Exam 3
Neonatal period for a newborn
28 days
A "crainal" NTD that is characterized by abnormal openings in the skull through which the brain tissue protrudes. It is associated with hydrocephalus, spina bifida, and polyhydramnios. A. Encephalocele B. Iniencephaly C. Acrania D. Anencephaly
A
A 35-year-old client has just given birth to a healthy newborn during her 43rd week of gestation. What should the nurse expect when assessing the condition of the newborn? A. meconium aspiration in utero or at birth B. seizures, respiratory distress, cyanosis, and shrill cry C. yellow appearance of the newborn's skin D. tremors, irritability, and high-pitched cry
A
A 6-week gestation client asks the nurse what foods she should eat to help prevent neural tube disorders in her growing baby. The nurse would recommend which foods? A. Spinach, oranges, and beans B. Milk, yogurt, and cheese C. Bananas, avocados, and coconut D. Pork, beans, and poultry
A
A newborn girl who was born at 38 weeks of gestation weighs 2000 g and is below the 10th percentile in weight. The nurse recognizes that this girl will be placed in which classification? A. term, small for gestational age, and low-birth-weight infant B. term, small for gestational age, and very-low-birth-weight infant C. late preterm and appropriate for gestational age D. late preterm, large for gestational age, and low-birth-weight infant
A
A nurse assisting in a birth notices that the amniotic fluid is stained greenish black as the baby is being born. Which intervention should the nurse implement as a result of this finding? A. intubation and suctioning of the trachea B. administration of oxygen via a bag and mask C. gently shaking the infant D. flicking the sole of the infant's foot
A
A nurse is assessing a newborn for jaundice. The nurse would first notice jaundice at which area? A. face B. trunk C. legs D. arms
A
A nurse is caring for a neonate of 25 weeks' gestation who is at risk for intraventricular hemorrhage (IVH). Which assessment finding should be reported immediately? A. a sudden drop in hemocrit B. soft, flat anterior fontanels C. pink skin with noted blue extremities D. intake and output for 8 hours
A
A nurse is caring for a newborn client who is diagnosed with myelomeningocele. Which nursing intervention would protect the newborn from injury? A. Place the newborn in a prone or lateral position. B. Delay the parents from holding the newborn. C. Place petroleum jelly gauze on the spinal sac to keep it moist. D. Place a urine collection bag on newborn for the continuous leakage.
A
A nurse is caring for an infant born with polycythemia. Which intervention is most appropriate when caring for this infant? A. Focus on decreasing blood viscosity by increasing fluid volume. B. Check blood glucose within 2 hours of birth by reagent test strip. C. Repeat screening every 2 to 3 hours or before feeds. D. Focus on monitoring and maintaining blood glucose levels.
A
A nurse is caring for an infant. A serum blood sugar of 40 was noted at birth. What care should the nurse provide to this newborn? A. Begin early feedings either by the breast or bottle. B. Give dextrose intravenously before oral feedings. C. Place infant on radiant warmer immediately. D. Focus on decreasing blood viscosity by introducing feedings.
A
A nurse is explaining to new parents how a newborn adapts to extrauterine life. When discussing the physiologic changes that occur, the nurse would explain that this transition usually takes the first: A. 6 to 10 hours of life. B. 4 to 6 hours of life. C. 8 to 12 hours of life. D. 2 to 4 hours of life.
A
A nurse is explaining to the parents the preoperative care for their infant born with bladder exstrophy. The parents ask, "What will happen to the bladder while waiting for the surgery?" What is the nurse's best response? A. "The bladder will covered in a sterile plastic bag to keep it moist." B. "Your baby will be cared for in the prone position with a cover over the bladder." C. "We will care for the bladder with frequent sterile tub baths to keep it moist." D. "Disturbances to the bladder with diaper changes will be kept to a minimum."
A
A nurse is providing preoperative care to a female newborn client with the congenital abnormality myelomeningocele. Which intervention is the priority? A. preventing infection B. promoting newborn nutrition C. preserving newborn GI function D. maximizing newborn motor function
A
A nursing instructor is teaching about newborn congenital disorders and realizes that the student needs further instruction after making which statement? A. "All congenital disorders can be diagnosed at birth." B. "Hydrocephalus may be recognized at birth." C. "Hydrocephalus may not be diagnosed until after a few weeks or months of life." D. "Congenital defects may be caused by genetic or environmental factors."
A
A preterm infant begins gagging, splaying fingers and toes, and goes limp when the parents are playing with the infant. What would the nurse teach the parents? A. These are signs the infant is stressed and needs to rest. B. These are signs the infant is enjoying the attention. C. These are signs the infant is hungry and needs to eat. D. There are signs the infant is hypoxic and needs oxygen.
A
A preterm newborn is noted to have hypotonia, apnea, bradycardia, a bulging fontanelle, cyanosis, and increased head circumference. These signs indicate the newborn has which complication? A. Intraventricular hemorrhage (IVH) B. Cold stress C. Respiratory distress syndrome D. Retinopathy of prematurity (ROP)
A
A woman who has given birth to a postterm newborn asks the nurse why her baby looks so thin with so little muscle. The nurse integrates understanding about which concept when responding to the mother? A. With postterm birth, the fetus uses stored nutrients to stay alive, and wasting occurs. B. The newborn aspirated meconium, causing the wasted appearance. C. A postterm newborn has begun to break down red blood cells more quickly. D. The newborn was exposed to an infection while in utero.
A
An obese woman with diabetes has just given birth to a term, large for gestational age (LGA) newborn. Which condition should the nurse most expect to find in this infant? A. hypoglycemia B. hyperglycemia C. hypotension D. hypertension
A
At birth, the infant has dry, cracked skin, absence of vernix, lack of subcutaneous fat, fingernail extending beyond the fingertips, and poor skin turgor. Based on these findings, how would the nurse would classify this neonate? A. postterm B. preterm C. SGA D. LGA
A
At birth, the newborn was at the 8th percentile with a weight of 2350g and born at 36 weeks gestation. Which documentation is most accurate? A. The infant was a preterm, low birth weight and small for gestational age B. The infant was born at term but at a low birth weight and small for gestational age C. The infant was born at term but a very low birth weight and small for gestational age D. The infant was a preterm, very low birthweight and small for gestational age
A
During the newborn examination, the nurse notes that an infant who is appropriate for gestational age by birth weight has a head circumference below the 10th percentile and the fontanelles are not palpable. What action would the nurse take? A. Report the findings to the pediatric provider. B. Reassess the head circumference in 24 hours. C. Document that the infant has microcephaly. D. Tell the parent the infant's brain is underdeveloped.
A
The nurse begins intermittent oral feedings for a small-for-gestational-age newborn to prevent which occurrence? A. hypoglycemia B. polycythemia C. meconium aspiration D. asphyxia
A
The nurse determines a newborn is small-for-gestational age based on which characteristics? A. wasted appearance of extremities, thin umbilical cord, and reduced subcutaneous fat stores B. wasted appearance of extremities, gelatinous umbilical cord, and abundant subcutaneous fat stores C. reduced subcutaneous fat stores to buttocks, thicker umbilical cord, and smaller head compared to body D. normal subcutaneous fat stores, cord-like umbilical cord, and increased development to extremities
A
The nurse is caring for a small-for-gestational-age infant at 1 hour old, after a difficult birth, with a glucose level of 40 mg/dL (2.5 mmol/L). Which nursing action would be the priority? A. Initiate early oral feedings. B. Ensure feedings are on demand. C. Initiate daily newborn weights. D. Monitor the infant at feedings.
A
The nurse suspects a preterm newborn receiving enteral feedings of having necrotizing enterocolitis (NEC). What assessment finding best correlates with this diagnosis? A. bloody stools B. poor suck reflex C. high-pitched cry D. meconium stools
A
What action by the nurse provides the neonate with sensory stimulation of a human face? A. assisting the mother to position the infant in an enface position B. encouraging the mother to view the baby through the isolette dome C. having mothers look at the infant through the isolette's porthole D. teaching parents to maintain a distance of 18 inches (2.54 cm) from the baby's face
A
When providing postpartum teaching to a couple, the nurse correctly identifies what time as when pathologic jaundice may be found in the newborn? A. during the first 24 hours of life B. between 2 and 4 days of life C. after 5 days postpartum D. often with formula-fed babies
A
Which newborn would the nurse suspect to be most at risk for intellectual disability due to the mother's actions during pregnancy? A. the child of a client who admits to drinking a liter of alcohol daily during the pregnancy B. the child of a teenage client who used marijuana through her pregnancy to cope with stress C. the newborn of a client addicted to heroin and in the methadone maintenance program D. the newborn of a client who used cocaine occasionally during her pregnancy
A
Which nursing measure is most effective in reducing newborn infections? A. Maintain medical asepsis while providing care. B. Limit the number of newborns in newborn nurseries. C. Place newborns in an isolette. D. Promote early discharge of all newborns.
A
During an extended initial resuscitation, what additional complications may be experienced by the infant during the resuscitation? Select all that apply. A. hypoglycemia B. dehydration C. hypokalemia D. anemia E. leukocytosis
A, B
Who is at risk for Retinopathy of Prematurity? Select all that apply. A. premature infants who weighed less then 1500 grams at birth B. Infants who were born before 30 weeks gestational age C. infants that are immunosuppressed D. infants who were born vaginally
A, B
After an extended resuscitation, the infant's body temp is 35.8°C. What assessment finding would the nurse anticipate as a consequence of a temperature of 35.8°C? Select all that apply. A. heart murmur B. hypoglycemia C. decreasing oxygen saturation D. hyperbilirubinemia E. leukocytosis
A, B, C
Some of the risk factors associated with neural tube defects include which of the following? Select all that apply. A. Poor nutrition B. Diabetes C. Exposure to certain chemicals/radiation during pregnancy D. History of NTD E. Rh incompatibility between mother and fetus
A, C, D
A neonate undergoing phototherapy treatment must be monitored for which adverse effect? A. Hyperglycemia B. Increased insensible water loss C. Severe decrease in platelet count D. Increased GI transit time
B
A newborn boy is diagnosed with esophageal atresia and tracheoesophageal fistula. After the nurse provides preoperative teaching, which statement indicates that the parents need additional teaching? A. "He'll need antibiotics for a bit after the surgery to prevent infection." B. "We can probably start feeding him with the bottle about a day after the surgery." C. "The head of his bed will be elevated to prevent him from aspirating." D. "We can give him a pacifier to help satisfy his need to suck."
B
A nurse is assessing a newborn during the first 24 hours after birth. Which findings would the nurse recognize as normal? A. heart rate of 90 to 100 bpm B. body temperature of 97.9° to 99.7° F (36.5° to 37.5°) C) rounded, symmetrical abdomen D. enlarged labia with pseudomenstruation E. positive Ortolani sign
B
A nurse is assigned to care for a newborn with hyperbilirubinemia. The newborn is relatively large in size and shows signs of listlessness. What most likely occurred? A. The infant's mother must have had a long labor. B. The infant's mother probably had diabetes. C. The infant may have experienced birth trauma. D. The infant may have been exposed to alcohol during pregnancy.
B
A nurse is caring for a newborn client diagnosed with spina bifida. Which assessment finding would be a priority for the nurse who is monitoring for the risk of hydrocephalus? A. Assess the motor function of the lower extremities. B. Assess head circumference measurements. C. Assess the newborn's weight. D. Assess the newborn's neurological response.
B
A nurse is caring for a preterm newborn born at 29 weeks' gestation. Which nursing diagnosis would have the highest priority? A. Grieving related to the loss of "a healthy full-term newborn" B. Ineffective thermoregulation related to decreased amount of subcutaneous fat C. Risk for injury related to the very thin epidermis layer of skin D. Imbalanced nutrition: Less than body requirements related to the premature digestive system
B
A nurse who has worked in a nursery for 15 years informs the nursing student that feeding an infant early has advantages. The nurse describes which biggest advantage? A. allows the baby to sleep longer B. allows the baby to pass stools, which helps to reduce bilirubin C. allows the mother to see if the baby can tolerate formula D. helps to ease the baby's hunger
B
A preterm infant will be hospitalized for an extended time. Assuming the infant's condition is improving, which environment would the nurse feel is most suitable for the child? A. Keep the environment free of color to reduce eye straining. B. Provide a mobile the child can see no matter how the child is turned. C. Place the infant's Isolette near the window so the child can see outside. D. Bring the child's open bassinet near the desk area so the infant sees people.
B
An 18-year-old client has given birth in the 28th week of gestation, and her newborn is showing signs of respiratory distress syndrome (RDS). Which statement is true for a newborn with RDS? A. Glucocorticosteroid is given to the newborn following birth. B. RDS is caused by a lack of alveolar surfactant. C. Respiratory symptoms of RDS typically improve within a short period of time. D. RDS is characterized by heart rates below 50 beats per minute.
B
An infant is suffering from neonatal abstinence syndrome. The nurse provides appropriate care and support for the infant during the infant's time on the unit. Besides nursing and medical care, what other step would the nurse take to support the infant? A. Contact the chaplain. B. Link the family with community sources for aid. C. Make sure the infant was in a bright, loud room. D. Make sure a volunteer feeds the baby.
B
At a prenatal class the nurse describes the various birth weight terms that may be used to describe a newborn at birth. The nurse feels confident learning has has occurred when a participant makes which statement? A. "Appropriate for gestational age means a newborn is born with a weight that falls in the 10th percentile." B. "Newborns who are appropriate for gestational age at birth have lower chance of complications than others." C. "Appropriate for gestational age describes a newborn with a weight over the 90th percentile at birth." D. "Infants who are larger for gestational age at birth have fewer complications than the other groups."
B
How is Retinopathy of Prematurity diagnosed? A. Based off of the number of weeks of immaturity B. All of these high-risk babies are examined in the NICU by an ophthalmologist (eye doctor) C. Based off of a STD that mom has during birth after she passes through the vaginal canal D. Based off of mom and dads genetics
B
In completing the newborn assessment checklist, the nurse documents a meconium stool. This documentation rules out which condition? A. Hiatal hernia B. Imperforate anus C. Spina bifida occulta D. Epispadias
B
The mother of a newborn with a caput succedaneum asks the nurse how this happened to her baby. Which response by the nurse would be most appropriate? A. "The forceps used during delivery caused this to happen." B. "During delivery, your vaginal wall put pressure on the baby's head." C. "It's normal for this to happen, but they don't really know why."
B
The nurse assesses an infant. Which finding may indicate heart failure? A. capillary refill time B. diminished peripheral pulses C. color of hands and feet D. blood glucose level
B
What medication does the nurse anticipate administering to the preterm newborn as an inhalant to improve the lungs' ability to mature? A. Rho(D) immune globulin B. surfactant C. neomycin D. heparin
B
Which health care provider assessment technique does the nurse anticipate being used to determine developmental dysplasia of the hip (DDH) on a newborn? A. Full range of motion of the hip B. Barlow sign and Ortolani click C. Assessing leg kicks for extension D. Visual inspection of the hip
B
Which nursing action is required when caring for the post-term infant? A. Echocardiogram at the end of pregnancy B. Serial blood glucose levels C. temperature checks every 2 hours D. IV initiation
B
A nurse is providing care to a preterm neonate. Which interventions would be most effective in minimizing the newborn's pain? Select all that apply. A. covering the newborn loosely with a blanket B. encouraging kangaroo care during procedures C. removing tape gently from the skin D. increasing the volume on device alarms E. using cool blankets to soothe the newborn F. using a colorful mobile for distraction
B, C, F
A client gives birth to a newborn baby at term. The nurse records the weight of the baby as 1.2 kg, interpreting this to indicate that the newborn is of: A. normal birth weight. B. low birth weight. C. very low birth weight. D. extremely low birth weight.
C
A nurse is assigned to care for a newborn with esophageal atresia. What preoperative nursing care is the priority for this newborn? A. Document the amount and color of esophageal drainage. B. Administer antibiotics and total parenteral nutrition as prescribed. C. Prevent aspiration by elevating the head of the bed, and insert an NG tube to low suction. D. Provide NG feedings only.
C
Four weeks before the birth of a client's already large child, the primary care provider has told the client that if the baby gets bigger and the baby's lungs are ready, the care provider would like to perform a cesarean birth. The woman asks the nurse what the downside is to having a cesarean rather than a vaginal birth. What is an appropriate response by the nurse? A. "If the care provider has recommended the procedure, it's likely that the benefits outweigh the risks." B. "The procedure isn't risky for the baby, but your healing takes longer, and you'll have a scar." C. "As the baby passes through the birth canal some of the excess fluid is expelled from the lungs; if that doesn't happen there's a higher risk of respiratory distress." D. "Some women don't have any problem giving birth to large babies. You might want to get a second opinion."
C
Hypoglycemia in a mature infant is defined as a blood glucose level below which amount? A. 100 mg/100 mL whole blood B. 80 mg/100 mL whole blood C. 40 mg/100 mL whole blood D. 30 mg/100 mL whole blood
C
The nurse assesses a large for gestational age infant admitted to the newborn observational unit with the diagnosis of hypoglycemia. What would best correlate with this diagnosis? A. jaundice B. positive Moro reflex C. jitteriness D. palmar creases
C
The nurse is assessing the plantar creases on the newborns for documentation on the Ballard Scale. Which documentation is interpreted as evidence of a full-term infant? A. Middle crease across the palm of the hand B. No deep creases on the newborn's body C. Creases covering two-thirds of the anterior foot D. Creases extending across the brow
C
The nurse is caring for a client who is at her due date. The client asks. "How long is the health care provider going to let me go?" The nurse is correct to state that typical a mother should not pass how many weeks gestation? A. 40 weeks B. 41 weeks C. 42 weeks D. 44 weeks
C
The nurse is working in the special care nursery caring for a newborn withdrawing from alcohol. Which nursing intervention promotes client comfort? A. Administer benzodiazepines B. Provide 1 ounce of formula C. Swaddle and decrease stimulation D. Promote parental bonding
C
The nurse observes a neonate born at 28 weeks' gestation. Which finding would the nurse expect to see? A. The skin is pale, and no vessels show through it. B. Creases appear on the interior two-thirds of the sole. C. The pinna of the ear is soft and flat and stays folded. D. The neonate has 7 to 10 mm of breast tissue.
C
What is a consequence of hypothermia in a newborn? A. respirations of 46 B. heart rate of 126 C. holds breath 25 seconds D. skin pink and warm
C
What would the nurse expect to prioritize in the assessment of a newborn who has a positive Coombs test? A. tremor activity B. hyperglycemia C. jaundice development D. phenylketonuria
C
When providing care to the newborn withdrawing from a drug such as cocaine or heroin, which drug is given to ease the symptoms and prevent complications? A. Acetaminophen B. Ibuprofen C. Morphine D. Aspirin
C
Which finding might be seen in a neonate suspected of having an infection? A. Flushed cheeks B. Increased activity level C. Decreased temperature
C
Which respiratory disorder in a neonate is usually mild and runs a self-limited course? A. Pneumonia B. Meconium aspiration syndrome C. Transient tachypnea D. Persistent pulmonary hypertension
C
The nurse in the NICU is caring for preterm newborns. Which guidelines are recommended for care of these newborns? Select all that apply. A. Handle the newborn as much as possible. B. Give the newborn a warm bath immediately. C. Dress the newborn in ways to preserve warmth. D. Take the newborn's temperature often. E. Supply oxygen for the newborn, if necessary. F. Discourage contact with parents to maintain asepsis.
C, D, E
A client asks the nurse what surfactant is. Which explanation would the nurse give as the main role of surfactant in the neonate? A. assists with ciliary body maturation in the upper airways B. helps maintain a rhythmic breathing pattern C. promotes clearing of mucus from the respiratory tract D. helps the lungs remain expanded after the initiation of breathing
D
A newborn does not breathe spontaneously at birth. The nurse administers oxygen by bag and mask. If oxygen is entering the lungs, the nurse should notice that the: A. abdomen rises while the chest falls with bag compressions. B. infant's pupils dilate after 3 minutes. C. infant's neck veins become prominent and palpable. D. chest rises with each bag compression.
D
A newborn is identifies as extremely low birth weight placing the newborn's weight at which level? A. More than 4,000 g. B. Approximately 2,500 g. C. At a maximum of 1,500 g. D. Less than 1,000 g.
D
A nurse is caring for a child with complex esophageal atresia who will be undergoing surgery for repair. What comment by the parents indicates further teaching is required? A. "They will be placing a tube in the stomach during surgery." B. "The baby will have tubes in the chest to drain chest fluids." C. "Intravenous fluids are going to be needed so that the baby won't get dehydrated." D. "After this surgery is done tomorrow, my baby will be able to eat and drink."
D
A nursing student, observing care of a 30-week-gestation infant in the neonatal intensive care unit, asks the nurse, "Are premature infants more susceptible to infection as I have to wash my hands so often in this department?" What is the nurse's best response? A. "Yes, as they lack the antibody called IdD that acts as protection from infections." B. "Not really, as premature infants are cared for in an isolate, protecting them from infection." C. "Feeding premature infants breast milk establishes the best protective mechanisms." D. "That is correct; a 30-week-gestation infant lacks the protective antibody called IgG."
D
An infant is suspected of having persistent pulmonary hypertension of the newborn (PPHN). What intervention implemented by the nurse would be most beneficial in treating this client? A. Encourage the parents to hold the infant for bonding. B. Place the infant in a cool environment to prevent overheating. C. Administer anticonvulsants as prescribed. D. Provide oxygen by oxygen hood or ventilator.
D
The nurse has developed a nursing plan for the care of a 6-year-old girl with congenital hydrocephalus whose shunt has become infected. The most important discharge teaching point for this family is: A. maintaining effective cerebral perfusion B. encouraging development of motor skills C. establishing seizure precautions for the child D. ensuring the parents know how to properly give antibiotics
D
The nurse is admitting a newborn male for observation with the diagnosis of preterm. What assessment finding corresponds with this gestational age diagnosis? A. abundant sole creases B. minimal vernix caseosa C. breasts clearly delineated D. undescended testes
D
The nurse is assessing a newborn suspected of having meconium aspiration syndrome. What sign or symptom would be most suggestive of this condition? A. high-pitched, shrill cry B. bile-stained emesis C. intermittent tachypnea D. expiratory grunting
D
The nurse is teaching nursing students about the risks that late preterm infants may experience. The nurse feels confident learning has taken place when the students make which statement? A. "Late preterm infant complications are considered minor compared to the preterm newborn." B. "The late preterm infant is more mature and able to cope as well as a full-term infant." C. "Late preterm newborns have fewer clinical problems leading to shorter hospital stays." D. "A late preterm newborn may have more clinical problems compared with full-term newborns."
D
The nurse realizes the educational session conducted on due dates was successful when a participant is overheard making which statement? A. "The ability of my amniotic fluid to provide adequate oxygen and nutrients to my baby after 42 weeks' gestation is thought to be compromised." B. "The ability of my umbilical cord to provide adequate oxygen and nutrients to my baby after 42 weeks' gestation is thought to be compromised." C. "The ability of my body to provide adequate oxygen and nutrients to my baby after 42 weeks' gestation is thought to be increased." D. "The ability of my placenta to provide adequate oxygen and nutrients to my baby after 42 weeks' gestation is thought to be compromised."
D
What chemical change occurs to stimulate respirations in a newborn's brain after birth? A. The carbon dioxide blood levels decrease. B. The oxygen levels in the blood increase. C. The newborn becomes alkalotic. D. The newborn's pH level falls.
D
What should the nurse expect for a full-term newborn's weight during the first few days of life? A. There is an increase in 3% to 5% of birth weight by day 3 in formula-fed babies. B. A formula-fed newborn should gain 3% to 5% of the initial birth weight in the first 48 hours, but a breastfed newborn may lose up to 3%. C. There is a loss of 5% to 10% of the birth weight in the first few days in breastfed infants only. D. There is a loss of 5% to 10% of birth weight in formula-fed and breastfed newborns.
D
When discussing heat loss in newborns, placing a newborn on a cold scale would be an example of what type of heat loss? A. evaporation B. convection C. radiation D. conduction
D
Which finding is indicative of hypothermia of the preterm infant? A. regular respirations B. oxygen saturation of 95% C. pink skin D. nasal flaring
D
Which symptom would most accurately indicate that a newborn has experienced meconium aspiration during the birth process? A. bluish skin discoloration B. listlessness or lethargy C. stained umbilical cord and skin D. meconium stained fluids followed by tachypnea
D
All the options are signs of respiratory distress in the newborn except: A. grunting B. nasal flaring C. chest retractions D. central cyanosis E. respiratory rate >50 breaths/minute F. coughing
E
A meconium plug is an extremely hard portion of meconium that has completely blocked the intestinal lumen, causing bowel obstruction. True or False?
True
Preterm infant deaths account for 80% to 90% of infant mortality in the first year of life. True or False?
True