376 Final Exam Practice Questions

A nursing instructor asks a nursing student to describe the procedure for administering erythromycin ointment into the eyes if a neonate. The instructor determines that the student needs to research this procedure further if the student states: "I will cleanse the neonate's eyes before instilling ointment." "I will flush the eyes after instilling the ointment." "I will instill the eye ointment into each of the neonate's conjunctival sacs within one hour after birth." "Administration of the eye ointment may be delayed until an hour or so after birth so that eye contact and parent-infant attachment and bonding can occur."

"I will flush the eyes after instilling the ointment."

Which neonatal behavior is most commonly associated with fetal alcohol syndrome (FAS)? Hypoactivity High birth weight Poor wake and sleep patterns High threshold of stimulation

Poor wake and sleep patterns

A neonate has been diagnosed with caput succedaneum. Which statement is correct about this condition? "It usually resolves in 3-6 weeks." "It doesn't cross the cranial suture line." "It's a collection of blood between the skull and the periosteum." "It involves swelling of tissue over the presenting part of the presenting head."

"It involves swelling of tissue over the presenting part of the presenting head."

The nurse instructs a primipara about safety considerations for the neonate. The nurse determines that the client does not understand the instructions when she says "All neonates should be in an approved car seat when in an automobile." "It's acceptable to prop the infant's bottle once in a while." "Pillows should not be used in the infant's crib." "Infants should never be left unattended on an unguarded surface."

"It's acceptable to prop the infant's bottle once in a while."

A nurse prepares to administer a vitamin K injection to a newborn infant. The mother asks the nurse why her newborn infant needs the injection. The best response by the nurse would be: "You infant needs vitamin K to develop immunity." "The vitamin K will protect your infant from being jaundiced." "Newborn infants are deficient in vitamin K, and this injection prevents your infant from abnormal bleeding." "Newborn infants have sterile bowels, and vitamin K promotes the growth of bacteria in the bowel."

"Newborn infants are deficient in vitamin K, and this injection prevents your infant from abnormal bleeding."

A newborn's mother is alarmed to find small amounts of blood on her infant girl's diaper. When the nurse checks the infant's urine it is straw colored and has no offensive odor. Which explanation to the newborn's mother is most appropriate? "It appears your baby has a kidney infection" "Breast-fed babies often experience this type of bleeding problem due to lack of vitamin C in the breast milk" "The baby probably passed a small kidney stone" "Some infants experience menstruation like bleeding when hormones from the mother are not available"

"Some infants experience menstruation like bleeding when hormones from the mother are not available"

The nurse hears the mother of a 5-pound neonate telling a friend on the telephone, "As soon as I get home, I'll give him some cereal to get him to gain weight?" The nurse recognizes the need for further instruction about infant feeding and tells her "If you give the baby cereal, be sure to use Rice to prevent allergy." "The baby is not able to swallow cereal, because he is too small." "The infant's digestive tract cannot handle complex carbohydrates like cereal." "If you want him to gain weight, just double his daily intake of formula."

"The infant's digestive tract cannot handle complex carbohydrates like cereal."

Within 3 minutes after birth the normal heart rate of the infant may range between: 100 and 180 130 and 170 120 and 160 100 and 130

120 and 160

The expected respiratory rate of a neonate within 3 minutes of birth may be as high as: 50 60 80 100

60

You're assessing the one minute APGAR score of a newborn baby. On assessment, you note the following about your newborn patient: heart rate 101, cyanotic body and extremities, no response to stimulation, no flexion of extremities, and strong cry. What is your patient's APGAR score? A. APGAR 4 B. APGAR 6 C. APGAR 3 D. APGAR 2

A. APGAR 4

A newborn's one minute APGAR score is 8. Which of the following nursing interventions will you provide to this newborn? A. Routine post-delivery care B. Full resuscitation assistance is needed and reassess APGAR score C. Continue to monitor and reassess the APGAR score in 10 minutes D. Some resuscitation assistance such as oxygen

A. Routine post-delivery care

The nurse is preparing to discharge a multipara 24 hours after a vaginal delivery. The client is breast-feeding her newborn. The nurse instructs the client that if engorgement occurs the client should Wear a tight fitting bra or breast binder. Apply warm, moist heat to the breasts Contact the nurse midwife for a lactation suppressant Restrict fluid intake to 1000 ml. daily

Apply warm, moist heat to the breasts

When performing an assessment on a neonate, which assessment finding is most suggestive of hypothermia? Bradycardia Hyperglycemia Metabolic alkalosis Shivering

Bradycardia

A postpartum nurse is providing instructions to the mother of a newborn infant with hyperbilirubinemia who is being breastfed. The nurse provides which most appropriate instructions to the mother? Switch to bottle feeding the baby for 2 weeks Stop the breast feedings and switch to bottle-feeding permanently Feed the newborn infant less frequently Continue to breastfeed every 2-4 hours

Continue to breastfeed every 2-4 hours

By keeping the nursery temperature warm and wrapping the neonate in blankets, the nurse is preventing which type of heat loss? Conduction Convection Evaporation Radiation

Convection

While assessing a 2-hour old neonate, the nurse observes the neonate to have acrocyanosis. Which of the following nursing actions should be performed initially? Activate the code blue or emergency system Do nothing because acrocyanosis is normal in the neonate Immediately take the newborn's temperature according to hospital policy Notify the physician of the need for a cardiac consult

Do nothing because acrocyanosis is normal in the neonate

A nurse is assessing a newborn infant following circumcision and notes that the circumcised area is red with a small amount of bloody drainage. Which of the following nursing actions would be most appropriate? Document the findings Contact the physician Circle the amount of bloody drainage on the dressing and reassess in 30 minutes Reinforce the dressing

Document the findings

A nurse in a delivery room is assisting with the delivery of a newborn infant. After the delivery, the nurse prepares to prevent heat loss in the newborn resulting from evaporation by: Warming the crib pad Turning on the overhead radiant warmer Closing the doors to the room Drying the infant in a warm blanket

Drying the infant in a warm blanket

A baby is born precipitously in the ER. The nurses initial action should be to: Establish an airway for the baby Ascertain the condition of the fundus Quickly tie and cut the umbilical cord Move mother and baby to the birthing unit

Establish an airway for the baby

The most common neonatal sepsis and meningitis infections seen within 24 hours after birth are caused by which organism? Candida albicans Chlamydia trachomatis Escherichia coli Group B beta-hemolytic streptococci

Group B beta-hemolytic streptococci

The primary critical observation for Apgar scoring is the: Heart rate Respiratory rate Presence of meconium Evaluation of the Moro reflex

Heart rate

Which action best explains the main role of surfactant in the neonate? Assists with ciliary body maturation in the upper airways Helps maintain a rhythmic breathing pattern Promotes clearing mucus from the respiratory tract Helps the lungs remain expanded after the initiation of breathing

Helps the lungs remain expanded after the initiation of breathing

The nurse is aware that a neonate of a mother with diabetes is at risk for what complication? Anemia Hypoglycemia Nitrogen loss Thrombosis

Hypoglycemia

A nurse is assessing a newborn infant who was born to a mother who is addicted to drugs. Which of the following assessment findings would the nurse expect to note during the assessment of this newborn? Sleepiness Cuddles when being held Lethargy Incessant crying

Incessant crying

A neonate is admitted to a hospital's central nursery. The neonate's vital signs are: temperature = 96.5 degrees F., heart rate = 120 bpm, and respirations = 40/minute. The infant is pink with slight acrocyanosis. The priority nursing diagnosis for the neonate is Ineffective thermoregulation related to fluctuating environmental temperatures. Potential for infection related to lack of immunity. Altered nutrition, less than body requirements related to diminished sucking reflex. Altered elimination pattern related to lack of nourishment.

Ineffective thermoregulation related to fluctuating environmental temperatures.

A nurse on the newborn nursery floor is caring for a neonate. On assessment the infant is exhibiting signs of cyanosis, tachypnea, nasal flaring, and grunting. Respiratory distress syndrome is diagnosed, and the physician prescribes surfactant replacement therapy. The nurse would prepare to administer this therapy by: Subcutaneous injection Intravenous injection Instillation of the preparation into the lungs through an endotracheal tube Intramuscular injection

Instillation of the preparation into the lungs through an endotracheal tube

The nurse is aware that a healthy newborn's respirations are: Regular, abdominal, 40-50 per minute, deep Irregular, abdominal, 30-60 per minute, shallow Irregular, initiated by chest wall, 30-60 per minute, deep Regular, initiated by the chest wall, 40-60 per minute, shallow

Irregular, abdominal, 30-60 per minute, shallow

A client with group AB blood whose husband has group O has just given birth. The major sign of ABO blood incompatibility in the neonate is which complication or test result? Negative Coombs test Bleeding from the nose and ear Jaundice after the first 24 hours of life Jaundice within the first 24 hours of life

Jaundice within the first 24 hours of life

When teaching umbilical cord care to a new mother, the nurse would include which information? Apply peroxide to the cord with each diaper change Cover the cord with petroleum jelly after bathing Keep the cord dry and open to air Wash the cord with soap and water each day during a tub bath

Keep the cord dry and open to air

A woman delivers a 3,250 g neonate at 42 weeks' gestation. Which physical finding is expected during an examination if this neonate? Abundant lanugo Absence of sole creases Breast bud of 1-2 mm in diameter Leathery, cracked, and wrinkled skin

Leathery, cracked, and wrinkled skin

Neonates of mothers with diabetes are at risk for which complication following birth? Atelectasis Microcephaly Pneumothorax Macrosomia

Macrosomia

To help limit the development of hyperbilirubinemia in the neonate, the plan of care should include: Monitoring for the passage of meconium each shift Instituting phototherapy for 30 minutes every 6 hours Substituting breastfeeding for formula during the 2nd day after birth Supplementing breastfeeding with glucose water during the first 24 hours

Monitoring for the passage of meconium each shift

A healthy term neonate born by C-section was admitted to the transitional nursery 30 minutes ago and placed under a radiant warmer. The neonate has an axillary temperature of 99.5oF, a respiratory rate of 80 breaths/minute, and a heel stick glucose value of 60 mg/dl. Which action should the nurse take? Wrap the neonate warmly and place her in an open crib Administer an oral glucose feeding of 10% dextrose in water Increase the temperature setting on the radiant warmer Obtain an order for IV fluid administration

Obtain an order for IV fluid administration A neonate with a rate of 80 breaths a minute shouldn't be fed but should receive IV fluids until the respiratory rate returns to normal

A nurse in a newborn nursery is performing an assessment of a newborn infant. The nurse is preparing to measure the head circumference of the infant. The nurse would most appropriately: Wrap the tape measure around the infant's head and measure just above the eyebrows. Place the tape measure under the infants head at the base of the skull and wrap around to the front just above the eyes Place the tape measure under the infants head, wrap around the occiput, and measure just above the eyes Place the tape measure at the back of the infant's head, wrap around across the ears, and measure across the infants mouth

Place the tape measure under the infants head, wrap around the occiput, and measure just above the eyes

When attempting to interact with a neonate experiencing drug withdrawal, which behavior would indicate that the neonate is willing to interact? Gaze aversion Hiccups Quiet alert state Yawning

Quiet alert state

When performing a newborn assessment, the nurse should measure the vital signs in the following sequence: Pulse, respirations, temperature Temperature, pulse, respirations Respirations, temperature, pulse Respirations, pulse, temperature

Respirations, pulse, temperature

After reviewing the client's maternal history of magnesium sulfate during labor, which condition would the nurse anticipate as a potential problem in the neonate? Hypoglycemia Jitteriness Respiratory depression Tachycardia

Respiratory depression

A nurse in the newborn nursery is monitoring a preterm newborn infant for respiratory distress syndrome. Which assessment signs if noted in the newborn infant would alert the nurse to the possibility of this syndrome? Hypotension and Bradycardia Tachypnea and retractions Acrocyanosis and grunting The presence of a barrel chest with grunting

Tachypnea and retractions

Which of the following behaviors would indicate that a client was bonding with her baby? The client asks her husband to give the baby a bottle of water. The client talks to the baby and picks him up when he cries. The client feeds the baby every three hours. The client asks the nurse to recommend a good child care manual.

The client talks to the baby and picks him up when he cries.

Vitamin K is prescribed for a neonate. A nurse prepares to administer the medication in which muscle site? Deltoid Triceps Vastus lateralis Biceps

Vastus lateralis

A mother of a term neonate asks what the thick, white, cheesy coating is on his skin. Which correctly describes this finding? Lanugo Milia Nevus flammeus Vernix

Vernix

The Obstetrician has ordered that Angelique's post-op patient-controlled analgesia (PCA) be discontinued. Which of the following actions by her nurse is appropriate? a) Discard the remaining medication in the presence of another nurse. b) Recommend waiting until her pain level is zero to discontinue the medication. c) Discontinue the medication only after the analgesia is completely absorbed. d) Return the unused portion of medication to the narcotics cabinet.

a) Discard the remaining medication in the presence of another nurse.

A client is 24 hours postpartum from a spontaneous vaginal delivery with rupture of membranes for 42 hours. Which of the following signs/symptoms should the nurse report to the Provider? a) Foul smelling lochia b) Engorged breasts c) Cracked nipples d) Cluster of hemorrhoids

a) Foul smelling lochia

The nurse in the obstetric clinic receives a telephone call from Susie, a bottle feeding mother of a 3 day old infant. Susie states that her breasts are firm, red, and warm to the touch. Which of the following is the best action for the nurse to advise Sally to perform? a) Intermittently apply cool packs to her axillae and breasts. b) Apply lanolin to her breasts and nipples every 3 hours. c) Express milk from the breasts every 3 hours. d) Ask her Obstetrician to order a milk suppressant.

a) Intermittently apply cool packs to her axillae and breasts.

A Mom, G4P4004, is 15 minutes postpartum. Her baby weighed 4595g at birth. For which of the following complications should the nurse monitor this patient? a) Seizures b) Hemorrhage c) Infection d) Thrombosis

b) Hemorrhage

A nurse is assisting a mother to feed a baby born with cleft lip and palate. Which of the following should the nurse teach the mother? a. The baby is likely to cry from pain during the feeding. b. The baby is likely to expel milk through the nose. c. The baby will feed more quickly than other babies. d. The baby will need to be fed high calorie formula.

b. The baby is likely to expel milk through the nose.

There is a baby in the neonatal intensive care unit (NICU) who is exhibiting signs of neonatal abstinence syndrome. Which of the following medications is contraindicated for this neonate? a. Morphine. b. Opium. c. Narcan. d. Phenobarbital.

c. Narcan.

A nurse, when providing discharge instructions to parents, emphasizes actions to prevent plagiocephaly and to promote gross motor development in their full-term infant. Which of the following actions should the nurse advise the parents to take? a. Breastfeed the baby frequently. b. Make sure the baby receives vaccinations at recommended intervals. c. Change the diapers regularly. d. Minimize supine positioning during supervised play periods.

d. Minimize supine positioning during supervised play periods.

A macrosomic infant of a non-insulin dependent diabetic mother has been admitted to the neonatal nursery. The baby's glucose level on admission to the nursery is 25mg/dl and after a feeding of mother's expressed breastmilk is 35mg/dl. Which of the following actions should the nurse take at this time? a. Nothing, because the glucose level is normal for an infant of a diabetic mother. b. Administer intravenous glucagon slowly over five minutes. c. Feed the baby a bottle of dextrose and water and reassess the glucose level. d. Notify the neonatologist of the abnormal glucose levels.

d. Notify the neonatologist of the abnormal glucose levels.

You're assessing the one minute APGAR score of a newborn baby. On assessment, you note the following about your newborn patient: heart rate 130, pink body and hands with cyanotic feet, weak cry, flexion of the arms and legs, active movement and crying when stimulated. What is your patient's APGAR score? A. APGAR 9 B. APGAR 10 C. APGAR 8 D. APGAR 5

C. APGAR 8

An insulin-dependent diabetic delivered a 10-pound male. When the baby is brought to the nursery, the priority of care is to Clean the umbilical cord with Betadine to prevent infection Give the baby a bath call the laboratory to Collect a PKU screening test Check the baby's serum glucose level and administer glucose if < 40 mg/dL

Check the baby's serum glucose level and administer glucose if < 40 mg/dl

A nurse in a newborn nursery receives a phone call to prepare for the admission of a 43-week-gestation newborn with Apgar scores of 1 and 4. In planning for the admission of this infant, the nurse's highest priority should be to: Connect the resuscitation bag to the oxygen outlet Turn on the apnea and cardiorespiratory monitors Set up the intravenous line with 5% dextrose in water Set the radiant warmer control temperature at 36.5* C (97.6*F)

Connect the resuscitation bag to the oxygen outlet

When performing nursing care for a neonate after a birth, which intervention has the highest nursing priority? Obtain a dextrostix Give the initial bath Give the vitamin K injection Cover the neonates head with a cap

Cover the neonates head with a cap Covering the neonates head with a cap helps prevent cold stress due to excessive evaporative heat loss from the neonate's wet head. Vitamin K can be given up to 4 hours after birth.

You're assessing the five minute APGAR score of a newborn baby. On assessment, you note the following about your newborn patient: heart rate 97, no response to stimulation, flaccid, absent respirations, cyanotic throughout. What is your patient's APGAR score? A. APGAR 2 B. APGAR 3 C. APGAR 0 D. APGAR 1

D. APGAR 1

You're assessing the one minute APGAR score of a newborn baby. On assessment, you note the following about your newborn patient: weak cry, some flexion of the arm and legs, active movement and cries to stimulation, heart rate 145, and pallor all over the body and extremities. What is your patient's APGAR score? A. APGAR 5 B. APGAR 9 C. APGAR 12 D. APGAR 6

D. APGAR 6

Which condition or treatment best ensures lung maturity in an infant? Meconium in the amniotic fluid Glucocorticoid treatment just before delivery Lecithin to sphingomyelin ratio more than 2:1 Absence of phosphatidylglycerol in amniotic fluid

Lecithin to sphingomyelin ratio more than 2:1

Regarding the scenario in the question above, when would you reassess the APGAR? A. 2 minutes B. 10 minutes C. 5 minutes D. No reassessment of the APGAR score is needed.

B. 10 minutes The APGAR score is performed at 1 minute and 5 minutes after birth and reassessed at 10 minutes (5 minutes later) after birth, IF the score is 6 or less.

6. You're assessing the five minute APGAR score of a newborn baby. On assessment, you note the following about your newborn patient: pink body and hands with cyanotic feet, heart rate 109, grimace to stimulation, flaccid, and irregular cry. What is your patient's APGAR score? A. APGAR 8 B. APGAR 5 C. APGAR 6 D. APGAR 3

B. APGAR 5

A newborn's five minute APGAR score is 5. Which of the following nursing interventions will you provide to this newborn? A. Routine post-delivery care B. Continue to monitor and reassess the APGAR score in 10 minutes. C. Some resuscitation assistance such as oxygen and rubbing baby's back and reassess APGAR score. D. Full resuscitation assistance is needed and reassess APGAR score.

C. Some resuscitation assistance such as oxygen and rubbing baby's back and reassess APGAR score. The answer is C. Scoring Interventions are as follows: 7-10: no interventions, baby doing good just needs routine post-delivery care, 4-6: some resuscitation assistance required like oxygen, suction.... stimulate the baby, rub baby's back, 0-3: needs full resuscitation

A client has just given birth at 42 weeks' gestation. When assessing the neonate, which physical finding is expected? A sleepy, lethargic baby Lanugo covering the body Desquamation of the epidermis Vernix caseosa covering the body

Desquamation of the epidermis

A newborn has small, whitish, pinpoint spots over the nose, which the nurse knows are caused by retained sebaceous secretions. When charting this observation, the nurse identifies it as: Milia Lanugo Whiteheads Mongolian spots

Milia

When newborns have been on formula for 36-48 hours, they should have a: Screening for PKU Vitamin K injection Test for necrotizing enterocolitis Heel stick for blood glucose level

Screening for PKU

The nurse decides on a teaching plan for a new mother and her infant. The plan should include: Discussing the matter with her in a non-threatening manner Showing by example and explanation how to care for the infant Setting up a schedule for teaching the mother how to care for her baby Supplying the emotional support to the mother and encouraging her independence

Showing by example and explanation how to care for the infant

What symptom would the nurse expect to observe in a postpartum client with a vaginal hematoma? a) Pain b) Bleeding c) Fever d) Redness

a) Pain

Immediately after delivery, Mary Jane is shaking uncontrollably. Which of the following nursing actions is most appropriate? a) Provide Mary Jane with warm blankets. b) Put Mary Jane in Trendelenburg position. c) Notify the Provider. d) Increase the intravenous infusion.

a) Provide Mary Jane with warm blankets.

During the same conversation, Sally states to her nurse, "I think that I must have a urinary tract infection. I don't have any urgency or burning, but I do have to go to the bathroom all the time!" Which of the following actions should the nurse take? a) Reassure the woman that frequent urination is normal after delivery. b) Obtain an order for a urine culture. c) Assess the urine for cloudiness. d) Ask the woman if she is prone to urinary tract infections.

a) Reassure the woman that frequent urination is normal after delivery.

A nurse is assessing a 1 day postpartum client who had a spontaneous vaginal delivery over an intact perineum. The fundus is firm at the umbilicus, lochia moderate, and perineum edematous. One hour after receiving Ibuprofen 600mg po, the client is complaining of perineal pain of a 9 on a 10 point scale. Based on this information, which of the following is an appropriate conclusion for the nurse to make about the client? a) She should be assessed by her Provider. b) She should have a sitz bath. c) She may have a hidden laceration. d) She needs a narcotic analgesic.

a) She should be assessed by her Provider.

While on the phone with the nurse, Susie asks to be reminded, "When may my husband and I begin having intercourse again?" The nurse should encourage the couple to wait until after which of the following has occurred? a) The client has had her 6 week postpartum check-up. b) The lochia has turned pink and the vagina is no longer tender. c) The client has her first postpartum menstrual period. d) The infant has slept through the night for the first time.

a) The client has had her 6 week postpartum check-up.

The nurse is admitting a 38-week-gestation client in labor. The nurse is unable to find the fetal heartbeat with the Doppler. Which of the following comments by the nurse would indicate that the nurse is in denial? a. "I'll keep trying until I find the heartbeat." b. "I am sure it is the machine. If I change the battery, I'm sure it'll work." c. "I am so sorry. I am not able to find your baby's heartbeat." d. "Sometimes I really hate these machines."

a. "I'll keep trying until I find the heartbeat."

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? a. Continue to monitor, as this is a normal weight loss. Normal for baby to lose up to 10% b. Notify the neonatologist of the significant weight loss. c. Advise the mother to bottle feed the baby at the next feed. d. Assess the baby for hypoglycemia with a glucose monitor.

a. Continue to monitor, as this is a normal weight loss. Normal for baby to lose up to 10%

A client with a fetal demise is admitted to labor and delivery in the latent phase of labor. Which of the following behaviors would the nurse expect this client to exhibit? a. Crying and sad b. Talkative and excited c. Quietly doing rapid breathing d. Loudly chanting songs

a. Crying and sad

13. A 40 week gestation neonate is in the first period of reactivity. Which of the following actions should the nurse take at this time? Select all that apply. a. Encourage the parents to bond with their baby. b. Notify the neonatologist of the finding. c. Encourage and support parents in feeding their baby. d. Perform the gestational age assessment. e. Place the baby under the overhead warmer. f. Swaddle the infant snuggly and sway, hoping to help settle the infant to sleep. g. Encourage extended family to visit so they can see the baby while awake.

a. Encourage the parents to bond with their baby. c. Encourage and support parents in feeding their baby.

A full term infant admitted to the newborn nursery has a blood glucose level of 35mg/dl. Which of the following actions should the nurse perform at this time? a. Feed the baby formula or breastmilk. b. Assess the baby's blood pressure. c. Tightly swaddle the baby. d. Monitor the baby's urinary output.

a. Feed the baby formula or breastmilk.

A 1-day old neonate, 32 weeks gestation, is in an overhead warmer. The nurse assesses the morning axillary temperature as 96.9 F. Which of the following could explain this assessment finding? a. This is a normal temperature for a preterm neonate. b. Axillary temperatures are not valid for preterm babies. c. The supply of brown adipose tissue is incomplete. d. Conduction heat loss is pronounced in the baby.

c. The supply of brown adipose tissue is incomplete.

Which of the following are important topics to educate parents on prior to discharge? Select all that apply. a. Feeding, Bathing, and Elimination b. Introduction of infant cereal c. Cord and Circ (if applicable) care d. Safe Infant Travel in appropriate car seat e. Holding and Positioning f. Sleep Patterns g. Follow-up care and Danger Signs

a. Feeding, Bathing, and Elimination c. Cord and Circ (if applicable) care d. Safe Infant Travel in appropriate car seat e. Holding and Positioning f. Sleep Patterns g. Follow-up care and Danger Signs

A neonate is found to have choanal atresia on admission to the nursery. Which of the following physiological actions will be hampered by this diagnosis? a. Feeding. b. Digestion. c. Immune response. d. Glomerular filtration.

a. Feeding.

A newborn in the nursery is exhibiting signs of neonatal abstinence syndrome. Which of the following signs/symptoms is the nurse observing? Select all that apply. a. Hyperphagia. b. Lethargy, with prolonged periods of sleep. c. Hyporeflexia. d. Persistent shrill cry.

a. Hyperphagia. d. Persistent shrill cry.

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 of which of the following diseases in the newborn? Select all that apply. a. Hypothyroidism b. Sickle cell disease c. Galactosemia d. Cerebral palsy e. Cystic fibrosis

a. Hypothyroidism b. Sickle cell disease c. Galactosemia e. Cystic fibrosis

To reduce the risk of hypoglycemia in a full-term newborn weighing 2900 grams, what should the nurse do? a. Maintain the infant's temperature above 97.7 degrees F. b. Feed the infant glucose water every 3 hours until breastfeeding well. c. Assess blood glucose levels every 3 hours for the first 12 hours. d. Encourage the mother to breastfeed every 4 hours.

a. Maintain the infant's temperature above 97.7 degrees F

A neonate is being assessed for necrotizing enterocolitis (NEC). Which of the following actions by the nurse is appropriate? Select all that apply. a. Perform hemoccult test on stools. b. Monitor for an increase in abdominal girth. c. Measure gastric contents before each feed. d. Assess bowel sounds before each feed. e. Maintain a strict every 3 hour feeding schedule.

a. Perform hemoccult test on stools. b. Monitor for an increase in abdominal girth. c. Measure gastric contents before each feed. d. Assess bowel sounds before each feed.

A full-term newborn was just born. Which nursing intervention is important for the nurse to perform first? a. Remove wet blankets b. Assess APGAR score c. Insert eye prophylaxis d. Elicit the Moro reflex.

a. Remove wet blankets

What are the 4 consequences of Cold Stress? Select all that apply. a. Respiratory distress and Hypoxemia b. Hyperglycemia c. Hypoglycemia d. Babinski e. Hyperbilirubinemia f. Erythema toxicum neonatorum g. Metabolic acidosis

a. Respiratory distress and Hypoxemia c. Hypoglycemia e. Hyperbilirubinemia g. Metabolic acidosis

A couple has delivered a 28-week fetal demise. Which of the following nursing actions are appropriate to take? Select all that apply. a. Swaddle the baby in a baby blanket. b. Discuss funeral options for the baby. c. Encourage the couple to try to get pregnant again in the near future. d. Ask the couple whether they would like to hold the baby. e. Advise the couple that the baby's death was probably for the best.

a. Swaddle the baby in a baby blanket. b. Discuss funeral options for the baby. d. Ask the couple whether they would like to hold the baby.

12. Four full-term babies were admitted to the neonatal nursery. The mothers of each of the babies had labors of 4 hours or less. The nursery nurse should carefully monitor which of the babies for hypothermia? a. The baby whose mother cultured positive for group B strep during her third trimester. b. The baby whose mother had gestational diabetes. c. The baby whose mother was hospitalized for 3 months with complete placenta previa. d. The baby whose mother previously had a stillbirth.

a. The baby whose mother cultured positive for group B strep during her third trimester.

A baby is in the NICU whose mother is addicted to heroin during the pregnancy. Which of the following nursing actions would be appropriate? a. Tightly swaddle the baby. b. Place the baby prone in the crib. c. Provide needed stimulation to the baby. d. Feed the baby half-strength formula.

a. Tightly swaddle the baby.

A baby was born 24 hours ago to a mother who received no prenatal care. The infant has tremors, sneezes excessively, constantly mouths for food, and has a shrill, high-pitched cry. The baby's serum glucose levels are normal. For which of the following should the nurse request an order from the pediatrician? a. Urine drug toxicology. b. Biophysical profile test. c. Chest and abdominal ultrasound evaluations. d. Oxygen saturation and blood gas assessments.

a. Urine drug toxicology.

The nurse manager is presenting education to her staff to promote consistency in the interventions used with lactating mothers. She emphasizes that the optimum time to initiate lactation is As soon as possible after the infant's birth. After the mother has rested for 4-6 hours. During the infant's second period of reactivity After the infant has taken sterile water without complications.

as soon as possible after the infant's birth.

The nurse is caring for Angelique, who had an emergency cesarean section, with her husband in attendance, the day before. The baby's Apgars were 9 and 9. The woman and her partner had attended childbirth education classes and had anticipated having a water birth with family present. Which of the following comments by the nurse is appropriate? a) "Sometimes babies just don't deliver the way we expect them to." b) "With all of your preparations, it must have been disappointing for you to have had a cesarean." c) "I know you had to have surgery, but you are very lucky that your baby was born healthy." d) "At least your husband was able to be with you when the baby was born."

b) "With all of your preparations, it must have been disappointing for you to have had a cesarean."

In order to help to prevent infection, the nurse teaches Sally to perform which of the following tasks? a) Apply antibiotic ointment to the perineum daily. b) Change the peripad at each voiding. c) Void at least every two hours. d) Spray the perineum with a povidone-iodine solution after toileting.

b) Change the peripad at each voiding.

The nurse informs Sally that Ibuprofen is especially effective for afterbirth pains. What is the rationale for this? a) Ibuprofen is taken every 2 hours. b) Ibuprofen has an antiprostaglandin effect. c) Ibuprofen is given via the parenteral route. d) Ibuprofen is administered in high doses.

b) Ibuprofen has an antiprostaglandin effect.

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? a. "I am required by law to give the medicine." b. "The medication is given to prevent eye infections." c. "The medicine promotes neonatal health." d. "All babies receive the medicine at delivery."

b. "The medication is given to prevent eye infections."

A 1000 gram neonate is being admitted to the NICU. The surfactant Survanta (beractant) has just been prescribed to prevent respiratory distress syndrome. Which of the following actions should the nurse take while administering this medication? a. Flush the intravenous line with normal saline solution. b. Assist the neonatologist during the intubation procedure. c. Inject the medication deep into the vastus lateralis muscle. d. Administer the reconstituted liquid via an oral syringe.

b. Assist the neonatologist during the intubation procedure.

Four babies have just been admitted to the newborn nursery. Which of the babies should the nurse assess first? a. Baby with respirations 42, oxygen saturation 96% b. Baby with APGARs 9 and 9, weight 4666 grams c. Baby with a temperature 98.0 degrees F, length 21 inches d. Baby with glucose 55 mg/dl, heart rate 121

b. Baby with APGARs 9 and 9, weight 4666 grams

The nurse should warm his or her hands and stethoscope prior to assessing an infant's vital signs to prevent heat loss resulting from: a. Evaporation b. Conduction c. Radiation d. Convection

b. Conduction

Which of the following behaviors should nurses know are characteristic of infant abductors? Select all that apply. a. Act on the spur of the moment. b. Create a diversion on the unit. c. Ask questions about the routine of the unit. d. Choose rooms near stairwells. e. Wear over-sized clothing.

b. Create a diversion on the unit. c. Ask questions about the routine of the unit. d. Choose rooms near stairwells. e. Wear over-sized clothing.

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? a. The baby will have a bath with soap every morning. b. During a supervised play period, the baby will be place on the tummy every day. c. The baby will be given a pacifier after each feeding. d. For the first month of life, the baby will sleep on its side in a crib next to the parents.

b. During a supervised play period, the baby will be place on the tummy every day.

3. A newborn nursery nurse notes that a 36-hour-old baby's body is jaundiced. Which of the following nursing interventions will be most therapeutic? a. Maintain a warm ambient environment. b. Have the mother feed the baby frequently. c. Have the mother hold the baby skin to skin. d. Place the baby naked by a closed, but sunlit window.

b. Have the mother feed the baby frequently.

10. Thirty seconds after birth a baby, who appears preterm, has exhibited no effort to breathe even after being stimulated. The heart rate is assessed at 50bpm. Which of the following actions should the nurse perform first? a. Perform a gestational age assessment. b. Inflate the lungs with positive pressure. c. Provide external chest compressions. d. Assess the oxygen saturation level.

b. Inflate the lungs with positive pressure.

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

b. Physiological destruction of fetal red blood cells during the extrauterine period.

In the delivery room, which of the following infant care interventions must a nurse perform when a neonate with a meningomyelocele is born? a. Perform nasogastric suctioning. b. Place baby in the prone position. c. Administer oxygen via face mask. d. Swaddle the baby in warmed blankets.

b. Place baby in the prone position.

17. 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? a. To promote melanin production in the neonatal period. b. To provide heat production when the baby is hypothermic. c. To protect the bony structures of the body from injury. d. To provide calories for neonatal growth between feedings.

b. To provide heat production when the baby is hypothermic.

A breastfeeding Mom calls the pediatric nurse it the following concern: "I woke up this morning with a terrible cold. I don't want the baby to get sick. Which kind of formula should I have my husband feed the baby until I get better?" Which of the following replies by the nurse is appropriate at this time? a) "Any formula brand is satisfactory, but it is essential that it be mixed with water that has been boiled for at least 5 minutes." b) "Don't forget to pump your breasts every 3 hours while the baby is being fed the prescribed formula." c) "The best way to keep your baby from getting sick is for you to keep breastfeeding the baby rather than switching him to formula." d) "In addition to giving the baby formula, you should wear a surgical face mask when you are around him."

c) "The best way to keep your baby from getting sick is for you to keep breastfeeding the baby rather than switching him to formula."

At 45 minutes postpartum, the nurse returns to the room to find the Mom (from #7 above) disoriented and lying in a pool of vaginal blood. What is the nurse's priority action? a) Take vital signs and check the bladder. b) Call the MD. c) Assess and massage the fundus. d) Step out into the hall to call for assistance.

c) Assess and massage the fundus.

You are covering for another nurse who is taking her lunch, and her patient's Methergine is due now. The medication order reads: Methergine 0.2 mg po every 6 hours x 4 doses. Which of the following assessments should be made before administering each dose of this medication? a) Apical pulse b) Lochia flow c) Blood pressure d) Episiotomy

c) Blood pressure

A nurse has administered Methergine 0.2mg po to a grand multipara who delivered vaginally 30 minutes earlier. Which of the following outcomes indicates the medication is effective? a) Blood pressure 120/80 b) Pulse rate 80 bpm and regular c) Fundus firm at the umbilicus d) Increase in prothrombin time.

c) Fundus firm at the umbilicus

In which of the following situations should a nurse report a possible deep vein thrombosis (DVT)? a) The woman complains of numbness in the toes and heel of one foot. b) The woman has cramping pain in a calf that is relieved when the foot is dorsiflexed. c) One of the woman's calves is swollen, red and warm to the touch. d) The veins in the ankle of one of the woman's legs are spider-like and purple.

c) One of the woman's calves is swollen, red and warm to the touch.

Sally, now 24 hours postpartum, is complaining of profuse diaphoresis. She has no other complaints. Which of the following actions by the nurse is appropriate? a) Take Sally's temperature. b) Advise the woman to decrease her fluid intake. c) Reassure Sally that this is normal. d) Inform the neonate's pediatrician.

c) Reassure Sally that this is normal.

On Mary Jane's transfer to the postpartum unit from labor and delivery, which of the following tasks should the nurse delegate to the nursing care assistant? a) Assess client's fundal height. b) Teach the client how to massage her fundus. c) Take the client's vital signs. d) Document in the patient's chart the quantity of lochia.

c) Take the client's vital signs.

Considering Mom's history (from #7 above), which possible cause of postpartum hemorrhage is most likely? a) Perineal laceration b) Retained placenta c) Uterine atony d) Coagulopathy

c) Uterine atony

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

c. 2 day old baby who is breathing irregularly at 70 breaths per minute

The following four babies are in the neonatal nursery. Which of the babies should be seen by the neonatologist first? a. 1 day old, HR 110 beats per minute, in deep sleep b. 2 day old, T 97.7 degrees F, slightly jaundiced c. 3 day old, breastfeeding every 3 hours, jittery d. 4 day old, crying, papular rash on erythematous base

c. 3 day old, breastfeeding every 3 hours, jittery

A 42-week gravida is delivering her baby. A nurse and a pediatrician are present at the birth. The amniotic fluid is green and thick. The baby fails to breathe spontaneously. Which of the following actions should the nurse take next? a. Stimulate the baby to breathe. b. Assess neonatal heart rate. c. Assist with intubation. d. Place the baby in the prone position.

c. Assist with intubation.

An infant in the neonatal nursery has low-set ears, Simian creases, and slanted eyes. The nurse should monitor this infant for which of the following signs/symptoms? a. Blood-tinged urine. b. Hemispheric paralysis. c. Cardiac murmurs. d. Hemolytic jaundice.

c. Cardiac murmurs.

In dealing with parents experiencing a perinatal loss, which of the following nursing interventions would be most appropriate? a. Sheltering the parents from the bad news b. Making all the decisions regarding care c. Encouraging them to participate in the newborn's care d. Leaving them by themselves to allow time to grieve

c. Encouraging them to participate in the newborn's care

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? a. He holds the baby in the en face position. b. He calls the baby by a full name rather than a nickname. c. He tells the mother to pick up the crying baby. d. He falls asleep in the chair with the baby on his chest.

c. He tells the mother to pick up the crying baby.

A baby is born with esophageal atresia and tracheoesophageal fistula. Which of the following complications of pregnancy would the nurse expect to note in the mother's history? a. Preeclampsia. b. Idiopathic thrombocytopenia. c. Polyhydramnios. d. Severe iron deficiency anemia.

c. Polyhydramnios.

2. Which of the following neonates is at highest risk for cold stress syndrome? a. Infant of diabetic mother. b. Infant with Rh incompatibility. c. Postdates neonate. d. Down syndrome neonate.

c. Postdates neonate.

14. A baby has been admitted to the NICU with a diagnosis of intrauterine growth restriction (IUGR). Which of the following maternal factors would predispose the baby to this diagnosis. Select all that apply. a. Hyperopia. b. Gestational diabetes. c. Substance abuse. d. Chronic hypertension. e. Advanced maternal age.

c. Substance abuse. d. Chronic hypertension. e. Advanced maternal age.

The nurse is caring for Angelique, who had a cesarean section yesterday. Angelique states that she needs to cough but that she is afraid to do so. Which of the following is the nurse's best response? a) "I know that it hurts but it is very important for you to cough." b) "Let me check your lung fields to see if coughing is really necessary." c) "If you take a few deep breaths in, that should be as good as coughing." d) "If you support your incision with a pillow, coughing should hurt less."

d) "If you support your incision with a pillow, coughing should hurt less."

Now 2 days postpartum, Sally who is breastfeeding her baby, states "I'm sick of being fat! When can I go on a diet?" Which of the following responses is appropriate? a) "It is fine for you to start dieting right now as long as you drink plenty of milk." b) "Your breastmilk will be low in vitamins if you start to diet while breastfeeding." c) "You must eat at least 3000 calories per day in order to produce enough milk for your baby." d) "Many mothers lose weight when they breastfeed because the baby consumes about 600 calories a day."

d) "Many mothers lose weight when they breastfeed because the baby consumes about 600 calories a day."

Sally is a G2P1102, who delivered 8 hours ago. She now has a temperature of 100.2 F. Which of the following is the appropriate nursing intervention at this time? a) Notify the Provider to get an order for acetaminophen. b) Request an infectious disease consult from the Provider. c) Provide Sally with a cool compress. d) Encourage intake of water and other fluids.

d) Encourage intake of water and other fluids.

The nurse is evaluating the involution of Mary Jane who is 3 days postpartum. Which of the following findings would the nurse evaluate as normal? a) Fundus 1 cm above the umbilicus, lochia rosa. b) Fundus 2 cm below the umbilicus, lochia alba. c) Fundus 2 cm above the umbilicus, lochia rubra. d) Fundus 3 cm below the umbilicus, lochia serosa.

d) Fundus 3 cm below the umbilicus, lochia serosa.

The nurse should suspect puerperal infection when a client exhibits which of the following? a) Temperature of 100.2 F. b) White blood cell count of 14,500 cells/mm3. c) Diaphoresis during the night. d) Malodorous lochial discharge.

d) Malodorous lochial discharge.

Mary Jane, a G2P2002, who is 6 hours postpartum from a spontaneous vaginal delivery, is assessed. The nurse notes that the fundus is firm at the umbilicus, there is heavy lochia, and perineal sutures are intact. Which of the following actions should the nurse take at this time? a) Do nothing. This is a normal finding. b) Massage Mary Jane's fundus. c) Take Mary Jane to the bathroom to void. d) Notify Mary Jane's Obstetrician.

d) Notify Mary Jane's Obstetrician.

Susie informs the nurse she intends to bottlefeed her baby. Which of the following actions should the nurse encourage Susie to perform? a) Increase her fluid intake for a few days. b) Massage her breasts every 4 hours. c) Apply heat packs to her axillae. d) Wear a supportive bra 24 hours a day.

d) Wear a supportive bra 24 hours a day.

A baby born by vacuum extraction has been admitted to the well baby nursery. The nurse should assess this baby for which of the following? a. Pedal abrasions. b. Hypobilirubinemia. c. Hyperglycemia. d. Cephalohematoma.

d. Cephalohematoma.

The nurse is caring for a couple who are in the labor/delivery room immediately after the delivery of a dead baby who exhibited visible birth defects. Which of the following actions by the nurse is appropriate? a. Discourage the parents from naming the baby. b. Advise the parents that the baby's defects would be too upsetting for them to see. c. Transport the baby to the morgue as soon as possible. d. Give the parents a lock of the baby's hair and a copy of the footprint sheet.

d. Give the parents a lock of the baby's hair and a copy of the footprint sheet.

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

d. Refer to a reliable resource to see whether the antibiotic is safe while breastfeeding.

11. The staff on the maternity unit is developing a protocol for nurses to follow after a baby is delivered who fails to breathe spontaneously. Which of the following should be included in the protocol as the first action for the nurse to take? a. Prepare epinephrine for administration. b. Provide positive pressure oxygen. c. Administer chest compressions. d. Rub the back and feet of the baby.

d. Rub the back and feet of the baby.

Four newborns were admitted into the neonatal nursery 1 hour ago. They are all sleeping in overhead warmers. Which of the babies should the nurse ask the neonatologist to evaluate? a. The neonate with T 98.9 degrees F and weight of 3000 grams. b. The neonate with white spots on the bridge of the nose. c. The neonate with raised white specks on the gums. d. The neonate with respirations of 72 and heartrate of 166.

d. The neonate with respirations of 72 and heartrate of 166.

What is the name of the screening test that includes phenylketonuria, and when is it done? a. PKU, one week of age b. CF, one month of age c. Eyes and Thighs, after 24 hours d. Wisconsin State Screen, after 24 hours

d. Wisconsin State Screen, after 24 hours

The home health nurse visits the Cox family 2 weeks after hospital discharge. She observes that the umbilical cord has dried and fallen off. The area appears healed with no drainage or erythema present. The mother can be instructed to Cover the umbilicus with a band-aid. Continue to clean the stump with alcohol for one week. Apply an antibiotic ointment to the stump Give him a bath in an infant tub now

give him a bath in an infant tub now

Soon after delivery a neonate is admitted to the central nursery. The nursery nurse begins the initial assessment by Auscultate bowel sounds. Determining chest circumference Inspecting the posture, color, and respiratory effort Checking for identifying birthmarks

inspecting the posture, color, and respiratory effort