Normal Newborn

1 (The baby has lost less than 4% of its birth weight. Babies often lose 5-10% of their birth weight. A loss greater than 10% is considered pathological.)

A 2 day breastfeeding baby born via normal spontaneous vag delivery has been weighed in the NB nursery. The nurse determines that baby has lost 3.5% of the birth weight. Which of the following nursing actions is appropriate? 1. do nothing because this is a normal weight loss 2. notify the neonatologist of the significant weight loss 3. Advise the mother to bottle feed the baby at the next feed 4. assess the baby for hypoglycemia with a glucose monitor

1 (All findings wnl.)

A 2 day old babys blood values are: type O- direct coombs neg hct 50% bilirubin 1.5 mg/dL The mothers blood type is A+. What should the nurse do at this time? 1. do nothing because the results are wnl 2. asssess the baby for opisthotonic posturing 3. admin Rhogam to the mother per Dr. order 4. call the Dr. for an order to place baby under bili lights

4 (yellow sclerae exhibits jaundice)

A 2 day old exclusively breastfed baby is to be discharged home. Under what conditions should the nurse teach the parents to call the pediatrician? 1. If the baby feeds 8-12 times a day 2. if the baby urinates 6-10 times a day 3. If the baby has stools that are watery and bright yellow 4. If the baby has eyes and sking that are tinged yellow

4 (Vit K is needed for blood clotting)

A 2 day old neonate received a Vit K injection at birth. Which of the following S/s in the baby would indicated that the treatment was effective? 1. skin color is pink 2. VS are normal 3. glucose levels are stable 4. blood clots after heel sticks

1 (babies with short frenulums are unable to extend their tongue enough to achieve a sufficient grasp, painful to mom)

A 2 day postpartum breastfeeding client is complaining of pain during feedings Which of the following may be causing pain? 1. the neonates frenulum is attached to the tip of the tongue 2. the babys tongue forms a trough around the breast during the feedings 3. The newborns feeds last for 30 mins every 2 hrs 4. the baby is latched to the nipple and to about 1 inch of the moms areola

2,3,4 (holding neonate steady in proper position will help ensure safe and accurate puncture. The NB is usually held in a C position to open the spaces between the vertebral column. This position puts the NB at risk for airway obstruction. Thus ensuring patency of airway is a priority. )

A 24 hr old neonate full term, is showing signs of possible sepsis. The nurse is assisting the HCP with a lumbar puncture. What should the nurse do to assist with this procedure? select all that apply 1. admin the IV antibiotic 2. hold the neonate steady in the correct position 3. ensure patent airway 4. maintain a sterile field 5. obtain serum glucose levels

2 (because peak bili levels are seen between days 3-5 and because the level is within normal range the nurse should expect baby discharge. )

A 4 day old baby is born via c section and is slightly jaundiced. The lab reports a bili assessment of 6 mg/dL. Which of the following would the nurse expect the neonatologist to order for the baby at this time? 1. to be placed under phototherapy 2. to be discharged home with parents 3. to be prepared for a replacement transfusion 4. to be fed glucose and water between routine feedings

1 (baby only lost 3.7% .. 100/2678x100%=3.7% This is below the accepted weight loss of 5-10%)

A 4 day old breast feeding neonate whose birth weight was 2678 grams has lost 100 grams since the C section birth. Which of the following actions should the nurse take? 1. nothing, this is acceptable weight loss 2. advise the mom to supplement feed with formula 3. notify the neonatologist for excessive weight loss 4. give the baby dextrose water between feedings

1 (babies are awake and alert for approx 30 min to 1 hr immed after birth. This is the perfect time to bond. )

A 40 week gestation neonate is in the first period of reactivity. Which of the following actions should the nruse take at this time? 1. encourage the parents to bond 2. notify the neonatologist 3. perform the gestational age assessment 4. place the baby under the overhead warmer

3 (The neonate has a HR greater than 100 which earns 2 points. His RR of 70 is 2 points. His flaccid tone is a 0. Pale overall color is a 0. Total score =4)

A 6 lb 8 oz NB was born vaginally at 38 weeks. At 5 mins of life, the NB has the following signs: HR 110, intermittent grunting with resp rate of 70, flaccid tone, no response to stimulus and overall pale white in color. The Apgar score is: 1. 2 2. 3 3. 4 4. 6

4

A CNA is working with the RN in the nursery. Which of the following actions should the RN perform rather than delegating it to the CNA? 1. Bathe and weigh a 1 hour old baby 2. Take the apical heart rate and RR of a 4 hour old baby 3. OBtain a stool sample from a 1 day old baby 4. Provide discharge teaching to the mother of a 4 day old baby

4 (once the reference has been consulted the nurse will have the facts to relay to the Dr. specifically that ampicillin is compatible with breatfeeding.. A call to the Dr. would then be appropriate)

A Dr. writes in a breastfeeding moms chart "ampicillin 500 mg q 6 h po. Baby should be bottlefed until med is discontinued" What should be the nurses next action? 1. follow the order as written 2. call the dr. and question the order 3. follow the antibiotic order but ignore the order to bottle feed the baby 4. refer to a text to see whether the antibiotic is safe while breastfeeding

2

A Mom 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? 1. I am required by law to give the medicine 2. The medicine helps prevent eye infections 3. The medicine promotes neonatal health 4. All babies receive the medicine at delivery

2 (The nurse advocates for the patient because the baby is unable to ask for pain medication. The AAP has made a policy that pain meds be used during all circumcision procedures. It is safe practice to ensure the baby does not eat right before the procedure, ensuring there is no hemorrhage is also safety, as is setting up the sterile field)

A baby boy is to be circumcised by the mothers OB. Which of the following actions shows that the nurse is being a patient advocate? 1. before the procedure the nurse prepares the sterile field for the HCP 2. The nurse refuses to unclothe the baby until the doctor orders something for pain 3. The nurse holds the feeding immed. before the circumcision 4. After the procedure the nurse monitors for signs of bleeding

2 (Heat loss resulting from conduction occurs when the baby comes in contact with cold objects. 1, evaporation occurs when baby is wet and exposed to air, 3. radiation when baby exposed to cold objects but not in direct contact with. 4. convection when baby is exposed to the movement of cold air such as ac currents)

A baby has just been admitted to the neonatal nursery. Before taking the NB VS, the nurse should warm his or her hands, and the stethoscope to prevent heat loss resulting from which of the following? 1. evaporation 2. conduction 3. radiation 4. convection

2

A baby is just delivered which of the following physiological changes is of highest priority? 1. thermoregulation 2. spontaneous respirations 3. extrauterine circulatory shift 4. successful feeding

1,2,4

A bottle feeding mom is providing a return demonstration of how to burp the baby. Which of the following would indicate the teaching was successful? select all 1. The woman gently strokes and pats babys back 2. woman positions the baby in a sitting position on her lap 3. woman waits to burp the baby until the feeding is complete 4. woman remarks that the baby does not need to burp after trying for 1 full minute

1 (2. prone position increases risk not supine. 3. the peak of SIDS is 2-4 months of age. 4. back to sleep guidelines are for all babies)

A breast feeding mom refuses to place her unclothed baby face down on her chest because "babies are always supposed to be put on their backs. Babies who are on their stomachs die from SIDS". The nurses action should be based on which of the following? 1. skin to skin contact facilitates breastfeeding and helps to maintain neonatal temp 2. The risk of SIDS increases whenever unsupervised babies are placed supine 3. SIDS rarely occurs before completion of the neonatal period 4. back to sleep guidlines have been modified for breast feeding babies

2 (babies that are born tongue-tied that is have a tight frenulum have difficulty extending their tongues while breastfeeding. The mothers nipple often becomes damaged as result.)

A breastfeeding baby is born with a tight frenulum. Which of the following is an important assessment for the nurse to make? 1. integrity of the babys uvula 2. Presence of maternal nipple damage 3. Presence of neonatal tongue injury 4. The babys breathing pattern

1

A breastfeeding mom 2 weeks postpartum is informed by the pediatrician that her 4 year old has chicken pox. The mother calls the nursery nurse because she is concerned about having the baby in contact with the sick sibling. The mother had chickenpox as a child. Which of the following responses by the nurse is appropriate? 1. The baby received passive immunity through the placenta plus the breast milk will also be protective 2. The baby should stay with relatives untill the ill sibling recovers from the chicken pox 3. Chickenpox is transmitted by contact route so careful had washing should prevent transmission 4. Because chicken pox is a spirochetal illness both the child and baby should receive the appropriate medications.

2

A breastfeeding mom mentions to the nurse that she has heard that babies sleep better at night if given a small amount of rice cereal in the evening. Which of the following comments by the nurse is appropriate? 1. That is correct. The rice cereal takes longer for them to digest so they sleep better and longer 2. It is recommended that babies receive breast milk for the first 4-6 months of their lives. 3. It is too early for rice cereal, but I would recommend giving the baby a bottle of formula at night 4. A better recommendation is to give apple sauce at 3 months of age and apple juice 1 month later

1

A client asks are there any foods to avoid while breastfeeding. which of the following responses by the nurse is appropriate? 1. no there are no foods strictly contraindicated 2. yes, the same foods that were dangerous during preg should be avoided 3. yes foods like onions, cauliflower, broccoli and cabbage make babies colicky 4. Yes spices from hot spicy foods get into the milk and can upset the baby

4 (The AAP although acknowledging that there are some advantages to circumcision states there is not enough evidence to suggest that all baby boys be circumcised.)

A couple asking the nurse whether or not their son should be circumcised. On which fact should the nurses response be based? 1. boys should not be ciucumcised for them to establish a positive self image 2. boys should not be circumcised because there is no medical rationale for the procedure 3. experts from the CDC argue that circumcision is desirable 4. A statement from the AAP asserts that ciucumcision is optional

1,2,3 (1. The patches are called mongolian spots and they are common in babies of color. They fade and disappear in time.2. The whitish discharge is called witchs milk and is excreted as a result of maternal hormones in the babys system. 3. The bloody discharge is called pseudomenses and occurs as a result of drop in maternal hormones. 4 is a port wine stain birthmark, permanent. 5. The dimple may be a pilonidial cyst or a small defect in the spinal cord (spina bifida). An ultrasound should be done to determine if a pathological condition is present)

A female AA baby has been admitted to the nursery. Which of the following physiological findingss would the nurse assess as normal? select all 1. purple colored patches on the buttocks 2. bilateral whitish discharge from the breasts 3. bloody discharge from the vagina 4. sharply demarcated dark red area on the face 5.. deep hair covered dimple at the base of the spine

3 (lethargy is the most common early symptom of hyperbilirubinemia. Babies will often feed poorly, and hyperreflexia is seen with prolonged periods of very elevated serum bilirubin. Normal bilirubin values are less than 2mg/dL in cord blood to approx 12-14 mg/dL on days 3-5. Babies will show neurological depression when bilirubin levels rise, and when they are very elevated permanent brain damage can result)

A full term babys bilirubin is 12 mg/dL on day 3. Which of the following neonatal behavior would the nurse expect to see? 1. excessive crying 2. increased appetite 3. lethargy 4. hyperreflexia

2 (Babies do not shiver, rather to produce heat they utilize chemical thermogenesis, also called nonshivering thermogenesis. BAT is metabolized during hypothermic episodes to maintain body temp. Unfortunately this can also lead to metabolic acidosis. )

A full term neonate has brown adipose fat tissue (BAT) stores that were deposited during the latter part of the 3rd trimester. What does the nurse understand is the function of BAT stores? 1. to promote melanin production in the neonatal period 2. to provide heat production when the baby is hypothermic 3. To protect the bony structures of the body from injury 4. To provide calories for neonatal growth between feedings

2 (normal Moro reflex)

A full term neonate is admitted to the nursery. When lifting the baby out of the crib, then nurse notes that the babys arms move sideways with the palms up and the thumbs flexed. What should the nurse do next? 1. call a code 2. identify this reflex as a normal finding 3. place the neonate on seizure precautions 4. start supplemental oxygen

1 (soft rales expected because babies born via c section do not have the advantage of having the amniotic fluid squeezed from the pulmonary system as occurs with vag birth. 2 bowel sounds should be normal. 3. Moro should be normal 4 Babies in LMA are not at high risk for developmental dysplasia of the hip, Breech babies are at high risk for DDH )

A full term neonate with Apgar 9/9, has just been admitted to the nursery after a c section. fetal position LMA, under epidural anesthesia. Which of the following physiological findings would the nurse expect to see? 1. soft pulmonary rales 2. absent bowel sounds 3. depressed Moro reflex 4. Positive Ortolani sign

1 (When newborns are wet they can become hypothermic from heat loss resulting from evaporation. They may develop cold stress syndrome. The first Apgar score is not done until 60 seconds after delivery. The wet blankets should be removed well before that. Eye prophylaxis can be delayed until after the parents begin bonding with the baby. Although tthe babies CNS must be carefully assessed, reflex assessment should be postponed until after the baby is dried and is breathing on his or her own.)

A full term newborn was just born. Which nursing intervention is important for the nurse to perform first? 1. remove wet blankets 2. assess Apgar score 3. insert eye prophylaxis 4. elicit the moro reflex

4 (radiant warmer if infant unstable and needs medical attention, blankets can be placed over NB while on moms chest. Hat can be added, but skin to skin is best)

A healthy NB was just born in stable condition. In addition to drying the infant, what is the preferred method to prevent heat loss? 1. placing the infant under a radiant warmer 2. wrapping the infant in warm blankets 3. applying a knit hat 4. placing the infant skin to skin on the mother

1 (breastfeeding should start asap. It promotes milk production, stability of the babys glucose levels, and meconium excretion as well as stabalize the baby temp with skin to skin contact)

A mom who gave birth 5 mins ago states that she would like to breastfeed. The babys Apgar is 9/9. Which of the following actions should the nurse perform first? 1. assist the woman to breastfeed 2. dress the baby in a shirt and diaper 3. admin the ophthalmic prophylaxis 4. take the babys rectal temp

2 (When neonates speed thru the birth canal during rapid deliveries, the presenting parts become bruised. The bruising often takes the form of petechiae hemorrhages. Petechiae can be present as a result of bacterial infections like meningococcemia, but in this situation there is no indication infection is present. Erythema toxicum, the newborn rash, is characterized by papules or pustules on an erythematous base. There is nothing in the scenario to suggest child abuse.)

A mother 1 day postpartum from a 3 hr labor and spontaneous vag delivery, questions the nurse about her babys face being purple. Upon exam, the nurse notes petechiae over the scalp, forehead, and cheeks of the baby. The nurses first response should be based on which of the following? 1. petechiae are indicative of serious bacterial infections 2. rapid deliveries can injure the neonatal presenting part 3. petechiae are characteristic of the normal NB rash 4. The injuries are a sign that the child has been abused

2,3,5 (Babies prefer sweet things, but respond to all forms of taste. Babies sense of touch is onsidered to be the most well developed sense. Babies hear quite well once the amniotic fluid is abosorbed from the ear canal. All NB hearing is tested prior to discharge from the NB nursery. If a baby is found to be hearing impaired, the baby should receive early intervention)

A mother asks the nurse to tell her about the responsiveness of neonates at birth. Which of the following answers is appropriate? select all 1. Babies have a poorly developed sense of smell until they are about 2 months old 2. Babies respond to all forms of taste well, but they prefer sweet things like breast milk 3. babies are especially sensitive to being touched and cuddled 4. babies are nearsighted with blurry vision until they are about 3 months old 5. babies respond to many sounds, especially the high pitched tone of the female voice

2 (No powder is recommended for babies)

A mother asks the nurse which powder she should purchase to use on the babys skin. What should the nurses response be? 1. any powder made for babys should be fine 2. it is recommended that powder not be put on babys 3. there is no real difference except that many babies are allergic to cornstarch so it should not be used 4. as long as you only put it on the buttocks area you can use any brand of baby powder you like

2 (This statement provides the mother with the knowledge that babies are obligate nose breathers so that they are able to suck, swallow and breathe without choking.)

A mother asks whether or not she should be concerned that her baby never opens his mouth to breathe when his nose is so small. Which of the following is the nurses best response? 1. The baby does rarely open his mouth but you can see that he isnt in any distress 2. Babies usually breathe in and out thru their noses so they can feed without choking 3. everything about babies is small. It is truly amazing how everything works so well 4. you are right, I will report the babys small nasal openings to the pediatrician right away

3 (subconjunctival hemorrhages are a normal finding and are not pathological. They will disappear over time. Explaining this is appropriate.)

A mother calls the nurse to the room because "my babys eyes are bleeding". The nurse notes bright red hemorrhages in the sclerae of both of the babys eyes. Which of the following actions by the nurse is appropriate at this time? 1. notify the pediatrician immed. of the finding 2. notify the social worker about the probably maternal abuse 3. reassure the mother that the trauma resulted from pressure changes at birth and that the hemorrhages will slowly disappear 4. obtain a ophthalmoscope from the nursery to evaluate the red reflex and condition of the retina in each eye

3

A mother confides to the nurse she has no crib at home for her baby. the mother asks the nurse which of the following places would be best for the baby to sleep. Of the the following choices, which location should the nurse suggest? 1. in bed with 5 year old brother 2. in a waterbed with mom and dad 3. in a large empty dresser drawer 4. in the living room on the pull out sofa

2,3,4 (babys mouth need to be wide open to latch, baby needs to be at level of the breast, nose towards nipple. 1. baby should be placed tummy to tummy with mom, baby cant swallow with head turned. 5. baby tongue must be below the nipple to suck effectively)

A mother is attemptint to latch her newborn baby to the breast. Which of the following actions are important for the mom to perform to achieve effective breastfeeding? select all 1. place the baby on his or her back in the mothers lap 2. wait until the baby opens his mouth wide 3. hold the baby at the level of the mothers breasts 4. point the babys nose to the mothers nipple 5. wait until the babys tongue is pointed toward the roof of his mouth

1,3 (Active untreated TB should be separated from her baby until she has been on antibiotic therapy for 2 weeks. She can pump her breast milk and have it fed to the baby thru alternative feeding method. HIV positive moms are advised to not breastfeed because of increased risk of transmission. 2. Hep B is not a contraindication. 4. acute bacterial infections are not contraindications unless there are meds mom is taking that are contraindicated. 5. Moms with mastitis are recommended to continue breastfeeding and draining milk to prevent developing abscess.)

A mother is told that she should bottle feed her child for medical reasons. Which of the following maternal disease states are consistent with the recommendation? select all 1. Untreated active TB 2. Hep B surface antigen positive 3. HIV positive 4. Chorioamnionitis 5. Mastitis

2 (bilirubin of 19 is above level.. intervention needed)

A mother of a 2 day old baby are preparing for discharge. which of the following situations would require the babies discharge be cancelled? 1. the parents own a car seat that only faces the rear of the car 2. the babys bilirubin is 19 mg/dL 3. the babys glucose is 65 mg/dL 4. There is a bluish spot on the left buttock of the baby

1,3,4,5 (4 is called the colic hold)

A mother tells the nurse that because of family history she is afraid her baby son will develop colic. Which of the following colic management strategies should the parents be taught? select all 1. small freq. feedings 2. prone sleep position 3. tightly swaddle baby 4. rock the baby while holding face down on the forearm 5. maintain smoke free home environment

4 (The drainage should be evaluated by the nurse. 1. Suction the mouth before the nose. 2. if the back of the throat is suctioned it will stimulate the gag reflex 3. The bulb should be compressed before it is inserted into the babys mouth)

A mucousy baby is being left with the parents for the first time after delivery. Which of the following should the nurse teach the parents regarding use of the bulb syringe? 1. Suction the nostrils before suctioning the mouth 2, make sure to suction the back of the throat 3. insert the syringe before compressing the bulb 4. dispose of the drainage in a tissue or cloth

3

A neonate born at 30 weeks and weighing 2000 g is admitted to the neonatal intensive care unit. What nursing measure will decrease insensible water loss in the neonate? 1. bathing the baby asap after birth 2. use of eye patches with phototherapy 3. use of humidity in the incubator 4. use of a radiant warmer

2 (With lung oxygenation the neonate no longer needs large numbers of RBC's. As a result excess RBC's are destroyed. Jaundice often results on day 2-4. )

A neonate has elevated bilirubin and is slightly jaundiced on day 3 of life. What is the probable reason for these changes? 1. hemolysis of neonatal RBC's by the maternal antibodies 2. Physiological destruction of fetal RBC's during the extrauterine period 3. Pathological liver function resulting from hypoxemia during the birthing process 4. Delayed meconium excretion resulting in the production of direct bilirubin.

1 (watch for bradycardia from potential vagus nerve stimulation.)

A neonate has large amounts of secretions. After vigorously suctioning the neonate ,,the nurse should assess for what possible result? 1. bradycardia 2. rapid eye movement 3. seizures 4. tachypnea

3 (A positive Ortolani sign indicates a likely developmental dysplasia of the hip. In the Ortolani sign, the thighs are gently abducted. If the trochanter displaces from the acetabulum, the result is positive and indicative of developmental dysplasia of the hip. The circumferences are wnl. The head should be 32-37 cm. The chest should be 1-2 cm smaller than the head.)

A neonate is admitted to the nursery. The nurse makes the following assessments: weight 3845 grams, head circumference 35 cm, chest circumference 33 cm, positive Ortolani sign, and presence of supernumerary nipples. Which of the assessments should be reported to the HCP? 1. birth weight 2. head and chest circumference 3. Ortolani sign 4. Supernumerary nipples

3,4 (When the scarf sign is assessed the premature baby would be able to move the elbow past the midline. A full term baby would not be able to do this. Ear pinnae that are slighly curved and slow to recoil are seen in preterm babies. 5= stork bite which are pale pink spots often found on the eyelids and nape of the neck which usually fade by age 2, 1. Harlequinn sign a deep red color over one side of the baby body and pale coloration over the other is transient and usually normal. 2=Babinski reflex which is expected until age of 2.)

A neonate is being admitted into the well baby nursery is exhibiting each of the following assessment findings. Which of the findings should the nurse report to the HCP. select all that apply 1. Harlequin sign 2. Extension of the toes when the lateral aspect of the sole is stroked 3. Elbow moves past the midline when the scarf sign is assessed 4. Slightly curved pinnae of the ears that are slow to recoil 5. Telangiectatic nevi

3 (Undescended testes-crytorchidism-is an unexpected finding. It is one sign of prematurity.)

A neonate is being admitted to the well baby nursery. Which of the following findings should be reported to the neonatologist? 1. Umbilical cord with 3 vessels 2. diamond shaped anterior fontanelle 3. cryptorchordism 4. cafe au lait spot

2

A neonate is born by c section at 36 weeks. The temp in the birthing room is 70F. To prevent heat loss from convection, which action should the nurse take? 1. dry the neonate quickly after birth 2. keep the neonate away from air conditioning vents 3. place the neonate away from outside windows 4. prewarm the bed

1 (showing signs of hunger and frustration describes the active alert or active awake state. Starting to whimper or cry describes the crying behavioral state. Wide awake and attending to a picture is the quiet alert state, sometimes called wide-awake state. Sleeping or breathing regularly describes deep or quiet sleep)

A neonate is in the active alert behavioral state. Which of the following would the nurse expect to see? 1. baby is showing signs of hunger and frustration 2. baby is starting to whimper and cry 3. baby is wide awake and attending to a picture 4. baby is asleep and breathing rhythmically

3

A neonate is to receive the Hep B vaccine in the nursery. Which of the following must the nurse have available before administering the vaccine? 1. Hep B immune globulin in a second syringe 2. Sterile water to dilute the vaccine before injecting 3. Epinephrine in case of severe allergic reaction 4. Oral syringe because the vaccine is given by mouth

4 (The anterior fontanelle closes between ages 12-18 months. Premature closure ; craniostenosis or premature synostosis; prevents proper growth and expansion of the brain, resulting in an intellectual disability. The posterior fontanel typically closes by ages 2-3 months)

A new mom asks "When will the soft spot near the front of my babys head close? The nurse should tell the mother the soft spot will close in about: 1. 2-3 months 2. 6-8 months 3. 9-10 months 4. 12-18 months

2 (the concern with this infant is sepsis based on prolonged rupture of membranes. Blood cultures will help but take 48 hrs. freq monitoring of VS, looking for changes and maintain contact with the parents is also part of care management while waiting for results. 1 would be the standard of care for normal newborn, but with RR > 60 and grunting and flaring are not normal. Intensive care is not warranted as NB with sepsis can be Tx with antibiotics at maternal bedside. Experts say to wait until infant is 6-12 hrs old before drawing a CBC to get accurate results)

A newborn who is 20 hrs old has a RR of 66, is grunting when exhaling, and has occasional nasal flaring. The newborns temp is 98F he is breathing room air and is pink with acrocyanosis. The mother had membranes that were ruptured 26 hrs before birth. What nursing actions are most indicated? 1. continue recording VS, voiding, stooling and eating patterns every 4 hrs 2. place a pulse oximeter and contact the HCP for a prescription to draw blood cultures 3. Arrange a transfer to the neonatal intensive care unit with Dx of possible sepsis 4. Draw a CBC with differential and feed the infant

4 (alcohol is found in the breast milk in exactly the same concentration as in the mothers blood. Alcohol consumption is not however incompatible with breastfeeding. The woman should breastfeed immed before consuming a drink and then wait 1-2 hrs to metabolize the drink before feeding again. If she decides to have more than one drink she can pump and dump her milk for a feeding or two)

A newly delivered mom states I have not had any alcohol since I decided to become pregnant. I have decided not to breastfeed because I would really like to go out and have a good time for a change. Which of the following is the best response by the nurse? 1 I understand that being good for so many months can become very frustrating 2. Even if you bottle feed the baby, you will have to refrain from drinking alcohol for the next 6 weeks to protect your health. 3. Alcohol can be consumed at any time while you breastfeed 4. You may drink alcohol when breastfeeding, although it is best to wait until the alcohol has been metabolized before you feed again.

1

A nurse brought an 2 hr old baby to a mom from the nursery The nurse is going to assist the mom with the first breastfeeding experience. Which of the following actions should the nurse perform first? 1. compare mom and babys id bracelets 2. help mom into a comfortable position 3. teach the mom about proper breast latch 4. tickle the babys lips with the moms nipple

1 (both upper and lower lips should be flanged. breastfed babies usually feed every 2-3 hrs. A 12% wweight loss is significant in both breast and bottle feeders. When the tongue stays behind the gum line, baby is unable to get milk)

A nurse caring for a mother/newborn dyad on the maternity unit has identified the following nursing diagnosis; effective breastfeeding. Which of the following would warrant this diagnosis? 1. babys lips are flanged when latched 2. baby feeds every 4 hrs 3. baby lost 12% of weight since birth 4. babys tongue stays behind gum line

4 (by one week of age breastfed babies should be urinating at least 6 times in 24 hrs)

A nurse determines that which of the following is an appropriate short term goal for a full term breastfed neonate? 1. the baby will regain birth weight by 4 weeks of age 2. The baby will sleep thru the night by 4 weeks of age 3. The baby will stool every 2-3 hrs by 1 week of age 4. The baby will urinate 6-10 times per day by 1 week of age

1,2,3,5 (With the baby placed flat on its back the practitioner grasps the babys thighs using his thumbs and index fingers. When assessing for ortolani sign, the babys thighs are abducted. When performing the barlow test, the baby's thighs are adducted. With the babys hips and knees at 90-degree angles, the hips are abducted. With DDH the trochanter dislocates from the acetabulum. The nurse would feel the dislocation while palpating the trochanter. Legs are extended to assess for equal leg lengths and for equal thigh and gluteal folds. )

A nurse doing a NB assessment on a new admission to the nursery. Which of the following actions should the nurse make when evaluating the baby for developmental dysplasia of the hip (DDH)? select all 1. grasp the babys legs with the thumbs on the inner thighs and forefingers on the outer thighs 2. gently adduct and abduct the babys thighs 3. palpate the trochanter during hip rotation 4. place the baby in a fetal position 5. compare the lengths of the babys legs

2 (This is the correct method. The med can be delayed until after the first feeding and bonding, its given even if not positive for gonorrhea)

A nurse is about to administer the ophthalmic preparation to a newly born neonate. Which of the following is the correct statement regarding the medication? 1. It is administered to prevent the development of neonatal cataracts 2. The medicine should be placed in the lower conjunctiva from the inner to outer canthus 3. The medicine must be administered immed upon delivery of the baby 4. It is administered to the neonates whose mothers test positive for gonorrhea during pregnancy

2,3,4 (Baby should be in rear facing car seat in the back seat until 2 years old. Since 2002 ca seats have two attachment points at the base of the car seat, use both. It should not move more thann 1 inch back and forth or side to side its not installed properly.)

A nurse is advising a mother of a neonate being discharged from the hospital regarding car seat safety. Which of the following should be included in the teaching plan? select all 1. place the babys car seat in the front passenger seat of the car 2. position the car seat rear facing until the baby reaches 2 years old 3. attach the car seat to the car at 2 latch points at the base of the car seat 4. check that the installed car seat moves no more than 1 inch side to side or front to back 5. Make sure that there is at least a 3 inch space between the straps of the seat and the babys body

1,4,5 (Babies do not starve themselves, if they refuse to eat it may mean they are seriously ill. Babies with cardiac defects often refuse to eat. Although babies may be difficult to rouse in a deep sleep, that lasts no more than an hr. If the baby continues to be unarousable, the Dr. should be notified. A temp above 100.4 should be reported. Newborns normally breathe irregularly. apnea spells of less than 10 sec are normal. newborns do not tear up when they cry, if they do he or she may have a blocked lacrimal duct)

A nurse is advising the parents of a newborn regarding when they should call their pediatrician. Which of the following responses show that the teaching was effective? select all 1. The baby repeatedly refuses to feed 2. The babys breathing is irregular 3. The baby has no tears when he cries 4. The baby is repeatedly difficult to awaken 5. If the babys temp is above 100.4 F

3 (assessing bonding not safety)

A nurse is assessing bonding of the father with the newborn. Which of the following actions by the father would concern the nurse? 1. he holds the baby en face position 2. he calls the baby by the full name instead of a nick name 3. he tells the mother to pick up the crying baby 4. he falls asleep in the chair with the baby on his chest

3 (Brachial pulse is the recommended site for assessing the pulse of a neonate undergoing CPR. The carotid can be used for an adult or child over 1 year old in CPR. The radial and pedal puses are never recommended for use in CPR)

A nurse is practising the procedures for conducting CPR in the neonate. Which site should the nurse use to assess the pulse of a baby? 1. carotid 2. radial 3. brachial 4. pedal

2,3 (Babies should always be shielded from direct sun. If they must be in direct sun sunscreen should be used to all exposed areas including the scalp. Liquid tylenol should be available in the home but should not be used until the parent speaks to the Dr. 1, Some babies do not respond to their own hunger. It is especially important that breastfed babies feed 8 times in 24 hrs. parents SHOULD wake the baby to feed if they sleep thru. 5. The top of the chest clip on the car seat should be positioned at the level of the babies arm pits)

A nurse is providing anticipatory guidance to a couple before they take home their newborn. Which of the following should be included? select all 1. If the baby is sleeping soundly they should not awaken the baby for a feeding 2. If their baby is exposed to the sun, they should put sunscreen on the baby 3. Theyu should purchase liquid acetaminophen to be used when ordered by the Dr. 4. They should notify the Dr when the umbilical cord falls off 5. When strapping their baby in a car seat, they should position the top of the chest clip at the level of the babys belly button

1,2,4,5 (The first of 3 Hep B injections is often given in the NB nursery, if not given by 1 month. It is recommended that the first of three polio vaccines be given at the 2 month check up. Three DTap injections are given during the first year of liefe and boosters as the child grows. Because the baby has received passive immunity from Mom, varivax is not given until the 2nd year of life. Because the baby has received passive immunity from Mom, MMR is not given until the 2nd year of life)

A nurse is providing anticipatory guidance to a couple regarding the babys immunization schedule. Which of the following statements by the parents shows that the teaching by the nurse was successful? select all 1. The first Hep B injection is given by 1 month 2. The first polio injection will be given at 2 months 3. The MMR immunization should be administered before the first birthday 4. Three DTaP shots will be given during the first year of life 5. The Varivax (varicella) immunization will be administered after the baby turns 1 year old

3 (squeezing soapy water over the penis cleanses the area without irritating the site and causing the site to bleed. Dry dressings are not applied. It is however usually recommended to apply petroleum jelly to the site with a sterile dressing.)

A nurse is teaching a mother how to care for her 3 day old sons circumcised penis. Which of the following actions demonstrates that the mother has learned the information? 1. The mother cleanses the glans with a cotton swab dipped in hydrogen peroxide. 2. The mother covers the glans with antifungal ointment after rinsing off any discharge. 3. The mother squeezes soapy water from a washcloth over the glans. 4. The mother replaces the dry sterile dressing before putting on the diaper.

2 (A 5/8 inch 25 gauge needle is an appropriate needle for a neonatal IM. A 1 inch would be too long and an 18 gauge would be too thick)

A nurse must give Vitamin K 0.5 mg IM to a newly born baby. Which of the following needles should the nurse choose for the injection? 1. 5/8 inch, 18 guage 2. 5/8 inch, 25 gauge 3. 1 inch, 18 gauge 4. 1 inch, 15 gauge

3 (The babys extremities are cyanotic as a result of the babys immature circ system. Swaddling helps to warm the babys hands and feet. Cyanotic hands and feet are not a sign of hypoxemia in the neonate.)

A nurse notes that a 6 hr old neonate has cyanotic hands and feet. Which of the following actions by the nurse is appropriate? 1. place the child in an isolette 2. admin O2 3. swaddle the baby in a blanket 4. apply pulse oximeter

4 (Brain damage is highly unlikely. Molding occurs during vag birth when the cranial bones tend to override or overlap as the head accommodates the size of the birth canal. The amount and duration of pressure on the head influences the degree of molding. Molding usually disappears in a few days with no special attention)

After explaining to a primiparous client about the cause of her NB cranial molding, which statement by the mother inicates a need for further instruction? 1. the molding was caused by an overlapping of the babys cranial bones during my labor 2. The amount of molding is related to the amount and length of pressure on the head 3. The molding will usually disappear in a couple of days 4. Brain damamge may occur if the molding does not resolve quickly

3 (3 is the tonic neck reflex. this reflex disappears in a matter of months as the infant matures. The stepping reflex is #1. The prone crawl reflex is #2, A normal Babinski reflex is #4)

After instructing a mother about normal reflexes of term NB's, the nurse determines that the mother understands the instructions when she describes the tonic neck reflex as occuring when the neonate displays which behavior? 1. steps briskly when held upright near a firm hard surface 2. pulls both arms and does not move the chin beyond the point of the elbows 3. turns head to the left, extends left extremities and flexes right extremities 4. extends and abducts the arms and legs with the toes fanning open

4 (The yellowish crust is normal and indicates scar formation at the site. It should not be removed because to do so may increase bleeding. The petroleum gauze prevents the diaper from sticking to the site and may fall off in the diaper, if this occurs the mom should not attempt to replace it but should simply appy plain petroleum jelly to the site. The guaze should be left in place for 24 hrs and the mom should apply petroleum jelly with each diaper change for 48 hrs. A few drops of blood is normal but if it is more than a few drops the mom should apply pressure and contact the HCP. Any bleeding after the 1st day should be reported)

After teaching the mom about the care of the NB after circumcision, with a Gomco clamp, which statement by the mother indicates to the nurse the mom needs additional instruction? 1. the petroleum gauze may fall off into the diaper 2. a few drops of blood oozing from the site is normal 3. I will leave the gauze in place for 24 hrs 4. I will remove any yellowish crusting gently with water

2 (if the infant is not breathing after the initial steps of resuscitation, the next thing the nurse must do is begin positive pressure ventilation.Apgar scores are an evaluation of the neonates status at 1 and 5 minutes of life. Waiting to restore respirations would be a waste of valuable time. O2 alone does little good if the NB is not breathing, chest compressions must be accompanied by adequate oxygenation)

After the birth of the neonate a quick assessment is completed. The NB is found to be apneic. After quickly drying and positioning the NB, what should the nurse do next? 1. assign the first Apgar score 2. start positive pressure ventilation 3. administer oxygen 4. start cardiac compressions

3 (norm umbilical cord has two arteries, one vein. When a NB is born with only one artery and one vein the nurse should notify the HCP for cardiac anomalies. Other common congenital problems assoc with a missing artery include renal, CNS lesions, tracheoesophageal fistulas, trisomy 13 and 18, and resp distress)

After vaginal birth of a term NB the nurse observes that the neonate has one artery and one vein in the umbilical cord. The nurse notifies the HCP based on the analysis that this may be indicative of which anomalies? 1. resp anomalies 2. muculoskeletal anomalies 3. cardiovascular anomalies 4. facial anomalies

3 (at 24 hours of age the NB is probably in a state of deep sleep as evidenced by the closed eyes and lack of eye movement, the other VS are wnl. The first period of reactivity occurs in the first 30 mins after birth, evidenced by alertness, sucking sounds and rapid HR and RR)

At 24 hours of age, assessment of the neonate reveals the following; eyes closed, skin pink, no sign of eye movements, HR 120, and RR 35. What is the neonate most likely experiencing? 1. drug withdrawal 2. a first period of reactivity 3. a state of deep sleep 4. respiratory distress

2

On admit to a maternity unit it is learned that a mom has smoked two packs of cigs per day and expects to continue to smoke after discharge. The mom also states that she expects to breastfeed her baby. The nurses response should be based on which of the following 1. breastfeeding is contraindicated for a mom that smokes cigarettes 2. breastfeeding is protective for the baby and should be encouraged 3. a 2 pack a day smoker should be reported to CPS for child abuse 4. a mother who admits to smoking cigarettes may also be abusing illicit substances

4 (cephalhematomas are subcutaneous swellings of accumulated blood from the trauma of delivery. The bulges may be one sided or bilateral and the swellings do not cross the suture lines 1. molding is overlapping of cranial bones, rarely one sided and feels like a ridge rather than a bulge. 2. caput succedaneum is the swelling of the tissues of the baby head over the entire cranium. 3. positioning usually results in molding.)

The mother notes that the baby has a bulge on the back of one side of the head. She calls the nurse into the room to ask what the bulge is. The nurse notes that the bulge covers the right parietal bone but does not cross the suture lines. The nurse explains to the mother that the bulge results form which of the following? 1. molding of the babies skull so that the baby could fit thru the pelvis 2. swelling of the tissues of the babys head from the pressure of her pushing 3. the position that the baby took in her pelvis during the last trimester of her pregnancy 4. small blood vessels that broke under the babys scalp during birth

1 (If mom is anxious and overly fatigued and or in pain, the secretion of oxytocin is inhibited, and this in turn inhibits the milk ejection reflex and insufficient milk may be consumed)

The nurse does not hear the baby swallow when suckling even though the baby appears to be latched properly. Which of the following situations may be the reason for this observation? 1. the mother reports a pain level of 4 on a 5 point scale 2. the baby has been suckling for over 10 minutes 3. the mother uses the cross cradle hold while feeding 4. the baby lies with the chin touching the under part of the breast

4 (The clothing should be removed and the mother educated about SIDS and the correlation between overheating and SIDS. The nurse should use a translator. 70 degrees is appropriate temp, and babies clothed in at most one layer more than needed by adults. )

The nurse enters a spanish speaking womans postpartum room and notes that her neonate is wearing a hat and is covered in 3 blankets. The room temp is 70 F, The nurse action should be based on which of the following? 1. overdressing babies is common in some cultures and should be ignored 2. the mother has dressed the baby appropriately for the temp 3. The nurse should drop the room temp because the baby is overdressed 4. overheating is dangerous for neonates and the extra clothing should be removed

4 (healthy infants are weighed at visits to the HCP. By 3 months 90% of babies sleep through the night. Projective vomit may indicate pyloric stosis and should not be seen in a normal NB. Bottle fed infants may stool one to three times a day)

The nurse has completed discharge teaching with new parents who will be bottlefeeding their normal term NB. Which statement by the parents reflects the need for more teaching? 1. our baby will require feedings through the night for several weeks or months after birth 2. the baby should burp during and after each feeding with no projective vomiting 3. our baby should have one to three soft formed stools a day 4. we should weigh our baby daily to make sure he is gaining weight

4 (many babies are Vit D deficient because of recommendations to keep out of direct sun)

The nurse informs the parents of a breastfed baby that the APA advises that babies be supplemented with which of the following vitamins? 1. Vit A 2. Vit B12 3. Vit C 4. Vit D

1 (placing the NB on his back after feeding is recommended to reduce the risk for SIDS. 2 the mom should bubble/burp the baby more than once during a feeding , including at least after 15 ml of formula and again when finished. Waiting until the baby has eaten 30 mL can lead to regurgitation. The entire nipple should be placed on top the babys tongue and into the mouth to prevent excessive air.. The nipple should be pointed directly into the mouth not towards the palate.)

The nurse instructs a primiparous client about bottle feeding the NB. Which action demonstrates that the mom has understood the instructions? 1. placing the NB on his back after feedings 2. bubbling the baby after 1 0z (30 mL) of formula 3. putting 3/4 of the bottle nipple into the babys mouth 4. pointing the nipple toward the NB palate

3 (This is a description of the Moro reflex. 1. Rooting reflex, 2. Babinski reflex, 4. Tonic neck reflex)

The nurse is about to elicit the Moro reflex. Which of the following responses should the nurse expect to see? 1. When the cheek of the baby is touched the NB turns toward the side that is touched 2. When the lateral aspect of the sole of the babys foot is stroked, the toes extend and fan outwards 3. When teh baby is suddenly lowered or startled the NB arms straighten outward and the knees flex 4. When the NB is supine and the head is turned to one side, the arm on the same side extends.

1 (intercostal retractions are a sign of Resp. distress. )

The nurse is assessing a NB on admission to the NB nursery. Which of the following findings should the nurse report to the neonatalogoist? 1. intercostal retractions 2. caput succedaneum 3. epstein pearls 4. harlequin sign

4 (nasal flaring is a SIGN of resp distress.)

The nurse is assessing a neonate in the newborn nursery. Which of the following findings in the NB should be reported to the neonatologist? 1. The eyes cross and uncross when they are open 2. The ears are positioned in alignment with the inner and outer canthus of the eyes 3. Axillae and femoral folds of the baby are covered with a white cheesy substance 4. The nostrils flare when the baby inhales

1

The nurse is concerned that a bottle fed baby may become obese because of which activity by the mother? 1 she endourages the baby to finish the bottle at each feed 2. she feeds the baby every 3-4 hrs 3. she feeds the baby a soy based formula 4. she burps the baby every 1/2 to 1 ounce

1 (2 is swimmers ear, 4 is congenital condition of blocked nasal passages that cause choking during feeding)

The nurse is conducting a state mandated eval of a neonates hearing. Infants are assessed for deficits because hearing impaired babies are at high risk for which of the following? 1. delayed speech development 2. otitis externa 3. poor parental bonding 4. choanal atresia

1 (even being breastfed the baby is still susceptible to illness. )

The nurse is developing a teaching plan for parents who are taking home their 2 day old breastfed baby. which of the following should the nurse include in the plan? 1. wash hands well before picking up baby 2. refrain from having visitors in the first month 3. wear a mask to prevent transmission of a cold 4. sterilize the breast pump supplies after each use

1,2,3,5 (congenital hypothyroidism is a malfunction or complete absence of the thyroid gland that is present from birth. It is screened for in all 50 states. Sickle cell is an autosomal recessive disease resulting in abnormally shaped RBC's that is screened for in all 50 states. Galactosemia is an incurable autosomal recessive disease characterized by the absence of the enzyme required to metabolize galactose and is screened for in all 50 states. Cystic fibrosis is an autosomal recessive illness characterized by the presence of thick mucus in the resp. tract and is screened for in all 50 states. Cerebral palsy is a disorder characterized by motor dysfunction resulting from a nonprogressive injury to brain tissue that may occur during preg, labor, delivery or shortly after delivery and blood screening is not diagnositic.)

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 in the newborn of which of the following? select all that apply 1. hypothyroidism 2. sickle cell disease 3. Galactosemia 4. Cerebral palsy 5. cystic fibrosis

4

The nurse is evaluating the effectiveness of an intervention when assisting a woman whose baby has been latched to the nipple only rather than to the nipple and aerola. Which response would indicate that further intervention is needed? 1. the client states pain decreased 2. the nurse hears the baby swallow after each suck 3. The babys jaws move up and down once every second 4. the babys cheeks move in and out with each suck

1 (vit k synthesis in the intestines needs food and normal intestinal flora. At birth the NB intestines are sterile. Therefore vitamin K is administered via injection to prevent a vit k deficiency that may result in a bleeding tendency. When administered vit k promotes formation in the liver of clotting factors II, VII, IX and X. NB are not susceptible to clotting disorders unless they are diagnosed with hemophilia or demonstrate a deficiency of or problem with clotting factors. Hemolysis of fetal RBCs does not destroy vit K. )

The nurse is preparing to administer a vitamin K injection to a male NB shortly after birth. What statement by the mom indicates that she understands the purpose of the injection? 1. My baby does not have the normal bacteria in is intestines to produce this vitamin 2. my baby is at high risk for a problem involving his bloods ability to clot 3. the RBC's my baby formed during pregnancy are destroyed by vitamin K 4. My babys liver is not able to produce enough of this vitamin so soon after birth

1 (NB typically consume 2-3 ounces of formula every 3-4 hrs during the first month)

The nurse is providing anticipatory guidance to a formula feeding mom who is concerned about how much formula she should offer her NB infant at each feed. The nurse would know that teaching was effective when the mom makes which of the following statements? 1. I should expect my baby to drink about 3 ounces every 3 hours or so 2. At the end of each pediatric appointment the dr will tell me how much to feed the baby 3. by the time we go home from the hospital I should expect him to drink at least 4 ounces per feeding 4. I should give my baby enough formula to make him sleep 4 hrs between feedings

3 (touch is believed to be the most highly developed sense at birth. By 4 months the neonate should turn eyes and head towards sound. Visual sense at birth is immature. Taste is well developed with a preference toward glucose, however touch is the more developed at birth)

The nurse is teaching the mom of a NB to develop her babys sensory system. To further improve the infants most developed sense the nurse should instruct the mother to: 1. speak in a high pitched voice to get the NB attention 2. place the NB about 12 inches from maternal face for best sight 3. stroke the NB cheek with her nipple to direct the babys mouth to nipple 4. give infant formula with a sweetened taste to stimulate feeding

1 (Always front to back. 2, vernix may be present and abosorbs over time, removing can irritate the babys tissues. 3. No powder recommended. 4. count diapers by numbers not weight )

The nurse is teaching the parents of a female baby how to change the babys diapers. Which of the following should be included in the teaching? 1. always wipe the perineum from front to back 2. remove any vernix caseosa from the labial folds 3. put powder on the buttocks every time the baby stools 4. weigh every diaper to assess hydration status

1 (rear facing best for child younger than 2, the middle of the back seat is safest. car seats expire)

The nurse knows the mother of a neonate has understood her car seat safety instructions when she comments: 1. I did not realize that even children between 1-2 years old are safer in rear facing car seats 2. I should put my car seat in the front so I can watch the baby when I drive 3. I plan to use the car seat I saved from my last baby 10 years ago 4. The front facing car seats do a better job supporting the head and neck of my baby

1 (Full term NB tend to lose 5-10% of their birth weight during the first few days after birth, typically regaining any weigh loss by 7-10 days of life)

The nurse makes a home visit to a 3 day old full term NB who weighed 3912 g (8 lb 10 oz) at birth. Today the neonate who is being bottle fed weight 3572 g (7 lb 14 oz). Which instructions should the nurse give the mother? 1. continue feeding every 3-4 hrs since the weight loss is normal 2. contact the HCP 3. switch to soy based formula because the current one seems inadequate 4. change to a higher calorie formula to prevent further weight loss

3 (The babys score is 8. The scoring scale is 2 for HR, 2 for RR, 1 for color, 2 for reflex irritablility, 1 for flexion. The total is 8)

The nurse notes that a NB who is 5 mins old exhibits the following characteristics: HR 108 bpm, RR 29 with lusty cry, pink body with bluish hands and feet, some flexion. What does the nurse determine the babys Apgar score is? 1. 6 2. 7 3. 8 4. 9

2 (tummy time while awake and supervised, helps to prevent plagiocephaly and to promote growth ad development. It is strongly recommended babies be on their back to sleep)

The nurse provided the anticipatory guidance to a couple who has just delivered a baby. Which of the following is an appropriate goal for the care of their new baby? 1. The baby will have a bath with soap every morning 2. during supervised play period, the baby will be placed on the tummy every day 3. the baby will be given a pacifier after each feeding 4. for the first month of life, the baby will sleep on his or her side in a crib next to the parents

2,5 (expiratory grunting is an indication of respiratory distress. Nasal flaring is a sign of respiratory distress. Although mottling and harlequin sign can be present with emergent findings they are usually normal findings. Pseudomenses is normal in a 1 day old female)

The nursery charge nurse is assessing a 1 day old female on morning rounds. Which of the following findings should be reported to the neonatologist as soon as possible? select all 1. blood in the diaper 2. grunting during expiration 3. deep red coloring on one side of the body with pale pink on the other 4. lacy and mottled appearance over the entire chest and abdomen 5. flaring of the nares during inspiration

1

The nursing diagnoses risk for suffocation is included in a standard care plan in the neonatal nursery. Which of the following outcome goals should be included in relation to this diagnosis? 1. baby will be places supine to sleep 2. baby will breastfeed in the side lying position 3. baby will be swaddled when in the open crib 4. baby will be strapped in a car seat

1 (when bili levels elevate to toxic levels babies can develop kernicterus. 2. erythroblastosis fetalis is a syndrome resulting from antigen antibody reaction related to RH incompatibility. )

The nursing management of a neonate with physiological jaundice should be directed toward which of the following client care goals? 1. the baby will exhibit no signs of kernicterus 2. the baby will not develop erythroblastosis fetalis 3. The baby will have a bilirubin of 16 mg/dL or higher at discharge 4. The baby will spend at least 20 hrs a day under phototherapy

1,4

The parents and their full term breastfed neonate were discharged from the hospital. Which behavior 2 days later indicates a positive response by the parents to the discharge teaching? select all 1. the parents count the babys diapers 2. the parents measure the babys intake 3. the parents give one bottle of formula every day 4. the parents take the baby to see the pediatrician 5. the parents time the babys feedings

1 (Hypothermia in the neonate is defined as a temp below 97.7. Cold stress syndrome may develop if the baby's temp is below that level. Hypoglycemia can result when a baby develops cold stress syndrome because babies metabolize food to create heat, when they use up their food stores they become hypoglycemic.)

To reduce the risk of hypoglycemia in a full term neonate weighing 2900 grams what should the nurse do? 1. maintain the infants temp above 97.7 F 2. feed the infant glucose water every 3 hrs until breast feeding well 3. assess the blood glucose levels every 3 hrs for the first 12 hrs 4. encourage the mother to breast feed every 4 hrs

4,5 (The scoring variables that are evaluated when assessing neonatal pain using the NIPS are facial expression, crying, breathing patterns, movement of arms and legs, and state of arousal. Other tools for assessing pain in NB's are the pain assessment tool PAT, the neonatal post op pain scale CRIES, and the premature infant pain profile PIPP)

Using the neonatal infant pain scale a nurse assessing the pain response of a NB who just had a circumcision. The nurse is assessing a change in which of the following S/S? select all that apply 1. HR 2. BP 3. Temp 4. facial expressions 5. breathing pattern

3,5 (consent not needed, ecg not performed. HR fluctuations are not assessed or recorded. A positive screen is defined as a difference of 3 percentage points between the pulse oximetry reading on the neonates right hand and the reading on the right foot)

When administering the neonatal screen for critical congenital heart defects on a baby (CCHD), the nurse should perform which of the following actions? select all 1. obtain parental consent before performing the screening 2. take the babys ECG 3. wait until the baby is at least 24 hr old 4. record the babies HR fluctuations for one full minute 5. report pulse oximetry readings of 96% on the hand and 92% on the foot

4 (The condition in which the urinary meatus is located on the ventral surface of the penis termed hypospadias, occurs in 1 out of 500 male births. Circumcision is delayed until the condition is corrected surgically usually between 6-12 months of age. Phimosis is an inability to retract the prepusce at an age it should be retractable or by age 3. Phimosis may necessitate circumcision or surgical intervention. Hydrocele is a painless swelling of the scrotum that is common in NB. Epispadias occurs when the urinary meatus is on the dorsal surface of the penis and is very rare and commonly assoc with bladder exstrophy)

When assessing a male NB whose mother desires him to be circumcised, the nurse observes that the NB urinary meatus appears to be located on the ventral surface of the penis. The HCP is notified because the nurse suspects which complication? 1. phimosis 2. hydrocele 3. epispadias 4. hypospadias

1 (Baby powder can aspirate into the baby lungs. The best prevention for diaper rash is freq diaper changes. )

When making a home visit to a primiparous client and her 3 day old son the nurse observes the mom changing the babys disposable diaper. Before putting the clean diaper on the NB the mother begins to apply baby powder to the NB buttocks. Which information should the nurse relate to the mother about the baby powder? 1. It may cause pneumonia to develop 2. it helps prevent diaper rash 3. it keeps the diaper from adhering to the skin 4. it can result in allergies later in life

2 (there is a correlation between cafe au lait spots and the development of neurofibromatosis. Acrocyanosis is a normal finding of bluish hands and feet as a result of poor capillary perfusion.)

When reviewing the prenatal history of a NB, the nurse notes that the mother has neurofibromatosis. the nurse should further assess the NB for: 1. acrocyanosis 2. cafe au lait spots 3. port wine nevis 4. strawberry hemangiomas

2 (unequal corneas should be reported as it may mean congenital glaucoma. The other findings are wnl)

Which assessment finding in a term neonate would cause the nurse to notify the HCP? 1. absence of tears 2. unequally sized corneas 3. pupillary constriction to bright light 4. red circle on pupils seen with a penlight

1 (Caput succedaneum is common with the use of a vacuum extractor. This edema may persist up to 7 days. Maternal lacerations may occur but are more common when forceps are used. Neonatal intracranial hemorrhage is a risk with both vacuum extraction and forceps births but is not a common finding)

Which finding would the nurse expect as common for a multiparous client giving birth to a viable neonate at 41 weeks with the aid of a vacuum extractor? 1. caput succedaneum 2. cephalohematoma 3. maternal lacerations 4. neonatal intracrainial hemorrhage

3 (sole creases covering the entire foot are indicative of a full term NB. If the neonates ear is lying flat against the head the neonate is most likely preterm. An absence of rugae in the scrotum is typical of preterm. A square window sign angle of 0 degrees occurs in neonates of 40-42 weeks gestation. A 90 degree square window angle suggests immature neonate of approx 28-30 weeks)

Which observation is expected when the nurse is assessing the gestational age of a neonate born at term? 1. ear lying flat against the head 2. absence of rugae in the scrotum 3. sole creases covering the entire foot 4. square window sign angle of 90 degrees

2,3,4,5

Which of the following behaviors should nurses know are characteristics of infant abductors? select all 1. act on the spur of the moment 2. create a diversion on the unit 3. ask questions about the routine of the unit 4. choose rooms near stairwells 5. wear oversized clothing

1 (seesaw breathing is an indication of respiratory distress. When the thoracic and abdominal areas rise and fall arrhythmic or out of sync, it is an indication of distress. Apnea spells of 10 sec or less are normal, but spells longer than 20 sec should be reported. Normal respiratory rate is 30-60 bpm)

Which of the following full term babies requires immed. intervention? 1. baby with see saw breathing 2. baby with irregular breathing with 10 sec apnea spells 3. baby with coordinated thoracic and abdominal breathing 4. baby with RR of 52

3 (caused by hormones from mom, disappears spontaneously.)

While changing the neonates diaper the client asks the nurse about some red tinged drainage from the neonates vagina. which response would be most appropriate? 1. It is of no concern because it is such a small amount 2. the cause is usually related to swallowing blood during birth 3. sometimes baby girls have this from hormones received from the mother 4. this vaginal spotting is caused by hemorrhagic disease of the newborn

3 (single crease on the palms is called simean crease and commonly assoc with Downs. The rest are normal findings)

While performing a Px assessment on a term NB shortly after birth, which finding would cause the nurse to notify the HCP? 1. deep creases in the soles of the feet 2. freq sneezing during the assessment 3. single crease on each of the palms 4. absence of lanugo on the skin

2 (an expiratory grunt is significant and should be reported promptly because it may indicate respiratory distress and the need for further intervention such as O2 resuscitation efforts. The presence of a red reflex in the eyes is normal. An absent red reflex may indicate congenital cataracts. A RR of 45 and a prominent xiphoid are normal findings)

While performing a complete assessment of a term NB, which finding would alert the nurse to notify the HCP? 1, red reflex in the eyes 2 .expiratory grunt 3 RR 45 4. prominent xiphoid process

4 (plagiocephaly is flattening of the back of babies heads)

A nurse when providing discharge teaching to the parents emphasizes actions to prevent plagiocephaly to promote gross motor development in their full term newborn. Which of the following actions should the nurse advise the parents to take? 1. breastfeed the baby freq 2. make sure the baby receives vaccines at recommended intervals 3. change the diapers reg 4. minimize supine positioning during supervised play periods

2

A baby has just been circumcised. If bleeding occurs which of the following actions should be taken first? 1. put the babys diapers on as tightly as possible 2. apply light pressure to the area with sterile guaze 3. call the Dr. who performed the surgery 4. assess the baby HR and O2 sat

3

A mother is preparing to breastfeed her baby. Which of the following actions would encourage the baby to open the mouth wide for feeding? 1. holding the baby en face position 2. pushing down on the babys lower jaw 3. tickling the babys lips with the nipple 4. giving the baby a trial bottle of formula

2 (convergent strabismus is common during infancy until about 6 months because of poor oculomotor coordination. The neonate has peripheral vision and can fixate on close objects for short periods. The neonate can also perceive colors, shapes and faces. Neonates can focus on light and should blink and close their eyes in resonse to light, however this is not associated with strabismus. An absent red reflex or white areas over the pupils not strabismus may indicate congenital cataracts. Most NB cannot focus well or accommodate distance immed after birth)

A primiparous client expresses concern asking the nurse why her neonates eyes are crossed. Which information should the nurse include when teaching the mother about neonatal strabismus? 1. The neonates eyes are unable to focus on light at this time 2. neonates commonly lack eye muscle coordination 3. congenital cataracts may be present 4. the neonate is able to fixate on distant objects immediately

2 (breastfed infants should eat within the first hour of life and approx every 2-3 hrs. The other info just before discharge)

A primiparous woman has recently given birth to a term infant. Priority teaching for the client includes info on : 1. SIDS 2. breastfeeding 3. infant bathing 4. infant wake cycles

3 (neonates that are septic use glucose at an increased rate. During the time the IV is not infusing, the neonate is using the limited glucose store available to a preterm neonate and may deplete them. Without the constand infusion hypoglycemia will result, tachy cardia can result from hypoglycemia)

A septic preterm neonates IV was removed due to infiltration. The nurse prioritizes restarting the IV to help which complication? 1. fever 2. hyperkalemia 3. hypoglycemia 4. tachycardia

3

A woman states she is going to bottle feed her baby because "I hate milk and I know that to make good breast milk I will have to drink milk". The nurses response about producing high quality breast milk should be based on which of the following? 1. The mother must drink at least 3 glasses a day of milk to absorb sufficient Calcium 2. The mother should consume at least 1 glass of milk a day but should also consume other dairy products like cheese 3. The mother can consume a variety of good calcium sources such as broccoli, fish with bones, as well as dairy products 4. The mother must monitor her protein intake more than her calcium intake because the baby needs protein for growth

4 (to minimize ingesting air hold bottle to keep nipple full. Stools in breastfed babies are bright yellow and loose, in bottle fed they are brownish and pasty. Dont enlarge nipples to preven aspiration. No microwave!)

A woman who has just delivered has decided to bottle feed her full term baby. Which of the following should be included in the patient teaching? 1. the baby stools will appear bright yellow and will usually be loose 2. the bottle nipples should be enlarged to ease the babys suckling 3. It is best to heat the bottle in the microwave before feeding 4. It is important to hold the bottle so as to keep the nipple filled with formula

3 (2% of all babies have congenital heart defects. Many have no S/s at birth)

After advising the parents of a 1 day old that the baby must have a heart defect test, the mother states "why? my baby is healthy. The pediatrician told me so." Which of the following responses by the nurse is appropriate? 1. I must have misread the name on the chart. It must be another baby who has to have the test 2. We do this test on all the babies before discharge, and I am sure your babies heart is healthy 3. This is a screening test done on all babies. It is performed to find any possible heart problems before discharge 4. You baby just had some minor symptoms that need to be checked. The test wont hurt the baby

2

After circumcision with a plastibell the nurse should instruct the NB mom to cleanse the circumcision site using which agent? 1. antibacterial soap 2. warm water 3. povidone-iodine solution 4. diluted hydrogen peroxide

3 (Infants can dehydrate quickly.)

After completing discharge instructions for a primiparous client who is bottle feeding her term NB, the nurse determines that the mother understands instructions when the mom says that she should contact the HCP if the NB exhibits which Sign or symptom? 1. ability to fall asleep easily after each feeding 2. spitting up a Tbsp of formula after feeding 3. passage of a liquid stool with a watery ring 4. production of one or two light brown stool daily

1 (apnea lasting longer than 20 seconds, mild cyanosis, and HR < 100 are assoc with a potentially life threatening event and subsequent respiratory arrest. The neonate needs further eval by the HCP. Pneumonia is assoc with tachycardia, anorexia, malaise, cyanosis, diminished breath sounds, and crackles. Intraventricular hemorrhage is assoc with prematurity. Assessment findings include bulging fontanelles and seizures. Epiglottis is a bacterial form of croup. Assessment findings include inspiratory stridor, cough and irritability. It occurs most commonly in children 3-7 years)

Assessment of a term neonate at 2 hrs after birth reveals a HR of less than 100 bpm, periods of apnea lasting approx 25-30 seconds and mild cyanosis around the mouth. The nurse notifies the HCP based on the interpretation that these findings may lead to which condition? 1, respiratory arrest 2. bronchial pneumonia 3. intraventricular hemorrhage 4. epiglottis

1

The client is preparing to feed her newborn in the cross-cradle position. Which of the following actions should the woman make? 1. place a pillow on her lap 2. position the head of the baby in her elbow 3. put the baby on his back 4. move the breast toward the mouth of the baby

2 (as part of the NB physiologic adaptation to birth at 90 mins after birth the neonate is typically in the rest or sleep phase. during this time the heart and rr slow and the neonate sleeps, unresponsive to stimuli. At this time the mom should rest and allow the neonate to sleep. Feeding should be given during the first period of reactivity, considered the first 30 mins after birth. During this period the neonates rr and hr are elevated. Getting to know the neonate typically occurs within the first hr. and then when the NB is awake and during feedings. Changeing the diaper can occur at any time but a 90 mins after birth the NB is usually in a deep sleep, unresponsive, and probably has not passed any meconium)

Based on the understanding of periods of reactivity the nurse should encourage the mom of a term neonate to do which approximately 90 minutes after birth? 1. feed the NB 2. allow the NB to sleep 3. get to know the NB 4. Change the NB diaper

3 (Normal neonatal breathing is irregular at 30-60 breaths per minute. This baby is tachypneic. Meconium should pass within 24 hrs of delivery. The glucose level is wnl. A milky discharge is normal, results from the drop in maternal hormones in the neonatal system following delivery)

Four NB's are in the neonatal nursery, none of whom is crying or in distress. Which of the babies should the nurse report to the neonatologist? 1. 16 hr baby who has yet to pass meconium 2. 16 hr baby whose blood glucose is 50 mg/dL 3. 2 day baby who is breathing irregularly at 70 breaths per minute 4. 2 day baby who is excreting a milky discharge from both nipples

2 (although the Apgar score is excellent, the babies weight is well above the avg of 2500 to 4000 grams. Babies who are large for gestational age are at high risk for hypoglycemia. A RR between 30-60 and O2 sat above 95% are normal. Blood glucose 40-60 mg/dL and HR 110-160 bpm are normal. Temp 97.7 to 99.0 F are normal.)

Four babies have just been admitted to the neonatal nursery. Which of the babies should the nurse assess first? 1. baby with RR 42, O2 96% 2. baby with Apgar 9/9, weight 4660 grams 3. baby with Temp 98 F, length 21 inches 4. Baby with glucose at 55 mg/dL, HR 121

1 (RBC's in the cephalhematoma will have to be broken down and excreted. The by product of the destruction-bilirubin-increases the babies risk of jaundice)

Four babies with the following conditions are in the well baby nursery. The baby with which of the conditions is at high risk for physiological jaundice? 1. cephalhematoma 2. caput succedaneum 3. harlequinn coloring 4. mongolian spotting

4 (The normal resting RR of a neonate is 30-60 and the normal resting HR of a neonate is 110-160)

Four newborns are admitted into the neonatal nursery 1 hr ago. They are all sleeping in overhead warmers. Which of the babies should the nurse ask the neonatologist to evaluate? 1. The neonate with temp 98.9 and weight 3000 grams 2. The neonate with white spots on the bridge of the nose 3. The neonate with raised white specs on the gums 4. The neonate with irregular respirations of 72 and HR of 166

1 (chemo and breastfeeding are contraindicated)

Four preg women advise the nurse that they wish to breastfeed their babies. Which mom should be advised to bottle feed her child? 1. woman with neoplasm requiring chemotherapy 2. woman with cholecystitis requireing surgery 3. woman with a concussion 4. woman with thrombosis

3 (The baby is in the quiet alert behavior state. Placing the baby en face will foster bonding between the father and baby.)

In which of the following situations would it be appropriate for the nruse to suggest to a new father to place his baby in the en face position to promote neonatal bonding? 1. The baby is asleep with little to no eye movement, regular breathing 2. the baby is asleep with rapid eye movement irregular breathing 3. The baby is awak looking intently at an object, irregular breathing 4. The baby is awake placing hands in the mouth , irregular breathing.

4

It has been discovered a newborn is missing from the maternity unit. The nursing staff should be watchful for which of the following individuals? 1. a middle aged male 2. an underweight female 3. pro life advocate 4. visitor of the same race

2,3,4,5

It is time for a baby who is in the drowsy behavioral state to breastfeed. Which of the following techniques could the mom use to arouse the baby? select all 1. swaddle or tightly bundle the baby 2, hand express milk onto the babys lips 3. talk with the baby while making eye contact 4. remove the babys shirt and change the diaper 5. play pat a cake with the baby

1,5,6 (PKU is an inherited autosomal recessive disorder, involves the bodys inability to metabolize the amino acid pheylalanine. A diet low in this must be followed. Foods such as milk, eggs, meats are high in phenylalanine. Assistance from a dietician is commonly necessary. Future children have a 25% change of PKU. The diet is followed until growth is complete sometime in adolescence. The child should achieve normal intelligence)

Metabolic screening of an infant revealed a high PKU level. Which statement by the infants mother indicates an understanding of the disease and its management? select all that apply 1. my baby cannot have milk based formulas 2. my baby will grow out of this by age 2 3. this is a hereditary disease, so any future children will have it too 4. my baby will eventually become mentally challenged because of this disease 5. we have to follow a strick low-phenylalanine diet 6. a dietitian can help me plan a diet that keeps a safe phenylalanine level but lets my baby grow

3 (It takes 1 week for the baby to be able to synthesize his or her own vitamin K. The gut at birth is sterile and Vit K is synthesized in the gut in the presence of normal flora)

The Dr writes the following order for the term newborn. Vitamin K 1 mg IM. Which of the following provides a rationale for this order? 1. During the neonatal period, babies absorb fat soluble vitamins poorly 2. Breast milk and formula contain insufficient quantities of Vit K 3. The neonatl gut is sterile 4. Vitamin K prevents hemolytic jaundice

3 (Babies who breastfeed fewer than 8 times a day are not receiving adequate nutrition, jitters are indicative of hypoglycemia. Slight jaundice on day 2 is wnl. The rash is normal newborn rash. Slight drops in HR are normal when sleeping)

The following babies are in the neonatal nursery. The nurse should report to the neonatologist that which of the babies should be seen? 1. 1 day old, HR 100 bpm in deep sleep 2. 2 day old, T 97.7, slightly jaundiced 3. 3 day old, breastfeeding every 4 hours, jittery 4. 4 day old, crying, papular rash on an erythematous base

3 (Never leave the baby in the bath area to get supplies. 1. The eyes should be cleansed from inner to outer. 2. never use a q tip, nothing smaller than their finger. 4. safest way to check bath temp is with a thermometer or if none avail the elbow or forearm.)

The nurse is teaching the parents of a 1 day baby how to give a sponge bath. Which of the following actions should be included? 1. Clean the eyes from outer canthus to inner canthus 2. cleanse the ear canals with a cotton swab 3. assemble the supplies before the beginning of the bath 4. check the temp of the bath with the fingertips

2 (Amniotic fluid is a reservoir for viral diseases like HIV and hepatitis B. If the woman is infected with those viruses, the amniotic fluid will be infectious. Meconium is a sterile stool, the newborn does not produce GI bacteria until a few days after delivery. Although babies are at high risk for infection, there is no need for nurses to wear gloves when routinely caring for the babies. Immed after the delivery the nurse is protecting herself from the baby, not the other way around. )

Then nursery nurse is careful to wear gloves when admitting neonates into the nursery. Which of the following is the scientific rationale for this action? 1. meconium is filled with enteric bacteria 2. amniotic fluid may contain harmful viruses 3. the high alkalinity of fetal urine is caustic to the skin 4. The baby is at high risk and must be protected

4 (Epstein pearls are small white specks located on the palate and gum, they are keratin containing cysts)

To check for the presence of Epstein pearls, the nurse should assess which part of the neonates body? 1. feet 2. hands 3. back 4. mouth