Test 5 OB- final exam
A nurse is caring for a newborn delivered by vaginal birth with a vacuum assist. The newborn's mother asks about the swollen area on her son's head. After palpation to identify that the swelling crosses the suture line, which of the following is an appropriate response by the nurse? "A caput succedaneum occurs due to compression of blood vessels." "Mongolian spots can be found on the skin of many newborns." "This is a cephalhematoma, which can occur spontaneously." "This is erythema toxicum, which is a transient condition."
"A caput succedaneum occurs due to compression of blood vessels."
A primiparous woman is watching her newborn sleep. She wants him to wake up and respond to her. The mother asks the nurse how much he will sleep every day. What is an appropriate response by the nurse? "The newborn sleeps approximately 17 hours a day, with periods of wakefulness gradually increasing." "He will only wake up to be fed, and you should not bother him between feedings." "He will probably follow your same sleep and wake patterns, and you can expect him to be awake soon." "He is being stubborn by not waking up when you want him to. You should try to keep him awake during the daytime so that he will sleep through the night."
"The newborn sleeps approximately 17 hours a day, with periods of wakefulness gradually increasing."
Which statement is the most appropriate for the nurse to make when caring for bereaved parents? "What can I do for you?" "This happened for the best." "You have an angel in heaven." "I know how you feel."
"What can I do for you?"
Which options for saying "good-bye" would the nurse want to discuss with a woman who is diagnosed with having a stillborn girl? "When your baby is born, would you like to see and hold her?" "Would you like a picture taken of your baby after birth?" The nurse should not discuss any options at this time; plenty of time will be available after the baby is born. "What funeral home do you want notified after the baby is born?"
"When your baby is born, would you like to see and hold her?"
An infant is being discharged from the NICU after 70 days of hospitalization. The infant was born at 30 weeks of gestation with several conditions associated with prematurity, including RDS, mild bronchopulmonary dysplasia (BPD), and retinopathy of prematurity (ROP), requiring surgical treatment. During discharge teaching, the infant's mother asks the nurse if her baby will meet developmental milestones on time, as did her son who was born at term. What is the nurse's most appropriate response? "Your baby will need to be corrected for prematurity." "Your baby will need to be followed very closely." "Your baby will develop exactly like your first child." "Your baby does not appear to have any problems at this time."
"Your baby will need to be corrected for prematurity."
The nurse is providing discharge instructions for a healthy 37-year-old first-time mother and her newborn. What should the nurse include in her instructions for this mother and her spouse? A reminder that addition of a newborn will alter established routines. Information related to contraception and sexually transmitted infections (STIs). A referral to a group class that provides information on newborn care. A referral for follow-up care with healthcare providers other than the obstetrician.
A reminder that addition of a newborn will alter established routines.
Which statement accurately describes an appropriate-for-gestational age (AGA) weight assessment? AGA weight assessment falls between the 10th and 90th percentiles for the infant's age. AGA weight assessment falls between the 25th and 75th percentiles for the infant's age. AGA weight assessment depends on the infant's length and the size of the newborn's head. AGA weight assessment is modified to consider intrauterine growth restriction (IUGR).
AGA weight assessment falls between the 10th and 90th percentiles for the infant's age.
Cleft lip or palate is a common congenital midline fissure, or opening, in the lip or palate resulting from the failure of the primary palate to fuse. Multiple genetic and, to a lesser extent, environmental factors may lead to the development of a cleft lip or palate. Which factors are included? (Select all that apply.) Alcohol consumption Female gender Use of some corticosteroid medications Maternal cigarette smoking
Alcohol consumption, Use of some corticosteroid medications, Maternal cigarette smoking
When planning the care for a preterm infant with ineffective thermoregulation, the nurse should include which intervention? Allow skin-to-skin contact with the mother to maintain warmth. Keep the baby's head uncovered. Rinse hands with cold water before providing care to the infant. Place incubator near a window or source of fresh air.
Allow skin-to-skin contact with the mother to maintain warmth.
A nurse is assessing a newborn who has developmental dysplasia of the hip (DDH). Which of the following findings should the nurse expect? Asymmetric thigh folds Absent plantar reflexes Lengthened thigh on the affected side Inwardly turned foot on the affected side
Asymmetric thigh folds
An infant boy was delivered minutes ago. The nurse is conducting the initial assessment. Part of the assessment includes the Apgar score. When should the Apgar assessment be performed? At least twice, 1 minute and 5 minutes after birth Only if the newborn is in obvious distress Once by the obstetrician, just after the birth Every 15 minutes during the newborn's first hour after birth
At least twice, 1 minute and 5 minutes after birth
Which would be considered a normal finding in a newborn less than 12 hours old? Bluish discoloration of the hands and feet Grunting respirations Heart rate of 190 beats/min A yellow discoloration of the sclera and body
Bluish discoloration of the hands and feet
A nurse is working in the labor and delivery unit. What statement does the nurse understand is true regarding newborn thermogenesis? Brown fat produces heat generation, and heat transfer to the peripheral circulation. Shivering occurs when skin receptors perceive a drop in the environmental temperature and transmit sensations to stimulate the sympathetic nervous system. Shivering thermogenesis uses the newborn's stores of brown fat to provide heat. The extra muscular activity by the infant in cold stress produces a large amount of body heat.
Brown fat produces heat generation, and heat transfer to the peripheral circulation.
The nurse assists with the examination of a newborn in the newborn nursery. Prior to placing the child on the exam table, she spreads a cotton pad over the surface. By doing so, the nurse is protecting against heat loss by which method? Conduction Convection Evaporation Radiation
Conduction
The nurse is reviewing the record of a newborn infant in the nursery and notes that the health care provider has documented the presence of a cephalohematoma. Based on this documentation, what should the nurse expect to note on assessment of the infant? Edema resulting from bleeding below the periosteum of the cranium A suture split greater than 1 cm A hard, rigid, immobile suture line Swelling of the soft tissues of the head and scalp
Edema resulting from bleeding below the periosteum of the cranium
A neonate is born with mild clubfeet. When the parents ask the nurse how this will be corrected, how should the nurse respond? Frequent, serial casting is tried first. Traction is tried first. Surgical intervention is needed. Children outgrow this condition when they learn to walk.
Frequent, serial casting is tried first.
A macrosomic infant is born after a difficult forceps-assisted delivery. After stabilization, the infant is weighed, and the birth weight is 4550 g (9 lb, 6 oz). What is the nurse's first priority? Frequently monitor blood glucose levels, and closely observe the infant for signs of hypoglycemia. Leave the infant in the room with the mother. Immediately take the infant to the nursery. Perform a gestational age assessment to determine whether the infant is large for gestational age.
Frequently monitor blood glucose levels, and closely observe the infant for signs of hypoglycemia.
Which practices are ideal for role modeling when attempting to prevent sudden infant death syndrome (SIDS)? (Select all that apply.) Fully supine position for all sleep Side-sleeping position as an acceptable alternative Infant sleep sacks or buntings Soft mattress
Fully supine position for all sleep, Infant sleep sacks or buntings
A newborn was admitted to the neonatal intensive care unit (NICU) after being delivered at 29 weeks of gestation to a 28-year-old multiparous, married, Caucasian woman whose pregnancy was uncomplicated until the premature rupture of membranes and preterm birth. The newborn's parents arrive for their first visit after the birth. The parents walk toward the bedside but remain approximately 5 feet away from the bed. What is the nurse's most appropriate action? Go to the parents, introduce him or herself, and gently encourage them to meet their infant. Explain the equipment first, and then focus on the newborn. Wait quietly at the newborn's bedside until the parents come closer. Leave the parents at the bedside while they are visiting so that they have some privacy. Tell the parents only about the newborn's physical condition and caution them to avoid touching their baby.
Go to the parents, introduce him or herself, and gently encourage them to meet their infant. Explain the equipment first, and then focus on the newborn.
A postpartum woman telephones the provider regarding her 5-day-old infant. The client is not scheduled for another weight check until the infant is 14 days old. The new mother is worried about whether breastfeeding is going well. Which statement indicates that breastfeeding is effective for meeting the infant's nutritional needs? Has 3 bowel movements and eight wet diapers per day Sleeps for 6 hours at a time between feedings Has at least one breast milk stool every 24 hours Gains 1 to 2 ounces per week
Has 3 bowel movements and eight wet diapers per day
At a 2-month well-baby examination, it was discovered that an exclusively breastfed infant had only gained 10 ounces in the past 4 weeks. The mother and the nurse develop a feeding plan for the infant to increase his weight gain. Which change in dietary management will assist the client in meeting this goal? Have one extra breastfeeding session every 24 hours. Start iron supplements Begin solid foods. Have a bottle of formula after every feeding.
Have one extra breastfeeding session every 24 hours.
Which infant is most likely to express Rh incompatibility? Infant of an Rh-negative mother and a father who is Rh positive and homozygous for the Rh factor Infant who is Rh negative and a mother who is Rh negative Infant of an Rh-negative mother and a father who is Rh positive and heterozygous for the Rh factor Infant who is Rh positive and a mother who is Rh positive
Infant of an Rh-negative mother and a father who is Rh positive and homozygous for the Rh factor
What is the most critical physiologic change required of the newborn after birth? Initiation and maintenance of respirations Closure of fetal shunts in the circulatory system Full function of the immune defense system Maintenance of a stable temperature
Initiation and maintenance of respirations
Which statement most accurately describes complicated grief? Is an extremely intense grief reaction that persists for a long time Occurs when, in multiple births, one child dies and the other or others live Is a state during which the parents are ambivalent, as with an abortion Is felt by the family of adolescent mothers who lose their babies
Is an extremely intense grief reaction that persists for a long time
An infant at 26 weeks of gestation arrives intubated from the delivery room. The nurse weighs the infant, places him under the radiant warmer, and attaches him to the ventilator at the prescribed settings. A pulse oximeter and cardiorespiratory monitor are placed. The pulse oximeter is recording oxygen saturations of 80%. The prescribed saturations are 92%. What is the nurse's most appropriate action at this time? Listening to breath sounds, and ensuring the patency of the endotracheal tube, increasing oxygen, and notifying a physician Continuing to observe and making no changes until the saturations are 75% Continuing with the admission process to ensure that a thorough assessment is completed Notifying the parents that their infant is not doing well
Listening to breath sounds, and ensuring the patency of the endotracheal tube, increasing oxygen, and notifying a physician
A pregnant woman was admitted for induction of labor at 43 weeks of gestation with sure dates. A nonstress test (NST) in the obstetrician's office revealed a nonreactive tracing. On artificial rupture of membranes, thick meconium-stained fluid was noted. What should the nurse caring for the infant after birth anticipate? Meconium aspiration, hypoglycemia, and dry, cracked skin Excessive vernix caseosa covering the skin, lethargy, and RDS Golden yellow to green-stained skin and nails, absence of scalp hair, and an increased amount of subcutaneous fat Hyperglycemia, hyperthermia, and an alert, wide-eyed appearance
Meconium aspiration, hypoglycemia, and dry, cracked skin
A newborn is placed under a radiant heat warmer. The nurse understands that thermoregulation presents a problem for the newborn. What is the rationale for this difficulty? Newborns have a relatively thin layer of subcutaneous fat that provides poor insulation. The renal function of a newborn is not fully developed, and heat is lost in the urine. The small body surface area of a newborn favors more rapid heat loss than does an adult's body surface area. Their normal flexed posture favors heat loss through perspiration.
Newborns have a relatively thin layer of subcutaneous fat that provides poor insulation.
What information regarding a fractured clavicle is most important for the nurse to take into consideration when planning the infant's care? No special treatment is necessary. Prone positioning facilitates bone alignment. Parents should be taught range-of-motion exercises. The shoulder should be immobilized with a splint.
No special treatment is necessary.
The nurse is preparing to administer a hepatitis B virus (HBV) vaccine to a newborn. Which intervention by the nurse is correct? Obtaining a syringe with a 25-gauge, 5/8-inch needle for medication administration Confirming that the newborn's mother has been infected with the HBV Assessing the dorsogluteal muscle as the preferred site for injection Confirming that the newborn is at least 24 hours old
Obtaining a syringe with a 25-gauge, 5/8-inch needle for medication administration
A newborn is jaundiced and is receiving phototherapy via ultraviolet bank lights. What is the most appropriate nursing intervention when caring for an infant with hyperbilirubinemia and receiving phototherapy? Placing eye shields over the newborn's closed eyes Limiting the newborn's intake of milk to prevent nausea, vomiting, and diarrhea Applying an oil-based lotion to the newborn's skin to prevent dying and cracking Changing the newborn's position every 4 hours
Placing eye shields over the newborn's closed eyes
Parents have been asked by the neonatologist to provide breast milk for their newborn son, who was born prematurely at 32 weeks of gestation. The nurse who instructs them regarding pumping, storing, and transporting the milk needs to assess their knowledge of lactation. Which statement is a valid basis for the instructions? Premature infants more easily digest breast milk than formula. A glass of wine just before pumping will help reduce stress and anxiety. The mother should only pump as much milk as the infant can drink. The mother should pump every 2 to 3 hours, including during the night.
Premature infants more easily digest breast milk than formula.
The nurse is caring for a term newborn. Which assessment finding would alert the nurse to suspect the potential for jaundice in this infant? Presence of a cephalhematoma Infant blood type of O negative Birth weight of 8 pounds 6 ounces A negative direct Coombs' test result
Presence of a cephalhematoma
What is the highest priority nursing intervention for an infant born with myelomeningocele? Protect the sac from injury. Prepare the parents for the child's paralysis from the waist down. Prepare the parents for closure of the sac when the child is approximately 2 years of age. Assess for cyanosis.
Protect the sac from injury.
After giving birth to a preterm infant who is being cared for in the neonatal intensive care unit (NICU), a client says, "My baby doesn't seem real because she's in the hospital and I'm at home." What can the nurse do to promote parent-infant attachment? Provide a picture of the infant including a footprint and current weight and length. Limit visits to the intensive care unit so as not to disrupt care the baby needs. Explain that once the baby is discharged to home, she will have evidence that the baby is real. Have the mother visit when the baby is asleep or resting.
Provide a picture of the infant including a footprint and current weight and length.
Which nursing diagnosis is most appropriate for a newborn diagnosed with a diaphragmatic hernia? Reduced gas exchange Potential for impaired parent-infant attachment Inadequate nutrition Potential for infection
Reduced gas exchange
The nurse conducting a 5-minute Apgar assessment on a newborn assigns the following ratings: Heart rate <100 beats per minute (1 point); slow, irregular respirations (1 point); some flexion of the extremities (1 point); a vigorous cry with flicking of the baby's foot (2 points); and a pink body with blue extremities (1 point). Based on this data, which nursing action is appropriate? Repeating the assessment every 5 minutes for up to 20 minutes Having the aide reassess the newborn's heart rate and respiratory rate when admitted to the nursery Swaddling the newborn to decrease the risk of increased energy expenditure Placing the newborn in the mother's arms and asking her to monitor her baby's breathing
Repeating the assessment every 5 minutes for up to 20 minutes
Which conditions are infants of diabetic mothers (IDMs) at a higher risk for developing? Respiratory distress syndrome Iron deficiency anemia Hyponatremia Sepsis
Respiratory distress syndrome
The nurse is assessing a premature newborn who is being cared for in the newborn intensive care unit (NICU). Which assessment finding indicates the newborn is experiencing respiratory distress? Substernal and intercostal retractions Acrocyanosis Respiratory rate of 58 breaths per minute Abdominal breathing
Substernal and intercostal retractions
Pain should be regularly assessed in all newborns. If the infant is displaying physiologic or behavioral cues that indicate pain, then measures should be taken to manage the pain. Which interventions are examples of nonpharmacologic pain management techniques? (Select all that apply.) Swaddling Nonnutritive sucking Sucrose Acetaminophen
Swaddling, Nonnutritive sucking, Sucrose
The nurse receives shift change report on infants born within the last 4 hours. Which newborn should the nurse assess first? Term newborn born 1 hour ago who is exhibiting grunting respirations. Newborn born at 37 weeks' gestation. Respiratory rate of 45 breaths per minute. Term newborn, 2 hours old, who has not passed a meconium stool. Term newborn born 3 hours ago. Heart rate is 150 beats per minute.
Term newborn born 1 hour ago who is exhibiting grunting respirations.
The nurse is providing care to a newborn born at 37 2/7 weeks' gestation. The newborn's weight is 1750 g (3 pounds, 10 ounces). What statement would the nurse use to describe these assessment findings? Term small for gestational age Preterm appropriate for gestational age Term appropriate for gestational age Preterm small for gestational age
Term small for gestational age
The nurse caring for a newborn checks the record to note clinical findings that occurred last shift. Which finding related to the renal system would be of increased significance and require further action? The newborn has not voided in 24 hours. The breastfed infant voided more often than a formula feed infant. Brick dust was noted on several diapers. Weight loss from fluid loss and other normal factors has yet to be regained.
The newborn has not voided in 24 hours.
Which finding would indicate to the nurse that the grieving parents have progressed to the reorganization phase of grieving? The parents are discussing sex and a future pregnancy The parents say that they "feel no pain." The parents have abandoned those moments of "bittersweet grief." The parents' questions have progressed from "Why?" to "Why us?"
The parents are discussing sex and a future pregnancy
The nurse should be cognizant of which important statement regarding care of the umbilical cord? The stump can become easily infected. If bleeding occurs from the vessels of the cord, then the nurse should immediately call for assistance. The cord clamp is removed at cord separation. The average cord separation time is 5 to 7 days.
The stump can become easily infected.
A client gives birth to a stillborn infant. At first, she appears stunned by the news, cries a little, and then asks the nurse to call her mother. What is the proper term for the phase of bereavement that this client is experiencing? Acute distress Anticipatory grief Intense grief Reorganization
acute distress
A pregnant woman arrives at the birth unit in labor at term, having had no prenatal care. After birth, her infant is noted to be small for gestational age with small eyes and a thin upper lip. The infant also is microcephalic. Based on her infant's physical findings, this woman should be questioned about her use of which substance during pregnancy? Alcohol Cocaine Heroin Marijuana
alcohol
Infants born between 34 0/7 and 36 6/7 weeks of gestation are called late-preterm infants because they have many needs similar to those of preterm infants. Because they are more stable than early-preterm infants, they may receive care that is similar to that of a full-term baby. These infants are at increased risk for which conditions? (Select all that apply.) Problems with thermoregulation Cardiac distress Hyperbilirubinemia Sepsis
problems with thermoregulation, hyperbilirubinemia, sepsis
A pregnant woman at 37 weeks of gestation has had ruptured membranes for 26 hours. A cesarean section is performed for failure to progress. The fetal heart rate (FHR) before birth is 180 beats per minute with limited variability. At birth the newborn has Apgar scores of 6 and 7 at 1 and 5 minutes and is noted to be pale and tachypneic. Based on the maternal history, what is the most likely cause of this newborn's distress? Sepsis Hypoglycemia Phrenic nerve injury Respiratory distress syndrome
sepsis
If the newborn has excess secretions, the mouth and nasal passages can be easily cleared with a bulb syringe. How should the nurse instruct the parents on the use of this instrument? Suction the mouth first. Avoid suctioning the nares. Insert the compressed bulb into the center of the mouth Remove the bulb syringe from the crib when finished
suction the mouth first
The nurse is providing care to a newborn during the first 24 hours of life. Which is an abnormal finding? Yellowing of the skin Respiratory rate of 58 breaths per minute Heart rate of 140 beats per minute Presence of meconium stool
yellowing of the skin
