ch6 OB (normal newborn)

The nurse is assessing a newborn on admission to the newborn nursery. Which of the following findings should the nurse report to the PHP? 1. Intracostal retractions. 2. Caput succedaneum. 3. Epstein's pearls. 4. Harlequin sign.

1. Intracostal retractions are a sign of respiratory distress.

A 4-day-old breastfeeding neonate whose birth weight was 2,678 grams has lost 100 grams since the cesarean birth. Which of the following actions should the nurse take? 1. Nothing because this is an acceptable weight loss. 2. Advise the mother to supplement feedings with formula. 3. Notify the neonatologist of the excessive weight loss. 4. Give the baby dextrose water between breast feedings.

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A mother, who gave birth 5 minutes ago, states that she would like to breastfeed. The baby's Apgar score is 9/9. Which of the following actions should the nurse perform first? 1. Assist the woman to breastfeed. 2. Dress the baby in a shirt and diaper. 3. Administer the ophthalmic prophylaxis. 4. Take the baby's rectal temperature.

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A nurse has brought a 2-hour-old baby to a mother from the nursery. The nurse is going to assist the mother with the first breastfeeding experience. Which of the following actions should the nurse perform first? 1. Compare mother's and baby's identification bracelets. 2. Help the mother into a comfortable position. 3. Teach the mother about a proper breast latch. 4. Tickle the baby's lips with the mother's nipple.

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Four pregnant women advise the nurse that they wish to breastfeed their babies. Which of the mothers should be advised to bottle feed her child? 1. The woman with a neoplasm requiring chemotherapy. 2. The woman with cholecystitis requiring surgery. 3. The woman with a concussion. 4. The woman with thrombosis.

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The nurse does not hear the baby swallow when suckling even though the baby appears to be latched properly to the breast. Which of the following situations may be the reason for this observation? 1. The mother reports a pain level of 4 on a 5-point scale. 2. The baby has been suckling for over 10 minutes. 3. The mother uses the cross-cradle hold while feeding. 4. The baby lies with the chin touching the under part of the breast.

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The nurse is providing anticipatory guidance to a formula feeding mother who is concerned about how much formula she should offer her newborn infant at each feeding. the nurse would know that teaching was effective when the mother makes which of the following statements? 1. I should expect my baby to drink about 3 ounces of formula every 3 hours or so 2. At the end of each pediatric appointment, the provider will tell me how much formula to feed my baby 3. By the time we go home from the hospital, I should expect him to drink at least 4 ounces per feeding 4. I should give my baby enough formula to make him sleep for 4 hours between feedings

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The nurse is conducting a state-mandated evaluation of a neonate's hearing. Infants are assessed for deficits because hearing-impaired babies are high risk for which of the following? 1. Delayed speech development. 2. Otitis externa. 3. Poor parental bonding. 4. Choanal atresia.

1 Babies learn to speak by imitatingthe speech of others in their environ- ment. If they are hearing impaired, there is a likelihood of delayed speech development

A 2-day-postpartum breastfeeding client is complaining of pain during feedings. Which of the following may be causing the pain? 1. The neonate's frenulum is attached to the tip of the tongue. 2. The baby's tongue forms a trough around the breast during the feedings. 3. The newborn's feeds last for 30 minutes every 2 hours. 4. The baby is latched to the nipple and to about 1 inch of the mother's areola.

1 Babies with short frenulums—tongue- tied babies—are unable to extend their tongues enough to achieve a suf- ficient grasp. Painful and damaged nipples often result.

A client is preparing to breastfeed her newborn son in the cross-cradle position. Which of the following actions should the woman make? 1. Place a pillow in her lap. 2. Position the head of the baby in her elbow. 3. Put the baby on his back. 4. Move the breast toward the mouth of the baby.

1 Even if the nurse is un- familiar with the cross-cradle position, making sure that the baby is at the level of the breast is one of the important principles for successfully breastfeeding a neonate. In addition, "tummy-to- tummy" positioning and having the baby brought to the mother rather than vice versa are also important. Plus, if the nurse had confused the cradle position with the cross-cradle position, it is rec- ommended that, when feeding in the cra- dle position, the baby's head be placed on the mother's forearm, not in the antecu- bital fossa

The nursing diagnosis-risk for suffocation-is included in a standard care plan in the neonatal nursery. which of the following outcome goals should be included in relation to this diagnosis? 1. baby is place supine for sleep 2. breastfed in side-lying position 3. swaddled when in the open crib 4. baby is strapped when seated in car seat

1 It has been shown that many neonatal SIDS deaths result from a form of suffocation. Babies breathe in their own exhaled carbon dioxide when they are placed prone for sleep. Ba- bies should be placed supine

Four babies with the following conditions are in the well-baby nursery. The baby with which of the conditions is high risk for physiological jaundice? 1. Cephalhematoma. 2. Caput succedaneum. 3. Harlequin coloring. 4. Mongolian spotting.

1 Red blood cells in the cephalhematoma will have to be broken down and excreted. The byproduct of the destruction—bilirubin—increases the baby's risk for physiological jaundice

A nurse reads that the neonatal mortality rate in the United States for a given year was 5. The nurse interprets that information as: 1. 5 babies less than 28 days old per 1,000 live births died. 2. 5 babies less than 1 year old per 1,000 live births died. 3. 5 babies less than 28 days old per 100,000 births died. 4. 5 babies less than 1 year old per 100,000 births died.

1 The neonatal period is defined as the first 28 days of life. The neonatal mortality rate is defined as neonatal deaths per 1000 live births. There- fore, 5 babies less than 28 days old per 1000 live births died

A client asks whether or not there are any foods that she must avoid eating while breastfeeding. Which of the following responses by the nurse is appropriate? 1. "No, there are no foods that are strictly contraindicated while breastfeeding." 2. "Yes, the same foods that were dangerous to eat during pregnancy should be avoided." 3. "Yes, foods like onions, cauliflower, broccoli, and cabbage make babies very colicky." 4. "Yes, spices from hot and spicy foods get into the milk and can bother your baby."

1 There are no foods that are absolutely contraindicated during lactation. Some babies may react to certain foods, but this must be determined on a case-by-case basis

A 2-day-old baby's blood values are: Blood type, O- (negative). Direct Coombs, negative. Hematocrit, 50%. Bilirubin, 1.5 mg/dL. The mother's blood type is A+. What should the nurse do at this time? 1. Do nothing because the results are within normal limits. 2. Assess the baby for opisthotonic posturing. 3. Administer RhoGAM to the mother per doctor's order. 4. Call the doctor for an order to place the baby under bili-lights.

1 These findings are all within normal limits. Blood incompatibilities are seen when the mother is Rh negative and the baby is Rh positive or when the mother is type O and the baby is either type A or type B. When the baby is ei- ther Rh negative or type O, there is ac- tually a reduced risk that pathological jaundice will result

A nurse is providing anticipatory guidance to a couple regarding the baby's immunization schedule. Which of the following statements by the parents shows that the teaching by the nurse was successful? SATA 1. the first hepatitis B injection is given by 1 month of age 2. the first polio injection will be given at 2 months of age 3. the MMR immunization should be administered before the first birthday 4. Three DTaP shots will be given during the first year of life 5. the varicella immunization will be administered after the baby turns 1 year of age

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The nursing management of a neonate with physiological jaundice should be directed toward which of the following client care goals? 1. The baby will exhibit no signs of kernicterus. 2. The baby will not develop erythroblastosis fetalis. 3. The baby will have a bilirubin of 16 mg/dL or higher at discharge. 4. The baby will spend at least 20 hours per day under phototherapy.

1 When bilirubin levels elevate to toxic levels, babies can develop kernicterus(a type of brain damage that can result from high levels of bilirubin in a baby's blood) This question asks the test taker to identify a client care goal for a newborn with physiological jaundice. The client care goal reflects the nurse's desired patient care outcome. The devel- opment of kernicterus is a potential pathological outcome resulting from hy- perbilirubinemia. The client care goal, therefore, is that the neonate not de- velop kernicterus

A bottle feeding mother is providing a return demonstration of how to burp the baby. Which of the following would indicate that the teaching was successful? SATA 1. The woman gently strokes and pats her baby's back. 2. The woman positions the baby in a sitting position on her lap. 3. The woman waits to burp the baby until the baby's feeding is complete. 4. The woman states that a small amount of regurgitated formula is acceptable. 5. The woman remarks that the baby does not need to burp after trying for 1 full minute

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The parents and their full-term, breastfed neonate were discharged from the hospital. Which behavior 2 days later indicates a positive response by the parents to the nurse's discharge teaching? SATA 1. The parents count their baby's diapers 2. The parents measure the baby's intake. 3. The parents give one bottle of formula every day. 4. The parents take the baby to see the primary healthcare provider 5. The parents time the baby's feedings.

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A mother is attempting to latch her newborn baby to the breast. Which of the following actions by the mother require follow up and more education by the nurse to the mother? Select all that apply. 1. The mother places the baby on his or her back in the mother's lap and leans down, toward the baby 2. The mother holds the baby at the level of her breasts in a tummy-to-tummy position 3. the mother waits until the baby opens its mouth wide before attempting a latch 4. the mother points the baby's nose to her nipple 5. the mother waits until the baby's tongue is pointed towards the roof of its mouth before attempting a latch

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A female African American baby has been admitted into the nursery. Which of the following physiological findings would the nurse assess as normal? Select all that apply. 1. Purple-colored patches on the buttocks and torso. 2. Bilateral whitish discharge from the breasts. 3. Bloody discharge from the vagina. 4. Sharply demarcated dark red area on the face. 5. Deep hair-covered dimple at the base of the spine.

1, 2, and 3 are correct. 1. The patches are called mongolian spots and they are commonly seen in babies of color. They will fade and disappear with time. 2. The whitish discharge is called witch's milk and is excreted as a result of the drop in maternal hormones in the baby's system. The discharge is temporary. 3. The bloody discharge is called pseudomenses and occurs as a result of the drop in maternal hormones in the baby's system. The discharge is temporary.

A nurse is advising the parents of a newborn regarding when they should call their pediatrician. Which of the following responses show that the teaching was effective? Select all that apply. 1. If the baby repeatedly refuses to feed. 2. If the baby's breathing is irregular. 3. If the baby has no tears when he cries. 4. If the baby is repeatedly difficult to awaken. 5. If the baby's temperature is above 100.4°F (38)

1, 4, and 5 are correct. 1. Babies do not starve themselves. If a baby refuses to eat, it may mean that the baby is seriously ill. For example, babies with cardiac defects often refuse to eat. 2. Newborns normally breathe irregularly. Apnea spells of 10 seconds or less are normal. 3. Newborns do not tear when they cry. If a baby does tear, he or she may have a blocked lacrimal duct. 4. Although babies who are in the deep sleep state are difficult to arouse, the deep sleep state lasts no more thanan hour. If the baby continues to be nonarousable, the pediatrician should be notified. A temperature above 100.4°F is a febrile state for a newborn and the pediatrician should be notified.

A mother tells the nurse that, because of family history, she is afraid her baby son will develop colic. which of the following colic management strategies should the parents be taught? SATA 1. small, frequent feedings 2. prone sleep positiong 3. tightly swaddling the baby 4. rocking the baby while holding him face down on the forearm 5. maintaining a home environment that is cigarette smoke-free

1,3,4,5 Small, frequent feedings reduce the symptoms of colic in some babies. The prone sleep position is not recommended for babies under 1 year of age. Some babies' symptoms have de- creased when they were tightly swaddled. This is called the colic hold. The position does help to soothe some colicky neonates. Babies who live in an environment where adults smoke have a higher incidence of colic than babies who live in a smoke-free environment.

To reduce the risk of hypoglycemia in a full-term newborn weighing 2,900 grams, what should the nurse do? 1. Maintain the infant's temperature above 97.7°F. (36.5) 2. Feed the infant glucose water every 3 hours until breastfeeding well. 3. Assess blood glucose levels every 3 hours for the first 12 hours. 4. Encourage the mother to breastfeed every 4 hours.

1. Hypothermia in the neonate is defined as a temperature below 97.7°F. Cold stress syndrome may develop if the baby's temperature is below that level.

The nurse is teaching the parents of a female baby how to change the baby's diapers. Which of the following should be included in the teaching? 1. Always wipe the perineum from front to back. 2. Remove any vernix caseosa from the labial folds. 3. Put powder on the buttocks every time the baby stools. 4. Weigh every diaper to assess hydration status.

1. The perineum of female babies should always be cleansed from front to back to prevent bacteria from the rectum from causing infection.

A full-term newborn was just born. Which nursing intervention is important for the nurse to perform first? 1. Remove wet blankets. 2. Assess Apgar score. 3. Insert eye prophylaxis. 4. Elicit the Moro reflex.

1. When newborns are wet they can become hypothermic from heat loss resulting from evaporation. They may then develop cold stress syndrome.

The nurse is developing a teaching plan for parents who are taking home their 2-day-old breastfed baby. Which of the following should the nurse include in the plan? 1. Wash hands well before picking up the baby. 2. Refrain from having visitors for the first month. 3. Wear a mask to prevent transmission of a cold. 4. Sterilize the breast pump supplies after every use.

1. the best way to prevent transmission of pathogens is to wash hands carefully before touching the baby

A breastfeeding mother mentions to the nurse that she has heard that babies sleep better at night if they are given a small amount of rice cereal in the evening. Which of the following comments by the nurse is appropriate? 1. "That is correct. The rice cereal takes longer for them to digest so they sleep better and longer." 2. "It is recommended that babies receive only breast milk for the first 4 to 6 months of their lives." 3. "It is too early for rice cereal, but I would recommend giving the baby a bottle of formula at night." 4. "A better recommendation is to give apple sauce at 3 months of age and apple juice 1 month later."

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A full-term neonate has brown adipose fat tissue (BAT) stores that were deposited during the latter part of the third trimester. What does the nurse understand is the function of BAT stores? 1. To promote melanin production in the neonatal period. 2. To provide heat production when the baby is hypothermic. 3. To protect the bony structures of the body from injury. 4. To provide calories for neonatal growth between feedings.

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A mother asks whether or not she should be concerned that her baby never opens his mouth to breathe when his nose is so small. Which of the following is the nurse's best response? 1. "The baby does rarely open his mouth but you can see that he isn't in any distress." 2. "Babies usually breathe in and out through their noses so they can feed and breathe without breaking the latch." 3. "Everything about babies is small. It truly is amazing how everything works so well." 4. "You are right. I will report the baby's small nasal openings to the pediatrician right away."

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A mother questions why the ophthalmic medication is given to the baby. Which of the following responses by the nurse would be appropriate to make at this time? 1. "I am required by law to give the medicine." 2. "The medicine helps to prevent eye infections." 3. "The medicine promotes neonatal health." 4. "All babies receive the medicine at delivery."

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A baby is just delivered. Which of the following physiological changes is of highest priority? 1. Thermoregulation. 2. Spontaneous respirations. 3. Extrauterine circulatory shift. 4. Successful feeding

2 If a baby does not breathe, the remaining physiological transitions cannot successfully take place. When answering a pri- oritizing question that has multiple phys- iological answers, one good way to ap- proach it is to think of the ABCs of CPR. The "A" for airway, is the first priority when conducting CPR. Similarly, it is the first priority of neonatal transitioning.

A baby has just been circumcised. If bleeding occurs, which of the following actions should be taken first? 1. Put the baby's diapers on as tightly as possible. 2. Apply light pressure to the area with sterile gauze. 3. Call the physician who performed the surgery. 4. Assess the baby's heart rate and oxygen saturation.

2 Putting direct pressure on the site is the best way to stop the bleeding

A 4-day-old baby born via cesarean section is slightly jaundiced. The laboratory reports a bilirubin assessment of 6.0 mg/dL. Which of the following would the nurse expect the neonatologist to order for the baby at this time? 1. To be placed under phototherapy. 2. To be discharged home with the parents. 3. To be prepared for a replacement transfusion. 4. To be fed glucose water between routine feeds.

2 Since peak bilirubin levels are seen between days 3 and 5, and since the level is well within normal range, the nurse should expect that the baby will be discharged home with parents. Hemolytic jaundice is seen within the first 24 hours of life. A neonatalogist would be concerned about the health of the baby with a bilirubin of 6 mg/dL during that time frame. Physio- logical jaundice, on the other hand, is seen in about 50% of healthy full-term babies with bilirubin levels rising after the first 24 hours and peaking at 3 to 5 days. A level of 6 mg/dL at 4 days, therefore, is well within normal limits

A mother and her 2-day-old baby are preparing for discharge. Which of the following situations would require the baby's discharge to be cancelled? 1. The parents own a car seat that only faces the rear of the car. 2. The baby's bilirubin is 19 mg/dL. 3. The baby's blood glucose is 65 mg/dL. 4. There is a large bluish spot on the left buttock of the baby.

2 The bilirubin level of 19 mg/dL is well above normal, and since bilirubin levels peak on day 3 to 5, it is likely that the level will rise even higher. It is likely that a therapeutic interven- tion, like phototherapy, will be ordered for this baby.

A nurse is about to administer the ophthalmic preparation to a newly born neonate. Which of the following is the correct statement regarding the medication? 1. It is administered to prevent the development of neonatal cataracts. 2. The medicine should be placed in the lower conjunctiva from the inner to outer canthus. 3. The medicine must be administered immediately upon delivery of the baby. 4. It is administered to neonates whose mothers test positive for gonorrhea during pregnancy.

2 This is the correct method of instilla- tion of the ophthalmic prophylaxis.

A neonate has an elevated bilirubin and is slightly jaundiced on day 3 of life. What is the probable reason for these changes? 1. Hemolysis of neonatal red blood cells by the maternal antibodies. 2. Physiological destruction of fetal red blood cells during the extrauterine period. 3. Pathological liver function resulting from hypoxemia during the birthing process. 4. Delayed meconium excretion resulting in the production of direct bilirubin

2 With lung oxygenation, the neonate no longer needs large numbers of red blood cells. As a result, excess red blood cells (RBCs) are destroyed. Jaundice often results on days 2 to 4. One of the important clues to the answer of this question is the age of the baby. The timing of jaun- dice is very important. Physiological jaundice, seen in a large number of neonates, is observed after the first 24 hours. Pathological jaundice, a much more serious problem, is seen during the first 24 hours.

Which of the following behaviors should nurses know are characteristic of infant abductors? SATA 1. Act on the spur of the moment 2. Create a diversion on the unit 3. Ask questions about the routine of the unit 4. Choose rooms near stairwells 5. Wear over-sized clothing

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The nursery charge nurse is assessing a 1-day-old female on morning rounds. Which of the following findings should be reported to the neonatologist as soon as possible? Select all that apply. 1. A spot of blood in the diaper. 2. Grunting during expiration. 3. Deep red coloring on one side of the body with pale pink on the other side. 4. Lacy and mottled appearance over the entire chest and abdomen. 5. Flaring of the nares during inspiration.

2 and 5 are correct. 1. Pseudomenses is a normal finding in a 1-day-old female. 2. Expiratory grunting is an indication of respiratory distress. 3. This is a description of the harlequin sign, a normal neonatal finding. 4. Neonates are often mottled when chilled. Unless other signs or symptoms are present, it is a normal finding. 5. Nasal flaring is an indication of respira- tory distress.

A mother asks the nurse to tell her about the responsiveness of neonates at birth. Which of the following answers is appropriate? Select all that apply. 1. "Babies have a poorly developed sense of smell until they are 2 months old." 2. "Babies respond to all forms of taste well, but they prefer to eat sweet things like breast milk." 3. "Babies are especially sensitive to being touched and cuddled." 4. "Babies are nearsighted with blurry vision until they are about 3 months of age." 5. "Babies respond to many sounds, especially to the high-pitched tone of the female voice."

2, 3, and 5 and correct. 1. All of the babies' senses are well developed at birth. 2. Babies respond to all forms of taste. They prefer sweet things. 3. Babies' sense of touch is considered to be the most well-developed sense. 4. Babies see quite well at 8 to 12 inches. They prefer to look at the human face. 5. Babies hear quite well once the amniotic fluid is absorbed from the ear canal. Be- cause early intervention benefits babies who are hearing impaired, in most hos- pitals their hearing is tested prior to discharge from the newborn nursery.

A nurse is providing anticipatory guidance to a couple before they take home their newborn. Which of the following should be included? SATA 1. If their baby is sleeping soundly, they should not awaken the baby for a feeding. 2. If they take their baby outside, they should put sunscreen on the baby. 3. They should purchase liquid acetaminophen to be used when ordered by the pediatrician. 4. They should notify their pediatrician when the umbilical cord falls off. 5. When strapping their baby into a car seat, they should position the top of the chest clip at the level of the baby's belly button.

2,3 2. babies should always shielded from direct sunlight, preferably under an umbrella 3. Liquid acetaminophen should be avail- able in the home, but it should not be administered until the parent speaks to the pediatrician.

A nurse must give vitamin K 0.5 mg IM to a newly born baby. Which of the following needles could the nurse safely choose for the injection? 1. 5⁄8 inch, 18 gauge. 2. 5⁄8 inch, 25 gauge. 3. 1 inch, 18 gauge. 4. 1 inch, 25 gauge.

2. A 5⁄8-inch, 25-gauge needle is an appropriate needle for a neonatal IM injection.

Four babies have just been admitted into the neonatal nursery. Which of the babies should the nurse assess first? 1. Baby with respirations 42, oxygen saturation 96%. 2. Baby with Apgar 9/9, weight 4,660 grams. 3. Baby with temperature 98.0°F(36.7), length 21 inches. 4. Baby with glucose 55 mg/dL, heart rate 121.

2. Although the Apgar score—9—is excel- lent, the baby's weight—4,660 grams— is well above the average of 2,500 to 4,000 grams. Babies who are large for gestational age are at high risk for hypoglycemia.

A nurse is advising a mother of a neonate being discharged from the hospital regarding car seat safety. Which of the following should be included in the teaching plan? Select all that apply. 1. Place the baby's car seat in the front passenger seat of the car. 2. Position the car seat rear facing until the baby reaches two years of age. 3. Attach the car seat to the car at 2 latch points at the base of the car seat. 4. Check that the installed car seat moves no more than 1 inch side to side or front to back. 5. Make sure that there is at least a 3-inch space between the straps of the seat and the baby's body.

2. The baby should be facing the rear in the back seat of the car. 3. Since 2002, infant car seats have been designed with 2 attachment points at the base of the car seat. The car seat should be attached to the seat of the car using both attachment points. 4. After being installed, if a car seat moves more than 1 inch back and forth or side to side, it is not installed properly.

The nurse has provided anticipatory guidance to a couple that has just delivered a baby. Which of the following is an appropriate short-term goal for the care of their new baby? 1. The baby will have a bath with soap every morning. 2. During a supervised play period, the baby will be placed on the tummy every day. 3. The baby will be given a pacifier after each feeding. 4. For the first month of life, the baby will sleep on its side in a crib next to the parents.

2. Tummy time, while awake and while supervised, helps to prevent plagio- cephaly and to promote growth and development.

A mother, 1 day postpartum from a 3-hour labor and a spontaneous vaginal delivery, questions the nurse because her baby's face is "purple." Upon examination, the nurse notes petechiae over the scalp, forehead, and cheeks of the baby. The nurse's response should be based on which of the following? 1. Petechiae are indicative of severe bacterial infections. 2. Rapid deliveries can injure the neonatal presenting part. 3. Petechiae are characteristic of the normal newborn rash. 4. The injuries are a sign that the child has been abused.

2. When neonates speed through the birth canal during rapid deliveries, the present- ing parts become bruised. The bruising often takes the form of petechial hemorrhages.

The nursery nurse is careful to wear gloves when admitting neonates into the nursery. Which of the following is the scientific rationale for this action? 1. Meconium is filled with enteric bacteria. 2. Amniotic fluid may contain harmful viruses. 3. The high alkalinity of fetal urine is caustic to the skin. 4. The baby is high risk for infection and must be protected.

2: Amniotic fluid is a reservoir for viral diseases like HIV and hepatitis B. If the woman is infected with those viruses, the amniotic fluid will be infectious.

A mother confides to a nurse that she has no crib at home for her baby. The mother asks the nurse which of the following places would be best for the baby to sleep. Of the following choices, which location should the nurse suggest? 1. In bed with his 5 year old brother 2. In a waterbed with his mother and father 3. In a large empty dresser drawer 4. In the living room on a pull-out sofa

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A nurse is assessing the bonding of the father with his newborn baby. Which of the following actions by the father would be of concern to the nurse? 1. He holds the baby in the en face position. 2. He calls the baby by a full name rather than a nickname. 3. He tells the mother to pick up the crying baby. 4. He falls asleep in the chair with the baby on his chest.

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After advising the parents of a 1-day-old baby that the baby must have a "Heart defect test," the mother states, "Why? My baby is healthy. The primary healthcare provider told me so." Which of the following responses by the nurse is appropriate? 1. I must have misread the name on the chart. It must be another baby who has to have the test 2. We do this test on all of the babies before discharge, and Im sure your baby's heart is healthy 3. This is a screening test done on all babies. It is performed to find any possible heart problems before babies are discharged 4. Your baby just had some minor symptoms that need to be checked. The test won't hurt the baby

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The nurse is about to elicit the Moro reflex. which of the following responses should the nurse expect to see? 1. when the cheek of the baby is touched, the newborn turns toward the side that is touched 2. when the lateral aspect of the sole of the baby's foot is stroked, the toes extend and fan outward. 3. when the baby is suddenly lowered or startled, the neonate's arms straighten outward and the knees reflex 4. when the newborn is supine and the head is turned to one side, the arm on that same side extends.

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A full-term baby's bilirubin level is 12 mg/dL on day 3. Which of the following neonatal behaviors would the nurse expect to see? 1. Excessive crying. 2. Increased appetite. 3. Lethargy. 4. Hyperreflexia.

3 Lethargy is one of the most common early symptoms of hyper- bilirubinemia.

A neonate, who is being admitted into the well-baby nursery, is exhibiting each of the following assessment findings. Which of the findings should the nurse report to the primary health care provider? Select all that apply. 1. Harlequin sign. 2. Extension of the toes when the lateral aspect of the sole is stroked. 3. Elbow moves past the midline when the scarf sign is assessed. 4. Slightly curved pinnae of the ears that are slow to recoil. 5. Telangiectatic nevi.

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When administering the neonatal screening for critical congenital heart defects on a baby in the well baby nursery, the nurse should perform which of the following actions? SATA 1. Obtain parental consent before performing the screen 2. Take the baby's electrocardiogram 3. Wait until the baby is at least 24 hours old. 4. Record the baby's heart rate fluctuations for 1 full minute 5. Report pulse oximetry readings of 96% on the hand and 92% on the foot

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The primary healthcare provider writes the following order for a term newborn: phytonadione 1 mg IM. Which of the following responses provides a rationale for this order? 1. During the neonatal period, babies absorb fat-soluble vitamins poorly. 2. Breast milk and formula contain insufficient quantities of vitamin K. 3. The neonatal gut is sterile. 4. Phytonadione prevents hemolytic jaundice.

3 It takes about 1 week for the baby to be able to synthesize his or her own vitamin K. The gut, at birth, is sterile It is important for the test taker to review how vitamin K is synthesized by the intestinal flora. Since the neonate is deficient in intestinal flora until 1 week of age, he or she is unable to manufacture vitamin K until that time. Vitamin K is important, especially for ba- bies who will be circumcised, because it is needed to activate coagulation factors synthesized in the liver

A woman states that she is going to bottle feed her baby because, "I hate milk and I know that to make good breast milk I will have to drink milk." The nurse's response about producing high-quality breast milk should be based on which of the following? 1. The mother must drink at least 3 glasses of milk per day to absorb sufficient quantities of calcium. 2. The mother should consume at least 1 glass of milk per day but should also consume other dairy products like cheese. 3. The mother can consume a variety of good calcium sources like broccoli and fish with bones as well as dairy products. 4. The mother must monitor her protein intake more than her calcium intake because the baby needs the protein for growth.

3. Dairy foods provide protein and other nutrients, including the important mineral calcium. The calcium can, however, be obtained from a number of other foods, such as broccoli and fish with bones.

A neonate is to receive the hepatitis B vaccine in the neonatal nursery. Which of the following must the nurse have available before administering the injection? 1. Hepatitis B immune globulin in a second syringe. 2. Sterile water to dilute the vaccine before injecting. 3. Epinephrine in case of severe allergic reactions. 4. Oral syringe because the vaccine is given by mouth.

3. Epinephrine should be available whenever vaccinations are adminis- tered in case the recipient should develop anaphylactic symptoms.

The following four babies are in the neonatal nursery. Which of the babies should be seen by the PHP? 1. 1-day-old, HR 100 beats per minute, in deep sleep. 2. 2-day-old, T 97.7°F(36.5), slightly jaundiced. 3. 3-day-old, breastfeeding every 4 hours, jittery. 4. 4-day-old, crying, papular rash on an erythematous base.

3. Babies who breastfeed fewer than 8 times a day are not receiving ade- quate nutrition. Jitters are indicative of hypoglycemia.

The nurse is teaching the parents of a 1-day-old baby how to give a sponge bath. Which of the following actions should be included? 1. Clean the eyes from outer canthus to inner canthus. 2. Cleanse the ear canals with a cotton swab. 3. Assemble all supplies before beginning the bath. 4. Check the temperature of the bath water with the fingertips.

3. If items must be obtained while the bath is being given, the baby may become hypothermic from evaporation resulting from exposure to the air when wet.

A nurse notes that a 6-hour-old neonate has cyanotic hands and feet. Which of the following actions by the nurse is appropriate? 1. Place child in an isolette. 2. Administer oxygen. 3. Swaddle baby in a blanket. 4. Apply pulse oximeter.

3. The baby's extremities are cyanotic as a result of the baby's immature circulatory system. Swaddling helps to warm the baby's hands and feet.

A nurse is providing discharge teaching to the parents of a newborn. Which of the following should be included when teaching the parents how to care for the baby's umbilical cord? 1. Cleanse it with hydrogen peroxide if it starts to smell. 2. Remove it with sterile tweezers at one week of age. 3. Call the doctor if greenish drainage appears. 4. Cover it with sterile dressings until it falls off.

3. The green drainage may be a sign of infection. The cord should become dried and shriveled.

In which of the following situations would it be appropriate for the father to place the baby in the "en face" position to promote neonatal bonding? 1. The baby is asleep with little to no eye movement, regular breathing. 2. The baby is asleep with rapid eye movement, irregular breathing. 3. The baby is awake, looking intently at an object, irregular breathing. 4. The baby is awake, placing hands in the mouth, irregular breathing.

3. This baby is in the quiet alert behavioral state. Placing the baby en face will foster bonding between the father and baby.

A mother is preparing to breastfeed her baby. Which of the following actions would encourage the baby to open the mouth wide for feeding? 1. Holding the baby in the en face position. 2. Pushing down on the baby's lower jaw. 3. Tickling the baby's lips with the nipple. 4. Giving the baby a trial bottle of formula.

3. Tickling the baby's lips with the nip- ple is the recommended method of encouraging a baby to open his or her mouth for feeding.

A neonate is being admitted to the well-baby nursery. Which of the following findings should be reported to the PHP? 1. Umbilical cord with three vessels. 2. Diamond-shaped anterior fontanelle. 3. Cryptorchidism. 4. Café au lait spot.

3. Undescended testes—cryptorchidism— is an unexpected finding. It is one sign of prematurity.

A 2-day-old neonate received a phytonadione injection at birth. Which of the following signs/symptoms in the baby would indicate that the treatment was effective? 1. Skin color is pink. 2. Vital signs are normal. 3. Glucose levels are stable. 4. Blood clots after heel sticks.

4

A 2-day-old, exclusively breastfed baby is to be discharged home. Under what conditions should the nurse teach the parents to call the pediatrician? 1. If the baby feeds 8 to 12 times each day. 2. If the baby urinates 6 to 10 times each day. 3. If the baby has stools that are watery and bright yellow. 4. If the baby has eyes and skin that are tinged yellow.

4

A woman who has just delivered has decided to bottle feed her full-term baby. Which of the following should be included in the patient teaching? 1. The baby's stools will appear bright yellow and will usually be loose. 2. The bottle nipples should be enlarged to ease the baby's suckling. 3. It is best to heat the baby's bottle in the microwave before feeding. 4. It is important to hold the bottle to keep the nipple filled with formula.

4

It has just been discovered that a newborn is missing from the maternity unit. The nursing staff should be watchful for which of the following individuals? 1. A middle-aged male. 2. An underweight female. 3. Pro-life advocate. 4. Visitor of the same race.

4

A certified nursing assistant (CNA) is working with a registered nurse (RN) in the neonatal nursery. Which of the following actions should the RN perform rather than delegating it to the CNA? 1. Bathe and weigh a 1-hour-old baby. 2. Take the apical heart rate and respirations of a 4-hour-old baby. 3. Obtain a stool sample from a 1-day-old baby. 4. Provide discharge teaching to the mother of a 4-day-old baby.

4 1. With training, unlicensed personnel are able to provide basic patient care, includ- ing taking vital signs, obtaining speci- mens, and performing activities of daily living (ADLs). 2. With training, unlicensed personnel are able to provide basic patient care, includ- ing taking vital signs, obtaining speci- mens, and performing ADLs. 3. With training, unlicensed personnel are able to provide basic patient care, includ- ing taking vital signs, obtaining speci- mens, and performing ADLs. 4. It is the registered nurse's responsi- bility to provide discharge teaching to clients. Only the RN knows the scientific rationales as well as the knowledge of teaching-learning prin- ciples necessary to provide accurate information and answer questions appropriately.

When providing discharge teaching to parents, a nurse emphasizes actions to prevent plagiocephaly and to promote gross motor development in their full-term newborn. which of the following actions should the nurse advise the parents to take? 1. breastfeed the baby frequently 2. make sure the baby receives vaccinations at recommended intervals 3. change the diapers regularly 4. minimize supine positioning during supervised play periods

4 Prolonged supine posturing by babies can result in flattening of the backs of babies' heads (plagiocephaly). Being placed in the prone position while awake allows babies to practice gross motor skills like rolling over.

The nurse enters a Latin woman's postpartum room and notes that her neonate is wearing a hat and is covered in three blankets. The room temperature is 70°F. The nurse's action should be based on which of the following? 1. Overdressing babies is common in some cultures and should be ignored. 2. The mother has dressed the baby appropriately for the room temperature. 3. The nurse should drop the room temperature because the baby is overdressed. 4. Overheating is dangerous for neonates and the extra clothing should be removed.

4 The clothing should be removed and the mother should be educated about SIDS and about the correlation be- tween overheating and SID

The mother notes that her baby has a "bulge" on the back of one side of the head. She calls the nurse into the room to ask what the bulge is. The nurse notes that the bulge covers the right parietal bone but does not cross the suture lines. The nurse explains to the mother that the bulge results from which of the following? 1. Molding of the baby's skull so that the baby could fit through her pelvis. 2. Swelling of the tissues of the baby's head from the pressure of her pushing. 3. The position that the baby took in her pelvis during the last trimester of her pregnancy. 4. Small blood vessels that broke under the baby's scalp during birth.

4. Cephalhematomas are subcutaneous swellings of accumulated blood from the trauma of delivery. The bulges may be one-sided or bilateral and the swellings do not cross suture lines.

Using the Neonatal Infant Pain Scale (NIPS), a nurse is assessing the pain response of a newborn who has just had a circumcision. The nurse is assessing a change in which of the following signs/symptoms? Select all that apply. 1. Heart rate. 2. Blood pressure. 3. Temperature. 4. Facial expression. 5. Breathing pattern.

4 and 5 are correct. 1. Although assessed in other pain scales, the heart rate is not part of the NIPS. 2. Blood pressure is not assessed in any infant pain scale. 3. Temperature is not assessed in any infant pain scale. 4. Facial expression is one variable that is evaluated as part of the NIPS. 5. Breathing pattern is one variable that is evaluated as part of the NIPS.

The nurse informs the parents of a breastfed baby that the American Academy of Pediatrics advises that babies be supplemented with which of the following vitamins? 1. Vitamin A. 2. Vitamin B12. 3. Vitamin C. 4. Vitamin D.

4. Many babies are vitamin D deficient because of the recommendation that they be kept out of direct sunlight to protect their skin from sunburn. For this reason, supplementation with vi- tamin D is recommended

The nurse is evaluating the effectiveness of an intervention when assisting a woman whose baby has been latched to the nipple only rather than to the nipple and the areola. Which response would indicate that further intervention is needed? 1. The client states that the pain has decreased. 2. The nurse hears the baby swallow after each suck. 3. The baby's jaws move up and down once every second. 4. The baby's cheeks move in and out with each suck.

4. Babies whose cheeks move in and out during feeds are attempting to use negative pressure to extract the milk from the breasts. This action is not an indicator of breastfeeding success.

A nurse determines that which of the following is an appropriate short-term goal for a full-term, breastfeeding newborn? 1. The baby will regain birth weight by 4 weeks of age. 2. The baby will sleep through the night by 4 weeks of age. 3. The baby will stool every 2 to 3 hours by 1 week of age. 4. The baby will urinate 6 to 10 times per day by 1 week of age.

4. By 1 week of age, breastfed babies should be urinating at least 6 times in every 24-hour period.

To check for the presence of Epstein's pearls, the nurse should assess which part of the neonate's body? 1. Feet. 2. Hands. 3. Back. 4. Mouth.

4. Epstein's pearls—small white specks (keratin-containing cysts)—are located on the palate and gums.

The nurse is assessing a neonate in the newborn nursery. Which of the following findings in a newborn should be reported to the PHP? 1. The eyes cross and uncross when they are open. 2. The ears are positioned in alignment with the inner and outer canthus of the eyes. 3. Axillae and femoral folds of the baby are covered with a white cheesy substance. 4. The nostrils flare whenever the baby inhales.

4. Nasal flaring is a symptom of respiratory distress.

A couple is asking the nurse whether or not their son should be circumcised. On which fact should the nurse's response be based? 1. Boys should be circumcised for them to establish a positive self-image. 2. Boys should not be circumcised because there is no medical rationale for the procedure. 3. Experts from the Centers for Disease Control and Prevention argue that circumcision is desirable. 4. A statement from the American Academy of Pediatrics asserts that circumcision is optional.

4. The AAP, although acknowledging that there are some advantages to circumcision, states that there is not enough evidence to suggest that all baby boys be circumcised.

Four newborns were admitted into the newborn nursery 1 hour ago. Which of the babies should the nurse ask the PHP to evaluate? 1. The neonate with a temperature of 98.9°F (37.2) and weight of 3,000 grams. 2. The neonate with white spots on the bridge of the nose. 3. The neonate with raised white specks on the gums. 4. The neonate with respirations of 72 and heart rate of 166.

4. The normal resting respiratory rate of a neonate is 30 to 60 and the normal resting heart rate of a neonate is 110 to 160.

The nurse is discussing the neonatal blood screening test with a new mother. The nurse knows that the teaching was successful when the mother states that the test screens for the presence in the newborn of which of the following diseases? Select all that apply. 1. Hypothyroidism. 2. Sickle cell disease. 3. Galactosemia. 4. Cerebral palsy. 5. Cystic fibrosis.

1, 2, 3, and 5 are correct. 1. Congenital hypothyroidism is a malfunc- tion of or complete absence of the thyroid gland that is present from birth. It is screened for in all 50 states. 2. Sickle cell disease is an autosomal re- cessive disease resulting in abnormally shaped red blood cells. It is screened for in all 50 states. 3. Galactosemia is an incurable autosomal recessive disease characterized by the absence of the enzyme required to metabolize galactose. It is screened for in all 50 states. 4. Cerebral palsy (CP) is a disorder character- ized by motor dysfunction resulting from a nonprogressive injury to brain tissue. The injury usually occurs during labor, delivery, or shortly after delivery. Physical examina- tion is required to diagnose CP. Blood screening is not an appropriate means of diagnosis. 5. Cystic fibrosis is an autosomal recessive illness characterized by the presence of thick mucus in many organs systems, most notably the respiratory track. It is screened for in all 50 states.

A nurse is doing a newborn assessment on a new admission to the nursery. Which of the following actions should the nurse make when evaluating the baby for developmental dysplasia of the hip (DDH)? Select all that apply. 1. Grasp the baby's legs with the thumbs on the inner thighs and forefingers on the outer thighs. 2. Gently adduct and abduct the baby's thighs. 3. Palpate the trochanter during hip rotation. 4. Place the baby in a fetal position. 5. Compare the lengths of the baby's legs.

1, 2, 3, and 5 are correct. 1. With the baby placed flat on its back, the practitioner grasps the baby's thighs using his or her thumbs and index fingers. 2. When assessing for Ortolani sign, the baby's thighs are abducted. When performing the Barlow test, the baby's thighs are adducted. 3. With the baby's hips and knees at 90° angles, the hips are abducted. With DDH, the trochanter dislocates from the acetabulum. 4. When performing both the Ortolani and Barlow tests, the baby is placed flat on its back. When assessing for symmetry of leg lengths and tissue folds, the baby is placed in both the supine and prone positions. 5. Legs are extended to assess for equal leg lengths and for equal thigh and gluteal folds.

The nurse is concerned that a bottle-fed baby may become obese because of which activity by the mother? 1. She encourages the baby to finish the bottle at each feed. 2. She feeds the baby every 3 to 4 hours. 3. She feeds the baby a soy-based formula. 4. She burps the baby every 1/2 to 1 ounce.

1. It has been shown that bottle-fed babies are at higher risk for obesity than breastfed babies. One of the reasons is the insistence by some mothers that the baby finish the formula in a bottle even if the baby initially rejects it. The increased calorie intake leads to increased weight gain.

A mother is told that she should bottle feed her child for medical reasons. Which of the following maternal disease states are consistent with the recommendation? Select all that apply. 1. Untreated, active tuberculosis. 2. Hepatitis B surface antigen positive. 3. Human immunodeficiency virus positive. 4. Chorioamnionitis. 5. Mastitis.

1,3 A mother with active untreated TB should be separated from her baby until the mother has been on antibi- otic therapy for about 2 weeks. She can, however, pump her breast milk and have it fed to baby through an al- ternate feeding method. Being hepatitis B surface antigen positive (HBSag" ) is not a contraindication to breastfeeding. Mothers who are HIV positive are ad- vised not to breastfeed because there is an increased risk of transmission of the virus to the infant. Acute bacterial infections, such as chorioamnionitis, are not contraindica- tions to breastfeeding unless the medica- tion given to the mother is contraindi- cated. There are, however, very few antibiotics that are incompatible with breastfeeding. It is recommended that a mother with mastitis continue to breastfeed. She must keep draining her breasts of milk to pre- vent the development of a breast abscess. Again, only antibiotics compatible with breastfeeding should be administered

A breastfeeding mother who is 2 weeks postpartum is informed by her primary healthcare provider that her 4-year-old has chickenpox (varicella). The mother calls the nursery nurse because she is concerned about having the baby in contact with the sick sibling. The mother had chickenpox as a child. Which of the following responses by the nurse is appropriate? 1. "The baby received passive immunity through the placenta, plus the breast milk will also be protective." 2. "The baby should stay with relatives until the ill sibling recovers from the episode of chickenpox." 3. "Chickenpox is transmitted by contact route so careful hand washing should prevent transmission." 4. "Because chickenpox is a spirochetal illness, both the child and baby should receive the appropriate medications."

1. Antibodies passed by passive immunity are usually evident in the neonatal system for at least 3 months. Since this baby is only 2 weeks old, the antibodies should protect the baby. Plus, since the baby is breastfeeding, the baby is receiving added protection

A newborn at 40-week-gestation is in the first period of reactivity. Which of the following actions should the nurse take at this time? 1. Encourage the parents to bond with their baby. 2. Notify the neonatologist of the finding. 3. Perform the gestational age assessment. 4. Place the baby under the overhead warmer.

1. Babies are awake and alert for approximately 30 minutes to 1 hour immediately after birth. This is the perfect time for the parents to begin to bond with their babies.

A nurse who is caring for a mother/newborn dyad on the maternity unit has identified the following nursing diagnosis: Effective breastfeeding. Which of the following would warrant this diagnosis? 1. Baby's lips are flanged when latched. 2. Baby feeds every 4 hours. 3. Baby lost 12% of weight since birth. 4. Baby's tongue stays behind the gum line.

1. Both the upper and lower lips should be flanged

a breastfeeding mother refuses to place her unclothed baby face down on her chest because, babies are always supposed to be put on their backs. babies who are on their stomaches die from SIDS. the nurse's action should be based on which of the following? 1. skin-to-skin contact facilitates breastfeeding and helps to maintain neonatal temperature 2. the risk of SIDS increases whenever unsupervised babies are place in the supine position 3. SIDS rarely occurs before the completion of the neonatal period 4. back to sleep guidelines have been modified for breastfeeding babies

1. Skin-to-skin contact (kangaroo care) has been shown to have many benefits for neonates, including promoting breast latch and stabilizing neonatal temperatures.

A full-term neonate, Apgar 9/9, has just been admitted to the nursery after a cesarean delivery, fetal position left mentum anterior (LMA), under epidural anesthesia. Which of the following physiological findings would the nurse expect to see? 1. Soft pulmonary rales. 2. Absent bowel sounds. 3. Depressed Moro reflex. 4. Positive Ortolani sign.

1. Soft rales are expected because babies born via cesarean section do not have the advantage of having the amniotic fluid squeezed from the pulmonary system as occurs during a vaginal birth Cesarean section (C/S) babies often respond differently in the immediate postdelivery period than ba- bies born vaginally. Remembering that one of the triggers for neonatal respira- tions is the mechanical compression of the thorax, which results in the forced expulsion of amniotic fluid from the baby's lungs, is important here. Because C/S babies do not traverse the birth canal, they do not have the benefit of that compression.

Which of the following full-term babies requires immediate intervention? 1. Baby with seesaw breathing. 2. Baby with irregular breathing with 10-second apnea spells. 3. Baby with coordinated thoracic and abdominal breathing. 4. Baby with respiratory rate of 52.

1. Seesaw breathing is an indication of respiratory distress.

A neonate is in the active alert behavioral state. Which of the following would the nurse expect to see? 1. Baby is showing signs of hunger and frustration. 2. Baby is starting to whimper and cry. 3. Baby is wide awake and attending to a picture. 4. Baby is asleep and breathing rhythmically.

1. Showing signs of hunger and frustration describes the active alert or active awake state.

A 2-day-old breastfeeding baby born via normal spontaneous vaginal delivery has just been weighed in the newborn nursery. The nurse determines that the baby has lost 3.5% of the birth weight. Which of the following nursing actions is appropriate? 1. Do nothing because this is a normal weight loss. 2. Notify the neonatologist of the significant weight loss. 3. Advise the mother to bottle feed the baby at the next feed. 4. Assess the baby for hypoglycemia with a glucose monitor.

1. The baby has lost less than 4% of its birth weight. Babies often lose between 5% and 10% of their birth weight. A loss greater than 10% is considered pathological.

It is time for a baby who is in the drowsy behavioral state to breastfeed. Which of the following techniques could the mother use to arouse the baby? Select all that apply. 1. Swaddle or tightly bundle the baby. 2. Hand express milk onto the baby's lips. 3. Talk with the baby while making eye contact. 4. Remove the baby's shirt and change the diaper. 5. Play pat-a-cake with the baby.

2,3,4,5 Babies who are in the drowsy behavioral state and who are tightly swaddled often fall asleep rather than become aroused. The smell and/or the taste of the milk often will arouse a drowsy baby. Drowsy babies will open their eyes when placed in the en face position and are interacted with. Performing manipulations like diaper- ing or playing pat-a-cake often will arouse a drowsy baby.

A breastfeeding baby is born with a tight frenulum. Which of the following is an important assessment for the nurse to make? 1. Integrity of the baby's uvula. 2. Presence of maternal nipple damage. 3. Presence of neonatal tongue injury. 4. The baby's breathing pattern.

2. Babies who are tongue-tied—that is have a tight frenulum—have difficulty extending their tongues while breast- feeding. The mothers' nipples often become damaged as a result.

A baby has just been admitted into the neonatal nursery. Before taking the newborn's vital signs, the nurse should warm his or her hands and the stethoscope to prevent heat loss resulting from which of the following? 1. Evaporation. 2. Conduction. 3. Radiation. 4. Convection.

2. Heat loss resulting from conduction occurs when the baby comes in contact with cold objects (hands or stethoscope).

A mother asks the nurse which powder she should purchase to use on the baby's skin. What should the nurse's response be? 1. "Any powder made especially for babies should be fine." 2. "It is recommended that powder not be put on babies." 3. "There is no real difference except that many babies are allergic to cornstarch so it should not be used." 4. "As long as you put it only on the buttocks area, you can use any brand of baby powder that you like."

2. It is recommended that powders, even if advertised for the purpose, not be used on babies.

A baby boy is to be circumcised by the mother's obstetrician. Which of the following actions shows that the nurse is being a patient advocate? 1. Before the procedure, the nurse prepares the sterile field for the physician. 2. The nurse refuses to unclothe the baby until the doctor orders something for pain. 3. The nurse holds the feeding immediately before the circumcision. 4. After the procedure, the nurse monitors the site for signs of bleeding.

2. The nurse is being a patient advocate because the baby is unable to ask for pain medication. The AAP has made a policy statement that pain medica- tions be used during all circumcision procedures.

On admission to the maternity unit, it is learned that a mother has smoked 2 packs of cigarettes per day and expects to continue to smoke after discharge. The mother also states that she expects to breastfeed her baby. The nurse's response should be based on which of the following? 1. Breastfeeding is contraindicated if the mother smokes cigarettes. 2. Breastfeeding is protective for the baby and should be encouraged. 3. A 2-pack-a-day smoker should be reported to child protective services for child abuse. 4. A mother who admits to smoking cigarettes may also be abusing illicit substances.

2. This is true. Breastfeeding is protective of the baby and should be encouraged. Even though smoking is discouraged because of the serious health risks associated with the addic- tion, it is a legal act. It is best for the nurse to promote behaviors that will mit- igate the negative impact of smoking. Breastfeeding the baby is one of those behaviors. Encouraging the mother to refrain from smoking inside the house is another.

Four newborns are in the newborn nursery, none of whom is crying or in distress. Which of the babies should the nurse report to the primary healthcare provider? 1. 16-hour-old baby who has yet to pass meconium. 2. 16-hour-old baby whose blood glucose is 50 mg/dL. 3. 2-day-old baby who is breathing irregularly at 70 breaths per minute. 4. 2-day-old baby who is excreting a milky discharge from both nipples.

3. Normal neonatal breathing is irregular at 30 to 60 breaths per minute. This baby is tachypneic.

A nurse is teaching a mother how to care for her 3-day-old son's circumcised penis. Which of the following actions demonstrates that the mother has learned the information? 1. The mother cleanses the glans with a cotton swab dipped in hydrogen peroxide. 2. The mother covers the glans with antifungal ointment after rinsing off any discharge. 3. The mother squeezes warm water from the wash cloth over the glans. 4. The mother replaces the dry sterile dressing before putting on the diaper.

3. Squeezing water over the penis cleanses the area without irritating the site and causing the site to bleed.

A mother calls the nurse to her room because "My baby's eyes are bleeding." The nurse notes bright red hemorrhages in the sclerae of both of the baby's eyes. Which of the following actions by the nurse is appropriate at this time? 1. Notify the pediatrician immediately and report the finding. 2. Notify the social worker about the probable maternal abuse. 3. Reassure the mother that the trauma resulted from pressure changes at birth and the hemorrhages will slowly disappear. 4. Obtain an ophthalmoscope from the nursery to evaluate the red reflex and condition of the retina in each eye.

3. Subconjunctival hemorrhages are a normal finding and are not pathologi- cal. They will disappear over time. Explaining this to the mother is the appropriate action.

A newly delivered mother states, "I have not had any alcohol since I decided to become pregnant. I have decided not to breastfeed because I would really like to go out and have a good time for a change." Which of the following is the best response by the nurse? 1. "I understand that being good for so many months can become very frustrating." 2. "Even if you bottle feed the baby, you will have to refrain from drinking alcohol for at least the next six weeks to protect your own health." 3. "Alcohol can be consumed at any time while you are breastfeeding." 4. "You may drink alcohol while breastfeeding, although it is best to wait until the alcohol has been metabolized before you feed again."

4 Alcohol is found in the breast milk in exactly the same concentration as in the mother's blood. Alcohol consump- tion is not, however, incompatible with breastfeeding. The woman should breastfeed immediately before consuming a drink and then wait 1 to 2 hours to metabolize the drink be- fore feeding again. If she decides to have more than one drink ,she can pump and dump her milk for a feed- ing or two

A physician writes in a breastfeeding mother's chart, "Ampicillin 500 mg q 6 h po. Baby should be bottle fed until medication is discontinued." What should be the nurse's next action? 1. Follow the order as written. 2. Call the doctor and question the order. 3. Follow the antibiotic order but ignore the order to bottle feed the baby. 4. Refer to a text to see whether the antibiotic is safe while breastfeeding.

4 Once the reference has been consulted, the nurse will have factual information to relay to the physician—specifically that ampicillin is compatible with breastfeeding. A call to the doctor would then be appropriate

A baby with mucousy secretions is being left with the parents for the first time after delivery. Which of the following should the nurse teach the parents regarding use of the bulb syringe? 1. Suction the nostrils before suctioning the mouth. 2. Make sure to suction the back of the throat. 3. Insert the syringe before compressing the bulb. 4. Dispose of the drainage in a tissue or a cloth.

4. The drainage should be evaluated by the nurse. The drainage, therefore, should be disposed of in a tissue or cloth.

A nurse is practicing the procedures for conducting cardiopulmonary resuscitation (CPR) in the neonate. Which site should the nurse use to assess the pulse of a baby? 1. Carotid. 2. Radial. 3. Brachial. 4. Pedal.

The recommended site for assessing the pulse of a neonate undergoing CPR is the brachial pulse.