Chapter 21 Care of newborn

A yellow crust has formed over the circumcision site. The mother calls the hotline at the local hospital 5 days after her son was circumcised. She is very concerned. On which rationale should the nurse base a reply? a. The yellow crust should not be removed. b. This yellow crust is an early sign of infection. c. Discontinue the use of petroleum jelly to the tip of the penis. d. After circumcision, the diaper should be changed frequently and fastened snugly.

A

In which position should the parents be instructed to place their newborn for sleep? a. On the back b. On the left side c. On the right side d. On the abdomen

A

The nurse is assessing a newborn's circumcision 30 minutes after the procedure. The nurse notes excessive bleeding coming from the circumcised area. Which priority intervention should the nurse implement? a. Apply pressure to the site. b. Continue to observe for another 30 minutes. c. Apply the diaper tightly over the circumcised area. d. Apply petroleum jelly to the site with a small piece of gauze.

A

Which newborn assessment finding requires the nurse to take an action? a. Glucose level of 40 mg/dL b. Axillary temperature of 37° C (98.6° F) c. Mild yellow tinge to skin at 32 hours of age d. Mild inflammation of conjunctiva after eye prophylaxis

A

Which are the reasons for having auditory screening on all newborns in the first month of life? (Select all that apply.) a. Early identification and treatment b. Reassurance for concerned new parents c. To prevent or reduce developmental delay d. To achieve one of the Healthy People 2020 goals

A, C, D

Which newborn testing must be performed prior to discharge from the hospital? (Select all that apply.) a. Pulse oximetry b. Hearing c. Guthrie d. Hypothyroidism e. Galactosemia

A, C, D, E

The nurse is preparing a newborn for a circumcision. Which prescribed interventions should the nurse implement to alleviate pain? (Select all that apply.) a. Oral sucrose during the procedure b. Bright lights after the procedure c. Adequate stimulation before and after the procedure d. Acetaminophen (Tylenol) postprocedure, as needed e. EMLA cream (eutectic mixture of local anesthetics) before the procedure

A, D, E

Administration of medications after birth is the topic of discussion during a prenatal education class. Which statement indicates to the nurse that the pregnant patient understands the primary indication for the administration of vitamin K? a. "The nurse will draw blood to determine if vitamin K is needed." b. "Vitamin K prevents the possibility of bleeding problems in my baby." c. "My baby will receive a shot when the nurse administers the vitamin K." d. "Vitamin K will be administered shortly after birth, generally within the first hour."

B

In reviewing safety concerns for the newborn nursery, an ad hoc committee has been organized to discuss methods to prevent infant abduction. Which option can be used to facilitate improved outcomes related to this potential problem? a. Allow only immediate adult family members to visitor the newborn nursery during unrestricted visiting hours. b. Require identification with picture ID confirmation of all family members and/or staff who want to have contact with the newborn. c. Make sure that all emergency exits are accessible to staff and clients on the unit. d. Limit the number of visitors to two per client who can be on the unit during visiting hours to maintain security.

B

The nurse is preparing a male infant for circumcision. On review of the chart, the nurse notes that the consent has been signed, vitamin K has been administered, the temperature has been between 36.8° to 37° C (98.2° to 98.6° F), and the heart rate range is 126 to 144 beats per minute (bpm). Which finding, if omitted from the chart, would cause the nurse to have to cancel the circumcision? a. Consent b. Vitamin K c. Heart rate d. Temperature

B

The postpartum nurse is reviewing oral-nasal bulb suctioning with a first-time mom. Which statement will the nurse need to correct? a. "Depress the bulb prior to inserting the tip." b. "Suction the nose first and then the mouth." c. "Keep a bulb syringe in the bassinet at all times." d. "Gradually release the pressure on the bulb while withdrawing it."

B

When an infant's temperature drops from 98.7° to 97.4° F (37° to 36.3° C), the nurse should: a. instruct parents on cold stress. b. determine time and amount of last feeding. c. increase the temperature in the mother's room. d. evaluate infant for the presence of a blood sugar level higher than 50 mg/dL.

B

Which should the nurse implement to prevent the kidnapping of a newborn from the hospital? a. Restricting the amount of time infants are out of the nursery b. Questioning anyone who is seen walking in the hallways carrying an infant c. Allowing no visitors in the maternity area except those who have identification bracelets d. Instructing the parents to not give the baby to anyone except the nurse assigned that day

B

The nurse has just completed discharge teaching to parents on newborn bathing. Which statement made by the parents indicates a further need for teaching? (Select all that apply.) a. "We will clean the diaper area last." b. "We will use cotton-tipped swabs to clean the ears." c. "We will use an antibacterial soap during the sponge bath." d. "We can submerge the baby in a tub of water after the cord falls off." e. "We will shampoo the baby's head using a football hold before unwrapping."

B, C

Which nursing action is a priority to prevent infection in the newborn? (Select all that apply.) a. Wearing gloves before touching neonates b. Washing hands before and after handling any neonate c. Washing hands and arms thoroughly at the beginning of the day d. Sharing some equipment that will not transmit infection from one neonate to another

B, C

A 38 weeks' gestation fetus is delivered via cesarean section and transported to the newborn nursery in an isolette. Apgar scores were 8, 9, and 10. At this time, the infant is receiving an initial assessment in the newborn nursery. Which is the priority nursing diagnosis? a. Risk for injury related to potential equipment malfunction of radiant warmer b. Altered tissue perfusion related to use of medications during delivery process c. Ineffective airway clearance due to mode of delivery and use of anesthetics d. Risk for ineffective thermoregulation related to gestational age

C

A nursing student has been caring for a client and her newborn all morning. After taking the newborn to the nursery for tests, the student is returning the newborn to the mother. Which procedure is correct for identifying the newborn? a. Ask the mother to state her name and the name of her infant. b. Call out the mother's full name before leaving the infant with her. c. Have the mother read her printed band number and verify that it matches the infant's number. d. Return the infant with no special procedure because the student knows the mother and infant.

C

An hour after birth, the nurse assesses a newborn's temperature and notes that it is 36.2° C (97.2° F). The next activity planned for the newborn is the bath, and the new mother and father are invited to participate in the procedure. What is the nurse's next action? a. Take the infant's temperature rectally. b. Ask the father to test the water to determine if it is too hot. c. Delay the bath until the newborn's temperature is above 36.7° C (98° F). d. Explain to the new parents that no soap should be used to cleanse the eyes.

C

The nurse is explaining the procedure of newborn screening to parents before discharge. Which statement by the parents indicates a need for further teaching? a. "We understand the tests are performed at 24 to 48 hours." b. "We're glad all the tests can be done on one blood sample." c. "We wish the tests would screen for congenital hypothyroidism." d. "We know that if the tests are done before 24 hours, the tests will need to be repeated at 1 to 2 weeks."

C

What should the nurse teach to parents about using a bulb syringe? a. Use it only once a day. b. Suction the back of the throat vigorously. c. Insert the syringe into the sides of the mouth. d. Always suction the mouth before suctioning the nose.

C

An infant's temperature is recorded at 36° C (96.8° F) during the morning assessment in the newborn nursery. Which priority action should the nurse implement? a. Note the findings in the electronic health record (EHR). b. Unwrap the infant and inspect for abnormalities. c. Provide the infant with glucose water. d. Make sure that the infant is wrapped securely with a blanket and recheck temperature in 15 minutes.

D

Most newborns receive a prophylactic injection of vitamin K soon after birth. Which site is appropriate for the newborn? a. Deltoid muscle b. Gluteal muscles c. Rectus femoris muscle d. Vastus lateralis muscle

D

Which is the purpose of state-required newborn screening? a. Keep the state records updated. b. Document the number of births. c. Allow for accurate statistical information. d. Recognize and treat newborn disorders early.

D

Which principle is important in providing and teaching cord care? a. Cord care is done only to control bleeding. b. Alcohol is the only agent used for cord care. c. It takes a minimum of 24 days for the cord to separate. d. Keeping the cord dry will decrease bacterial growth.

D