NRSG408 Test 2

Why is vitamin K administered to newborns? 1) It reduces bilirubin levels. 2) It increases the production of red blood cells. 3) It enhances the ability of blood to clot. 4) It stimulates the formation of surfactant.

3) It enhances the ability of blood to clot.

Which noninvasive test is done during initial diagnostic testing for infertility? 1) Hysterosalpingography 2) Endometrial biopsy 3) Semen analysis 4) Laparoscopy

3) Semen analysis

For which reason would the nurse attempt to blanch pinpoint hemorrhagic areas on the face of an infant? 1) To differentiate between skin rash and Mongolian spots 2) To determine the intensity of the hemorrhages 3) To differentiate hemorrhagic areas from skin rashes 4) To determine the cause for the hemorrhagic areas

3) To differentiate hemorrhagic areas from skin rashes Rationale: Ecchymoses and petechiae are pinpoint hemorrhages on the neonate's body that indicate soft tissue injury caused by the use of forceps or a vacuum during delivery. The nurse would blanch the infant's skin at the site of the hemorrhagic areas to determine whether or not skin blanching occurs.

Which neonatal electrolyte imbalance is associated with maternal diabetes? 1) Decreased sodium levels 2) Decreased potassium levels 3) Decreased phosphate levels 4) Decreased magnesium levels

4) Decreased magnesium levels

Which reproductive therapy would help the client diagnosed with endometriosis to conceive? 1) Gestational carrier 2) Assisted hatching technique 3) Intrauterine insemination technique 4) In vitro fertilization-embryo transfer (IVF-ET)

4) In vitro fertilization-embryo transfer (IVF-ET)

What complication would the nurse monitor for in an infant with a Pavlik? 1) Convulsions 2) Hypothyroidism 3) Jejunoileal atresia 4) Skin breakdown

4) Skin breakdown Rationale: The Pavlik harness is used for an infant with hip dislocation, and may cause skin irritation under the straps. Therefore, the nurse would regularly assess the skin under the straps three or four times a day.

Which action would the nurse take when weighing a newborn? 1) Leave the diaper on for comfort. 2) Place a sterile scale paper on the scale for infection control. 3) Keep hand on the newborn's abdomen for safety. 4) Weigh the newborn at the same time each day for accuracy.

4) Weigh the newborn at the same time each day for accuracy.

A client with severe preeclampsia is receiving a magnesium sulfate infusion. Which assessment finding would be most concerning to the nurse? A. A sleepy, sedated affect B. A respiratory rate of 10 breaths/min C. Deep tendon reflexes of 2+ D. Absent ankle clonus

A respiratory rate of 10 breaths/min

Which assessment finding would the nurse recognize as an indicator for early screening for gestational diabetes mellitus (GDM)? A. The client is 24 years of age. B. The client's body mass index (BMI) is 22. C. The client does not have diabetes. D. The client had a previous stillbirth.

D. The client had a previous stillbirth.

Which symptom at birth would the nurse identify as likely associated with a congenital cardiac defect? 1) skin color 2) muffled cry 3) restlessness 4) heart murmur

2) muffled cry

Which characteristic is specific to the maternal blood type O-negative that can result in hemolytic disease in a newborn who is AB-positive? Select all that apply. 1) Absent Rh D antigen 2) Present Rh D antigen 3) Type O blood has antigens 4) Type O has antibodies to type A blood 5) Type O blood has antigens to type B blood

1) Absent Rh D antigen 4) Type O has antibodies to type A blood 5) Type O blood has antigens to type B blood Rationale: The maternal blood type does not contain an Rh D antigen. Blood type O has antibodies to blood types A and B. Present antigens indicate a positive Rh. Type O blood does not have antigens.

Which clinical manifestations are associated with the infection caused by Toxoplasma gondii? Select all that apply. 1) Chorioretinitis 2) Hydrocephalus 3) Polyhydramnios 4) Respiratory distress 5) Cerebral calcifications

1) Chorioretinitis 2) Hydrocephalus 5) Cerebral calcifications think eyes & brain issues

Which outcome describes the pathophysiology of a newborn with aortic stenosis? Select all that apply. 1) Decreased cardiac output 2) Left ventricular hypertrophy 3) Right ventricular hypertrophy 4) Pulmonary vascular congestion 5) Decreased pulmonary blood flow

1) Decreased cardiac output 2) Left ventricular hypertrophy 4) Pulmonary vascular congestion

Which risk factors contribute to the increased risk for congenital cardiac defects? Select all that apply. 1) Obesity 2) Hypertension 3) Inadequate nutritional intake 4) STIs 5) Smoking a pack of cigarettes per week

1) Obesity 3) Inadequate nutritional intake

Which structural anatomical anomalies are associated with atresia of the esophagus and tracheoesophageal fistulas and increase the newborn's risk for aspiration? Select all that apply. 1) The upper and lower segments of the esophagus ending in a blind sac. 2) Both segments of the esophagus connect by fistulous tracts to the trachea. 3) The esophagus is continuous but connects by a fistulous tract to the trachea. 4) The upper segment of the esophagus ends in atresia and connects to the trachea by a fistulous tract. 5) The upper segment of the esophagus ends in a blind pouch; the lower segment connects with the trachea by small fistulous tract.

1) The upper and lower segments of the esophagus ending in a blind sac. 5) The upper segment of the esophagus ends in a blind pouch; the lower segment connects with the trachea by small fistulous tract. rationale: The esophagus that ends with a blind sac or pouch does not allow fluids or food to pass through to the trachea, which bifurcates into the right and left lungs. The esophagus or any segment of the esophagus that is connected by a fistulous tract or tracts to the trachea place the newborn at risk for aspiration. atresia: the absence or abnormal narrowing of an opening or passage in the body.

Prenatal exposure to which substance can result in craniofacial anomalies in the newborn? 1) alcohol 2) cocaine 3) heroin 4) tobacco

1) alcohol

Which newborn reflex is characterized by abrupt abduction and extension of the arms with the fingers fanned out while the thumb and forefinger form a "C"? 1) Tonic neck reflex 2) Moro reflex 3) Cremasteric reflex 4) Babinski reflex

2) Moro reflex

Which is the normal range of amniotic fluid index? a. 1 to 5 cm b. 10 to 25 cm c. 25 to 40 cm d. 40 to 65 cm

10 to 25 cm rationale: Amniotic fluid index is a biophysical profile that helps to estimate the amniotic fluid volume and fetal wellbeing. An amniotic fluid index of 10 to 25 cm is a normal finding. An amniotic fluid value of 1 to 5 cm is indicative of oligohydramnios. An amniotic fluid index of greater than 25 cm is indicative of polyhydramnios. Therefore, neither 25 to 40 cm nor 40 to 65 cm is a normal range of amniotic fluid index.

The nurse grasps the base of the umbilical cord and counts 14 beats for 6 seconds. What is the heart rate of the newborn? Record your answer using a whole number. _____ beats/min

140 bpm

Which statement by the student nurse indicates effective learning regarding the prevention of healthcare-associated infections in the nursery unit? 1) "Changing used equipment often may cause healthcare-associated infections." 2) "Handwashing helps prevent healthcare-associated infections in the nursery unit." 3) "Nursery visitors are allowed if they wear masks." 4) "Soiled diapers are disposed of away from the infant."

2) "Handwashing helps prevent healthcare-associated infections in the nursery unit."

Which statement regarding infections in premature infants would the nurse recognize as accurate? 1) To prevent infection, all premature infants receive prophylactic antibiotics. 2) Health care-associated infections can be prevented by effective handwashing. 3) Infection rates are lower in premature infants because of maternal immunoglobulins. 4) The clinical sign of a rapid, high fever makes infection easier to diagnose.

2) Health care-associated infections can be prevented by effective handwashing.

Which condition may be seen in an infant born to a client who consumed excessive alcohol during pregnancy? 1) Respiratory distress 2) Hypothyroidism 3) Congenital abnormalities 4) Skull fractures

3) Congenital abnormalities Rationale: Infants exposed to alcohol prenatally are at risk for congenital abnormalities. Respiratory distress is not usually seen in an infant exposed to alcohol. Hypothyroidism is a genetic disorder not related to alcohol consumption. Skull fractures are sometimes caused during a difficult birth because of the pressure of the fetal skull against the maternal pelvis.

Which pathology pertains to phenylketonuria? 1) Disorder in purine metabolism 2) Deficiency in thyroid hormones 3) Defect in amino acid metabolism 4) Inability to convert galactose to glucose

3) Defect in amino acid metabolism Rationale: Phenylketonuria is an amino acid disorder that results from the deficiency of the enzyme phenylalanine dehydrogenase, which is needed to metabolize the essential amino acid phenylalanine.

Which factors predispose an infant to birth injuries? Select all that apply. 1) Multipara between 25 and 30 years of age 2) Vertex presentation 3) Internal fetal scalp electrode application 4) Vacuum-assisted birth 5) Small for gestational age (SGA)

3) Internal fetal scalp electrode application 4) Vacuum-assisted birth rationale: The use of an internal fetal scalp electrode could result in a scalp injury that would be evident on birth. The use of vacuum extraction could lead to a birth injury. Very young clients who are primiparas are more likely to predispose an infant to birth injuries. Vertex presentation is considered to be a normal finding and as such would not typically lead to a birth injury. Small for gestational age (SGA) infants have less likelihood of birth injuries.

Which nursing instruction is appropriate when discussing self-care after a miscarriage? Select all that apply. A. Increase dietary intake of iron. B. Avoid tub baths for 2 weeks. C. Avoid intercourse for 4 weeks. D. Avoid trying to get pregnant until a menstrual cycle has passed. E. Notify the health care provider if vaginal discharge has a foul odor.

A. Increase dietary intake of iron. B. Avoid tub baths for 2 weeks. E. Notify the health care provider if vaginal discharge has a foul odor.

Which nursing information is appropriate to include when discussing dietary self-management for a client with hyperemesis? Select all that apply. A. Try to eat more dairy. B. Drink liquids from a cup with a straw. C. Eat a snack that is high in carbohydrates before bed. D. Consume protein after eating a sweet snack. E. Try drinking your water with a slice of lemon.

A. Try to eat more dairy. D. Consume protein after eating a sweet snack. E. Try drinking your water with a slice of lemon.

Which interventions would the nurse use to monitor the hematologic status of a preterm neonate? Select all that apply. One, some, or all responses may be correct. A. Weigh the infant daily. B. Assess puncture sites for bleeding. C. Assess stool and emesis for blood. D. Monitor the level of consciousness. E. Implement continuous monitoring of oxygen saturation.

A. Weigh the infant daily. B. Assess puncture sites for bleeding. C. Assess stool and emesis for blood. D. Monitor the level of consciousness. Rationale: Preterm infants are at increased risk for bleeding and anemia. The nurse would weigh the infant daily, assess puncture sites for bleeding as well as the stool and emesis for blood, and monitor the neonate's level of consciousness. There is no indication that oxygen saturation requires continuous monitoring.

Which infection is caused by the varicella zoster virus? A. Syphilis B. Chickenpox C. Toxoplasmosis D. German measles

B. Chickenpox The causative agent of chickenpox and shingles is varicella zoster virus, which is a member of the herpes family. Treponema pallidum causes syphilis, a sexually transmitted infection. Toxoplasma gondii is protozoan that causes toxoplasmosis. Rubella virus is the causative agent of German measles.

Which nursing information is appropriate to include in an explanation to the parents regarding their 24-hour-old newborn who did not pass the initial hearing screening? A. A consult with an audiologist will be obtained. B. The screening will be repeated before discharge. C. The screening will be repeated at 2 months of age. D. The screening will be repeated in the health care provider's office on the first visit

B. The screening will be repeated before discharge.

Which technique would the nurse use to assess the plantar reflex of an infant? A. Touch the corner of the infant's mouth with a finger. B. Tap over the bridge of the infant's nose when awake. C. Place a finger at the base of the infant's toes. D. Place a finger in the palm of the infant's hand

C. Place a finger at the base of the infant's toes.

Via which route would the nurse administer synthetic surfactant to a premature infant with respiratory distress syndrome (RDS)? A. Intramuscular B. Subcutaneous C. Endotracheal tube D. Oral

C. Endotracheal tube rationale: Exogenous surfactant is administered via endotracheal tube as a bolus or in smaller amounts into the endotracheal tube through an adapter port. Surfactant is not given via the intramuscular, subcutaneous, or oral routes.

Which nursing intervention is appropriate when identifying the barriers to effective coping in a client with infertility? A. Build rapport using therapeutic communication. B. Assess the client's behavior for signs of depression. C. Evaluate the client's support system. D. Assess the client's level of understanding.

C. Evaluate the client's support system. Rationale: If a client has ineffective coping due to infertility, the nurse would evaluate the barriers that are obstructing the client's coping mechanisms. The nurse would evaluate the client's support system. The nurse would find out whether the client and the partner help each other in coping. Discussing the couple's feelings and concerns helps identify common feelings and perceived stressors. Building rapport using therapeutic communication may help the client in confiding in the nurse; however, it may not provide information about the barriers to effective coping. The nurse would assess the client's behavior for signs of depression to prevent impending crisis. Assessing the client's level of understanding about conception is useful to identify misconceptions or gaps in knowledge.

A client diagnosed with marginal placenta previa gave birth vaginally 15 minutes ago. At the present time, the client is at the greatest risk for which complication? a. Hemorrhage b. Infection c. Urinary retention d. Thrombophlebitis

Hemorrhage

The nurse caring for a pregnant client knows that which situation is the most common medical complication of pregnancy? A. Hypertension B. Hyperemesis gravidarum C. Hemorrhagic complications D. Infections

Hypertension rationale: Preeclampsia and eclampsia are two noted, deadly forms of hypertension; hypertension is the most common complication of pregnancy.

Which electrolyte imbalance results in jitteriness for the neonate born to an insulin-dependent diabetic mother? Select all that apply. 1) Hyperkalemia 2) Hypocalcemia 3) Hypernatremia 4) Hypomagnesemia 5) Hypophosphatemia

Hypocalcemia and Hypomagnesemia

Which fetal conditions are associated with maternal diabetes? Select all that apply. 1) Fetal microsomia 2) Hypoglycemia 3) Respiratory distress syndrome 4) Galactosemia 5) Phenylketonuria

Hypoglycemia and RDS rationale: hypoglycemia is seen in infants of diabetic women at birth, as the infant's glucose supply is removed abruptly at the time of birth. Hyperinsulinemia and hyperglycemia reduce fetal surfactant synthesis and cause respiratory distress syndrome in the infant of a diabetic mother. Fetal macrosomia (not microsomia) is seen in some infants born to diabetic women as a result of maternal hyperlipidemia and increased lipid transfer to the fetus. Galactosemia is an autosomal recessive disorder that results from various gene mutations. Phenylketonuria is an inborn error of metabolism.

Which procedure describes when ova are removed by laparoscopy, mixed with sperm, and the embryo(s) returned to the woman's uterus? 1) In vitro fertilization 2) Tubal embryo transfer 3) Therapeutic insemination 4) Gamete intrafallopian transfer

IVF

The ultrasound report of a 12-week-pregnant client shows a snowstorm pattern. On further examination, the nurse finds elevated human chorionic gonadotropin (hCG) levels and dark brown vaginal discharge. Which complication would the nurse expect in the client? A. Hemorrhage B. Hypertension C. Hyperglycemia D. Molar pregnancy

Molar pregnancy

Which drug is prescribed to treat oral thrush in neonates? 1) Ampicillin 2) Nystatin 3) Erythromycin 4) Miconazole 2%

Nystatin (topical)

A pregnant client after 20 weeks of gestation reports painless bright red vaginal bleeding. On assessment, the nurse finds that the client's vital signs are normal. Which condition would the nurse suspect in the client? A. Eclampsia B. Preeclampsia C. Pyelonephritis D. Placenta previa

Placenta previa

Which condition is associated with a high risk for disseminated intravascular coagulation (DIC)? a. Eclampsia b. Placenta previa c. Placental abruption d. Gestational hypertension

Placental abruption rationale: Placental abruption is the most common cause of severe consumptive coagulopathy in obstetrics.

Which condition in a pregnant client with severe preeclampsia is an indication for administering magnesium sulfate? A. Seizure activity B. Renal dysfunction C. Pulmonary edema D. Low blood pressure

Seizure activity

Which neonatal infections are viral? Select all that apply. 1) Parvovirus B19 2) Chlamydia 3) Syphilis 4) Rubella 5) Escherichia coli 6) Human immunodeficiency virus (HIV)

Viral: Parvovirus B19, Rubella, HIV Bacterial: chlamydia, syphilis, E. coli

Which infant behavior would the nurse recognize as indicating respiratory distress? a. Absent cry after birth b. Hypoactive bowel sounds c. Side-to-side head movement d. Elevated BP

a. Absent cry after birth

Which are the manifestations of HELLP syndrome? Select all that apply. a. Hemolysis b. Tachycardia c. Hyperventilation d. Low platelet count e. Elevated liver enzymes

a. Hemolysis d. Low platelet count e. Elevated liver enzymes

An 8-month-pregnant client presents with preeclampsia. Which clinical findings in the client indicate that the disease has progressed to HELLP syndrome? Select all that apply. a. Hepatic dysfunction b. Elevated liver enzymes c. Vaginal bleeding d. Low platelet count e. Chronic hypertension

a. Hepatic dysfunction b. Elevated liver enzymes d. Low platelet count

A client with severe preeclampsia has been receiving magnesium sulfate by intravenous infusion for 8 hours. The nurse assesses the client and documents the following findings: temperature 37.1° C, pulse rate 96 beats/min, respiratory rate 24 breaths/min, blood pressure 155/112 mm Hg, 3+ deep tendon reflexes, and no ankle clonus. The nurse calls the primary health care provider and anticipates a prescription for which medication? a. Hydralazine b. Magnesium sulfate bolus c. Diazepam d. Calcium gluconate

a. Hydralazine

Which nursing action would be included in the initial treatment of a thyroid storm? Select all that apply. One, some, or all responses may be correct. a. Oxygen b. Intravenous fluids c. Administration of iodide d. Administration of dexamethasone e. High doses of propylthiouracil (PTU)

a. Oxygen b. IV fluids e. High doses of PTU

A client reports painless, bright red vaginal bleeding during the second trimester of pregnancy. On assessment, the nurse notes decreased urine output, increased fundal height, and a non-tender uterus with normal tone. Which client condition would the nurse interpret from these findings? a. Placenta previa b. Ectopic pregnancy c. Hydatidiform mole d. Normal development

a. Placenta previa Rationale: Placenta previa is an obstetric complication in which the placenta is implanted partially or completely in the lower uterine segment (near to or covering the cervix).

Which signs and symptoms would the nurse find in assessing the client with abruption placentae? Select all that apply. A. Hypoglycemia B. Abdominal pain C. Vaginal bleeding D. Delayed menses E. Uterine tenderness

b. Abdominal pain c. Vaginal bleeding e. Uterine tenderness

When assessing a pregnant client, the nurse is aware of which maternal and neonatal risks associated with gestational diabetes mellitus? a. Maternal premature rupture of membranes and neonatal sepsis. b. Maternal hyperemesis and neonatal low birth weight. c. Maternal preeclampsia and fetal macrosomia. d. Maternal placenta previa and fetal prematurity.

b. Maternal hyperemesis and neonatal low birth weight.

Which tests are used to identify tubal patency? Select all that apply. a. urine predictor test b. hysterosalpingogram c. clomiphene citrate challenge test d. Hysterosalpingography e. chlamydia immunoglobulin G antibody testing

b. hysterosalpingogram d. Hysterosalpingography e. chlamydia immunoglobulin G antibody testing Rationale: Hysterosalpingogram, hysterosalpingography, and chlamydia immunoglobulin G antibody testing are used to identify tubal patency. The urine predictor test is used to detect the timing of luteinizing hormone (LH) surge before ovulation. The clomiphene citrate challenge test is used to check the level of follicle-stimulating hormone (FSH).

The nurse is caring for a pregnant client who is scheduled for cordocentesis. Which could be a complication of the test? A. Destruction of red blood cells B. Fetal hyperbilirubinemia C. Fetomaternal hemorrhage D. Deformity of extremities

c. Fetomaternal hemorrhage

The nurse caring for a 37-week-gestation client with gestational hypertension determines that the client has very elevated blood pressure. Which is the best intervention to prevent complications in the client? a. Instruct the client to stay in bed. b. Provide the client with a nutritious dietary plan. c. Prepare the client for induction of labor. d. Instruct the client to come next week.

c. Prepare the client for induction of labor.

Which nursing explanation is appropriate to include when preparing a client for a nonstress test? a. "I will be using stimulation to wake up the baby." b. "You can recline a bit with a slight tilt to the side." c. "Push this button when you feel the baby move." d. "You can lie on your back and get comfortable."

d. "You can recline a bit with a slight tilt to the side." rationale: The client would be positioned in the semi-Fowler position with a slight lateral tilt to improve uterine perfusion and prevent supine hypotension. It is not necessary to use vibroacoustic stimulation to wake up the baby unless the fetal heart rate pattern is nonreactive. The client would be instructed to push a button if evidence of fetal movement is not on the tracing. The client would not be placed in the supine position as it can impede uterine perfusion and result in supine hypotension.

Which are common clinical signs of neonatal sepsis? Select all that apply. 1) lethargy 2) tachypnea 3) apnea 4) HTN 5) metabolic alkalosis

lethargy, tachypnea, apnea Rationale: Sepsis is a life-threatening condition associated with the presence of microorganisms or their toxins in the blood. Common clinical signs of neonatal sepsis include abnormal neurologic status (irritability, lethargy, poor feeding); respiratory distress (tachypnea, increased work of breathing, hypoxemia); apnea; abnormal temperature (hyperthermia or hypothermia); bleeding problems (petechiae, purpura, oozing); cardiovascular compromise (tachycardia, hypotension, poor perfusion); cyanosis; gastrointestinal symptoms (abdominal distention, emesis, diarrhea); jaundice; and seizures. Sepsis is associated with a decrease in cardiac output, leading to hypotension. Sepsis causes respiratory acidosis and results in metabolic acidosis, not metabolic alkalosis.

Which are signs of acute pain in the neonate? Select all that apply. One, some, or all responses may be correct. 1) Pallor 2) Listlessness 3) Quivering chin 4) Constricted pupils 5) Decreased muscle tone

pallor, listlessness, quivering chin