High Risk Newborn NCLEX
2
114. Four babies in the well-baby nursery were born with congenital defects. Which of the babies' complications developed as a result of the delivery method? 1. Clubfoot. 2. Brachial palsy. 3. Gastroschisis. 4. Hydrocele.
4
5. A baby is grunting in the neonatal nursery. Which of the following actions by the nurse is appropriate? 1. Place a pacifier in the baby's mouth. 2. Check the baby's diaper. 3. Have the mother feed the baby. 4. Assess the respiratory rate.
4
111. A newborn in the well-baby nursery is noted to have a chignon. The nurse concludes that the baby was born via which of the following methods? 1. Cesarean section. 2. High forceps delivery. 3. Low forceps delivery. 4. Vacuum extraction.
4
112. 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? 1. Pedal abrasions. 2. Hypobilirubinemia. 3. Hyperglycemia. 4. Cephalhematoma.
2
A baby born addicted to cocaine is being given paregoric. The nurse knows that which of the following is a rationale for its use? 1. Paregoric is nonaddictive. 2. Paregoric corrects diarrhea. 3. Paregoric is nonsedating. 4. Paregoric suppresses the cough reflex.
1 2 3 4
113. A macrosomic baby in the nursery is suspected of having a fractured clavicle from a traumatic delivery. Which of the following signs/symptoms would the nurse expect to see? (Select all that apply) 1. Pain with movement. 2. Hard lump at the fracture site. 3. Malpositioning of the arm. 4. Asymmetrical Moro reflex. 5. Marked localized ecchymosis
3
1. 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? 1. This is a normal temperature for a preterm neonate. 2. Axillary temperatures are not valid for preterm babies. 3. The supply of brown adipose tissue is incomplete. 4. Conduction heat loss is pronounced in the baby.
1
10, A baby's blood type is B negative. The baby is at risk for hemolytic jaundice if the mother has which of the following blood types? 1. Type O negative. 2. Type A negative. 3. Type B positive. 4. Type AB positive.
2
100. The nurse assessed four newborns in the neonatal nursery. The nurse called the neonatologist for a cardiology consult on the baby, who exhibited which of the following signs/symptoms? 1. Setting sun sign. 2. Anasarca. 3. Flaccid extremities. 4. Polydactyly
3
101. A preterm infant has a patent ductus arteriosus (PDA). Which of the following explanations should the nurse give to the parents about the condition? 1. Hole has developed between the left and right ventricles. 2. Hypoxemia occurs as a result of the poor systemic circulation. 3. Oxygenated blood is reentering the pulmonary system. 4. Blood is shunting from the right side of the heart to the left.
3 5
102. A nurse hears a heart murmur on a full-term neonate in the well-baby nursery. The baby's color is pink while at rest and while feeding. Which of the following cardiac defects is consistent with the nurse's findings? (Select all that apply) 1. Transposition of the great vessels. 2. Tetralogy of Fallot. 3. Ventricular septal defect. 4. Pulmonic stenosis. 5. Patent ductus arteriosus.
1 - D 2 - A 3 - C 4 - B
103. Four babies are born with distinctive skin markings. Identify which marking matches its description: 1. Café au lait spot 2. Hemangioma 3. Mongolian spots 4. Port wine stain A. Raised, blood vessel-filled lesion B. Flat, sharply demarcated red-to-purple lesion C. Multiple grayish-blue, hyperpigmented skin areas D. Pale tan- to coffee-colored marking.
1
104. A baby, admitted to the nursery, was diagnosed with galactosemia from an amniocentesis. Which of the following actions must the nurse take? 1. Feed the baby a specialty formula. 2. Monitor the baby for central cyanosis. 3. Do hemoccult testing on every stool. 4. Monitor the baby for signs of abdominal pain.
1
105. On admission to the nursery, a baby's head and chest circumferences are 39 cm and 32 cm, respectively. Which of the following actions should the nurse take next? 1. Assess the anterior fontanel. 2. Measure the abdominal girth. 3. Check the apical pulse rate. 4. Monitor the respiratory effort.
1
106. 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? 1. Feeding. 2. Digestion. 3. Immune response. 4. Glomerular filtration.
4
107. A baby is born to a mother who was diagnosed with oligohydramnios during her pregnancy. The nurse notifies the neonatologist to order tests to assess the functioning of which of the following systems? 1. Gastrointestinal. 2. Hepatic. 3. Endocrine. 4. Renal.
3
108. 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? 1. Preeclampsia. 2. Idiopathic thrombocytopenia. 3. Polyhydramnios. 4. Severe iron deficiency anemia.
3
109. A baby is born with a diaphragmatic hernia. Which of the following signs/symptoms would the nurse observe in the delivery room? 1. Projectile vomiting. 2. High-pitched crying. 3. Respiratory distress. 4. Fecal incontinence.
4
11. A newborn admitted to the nursery has a positive direct Coombs' test. Which of the following is an appropriate action by the nurse? 1. Monitor the baby for jitters. 2. Assess the blood glucose level. 3. Assess the rectal temperature. 4. Monitor the baby for jaundice.
3
110. A woman, who has recently received Demerol (meperidine) 100 mg IM for labor pain, is about to deliver. Which of the following medications is highest priority for the nurse to prepare in case it must be administered to the baby following the delivery? 1. Oxytocin (Pitocin). 2. Xylocaine (Lidocaine). 3. Naloxone (Narcan). 4. Butorphanol (Stadol).
1
115. Monochorionic twins, whose gestation was complicated by twin-to-twin transfusion, are admitted to the neonatal intensive care unit. Which of the following characteristic findings would the nurse expect to see in the smaller twin? 1. Pallor. 2. Jaundice. 3. Opisthotonus. 4. Hydrocephalus.
2
116. Monochorionic twins, whose gestation was complicated by twin-to-twin transfusion, are admitted to the neonatal intensive care unit. Which of the following characteristic findings would the nurse expect to see? 1. Recipient twin has petechial rash. 2. Recipient twin is 20% larger than the donor twin. 3. Donor twin has 30% higher hematocrit than recipient twin. 4. Donor twin is ruddy and plethoric.
1
117. A nurse working with a 24-hour-old neonate in the well-baby nursery has made the following nursing diagnosis: Risk for altered growth. Which of the following assessments would warrant this diagnosis? 1. The baby has lost 8% of weight since birth. 2. The baby has not urinated since birth. 3. The baby weighed 3,000 grams at birth. 4. The baby exhibited signs of torticollis.
1
118. A baby exhibits weak rooting and sucking reflexes. Which of the following nursing diagnoses would be appropriate? 1. Risk for deficient fluid volume. 2. Activity intolerance. 3. Risk for aspiration. 4. Feeding self-care deficit.
14.16%
119. A baby, born at 3,199 grams, now weighs 2,746 grams. The baby is being monitored for dehydration because of the following percent weight loss. (Calculate to the nearest hundredth.) __________%
2
12. An 18-hour-old baby is placed under the bili-lights with an elevated bilirubin level. Which of the following is an expected nursing action in these circumstances? 1. Give the baby oral rehydration therapy after all feedings. 2. Rotate the baby from side to back to side to front every two hours. 3. Apply restraints to keep the baby under the light source. 4. Administer intravenous fluids via pump per doctor orders.
3
120. A breastfeeding mother of a newborn states, "I was good all during my pregnancy. I stopped drinking alcohol and I quit smoking marijuana during my pregnancy. Now that I'm no longer pregnant, one of the first things I'm going to do when I get home is have a joint." Which of the following responses is appropriate for the nurse to give? 1. "I am proud of you for waiting to have those things. It must have been hard for you to abstain for so many months." 2. "You are making the best choice since marijuana is safe while breastfeeding but alcohol is contraindicated." 3. "Because the drug in marijuana does get into breast milk and can alter a baby's development, it is best not to use the drug while breastfeeding." 4. "Both alcohol and marijuana are removed from the body within about two hours. It would be best to wait that long before breastfeeding after consuming either of them."
1
121. A baby, 30 weeks' gestation, is admitted to the neonatal intensive care unit. The mother had been treated with the tocolytic, intravenous magnesium sulfate, for the preceding 10 days. For which of the following laboratory findings should the nurse assess the neonate? 1. Hypocalcemia. 2. Hyperkalemia. 3. Hypochloremia. 4. Hypernatremia.
2
122. Intravenous magnesium sulfate has been ordered for a 31 weeks' gestation client in preterm labor. The client's vital signs are: TPR 98.6°F /37°C, 92, 22; BP 110/70. The nurse knows that, in addition to its tocolytic action, the rationale for its administration is to prevent which of the following neonatal complications? 1. Hypoxemia. 2. Cerebral palsy. 3. Cold stress syndrome. 4. Necrotizing enterocolitis.
1, 2
123. A full-term, 36-hour-old neonate's bilirubin level is 13 mg/dL. Which of the following signs and symptoms would the nurse expect to see? Select all that apply. 1. Lethargy. 2. Jaundice. 3. Polyphagia. 4. Diarrhea. 5. Excessive yawning.
1, 2, 3, 5
124. A 37-week-gestation neonate, Apgars 1 and 3, is admitted to the neonatal intensive care nursery. The neonatologist orders induced hypothermia be instituted to prevent which of the following complications of hypoxic-ischemic encephalopathy? Select all that apply. 1. Cerebral palsy. 2. Autism. 3. Attention defi cit disorder. 4. Bipolar disease. 5. Epilepsy .
2
125. A baby is born to a mother with a history of depression. The mother was prescribed Prozac (fl uoxetine) to control her symptoms. For which of the following signs and symptoms should the nurse monitor the neonate in the neonatal nursery? 1. Elevated blood pressures in the upper extremities. 2. Marked systemic cyanosis. 3. Pronounced mucus production immediately after birth. 4. Flaccid tone of all musculature.
1
126. A baby who is receiving phototherapy for hyperbilirubinemia must have a venipuncture to obtain a blood specimen. Which of the following nursing care actions should the nurse perform at this time? 1. Provide the baby with a sucrose-covered pacifier to suck on. 2. Advise the baby's mother to leave the room while the procedure is being performed. 3. Administer oxygen to the baby via face mask throughout the procedure. 4. Remove the eye patches while the procedure is being performed.
1-B 2-A 3-D 4-C
127. In the special care nursery, a nurse is caring for preterm neonates receiving ventilatory support from a variety of different methods. Please identify which ventilation method matches its description: 1. Continuous positive airway pressure(CPAP). 2. Noninvasive positive airway pressure (NIPP). 3. Extracorporeal membrane oxygenation (ECMO). 4. Mechanical ventilation. A. Augments babies' spontaneous breaths. B. Keeps alveoli open during exhalation. C. Requires endotracheal tube insertion. D. Form of cardiopulmonary bypass.
1, 2, 3, 4,
128. An infant in the neonatal intensive care unit has had a peripherally inserted central catheter (PICC) inserted. The nurse caring for the baby carefully monitors the neonate for which of the following complications related to the procedure? Select all that apply. 1. Infection. 2. Tip migration. 3. Myocardial perforation. 4. Paralysis of the diaphragm. 5. Neurological complications related to scalp vein insertions.
3
13. A jaundice neonate must have a heel stick to assess bilirubin levels. Which of the following actions should the nurse make during the procedure? 1. Cover the foot with an iced wrap for one minute prior to the procedure. 2. Avoid puncturing the lateral heel to prevent damaging sensitive structures. 3. Allow the site with a dry gauze after rubbing it with an alcohol swab. 4. Firmly grasp the calf of the baby during the procedure to prevent injury.
2
14. 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? 1. Maintain a warm ambient environment. 2. Have the mother feed the baby frequently. 3. Have the mother hold the baby skin to skin. 4. Place the baby naked by a closed sunlit window.
4
15. A neonate is under phototherapy for elevated bilirubin levels. The baby's stools are now loose and green. Which of the following actions should the nurse take at this time? 1. Discontinue the phototherapy. 2. Notify the health care practitioner. 3. Take the baby's temperature. 4. Assess the baby's skin integrity.
1
16. A nursing diagnosis for a 5-day-old newborn under phototherapy is: Risk for fluid volume deficit. For which of the following client outcomes should the nurse plan to monitor the baby? 1. 6 saturated diapers in 24 hours. 2. Breastfeeds 2-4 times in 24 hours. 3. less than 12% weight loss since birth. 4. Apical heart rate of 160-170 bpm.
3
17. 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? 1. Morphine. 2. Metadone 3. Narcan. 4. Phenobarbital.
1
18. A baby is in the NICU whose mother was addicted to heroin during the pregnancy. Which of the following nursing actions would be appropriate? 1. Tightly swaddle the baby. 2. Place the baby prone in the crib. 3. Provide needed stimulation to the baby. 4. Feed the baby half-strength formula.
1 5
19. 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) 1. Hyperphagia (excessive Hunger) 2. Lethargy. 3. Prolonged periods of sleep. 4. Hyporeflexia. 5. Persistent shrill cry
2
23. A nurse makes the following observations when admitting a full-term, breastfeeding baby into the neonatal nursery: 9 lb 2 oz, 21 inches long, TPR: 96.6°F, 158, 62, jittery, pink body with bluish hands and feet, crying. Which of the following actions is of highest probability? 1. Swaddle the baby to provide warmth. 2. Assess the glucose level of the baby. 3. Take the baby to the mother for feeding. 4. Administer the neonatal medications.
2
50. A baby in the newborn nursery was born to a mother with spontaneous rupture of membranes for 14 hours. The woman has Candida vaginitis. For which of the following should the baby be assessed? 1. Papular facial rash. 2. Thrush. 3. Fungal conjunctivitis. 4. Dehydration.
0.25 mL
65. The neonatologist has ordered 12.5 micrograms of digoxin po for a neonate in congestive heart failure. The medication is available in the following elixir—0.05 mg/mL. How many milliliters (mL) should the nurse administer? (Calculate to the nearest hundredth.) _____________ mL.
3
47. During a health maintenance visit at the pediatrician's office, the nurse notes that a breastfeeding baby has thrush. Which of the following actions should the nurse take? 1. Nothing because thrush is a benign problem. 2. Advise the mother to bottle feed until the thrush is cured. 3. Obtain an order for antifungals for both mother and baby. 4. Assess for other evidence of immunosuppression.
3
48. A neonate whose mother is HIV positive is admitted to the NICU. A nursing diagnosis: Risk for infection related to perinatal exposure to HIV/AIDS is made. Which of the following interventions should the nurse make in relation to the diagnosis? 1. Monitor daily viral load laboratory reports. 2. Check the baby's viral antibody status. 3. Obtain an order for antiviral medication. 4. Place the baby on strict precautions.
3
2. Which of the following neonates is at highest risk for cold stress syndrome? 1. Infant of diabetic mother. 2. Infant with Rh incompatibility. 3. Postdates neonate. 4. Down syndrome neonate.
1
20. Based on maternal history of alcohol addiction, a baby in the neonatal nursery is being monitored for signs of fetal alcohol syndrome (FAS). The nurse should assess this baby for which of the following? 1. Poor suck reflex. 2. Ambiguous genitalia. 3. Webbed neck. 4. Absent Moro reflex.
1, 2, 5
21. A baby born addicted to cocaine is being given oral morphine. The nurse knows that which of the following are the main reasons for its use? Select all that apply. 1. Oral morphine contains no alcohol. 2. Oral morphine helps to correct the diarrhea. 3. Oral morphine is nonsedating. 4. Oral morphine improves respiratory effort. 5. Oral morphine helps to control seizures.
1
22. 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, highpitched cry. The baby's serum glucose levels are normal. For which of the following should the nurse request an order from the pediatrician? 1. Urine drug toxicology test. 2. Biophysical profile test. 3. Chest and abdominal ultrasound evaluations. 4. Oxygen saturation and blood gas assessments.
2
24. An infant admitted to the newborn nursery has a blood glucose level of 35 mg/dL. The nurse should monitor this baby carefully for which of the following? 1. Jaundice. 2. Jitters. 3. Erythema toxicum. 4. Subconjunctival hemorrhages
1
25. A full-term infant admitted to the newborn nursery has a blood glucose level of 35 mg/dL. Which of the following actions should the nurse perform at this time? 1. Feed the baby formula or breast milk. 2. Assess the baby's blood pressure. 3. Tightly swaddle the baby. 4. Monitor the baby's urinary output.
1
26. A nurse is inserting a gavage tube into a preterm baby who is unable to suck and swallow. Which of the following actions must the nurse take during the procedure? 1. Measure the distance from the tip of the ear to the nose. 2. Lubricate the tube with an oil-based solution. 3. Insert the tube quickly if the baby becomes cyanotic. 4. Inject a small amount of sterile water to check placement.
3
27. A neonate is in the warming crib for poor thermoregulation. Which of the following sites is appropriate for the placement of the skin thermal sensor? 1. Xiphoid process. 2. Forehead. 3. Abdominal wall. 4. Great toe.
4 2 1 3
28. The nurse must perform nasopharyngeal suctioning of a newborn with profuse secretions. Place the following nursing actions for nasopharyngeal suctioning in chronological order. 1. Slowly rotate and remove the suction catheter. 2. Place thumb over the suction control on the catheter. 3. Assess type and amount of secretions. 4. Insert free end of the tubing through the nose.
1
29. A neonate is being given intravenous fluids through the dorsal vein of the wrist. Which of the following actions by the nurse is essential? 1. Tape the arm to an arm board. 2. Change the tubing every 24 hours. 3. Monitor the site every 5 minutes. 4. Infuse the fluid intermittently.
2
A 30-week-gestation neonate, 2 hours old, has received Survanta (beractant). Which of the following would indicate a positive response to the medication? 1. Axillary temperature 98.0°F 2. Oxygen saturation 96%. 3. Apical heart rate 154 bpm. 4. Serum potassium 4.0 mEq/L
1,2,3,5
40. A 42-week gravida is delivering her baby. A nurse and 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? (Select all that apply) 1. Stimulate the baby to breathe. 2. Assess neonatal heart rate. 3. Prepare to assist with intubation. 4. Place the baby in the prone position. Place the baby under an overhead warmer
1
49. A baby was just born to a mother who had positive vaginal cultures for group B streptococcus. The mother was admitted to the labor room 2 hours before the birth. For which of the following should the nursery nurse closely observe this baby? 1. Hypothermia. 2. Mottling. 3. Omphalocele. 4. Stomatitis.
2
41. 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 70 bpm. Which of the following actions should the nurse perform first? 1. Perform a gestational age assessment. 2. Inflate the lungs with positive pressure. 3. Provide external chest compressions. 4. Assess the oxygen saturation level.
3
3. Which of the following would lead the nurse to suspect cold stress syndrome in a newborn with a temperature of 96.5°F? 1. Blood glucose of 50 mg/dL. 2. Acrocyanosis. 3. Tachypnea. 4. Oxygen saturation of 96%
2
30. A Roman Catholic couple has just delivered a baby with an Apgar score of 1 at 1 minute, 2 at 5 minutes, and 2 at 10 minutes. Which of the following interventions is appropriate at this time? 1. Advise the parents that they should pray very hard so that everything turns out well. 2. Ask the parents whether they would like the nurse to baptize the baby. 3. Leave the parents alone to work through their thoughts and feelings. 4. Inform the parents that a priest will listen to their confessions whenever they are ready.
Apgar score 3
31. The nurse assesses a newborn as follows: Heart rate: 70 Respirations: weak and irregular Tone: flaccid Color: pale Baby grimaces when a pediatrician attempts to insert an endotracheal tube What should the nurse calculate the baby's Apgar score to be?
2
42. A neonatologist requests Narcan (naloxone) during a neonatal resuscitation effort for a baby weighing 3 kg. The recommended dosage of Narcan for a neonate is 0.01 mg/kg to 0.1 mg/kg. Which of the following dosages would be within the range of safety for the nurse to prepare? 1. 4 micrograms. 2. 40 micrograms. 3. 4 milligrams. 4. 40 milligrams.
2
32. A neonate is in the neonatal intensive care nursery with a diagnosis of large-forgestational age. The baby was born at 38 weeks' gestation and weighed 3,500 grams. Based on this information, which of the following responses is correct? 1. The diagnosis is accurate because the baby's weight is too high for a diagnosis of appropriate-for-gestational age. 2. The diagnosis is inaccurate because the baby's weight needs to be higher than 3,500 grams. 3. The diagnosis is inaccurate because the baby's weight needs to be lower than 3,500 grams. 4. The diagnosis is inaccurate because full-term babies are never large-for-gestational age.
24 weeks
33. A neonate has been admitted to the neonatal intensive care unit with the following findings: -Completely flaccid posturing -Square window sign of 60° -Arm recoil of 180° -Popliteal angle of 160° -Full scarf sign -Heel that touches the ear -Skin that is red and translucent -Sparse lanugo -Faint red marks on the plantar surface -Barely perceptible breast tissue -Eyelids that are open but flat ear pinnae -Prominent clitoris and small labia minora Using the Ballard scale, what is the gestational age of this neonate estimated to be? _____________ weeks
1
34. A neonate is in the neonatal intensive care unit. The baby is 28 weeks' gestation and weighs 1,000 grams. Which of the following is correct in relation to this baby's growth? 1. Weight is appropriate-for-gestational age. 2. Weight is below average for gestational age. 3. Baby experienced intrauterine growth restriction. 4. Baby experienced congenital growth hypertrophy.
1
36. A 42-week-gestation baby, 2,400 grams, whose mother had no prenatal care, is admitted into the NICU. The neonatologist orders blood work. Which of the following laboratory findings would the nurse expect to see? 1. Blood glucose 30 mg/dL. 2. Leukocyte count 1,000 cells/mm3. 3. Hematocrit 30%. 4. Serum pH 7.8.
2
37. A woman who received an intravenous analgesic 4 hours ago has had prolonged late decelerations in labor. She will deliver her baby shortly. Which of the following is the priority action for the delivery room nurse to take? 1. Preheat the overhead warmer. 2. Page the neonatologist on call. 3. Draw up Narcan (naloxone) for injection. 4. Assemble the neonatal eye prophylaxis.
4
38. A baby has been admitted to the neonatal intensive care unit with a diagnosis of postmaturity. The nurse expects to find which of the following during the initial newborn assessment? 1. Abundant lanugo. 2. Flat breast tissue. 3. Prominent clitoris. 4. Wrinkled skin.
4
39. A 42-week-gestation baby has been admitted to the neonatal intensive care unit. At delivery, thick green amniotic fluid was noted. Which of the following actions by the nurse is critical at this time? 1. Bath to remove meconium-contaminated fluid from the skin. 2. Ophthalmic assessment to check for conjunctival irritation. 3. Rectal temperature to assess for septic hyperthermia. 4. Respiratory evaluation to monitor for respiratory distress.
1
43. During neonatal cardiopulmonary resuscitation, which of the following actions should be performed? 1. Provide assisted ventilation about 30 breaths per minute. 2. Begin chest compressions when heart rate is 0 to 20 beats per minute. 3. Compress the chest using the three-finger technique. 4. Administer compressions and breaths in a 5:1 ratio.
4
44. 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? 1. Prepare epinephrine for administration. 2. Provide positive pressure oxygen. 3. Administer chest compressions. 4. Rub the back and feet of the baby
2
45. A nurse in the newborn nursery suspects that a new admission, 42 weeks' gestation, was exposed to meconium in utero. What would lead the nurse to suspect this? 1. The baby is bradycardic. 2. The baby's umbilical cord is green. 3. The baby's anterior fontanel is sunken. 4. The baby is desquamating.
1
4.Four babies are in the newborn nursery. The nurse pages the neonatologist to see the baby who exhibits which of the following? 1. Intracostal retractions. 2. Erythema toxicum. 3. Pseudostrabismus. 4. Vernix caseosa.
2
46. The birth of a baby, weight 4,500 grams, was complicated by shoulder dystocia. Which of the following neonatal complications should the nursery nurse observe for? 1. Leg deformities. 2. Brachial palsy. 3. Fractured radius. 4. Buccal abrasions.
3
51. A baby has been admitted to the neonatal nursery whose mother is hepatitis B-surface antigen positive. Which of the following actions by the nurse should be taken at this time? 1. Monitor the baby for signs of hepatitis B. 2. Place the baby on contact isolation. 3. Obtain an order for the hepatitis B vaccine and the immune globulin. 4. Advise the mother that breastfeeding is absolutely contraindicated.
1
52. 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? 1. The baby whose mother cultured positive for group B strep during her third trimester. 2. The baby whose mother had cerebral palsy 3. The baby whose mother was hospitalized for 3 months with complete placenta previa. 4. The baby whose mother previously had a stillbirth.
1
53. Four 38-week-gestation gravidas have just delivered. Which of the babies should be monitored closely by the nurse for respiratory distress? 1. The baby whose mother has diabetes mellitus. 2. The baby whose mother has lung cancer. 3. The baby whose mother has a mitral valve prolapse 4. The baby whose mother has asthma.
2
54. A client is seeking preconception counseling. She has type 1 diabetes mellitus and is found to have an elevated glycosylated hemoglobin (HgbA1c) level. Before actively trying to become pregnant, she is strongly encouraged to stabilize her blood glucose to reduce the possibility of her baby developing which of the following? 1. Port wine stain. 2. Cardiac defect. 3. Hip dysplasia. 4. Intussusception.
2
55. A baby is born with caudal agenesis. Which of the following maternal complications is associated with this defect? 1. Poorly controlled myasthenia gravis. 2. Poorly controlled diabetes mellitus. 3. Poorly controlled splenic syndrome. 4. Poorly controlled hypothyroidism.
4
56. 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 30 mg/dL and after a feeding of mother's expressed breast milk is 35 mg/dL. Which of the following actions should the nurse take at this time? 1. Nothing, because the glucose level is normal for an infant of a diabetic mother. 2. Administer intravenous glucagon slowly over five minutes. 3. Feed the baby a bottle of dextrose and water and reassess the glucose level. 4. Notify the neonatologist of the abnormal glucose levels.
2
57. A baby has just been born to a type 1 diabetic mother with retinopathy and nephropathy. Which of the following neonatal findings would the nurse expect to see? 1. Hyperalbuminemia. 2. Polycythemia. 3. Hypercalcemia. 4. Hypoinsulinemia.
1
58. A baby is born to a type 1 diabetic mother. Which of the following lab values would the nurse expect the neonate to exhibit? 1. Plasma glucose 30 mg/dL. 2. Red blood cell count 1 million/mm3. 3. White blood cell count 2,000/mm3. 4. Hemoglobin 8 g/dL.
3 4 5
59. A baby has just been admitted into the neonatal intensive care unit 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) 1. Hyperopia. 2. Gestational diabetes. 3. Substance abuse. 4. Chronic hypertension. 5. Advanced maternal age.
3
6. A 6-month-old child developed kernicterus immediately after birth. Which of the following tests should be done to determine whether or not this child has developed any sequelae to the illness? 1. Blood urea nitrogen and serum creatinine. 2. Alkaline phosphatase and bilirubin. 3. Hearing testing and vision assessment. 4. Peak expiratory flow and blood gas assessments.
2
60. A baby has been admitted to the neonatal intensive care unit with a diagnosis of symmetrical intrauterine growth restriction (IUGR). Which of the following pregnancy complications would be consistent with this diagnosis? 1. Severe preeclampsia. 2. Chromosomal defect. 3. Infarcts in an aging placenta. 4. Premature rupture of the membranes.
3 4
61. A neonate has intrauterine growth restriction secondary to placental insufficiency. Which of the following signs/symptoms should the nurse expect to observe at delivery? (Select all that apply) 1. Thrombocytopenia. 2. Neutropenia. 3. Polycythemia. 4. Hypoglycemia. 5. Hyperlipidemia
1
62. A woman is visiting the NICU to see her 26-week-gestation baby for the first time. Which of the following methods would the nurse expect the mother to use when first making physical contact with her baby? 1. Fingertip touch. 2. Palmar touch. 3. Kangaroo hold. 4. Cradle hold.
1 2 3 5
63. A 6-month-old child is being seen in the pediatrician's office. The child was born preterm and remained in the neonatal intensive care unit for the first 5 months of life. The child is being monitored for 5 chronic problems. Which of the following problems are directly related to the prematurity? (Select all that apply) 1. Bronchopulmonary dysplasia. 2. Cerebral palsy. 3. Retinopathy. 4. Hypothyroidism. 5. Seizure disorders.
4.13
64. A neonatologist prescribes Garamycin (gentamicin) for a 2-day-old, septic preterm infant who weighs 1,653 grams and is 38 centimeters long. The drug reference states: Neonatal dosage of Garamycin for babies less than 1 week of age is 2.5 mg/kg q 12-24 hours. Calculate the safe daily dosage of this medication. (Calculate to the nearest hundredth.) _____________ mg q 24 hours.
6.9 mg
66. A neonatologist prescribes Platinol-AQ (cisplatin) for a neonate born with a neuro blastoma. The baby's current weight is 3,476 grams and the baby is 57 centimeters long. The drug reference states: Children: IV 30 mg/m2 q week. Calculate the safe dosage of this medication. (Calculate to the nearest tenth.) ____________ mg q week.
3.33 mL/hr
67. A preterm baby is to receive 4 mg Garamycin (gentamicin) IV every 24 hours. The medication is being injected into an IV soluset. A total of 5 mL is to be administered via IV pump over 90 minutes. The pump should be set at what rate? (Calculate to the nearest hundredth.) _____________ mL/hr.
3
68. A mother of a preterm baby is performing kangaroo care in the neonatal nursery. Which of the following responses would the nurse evaluate as a positive neonatal outcome? 1. Respiratory rate of 70. 2. Temperature of 97.0°F. 3. Licking of mother's nipples. 4. Flaring of the baby's nares.
1 2 3 4
69. A neonate is being assessed for necrotizing enterocolitis (NEC). Which of the following actions by the nurse is appropriate? (Select all that apply) 1. Perform hemoccult test on stools. 2. Monitor for an increase in abdominal girth. 3. Measure gastric contents before each feed. 4. Assess bowel sounds before each feed. 5. Assess for anal fissures daily.
1
7. A baby with hemolytic jaundice is being treated with fluorescent phototherapy. To provide safe newborn care, which of the following actions should the nurse perform? 1. Cover the baby's eyes with eye pads. 2. Turn the lights on for ten minutes every hour. 3. Clothe the baby in a shirt and diaper only. 4. Tightly swaddle the baby in a baby blanket.
2
70. A woman whose 32-week-gestation neonate is to begin oral feedings is expressing breast milk (EBM) for the baby. The neonatologist is recommending that fortifier be added to the milk because which of the following needs of the baby are not met by the EBM? 1. Need for iron and zinc. 2. Need for calcium and phosphorus. 3. Need for protein and fat. 4. Need for sodium and potassium.
2
71. A 1,000-gram neonate is being admitted to the neonatal intensive care unit. 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? 1. Flush the intravenous line with normal saline solution. 2. Assist the neonatologist during the intubation procedure. 3. Inject the medication deep into the vastus lateralis muscle. 4. Administer the reconstituted liquid via an oral syringe.
2
72. A 30-week-gestation neonate, 2 hours old, has received exogenous surfactant Curosurf (poractant alfa). Which of the following would indicate a positive response to the medication? 1. Axillary temperature 98°F /36.7°C. 2. Oxygen saturation 96%. 3. Apical heart rate 154 bpm. 4. Serum potassium 4 mEq/L.
1
73. For which of the following reasons would a nurse in the well-baby nursery report to the neonatologist that a newborn appears to be preterm? 1. Baby has a square window angle of 90°. 2. Baby has leathery and cracked skin. 3. Baby has popliteal angle of 90°. 4. Baby has pronounced plantar creases.
1
74. A full-term neonate in the NICU has been diagnosed with congestive heart failure secondary to a cyanotic heart defect. Which of the following activities is most likely to result in a cyanotic episode? 1. Feeding. 2. Sleeping in the supine position. 3. Rocking in an infant swing. 4. Swaddling.
4
75. The nurse is providing discharge teaching to the parents of a baby born with a cleft lip and palate. Which of the following should be included in the teaching? 1. Correct technique for the administration of a gastrostomy feeding. 2. Need to watch for the appearance of blood-stained mucus from the nose. 3. Optimal position for burping after nasogastric feedings. 4. Need to give the baby sufficient time to rest during each feeding.
2 4
76. A baby is suspected of having esophageal atresia. The nurse would expect to see which of the following signs/symptoms? (Select all that apply) 1. Frequent vomiting. 2. Excessive mucus. 3. Ruddy complexion. 4. Abdominal distention. 5. Pigeon chest.
4
77. The nurse is teaching a couple about the special health care needs of their newborn child with Down syndrome. The nurse knows that the teaching was successful when the parents state that the child will need which of the following? 1. Yearly three-hour glucose tolerance testing. 2. Immediate intervention during bleeding episodes. 3. A formula that is low in lactose and phenylalanine. 4. Prompt treatment of upper respiratory infections.
3
78. An infant in the neonatal nursery has low-set ears, Simian creases, and slanted eyes. The nurse should monitor this infant carefully for which of the following signs/symptoms? 1. Blood-tinged urine. 2. Hemispheric paralysis. 3. Cardiac murmur. 4. Hemolytic jaundice.
2
79. Which of the following actions would the NICU nurse expect to perform when caring for a neonate with esophageal atresia and tracheoesophageal fistula (TEF)? 1. Position the baby flat on the left side. 2. Maintain low nasogastric suction. 3. Give small, frequent feedings. 4. Place on hypothermia blanket.
2
8. A baby is born with erythroblastosis fetalis. Which of the following signs/symptoms would the nurse expect to see? 1. Ruddy complexion. 2. Anasarca. 3. Alopecia. 4. Erythema toxicum
2
80. 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? 1. The baby is likely to cry from pain during the feeding. 2. The baby is likely to expel milk through the nose. 3. The baby will feed more quickly than other babies. 4. The baby will need to be fed high calorie formula.
1
81. A neonate that is admitted to the neonatal nursery is noted to have a 2-vessel cord. The nurse notifies the neonatologist to get an order for which of the following assessments? 1. Renal function tests. 2. Echocardiogram. 3. Glucose tolerance test. 4. Electroencephalogram.
2
82. In the delivery room, which of the following infant care interventions must a nurse perform when a neonate with a meningomyelocele is born? 1. Perform nasogastric suctioning. 2. Place baby in the prone position. 3. Administer oxygen via face mask. 4. Swaddle the baby in warmed blankets.
1
83. A baby in the NICU, who is exhibiting signs of congestive heart failure from an atrioventricular canal defect, is receiving a diuretic. In the plan of care, the nurse should include that the desired outcome for the child will be which of the following? 1. Loss of body weight. 2. Drop in serum sodium level. 3. Rise in urine specific gravity. 4. Increase in blood pressure.
4
84. The nurse caring for a neonate with congestive heart failure identifies which of the following nursing diagnoses as highest priority? 1. Fatigue. 2. Activity intolerance. 3. Sleep pattern disturbance. 4. Altered tissue perfusion.
2
85. The nurse administers Lanoxin (digoxin) to a baby in the NICU that has a cardiac defect. The baby vomits shortly after receiving the medication. Which of the following actions should the nurse perform next? 1. Give a repeat dose. 2. Notify the physician. 3. Assess the apical and brachial pulses concurrently. 4. Check the vomitus for streaks of blood.
3
86. A baby is born with a meningomyelocele at L2. In assessing the baby, which of the following would the nurse expect to see? 1. Sensory loss in all four extremities. 2. Tuft of hair over the lumbosacral region. 3. Flaccid paralysis of the legs. 4. Positive Moro reflex.
4
87. When examining a nenonate in the well-baby nursery, the nurse notes that the sclerae of the baby's eyes are visible above the iris of the eyes. Which of the following assessments is highest priority for the nurse to make next? 1. Babinski and tonic neck reflexes. 2. Evaluation of bilateral eye coordination. 3. Blood type and Coombs' test results. 4. Circumferences of the head and chest.
1
88. A baby is born with a suspected coarctation of the aorta. Which of the following assessments should be done by the nurse? 1. Check blood pressures in all four limbs. 2. Palpate the anterior fontanel for bulging. 3. Assess hematocrit and hemoglobin values. 4. Monitor for harlequin color changes.
3
89. The nurse is developing a teaching plan for parents of an infant with a tetralogy of Fallot. In which of the following positions should parents be taught to place the infant during a "blue," or "tet," spell? 1. Supine. 2. Prone. 3. Knee-chest. 4. Semi-Fowler's.
1
9. Which of the following laboratory findings would the nurse expect to see in a baby diagnosed with erythroblastosis fetalis? 1. Hematocrit 24%. 2. Leukocyte count 45,000 cells/mm3. 3. Sodium 125 mEq/L. 4. Potassium 5.5 mEq/L.
3
90. A child has been diagnosed with a small ventricular septal defect (VSD). Which of the following symptoms would the nurse expect to see? 1. Cyanosis and clubbing of the fingers. 2. Respiratory distress and extreme fatigue. 3. Systolic murmur with no other obvious symptoms. 4. Feeding difficulties with marked polycythemia.
1
91. A newborn in the NICU has just had a ventriculoperitoneal shunt inserted. Which of the following signs indicates that the shunt is functioning properly? 1. Decrease of the baby's head circumference. 2. Absence of cardiac arrhythmias. 3. Rise of the baby's blood pressure. 4. Appearance of setting sun sign.
2
92. A neonate has just been born with a meningomyelocele. Which of the following nursing diagnoses should the nurse identify as related to this medical diagnosis? 1. Deficient fluid volume. 2. High risk for infection. 3. Ineffective breathing pattern. 4. Imbalanced nutrition: less than body requirements.
1
93. The neonatologist assesses a newborn for Hirschsprung's disease after the baby exhibited which of the following signs/symptoms? 1. Passed meconium at 50 hours of age. 2. Apical heart rate of 200 beats per minute. 3. Maculopapular rash. 4. Asymmetrical leg folds.
1
94. The nurse assessed four newborns admitted to the neonatal nursery and called the neonatologist for a consult on the baby, who exhibited which of the following? 1. Excessive amounts of frothy saliva from the mouth. 2. Blood-tinged discharge from the vaginal canal. 3. Secretion of a milk-like substance from both breasts. 4. Heart rate that sped during inhalation and slowed with exhalation
1
95. The nurse is caring for a baby diagnosed with developmental dysplasia of the hip (DDH). Which of the following therapeutic interventions should the nurse expect to perform? 1. Place (Maintain) the baby's legs in abduction. 2. Administer pain medication as needed. 3. Assist with bilateral leg casting. 4. Monitor pedal pulses bilaterally.
3
96. A baby has been diagnosed with developmental dysplasia of the hip (DDH). Which of the following findings would the nurse expect to see? 1. Pronounced hip abduction. 2. Swelling at the site. 3. Asymmetrical leg folds. 4. Weak femoral pulses.
1
97. The nurse suspects that a newborn in the nursery has a clubbed right foot because the foot is plantar flexed as well as which of the following? 1. Inability to move the foot into alignment. 2. Positive Ortolani sign on the right. 3. Shortened right metatarsal arch. 4. Positive Babinski reflex on the right.
1
98. The parents of a baby born with bilateral talipes equinovarus ask the nurse what medical care the baby will likely need. Which of the following should the nurse tell the parents? The baby will: 1. Need a series of leg casts until the correction is accomplished. 2. Have a Harrington rod inserted when the child is about three years old. 3. Have a Pavlik harness fitted before discharge from the nursery. 4. Need to wear braces on both legs until the child begins to walk.
2 3 4
99. The nurse caring for an infant with a congenital cardiac defect is monitoring the child for which of the following early signs of congestive heart failure? (Select all that apply) 1. Palpitations. 2. Tachypnea. 3. Tachycardia. 4. Diaphoresis. 5. Irritability
