortened humerus and femur. Congenital diaphragmatic hernia may be detected with a thoracic mass and visible peristalsis. The classic presentation of duodenal atresia is the "double-bubble," which represents a dilated stomach and duodenum proximal to the atresia.

An infant is transferred to a NICU with multiple anomalies, including omphalocele, large tongue, and hypoglycemia. What is the suspected diagnosis? A:Beckwith-Weidemann syndrome B:VATER association C:DiGeorge syndrome D:Turner syndrome

Correct:A Infants with Beckwith-Wiederman present with macroglossia and hypoglycemia. Additional findings include macrosomia, umbilical hernia, omphalocele, abnormally large organs, ear creases or pits, and kidney abnormalities.

An infant is delivered with a maternal history of an elevated serum alpha-fetoprotein level. What is the finding that the nursing assessment is most likely to reveal? A:Neural tube defect B:Polycystic kidney C:Transposition of great vessels D:Tetralogy of Fallot

Correct:A Maternal serum alpha-fetoprotein (AFP) is most useful as a screening test for neural tube defects. An elevated AFP screening may also indicate abdominal wall defects or chromosomal anomalies, but neural tube defects are most common. A fetal ultrasound is indicated for any mother with an elevated AFP to determine what particular defect, if any, exists.

A 34-week infant develops apnea, lethargy, and hypotension at 12 hours of life, consistent with early-onset sepsis. Which of the following organisms should the nurse most likely suspect as the source of the infection? A:Group B streptococcus B:Pseudomonas aeruginosa C:Candida albicans D:Staphylococcus aureus

Correct:A Neonatal sepsis is classified as early-onset sepsis, occurring before 72 hours of life, or as late-onset sepsis, occurring between 72 hours and 7 days of life. Septic infants may present with lethargy and poor feeding, but may also have more systemic manifestations, such as respiratory distress, hypotension, and temperature instability. The most common pathogens leading to early-onset neonatal sepsis are group B streptococcus and Escherichia coli. Staphylococcus aureus, Candida spp., and Pseudomonas aeruginosa are common organisms contributing to late-onset sepsis.

An infant is admitted with a history of preterm premature rupture of the membranes (PPROM). Which of the following statements by the nurse would be correct regarding PPROM? A:Rupture of the fetal membranes before labor prior to 37 weeks' gestation B:Rupture of the fetal membranes for greater than 18 hours before 37 weeks' gestation C:Rupture of membranes during prodromal labor before term gestation D:Rupture of membranes during induction of labor

Correct:A Rupture of the membranes involves the separation of the chorion and the decidua. The rupture of the membranes before the onset of contractions is referred to as premature rupture of the membranes. The rupture of the membranes before the onset of labor before term gestation at 37 weeks is referred to as preterm premature rupture of the membranes.

An infant receiving zidovudine (AZT) for prevention of maternal-fetal human immunodeficiency virus transmission should be monitored for: A:anemia. B:neutrophilia. C:hypotension. D:hypokalemia.

Correct:A Severe anemia is one of the most common side effects in infants receiving zidovudine.

What is an important nursing consideration when caring for a newborn whose mother had a Chlamydia trachomatis infection at the time of delivery? A:Observe the infant for eyelid edema and purulent discharge. B:Administer silver nitrate drops to prevent chlamydial conjunctivitis. C:Delay eye prophylaxis for 24 hours to determine whether conjunctivitis develops. D:Administer erythromycin ointment, but further assessment is unnecessary.

Correct:A Symptoms of chlamydial eye infection include severe eyelid edema and purulent discharge.

Patterns of predictable methods of inheritance include which of the following? A:X-linked recessive B:Deletions C:Trisomy 21 D:Translocations

Correct:A The current patterns of inheritance include autosomal dominant, autosomal recessive, X-linked dominant, X-linked recessive, codominant, and mitochondrial or maternal inheritance.

Which of the following infants are at the greatest risk for developing retinopathy of prematurity? A:26 weeks' gestation, Caucasian male, weighing 990 grams at birth, having never required supplemental oxygen B:27 weeks' gestation, African American male, weighing 900 grams at birth, having never required supplemental oxygen C:29 weeks' gestation, requiring mechanical ventilation and supplemental oxygen since birth D:30 weeks' gestation, with extremely labile oxygen saturations, requiring supplemental oxygen, on phototherapy for hyperbilirubinemia with a symptomatic patent ductus arteriosus

Correct:A The incidence of retinopathy of prematurity (ROP) appears inversely proportional to gestational age and birth weight. Therefore those infants at greatest risk for development of ROP are the smallest, most premature infants. The 26-week infant is therefore at greater risk than the 27-, 29-, and 30-week infants. ROP also seems to occur more often and with greater severity in Caucasian infants compared with African American infants.

The newborn nursery nurse observes edematous eyelids with purulent exudate in a 1-day-old infant brought by ambulance to the hospital emergency department immediately after being born at home to a mother who had no prenatal care. The records do not indicate whether the infant received eye prophylaxis. The nurse should expect the infant to receive: A:Intravenous ceftriaxone. B:erythromycin ophthalmic ointment. C:PO erythromycin base or ethyl succinate. D:tetracycline ophthalmic ointment.

Correct:A The symptoms are consistent with gonococcal conjunctivitis. Symptoms of gonococcal conjunctivitis begin 1 to 4 days after birth. Although chlamydial conjunctivitis is the most commonly identified infectious conjunctivitis in the United States and may present with similar symptoms, chlamydial conjunctivitis does not present until 5 to 14 days of age. The appropriate treatment for gonococcal conjunctivitis is a single dose of ceftriaxone IV.

A 33-week, African American infant born vaginally with forceps is admitted to the NICU. The infant is on room air, and physical examination is unremarkable except for a large blue-green patch over the buttocks. The father comes to see the infant for the first time since delivery and, after seeing the patch, is very concerned that the infant suffered a birth injury. He states that they had to use "large clamps" to get his baby out. What would be the best response to the father? A:"These patches are consistent with what is referred to as hyperpigmented macules, consistent with increased presence of melanocytes. They are a benign finding and may fade with time." B:"Your baby is fine, they pulled him out 'head first,' so if there was an injury it would be on the head. The baby sustained a 'bruise' during delivery but it should fade with time." C:"I will document the presence of the bruise. I really think the etiology of the bruise is not due to the forceps, but I will ask the doctor to come explain it." D:"These patches are consistent with what is referred to as Mongolian spots, and they occur only in African American infants. We will perform a laboratory test called a DIC panel (disseminated intravascular coagulation) in order to make sure that your infant is not at risk for bleeding."

Correct:A This infant's presentation is consistent with hyperpigmented macules (previously referred to as Mongolian spots). It is important to emphasize with the family that these are a benign, normal finding seen most often over the buttocks, flanks, or shoulders. Up to 80% of African American, Asian, and Hispanic infants have this normal variant, whereas lighter-skinned infants present with them occasionally as well.

A newborn infant presents with a few vesicopustules on the scalp, latera l to the site of the fetal monitor electrode. The nurse notifies the provider and anticipates the initial intervention to be: A:an antiviral agent, such as acyclovir, will be ordered. B:broad-spectrum antibiotics will be ordered, such as ampicillin and gentamicin. C:nothing, because the nurse knows that seborrheic dermatitis is self-limiting. D:standard monitoring, because the nurse knows these are consistent with transient neonatal pustular melanosis.

Correct:A This presentation is concerning for neonatal herpes. Herpes can be localized central nervous system disease; disseminated disease; or localized to the skin, eyes, and mouth. Herpes can be transmitted to the newborn during delivery and often will have vesiculopustules on the presenting part. Given that this infant had a scalp electrode, the nurse knows that the infant's head was thus exposed and therefore vulnerable to transmission. When vesicles are noted and herpes is suspected, treatment with acyclovir should begin immediately.

At 48 hours of life, a term infant is noted to have jitteriness, irritability, sneezing, and elevated temperature. The maternal history is significant for recreational drug use. Which of the following actions should the nurse take? A:Begin neonatal abstinence scoring. B:Discharge the infant with the parents. C:Administer intravenous fluids containing glucose. D:Draw blood cultures and place on antibiotics.

Correct:A Withdrawal symptoms often appear within the first 2 to 3 days of life, and nearly 60% to 90% of exposed infants develop withdrawal symptoms. Symptoms of withdrawal typically involve gastrointestinal disturbances, such as emesis, loose stools, and poor feeding; central nervous system disturbances, such as irritability, hypertonicity, high-pitched cry, and exaggerated reflexes; and metabolic/respiratory disturbances, such as sneezing, tachypnea, and fever. Infants with hypoglycemia may exhibit irritability, jitteriness, hypotonia, hypothermia, and seizures but do not sneeze. Signs of sepsis typically manifest within 12 hours of birth. Infants with neonatal sepsis commonly present with irritability, apnea, respiratory distress, and lethargy, with hypothermia more common than hyperthermia.

Even with appropriate neonatal prophylaxis, breast-feeding poses additional risks for infants whose mothers test positive for: A:human immunodeficiency virus (HIV). B:hepatitis B surface antigen (HBsAg). C:both HBsAg and HIV. D:neither HBsAg nor HIV.

Correct:A Human immunodeficiency virus (HIV) has been isolated from breast milk and can be transmitted through breast-feeding. In the United States HIV-infected women should be counseled not to breast-feed even if neonatal prophylaxis is given.

Which of the following is true of an autosomal-dominant disorder? A:There is a 25% chance with each pregnancy of having an affected offspring. B:There is a 50% chance with each pregnancy of having an affected offspring. C:Only female offspring are affected. D:Only male offspring are affected.

Correct:B A dominant disorder requires only one gene to be present to be expressed. In an autosomal-dominant disorder, males and females are affected equally, and there is a 50% chance with each pregnancy that the offspring will be affected.

A sequence is defined as a(n): A:nonrandom occurrence of multiple anomalies. B:set of anomalies that arises when a primary event or anomaly gives rise to a pattern of other events or anomalies. C:abnormality of morphogenesis caused by intrinsic problems within developing structures. D:abnormality of morphogenesis caused by disruptive forces acting on the developing structure.

Correct:B A sequence is a group of anomalies resulting from a cascade of events initiated by a single malformation. Pierre Robin is an example of a sequence. The initial event in Pierre Robin sequence is mandibular hypoplasia, which occurs between the seventh and eleventh weeks of gestation. The tongue is held high in the oral cavity, which causes a cleft in the palate by preventing closure of the palatal shelves.

A 3-month-old, former 24-week infant is scheduled for a voiding cystourethrogram. The nurse should include which of the following information statements in the parent education plan? A:This procedure is diagnostic for multicystic kidney disease. B:Results of the study will determine need for daily antibiotic prophylaxis. C:A nasogastric tube will be inserted for the administration of radiopaque dye. D:This procedure will require general anesthesia.

Correct:B A voiding cystourethrogram (VCUG) will evaluate for the presence of vesicoureteral reflux (VUR). If VUR is noted on VCUG, then prolonged antibiotic prophylaxis may be necessary to prevent urinary tract infections.

During evaluation of an infant's ears, the nurse notes a small pit anterior to the tragus. What is the best explanation for this finding? A:A normal variant that has no associated risks to the newborn B:A minor malformation that may communicate with the internal ear or brain and lead to infection C:A significant finding that is strongly associated with chromosomal anomalies D:A significant finding that is associated with hearing loss

Correct:B Preauricular skin pits are minor malformations that may be familial or associated with other anomalies. The sinus may end in a blind pouch or communicate with the inner ear or brain and can lead to chronic infection, in which case the sinus tract would need to be removed.

A neonate is admitted with a history of umbilical cord prolapse and emergent cesarean section. Which of the following findings should the nurse anticipate given this delivery history? A:Apgar scores of 8 and 9 at 1 and 5 minutes, respectively B:Arterial pH 7.15 with base deficit -10 C:Lactate level of 1.4 mmol/L D:Hemoglobin 15.8 g/dl and hematocrit 51%

Correct:B Arterial pH 7.15 with base deficit -10 is consistent with umbilical cord prolapse when the umbilical cord presents before the fetal presenting part. Fetal decelerations due to cord compression often accompany umbilical cord prolapse. These infants typically have prolonged bradycardia with severe variable decelerations and are at high risk of fetal asphyxia. Approximately one third of infants with umbilical cord prolapse had Apgars less than 7 at 5 minutes of life. Umbilical cord prolapse and the subsequent compression of the cord lead to respiratory acidosis and, if prolonged, anaerobic metabolism. The resulting blood gas is likely to demonstrate a mixed respiratory and metabolic acidosis. Hgb and Hct levels are not significantly affected, given the absence of a hemorrhagic event. Lactate levels will also be elevated in the case of a prolapsed cord and asphyxia.

A pregnant woman asks the nurse, "What is the most practical method for me to prevent getting a cytomegalovirus infection while I'm pregnant?" What should the nurse tell the pregnant woman? A:She should avoid contact with cat feces by wearing gloves to empty the litter box. B:Avoiding exposure is virtually impossible. C:She should avoid eating raw/undercooked meat. D:She should avoid contact with anyone exhibiting symptoms consistent with an influenzalike illness.

Correct:B Avoiding exposure to cytomegalovirus (CMV) is virtually impossible because the virus is ubiquitous and infectious people are usually asymptomatic.

During fetal development, the structure that will eventually give rise to the vas deferens in the presence of testosterone is the: A:metanephros. B:mesonephros. C:pronephros. D:macronephros.

Correct:B By the end of the second month of gestation, most portions of the mesonephros disappear. However, a few caudal tubules remain in close proximity to the testis and ovaries, developing into the vas deferens in males and remaining as remnant tissue in females.

The parents of an infant with cystic fibrosis ask the nurse if their future offspring could also have this disorder. What is the nurse's best response? A:Because cystic fibrosis is an autosomal-dominant condition, there is a 50% chance with each pregnancy of having another affected offspring. B:Because cystic fibrosis is an autosomal-recessive condition, there is a 25% chance with each pregnancy of having another affected offspring. C:Cystic fibrosis is caused by a chromosomal microdeletion, and no future offspring will have this disorder. D:Cystic fibrosis is an X-linked recessive disorder, and only future male offspring will have this disorder.

Correct:B Cystic fibrosis is an autosomal-recessive condition, which carries a 25% chance with each pregnancy of having an affected offspring. The risk of inheriting this condition is gender neutral.

During electronic fetal monitoring, the fetal heart rate slows with the initiation of a contraction, but returns to baseline as the contraction ends. Which of the following is the correct interpretation by the nurse of this tracing? A:Nonreassuring fetal heart rate B:Vagal response to head compression C:Late deceleration D:Umbilical cord compression

Correct:B Early decelerations occur in conjunction with uterine contractions and have a uniform pattern with gradual deceleration and return to baseline: the increased intracranial pressure causes vagal nerve stimulation resulting in fetal bradycardia.

A 40-week, 4.5-kilogram infant was born via vaginal delivery with forceps assist. On examination, the infant has an internally rotated right arm with a pronated wrist and does not move the right arm. The nurse should consider these finding are most characteristic of: A:Klumpke palsy. B:Erb-Duchenne palsy. C:clavicle fracture. D:humerus fracture.

Correct:B Erb-Duchenne palsy results from excessive traction and stretching of the brachial plexus nerves. These infants present with an internally rotated arm and a pronated, flexed wrist and typically have an absent Moro reflex.

Which of the following is true when considering erythema toxicum? A:Erythema toxicum appears as yellow or pearly white papules on the brow, cheeks, and nose. B:Erythema toxicum has an erythematous base and can behave transiently, appearing on the face, trunk, and limbs. C:Erythema toxicum presents as generalized white or yellow pustules in infants up to 3 months of age. D:Erythema toxicum occurs most commonly in infants with trisomies 18 and 21.

Correct:B Erythema toxicum is characterized by pustules with an erythematous base, said to be caused by histamine release. The pustules can come and go on varying sites of the body, including the face, trunk, and limbs, but are never visualized on the palms of the hands or the soles of the feet.

A 1500-gram preterm infant born to a hepatitis B surface antigen-negative mother should receive the initial dose of hepatitis B vaccine at: A:2000 grams or at hospital discharge (whichever is first). B:1 month of age or at hospital discharge (whichever is first). C:37 weeks postmenstrual age. D: birth

Correct:B For infants weighing less than 2000 grams, the initial dose of hepatitis B vaccine should be delayed until 1 month of age or hospital discharge, whichever is first, because of suboptimal immune response in some preterm infants. The exception is when hospital discharge occurs in less than 1 month of age, in which case, the vaccine should be given at discharge.

The most common renal congenital abnormality detected on prenatal ultrasound is: A:renal agenesis. B:hydronephrosis. C:patent urachus. D:hypospadias.

Correct:B Hydronephrosis is the most common congenital abnormality detected on prenatal ultrasound: 1% to 5% of all pregnancies.

Considering the extremely low-birth-weight infant's fluid status, the nurse considers which of the following interventions as most appropriate in providing skin care? A:Incubator humidity should be kept at 80% to 90% during the first 2 weeks of life. B:Incubator humidity should be kept at 70% to 90% for the first 7 days of life and then decreased to 50% on day of life 8. C:Humidity should be avoided because the preterm infant has a greater proportion of extracellular fluid than intracellular fluid, and humidity can precede fluid overload. D:Humidity should be kept at 80% during the first 2 weeks of life, after which it can be decreased, unless the infant is under phototherapy.

Correct:B Incubator humidity should be kept between 70% and 90% for the first week in order to reduce insensible water loss in the extremely low-birth-weight infant (ELBW). Incubator humidity should be kept between 70% and 90% for the first week in order to reduce insensible water loss in the extremely low-birth-weight infant (ELBW). Thereafter, it is reasonable to gradually reduce the humidity to 50%.

Seizure disorders during pregnancy should be managed with monotherapy antiepileptic drugs (AEDs) when possible. The neonatal caregiver knows that AEDs: A:are not known to have a teratogenic effect. B:are associated with low levels of maternal folate, increasing the risk of neural tube defects. C:must be administered concurrently for synergy. D:should be dosed at the high end of the therapeutic range.

Correct:B Pregnant women should receive the smallest dose of antiepileptic drugs (AEDs) to effectively control the seizures and should be managed with monotherapy whenever possible to avoid the risk of tetragenicity. Congenital malformations often seen with AED use during pregnancy include neural tube defects, heart disease, limb anomalies, intestinal atresias, and cleft lip and palate. Many AEDs, particularly valproic acid and carbamazepine, are associated with low maternal folate levels and pose a significant risk for neural tube defects in the fetus.

A mother is admitted for hypertension, proteinuria, and a headache at 32 weeks' gestation. Shortly after admission, she progresses to eclampsia. The nurse should anticipate that the definitive treatment for this condition is: A:continuance of pregnancy until labor occurs. B:immediate delivery of the fetus. C:administration of antiepileptic medications. D:administration of steroids.

Correct:B The development of seizures in the setting of preeclampsia is termed eclampsia when all other causes of seizure have been ruled out. In the setting of preeclampsia in an otherwise stable mother, expectant management may be considered if less than 32 weeks' gestation. Mothers with preeclampsia who present before 34 weeks' gestation should be given antihypertensive medications for blood pressure control, magnesium sulfate for seizure prophylaxis and fetal neuroprotection, and betamethasone for fetal lung maturation. However, immediate delivery should occur with any maternal or fetal deterioration such as eclampsia.

What should the nurse anticipate when caring for an infant whose mother had been exposed to Toxoplasma gondii in the first trimester of her pregnancy? A:Observe the infant for periorbital edema and purulent eye discharge. B:Monitor for seizure activity, prepare for head computed tomography and eye examination. C:Observe the infant for cataracts. D:Start prophylactic phototherapy.

Correct:B The evaluation of an infant with suspect congenital toxoplasmosis should include a review of maternal history and serology; a complete physical examination; Toxoplasma gondii serology; and evaluation for ophthalmologic, neurologic, and other manifestations that may not be evident upon cursory physical examination. Chorioretinitis may be the only finding, and is evident upon an ophthalmologic examination. Neurologic testing would include a lumbar puncture and a head computed tomograph (CT), the former to test for elevated cerebrospinal fluid (CSF) protein and/or mononuclear CSF pleocytosis. One can also test for Toxoplasma-specific IgM in the CSF or isolation of T. gondii from the CSF. A head CT would be performed in lieu of a brain magnetic resonance imaging (MRI) or head ultrasound to test for the presence of hydrocephalus or focal brain lesions, because a CT is less costly than an MRI and can be done without sedation, and is better at visualizing small calcified lesions than an ultrasound. The nurse should also observe the infant for potential seizure activity, as such has been found to occur in roughly 41% of relevant cases. The most common clinical manifestation of congenital T. gondii is chorioretinitis, which is typically evident upon ophthalmologic examination.

The main structures of the nephron from proximal to distal are: A:distal convoluted tubule, glomerulus, and ascending and descending loop of Henle. B:glomerulus, descending and ascending loop of Henle, and distal convoluted tubule. C:glomerulus, distal convoluted tubule, and ascending and descending loop of Henle. D:descending and ascending loop of Henle, glomerulus, and distal convoluted tubule.

Correct:B The nephron consists of a glomerulus, descending and ascending loops of Henle, and distal convoluted tubule.

A term infant is delivered via vacuum extraction. Within a few hours of birth, the infant is noted to have respiratory distress, pallor, and increasing head circumference. The nurse should anticipate this clinical presentation to be most consistent with: A:surfactant deficiency. B:subgaleal hemorrhage. C:hypoxic-ischemic encephalopathy. D:caput succedaneum.

Correct:B The traction associated with vacuum extraction results in severing of the blood vessels within the subgaleal space. This space can accommodate large volumes of blood; therefore the infant is at risk for massive hemorrhaging and death. Infants with subgaleal hemorrhage often present with diffuse scalp swelling, a fluctuant mass, hypotonia, and pallor.

Which of the following is the best predictor of the occurrence of preterm labor? A:Creasy risk scoring system B:Prior preterm delivery C:Short cervical length D:Fetal fibronectin

Correct:B Women with cervical length less than 25 millimeters are at risk of preterm labor. The Creasy risk scoring system has demonstrated low predictive value and a wide range of accuracy. A short cervical length in addition to positive fetal fibronectin conferred a 16.7% chance of preterm delivery. Fetal fibronectin is a protein found in the extracellular matrix between the chorion and the decidua. This membrane separates with the rupture of membranes before delivery. History of prior preterm delivery has been associated with a 3.3-fold increase in preterm delivery and a 13.5-fold risk of delivery before 28 weeks. Although all are associated with preterm labor, history of preterm delivery is the strongest predictor of prematurity.

What is the indicated intervention(s) for an asymptomatic 38-week-gestation infant who was born to a mother diagnosed with chorioamnionitis? A:Blood culture, complete blood count (CBC) with differential and platelet count, lumbar puncture, antibiotic therapy B:Observation for ≥48 hours C:Blood culture, CBC with differential and platelet count, antibiotic therapy D:Blood culture, CBC with differential and platelet count, observation for ≥48 hours

Correct:C A limited evaluation blood culture at birth and complete blood count with differential and platelets at birth, 6 to 12 hours of life, or both and antibiotic therapy is the recommended management for asymptomatic infants when maternal chorioamnionitis is diagnosed clinically.

A 14-day-old term infant is noted upon nursing assessment to have an intact and moist umbilical cord. The nurse should perform which of the following actions? A:Keep the umbilical area open to air by folding down the diaper. B:Apply silver nitrate to the cord area. C:Notify the physician of this finding. D:Swab the cord with alcohol with each diaper change.

Correct:C A moist umbilicus at 2 weeks of age despite appropriate cord care is not a normal finding and warrants physician evaluation for patent urachus

Maternal administration of betamethasone improves fetal lung maturity and reduces the risk of surfactant deficiency by which of the following mechanisms? A:Increased placental blood flow to the fetal lungs B:Down regulation of cellular sodium channels to prompt removal of fetal lung fluid C:Stimulation of type 2 pneumocytes to improve surfactant synthesis D:Inhibition of adenosine receptors to increase respiratory responsiveness

Correct:C By the end of the canalicular stage of pulmonary development, the bronchial tree is completely formed and immature type II pneumocytes capable of surfactant synthesis begin to appear. Steroids accelerate the normal pattern of lung growth which leads to thinning of the intra-alveolar septa and increases the size of the alveoli. The number of surfactant producing type II pneumocytes increases and results in increased synthesis of surfactant phosopholipids. Surfactant production increases to term gestation; therefore infants born before term gestation are at risk of respiratory distress due to surfactant deficiency.

An infant is born to a 20 year old, primigravida mother with a history of cocaine use and cigarette smoking. Hypovolemia is noted after delivery. The nurse should anticipate this clinical presentation to be most consistent with which of the following maternal placental conditions? A:Placenta previa B:Placenta accreta C:Placental abruption D:Circumvallate placenta

Correct:C Cocaine use and cigarette smoking are two risk factors commonly associated with placenta abruption as a result of a hypertensive state. Hypovolemia is a known neonatal complication of placenta abruption due to acute blood loss at the time of delivery.

A 37-week-gestational-age infant is born with hydrocephalus, diffuse generalized intracranial calcifications, and chorioretinitis. What congenital infection is associated with these clinical findings? A:Herpes infection B:Rubella C:Toxoplasmosis D:Cytomegalovirus infection

Correct:C Hydrocephalus with generalized calcifications and chorioretinitis are clinical findings suggestive of congenital toxoplasmosis.

Which immunoglobulin (Ig) crosses the placenta in significant amounts? A:IgA B:IgE C:IgG D:IgM

Correct:C Immunoglobulin G (IgG) placental transport begins during fetal development, and the term infant has a complete store of maternal IgG antibodies, which protects the newborn from many infections during the first months of life.

Which of the following clinical factors is associated with a decreased total neutrophil count? A:Birth stress B:Neonatal seizures C:Maternal hypertension D:Uncomplicated respiratory distress syndrome

Correct:C Maternal hypertension is associated with decreased total neutrophil counts. The cause is uncertain.

A 36-week infant is born to a mother with known systemic lupus erythematosus. After delivery, the infant has the following vital signs: temperature 36.7° C (98° F), heart rate 64, respiratory rate 58, blood pressure 65/38, O2 saturation 98%. Capillary refill is less than 2 seconds. What is the most appropriate response by the nurse? A:Provide positive pressure ventilation followed by intubation. B:Obtain order for chest radiograph. C:Obtain stat electrocardiogram. D:Place an emergent umbilical venous catheter and administer epinephrine.

Correct:C Maternal systemic lupus erythematosus has been associated with neonatal congenital heart block. Infants with neonatal lupus should receive an electrocardiogram at birth.

Which of the following statements regarding the use of C-reactive protein (CRP) as a marker for neonatal sepsis is most accurate? A:CRP levels have higher sensitivity and negative predictive values if the infant's gestational age is at least 37 weeks. B:CRP response is better in coagulase-negative Staphylococcus than gram-negative infections. C:Serial CRP measurements may improve sensitivity and positive predictive value. D:Sensitivity is highest when the CRP is obtained within 6 to 8 hours of the infective process.

Correct:C Serial C-reactive protein (CRP) measurements at 24 and 48 hours improve sensitivity to 82% to 84% and improve positive predictive value to 83% to 100%. Serial measurements may be helpful in monitoring resolution of infection and guiding antibiotic therapy.

A mother is admitted for bright red, painless vaginal bleeding at 32 weeks gestation. The nurse should anticipate which of the following as expected treatment? A:Serial vaginal examinations B:Vaginal birth if placenta 1 cm from cervical os C:Serial fetal ultrasounds D:Few activity restrictions

Correct:C Serial fetal ultrasounds are needed to confirm diagnosis of placenta previa, rule out IUGR and monitor fetal growth. No vaginal examinations should be performed with could precipitate bleeding. Activity restrictions will be determined by clinical presentation but avoidance of intercourse or orgasm which can cause uterine contractions is necessary. Vaginal birth can be planned if the placenta is greater than 2-3 cms from the cervical os

A set of monochorionic twins is admitted with a history of twin-to-twin transfusion. The nurse should be aware that this syndrome is most commonly associated with which of the following? A:Recipient twin who presents with anemia B:Donor twin who presents with plethora C:Donor twin who is small for gestational age D:Recipient twin who is small for gestational age

Correct:C The donor twin presents with oligohydramnios and smaller crown-rump length and abdominal circumference, whereas the recipient twin often manifests with polyhydramnios and larger growth parameters.

Which of the following statements about respiratory syncytial virus (RSV) is generally true? A:RSV usually occurs in the spring and summer. B:Infection is by noncontact mode of transmission (eg, airborne or vehicle). C:Prophylaxis with palivizumab decreases the risk of severe RSV disease and hospitalization. D:Palivizumab is effective as a control measure for hospital outbreaks of RSV infection.

Correct:C The risk of severe respiratory syncytial virus (RSV) disease and hospitalization is reduced by approximately 50% when prophylaxis with palivizumab is given.

The nurse should be aware that the highest rate of blood flow to the kidneys occurs within which of the following time frames? A:23 weeks' gestation B:36 weeks' gestation C:1 hour after delivery D:2 weeks of life

Correct:C There is high vascular resistance in the kidneys in utero. Renal blood flow increases gradually throughout gestation, and there is a dramatic increase immediately after birth. Renal blood flow does not reach adult levels until 2 years of age.

A newborn infant presents with hepatomegaly and cataracts, with noted petechiae and purpuric lesions on the trunk and extremities. A screening complete blood count shows an elevated white blood count but is otherwise unremarkable. What is the most likely cause of these skin lesions? A:Underlying thrombocytopenia B:Fulminant sepsis C:Dermal hematopoiesis D:Variant presentation of café-au-lait spots consistent with a genetic disorder

Correct:C These lesions are often described as "blueberry muffin" spots, or dermal hematopoiesis, and occur when the skin is called upon to perform blood cell production, which can occur in instances of congenital viral infections, typically rubella, but also cytomegalovirus, toxoplasmosis, syphilis, and herpes. Associated symptoms can include growth restriction, cataracts, jaundice, hepatosplenomegaly, and thrombocytopenia.

A nurse notes the presence of a chordee on the admission physical examination of a term newborn male. This finding most likely indicates: A:cryptorchidism. B:hydrocele. C:hypospadias. D:ambiguous genitalia.

Correct:C Three anomalies typically found with hypospadias are ectopic opening of the urethral meatus, chordee, and hooded foreskin.

A 35-week male infant is delivered via cesarean section due to maternal complications of hypertension and proteinuria. On routine labs at 24 hours of life, the infant is noted to have thrombocytopenia. The nurse should consider this finding to be most likely the result of: A:fungal infection. B:disseminated intravascular coagulopathy. C:maternal preeclampsia. D:bacterial infection.

Correct:C Thrombocytopenia is characterized by a platelet count less than 150,000 per microliter. Maternal preeclampsia leads to placental insufficiency and exposes the fetus to chronic hypoxia. The fetal response to chronic hypoxia is increased erythropoiesis, which is thought to suppress platelet production. Neonatal thrombocytopenia related to maternal hypertensive disorders is typically mild, reaches nadir at 4 to 7 days, and resolves spontaneously by 10 to 14 days. Thrombocytopenia may be associated with fungal infection, particularly Candida spp., disseminated intravascular coagulation, and hemorrhage; however, the thrombocytopenia is more likely to be late-onset thrombocytopenia, occurring after 72 hours of life.

Which of the following interventions is mandatory for an infant suspected of having congenital syphilis? A:Long-bone x-ray examination B:Cranial ultrasound C:Venereal disease research laboratory tests on cerebrospinal fluid D:Fluorescent treponemal-antibody absorption immunoglobulin M (IgM)

Correct:C Venereal disease research laboratory (VDRL) testing on cerebrospinal fluid is mandatory in all infants suspected of congenital syphilis because treatment regimens differ depending on whether or not there is central nervous system involvement.

A mother questions the nurse as to the purpose of a fetal biophysical profile (BPP). Which of the following statements is the most appropriate response by the nurse? A:A score of 10/10 indicates significant fetal asphyxia. B:It is an invasive procedure that requires anesthesia. C:The BPP profile reflects fetal response to uterine contractions during labor. D:It provides information on fetal tone, breathing, movement, heart rate patterns, and amniotic fluid level.

Correct:D A biophysical profile (BPP) is a noninvasive test, which uses ultrasonography to assess fetal movement, fetal breathing, fetal tone, and amniotic fluid levels over a 30-minute period. These variables are then combined with a nonstress test. Each variable is scored with either a 0, indicating not present, or a 2, indicating a normal response. Thus the BPP is reported on a scale of 0 to 10. A score greater than or equal to 8 is associated with fetal well-being, whereas a score less than or equal to 4 is concerning for fetal asphyxia. Delivery is recommended for scores less than or equal to 4. Electronic fetal monitoring is used to evaluate fetal response in relate to uterine contractions

Which of the following abnormalities is associated with an autosomal-dominant inheritance pattern? A:Turner syndrome B:Sickle cell anemia C:Hemophilia D:Osteogenesis imperfecta

Correct:D Autosomal-dominant disorders are disorders that require only one gene to be present in order to be expressed. Six types of osteogenesis imperfecta have been described, five of which are autosomal dominant.

An adult quantity of nephrons is achieved by how many weeks of gestational age? A:10 B:14 C:24 D:34

Correct:D By 34 weeks' gestation nephrogenesis is complete and each kidney contains 800,000 to 1,200,000 nephrons.

What is the organism most commonly responsible for nosocomial bloodstream infection in NICU patients? A:Enterococcus B:Group B streptococci C:Staphylococcus aureus D:Coagulase-negative staphylococci

Correct:D Coagulase-negative staphylococci are the organisms that most commonly cause nosocomial infections in the NICU, accounting for approximately 50% of bloodstream infections.

A newborn infant is diagnosed with cutis aplasia. The nurse knows that this condition: A:is associated with infants with trisomy 18 and cleft lip and palate. B:presents with hard, thick, gray or yellow scales that cause deformities of the skeletal and soft tissues. C:is infectious in origin. D:will heal slowly over several months, leaving atrophic or hypertrophic scar tissue.

Correct:D Cutis aplasia refers to the congenital absence of skin. It can have a varying presentation, as a midline, posterior scalp, or upper or lower extremity defect. These lesions heal slowly over a matter of months, leaving scarring.

Which of the following should be performed to confirm a diagnosis of DiGeorge syndrome? A:Rectal biopsy B:Electrocardiography C:Oxygen challenge test D:Fluorescence in situ hybridization chromosomal analysis

Correct:D DiGeorge syndrome is one of several velocardiofacial syndromes caused by a deletion in chromosome band 22q11. Fluorescence in situ hybridization is a genetic testing method used to detect microdeletions on chromosomes.

A 34-week-gestation infant is found to have anemia and hyperbilirubinemia at 12 hours of life. The infant is direct antibody positive. Which condition should the nurse consider as the most likely the etiology of these findings? A:Physiologic jaundice B:Vitamin K deficiency C:Cephalohematoma D:Rh isoimmunization

Correct:D Due to immature hepatic function, physiologic jaundice in preterm infants should be closely monitored. Physiologic jaundice in preterm infants peaks between 10 and 12 mg/dl on the fifth day of life. There are a number of causes of pathologic unconjugated hyperbilirubinemia, with Rh isoimmunization being one of the more common causes. Rh isoimmunization results when fetal erythrocytes carry different antigens than maternal erythrocytes. The maternal immune system reacts against the foreign antigen and produces IgG antibodies, which bind to and then subsequently destroy the fetal erythrocyte. Infants with Rh incompatibility present with jaundice within a few hours of birth and pallor due to the destruction of fetal erythrocytes. Common laboratory findings with Rh isoimmunization include anemia, reticulocytosis, and a positive direct antiglobulin test. Infants have limited vitamin K stores at birth and are at high risk of bleeding because vitamin K plays a key role in the production of coagulation factors. Vitamin K deficiency often presents with abnormal bleeding, particularly from the gastrointestinal tract, the umbilical stump, or after circumcision. Cephalohematoma often develops slowly and does not extend across suture lines. The infant may develop anemia and hyperbilirubinema if the hemorrhage is severe, but cephalohematoma typically resolves without any treatment.

Chromosomal analysis of an infant has revealed a 47,XXY karyotype. This is defined as Klinefelter syndrome. This multifactorial disease is related to which of the following? A:Advanced parental age, monosomy, and paternal meiosis errors B:Advanced maternal age, monosomy, and maternal meiosis errors C:Advanced maternal age, partial trisomy, and paternal meiosis errors D:Advanced maternal age, parental nondisruption errors, and maternal meiosis errors

Correct:D Klinefelter syndrome is a genetic disorder related to several factors, including advanced maternal age, parental nondisruption errors, maternal meiosis errors, and production of XY sperm by older fathers. All of these factors increase the risk of the disease.

What strategy is effective for preventing influenza in newborns? A:Inactivated influenza vaccine B:Antiviral chemoprophylaxis C:Live attenuated influenza vaccine D:Maternal immunity

Correct:D Maternal immunity is the only effective means to prevent influenza in newborns because the vaccine is not approved for use in infants younger than 6 months.

During intrapartum monitoring, a woman is noted to have the following vital signs: heart rate 110, respiratory rate 16, SpO2 99%, blood pressure 126/84, temperature 38.5° C (101.3° F) and reports uterine tenderness. The nurse should recognize this as indicative of which of the following? A:Placental abruption B:Placenta previa C:Umbilical cord prolapse D:Chorioamnionitis

Correct:D Mothers with chorioamnionitis present with fever >100.4° F, tachycardia >100 beats per minute, and uterine tenderness. Foul-smelling amniotic fluid and leukocytosis may also be present. Placental abruption may present with uterine tenderness, but vaginal bleeding is also present. Placenta previa occurs when the placenta is covering the cervical opening. The symptoms are painless bleeding in the absence of uterine tenderness. Umbilical cord prolapse occurs when the umbilical cord presents alongside or before the fetal presenting part. Umbilical cord prolapse is not associated with infection, but rather fetal hypoxia.

A former 24-week-gestation infant now corrected to 34 weeks gestational age has recently been diagnosed with nephrocalcinosis. Which of the following information statements should the nurse share with the parents? A:This is relatively common in infants who have received long-term courses of thiazide diuretics. B:This will require surgical intervention to correct. C:The condition is most likely related to increased magnesium intake. D:This is common in infants who have received long-term courses of loop diuretics.

Correct:D Nephrocalcinosis occurs in neonates secondary to high urinary calcium excretion from chronic treatment with loop diuretics.

Which of the following measures is the most effective in preventing nosocomial infections in preterm infants? A:Avoiding overcrowding in the NICU B:Cohorting C:Limiting parent and sibling visits D:Proper hand hygiene

Correct:D Studies demonstrate that proper hand hygiene before and after each patient contact is the single most effective means of preventing nosocomial infections. In addition to hand washing, alcohol-based disinfectants are effective for use before and after patient contact.

After instillation of mydriatic eye drops, which of the following interventions should the nurse implement to reduce systemic absorption of the medication? A:Cover eyes with eye shields. B:Turn head to the ipsilateral side. C:Apply a cool compress over eyes. D:Apply gentle pressure to the nasolacrimal duct for 1 minute.

Correct:D Systemic absorption of mydriatic eye drops can lead to tachycardia and restlessness. Wiping away excess eye drops and applying gentle pressure over the nasolacrimal duct will minimize systemic absorption.

The parents of an infant with an isolated cardiac defect ask the nurse if either of them caused their baby to have this anomaly. The best response is based on which of the following? A:There is no genetic basis or inheritance pattern for cardiac defects. B:Most cardiac defects are inherited from paternal genes. C:Most cardiac defects are inherited from maternal genes. D:The etiology of congenital heart defects is considered multifactorial.

Correct:D The exact cause of most cardiac defects is unknown and believed to be due to a complex interaction between genetic and environmental factors.

Which of the following sets of hematologic values best predicts infection in a 1-hour-old term neonate? A:WBCs 8.25 × 103/mm3; segs 52%; bands 12% B:WBCs 6.1 × 103/mm3; segs 32%; bands 4% C:WBCs 15 × 103/mm3; segs 17%; bands 3% D:WBCs 4.7 × 103/mm3; segs 27%; bands 8%

Correct:D The lower limit of the total neutrophil count is 1750/mm3 at birth and rises to 7200/mm3 by 12 hours of age. It then declines to approximately 1720/mm3 by 72 hours of age. The absolute neutrophil count (ANC) and immature neutrophils to total neutrophils (I/T ratio) are useful neutrophil indices in the diagnosis of neonatal sepsis. Values suggestive of infection include the following:

Which of the following antimicrobials is contraindicated for use in newborns? A:Ticarcillin (Ticar) B:Amikacin (Amikin) C:Ceftazidime (Fortaz) D:Sulfonamides (eg, Bactrim)

Correct:D The use of sulfonamides, such as sulfamethoxazole/trimethoprim, is contraindicated in newborns because these agents displace bilirubin from albumin-binding sites.