NSG 355 EXAM 2 Readings!
Common respiratory complications affecting neonates include... (4)
- RDS - meconium aspiration - pneumonia - persistent pulmonary hypertension of the newborn
What happens during the second period of reactivity? (RR, skin, MS, GI) 5
- brief periods of tachycardia and tachypnea occur - increased muscle tone - changes in skin color - changes in mucus production - meconium is commonly passed during this period
What are the mechanical factors for the initiation of respirations?
- changes in intrathoracic pressure resulting from compression of the chest during vaginal birth - crying increases the distribution of air in the lungs and promotes expansion of alveoli - the positive pressure created by crying helps keep the alveoli open
Sensory stimulation occurs in a variety of ways with birth, like... (7)
- handling of infant - suctioning - pain - new lights - sounds - smells - the drying by the nurses
Signs of respiratory distress in newborns include... (3)
- nasal flaring - intercostal or subcostal retractions - grunting with respirations
The bones in the spine of the newborn form two primary curvatures...
- one in the thoracic region and one in the sacral region - both are forward, concave curvatures
What happens during the first period of reactivity to respirations? (3)
- respirations are irregular, with a rate between 60-80 bpm - fine crackles can be present on auscultation - audible grunting, nasal flaring, and retractions of the chest should cease within 1 hour of birth
What happens during sleep period/period of inactivity after the first period of reactivity? (skin, RR, and GI) 3
- the infant is pink - respirations are rapid and shallow (up to 60 breaths/min) but unlabored - bowel sounds are audible and peristaltic waves may be noted over the rounded abdomen
The folic acid supplement for women of childbearing age...
0.4 mg/day
What is the recommended folic acid supplement for women who are pregnant?
0.6 mg/day
Breastfeeding should continue for ... and then as desired by the mother and infant
1 year
The onset of infection following perinatal transmission is usually within ... after birth
1-2 weeks
Clinical significance of late decelerations:
1. Abnormal pattern associated fetal hypoxemia, acidemia, and low Apgar scores; considered ominous if persistent and uncorrected, especially when associated with absent or minimal baseline variability
Related risk factors for intrauterine growth; fetoplacental causes:
1. Chromosomal abnormalities 2. Congenital malformations 3. Intrauterine infection 4. Genetic syndromes 5. Abnormal placental developmental
What preexisting medical or genetic conditions are risk factors for preeclampsia?
1. Chronic hypertension 2. Renal disease 3. Pre-gestational DM 4. Connective tissue disease (SLE, RA) 5. Thrombophilia 6. Obesity
Related risk factors for intrauterine growth; maternal causes:
1. Hypertensive disorders 2. Diabetes 3. Chronic renal disease 4. Collagen vascular disease 5. Thrombophilia 6. Cyanotic heart disease 7. Poor weight gain 8. Smoking, alcohol use, illicit drug use 9. Living at a high altitude
Clinical significance of variable decelerations:
1. Occur in approximately 50% of all labors and usually are transient and correctable
Nursing interventions for late decelerations:
1. The usual priority is as follows: a. Change maternal position (lateral). b. Correct maternal hypotension by elevating legs. c. Increase rate of maintenance IV solution. d. Palpate uterus to assess for tachysystole. e. Discontinue oxytocin if infusing. f. Administer oxygen at 8-10 L/minute by nonrebreather face mask. g. Notify physician or nurse-midwife. h. Consider internal monitoring more accurate fetal and uterine assessment. i. Assist with birth (cesarean or vaginal assisted) if the pattern cannot be corrected
Nursing interventions for variable decelerations:
1. The usual priority is as follows: a. Change maternal position (side to side, knee-chest). b. Discontinue oxytocin if infusing. c. Administer oxygen at 8-10 L/minute by nonrebreather face mask. d. Notify physician or nurse-midwife. e. Assist with vaginal or speculum examination to assess for cord prolapse. f. Assist with amnioinfusion if ordered. g. Assist with birth if the pattern cannot be corrected.
Legs are about ... of the body length
1/3
Vertical transmission of parvovirus occurs in about ... of maternal infections
1/3
A normal amniotic fluid index is...
10 cm or greater, with the upper range of normal around 25 cm
Infants have fairly predictable growth spurts at approximately...
10 days, 3 weeks, 6 weeks, 3 months, and 6 months
Each small square on the monitor paper or screen represents...
10 seconds
The average cord separation time is...
10 to 14 days, but it can take up to 3 weeks
Cell-free DNA screening provides a definitive diagnosis noninvasively for fetal Rh status, fetal gender, and certain paternally transmitted single gene disorders; can be performed as early as...
10 weeks
HR should be greater than...
100 bpm
The infant whose weight is appropriate for gestational age (AGA) is between the...
10th and 90th percentile
The infant who is small for gestational age (SGA) is less than the...
10th percentile and can be presumed to have grown at a restricted rate during intrauterine life
The normal FHR at term is...
110-160
The normal HR is .... when the infant is awake
110-160 bpm
The heart rate for a term newborn is...
110-160 bpm with brief fluctuations
Treatment for cleft lip is surgical repair, which is done by...
12 weeks
Gestational hypertension doesn't persist longer than...
12 weeks postpartum and usually resolves during the first postpartum week
The magnesium sulfate is continued throughout the postpartum period for seizure prophylaxis for...
12-24 hours
BP of ______ should be maintained
120-160/80-105 mmHg
To reduce the risk of pulmonary edema, total IV and oral fluids should not exceed...
125 ml/hr
At birth, Hgb from...
14-20 g/dL
Velocity waveforms from the umbilical and uterine arteries, reported as systolic/diastolic ratios, can be first detected at...
15 weeks of pregnancy
Sucking is a reflex behavior that begins as early as...
15-16 weeks in utero
Each female breast is composed of...
15-20 segments (lobes) embedded in fat and connective tissue and well supplied with blood vessels, lymphatic vessels, and nerves
In the first 24-48 hours after birth, the infant consumes...
15-30 mL of formula at a feeding
Platelet count ranges between ___ for the newborn.
150,000 and 300,000
The optimal time to perform the quad screening is between...
16 and 18 weeks of gestation
The newborn sleeps about ..., with periods of wakefulness gradually increasing
16-19 hours a day
It is not unusual for an infant crying to have a HR greater than ..., the HR should decrease when the crying ceases
160
The clearest visual distance is...
17-20 cm
When a term infant is crying, the heart rate can increase up to...
180 bpm or higher
Healthy low-risk infants who are considered at low to intermediate risk should receive follow-up care within...
2 days
In congenital CMV, chorioretinitis, microcephaly, intellectual disability, and neuromuscular deficits can occur by...
2 years of age
Average findings for chest circumference:
2-3 cm less than head circumference, average 30-33 cm
Newborns prefer black and white because of the greater contrast but can discriminate colors within...
2-3 months
Breastfeeding-associated jaundice begins at...
2-5 days
In utero fetal Po2 is...
20-30 mmHg
When engorgement occurs, it is usually a temporary condition that is usually resolved within...
24 hours
High-risk infants should be seen within ..., with TSB levels assessed, successful breastfeeding promoted, visual estimation of the degree of jaundice can lead to errors and providing information to parents about newborn jaundice
24 hours or sooner
TTNB usually resolves in...
24-48 hours
AFI greater than ___ cm is considered polyhydramnios
25
In the term infant, a serum bilirubin level of ... is considered the upper limit, beyond which the infant is considered at a greater risk for ABE
25 mg/dL
About ... of CHA are considered severe and can be called critical congenital heart defects, usually obvious at birth, and infants with CCHDs are transferred to the NICU
25%
Uterine activity during normal rarely exceeds...
250 MVUs
Birth weight of the term neonate is usually from...
2500 to 4000 g
Normal variations for weight:
2500-4000 g, acceptable weight loss 10% or less in first 3-5 days, second baby weighing more than the first
Intrauterine fetal surgery may be performed before ... to repair a myelomeningocele
26 weeks
The ratio of glandular to adipose tissue in the lactating breast is ..., where the average breast is 1:1
2:1
A DFMC less than ... fetal movements an hour warrants further evaluation by a nonstress test or a contraction stress test and a complete or modified biophysical profile
3
It is best not to introduce more than __ new foods a week
3
Most infants assume their normal head shape within ____ after birth
3 days
Babies normally consume small amounts of milk with feedings during the first...
3 days of life
Amylase is produced by...
3 months in salivary glands and 6 months in the pancreas
The ability to concentrate urine is attained by...
3 months of age
The reflex of opening the mouth in response to nasal blockage is not developed until...
3 weeks after birth
It is best to avoid bottles until breastfeeding is established, usually after...
3-4 weeks
Permanent closure of ductus arterioles usually occurs within...
3-4 weeks, and the ductus arteriosus becomes a ligament
During the 3rd trimester, the fetus makes about ... gross body movement each hour
30
Sleep states for fetuses do not last longer than...
30 minutes
The first stage of the transition period lasts up to...
30 minutes after birth
At birth the GFR is about .... of the adult GFR
30-50%
The term neonate's head circumference ranges from...
32 to 36.8 cm
Normal variations for head circumference:
32-36.8 cm
Average findings for head circumference:
33-35 cm, circumference of head and chest approximately the same for the first 1-2 days after birth
Induced labor is recommended for women with severe preeclampsia at...
34 weeks
Women with a history of herpes infection may be prescribed antiviral medication beginning at ___ weeks of gestation to reduce the likelihood of recurrent infection at birth
36
In the US the Monica AN24 is only approved in those who have completed...
36 weeks of pregnancy
The normal axillary temperature ranges from...
36.5-37.5 C
The normal axillary temperature averages...
37 C
Vaginal birth by induction of labor, preceded by cervical ripening is recommended at...
37 weeks
A nuchal fluid collection greater than ... is considered abnormal
3mm
Breastfed infants should receive a daily iron supplement starting at...
4 months
Introducing solid foods can occur from...
4-6 months of age
The mucosal barrier in the intestines is not fully mature until...
4-6 months of age, which allows antigens and bacteria to be transported across the intestines into the systemic circulation
At birth, RBC are from...
4.6-5.2 million/mm3
After ___ weeks the testes can be palpated in the scrotum and rugae cover the scrotal sac.
40
The average RR is...
40 breaths/min but can vary between 30-60 breaths/min
Untreated maternal syphilis leads to death of ... of the neonates
40%
Diastolic pressure in a term neonate averages ...
40-50 mmHg
Term newborn diastolic:
40-50 mmHg
Normal variations for length:
45-55 cm
Breastfeeding moms should add about ... calories per day
450-500
The signs and symptoms of preeclampsia usually resolve in...
48 hours after birth
AFI less than ___ cm is considered oligohydramnios
5
In Caucasian and African-American babies there is a rapid decline in bilirubin levels back to 3 mg/dL by...
5 day after birth
Breast milk jaundice (late onset jaundice) occurs from...
5-10 days
Late onset jaundice or breast milk jaundice develops between...
5-10 days of age
Hypertensive disorders are common, occur in ___ of all pregnancies.
5-10%
Newborns typically lose ... of body weight after birth before they begin to gain weight
5-6%
Average findings for length:
50 cm
Term newborns can see objects up to...
50 cm
With the Monica AN24, the woman may move up to....
50 feet without signal loss
At birth, Hct from...
51-56%
Fetal heart activity can be demonstrated by about ___ weeks of gestation using transvaginal US
6
Fruit juices are to be started after...
6 months
Half of the neonatal murmurs disappear by...
6 months and have no pathological significance
Solid (complementary) foods should be introduced at about...
6 months of age
Fruits and vegetables should be offered to infants daily starting at...
6-8 months
The period of sleep after the first period of reactivity lasts from...
60-100 minutes
Within the first week, infant blood glucose levels stabilize to...
60-80 mg/dL
The daily fluid requirement for full term infants is ... during the first 2 days of life
60-80 ml/kg
Systolic BP in a term neonate ranges from...
60-80 mmHg
Term newborn systolic:
60-80 mmHg
In the first week, milk intake goes from 15-30 mL to...
60-90 mL
Weight loss of ... or more in a breastfeeding infant during the first 3 days of life needs to be investigated
7%
Seroimmune pregnant women exposed to active chickenpox can be given varicella zoster immune globulin (VZIG), which does not reduce the incidence of infection but should decrease the effects of the virus on the fetus; but it must be given within .... of exposure to be effective
72 hours
In the term neonate approximately ... of body weight consists of total body water
75%
The BP cuff should cover ___ of the distance between the axilla and elbow.
75%
The mortality rate for full-blown hepatitis is...
75%
Every newborn should be assessed for jaundice every...
8-12 hours
The nurse should observe a feeding at least every ... while the mother and newborn are in the hospital
8-12 hours
Newborns need to feed at least...
8-12 times a day
Normal variations for vital signs:
80-100 bpm when asleep and up to 180 bpm when crying; possibly irregular HR for brief periods (esp. after crying), murmur (esp. over the base or at left sternal border in interspace 3 or 4, 36.5-37.5 C, heat loss, 30-60 breaths/min, short periods of breathing episodes and no evidence of respiratory distress or apnea, periodic breathing, BP variation with change in activity level: awake, crying, sleeping
Spontaneous labor usually begins when MVUs are between...
80-120.
A term infant in deep sleep can have a heart rate in the ... and the rate should increase when the baby awakens
80s-90s
Blood volume in term newborns averages ___ of body weight.
85 mL/kg
In the term fetus, accelerations are associated with movement ___ of the time
85%
When a term infant is sleeping, the heart rate can be...
85-100 bpm
The transmission rate of HBV to the newborn ranges from .... when the mother is seropositive for both Hep B surface antigen and Hep B e antigen
85-90%
Intake gradually increases during the first week of life. By the second week of life the infant is drinking...
90-150 mL at a feeding
The infant who is large for gestational age (LGA) is more than...
90th percentile can be presumed to have grown at an accelerated rate during fetal life
A RR of ... should be reported.
< 30 or > 60
AB blood
A and B antigen, no antibodies
A blood
A antigen, antibodies to type B blood
What is a herniation of the meninges at the site of the defect in the vertebral column and is typically covered by skin?
A meningocele
a visually apparent decrease in FHR of at least 5 bpm below the baseline and lasting more than 2 minutes but less than 10 minutes
A prolonged deceleration
What is an abnormal opening between the right and left ventricles?
A ventricular septal defect
... appears between 2-6 days after birth
ABE
Hypoxia, asphyxia, acidosis, hypothermia, hypoglycemia, sepsis, treatment with certain medications, and hypoalbuminemia increase the risk of...
ABE
The most common hemolytic diseases are...
ABO and Rh incompatibilities
What is the most common cause of hemolytic disease in the newborn that occurs in up to 25% of newborns?
ABO incompatibility
Jaundice can indicate...
ABO or Rh factor incompatibility problems
Abnormalities in .... are frequently associated with fetal disorders
AFV
The BPP includes...
AFV, FBMs, fetal movements, and fetal tone determined by US and FHR reactivity by means of NST
Physiologic parameters of the fetus that can be assessed with US scanning include...
AFV, vascular movements (FBMs), fetal urine production, and fetal limb and head movements
The initial assessment of the neonate is performed immediately after birth using the...
APGAR score
What is the mildest form of DDH, there is a delay in acetabular development evidenced by osseous hypoplasia of the acetabular roof that is oblique and shallow, although the cartilaginous roof is comparatively intact?
Acetabular dysplasia
What are serious neurologic complications resulting from high levels of unconjugated bilirubin?
Acute bilirubin encephalopathy and kernicterus
What can be used to treat infants with generalized involvement of varicella zoster?
Acyclovir
What is encouraged to enhance renal perfusion and bowel function?
Adequate fluid intake
Inguinal hernias can be present and become more obvious when the infant cries and are common in .... and usually require no treatment because they resolve with time
African-American neonates
performed to obtain amniotic fluid that contain fetal cells, can be performed after 14 weeks
Amniocentesis
What is necessary for converting starch into maltose and occurs in high amounts in the colostrum?
Amylase
What is an abnormal opening between the right and left atria?
An atrial septal defect
What is an incomplete fusion of the endocardial cushions?
An atrioventricular canal defect
What should be done to determine whether the mom has antibodies to the Rh antigen at the first prenatal visit?
An indirect Coomb's test
What is the absence of both cerebral hemispheres and of the overlying skull?
Anencephaly
What increases the risk of severe disease and death?
Antenatal transmission of enteroviruses
What is a narrowing or stricture of the aortic valve, causing resistance to blood flow in the left ventricle, decreased cardiac output, left ventricular hypertrophy, and pulmonary vascular congestion?
Aortic stenosis
The immediate assessment of the newborn includes...
Apgar scoring and the general evaluation of physical status
What helps promote emptying of the breast and release of the plug?
Application of warm compresses to the affected area and to the nipple before feeding
The simian line is often seen in...
Asian infants and infants with Down syndrome
when fetal hypoxia results in metabolic acidosis
Asphyxia
What are the responsibilities of the nurse providing care to a woman in labor?
Assessing FHR and UA patterns, implementing independent nursing interventions, documenting observations and actions according to the established standard of care, and reporting abnormal patterns to the primary care provider
B blood
B antigen, antibodies to type A blood
Criteria for preeclampsia home management includes...
BP less than 150/100 mmHg and no increase in proteinuria if they have no symptoms, a normal platelet count, and normal liver enzymes
What is recommended if the infant has oral thrush?
Boiling of feeding equipment
a baseline FHR of fewer than 110 bpm for 10 minutes or longer
Bradycardia
What are useful for sore nipples to keep the mother's bra or clothing from touching the nipples?
Breast shells
the transfer of human milk from the mother to infant; the infant receives milk directly from the mother's breast
Breastfeeding
Intestinal malrotation is associated with...
CDH
What is the most common cause of congenital viral infections in humans?
CMV
What are obtained from newborn infants using a heel stick, blood is collected on a special filter paper and sent to a lab for analysis?
Capillary blood samples
HELLP happens more in...
Caucasian women
What is a collection of blood between a skull bone and its periosteum that does not cross the suture line, is firmer and well defined and usually resolves in 2-8 weeks?
Cephalhematoma
What are the behavioral changes in state responses in the neonate?
Changes in sleep-wake cycles Changes in feeding behavior Changes in activity level Fussiness, irritability Listlessness
What is from the improper development and downward displacement of the hindbrain into the cervical spinal canal?
Chiari malformation
What is the most common STI in women in the US and the most common cause of PID?
Chlamydia
What is the most common congenital anomaly of the nose, the posterior nares can be blocked by a bony or soft-tissue obstruction and can be unilateral or bilateral?
Choanal atresia
performed in the first or second trimester, between weeks 10-13 of gestation, and involves the removal of a small tissue specimen from the fetal portion of the placenta
Chorionic villus sampling
hypertension that is present before the pregnancy OR hypertension that persists longer than 12 weeks postpartum
Chronic hypertension
What is the removal of all of part of the foreskin of the penis?
Circumcision
Which occurs more cleft lip or cleft palate?
Cleft lip occurs more frequently than cleft palate
What is a congenital midline fissure in the lip or palate resulting from failure of the primary palate to fuse?
Cleft lip or palate
What is characterized by localized narrowing of the aorta near the insertion of the ductus arteriosus?
Coarctation of the aorta
What increases the need for oxygen and can deplete glucose stores?
Cold stress
What acts as a laxative to promote stooling, which helps the body get rid of bilirubin?
Colostrum
What has all the nutrients that infants need for the first six months of life?
Commercial iron-fortified formula
What formula is less expensive ad is diluted with equal parts of water?
Concentrated
What infection is rare and characterized by in utero destruction of normally formed organs?
Congenital HSV infection
What are the most common of all congenital malformations, they are more common in preterm infants?
Congenital cardiac anomalies
What is a deformity of the foot and ankle that includes forefoot adduction, midfoot supination, hindfoot varus, and ankle equinus?
Congenital clubfoot
What are the leading cause of death in infants younger than 1 year of age?
Congenital defects
What results from a defect in the formation of the diaphragm, allowing the abdominal organs to be displaced into the thoracic cavity?
Congenital diaphragmatic hernia (CDH)
What results from a deficiency of thyroid hormones and can be permanent or transient?
Congenital hypothyroidism
Breastfeeding benefits for families and society:
Convenient; ready to feed. No bottle or other necessary equipment. Less expensive than infant formula. Reduced annual health care costs. Less parental absence from work because of ill infant. Reduced environmental burden related to disposal of formula packaging and equipment.
What is a language that an infant uses most often to communicate needs?
Crying
What is an infant's first social communication?
Crying
What during pregnancy can result in miscarriage, stillbirth, or congenital or neonatal cytomegalic inclusion disease (CMID)?
Cytomegalovirus (CMV) infection
Of all the forms of the Rh antigen, the ... is the most significant because it causes the most antibody production in someone who is Rh negative
D antigen
What is more common among ethnic groups such as Navajo infants and those from other countries who traditionally swaddle infants with legs extended and hips adducted?
DDH
What is used to monitor fetuses in pregnancies that are complicated by conditions that may affect fetal oxygenation?
DFMC
Biophysical assessment techniques include...
DFMCs, US, and MRI
Breastfeeding benefits for the mother:
Decreased postpartum bleeding and more rapid uterine involution. Reduced risk for: ovarian cancer and breast cancer, type 2 diabetes, hypertension, hypercholesteremia, and CVD, and RA. Unique bonding experience. Increased maternal role attainment
What are the physiologic oxygenation changes in response to acute pain in the neonate?
Decreased transcutaneous oxygen saturation Decreased arterial oxygen saturation
What is an important, safe technique in antepartum fetal surveillance; may be called the most valuable diagnostic tool in obstetrics?
Diagnostic ultrasonography
the femoral head loses contact with the acetabulum and is displaced posteriorly and superiorly over the fibrocartilaginous rim
Dislocation
What are sepsis-like and can involve virtually every organ system but are most likely to involve the liver, adrenal glands, and lungs?
Disseminated infections
What is a helpful tool in the management of pregnancies at risk because of maternal hypertension and DM, IUGR, multiple fetuses, and preterm labor because it provides an indication of fetal adaptation and reserve?
Doppler blood flow analysis
when a sound wave is reflected from a moving target, a change occurs in the frequency of the reflected wave relative to the transmitted wave
Doppler effect
Elevated inhibin A levels indicate the possibility of...
Down syndrome
What occurs in many infants with galactosemia?
E. coli sepsis
What is the primary mode of intrapartum fetal assessment in the US and is the most commonly performed obstetric procedure in the country?
EFM
½ of the infants who have ABE will survive but will have permanent sequelae including...
EPS movement disorders gaze abnormalities, auditory disturbances, cognitive impairment, and enamel dysplasia of the deciduous teeth
Effects of syphilis on neonates.
Early congenital syphilis can result in hydrops fetalis, prematurity, and failure to thrive. Hepatosplenomegaly and jaundice are common in neonates with syphilis. Hematologic findings include anemia, leukocytosis, and thrombocytopeniaBony lesions occur in the long bones, cranium, and the spine, and include osteochondritis, osteomyelitis, and periostitis. Snuffles, mucocutaneous lesions, edema, copper-colored maculopapular dermal rash first noticeable on the palms, feet, and in the diaper area, condylomatas, rhagades, exfoliation of nails and loss of hair, and iritis and choroiditis. Nephrotic syndrome secondary to renal infection, hepatitis with jaundice, lymphadenopathy, and inflammation of the pancreas, testes, and colon; and pseudoparalysis of the extremities.
a visually apparent gradual decrease in and return to baseline FHR associated with UCs
Early deceleration of the FHR
What is a useful tool for visualizing FHR patterns?
Electronic FHR monitoring
What is a common response of the breasts to the sudden change in hormones and the onset of significantly increased milk volume; usually occurs 3-5 days after birth?
Engorgement
What is the third most common cause of viral outbreaks in the NICU?
Enterovirus
What is rare and results from failure of urethral canalization?
Epispadias
urethra is located on dorsal surface
Epispadias
What can be used to prevent conjunctivitis?
Erythromycin, silver nitrate, and tetracycline
What is a congenital anomaly in which the esophagus ends in a blind pouch, thus failing to form a continuous passageway to the stomach?
Esophageal atresia
What is the most life-threatening anomalies of the esophagus, typically occur together, although they can occur singly?
Esophageal atresia and tracheoesophageal fistula (TEF)
What is accomplished by alternately removing a small amount of the infant's blood and replacing it with an equal amount of donor blood?
Exchange transfusion
the infant receives no other liquid or solid food
Exclusive breastfeeding
What can be used in infants with severe circulatory and respiratory complications?
Extracorporeal membrane oxygenation (ECMO) or high-frequency oscillation ventilation
Fetal well-being during labor can be measured by the response of the...
FHR to UCs
What supplement is used to prevent anemia?
Folic acid
i. Recorded and played back in succession. ii. Fetus is viewed in real time.
Four-dimensional US
Normal variations for posture:
Frank breech - legs are straighter and stiff, newborn assuming repose for a few days and prenatal pressure on limb or shoulder, possibly causing temporary facial asymmetry or resistance to extension of extremities
What could be used to treat plugged milk ducts?
Frequent feeding, massage, varying feeding positions, and taking lecithin
African-Americans and Mediterranean people have a higher incidence of...
G6PD deficiency
Fussiness can be related to...
GI problems
What can be recommended for moms who have tried nonpharmacologic measures to increase milk supply and failed?
Galactagogues
What is caused by a deficiency of the enzyme galactose 1-phosphate uridyltransferase, resulting in the inability to convert galactose to glucose?
Galactosemia
What is the herniation of the bowel through a defect in the abdominal wall to the right of the umbilical cord?
Gastroschisis
the onset of hypertension without proteinuria or other systemic findings diagnostic for preeclampsia after week 20 of pregnancy
Gestational hypertension
What are the behavioral facial expression responses in the neonate?
Grimaces Brow furrowed Chin quivering Eyes tightly closed Mouth open and squarish
What are the serotypes most commonly affecting neonates and can be transmitted transplacentally or through exposure to maternal blood or secretions during birth?
Group B coxsackievirus and echovirus 11
Viral hepatitis has several forms of transmission; ... infections carry the greatest risk
HBV
a diagnosis for severe preeclampsia that involves hepatic dysfunction, characterized by hemolysis (H), elevated liver enzymes (EL), and low platelet count (LP).
HELLP syndrome
All infants born to seropositive mothers should be presumed to be ...
HIV positive until proven otherwise
The most accurate test for newborns and infants younger than 18 months is the ..., which is performed on neonatal blood
HIV-1 DNA PCR assay
What is the most common viral STI?
HPV
What is most common transmitted from mom to baby through viral shredding during labor and birth?
HSV
What is a protective mechanism that allows the infant to become accustomed to environmental stimuli?
Habituation
What is increased in preeclampsia?
Hct
What is the most common result of rubella infection appears to be progressive after birth?
Hearing loss
What is the most commonly diagnosed genetic disorder of all the core conditions?
Hearing loss
What are often recommended for breastfeeding women, especially when there is an increased need to increase milk supply?
Herbs and herbal preparations
The minority group most likely to breast feed is...
Hispanic women
What are not recommended for breastfeeding mothers because of the potential for reducing milk supply?
Hormonal contraceptives
What is the ideal food for human infants?
Human milk
What provides the best nutrition for infants and is the gold standard for infant nutrition because it is uniquely designed to meet the needs of the infant?
Human milk
if the infant is fed expressed breast milk from the mother or a donor milk bank
Human milk feeding
What are effective drugs for treating hypertension intrapartum and postpartum?
Hydralazine, labetalol, and nifedipine
What is caused by an accumulation of fluid around the testes?
Hydrocele
What is a condition in which there is excess CSF in the ventricles of the brain?
Hydrocephalus
total serum bilirubin level in the blood is increased; presents as a yellowish discoloration of the skin, mucous membranes, sclera, and various organs
Hyperbilirubinemia
What are the physiologic lab evidence of metabolic or endocrine changes changes in response to acute pain in the neonate?
Hyperglycemia Lowered pH Elevated corticosteroids
What are a major cause of perinatal morbidity and mortality, primarily related to uteroplacental insufficiency and premature birth?
Hypertensive disorders
What is a body temperature greater than 37.5 C (99.5 F) and is typically caused by excess heat production related to sepsis or a decrease in heat loss?
Hyperthermia
What is characterized by underdevelopment of the left side of the heart, resulting in a hypoplastic left ventricle and aortic atresia?
Hypoplastic left heart syndrome
What encompasses a range of penile anomalies associated with an abnormally located urinary meatus?
Hypospadias
urethra is located on ventral surface of the penis
Hypospadias
a deficiency of oxygen in the arterial blood
Hypoxemia
an inadequate supply of oxygen at the cellular level that can cause metabolic acidosis
Hypoxia
Cons of IA
IA can be hard in obese women
Pros of IA
IA is easy to use, less invasive, and more inexpensive than EFM. It gives the mom more freedom of movement and is more comfortable
Hepatitis B vaccine is given.... before discharge.
IM
Preeclampsia is a risk factor for...
IUGR and fetal demise
Neonates with CMID display:
IUGR and have microcephaly, seizures, and lethargy
Fetal risks for chronic hypertension during pregnancy:
IUGR, death, and preterm birth
Abnormalities present with congenital rubella syndrome:
IUGR, microphthalmia, hypotonia, hepatosplenomegaly, thrombocytopenic purpura, dermatoglyphic abnormalities, bony radiolucencies, microcephaly, and brain wave abnormalities
Syphilis fetal effects:
IUGR, preterm birth, stillbirth, and congenital infection
For UA to be measured internally an ... is introduced into the uterine cavity.
IUPC
Magnesium sulfate is almost always administered...
IVPB
When can routine care begin?
If the infant is born at term, is crying or breathing, and has good muscle tone
When is further BP testing needed for the newborn?
If the systolic pressure is more than 10 mmHg higher in the upper extremities than in the lower extremities
What in human breast milk acts locally in the intestines to neutralize bacterial and viral pathogens?
IgA
The major immunoglobulins in human milk are secretory...
IgA, T and B lymphocytes, epidermal growth factor, cytokines, interleukins, bifidus factor, complement (C3 and C4), and lactoferrin
What is key to immunity to bacteria and viruses?
IgG
What is important for immunity to blood-borne infections and is the first major immunoglobulin by the first month?
IgM
What can predispose the mother to mastitis?
Inadequate emptying of the breasts, sore nipples that are cracked, stress, fatigue, ill family members, breast trauma, and maternal illness
What are biochemical genetic disorders that result from defects in single genes?
Inborn errors of metabolism
What are the physiologic vital sign changes in response to acute pain in the neonate?
Increased heart rate Increased BP Rapid, shallow respirations
What are the physiologic other observations in response to acute pain in the neonate?
Increased muscle tone Dilated pupils Decreased vagal nerve tone Increased intracranial pressure
What are essential to protect care providers and to prevent health personnel-related infection of clients, regardless of the infectious agent?
Infection-control measures
What are two consequences of maternal infection that last a life time?
Infertility and sterility
listening to fetal heart sounds at periodic intervals to assess the FHR
Intermittent auscultation (IA)
What is the irreversible, chronic consequence of bilirubin toxicity?
Kernicterus
With the LATCH assessment tool
L stands for latch, A stands for audible swallowing, T stands for type of nipple, C stands for comfort level of the mother, and H stands for hold
Accurate assessment of fetal lung maturity can be done by examining amniotic fluid to determine the...
L/S ratio or for the presence of PG
What are used for women with chronic hypertension in pregnancy?
Labetalol, nifedipine, and methyldopa
What is defined as placement of the infant's mouth over the nipple, areola, and breast, making a seal between the mouth and breast to create adequate suction for milk removal?
Latch, or latch-on
a visually apparent gradual decrease in and return to baseline FHR associated with UCs that is shifted to the right of the contraction
Late deceleration of the FHR
Mongolian spots are most common in...
Latin American, Asian, African, or Mediterranean infants
What are the behavioral body movement and posture responses in the neonate?
Limb withdrawal Thrashing Rigidity Flaccidity Fist clenching
performed for specific indications such as identifying fetal presentation during or estimating AFV
Limited US
What is secreted by the pancreas and is necessary for the digestion of fat?
Lipase
What most often occur with skin findings or rarely with isolated oral cavity lesions?
Localized HSV infections
a noninvasive radiologic technique used for obstetric and gynecologic diagnosis
MRI
What is the drug of choice for preventing and treating seizure activity (eclampsia)?
Magnesium sulfate
What are the leading cause of death in term neonates?
Major congenital defects
What is used to refer to infection of the breast?
Mastitis
What fills the lower intestine at birth and it is greenish black and viscous and contains occult blood?
Meconium
What refers to a head circumference that measures two or more standard deviations below the mean for age and sex?
Microcephaly
What is common during the first few days of breastfeeding?
Mild nipple soreness
What can be part of a characteristic pattern of malformations?
Minor anomalies
What are calculated by subtracting the baseline uterine pressure from the peak contraction pressure for each contraction that occurs in a 10-minute window, and then adding together the pressures generated by each contraction that occurs during the period of time?
Montevideo units (MVUs)
What are examples of primary NTDs?
Myelomeningocele, encephalocele, and anencephaly
Maternal serum alpha-fetoprotein (AFP) levels are used as a screening tool for .... in pregnancy
NTDs
Instilling prophylactic agents in the eyes of newborns to prevent ophthalmia neonatorum or neonatal conjunctivitis which is commonly caused by...
Neisseria gonorrhoeae
What else can develop after ROM?
Neonatal gonococcal arthritis, septicemia, meningitis, vaginitis, and scalp abscesses
What are thought to stem from the interaction of many genes that can be influenced by factors in the fetal environment?
Neural tube defects
A frequently used method to determine gestational age is the ..., which can be used to measure gestational ages of infants as young as 20 weeks of gestation
New Ballard Score
What are among the most common viruses that infect humans?
Nonpolio enteroviruses
a test that does not demonstrate at least two qualifying accelerations within a 20-minute window
Nonreactive NST
Clinical significance of accelerations:
Normal pattern; acceleration with fetal movement signifies fetal wellbeing representing fetal alertness and arousal states
What measures the fluid in the nape of the neck between 10-14 weeks to identify fetal abnormalities?
Nuchal translucency
absence of fluid pockets in the uterine cavity and the impression of crowding of small fetal parts
Oligohydramnios
What are two of the more common congenital defects of the abdominal wall?
Omphalocele and gastroschisis
Subluxation and dislocation can be demonstrated by the...
Ortolani or Barlow tests
What is essential to lactation?
Oxytocin
What is responsible for the milk ejection reflex (MER), or let-down reflex?
Oxytocin
the bottle is held at more of a horizontal angle, when the baby pauses between sucks, the parent withdraws the nipple and allows it to sit on the baby's lip until they are ready to resume sucking
Paced bottle feeding
What are the physiologic skin changes in response to acute pain in the neonate?
Pallor or flushing Diaphoresis Palmar sweating
What is a major factor in the mother's decision to breastfeed?
Partner and family support
What is well known in older children as fifth disease or slapped cheek illness?
Parvovirus
What is a vascular connection that during fetal life bypasses the pulmonary vascular bed and directs blood from the pulmonary artery to the aorta?
Patent ductus arteriosus
What is amino acid disorder that results from a deficiency of the enzymes phenylalanine dehydrogenase, which is needed to metabolize the essential amino acid phenylalanine?
Phenylketonuria (PKU)
What is thought to cause endothelial cell dysfunction by stimulating the release of a substance that is toxic to endothelial cells, which causes generalized vasospasm (resulting in poor tissue perfusion in all organ systems), increased peripheral resistance and BP, and increased endothelial cell permeability?
Placental ischemia
What may be a treatment for enteroviral infections in neonates and infants?
Pleconaril
What are most often the result of inadequate removal of milk from the breast, which can be caused by clothing that is too tight, a poorly fitting or underwire bra, or always using the same position for feeding?
Plugged milk ducts
extra fingers or toes, can be hereditary
Polydactyly
multiple large pockets of fluid, the impression of a floating fetus, and free movement of fetal limbs
Polyhydramnios
recognized by rhythmic oscillations of one or more beats felt when the foot is in dorsiflexion and seen as the foot drops to the plantar-flexed position
Positive clonus response
What is indicated if apnea or gasping respirations are occurring?
Positive pressure ventilation
What formula is the least expensive and is easily mixed by using one scoop for every 60 mL of water?
Powdered
What is unique to human pregnancy?
Preeclampsia
pregnancy-specific condition in which hypertension and proteinuria develops after 20 weeks' gestation in a woman who previously had neither of those things
Preeclampsia
What is the leading cause of cerebral palsy?
Prematurity
What is the primary prenatal focus of care?
Prevention of hyperbilirubinemia
Who are most likely to experience early breastfeeding problems?
Primiparous women
What have been called the mothering hormones because they affect the postpartum woman's emotions and her physical state?
Prolactin and oxytocin
What are the responsibilities of the nurse and other health care professionals regarding breastfeeding?
Promoting feelings of competence and confidence in the breastfeeding mother and reinforcing the unequaled contribution she is making toward the health and well-being of her infant
What is a narrowing at the entrance to the pulmonary artery?
Pulmonic stenosis
What can make a CCHD apparent?
Pulse oximetry
For internal monitoring, what must have already occurred?
ROM must have already occurred, cervix must be dilated at least 2-3 cm, and the presenting part must be low enough to allow placement of the spiral electrode or IUPC or both
two accelerations in a 20-minute period, each lasting at least 15 seconds and peaking at least 15 bpm above the baseline
Reactive NST
What formula is the most expensive but the easiest to use?
Ready to feed
Breastfeeding benefits for the infant:
Reduced risk for: nonspecific GI infections, Celiac disease, childhood IBD, necrotizing enterocolitis in preterm infants, clinical asthma, atopic dermatitis, and eczema, lower respiratory tract infections, otitis media, SIDS, obesity in adolescence and adulthood, type 1 and 2 diabetes, and acute lymphocytic and myeloid leukemia. Enhanced neurodevelopmental outcomes, especially in preterm infants.
What is recommended for the duration of pregnancy once preeclampsia is found?
Restricted activity rather than complete or partial bedrest
What manually displaces the areolar interstitial fluid inward, softening the areola and making it easier for the infant's mouth to grasp the nipple and areola with latch?
Reverse pressure softening
Potential causes of pathologic hyperbilirubinemia in neonates (maternal):
Rh and ABO or other blood group incompatibilities, maternal infections, maternal diabetes, oxytocin administration during labor, maternal ingestion of sulfonamides, diazepam, or salicylates near time of birth
The indirect Coombs' test is a screening tool for...
Rh incompatibility
What occurs when a Rh-negative mother has a Rh-positive fetus who inherits the dominant Rh-positive gene from the father?
Rh incompatibility, or isoimmunization
The administration of ... immune globulin to Rh-negative and Coombs' test-negative women provides passive immunity and minimizes the possibility of isoimmunization
Rho(D)
What is a commercial preparation of passive antibodies against the Rh factor?
RhoGAM
What are key STI-prevention strategies?
Risk-reduction sexual practices
Because of the correlation of pacifier use and decreased risk of ...., experts recommend pacifier use during naps or sleep time, but only after breastfeeding is established
SIDS
Interrupting the transmission of infection is crucial to...
STI control
What are responsible for substantial morbidity and mortality, great personal suffering, and heavy economic burden in the US?
STIs
Reproductive tract infections include...
STIs and common genital tract infections
What are biologic events for which all individuals have a right to expect objective, compassionate, and effective health care?
STIs and vaginitis
What is more deeply pigmented than the rest of the skin?
Scrotum
What are a compensatory response to compression of the umbilical vein?
Shoulders
What keeps the airway patent?
Slight extension of the neck
What is a form of wave energy that causes small particles in a medium to oscillate; expressed in hertz (Hz)?
Sound
performed if the woman is suspected of carrying an anatomically or physiologically abnormal fetus
Specialized/target US
What is the milder form and is a malformation in which the posterior portion of the laminae fails to close, but the spinal cord or meninges do not herniate or protrude through the defect and there is no abnormality of the spinal cord; skin can cover this, there can be a bulge under the skin where the ends of the spinal cord turns into fatty tissue. A birthmark or hairy patch is present above the defect
Spina bifida occulta
used most frequently, used to evaluate fetal presentation, amniotic fluid volume, cardiac activity, placental position, fetal growth parameters, number of fetuses, and perform an anatomic survey of fetus
Standard US
What is bleeding into the subgaleal compartment?
Subgaleal hemorrhage
What accounts for the largest percentage of DDH, implies incomplete dislocation of the hip and is regarded as an intermediate state in the development from primary dysplasia to complete dislocation?
Subluxation
What is needed for chlamydial conjunctivitis?
Systemic treatment
What is an abnormal connection between the esophagus and the trachea?
TEF
the baseline FHR greater than 160 bpm for 10 minutes or longer
Tachycardia
What can be a clue that an infant has a cardiac malformation?
Tachypnea
Teaching for sexually transmitted infections:
Take your medication as directed. Use comfort measures for symptom relief as suggested by your health care provider. Keep your appointment for repeat cultures or checkups after your treatment to make sure your infection is cured. Inform your sexual partner(s) of the need to be tested and treated, if necessary. Abstain from sexual intercourse until your treatment is completed or for as long as you are advised by your health care provider. Use sex practices that decrease risk when sexual intercourse us resumed. Call your health care provider immediately if you notice bumps, sores, rashes, or discharges. Keep all future appointments with your health care provider, even if things appear normal.
dorsiflexion, in which the toes are higher than the heel
Talipes calcaneus
What is the most common variation of clubfoot?
Talipes equinovarus
plantar flexion in which the toes are lower than the heel
Talipes equinus
an eversion or bending outward
Talipes valgus
an inversion or a bending inward
Talipes varus
the practice of breastfeeding a newborn and an older child
Tandem nursing
What refers to individual variations in the reaction pattern of newborns?
Temperament
What is the most common type of heart defect with decreased pulmonary blood flow?
Tetralogy of Fallot
What fontanels are the most important?
The anterior and posterior
What is used as follow-up if the initial screening is abnormal?
The auditory brainstem response (ABR)
What is the average rate during a 10-minute segment that excludes periodic or episodic changes, periods of marked variability, and segments of the baseline that differ by more than 25 beats/minute?
The baseline fetal heart rate
What is a noninvasive dynamic assessment of a fetus that is based on acute and chronic markers of fetal disease?
The biophysical profile (BPP)
What bottle feeding is usually the last one to remain?
The bottle feeding before bedtime
used to identify the jeopardized fetus that is stable at rest but showed evidence of compromise after stress
The contraction stress test (CST) or oxytocin challenge test
What mode of EFM uses external transducers placed on the maternal abdomen to assess FHR and UA?
The external mode of EFM
What mode of EFM uses a spiral electrode applied to the fetal presenting part to assess the FHR and an intrauterine pressure catheter to assess UA and uterine resting tone?
The internal mode of EFM
What controls the FHR?
The intrinsic rhythmicity of the fetal heart, the CNS system, and the fetal ANS
What is being used increasingly as a way to shorten the testing time required for the complete BPP by assessing the components that are most predictive of perinatal outcome?
The modified BPP
What happens to nipples and areolae in pregnancy?
The nipples become more erect, and the areolae darken and they both enlarge
the most widely applied technique for antepartum evaluation of the fetus
The nonstress test
What has been associated with trisomy 21 (down syndrome)?
The presence or absence of a nasal bone, short femur or humerus, echogenic intracardiac focus, echogenic bowel, and pyelectasis,
What are not accurate indicators of its ability to produce milk?
The size and shape of the breast
i. Sound waves are sent at different angles. ii. Sepia. iii. Can be used for diagnostic or management purposes like viewing anomalies or for family enjoyment
Three-dimensional US
What is a rare defect characterized by a failure of the pulmonary veins to join the left atrium?
Total anomalous pulmonary venous connection
What is a multisystem disease caused by the protozoan Toxoplasma gondii parasite?
Toxoplasmosis
What is an embryogenic defect caused by a straight division of the bulbar trunk without normal spiraling?
Transposition of the great vessels
the probe is inserted into the vagina, allows pelvic anatomic features to be evaluated in greater detail and intrauterine pregnancy to be diagnosed earlier; useful in obese women
Transvaginal ultrasonography
What is characterized by a small right ventricle, a large left ventricle, and usually a diminished pulmonary circulation?
Tricuspid valvular atresia
What is a retention of the embryologic bulbar trunk?
Truncus arteriosus
i. Sound waves are sent straight down from the US transducer. ii. Appears flat. iii. Black, white, and gray. iv. Standard medical scan used in pregnancy
Two-dimensional US
Variable decelerations have a...
U, V, or W shape, characterized by rapid descent and ascent to and from the nadir of the deceleration
Group B streptococci maternal effects:
UTI, chorioamnionitis, postpartum endometritis, sepsis, meningitis (rare)
What is sound frequency higher than that detectable by humans?
Ultrasound
What are performed at the time preeclampsia is diagnosed?
Ultrasound evaluation of amniotic fluid status and determination of estimated fetal weight
What is inappropriate for infants less than 1 year of age?
Unmodified cow milk
What has been known to increase the risk for NTDs?
Use of anticonvulsants and methotrexate, folic acid deficiency, excessive body heat during the first trimester, febrile illness, lower socioeconomic class, and maternal diabetes
Infants born before 28 weeks of gestation are at risk of varicella regardless of their mother's status, and probably benefit from ... if exposed to chickenpox
VZIG
Infants born to mothers in whom chickenpox develops between 5 days before birth and 48 hours after birth should be given ... at birth because of the risk of severe disease
VZIG
What is the most common type of heart defect with increased pulmonary blood flow?
Ventricular septal defect
Leukocytosis is normal at birth.
WBC at about 18,000
Who are at greatest risk for STIs and HIV?
Young, sexually active women who do not practice risk-reducing sexual behaviors and have multiple partners
IA can be performed with...
a Pinard fetoscope, Doppler ultrasound, an ultrasound stethoscope, or a DeLee-Hillis fetoscope
Tachypnea in the infant
a RR greater than 60 breaths/min without dyspnea
A deceleration lasting longer than 10 minutes is considered...
a baseline change
Acceleration for more than ten minutes is considered...
a change in baseline
1/3 of fetuses with an increased NT have...
a chromosomal abnormality and half of those are trisomy 21
Four conditions are essential for maintaining an adequate oxygen supply:
a clear airway effective establishment of respirations, adequate circulation, perfusion, and effective cardiac function, and adequate thermoregulation. Preterm infants are at greatest risk for respiratory distress
The initiation of respirations in the neonate is the result of...
a combination of chemical, mechanical, thermal, and sensory factors
What is a defect that is present at birth and can be caused by genetic or environmental factors, or both; it is defined as a structural or functional deviation from the normal pattern of development?
a congenital anomaly
Desquamation of the skin of the term infant does not occur until...
a few days after birth
During abdominal US the woman should have...
a full bladder
Auscultation should be for...
a full minute, preferably when the infant is asleep
Parents who make the decision to formula feed usually do so because of...
a lack of knowledge and understanding of the benefits of breastfeeding
Sodium reabsorption is decreased as a result of...
a lowered sodium or potassium activated adenosine triphosphatase activity
What is a herniation of the meninges and spinal cord at the site of the defect, with or without skin or vertebral covering; which can tear and allow CSF to leak out and provide entry for infectious agents into the CNS?
a myelomeningocele
The goal of care is to provide..
a neutral thermal environment for the neonate in which heat balance is maintained
What is a common type of capillary hemangioma that occurs more often in females and is raised, sharply demarcated, bright or dark red, and usually appears on the head?
a nevus vascularis, or strawberry hemangioma
Amniocentesis' are performed when there is...
a prenatal diagnosis of genetic disorders or congenital anomalies, assessment of pulmonary maturity, and diagnosis of fetal hemolytic disease
The tocotransducer may have trouble finding UA in...
a preterm delivery.
After 35 weeks the skin is covered in vernix caseosa that is fused with the epidermis and serves as...
a protective covering
Clamping the umbilical cord causes...
a rise in blood pressure, which increases circulation and lung perfusion
The most common genetic indication for PUBS is evaluation of mosaic results found on amniocentesis or CVS, when...
a sample of blood is required to determine the specific mutation
regular, smooth, undulating wavelike is not included in the definition of FHR variability, it commonly occurs with severe fetal anemia
a sinusoidal pattern
A pilonidal dimple, esp. with a sinus and nevus pilosis can be associated with...
a spina bifida
Nevus simplex are also known as salmon patches, telangiectatic nevi, "stork bites", or "angel kisses" are the result of...
a superficial capillary defect
To ensure accurate results, proteinuria should be determined using only...
a urine specimen that has been collected by either a thorough clean-catch midstream technique or catheterization
HELLP syndrome, which is usually diagnosed during the third trimester, is...
a variant of preeclampsia, not a separate illness
How would the nurse optimally reassure the parents of an infant who develops a cephalhematoma? a. A cephalhematoma may occur with a spontaneous vaginal birth. b. A cephalhematoma only happens as a result of a forceps- or vacuum-assisted delivery. c. It is present immediately after birth. d. The blood will gradually absorb over the first few months of life.
a. A cephalhematoma may occur with a spontaneous vaginal birth.
A mother is changing the diaper of her newborn son and notices that his scrotum appears large and swollen. The client is concerned. What is the best response from the nurse? a. A large scrotum and swelling indicate a hydrocele, which is a common finding in male newborns. b. I dont know, but Im sure it is nothing. c. Your baby might have testicular cancer. d. Your babys urine is backing up into his scrotum.
a. A large scrotum and swelling indicate a hydrocele, which is a common finding in male newborns.
Part of the health assessment of a newborn is observing the infants breathing pattern. What is the predominate pattern of newborns breathing? a. Abdominal with synchronous chest movements b. Chest breathing with nasal flaring c. Diaphragmatic with chest retraction d. Deep with a regular rhythm
a. Abdominal with synchronous chest movements
A new mother states that her infant must be cold because the babys hands and feet are blue. This common and temporary condition is called what? a. Acrocyanosis b. Erythema toxicum neonatorum c. Harlequin sign d. Vernix caseosa
a. Acrocyanosis
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 infants physical findings, this woman should be questioned about her use of which substance during pregnancy? a. Alcohol b. Cocaine c. Heroin d. Marijuana
a. Alcohol
Which substance, when abused during pregnancy, is the most significant cause of cognitive impairment and dysfunction in the infant? a. Alcohol b. Tobacco c. Marijuana d. Heroin
a. Alcohol
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.) a. Alcohol consumption b. Female gender c. Use of some anticonvulsant medications d. Maternal cigarette smoking e. Antibiotic use in pregnancy
a. Alcohol consumption c. Use of some anticonvulsant medications d. Maternal cigarette smoking
The AAP recommends pasteurized donor milk for preterm infants if the mothers own milk in not available. Which statements regarding donor milk and milk banking are important for the nurse to understand and communicate to her client? (Select all that apply.) a. All milk bank donors are screened for communicable diseases. b. Internet milk sharing is an acceptable source for donor milk. c. Donor milk may be given to transplant clients. d. Donor milk is used in neonatal intensive care units (NICUs) for severely low-birth-weight infants only. e. Donor milk may be used for children with immunoglobulin A (IgA) deficiencies.
a. All milk bank donors are screened for communicable diseases. c. Donor milk may be given to transplant clients. e. Donor milk may be used for children with immunoglobulin A (IgA) deficiencies.
What is the most likely cause for early decelerations in the fetal heart rate (FHR) pattern? a. Altered fetal cerebral blood flow b. Umbilical cord compression c. Uteroplacental insufficiency d. Spontaneous rupture of membranes
a. Altered fetal cerebral blood flow
A 3.8-kg infant was vaginally delivered at 39 weeks after a 30-minute second stage. A nuchal cord was found at delivery. After birth, the infant is noted to have petechiae over the face and upper back. Which information regarding petechiae is most accurate and should be provided to the parents? a. Are benign if they disappear within 48 hours of birth b. Result from increased blood volume c. Should always be further investigated d. Usually occur with a forceps-assisted delivery
a. Are benign if they disappear within 48 hours of birth
Which information is the highest priority for the nurse to comprehend regarding the BPP? a. BPP is an accurate indicator of impending fetal well-being. b. BPP is a compilation of health risk factors of the mother during the later stages of pregnancy. c. BPP consists of a Doppler blood flow analysis and an amniotic fluid index (AFI). d. BPP involves an invasive form of an ultrasonic examination.
a. BPP is an accurate indicator of impending fetal well-being.
Which newborn reflex is elicited by stroking the lateral sole of the infants foot from the heel to the ball of the foot? a. Babinski b. Tonic neck c. Stepping d. Plantar grasp
a. Babinski
On vaginal examination of a 30-year-old woman, the nurse documents the following findings: profuse, thin, grayish-white vaginal discharge with a fishy odor and complaints of pruritus. Based upon these findings, which condition would the nurse suspect? a. Bacterial vaginosis b. Candidiasis c. Trichomoniasis d. Gonorrhea
a. Bacterial vaginosis
A pregnant woman wants to breastfeed her infant; however, her husband is not convinced that there are any scientific reasons to do so. The nurse can give the couple printed information comparing breastfeeding and bottle feeding. Which statement regarding bottle feeding using commercially prepared infant formulas might influence their choice? a. Bottle feeding using a commercially prepared formula increases the risk that the infant will develop allergies. b. Bottle feeding helps the infant sleep through the night. c. Commercially prepared formula ensures that the infant is getting iron in a form that is easily absorbed. d. Bottle feeding requires that multivitamin supplements be given to the infant.
a. Bottle feeding using a commercially prepared formula increases the risk that the infant will develop allergies.
Which statements concerning the benefits or limitations of breastfeeding are accurate? (Select all that apply.) a. Breast milk changes over time to meet the changing needs as infants grow. b. Breastfeeding increases the risk of childhood obesity. c. Breast milk and breastfeeding may enhance cognitive development. d. Long-term studies have shown that the benefits of breast milk continue after the infant is weaned. e. Benefits to the infant include a reduced incidence of SIDS.
a. Breast milk changes over time to meet the changing needs as infants grow. c. Breast milk and breastfeeding may enhance cognitive development. d. Long-term studies have shown that the benefits of breast milk continue after the infant is weaned. e. Benefits to the infant include a reduced incidence of SIDS.
A nurse is discussing the signs and symptoms of mastitis with a mother who is breastfeeding. Which findings should the nurse include in the discussion? (Select all that apply.) a. Breast tenderness b. Warmth in the breast c. Area of redness on the breast often resembling the shape of a pie wedge d. Small white blister on the tip of the nipple e. Fever and flulike symptoms
a. Breast tenderness b. Warmth in the breast c. Area of redness on the breast often resembling the shape of a pie wedge e. Fever and flulike symptoms
A nurse providing couplet care should understand the issue of nipple confusion. In which situation might this condition occur? a. Breastfeeding babies receive supplementary bottle feedings. b. Baby is too abruptly weaned. c. Pacifiers are used before breastfeeding is established. d. Twins are breastfed together.
a. Breastfeeding babies receive supplementary bottle feedings.
Which statement regarding congenital anomalies of the cardiovascular and respiratory systems is correct? a. Cardiac disease may demonstrate signs and symptoms of respiratory illness. b. Screening for congenital anomalies of the respiratory system need only be performed for infants experiencing respiratory distress. c. Choanal atresia can be corrected with the use of a suction catheter to remove the blockage. d. Congenital diaphragmatic hernias are diagnosed and treated after birth.
a. Cardiac disease may demonstrate signs and symptoms of respiratory illness.
Which presentation is accurately described in terms of both the resenting part and the frequency of occurrence? a. Cephalic: occiput, at least 96% b. Breech: sacrum, 10% to 15% c. Shoulder: scapula, 10% to 15% d. Cephalic: cranial, 80% to 85%
a. Cephalic: occiput, at least 96%
Which nursing intervention would result in an increase in maternal cardiac output? a. Change in position b. Oxytocin administration c. Regional anesthesia d. IV analgesic
a. Change in position
While evaluating an external monitor tracing of a woman in active labor, the nurse notes that the FHR for five sequential contractions begins to decelerate late in the contraction, with the nadir of the decelerations occurring after the peak of the contraction. What is the nurses first priority? a. Change the womans position. b. Notify the health care provider. c. Assist with amnioinfusion d. Insert a scalp electrode.
a. Change the womans position.
During life in utero, oxygenation of the fetus occurs through transplacental gas exchange. When birth occurs, four factors combine to stimulate the respiratory center in the medulla. The initiation of respiration then follows. What are these four essential factors? a. Chemical b. Mechanical c. Thermal d. Psychologic e. Sensory
a. Chemical b. Mechanical c. Thermal e. Sensory
Which client would not be a suitable candidate for internal EFM? a. Client who still has intact membranes b. Woman whose fetus is well engaged in the pelvis c. Pregnant woman who has a comorbidity of obesity d. Client whose cervix is dilated to 4 to 5 cm
a. Client who still has intact membranes
A number of common drugs of abuse may cross into the breast milk of a mother who is currently using these substances, which may result in behavioral effects in the newborn. Which substances are contraindicated if the mother elects to breastfeed her infant? (Select all that apply.) a. Cocaine b. Marijuana c. Nicotine d. Methadone e. Morphine
a. Cocaine b. Marijuana c. Nicotine
A new mother asks whether she should feed her newborn colostrum, because it is not real milk. What is the nurses most appropriate answer? a. Colostrum is high in antibodies, protein, vitamins, and minerals. b. Colostrum is lower in calories than milk and should be supplemented by formula. c. Giving colostrum is important in helping the mother learn how to breastfeed before she goes home. d. Colostrum is unnecessary for newborns.
a. Colostrum is high in antibodies, protein, vitamins, and minerals.
Which statement best describes a normal uterine activity pattern in labor? a. Contractions every 2 to 5 minutes b. Contractions lasting approximately 2 minutes c. Contractions approximately 1 minute apart d. Contraction intensity of approximately 500 mm Hg with relaxation at 50 mm Hg
a. Contractions every 2 to 5 minutes
What are the legal responsibilities of the perinatal nurses? a. Correctly interpreting FHR patterns, initiating appropriate nursing interventions, and documenting the outcomes b. Greeting the client on arrival, assessing her status, and starting an IV line c. Applying the external fetal monitor and notifying the health care provider d. Ensuring that the woman is comfortable
a. Correctly interpreting FHR patterns, initiating appropriate nursing interventions, and documenting the outcomes
The nurse sees a woman for the first time when she is 30 weeks pregnant. The client has smoked throughout the pregnancy, and fundal height measurements now are suggestive of intrauterine growth restriction (IUGR) in the fetus. In addition to ultrasound to measure fetal size, what is another tool useful in confirming the diagnosis? a. Doppler blood flow analysis b. Contraction stress test (CST) c. Amniocentesis d. Daily fetal movement counts
a. Doppler blood flow analysis
Which intervention can nurses use to prevent evaporative heat loss in the newborn? a. Drying the baby after birth, and wrapping the baby in a dry blanket b. Keeping the baby out of drafts and away from air conditioners c. Placing the baby away from the outside walls and windows d. Warming the stethoscope and the nurses hands before touching the baby
a. Drying the baby after birth, and wrapping the baby in a dry blanket
Part of the nurses role is assisting with pushing and positioning. Which guidance should the nurse provide to her client in active labor? a. Encourage the womans cooperation in avoiding the supine position. b. Advise the woman to avoid the semi-Fowler position. c. Encourage the woman to hold her breath and tighten her abdominal muscles to produce a vaginal response. d. Instruct the woman to open her mouth and close her glottis, letting air escape after the push.
a. Encourage the womans cooperation in avoiding the supine position.
Which sexual behaviors are associated with exposure to an STI? (Select all that apply.) a. Fellatio b. Unprotected anal intercourse c. Multiple sex partners d. Dry kissing e. Abstinence
a. Fellatio b. Unprotected anal intercourse c. Multiple sex partners
Cell-free deoxyribonucleic acid (DNA) screening is a new method of noninvasive prenatal testing (NIPT) that has recently become available in the clinical setting. This technology can provide a definitive diagnosis of which findings? (Select all that apply.) a. Fetal Rh status b. Fetal gender c. Maternally transmitted gene disorder d. Paternally transmitted gene disorder e. Trisomy 21
a. Fetal Rh status b. Fetal gender d. Paternally transmitted gene disorder e. Trisomy 21
Which assessments are included in the fetal BPP? (Select all that apply.) a. Fetal movement b. Fetal tone c. Fetal heart rate d. AFI e. Placental grade
a. Fetal movement b. Fetal tone c. Fetal heart rate d. AFI
Which stage of labor varies the most in length? a. First b. Second c. Third d. Fourth
a. First
Which description of the four stages of labor is correct for both the definition and the duration? a. First stage: onset of regular uterine contractions to full dilation; less than 1 hour to 20 hours b. Second stage: full effacement to 4 to 5 cm; visible presenting part; 1 to 2 hours c. Third stage: active pushing to birth; 20 minutes (multiparous woman), 50 minutes (nulliparous woman) d. Fourth stage: delivery of the placenta to recovery; 30 minutes to 1 hour
a. First stage: onset of regular uterine contractions to full dilation; less than 1 hour to 20 hours
The nurse is using the New Ballard Scale to determine the gestational age of a newborn. Which assessment finding is consistent with a gestational age of 40 weeks? a. Flexed posture b. Abundant lanugo c. Smooth, pink skin with visible veins d. Faint red marks on the soles of the feet
a. Flexed posture
A client exhibits a thick, white, lumpy, cottage cheeselike discharge, along with white patches on her labia and in her vagina. She complains of intense pruritus. Which medication should the nurse practitioner order to treat this condition? a. Fluconazole b. Tetracycline c. Clindamycin d. Acyclovir
a. Fluconazole
The nurse should be cognizant of which statement regarding the unique qualities of human breast milk? a. Frequent feedings during predictable growth spurts stimulate increased milk production. b. Milk of preterm mothers is the same as the milk of mothers who gave birth at term. c. Milk at the beginning of the feeding is the same as the milk at the end of the feeding. d. Colostrum is an early, less concentrated, less rich version of mature milk.
a. Frequent feedings during predictable growth spurts stimulate increased milk production.
As recently as 2005, the AAP revised safe sleep practices to assist in the prevention of SIDS. The nurse should model these practices in the hospital and incorporate this information into the teaching plan for new parents. Which practices are ideal for role modeling? (Select all that apply.) a. Fully supine position for all sleep b. Side-sleeping position as an acceptable alternative c. Tummy time for play d. Infant sleep sacks or buntings e. Soft mattress
a. Fully supine position for all sleep c. Tummy time for play d. Infant sleep sacks or buntings
The Baby Friendly Hospital Initiative endorsed by the World Health Organization (WHO) and the United Nations Childrens Fund (UNICEF) was founded to encourage institutions to offer optimal levels of care for lactating mothers. Which actions are included in the Ten Steps to Successful Breastfeeding for Hospitals? (Select all that apply.) a. Give newborns no food or drink other than breast milk. b. Have a written breastfeeding policy that is communicated to all staff members. c. Help mothers initiate breastfeeding within hour of childbirth. d. Give artificial teats or pacifiers as necessary. e. Return infants to the nursery at night.
a. Give newborns no food or drink other than breast milk. b. Have a written breastfeeding policy that is communicated to all staff members. c. Help mothers initiate breastfeeding within hour of childbirth.
What is the most important nursing action in preventing neonatal infection? a. Good handwashing b. Isolation of infected infants c. Separate gown technique d. Standard Precautions
a. Good handwashing
Which viral sexually transmitted infection is characterized by a primary infection followed by recurrent episodes? a. Herpes simplex virus 2 (HSV-2) b. HPV c. HIV d. CMV
a. Herpes simplex virus 2 (HSV-2)
A woman with severe preeclampsia has been receiving magnesium sulfate by intravenous infusion for 8 hours. The nurse assesses the client and documents the following findings: temperature of 37.1 C, pulse rate of 96 beats per minute, respiratory rate of 24 breaths per minute, BP of 155/112 mm Hg, 3+ DTRs, and no ankle clonus. The nurse calls the provider with an update. The nurse should anticipate an order for which medication? a. Hydralazine b. Magnesium sulfate bolus c. Diazepam d. Calcium gluconate
a. Hydralazine
What is the most common medical complication of pregnancy? a. Hypertension b. Hyperemesis gravidarum c. Hemorrhagic complications d. Infections
a. Hypertension
A nurse is discussing the storage of breast milk with a mother whose infant is preterm and in the special care nursery. Which statement indicates that the mother requires additional teaching? a. I can store my breast milk in the refrigerator for 3 months. b. I can store my breast milk in the freezer for 3 months. c. I can store my breast milk at room temperature for 4 hours. d. I can store my breast milk in the refrigerator for 3 to 5 days.
a. I can store my breast milk in the refrigerator for 3 months.
Nursing follow-up care often includes home visits for the new mother and her infant. Which information related to home visits is correct? a. Ideally, the visit is scheduled within 72 hours after discharge. b. Home visits are available in all areas. c. Visits are completed within a 30-minute time frame. d. Blood draws are not a part of the home visit.
a. Ideally, the visit is scheduled within 72 hours after discharge.
Which information regarding to injuries to the infants plexus during labor and birth is most accurate? a. If the nerves are stretched with no avulsion, then they should completely recover in 3 to 6 months. b. Erb palsy is damage to the lower plexus. c. Parents of children with brachial palsy are taught to pick up the child from under the axillae. d. Breastfeeding is not recommended for infants with facial nerve paralysis until the condition resolves.
a. If the nerves are stretched with no avulsion, then they should completely recover in 3 to 6 months.
Interventions for maternal hypotension:
a. Increase the rate of the primary IV infusion. b. Change to lateral or Trendelenburg positioning. c. Administer ephedrine or phenylephrine per unit protocol or standing order if other measures are unsuccessful in increasing blood pressure
The nurse expects which maternal cardiovascular finding during labor? a. Increased cardiac output b. Decreased pulse rate c. Decreased white blood cell (WBC) count d. Decreased blood pressure
a. Increased cardiac output
Which intervention is most important when planning care for a client with severe gestational hypertension? a. Induction of labor is likely, as near term as possible. b. If at home, the woman should be confined to her bed, even with mild gestational hypertension. c. Special diet low in protein and salt should be initiated. d. Vaginal birth is still an option, even in severe cases.
a. Induction of labor is likely, as near term as possible.
Under which circumstance should the nurse immediately alert the pediatric provider? a. Infant is dusky and turns cyanotic when crying. b. Acrocyanosis is present 1 hour after childbirth. c. The infants blood glucose level is 45 mg/dl. d. The infant goes into a deep sleep 1 hour after childbirth.
a. Infant is dusky and turns cyanotic when crying.
Which infant is most likely to express Rh incompatibility? a. Infant of an Rh-negative mother and a father who is Rh positive and homozygous for the Rh factor b. Infant who is Rh negative and a mother who is Rh negative c Infant of an Rh-negative mother and a father who is Rh positive and heterozygous for the Rh factor d. Infant who is Rh positive and a mother who is Rh positive
a. Infant of an Rh-negative mother and a father who is Rh positive and homozygous for the Rh factor
A new mother asks the nurse what the experts say about the best way to feed her infant. Which recommendation of the American Academy of Pediatrics (AAP) regarding infant nutrition should be shared with this client? a. Infants should be given only human milk for the first 6 months of life. b. Infants fed on formula should be started on solid food sooner than breastfed infants. c. If infants are weaned from breast milk before 12 months, then they should receive cows milk, not formula. d. After 6 months, mothers should shift from breast milk to cows milk.
a. Infants should be given only human milk for the first 6 months of life.
A 23-year-old primiparous client with inconsistent prenatal care is admitted to the hospitals maternity unit in labor. The client states that she has tested positive for the HIV. She has not undergone any treatment during her pregnancy. The nurse understands that the risk of perinatal transmission can be significantly decreased by a number of prophylactic interventions. Which interventions should be included in the plan of care? a. Intrapartum treatment with antiviral medications b. Cesarean birth c. Postpartum treatment with antiviral medications d. Avoidance of breastfeeding e. Pneumococcal, HBV, and Haemophilus influenzae vaccine
a. Intrapartum treatment with antiviral medications b. Cesarean birth d. Avoidance of breastfeeding
Which neonatal complications are associated with hypertension in the mother? a. Intrauterine growth restriction (IUGR) and prematurity b. Seizures and cerebral hemorrhage c. Hepatic or renal dysfunction d. Placental abruption and DIC
a. Intrauterine growth restriction (IUGR) and prematurity
The most serious complication of an infant heelstick is necrotizing osteochondritis resulting from lancet penetration of the bone. What approach should the nurse take when performing the test to prevent this complication? a. Lancet should penetrate at the outer aspect of the heel. b. Lancet should penetrate the walking surface of the heel. c. Lancet should penetrate the ball of the foot. d. Lancet should penetrate the area just below the fifth toe.
a. Lancet should penetrate at the outer aspect of the heel.
Which changes take place in the womans reproductive system, days or even weeks before the commencement of labor? (Select all that apply.) a. Lightening b. Exhaustion c. Bloody show d. Rupture of membranes e. Decreased fetal movement
a. Lightening c. Bloody show d. Rupture of membranes
In assessing the immediate condition of the newborn after birth, a sample of cord blood may be a useful adjunct to the Apgar score. Cord blood is then tested for pH, carbon dioxide, oxygen, and base deficit or excess. Which clinical situation warrants this additional testing? (Select all that apply.) a. Low 5-minute Apgar score b. Intrauterine growth restriction (IUGR) c. Maternal thyroid disease d. Intrapartum fever e. Vacuum extraction
a. Low 5-minute Apgar score b. Intrauterine growth restriction (IUGR) c. Maternal thyroid disease d. Intrapartum fever
Which clinical finding or intervention might be considered the rationale for fetal tachycardia to occur? a. Maternal fever b. Umbilical cord prolapse c. Regional anesthesia d. Magnesium sulfate administration
a. Maternal fever
Counseling and education are critical components of the nursing care of women with herpes infections. Clients should be taught to identify triggers that might result in a herpes attack. Which factors are possible triggers for a recurrence? (Select all that apply.) a. Menstruation b. Trauma c. Febrile illness d. Soap e. Ultraviolet light
a. Menstruation b. Trauma c. Febrile illness e. Ultraviolet light
The condition, hypospadias, encompasses a wide range of penile abnormalities. Which information should the nurse provide to the anxious parents of an affected newborn? a. Mild cases involve a single surgical procedure. b. Infant should be circumcised. c. Repair is performed as soon as possible after birth. d. No correlation exists between hypospadia and testicular cancer.
a. Mild cases involve a single surgical procedure.
Of these psychosocial factors, which has the least negative effect on the health of the mother and/or fetus? a. Moderate coffee consumption b. Moderate alcohol consumption c. Cigarette smoke d. Emotional distress
a. Moderate coffee consumption
Which statement is the best rationale for recommending formula over breastfeeding? a. Mother has a medical condition or is taking drugs that could be passed along to the infant via breast milk. b. Mother lacks confidence in her ability to breastfeed. c. Other family members or care providers also need to feed the baby. d. Mother sees bottle feeding as more convenient.
a. Mother has a medical condition or is taking drugs that could be passed along to the infant via breast milk.
Transvaginal ultrasonography is often performed during the first trimester. While preparing a 6-week gestational client for this procedure, she expresses concerns over the necessity for this test. The nurse should explain that this diagnostic test may be indicated for which situations? (Select all that apply.) a. Multifetal gestation b. Obesity c. Fetal abnormalities d. Amniotic fluid volume e. Ectopic pregnancy
a. Multifetal gestation b. Obesity c. Fetal abnormalities e. Ectopic pregnancy
Which analysis of maternal serum may predict chromosomal abnormalities in the fetus? a. Multiple-marker screening b. L/S ratio c. BPP d. Blood type and crossmatch of maternal and fetal serum
a. Multiple-marker screening
A woman is undergoing a nipple-stimulated CST. She is having contractions that occur every 3 minutes. The fetal heart rate (FHR) has a baseline heart rate of approximately 120 beats per minute without any decelerations. What is the correct interpretation of this test? a. Negative b. Positive c. Satisfactory d. Unsatisfactory
a. Negative
Which statements regarding physiologic jaundice are accurate? (Select all that apply.) a. Neonatal jaundice is common; however, kernicterus is rare. b. Appearance of jaundice during the first 24 hours or beyond day 7 indicates a pathologic process. c. Because jaundice may not appear before discharge, parents need instruction on how to assess for jaundice and when to call for medical help. d. Jaundice is caused by reduced levels of serum bilirubin. e. Breastfed babies have a lower incidence of jaundice.
a. Neonatal jaundice is common; however, kernicterus is rare. b. Appearance of jaundice during the first 24 hours or beyond day 7 indicates a pathologic process. c. Because jaundice may not appear before discharge, parents need instruction on how to assess for jaundice and when to call for medical help.
The nurse should be familiar with the use of the five Ps as a tool for evaluating risk behaviors for STIs and the HIV. Which components would the nurse include in her use of the five Ps as an assessment tool? (Select all that apply.) a. Number of partners b. Level of physical activity c. Prevention of pregnancy d. Protection from STIs e. Past history
a. Number of partners c. Prevention of pregnancy d. Protection from STIs e. Past history
The nurse is preparing to administer a hepatitis B virus (HBV) vaccine to a newborn. Which intervention by the nurse is correct? a. Obtaining a syringe with a 25-gauge, 5/8-inch needle for medication administration b. Confirming that the newborns mother has been infected with the HBV c. Assessing the dorsogluteal muscle as the preferred site for injection d. Confirming that the newborn is at least 24 hours old
a. Obtaining a syringe with a 25-gauge, 5/8-inch needle for medication administration
The human papillomavirus (HPV), also known as genital warts, affects 79 million Americans, with an estimated number of 14 million new infections each year. The highest rate of infection occurs in young women, ages 20 to 24 years. Prophylactic vaccination to prevent the HPV is now available. Which statement regarding this vaccine is inaccurate? a. Only one vaccine for the HPV is available. b. The vaccine is given in three doses over a 6-month period. c. The vaccine is recommended for both boys and girls. d. Ideally, the vaccine is administered before the first sexual contact.
a. Only one vaccine for the HPV is available.
What is the correct placement of the tocotransducer for effective EFM? a. Over the uterine fundus b. On the fetal scalp c. Inside the uterus d. Over the mothers lower abdomen
a. Over the uterine fundus
The Period of Purple Crying is a program developed to educate new parents about infant crying and the dangers of shaking a baby. Each letter in the acronym PURPLE represents a key concept of this program. Which concepts are accurate? (Select all that apply.) a. P: peak of crying and painful expression b. U: unexpected c. R: baby is resting at last d. L: extremely loud e. E: evening
a. P: peak of crying and painful expression b. U: unexpected e. E: evening
Because of its size and rigidity, the fetal head has a major effect on the birth process. Which bones comprise the structure of the fetal skull? (Select all that apply.) a. Parietal b. Temporal c. Fontanel d. Occipital e. Femoral
a. Parietal b. Temporal d. Occipital
At least five factors affect the process of labor and birth. These are easily remembered as the five Ps. Which factors are included in this process? (Select all that apply.) a. Passenger b. Passageway c. Powers d. Pressure e. Psychologic response
a. Passenger b. Passageway c. Powers e. Psychologic response
A nurse caring for a woman in labor should understand that absent or minimal variability is classified as either abnormal or indeterminate. Which condition related to decreased variability is considered benign? a. Periodic fetal sleep state b. Extreme prematurity c. Fetal hypoxemia d. Preexisting neurologic injury
a. Periodic fetal sleep state
A 3.8-kg infant was vaginally delivered at 39 weeks of gestation after a 30-minute second stage. A nuchal cord occurred. After the birth, the infant is noted to have petechiae over the face and upper back. Based on the nurses knowledge, which information regarding petechiae should be shared with the parents? a. Petechiae (pinpoint hemorrhagic areas) are benign if they disappear within 48 hours of childbirth. b. These hemorrhagic areas may result from increased blood volume. c. Petechiae should always be further investigated. d. Petechiae usually occur with a forceps delivery.
a. Petechiae (pinpoint hemorrhagic areas) are benign if they disappear within 48 hours of childbirth.
The most widespread use of postnatal testing for genetic disease is the routine screening of newborns for inborn errors of metabolism (IEM). Which conditions are considered metabolic disorders? (Select all that apply.) a. Phenylketonuria (PKU) b. Galactosemia c. Hemoglobinopathy d. Cytomegalovirus (CMV) e. Rubella
a. Phenylketonuria (PKU) b. Galactosemia c. Hemoglobinopathy
Which adverse prenatal outcomes are associated with the HELLP syndrome? (Select all that apply.) a. Placental abruption b. Placenta previa c. Renal failure d. Cirrhosis e. Maternal and fetal death
a. Placental abruption c. Renal failure e. Maternal and fetal death
IUGR is associated with which pregnancy-related risk factors? (Select all that apply.) a. Poor nutrition b. Maternal collagen disease c. Gestational hypertension d. Premature rupture of membranes e. Smoking
a. Poor nutrition b. Maternal collagen disease c. Gestational hypertension e. Smoking
The nurse is caring for an infant with DDH. Which clinical manifestations should the nurse expect to observe? (Select all that apply.) a. Positive Ortolani click b. Unequal gluteal folds c. Negative Babinski sign d. Trendelenburg sign e. Telescoping of the affected limb
a. Positive Ortolani click b. Unequal gluteal folds
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 valid? a. Premature infants more easily digest breast milk than formula. b. A glass of wine just before pumping will help reduce stress and anxiety. c. The mother should only pump as much milk as the infant can drink. d. The mother should pump every 2 to 3 hours, including during the night.
a. Premature infants more easily digest breast milk than formula.
Hearing loss is one of the genetic disorders included in the universal screening program. Auditory screening of all newborns within the first month of life is recommended by the AAP. What is the rationale for having this testing performed? (Select all that apply.) a. Prevents or reduces developmental delays b. Reassures concerned new parents c. Provides early identification and treatment d. Helps the child communicate better e. Is recommended by the Joint Committee on Infant Hearing
a. Prevents or reduces developmental delays c. Provides early identification and treatment d. Helps the child communicate better e. Is recommended by the Joint Committee on Infant Hearing
What is the nurses understanding of the appropriate role of primary and secondary powers? a. Primary powers are responsible for the effacement and dilation of the cervix. b. Effacement is generally well ahead of dilation in women giving birth for the first time; they are closer together in subsequent pregnancies. c. Scarring of the cervix caused by a previous infection or surgery may make the delivery a bit more painful, but it should not slow or inhibit dilation. d. Pushing in the second stage of labor is more effective if the woman can breathe deeply and control some of her involuntary needs to push, as the nurse directs.
a. Primary powers are responsible for the effacement and dilation of the cervix.
What is the highest priority nursing intervention for an infant born with myelomeningocele? a. Protect the sac from injury. b. Prepare the parents for the childs paralysis from the waist down. c. Prepare the parents for closure of the sac when the child is approximately 2 years of age. d. Assess for cyanosis.
a. Protect the sac from injury.
Interventions for uterine tachysystole:
a. Reduce or discontinue the dose of any uterine stimulants in use. b. Administer a uterine relaxant.
The client has delivered by urgent caesarean birth for fetal compromise. Umbilical cord gases were obtained for acid-base determination. The pH is 6.9, partial pressure of carbon dioxide (PCO2) is elevated, and the base deficit is 11 mmol/L. What type of acidemia is displayed by the infant? a. Respiratory b. Metabolic c. Mixed d. Turbulent
a. Respiratory
What nursing diagnosis is the most appropriate for a woman experiencing severe preeclampsia? a. Risk for injury to mother and fetus, related to central nervous system (CNS) irritability b. Risk for altered gas exchange c. Risk for deficient fluid volume, related to increased sodium retention secondary to the administration of magnesium sulfate d. Risk for increased cardiac output, related to the use of antihypertensive drugs
a. Risk for injury to mother and fetus, related to central nervous system (CNS) irritability
An essential component of counseling women regarding safe sex practices includes a discussion regarding avoiding the exchange of body fluids. The most effective physical barrier promoted for the prevention of STIs and HIV is the condom. To educate the client about the use of condoms, which information related to condom use is the most important? a. Strategies to enhance condom use b. Choice of colors and special features c. Leaving the decision up to the male partner d. Places to carry condoms safely
a. Strategies to enhance condom use
Which factors influence cervical dilation? (Select all that apply.) a. Strong uterine contractions b. Force of the presenting fetal part against the cervix c. Size of the woman d. Pressure applied by the amniotic sac e. Scarring of the cervix
a. Strong uterine contractions b. Force of the presenting fetal part against the cervix d. Pressure applied by the amniotic sac e. Scarring of the cervix
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.) a. Swaddling b. Nonnutritive sucking c. Skin-to-skin contact with the mother d. Sucrose e. Acetaminophen
a. Swaddling b. Nonnutritive sucking c. Skin-to-skin contact with the mother d. Sucrose
A first-time father is changing the diaper of his 1-day-old daughter. He asks the nurse, What is this black, sticky stuff in her diaper? What is the nurses best response? a. Thats meconium, which is your babys first stool. Its normal. b. Thats transitional stool. c. That means your baby is bleeding internally. d. Oh, dont worry about that. Its okay.
a. Thats meconium, which is your babys first stool. Its normal.
Which information is an important consideration when comparing the CST with the NST? a. The NST has no known contraindications. b. The CST has fewer false-positive results when compared with the NST. c. The CST is more sensitive in detecting fetal compromise, as opposed to the NST. d. The CST is slightly more expensive than the NST.
a. The NST has no known contraindications.
Which explanation will assist the parents in their decision on whether they should circumcise their son? a. The circumcision procedure has pros and cons during the prenatal period. b. American Academy of Pediatrics (AAP) recommends that all male newborns be routinely circumcised. c. Circumcision is rarely painful, and any discomfort can be managed without medication. d. The infant will likely be alert and hungry shortly after the procedure.
a. The circumcision procedure has pros and cons during the prenatal period.
One of the most important components of the physical assessment of the pregnant client is the determination of BP. Consistency in measurement techniques must be maintained to ensure that the nuances in the variations of the BP readings are not the result of provider error. Which techniques are important in obtaining accurate BP readings? (Select all that apply.) a. The client should be seated. b. The clients arm should be placed at the level of the heart. c. An electronic BP device should be used. d. The cuff should cover a minimum of 60% of the upper arm. e. The same arm should be used for every reading.
a. The client should be seated. b. The clients arm should be placed at the level of the heart. e. The same arm should be used for every reading.
The client is being induced in response to worsening preeclampsia. She is also receiving magnesium sulfate. It appears that her labor has not become active, despite several hours of oxytocin administration. She asks the nurse, Why is this taking so long? What is the nurses most appropriate response? a. The magnesium is relaxing your uterus and competing with the oxytocin. It may increase the duration of your labor. b. I dont know why it is taking so long. c. The length of labor varies for different women. d. Your baby is just being stubborn.
a. The magnesium is relaxing your uterus and competing with the oxytocin. It may increase the duration of your labor.
Which statements describe the first stage of the neonatal transition period? (Select all that apply.) a. The neonatal transition period lasts no longer than 30 minutes. b. It is marked by spontaneous tremors, crying, and head movements. c. Passage of the meconium occurs during the neonatal transition period. d. This period may involve the infant suddenly and briefly sleeping. e. Audible grunting and nasal flaring may be present during this time.
a. The neonatal transition period lasts no longer than 30 minutes. b. It is marked by spontaneous tremors, crying, and head movements. c. Passage of the meconium occurs during the neonatal transition period. e. Audible grunting and nasal flaring may be present during this time.
The nurse caring for a newborn checks the record to note clinical findings that occurred before her shift. Which finding related to the renal system would be of increased significance and require further action? a. The pediatrician should be notified if the newborn has not voided in 24 hours. b. Breastfed infants will likely void more often during the first days after birth. c. Brick dust or blood on a diaper is always cause to notify the physician. d. Weight loss from fluid loss and other normal factors should be made up in 4 to 7 days.
a. The pediatrician should be notified if the newborn has not voided in 24 hours.
The nurse should be cognizant of which important statement regarding care of the umbilical cord? a. The stump can become easily infected. b. If bleeding occurs from the vessels of the cord, then the nurse should immediately call for assistance. c. The cord clamp is removed at cord separation. d. The average cord separation time is 5 to 7 days.
a. The stump can become easily infected.
A pregnant womans BPP score is 8. She asks the nurse to explain the results. How should the nurse respond at this time? a. The test results are within normal limits. b. Immediate delivery by cesarean birth is being considered. c. Further testing will be performed to determine the meaning of this score. d. An obstetric specialist will evaluate the results of this profile and, within the next week, will inform you of your options regarding delivery.
a. The test results are within normal limits.
A group of infections known collaboratively as TORCH infections are capable of crossing the placenta and causing serious prenatal effects on the fetus. Which infections are included in this group of organisms? (Select all that apply.) a. Toxoplasmosis b. Other infections c. Roseola d. Clostridium e. Herpes simplex
a. Toxoplasmosis b. Other infections e. Herpes simplex
A 39-year-old primigravida woman believes that she is approximately 8 weeks pregnant, although she has had irregular menstrual periods all her life. She has a history of smoking approximately one pack of cigarettes a day; however, she tells the nurse that she is trying to cut down. Her laboratory data are within normal limits. What diagnostic technique would be useful at this time? a. Ultrasound examination b. Maternal serum alpha-fetoprotein (MSAFP) screening c. Amniocentesis d. Nonstress test (NST)
a. Ultrasound examination
Which actions are examples of appropriate techniques to wake a sleepy infant for breastfeeding? (Select all that apply.) a. Unwrapping the infant b. Changing the diaper c. Talking to the infant d. Slapping the infants hands and feet e. Applying a cold towel to the infants abdomen
a. Unwrapping the infant b. Changing the diaper c. Talking to the infant
Interventions for abnormal fetal heart rate pattern during the second stage of labor
a. Use open-glottis pushing. b. Use fewer pushing efforts during each contraction. c. Make individual pushing efforts shorter. d. Push only with every other or every third contraction. e. Push only with a perceived urge to push.
Which alteration in the FHR pattern would indicate the potential need for an amnioinfusion? a. Variable decelerations b. Late decelerations c. Fetal bradycardia d. Fetal tachycardia
a. Variable decelerations
What is the correct term for the cheeselike, white substance that fuses with the epidermis and serves as a protective coating? a. Vernix caseosa b. Surfactant c. Caput succedaneum d. Acrocyanosis
a. Vernix caseosa
Which component of the sensory system is the least mature at birth? a. Vision b. Hearing c. Smell d. Taste
a. Vision
Clients treated for syphilis with penicillin may experience a Jarisch-Herxheimer reaction. Which clinical presentation would be unlikely if a client is experiencing this reaction? a. Vomiting and diarrhea b. Headache, myalgias, and arthralgia c. Preterm labor d. Jarisch-Herxheimer in the first 24 hours after treatment
a. Vomiting and diarrhea
The health history and physical examination cannot reliably identify all persons infected with HIV or other blood-borne pathogens. Which infection control practice should the nurse use when providing eye prophylaxis to a term newborn? a. Wear gloves. b. Wear mouth, nose, and eye protection. c. Wear a mask. d. Wash the hands after medication administration.
a. Wear gloves.
A client is warm and asks for a fan in her room for her comfort. The nurse enters the room to assess the mother and her infant and finds the infant unwrapped in his crib with the fan blowing over him on high. The nurse instructs the mother that the fan should not be directed toward the newborn and that the newborn should be wrapped in a blanket. The mother asks why. How would the nurse respond? a. Your baby may lose heat by convection, which means that he will lose heat from his body to the cooler ambient air. You should keep him wrapped, and should prevent cool air from blowing on him. b. Your baby may lose heat by conduction, which means that he will lose heat from his body to the cooler ambient air. You should keep him wrapped, and should prevent cool air from blowing on him. c. Your baby may lose heat by evaporation, which means that he will lose heat from his body to the cooler ambient air. You should keep him wrapped, and should prevent cool air from blowing on him. d. Your baby will easily get cold stressed and needs to be bundled up at all times.
a. Your baby may lose heat by convection, which means that he will lose heat from his body to the cooler ambient air. You should keep him wrapped, and should prevent cool air from blowing on him.
During a prenatal examination, a woman reports having two cats at home. The nurse informs her that she should not be cleaning the litter box while she is pregnant. The client questions the nurse as to why. What is the nurses most appropriate response? a. Your cats could be carrying toxoplasmosis. This is a zoonotic parasite that can infect you and have severe effects on your unborn child. b. You and your baby can be exposed to the HIV in your cats feces. c. Its just gross. You should make your husband clean the litter boxes. d. Cat feces are known to carry Escherichia coli, which can cause a severe infection in you and your baby.
a. Your cats could be carrying toxoplasmosis. This is a zoonotic parasite that can infect you and have severe effects on your unborn child.
A client asks her nurse, My doctor told me that he is concerned with the grade of my placenta because I am overdue. What does that mean? What is the nurses best response? a. Your placenta changes as your pregnancy progresses, and it is given a score that indicates how well it is functioning. b. Your placenta isnt working properly, and your baby is in danger. c. We need to perform an amniocentesis to detect if you have any placental damage. d. Dont worry about it. Everything is fine.
a. Your placenta changes as your pregnancy progresses, and it is given a score that indicates how well it is functioning.
Newborn respirations are .... in nature
abdominal
______ breathing is characteristic of newborns.
abdominal
The Monica AN24 uses .... to monitor both FHR and UA.
abdominally obtained electronic impulses
Seesaw or paradoxical respirations are...
abnormal breathing patterns
Cyanosis and mottling can be indicative of...
abnormal newborn breathing
Pulse oximetry less than 95% is indicative of...
abnormal newborn breathing
Symptoms of magnesium toxicity include:
absent deep tendon reflexes, respiratory depression, blurred vision, slurred speech, severe muscle weakness, and cardiac arrest
Four possible categories of variability have been identified:
absent, minimal, moderate, and marked
An increase in the SNS response results in...
accelerations in the FHR
visually apparent abrupt increase in FHR above the baseline rate, at least 15 bpm increase, and the acceleration lasts 15 seconds or more, with a return to baseline in less than 2 minutes, can be episodic or periodic, may occur with fetal movement or spontaneously
accelerations of the FHR
Jaundice is caused by the...
accumulation in the skin of unconjugated bilirubin
Three degrees of DDH:
acetabular dysplasia, subluxation, and dislocation
the bluish discoloration of hands and feet, is a normal finding in the first 24 hours after birth
acrocyanosis
Women should not breastfeed if they have...
active TB or active herpes simplex lesions on her breasts
Infants use purposeful behavior to maintain the optimal arousal state:
actively withdrawing by increasing physical distance, rejecting by pushing way with hands and feet, decreasing sensitivity by falling asleep or breaking eye contact by turning the head, or using signaling behaviors such as fussing and crying
CMV can be transmitted through breast milk while the mother has...
acute CMV infection
acute CNS manifestations seen in the first weeks after birth
acute bilirubin encephalopathy
What can pathologic jaundice that if left untreated result in?
acute bilirubin encephalopathy or kernicterus
If there is a history of active lesions at delivery in a woman with no previous history of HSV infection neonatal prophylaxis with ... is recommended
acyclovir
The IUPC can be used to evaluate the...
adequacy of UA for achieving progress in labor
An infant who has not voided in the first 24 hours should be assessed for... (4)
adequacy of fluid intake, bladder distention, restlessness, and symptoms of pain
The brain requires oxygen for...
adequate metabolism
Related risk factors for chromosomal abnormalities:
advanced maternal age, parental chromosomal rearrangements, previous pregnancy with autosomal trisomy, abnormal US findings during the current pregnancy, increased risk as calculated from noninvasive screening results
The late deceleration starts...
after the contraction has started
The nadir of the deceleration occurs...
after the peak of the contraction and doesn't return to baseline until after the contraction is over
Infants can continue breastfeeding until...
age 2 or beyond
Newborn BP varies from...
age, weight, state of alertness, and cuff size
It is usually safe to administer ... to HIV-1-infected children
all inactivated vaccines
An apical pulse should be obtained on...
all newborns
Average findings for chest:
almost circular, barrel shaped, symmetric chest movements, chest and abdominal movements synchronized during respirations, clavicles are intact, rib cage is symmetric, intact and moves with respirations, nipples are prominent, well-formed, symmetrically placed, breast nodule: approximately 6 mm in term infant
Biochemical monitoring techniques include...
amniocentesis, PUBS, CVS, MSAFP, multiple marker screens, and cell-free DNA screening in maternal blood
Procedures used to obtain needed specimens for biochemical assessment include...
amniocentesis, percutaneous umbilical blood sampling, chorionic villus sampling, and maternal sampling
The parvovirus B19 can be isolated from...
amniotic fluid, fetal blood, or tissues using DNA PCR assay
What is a herniation of the brain and meninges through a skull defect, usually in the occipital area?
an encephalocele
Pathologic jaundice is the result of...
an increased level of total serum bilirubin
Late decelerations should be considered...
an ominous sign when associated with absent or minimal variability
What is a covered defect of the umbilical ring into which varying amounts of the abdominal organs can herniate?
an omphalocele
Suprasternal or subclavicular retractions with stridor or gasping most often represent in...
an upper airway obstruction
Pallor in the immediate post-birth period is often a sign of underlying problems such as...
anemia or marked peripheral vasoconstriction as a result of intrapartum asphyxia or sepsis
Erythroblastis fetalis leads to..
anemia, edema, and the cytotoxic effects of unconjugated bilirubin
Persistent tachycardia can be associated with...
anemia, hypovolemia, hyperthermia, or sepsis
The newborn responds to...
animate and inanimate stimuli
If the tongue is not extruding over the lower gum and the mother reports pain or pinching with sucking, the baby may have...
ankyloglossia (tongue-tie, short frenulum)
What includes a range of congenital defects involving the anus, rectum, and genitourinary system?
anorectal malformations, or imperforate anus
HELLP syndrome usually occurs in the...
antepartum period
Most eclamptic seizures occur during the...
antepartum period
Human milk contains...
anti-infective and nutritional components combined with growth factors, enzymes that aid in digestion and absorption of nutrients, and fatty acids that promote brain growth and development
Treatment of mastitis includes:
antibiotics for 10-14 days and antipyretics, rest, breast and pump frequently, warm compresses, and adequate fluid intake and a balanced diet
Drugs that are associated with adverse effects on the breastfeeding infant include...
antimetabolite, cytotoxic medications, and drugs of abuse
Rapid warming can cause...
apneic spells and acidosis
Rubella (3-day or German measles; virus) fetal effects:
approximately 50-80% of fetuses exposed to the virus within 12 weeks after conception will show signs of congenital infection, very few fetuses are affected if infection occurs after 18 weeks of gestation, and the most common fetal anomalies associated with congenital rubella syndrome are deafness, eye defects, central nervous system defects, and cardiac defects
at term, which is longer arms or legs?
arms
Average findings for posture:
arms and legs in moderate flexion, fists clenched, resistance to having extremities extended for long periods of time and crying is possible if it is attempted, cessation of crying when allowed to resume curled-up fetal position, and normal spontaneous movement bilaterally asynchronous but equal extension in all extremities
The pathologic changes of HELLP syndrome occur as a result of...
arteriolar vasospasm, endothelial cell dysfunction with fibrin deposits, and adherence of platelets in blood vessels
During breastfeeding, the mother should be...
as comfortable as possible
Because of the delay in developing the reflex of opening the mouth in response to nasal blockade, what can occur with nasal blockage?
asphyxia and cyanosis
The inability to suck and swallow normally allows the milk to pool in the nasopharynx, which increases the likelihood of...
aspiration
Care begins immediately after birth and focuses on...
assessing and stabilizing the newborn's condition
The primary goal of care in the first moments after birth is to...
assist the newly born infant to transition to extrauterine life by establishing effective respirations
Average findings for extremities:
assuming a position maintained in utero, attitude of general flexion, full range of motion, spontaneous movements, arms longer than legs in the newborn period, contours and movements symmetric, five fingers on each hand, first often clenched with thumb under fingers, full ROM of joints, symmetric contour, palmar and plantar grasp present, appearance of bowing in the legs because lateral muscles are more developed than medial muscles, five toes on each foot, intact femur, major gluteal folds even, soles of feet well lined over two thirds of foot in term infants, plantar fat pad giving flat-footed effect full ROM in lower joints, symmetric contour of lower joints
A port-wine stain, or nevus flammeus is usually visible at birth and is due to an...
asymmetric postcapillary venule malformation
CMV infections acquired after birth usually are...
asymptomatic and have no sequelae
Variable decelerations can occur...
at any time during the UC phase and are caused by compression of the umbilical cord
All skin structures are present...
at birth
For women with gestational hypertension, preeclampsia, or superimposed preeclampsia, it is recommended that BP be monitored in the hospital or that equivalent outpatient surveillance be performed for...
at least 72 hours after birth
In a 24-hour specimen, proteinuria is defined as a concentration...
at or greater than 300 mg
Congenital intestinal obstruction can occur anywhere in the GI tract and takes one of the following forms:
atresia, partial obstruction, or malrotation of the intestine
Internal monitoring of the FHR is accomplished by...
attaching a spiral electrode to the presenting part
After learning to modulate the state of consciousness, they finally reach the level of...
attention and social interaction
the relation of the fetal body parts to one another, general flexion is most common
attitude
Use of CVS and amniocentesis is declining because of the...
availability of noninvasive procedures
At 1 minute after birth a nurse assesses an infant and notes a heart rate of 80 beats per minute, some flexion of extremities, a weak cry, grimacing, and a pink body but blue extremities. Which Apgar score does the nurse calculate based upon these observations and signs? a. 4 b. 5 c. 6 d. 7
b. 5
Nurses can help their clients by keeping them informed about the distinctive stages of labor. Which description of the phases of the first stage of labor is accurate? a. Latent: Mild, regular contractions; no dilation; bloody show; duration of 2 to 4 hours b. Active: Moderate, regular contractions; 4- to 7-cm dilation; duration of 3 to 6 hours c. Lull: No contractions; dilation stable; duration of 20 to 60 minutes d. Transition: Very strong but irregular contractions; 8- to 10-cm dilation; duration of 1 to 2 hours
b. Active: Moderate, regular contractions; 4- to 7-cm dilation; duration of 3 to 6 hours
Which information about variations in the infants blood counts is important for the nurse to explain to the new parents? a. A somewhat lower-than-expected red blood cell count could be the result of a delay in clamping the umbilical cord. b. An early high white blood cell (WBC) count is normal at birth and should rapidly decrease. c. Platelet counts are higher in the newborn than in adults for the first few months. d. Even a modest vitamin K deficiency means a problem with the bloods ability to properly clot.
b. An early high white blood cell (WBC) count is normal at birth and should rapidly decrease.
Which intervention by the nurse would reduce the risk of abduction of the newborn from the hospital? a. Instructing the mother not to give her infant to anyone except the one nurse assigned to her that day b. Applying an electronic and identification bracelet to the mother and the infant c. Carrying the infant when transporting him or her in the halls d. Restricting the amount of time infants are out of the nursery
b. Applying an electronic and identification bracelet to the mother and the infant
What is the rationale for evaluating the plantar crease within a few hours of birth? a. Newborn has to be footprinted. b. As the skin dries, the creases will become more prominent. c. Heel sticks may be required. d. Creases will be less prominent after 24 hours.
b. As the skin dries, the creases will become more prominent.
Which treatment regime would be most appropriate for a client who has been recently diagnosed with acute pelvic inflammatory disease (PID)? a. Oral antiviral therapy b. Bed rest in a semi-Fowler position c. Antibiotic regimen continued until symptoms subside d. Frequent pelvic examination to monitor the healing progress
b. Bed rest in a semi-Fowler position
A 41-week pregnant multigravida arrives at the labor and delivery unit after a NST indicated that her fetus could be experiencing some difficulties in utero. Which diagnostic tool yields more detailed information about the condition of the fetus? a. Ultrasound for fetal anomalies b. Biophysical profile (BPP) c. MSAFP screening d. Percutaneous umbilical blood sampling (PUBS)
b. Biophysical profile (BPP)
Which statement related to fetal positioning during labor is correct and important for the nurse to understand? a. Position is a measure of the degree of descent of the presenting part of the fetus through the birth canal. b. Birth is imminent when the presenting part is at +4 to +5 cm below the spine. c. The largest transverse diameter of the presenting part is the suboccipitobregmatic diameter. d. Engagement is the term used to describe the beginning of labor.
b. Birth is imminent when the presenting part is at +4 to +5 cm below the spine.
The breastfeeding mother should be taught a safe method to remove the breast from the babys mouth. Which suggestion by the nurse is most appropriate? a. Slowly remove the breast from the babys mouth when the infant has fallen asleep and the jaws are relaxed. b. Break the suction by inserting your finger into the corner of the infants mouth. c. A popping sound occurs when the breast is correctly removed from the infants mouth. d. Elicit the Moro reflex to wake the baby and remove the breast when the baby cries.
b. Break the suction by inserting your finger into the corner of the infants mouth.
The nurse is explaining the benefits associated with breastfeeding to a new mother. Which statement by the nurse would provide conflicting information to the client? a. Women who breastfeed have a decreased risk of breast cancer. b. Breastfeeding is an effective method of birth control. c. Breastfeeding increases bone density. d. Breastfeeding may enhance postpartum weight loss.
b. Breastfeeding is an effective method of birth control.
A tiered system of categorizing FHR has been recommended by professional organizations. Nurses, midwives, and physicians who care for women in labor must have a working knowledge of fetal monitoring standards and understand the significance of each category. What is the correct nomenclature for these categories? (Select all that apply.) a. Reassuring b. Category I c. Category II d. Nonreassuring e. Category III
b. Category I c. Category II e. Category III
The nurse has received a report regarding a client in labor. The womans last vaginal examination was recorded as 3 cm, 30%, and 2. What is the nurses interpretation of this assessment? a. Cervix is effaced 3 cm and dilated 30%; the presenting part is 2 cm above the ischial spines. b. Cervix is dilated 3 cm and effaced 30%; the presenting part is 2 cm above the ischial spines. c. Cervix is effaced 3 cm and dilated 30%; the presenting part is 2 cm below the ischial spines. d. Cervix is dilated 3 cm and effaced 30%; the presenting part is 2 cm below the ischial spines.
b. Cervix is dilated 3 cm and effaced 30%; the presenting part is 2 cm above the ischial spines.
The process during which bilirubin is changed from a fat-soluble product to a water-soluble product is known as what? a. Enterohepatic circuit b. Conjugation of bilirubin c. Unconjugated bilirubin d. Albumin binding
b. Conjugation of bilirubin
What are the various modes of heat loss in the newborn? (Select all that apply.) a. Perspiration b. Convection c. Radiation d. Conduction e. Urination
b. Convection c. Radiation d. Conduction
A new father is ready to take his wife and newborn son home. He proudly tells the nurse who is discharging them that within the next week he plans to start feeding the infant cereal between breastfeeding sessions. Which information should the nurse provide regarding this feeding plan? a. Feeding solid foods before your son is 4 to 6 months old may decrease your sons intake of sufficient calories. b. Feeding solid foods between breastfeeding sessions before your son is 4 to 6 months old will lead to an early cessation of breastfeeding. c. Your feeding plan will help your son sleep through the night. d. Feeding solid foods before your son is 4 to 6 months old will limit his growth.
b. Feeding solid foods between breastfeeding sessions before your son is 4 to 6 months old will lead to an early cessation of breastfeeding.
A woman gave birth to a healthy 7-pound, 13-ounce infant girl. The nurse suggests that the client place the infant to her breast within 15 minutes after birth. The nurse is aware that the initiation of breastfeeding is most effective during the first 30 minutes after birth. What is the correct term for this phase of alertness? a. Transition period b. First period of reactivity c. Organizational stage d. Second period of reactivity
b. First period of reactivity
Five different viruses (A, B, C, D, and E) account for almost all cases of hepatitis infections. Which statement regarding the various forms of hepatitis is most accurate? a. Vaccine exists for hepatitis C virus (HCV) but not for HBV. b. HAV is acquired by eating contaminated food or drinking polluted water. c. HBV is less contagious than HIV. d. Incidence of HCV is decreasing.
b. HAV is acquired by eating contaminated food or drinking polluted water.
Which laboratory testing is used to detect the human immunodeficiency virus (HIV)? a. HIV screening b. HIV antibody testing c. Cluster of differentiation 4 (CD4) counts d. Cluster of differentiation 8 (CD8) counts
b. HIV antibody testing
A 25-year-old single woman comes to the gynecologists office for a follow-up visit related to her abnormal Papanicolaou (Pap) smear. The test revealed that the client has the HPV. The woman asks, What is that? Can you get rid of it? Which is the best response for the nurse to provide? a. Its just a little lump on your cervix. We can just freeze it off. b. HPV stands for human papillomavirus. It is a sexually transmitted infection that may lead to cervical cancer. c. HPV is a type of early human immunodeficiency virus. You will die from this. d. You probably caught this from your current boyfriend. He should get tested for this.
b. HPV stands for human papillomavirus. It is a sexually transmitted infection that may lead to cervical cancer.
To explain hemolytic disorders in the newborn to new parents, the nurse who cares for the newborn population must be aware of the physiologic characteristics related to these conditions. What is the most common cause of pathologic hyperbilirubinemia? a. Hepatic disease b. Hemolytic disorders c. Postmaturity d. Congenital heart defect
b. Hemolytic disorders
What is the clinical finding most likely to be exhibited in an infant diagnosed with erythroblastosis fetalis? a. Edema b. Immature red blood cells c. Enlargement of the heart d. Ascites
b. Immature red blood cells
Which cardiovascular changes cause the foramen ovale to close at birth? a. Increased pressure in the right atrium b. Increased pressure in the left atrium c. Decreased blood flow to the left ventricle d. Changes in the hepatic blood flow
b. Increased pressure in the left atrium
The parents of a newborn ask the nurse how much the newborn can see. The parents specifically want to know what type of visual stimuli they should provide for their newborn. What information provided by the nurse would be most useful to these new parents? a. Infants can see very little until approximately 3 months of age. b. Infants can track their parents eyes and can distinguish patterns; they prefer complex patterns. c. The infants eyes must be protected. Infants enjoy looking at brightly colored stripes. d. Its important to shield the newborns eyes. Overhead lights help them see better.
b. Infants can track their parents eyes and can distinguish patterns; they prefer complex patterns.
Which nursing intervention is necessary before a first-trimester transabdominal ultrasound? a. Place the woman on nothing by mouth (nil per os [NPO]) for 12 hours. b. Instruct the woman to drink 1 to 2 quarts of water. c. Administer an enema. d. Perform an abdominal preparation.
b. Instruct the woman to drink 1 to 2 quarts of water.
The condition during which infants are at an increased risk for subgaleal hemorrhage is called what? a. Infection b. Jaundice c. Caput succedaneum d. Erythema toxicum neonatorum
b. Jaundice
Which statement best describes the transition period between intrauterine and extrauterine existence for the newborn? a. Consists of four phases, two reactive and two of decreased responses b. Lasts from birth to day 28 of life c. Applies to full-term births only d. Varies by socioeconomic status and the mothers age
b. Lasts from birth to day 28 of life
Which FHR decelerations would require the nurse to change the maternal position? (Select all that apply.) a. Early decelerations b. Late decelerations c. Variable decelerations d. Moderate decelerations e. Prolonged decelerations
b. Late decelerations c. Variable decelerations e. Prolonged decelerations
Which characteristic correctly matches the type of deceleration with its likely cause? a. Early decelerationumbilical cord compression b. Late decelerationuteroplacental insufficiency c. Variable decelerationhead compression d. Prolonged decelerationunknown cause
b. Late decelerationuteroplacental insufficiency
A new mother recalls from prenatal class that she should try to feed her newborn daughter when she exhibits feeding readiness cues rather than waiting until the baby is frantically crying. Which feeding cue would indicate that the baby is ready to eat? a. Waves her arms in the air b. Makes sucking motions c. Has the hiccups d. Stretches out her legs straight
b. Makes sucking motions
Which statement is the best rationale for assessing the maternal vital signs between uterine contractions? a. During a contraction, assessing the fetal heart rate is the priority. b. Maternal circulating blood volume temporarily increases during contractions. c. Maternal blood flow to the heart is reduced during contractions. d. Vital signs taken during contractions are not accurate.
b. Maternal circulating blood volume temporarily increases during contractions.
Most congenital anomalies of the CNS result from defects in the closure of the neural tube during fetal development. Which factor has the greatest impact on this process? a. Maternal diabetes b. Maternal folic acid deficiency c. Socioeconomic status d. Maternal use of anticonvulsant
b. Maternal folic acid deficiency
What is the correct term describing the slight overlapping of cranial bones or shaping of the fetal head during labor? a. Lightening b. Molding c. Ferguson reflex d. Valsalva maneuver
b. Molding
What information regarding a fractured clavicle is most important for the nurse to take into consideration when planning the infants care? a. Prone positioning facilitates bone alignment. b. No special treatment is necessary. c. Parents should be taught range-of-motion exercises. d. The shoulder should be immobilized with a splint.
b. No special treatment is necessary.
During labor a fetus displays an average FHR of 135 beats per minute over a 10-minute period. Which statement best describes the status of this fetus? a. Bradycardia b. Normal baseline heart rate c. Tachycardia d. Hypoxia
b. Normal baseline heart rate
What is the nurses initial action while caring for an infant with a slightly decreased temperature? a. Immediately notify the physician. b. Place a cap on the infants head, and have the mother perform kangaroo care. c. Tell the mother that the infant must be kept in the nursery and observed for the next 4 hours. d. Change the formula; a decreased body temperature is a sign of formula intolerance.
b. Place a cap on the infants head, and have the mother perform kangaroo care.
The nurse is planning the care for a laboring client with diabetes mellitus. This client is at greater risk for which clinical finding? a. Oligohydramnios b. Polyhydramnios c. Postterm pregnancy d. Chromosomal abnormalities
b. Polyhydramnios
Which instruction should the nurse provide to reduce the risk of nipple trauma? a. Limit the feeding time to less than 5 minutes. b. Position the infant so the nipple is far back in the mouth. c. Assess the nipples before each feeding. d. Wash the nipples daily with mild soap and water.
b. Position the infant so the nipple is far back in the mouth.
Which clinical finding is a major use of ultrasonography in the first trimester? a. Amniotic fluid volume b. Presence of maternal abnormalities c. Placental location and maturity d. Cervical length
b. Presence of maternal abnormalities
The client being cared for has severe preeclampsia and is receiving a magnesium sulfate infusion. Which new finding would give the nurse cause for concern? a. Sleepy, sedated affect b. Respiratory rate of 10 breaths per minute c. DTRs of 2 d. Absent ankle clonus
b. Respiratory rate of 10 breaths per minute
According to the National Institute of Child Health and Human Development (NICHD) Three-Tier System of FHR Classification, category III tracings include all FHR tracings not categorized as category I or II. Which characteristics of the FHR belong in category III? (Select all that apply.) a. Baseline rate of 110 to 160 beats per minute b. Tachycardia c. Absent baseline variability not accompanied by recurrent decelerations d. Variable decelerations with other characteristics such as shoulders or overshoots e. Absent baseline variability with recurrent variable decelerations f. Bradycardia
b. Tachycardia d. Variable decelerations with other characteristics such as shoulders or overshoots e. Absent baseline variability with recurrent variable decelerations f. Bradycardia
A new client and her partner arrive on the labor, delivery, recovery, and postpartum (LDRP) unit for the birth of their first child. The nurse applies the electronic fetal monitor (EFM) to the woman. Her partner asks you to explain what is printing on the graph, referring to the EFM strip. He wants to know what the babys heart rate should be. What is the nurses best response? a. Dont worry about that machine; thats my job. b. The babys heart rate will fluctuate in response to what is happening during labor. c. The top line graphs the babys heart rate, and the bottom line lets me know how strong the contractions are. d. Your physician will explain all of that later.
b. The babys heart rate will fluctuate in response to what is happening during labor.
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? a. He will only wake up to be fed, and you should not bother him between feedings. b. The newborn sleeps approximately 17 hours a day, with periods of wakefulness gradually increasing. c. He will probably follow your same sleep and wake patterns, and you can expect him to be awake soon. d. 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.
b. The newborn sleeps approximately 17 hours a day, with periods of wakefulness gradually increasing.
The nurse is completing a physical examination of the newborn 24 hours after birth. Which component of the evaluation is correct? a. The parents are excused to reduce their normal anxiety. b. The nurse can gauge the neonates maturity level by assessing his or her general appearance. c. Once often neglected, blood pressure is now routinely checked. d. When the nurse listens to the neonates heart, the S1 and S2 sounds can be heard; the S1sound is somewhat higher in pitch and sharper than the S2 sound.
b. The nurse can gauge the neonates maturity level by assessing his or her general appearance.
A new father wants to know what medication was put into his infants eyes and why it is needed. How does the nurse explain the purpose of the erythromycin (Ilotycin) ophthalmic ointment? a. Erythromycin (Ilotycin) ophthalmic ointment destroys an infectious exudate caused by Staphylococcus that could make the infant blind. b. This ophthalmic ointment prevents gonorrheal and chlamydial infection of the infants eyes, potentially acquired from the birth canal. c. Erythromycin (Ilotycin) prevents potentially harmful exudate from invading the tear ducts of the infants eyes, leading to dry eyes. d. This ointment prevents the infants eyelids from sticking together and helps the infant see.
b. This ophthalmic ointment prevents gonorrheal and chlamydial infection of the infants eyes, potentially acquired from the birth canal.
The nurse is circulating during a cesarean birth of a preterm infant. The obstetrician requests that cord clamping be delayed. What is the rationale for this directive? a. To reduce the risk for jaundice b. To reduce the risk of intraventricular hemorrhage c. To decrease total blood volume d. To improve the ability to fight infection
b. To reduce the risk of intraventricular hemorrhage
The Centers for Disease Control and Prevention (CDC) recommends which therapy for the treatment of the HPV? a. Miconazole ointment b. Topical podofilox 0.5% solution or gel c. Two doses of penicillin administered intramuscularly (IM) d. Metronidazole by mouth
b. Topical podofilox 0.5% solution or gel
What is the primary difference between the labor of a nullipara and that of a multipara? a. Amount of cervical dilation b. Total duration of labor c. Level of pain experienced d. Sequence of labor mechanisms
b. Total duration of labor
What three measures should the nurse implement to provide intrauterine resuscitation? a. Call the provider, reposition the mother, and perform a vaginal examination. b. Turn the client onto her side, provide oxygen (O2) via face mask, and increase intravenous (IV) fluids. c. Administer O2 to the mother, increase IV fluids, and notify the health care provider. d. Perform a vaginal examination, reposition the mother, and provide O2 via face mask.
b. Turn the client onto her side, provide oxygen (O2) via face mask, and increase intravenous (IV) fluids.
An MSAFP screening indicates an elevated level of alpha-fetoprotein. The test is repeated, and again the level is reported as higher than normal. What is the next step in the assessment sequence to determine the well-being of the fetus? a. PUBS b. Ultrasound for fetal anomalies c. BPP for fetal well-being d. Amniocentesis for genetic anomalies
b. Ultrasound for fetal anomalies
What is the most likely cause for variable FHR decelerations? a. Altered fetal cerebral blood flow b. Umbilical cord compression c. Uteroplacental insufficiency d. Fetal hypoxemia
b. Umbilical cord compression
The nurse should be cognizant of which condition related to skeletal injuries sustained by a neonate during labor or childbirth? a. Newborns skull is still forming and fractures fairly easily. b. Unless a blood vessel is involved, linear skull fractures heal without special treatment. c. Clavicle fractures often need to be set with an inserted pin for stability. d. Other than the skull, the most common skeletal injuries are to leg bones.
b. Unless a blood vessel is involved, linear skull fractures heal without special treatment.
Which statements regarding the HPV are accurate? (Select all that apply.) HPV infections: a. are thought to be less common in pregnant women than in women who are not pregnant. b. are thought to be more common in pregnant women than in women who are not pregnant. c. were previously called genital warts. d. were previously called herpes. e. may cause cancer.
b. are thought to be more common in pregnant women than in women who are not pregnant. c. were previously called genital warts. e. may cause cancer.
on sole of foot, beginning at heel, stroke upward along lateral aspect of sole; then move finger across ball of foot; all toes hyperextend, with dorsiflexion of big toe is recorded as a positive sign
babinski reflex
Milk production gradually increases as the...
baby grows
One of the most common concerns of breastfeeding mother is how to determine if the...
baby is getting enough milk
The umbilical cord stump is an excellent medium for...
bacterial growth and can easily become infected
The BP is usually not measured on a routine basis except for as a...
baseline
Why is infant specific gravity low?
because full-term infants have a limited capacity to concentrate urine
Why is G6PD deficiency more common in males?
because it is sex-linked
Breastfeeding delays the return of ovulation and menstruation, but ovulation can occur...
before the first menstrual period after birth
Normally the urethral opening is located...
behind the clitoris
During the prenatal period expectant parents should be informed of the...
benefits of breastfeeding for infants, mothers, families, and society
Women most often choose to breastfeed because they are aware of the...
benefits to the infant
A deceleration may be...
benign or abnormal
If the syphilis tests are normal, then the neonate should be treated with an IM dose of..
benzathine penicillin
When does the second period of reactivity occur and how long does it last?
between 2-8 hours after birth and lasts from 10 minutes to several hours
Signs of neonatal GI obstruction:
bilious vomiting, abdominal distention, and failure to pass normal amounts of meconium in the first 24 hours
Biochemical assessment involves...
biologic examination and chemical determinations
factors that originate within the mother or fetus and affect the development or functioning of either one or birth
biophysical risks
Categories of risk include...
biophysical, psychosocial, sociodemographic, and environmental
HIV transmission mostly occurs during...
birth
Syphilis has reemerged as a common STI, affecting .... more than any other ethnic group
black women
Skin rashes and discolorations will....
blanch
The administration of IM vitamin K helps prevent...
bleeding problems
We must wear gloves when handling infants until...
blood and amniotic fluid have been removed from the skin, when drawing blood, when caring for a fresh wound, and during diaper changes
Because history and examination cannot reliably identify everyone with HIV or other blood-borne pathogens...
blood and body-fluid precautions should be used consistently for everyone all the time
The liver plays an important role in...
blood coagulation
Cord blood samples may be used to identify the infant's...
blood type and Rh status
HIV is transmitted through...
body fluids, primarily blood, semen, and vaginal secretions
The fetoscope is applied to the listener's forehead because...
bone conduction amplifies the FH sounds for counting
Failure to pass meconium could indicate...
bowel obstruction
What happens during the first period of reactivity to GI system?
bowel sounds are audible, and meconium may be passed
Complications of mastitis include...
breast abscesses, chronic mastitis, and fungal infections of the breast
What is associated with factors in the breast milk that either inhibit the conjugation of bilirubin or decrease the excretion of bilirubin?
breast milk jaundice
What is a lack of effective breastfeeding that contributes to the hyperbilirubinemia?
breast-feeding associated jaundice
Newborns without complications should be allowed to remain in skin-to-skin contact until the baby can...
breastfeed for the first time
Women with chronic hypertension may...
breastfeed if they please
As long as no suspicious lesions are present on the mother's breasts, ... is allowed
breastfeeding
Early skin to skin contact, which places the neonate directly on the mother's chest after birth, fosters the initiation of ... during the first hour
breastfeeding
Woman can continue their prenatal vitamins as long as they are ...
breastfeeding
Early and extended skin-to-skin contact promotes...
breastfeeding and prevents hypothermia in the late preterm infant
The mother needs to know and understand infant behaviors in relation to...
breastfeeding and recognize signs that the baby is ready to feed
Breastfeeding mothers who become pregnant can continue...
breastfeeding if there are no medical contraindications
Who loses weight faster? Bottle-feeding moms or breastfeeding moms?
breastfeeding moms
Mothers of preterm infants often receive specific emotional benefits in...
breastfeeding or providing breast milk for their babies
The newborn should be...
breathing spontaneously, trunk and lips should be pink
Some VD are preceded and followed by...
brief accelerations of the FHR known as shoulders
Fussiness during feeding can be the result of birth injury such as...
bruising of the head or fractured clavicle
Mouth and nasal passages can be gently suctioned with a...
bulb syringe
When does the cerebellum end its growth spurt, which began at approximately 30 gestational weeks?
by the end of the first year
While working with the pregnant client in her first trimester, what information does the nurse provide regarding when CVS can be performed (in weeks of gestation)? a. 4 b. 8 c. 10 d. 14
c. 10
The nurse is assessing a full term, quiet, and alert newborn. What is the average expected apical pulse range (in beats per minute)? a. 80 to 100 b. 100 to 120 c. 120 to 160 d. 150 to 180
c. 120 to 160
The American College of Obstetricians and Gynecologists (ACOG) has developed a comprehensive list of risk factors associated with the development of preeclampsia. Which client exhibits the greatest number of these risk factors? a. 30-year-old obese Caucasian with her third pregnancy b. 41-year-old Caucasian primigravida c. 19-year-old African American who is pregnant with twins d. 25-year-old Asian American whose pregnancy is the result of donor insemination
c. 19-year-old African American who is pregnant with twins
The indirect Coombs test is a screening tool for Rh incompatibility. If the titer is greater than ______, amniocentesis may be a necessary next step. a. 1:2 b. 1:4 c. 1:8 d. 1:12
c. 1:8
The nurse should understand the process by which the HIV infection occurs. Once the virus has entered the body, what is the time frame for seroconversion to HIV positivity? a. 6 to 10 days b. 2 to 4 weeks c. 6 to 12 weeks d. 6 months
c. 6 to 12 weeks
How many kilocalories per kilogram (kcal/kg) of body weight does a breastfed term infant require each day? a. 50 to 65 b. 75 to 90 c. 95 to 110 d. 150 to 200
c. 95 to 110
Which information related to a prolonged deceleration is important for the labor nurse to understand? a. Prolonged decelerations present a continuing pattern of benign decelerations that do not require intervention. b. Prolonged decelerations constitute a baseline change when they last longer than 5 minutes. c. A disruption to the fetal oxygen supply causes prolonged decelerations. d. Prolonged decelerations require the customary fetal monitoring by the nurse.
c. A disruption to the fetal oxygen supply causes prolonged decelerations.
Which statement accurately describes an appropriate-for-gestational age (AGA) weight assessment? a. AGA weight assessment falls between the 25th and 75th percentiles for the infants age. b. AGA weight assessment depends on the infants length and the size of the newborns head. c. AGA weight assessment falls between the 10th and 90th percentiles for the infants age. d. AGA weight assessment is modified to consider intrauterine growth restriction (IUGR).
c. AGA weight assessment falls between the 10th and 90th percentiles for the infants age.
A client in the third trimester has just undergone an amniocentesis to determine fetal lung maturity. Which statement regarding this testing is important for the nurse in formulating a care plan? a. Because of new imaging techniques, an amniocentesis should have been performed in the first trimester. b. Despite the use of ultrasonography, complications still occur in the mother or infant in 5% to 10% of cases. c. Administration of Rho(D) immunoglobulin may be necessary. d. The presence of meconium in the amniotic fluid is always a cause for concern.
c. Administration of Rho(D) immunoglobulin may be necessary.
At 35 weeks of pregnancy, a woman experiences preterm labor. Although tocolytic medications are administered and she is placed on bed rest, she continues to experience regular uterine contractions and her cervix is beginning to dilate and efface. What is an important test for fetal well-being at this time? a. PUBS b. Ultrasound for fetal size c. Amniocentesis for fetal lung maturity d. NST
c. Amniocentesis for fetal lung maturity
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? a. Only if the newborn is in obvious distress b. Once by the obstetrician, just after the birth c. At least twice, 1 minute and 5 minutes after birth d. Every 15 minutes during the newborns first hour after birth
c. At least twice, 1 minute and 5 minutes after birth
The nurse is performing an initial assessment of a client in labor. What is the appropriate terminology for the relationship of the fetal body parts to one another? a. Lie b. Presentation c. Attitude d. Position
c. Attitude
What is the rationale for the administration of vitamin K to the healthy full-term newborn? a. Most mothers have a diet deficient in vitamin K, which results in the infant being deficient. b. Vitamin K prevents the synthesis of prothrombin in the liver and must be administered by injection. c. Bacteria that synthesize vitamin K are not present in the newborns intestinal tract. d. The supply of vitamin K in the healthy full-term newborn is inadequate for at least 3 to 4 months and must be supplemented.
c. Bacteria that synthesize vitamin K are not present in the newborns intestinal tract.
A breastfeeding woman develops engorged breasts at 3 days postpartum. What action will help this client achieve her goal of reducing the engorgement? a. Skip feedings to enable her sore breasts to rest. b. Avoid using a breast pump. c. Breastfeed her infant every 2 hours. d. Reduce her fluid intake for 24 hours.
c. Breastfeed her infant every 2 hours.
While discussing the societal impacts of breastfeeding, the nurse should be cognizant of the benefits and educate the client accordingly. Which statement as part of this discussion would be incorrect? a. Breastfeeding requires fewer supplies and less cumbersome equipment. b. Breastfeeding saves families money. c. Breastfeeding costs employers in terms of time lost from work. d. Breastfeeding benefits the environment.
c. Breastfeeding costs employers in terms of time lost from work.
Which statement regarding the nutrient needs of breastfed infants is correct? a. Breastfed infants need extra water in hot climates. b. During the first 3 months, breastfed infants consume more energy than formula-fed infants. c. Breastfeeding infants should receive oral vitamin D drops daily during at least the first 2 months. d. Vitamin K injections at birth are not necessary for breastfed infants.
c. Breastfeeding infants should receive oral vitamin D drops daily during at least the first 2 months.
What is the drug of choice for the treatment of gonorrhea? a. Penicillin G b. Tetracycline c. Ceftriaxone d. Acyclovir
c. Ceftriaxone
Which statement most accurately describes the HELLP syndrome? a. Mild form of preeclampsia b. Diagnosed by a nurse alert to its symptoms c. Characterized by hemolysis, elevated liver enzymes, and low platelets d. Associated with preterm labor but not perinatal mortality
c. Characterized by hemolysis, elevated liver enzymes, and low platelets
Which sexually transmitted infection (STI) is the most commonly reported in American women? a. Gonorrhea b. Syphilis c. Chlamydia d. Candidiasis
c. Chlamydia
Near the end of the first week of life, an infant who has not been treated for any infection develops a copper-colored maculopapular rash on the palms and around the mouth and anus. The newborn is displaying signs and symptoms of which condition? a. Gonorrhea b. Herpes simplex virus (HSV) infection c. Congenital syphilis d. HIV
c. Congenital syphilis
A primigravida is being monitored at the prenatal clinic for preeclampsia. Which finding is of greatest concern to the nurse? a. Blood pressure (BP) increase to 138/86 mm Hg b. Weight gain of 0.5 kg during the past 2 weeks c. Dipstick value of 3+ for protein in her urine d. Pitting pedal edema at the end of the day
c. Dipstick value of 3+ for protein in her urine
While assessing the integument of a 24-hour-old newborn, the nurse notes a pink papular rash with vesicles superimposed on the thorax, back, and abdomen. What action is the highest priority for the nurse to take at this time? a. Immediately notify the physician. b. Move the newborn to an isolation nursery. c. Document the finding as erythema toxicum neonatorum. d. Take the newborns temperature, and obtain a culture of one of the vesicles.
c. Document the finding as erythema toxicum neonatorum.
Nurses should be cognizant of what regarding the mechanism of labor? a. Seven critical movements must progress in a more or less orderly sequence. b. Asynclitism is sometimes achieved by means of the Leopolds maneuver. c. Effects of the forces determining descent are modified by the shape of the womans pelvis and the size of the fetal head. d. At birth, the baby is said to achieve restitution; that is, a return to the C-shape of the womb.
c. Effects of the forces determining descent are modified by the shape of the womans pelvis and the size of the fetal head.
A primigravida has just delivered a healthy infant girl. The nurse is about to administer erythromycin ointment in the infants eyes when the mother asks, What is that medicine for? How should the nurse respond? a. It is an eye ointment to help your baby see you better. b. It is to protect your baby from contracting herpes from your vaginal tract. c. Erythromycin is prophylactically given to prevent a gonorrheal infection. d. This medicine will protect your babys eyes from drying out over the next few days.
c. Erythromycin is prophylactically given to prevent a gonorrheal infection.
Women with mild gestational hypertension and mild preeclampsia can be safely managed at home with frequent maternal and fetal evaluation. Complete or partial bed rest is still frequently ordered by some providers. Which complication is rarely the result of prolonged bed rest? a. Thrombophlebitis b. Psychologic stress c. Fluid retention d. Cardiovascular deconditioning
c. Fluid retention
A womans position is an important component of the labor progress. Which guidance is important for the nurse to provide to the laboring client? a. The supine position, which is commonly used in the United States, increases blood flow. b. The laboring client positioned on her hands and knees (all fours position) is hard on the womans back. c. Frequent changes in position help relieve fatigue and increase the comfort of the laboring client. d. In a sitting or squatting position, abdominal muscles of the laboring client will have to work harder.
c. Frequent changes in position help relieve fatigue and increase the comfort of the laboring client.
A neonate is born with mild clubfeet. When the parents ask the nurse how this will be corrected, how should the nurse respond? a. Traction is tried first. b. Surgical intervention is needed. c. Frequent, serial casting is tried first. d. Children outgrow this condition when they learn to walk.
c. Frequent, serial casting is tried first.
Which STI does not respond well to antibiotic therapy? a. Chlamydia b. Gonorrhea c. Genital herpes d. Syphilis
c. Genital herpes
A mother expresses fear about changing her infants diaper after he is circumcised. What does the client need to be taught to care for her newborn son? a. Cleanse the penis with prepackaged diaper wipes every 3 to 4 hours. b. Apply constant, firm pressure by squeezing the penis with the fingers for at least 5 minutes if bleeding occurs. c. Gently cleanse the penis with water and apply petroleum jelly around the glans after each diaper change. d. Wash off the yellow exudate that forms on the glans at least once every day to prevent infection.
c. Gently cleanse the penis with water and apply petroleum jelly around the glans after each diaper change.
In the past, factors to determine whether a woman was likely to develop a high-risk pregnancy were primarily evaluated from a medical point of view. A broader, more comprehensive approach to high-risk pregnancy has been adopted today. Four categories have now been established, based on the threats to the health of the woman and the outcome of pregnancy. Which category should not be included in this group? a. Biophysical b. Psychosocial c. Geographic d. Environmental
c. Geographic
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? a. Begin solid foods. b. Have a bottle of formula after every feeding. c. Have one extra breastfeeding session every 24 hours. d. Start iron supplements.
c. Have one extra breastfeeding session every 24 hours.
The labor of a pregnant woman with preeclampsia is going to be induced. Before initiating the oxytocin (Pitocin) infusion, the nurse reviews the womans latest laboratory test findings, which reveal a platelet count of 90,000 mm3, an elevated aspartate aminotransaminase (AST) level, and a falling hematocrit. The laboratory results are indicative of which condition? a. Eclampsia b. Disseminated intravascular coagulation (DIC) syndrome c. Hemolysis, elevated liver enzyme levels, and low platelet levels (HELLP) syndrome d. Idiopathic thrombocytopenia
c. Hemolysis, elevated liver enzyme levels, and low platelet levels (HELLP) syndrome
Which condition is the most life-threatening virus to the fetus and neonate? a. Hepatitis A virus (HAV) b. Herpes simplex virus (HSV) c. Hepatitis B virus (HBV) d. Cytomegalovirus (CMV)
c. Hepatitis B virus (HBV)
While examining a newborn, the nurse notes uneven skinfolds on the buttocks and a clunk when performing the Ortolani maneuver. These findings are likely indicative of what? a. Polydactyly b. Clubfoot c. Hip dysplasia d. Webbing
c. Hip dysplasia
An infant was born 2 hours ago at 37 weeks of gestation and weighs 4.1 kg. The infant appears chubby with a flushed complexion and is very tremulous. The tremors are most likely the result of what condition? a. Birth injury b. Hypocalcemia c. Hypoglycemia d. Seizures
c. Hypoglycemia
A new mother wants to be sure that she is meeting her daughters needs while feeding the baby commercially prepared infant formula. The nurse should evaluate the mothers knowledge about appropriate infant feeding techniques. Which statement by the client reassures the nurse that correct learning has taken place? a. Since reaching 2 weeks of age, I add rice cereal to my daughters formula to ensure adequate nutrition. b. I warm the bottle in my microwave oven. c. I burp my daughter during and after the feeding as needed. d. I refrigerate any leftover formula for the next feeding.
c. I burp my daughter during and after the feeding as needed.
The nurse is teaching new parents about metabolic screening for the newborn. Which statement is most helpful to these clients? a. All states test for phenylketonuria (PKU), hypothyroidism, cystic fibrosis, and sickle cell diseases. b. Federal law prohibits newborn genetic testing without parental consent. c. If genetic screening is performed before the infant is 24 hours old, then it should be repeated at age 1 to 2 weeks. d. Hearing screening is now mandated by federal law.
c. If genetic screening is performed before the infant is 24 hours old, then it should be repeated at age 1 to 2 weeks.
As the nurse assists a new mother with breastfeeding, the client asks, If formula is prepared to meet the nutritional needs of the newborn, what is in breast milk that makes it better? What is the nurses best response? a. More calories b. Essential amino acids c. Important immunoglobulins d. More calcium
c. Important immunoglobulins
The nurse is evaluating a neonate who was delivered 3 hours ago by vacuum-assisted delivery. The infant has developed a cephalhematoma. Which statement is most applicable to the care of this neonate? a. Intracranial hemorrhage (ICH) as a result of birth trauma is more likely to occur in the preterm, low-birth-weight infant. b. Subarachnoid hemorrhage (the most common form of ICH) occurs in term infants as a result of hypoxia. c. In many infants, signs of hemorrhage in a full-term infant are absent and diagnosed only through laboratory tests. d. Spinal cord injuries almost always result from vacuum-assisted deliveries.
c. In many infants, signs of hemorrhage in a full-term infant are absent and diagnosed only through laboratory tests.
Which adaptation of the maternal-fetal exchange of oxygen occurs in response to uterine contraction? a. The maternal-fetal exchange of oxygen and waste products continues except when placental functions are reduced. b. This maternal-fetal exchange increases as the blood pressure decreases. c. It diminishes as the spiral arteries are compressed. d. This exchange of oxygen and waste products is not significantly affected by contractions.
c. It diminishes as the spiral arteries are compressed.
The nurse is performing a gestational age and physical assessment on the newborn. The infant appears to have an excessive amount of saliva. This clinical finding may be indicative of what? a. Excessive saliva is a normal finding in the newborn. b. Excessive saliva in a neonate indicates that the infant is hungry. c. It may indicate that the infant has a tracheoesophageal fistula or esophageal atresia. d. Excessive saliva may indicate that the infant has a diaphragmatic hernia.
c. It may indicate that the infant has a tracheoesophageal fistula or esophageal atresia.
A nurse is assessing a newborn girl who is 2 hours old. Which finding warrants a call to the health care provider? a. Blood glucose of 45 mg/dl using a Dextrostix screening method b. Heart rate of 160 beats per minute after vigorously crying c. Laceration of the cheek d. Passage of a dark black-green substance from the rectum
c. Laceration of the cheek
A 30-year-old gravida 3, para 2-0-0-2 is at 18 weeks of gestation. Which screening test should the nurse recommend be ordered for this client? a. BPP b. Chorionic villi sampling c. MSAFP screening d. Screening for diabetes mellitus
c. MSAFP screening
The nurse observes a sudden increase in variability on the ERM tracing. Which class of medications may cause this finding? a. Narcotics b. Barbiturates c. Methamphetamines d. Tranquilizers
c. Methamphetamines
Providing care for the neonate born to a mother who abuses substances can present a challenge for the health care team. Nursing care for this infant requires a multisystem approach. What is the first step in the provision of care for the infant? a. Pharmacologic treatment b. Reduction of environmental stimuli c. Neonatal abstinence syndrome (NAS) scoring d. Adequate nutrition and maintenance of fluid and electrolyte balance
c. Neonatal abstinence syndrome (NAS) scoring
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? a. The renal function of a newborn is not fully developed, and heat is lost in the urine. b. The small body surface area of a newborn favors more rapid heat loss than does an adults body surface area. c. Newborns have a relatively thin layer of subcutaneous fat that provides poor insulation. d. Their normal flexed posture favors heat loss through perspiration.
c. Newborns have a relatively thin layer of subcutaneous fat that provides poor insulation.
A labor and delivery nurse should be cognizant of which information regarding how the fetus moves through the birth canal? a. Fetal attitude describes the angle at which the fetus exits the uterus. b. Of the two primary fetal lies, the horizontal lie is that in which the long axis of the fetus is parallel to the long axis of the mother. c. Normal attitude of the fetus is called general flexion. d. Transverse lie is preferred for vaginal birth.
c. Normal attitude of the fetus is called general flexion.
How would the nurse differentiate a meconium stool from a transitional stool in the healthy newborn? a. Observed at age 3 days b. Is residue of a milk curd c. Passes in the first 12 hours of life d. Is lighter in color and looser in consistency
c. Passes in the first 12 hours of life
What marks on a babys skin may indicate an underlying problem that requires notification of a physician? a. Mongolian spots on the back b. Telangiectatic nevi on the nose or nape of the neck c. Petechiae scattered over the infants body d. Erythema toxicum neonatorum anywhere on the body
c. Petechiae scattered over the infants body
A first-time dad is concerned that his 3-day-old daughters skin looks yellow. In the nurses explanation of physiologic jaundice, what fact should be included? a. Physiologic jaundice occurs during the first 24 hours of life. b. Physiologic jaundice is caused by blood incompatibilities between the mother and the infant blood types. c. Physiologic jaundice becomes visible when serum bilirubin levels peak between the second and fourth days of life. d. Physiologic jaundice is also known as breast milk jaundice.
c. Physiologic jaundice becomes visible when serum bilirubin levels peak between the second and fourth days of life.
The baseline FHR is the average rate during a 10-minute segment. Changes in FHR are categorized as periodic or episodic. These patterns include both accelerations and decelerations. The labor nurse is evaluating the clients most recent 10-minute segment on the monitor strip and notes a late deceleration. Which is likely to have caused this change? (Select all that apply.) a. Spontaneous fetal movement b. Compression of the fetal head c. Placental abruption d. Cord around the babys neck e. Maternal supine hypotension
c. Placental abruption e. Maternal supine hypotension
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? a. Applying an oil-based lotion to the newborns skin to prevent dying and cracking b. Limiting the newborns intake of milk to prevent nausea, vomiting, and diarrhea c. Placing eye shields over the newborns closed eyes d. Changing the newborns position every 4 hours
c. Placing eye shields over the newborns closed eyes
Which action by the mother will initiate the milk ejection reflex (MER)? a. Wearing a firm-fitting bra b. Drinking plenty of fluids c. Placing the infant to the breast d. Applying cool packs to her breast
c. Placing the infant to the breast
In which clinical situation would the nurse most likely anticipate a fetal bradycardia? a. Intraamniotic infection b. Fetal anemia c. Prolonged umbilical cord compression d. Tocolytic treatment using terbutaline
c. Prolonged umbilical cord compression
When assessing the fetus using Leopolds maneuvers, the nurse feels a round, firm, and movable fetal part in the fundal portion of the uterus and a long, smooth surface in the mothers right side close to midline. What is the position of the fetus? a. ROA b. LSP c. RSA d. LOA
c. RSA
Which type of formula is not diluted with water, before being administered to an infant? a. Powdered b. Concentrated c. Ready-to-use d. Modified cows milk
c. Ready-to-use
The nurse should be cognizant of which important information regarding the gastrointestinal (GI) system of the newborn? a. The newborns cheeks are full because of normal fluid retention. b. The nipple of the bottle or breast must be placed well inside the babys mouth because teeth have been developing in utero, and one or more may even be through. c. Regurgitation during the first day or two can be reduced by burping the infant and slightly elevating the babys head. d. Bacteria are already present in the infants GI tract at birth because they traveled through the placenta.
c. Regurgitation during the first day or two can be reduced by burping the infant and slightly elevating the babys head.
Which conditions are infants of diabetic mothers (IDMs) at a higher risk for developing? a. Iron deficiency anemia b. Hyponatremia c. Respiratory distress syndrome d. Sepsis
c. Respiratory distress syndrome
The nurse is instructing a family how to care for their infant in a Pavlik harness to treat DDH. What information should be included in the teaching? a. Apply lotion or powder to minimize skin irritation. b. Remove the harness several times a day to prevent contractures. c. Return to the clinic every 1 to 2 weeks. d. Place a diaper over the harness, preferably using an absorbent disposable diaper.
c. Return to the clinic every 1 to 2 weeks.
Which information should the nurse provide to a breastfeeding mother regarding optimal self-care? a. She will need an extra 1000 calories a day to maintain energy and produce milk. b. She can return to prepregnancy consumption patterns of any drinks as long as she gets enough calcium. c. She should avoid trying to lose large amounts of weight. d. She must avoid exercising because it is too fatiguing.
c. She should avoid trying to lose large amounts of weight.
A woman with worsening preeclampsia is admitted to the hospitals labor and birth unit. The physician explains the plan of care for severe preeclampsia, including the induction of labor, to the woman and her husband. Which statement by the husband leads the nurse to believe that the couple needs further information? a. I will help my wife use the breathing techniques that we learned in our childbirth classes. b. I will give my wife ice chips to eat during labor. c. Since we will be here for a while, I will call my mother so she can bring the two boys 2 years and 4 years of age to visit their mother. d. I will stay with my wife during her labor, just as we planned.
c. Since we will be here for a while, I will call my mother so she can bring the two boys 2 years and 4 years of age to visit their mother.
For an infant experiencing symptoms of drug withdrawal, which intervention should be included in the plan of care? a. Administering chloral hydrate for sedation b. Feeding every 4 to 6 hours to allow extra rest between feedings c. Snugly swaddling the infant and tightly holding the baby d. Playing soft music during feeding
c. Snugly swaddling the infant and tightly holding the baby
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? a. Avoid suctioning the nares. b. Insert the compressed bulb into the center of the mouth. c. Suction the mouth first. d. Remove the bulb syringe from the crib when finished.
c. Suction the mouth first.
Which statement by the client would lead the nurse to believe that labor has been established? a. I passed some thick, pink mucus when I urinated this morning. b. My bag of waters just broke. c. The contractions in my uterus are getting stronger and closer together. d. My baby dropped, and I have to urinate more frequently now.
c. The contractions in my uterus are getting stronger and closer together.
Which information should nurses provide to expectant mothers when teaching them how to evaluate daily fetal movement counts (DFMCs)? a. Alcohol or cigarette smoke can irritate the fetus into greater activity. b. Kick counts should be taken every hour and averaged every 6 hours, with every other 6-hour stretch off. c. The fetal alarm signal should go off when fetal movements stop entirely for 12 hours. d. A count of less than four fetal movements in 1 hour warrants future evaluation.
c. The fetal alarm signal should go off when fetal movements stop entirely for 12 hours.
Which information related to the newborns developing cardiovascular system should the nurse fully comprehend? a. The heart rate of a crying infant may rise to 120 beats per minute. b. Heart murmurs heard after the first few hours are a cause for concern. c. The point of maximal impulse (PMI) is often visible on the chest wall. d. Persistent bradycardia may indicate respiratory distress syndrome (RDS).
c. The point of maximal impulse (PMI) is often visible on the chest wall.
What is a distinct advantage of external EFM? a. The ultrasound transducer can accurately measure short-term variability and beat-to-beat changes in the FHR. b. The tocotransducer can measure and record the frequency, regularity, intensity, and approximate duration of uterine contractions. c. The tocotransducer is especially valuable for measuring uterine activity during the first stage of labor. d. Once correctly applied by the nurse, the transducer need not be repositioned even when the woman changes positions.
c. The tocotransducer is especially valuable for measuring uterine activity during the first stage of labor.
A pregnant woman has been receiving a magnesium sulfate infusion for treatment of severe preeclampsia for 24 hours. On assessment, the nurse finds the following vital signs: temperature 37.3 C, pulse rate 88 beats per minute, respiratory rate 10 breaths per minute, BP 148/90 mm Hg, absent deep tendon reflexes (DTRs), and no ankle clonus. The client complains, Im so thirsty and warm. What is the nurses immediate action? a. To call for an immediate magnesium sulfate level b. To administer oxygen c. To discontinue the magnesium sulfate infusion d. To prepare to administer hydralazine
c. To discontinue the magnesium sulfate infusion
What is the primary purpose for magnesium sulfate administration for clients with preeclampsia and eclampsia? a. To improve patellar reflexes and increase respiratory efficiency b. To shorten the duration of labor c. To prevent convulsions d. To prevent a boggy uterus and lessen lochial flow
c. To prevent convulsions
What is the primary rationale for nurses wearing gloves when handling the newborn? a. To protect the baby from infection b. As part of the Apgar protocol c. To protect the nurse from contamination by the newborn d. Because the nurse has the primary responsibility for the baby during the first 2 hours
c. To protect the nurse from contamination by the newborn
The nurse providing care for a high-risk laboring woman is alert for late FHR decelerations. Which clinical finding might be the cause for these late decelerations? a. Altered cerebral blood flow b. Umbilical cord compression c. Uteroplacental insufficiency d. Meconium fluid
c. Uteroplacental insufficiency
The nurse who provides care to clients in labor must have a thorough understanding of the physiologic processes of maternal hypotension. Which outcome might occur if the interventions for maternal hypotension are inadequate? a. Early FHR decelerations b. Fetal arrhythmias c. Uteroplacental insufficiency d. Spontaneous rupture of membranes
c. Uteroplacental insufficiency
The nurse is cognizant of which information related to the administration of vitamin K? a. Vitamin K is important in the production of red blood cells. b. Vitamin K is necessary in the production of platelets. c. Vitamin K is not initially synthesized because of a sterile bowel at birth. d. Vitamin K is responsible for the breakdown of bilirubin and the prevention of jaundice.
c. Vitamin K is not initially synthesized because of a sterile bowel at birth.
Which nursing assessment indicates that a woman who is in second-stage labor is almost ready to give birth? a. Fetal head is felt at 0 station during the vaginal examination. b. Bloody mucous discharge increases. c. Vulva bulges and encircles the fetal head. d. Membranes rupture during a contraction.
c. Vulva bulges and encircles the fetal head.
In assisting the breastfeeding mother to position the baby, which information regarding positioning is important for the nurse to keep in mind? a. The cradle position is usually preferred by mothers who had a cesarean birth. b. Women with perineal pain and swelling prefer the modified cradle position. c. Whatever the position used, the infant is belly to belly with the mother. d. While supporting the head, the mother should push gently on the occiput.
c. Whatever the position used, the infant is belly to belly with the mother.
According to demographic research, which woman is least likely to breastfeed and therefore most likely to need education regarding the benefits and proper techniques of breastfeeding? a. Between 30 and 35 years of age, Caucasian, and employed part time outside the home b. Younger than 25 years of age, Hispanic, and unemployed c. Younger than 25 years of age, African-American, and employed full time outside the home d. 35 years of age or older, Caucasian, and employed full time at home
c. Younger than 25 years of age, African-American, and employed full time outside the home
How long can it take Asian babies bilirubin to decline?
can take up to 7-10 days after birth
The mother who has a sudden onset of sore nipples after days or weeks of comfortable breastfeeding likely has some type of fungal or bacterial infection, most likely...
candidiasis
Bruising of the scalp is often seen in the presence of...
caput succedaneum
edematous area of the scalp, most commonly found on the occiput, crosses suture lines
caput succedaneum
Normal variations for head:
caput succedaneum, slight asymmetry from intrauterine position, lack of molding, variation in fontanel size and degree of molding, difficulty in feeling sutures due to molding, possible overlap of sutures with molding, and variation in amount of hair
Maternal illness such as rubella, metabolic disease such as diabetes, and drug ingestion are associated with an increased risk of...
cardiac defects
BP is not routinely checked unless...
cardiac problems are suspected
Providing a protective environment is a key responsibility of the nurse and includes...
careful identification procedures, support of physiologic functions, and ways to prevent infection
At birth, more ... is present than ossified bone
cartilage
Congenital rubella syndrome includes...
cataracts or glaucoma, hearing loss, and cardiac defects
Early decelerations are thought to be....
caused by transient fetal head compression and is considered a normal and benign finding
Infants with a gonococcal eye infection should receive one dose of .... to prevent systemic infection
ceftriaxone
The main three presentations are:
cephalic (96%), breech (3%), and shoulder (1%)
Neurologic complications associated with preeclampsia include...
cerebral edema and hemorrhage and increased CNS irritability
Fine crackles may be auscultated for several hours after birth, especially in neonates born by...
cesarean section
As soon as the presenting part reaches the pelvic floor, the contractions...
change in nature and become expulsive
Lung expansion depends on...
chest wall contraction and adequate surfactant secretion
Many women with gonorrhea often have a concurrent...
chlamydia trachomatis infection
Most infants with toxoplasmosis gondii are asymptomatic at birth, but develop...
chorioretinitis, hydrocephalus, and/or signs of CNS involvement, such as learning disabilities
Microphthalmos, cataracts, and corneal scarring can result from...
chorioretinitis, keratitis, and retinal hemorrhage
Causes of ambiguous genitalia:
chromosomal abnormalities, defective sex hormone synthesis in male infants, and the placental transfer of masculinizing agents to female fetuses
Infants who become carries of HBV are at high risk for...
chronic hepatitis, cirrhosis of the liver, or liver cancer years later
Early or delayed clamping of the umbilical cord changes the...
circulatory dynamics of the newborn
Anxiety and depression medication that is not recommended during pregnancy includes:
citalopram, diazepam, escitalopram, fluoxetine, lithium, nortriptyline, sertraline, and venlafaxine
Bathing serves several purposes like...
cleansing the skin, observing the infant's condition, promoting comfort, and parent-child-family interaction
Auscultation of newborns usually sounds like...
clear, loud breath sounds that are very near due to lack of chest tissue
Multiple genetic and environmental factors have been linked to...
cleft lip/palate
Feeding problems are greater in infants with...
cleft palate than cleft lip
Average findings for female genitalia:
clitoris is edematous, labia majora edematous, covering labia minora in term infants, labia minora has possible protrusion over labia majora, smegma discharge, open orifice, mucoid discharge, hymenal/vaginal tag, urinary meatus underneath clitoris and difficult to see, void within 24 hours, voiding 2-6 times per 24 hr four first 1-2 days, voiding 6-8 times per day by day 4 or 5
Second heart sound is the...
closure of the aortic and pulmonic valves
First heart sound is the...
closure of the mitral and tricuspid valves
Abnormal breath sounds:
coarse or fine crackles, wheezes, expiratory grunt
Congenital CMV can cause a variety of neurologic problems such as...
cognitive disabilities, hearing loss, or visual impairment
With microcephaly, restricted brain growth is common so...
cognitive impairment is common
Reserves of brown fat are rapidly depleted with...
cold stress
Vasoconstriction occurs when the neonate's temperature drops and if not treated, it can progress to....
cold stress
Vaginal and hymenal tags are...
common findings and have no clinical significance
The odor of the secretions can be used as a means of ... with the infant
communication
Newborns prefer...
complex patterns over nonpatterned stimuli
Within the breast is a...
complex, intertwining network of milk ducts that transport milk from the alveoli to the nipple
The loss of heat from the body surface to cooler surfaces in direct contact
conduction
Current technology permits the prenatal diagnosis of many...
congenital anomalies and disorders
Oligohydramnios is associated with...
congenital anomalies and growth restriction
Maternal obesity can increase the risk of...
congenital heart anomalies
Maternal smoking is associated with a greater risk of...
congenital heart anomalies
Persistent bradycardia can be associated with...
congenital heart block or hypoxemia
What are the most common types of congenital malformations?
congenital heart defects
What is the leading cause of death in children with congenital defects?
congenital heart disease
The most common major congenital anomalies that cause serious problems in the neonate are...
congenital heart disease, neural tube defects, cleft lip or palate, and development dysplasia of the hip
The most common congenital anomalies that cause serious problems in the neonate are...
congenital heart disease, neural tube defects, cleft lip or palate, clubfoot, and developmental dysplasia of the hip
Herpes simplex virus fetal effects:
congenital infection (rare)
Toxoplasmosis fetal effects:
congenital infection is most likely to occur when maternal infection develops during the third trimester, risk of fetal injury is greatest when maternal infection occurs during the first trimester
For every 100 women diagnosed with primary or secondary syphilis, 2-5 infants will contract..
congenital syphilis
Maternal risk factors for microcephaly include...
congenital viral infections, chromosomal disorders, and malnutrition
Fetal assessment for women with severe preeclampsia
continuous electronic fetal heart rate monitoring, a biophysical profile, and US evaluation of fetal growth and amniotic fluid
The flow of heat from the body surface to cooler ambient air
convection
Heat loss of the infant occurs by four modes:
convection, radiation, evaporation, and conduction
Breastfeeding is
convenient
The risk of intraventricular hemorrhage is significantly reduced in preterm infants when...
cord clamping is delayed
The key to preventing sore nipples is...
correct breastfeeding technique
Average findings for ears:
correct placement line drawn through inner or outer canthi of eyes reaching to top notch of ears, well-formed with firm cartilage, responds to voice and other sounds, and both ears pass test
The four main categories of commercial formula:
cow's milk-based formulas, soy-based formulas, casein- or whey-hydrolysate formulas, and amino acid formulas
Postterm or post mature infants skin is likely to be...
cracked, parchment-like, and desquamating
place newborn on abdomen; newborn makes crawling movements with arms and legs
crawling reflex
with infant in supine position, examiner extends one leg of infant and presses down knee; stimulation of soles of foot of fixated limb should cause free leg to flex, adduct, and extend as if attempting to push away stimulating agent; opposite leg flexes, adducts, and then extends
crossed extension reflex
What are the behavioral vocalization responses in the neonate?
crying, whimpering, and groaning
Breastfeeding practices vary among...
cultures
Tetralogy of Fallot:
cyanosis, dyspnea, and hypoxia
A new mother asks the nurse when the soft spot on her sons head will go away. What is the nurses best response, based upon her understanding of when the anterior frontal closes? a. 2 months b. 8 months c. 12 months d. 18 months
d. 18 months
Screening for critical congenital heart disease (CCHD) was added to the uniform screening panel in 2011. The nurse has explained this testing to the new mother. Which action by the nurse related to this test is correct? a. Screening is performed when the infant is 12 hours of age. b. Testing is performed with an electrocardiogram. c. Oxygen (O2) is measured in both hands and in the right foot. d. A passing result is an O2 saturation of 95%.
d. A passing result is an O2 saturation of 95%.
A woman at 39 weeks of gestation with a history of preeclampsia is admitted to the labor and birth unit. She suddenly experiences increased contraction frequency of every 1 to 2 minutes, dark red vaginal bleeding, and a tense, painful abdomen. Which clinical change does the nurse anticipate? a. Eclamptic seizure b. Rupture of the uterus c. Placenta previa d. Abruptio placentae
d. Abruptio placentae
Which definition of an acceleration in the fetal heart rate (FHR) is accurate? a. FHR accelerations are indications of fetal well-being when they are periodic. b. FHR accelerations are greater and longer in preterm gestations. c. FHR accelerations are usually observed with breech presentations when they are episodic. d. An acceleration in the FHR presents a visually apparent and abrupt peak.
d. An acceleration in the FHR presents a visually apparent and abrupt peak.
Syphilis is a complex disease that can lead to serious systemic illness and even death if left untreated. Which manifestation differentiates primary syphilis from secondary syphilis? a. Fever, headache, and malaise b. Widespread rash c. Identified by serologic testing d. Appearance of a chancre 2 months after infection
d. Appearance of a chancre 2 months after infection
The client has been on magnesium sulfate for 20 hours for the treatment of preeclampsia. She just delivered a viable infant girl 30 minutes ago. What uterine findings does the nurse expect to observe or assess in this client? a. Absence of uterine bleeding in the postpartum period b. Fundus firm below the level of the umbilicus c. Scant lochia flow d. Boggy uterus with heavy lochia flow
d. Boggy uterus with heavy lochia flow
When attempting to screen and educate parents regarding the treatment of developmental dysplasia of the hip (DDH), which intervention should the nurse perform? a. Be able to perform the Ortolani and Barlow tests. b. Teach double or triple diapering for added support. c. Explain to the parents the need for serial casting. d. Carefully monitor infants for DDH at follow-up visits.
d. Carefully monitor infants for DDH at follow-up visits.
The brain is vulnerable to nutritional deficiencies and trauma in early infancy. What is the rationale for this physiologic adaptation in the newborn? a. Incompletely developed neuromuscular system b. Primitive reflex system c. Presence of various sleep-wake states d. Cerebellum growth spurt
d. Cerebellum growth spurt
The nurse providing care in a womens health care setting must be knowledgeable about STIs. Which STIs can be successfully treated? a. HSV b. AIDS c. Venereal warts d. Chlamydia
d. Chlamydia
Which statement best describes chronic hypertension? a. Chronic hypertension is defined as hypertension that begins during pregnancy and lasts for the duration of the pregnancy. b. Chronic hypertension is considered severe when the systolic BP is higher than 140 mm Hg or the diastolic BP is higher than 90 mm Hg. c. Chronic hypertension is general hypertension plus proteinuria. d. Chronic hypertension can occur independently of or simultaneously with preeclampsia.
d. Chronic hypertension can occur independently of or simultaneously with preeclampsia.
A nurse is responsible for teaching new parents regarding the hygienic care of their newborn. Which instruction should the nurse provide regarding bathing? a. Avoid washing the head for at least 1 week to prevent heat loss. b. Sponge bathe the newborn for the first month of life. c. Cleanse the ears and nose with cotton-tipped swabs, such as Q-tips. d. Create a draft-free environment of at least 24 C (75 F) when bathing the infant.
d. Create a draft-free environment of at least 24 C (75 F) when bathing the infant.
Which statement regarding the care of a client in labor is correct and important to the nurse as he or she formulates the plan of care? a. The womans blood pressure will increase during contractions and fall back to prelabor normal levels between contractions. b. The use of the Valsalva maneuver is encouraged during the second stage of labor to relieve fetal hypoxia. c. Having the woman point her toes will reduce leg cramps. d. Endogenous endorphins released during labor will raise the womans pain threshold and produce sedation.
d. Endogenous endorphins released during labor will raise the womans pain threshold and produce sedation.
What physiologic change occurs as the result of increasing the infusion rate of nonadditive IV fluids? a. Maintaining normal maternal temperature b. Preventing normal maternal hypoglycemia c. Increasing the oxygen-carrying capacity of the maternal blood d. Expanding maternal blood volume
d. Expanding maternal blood volume
A woman arrives at the clinic seeking confirmation that she is pregnant. The following information is obtained: She is 24 years old with a body mass index (BMI) of 17.5. She admits to having used cocaine several times during the past year and occasionally drinks alcohol. Her blood pressure is 108/70 mm Hg. The family history is positive for diabetes mellitus and cancer. Her sister recently gave birth to an infant with a neural tube defect (NTD). Which characteristics places this client in a high-risk category? a. Blood pressure, age, BMI b. Drug and alcohol use, age, family history c. Family history, blood pressure (BP), BMI d. Family history, BMI, drug and alcohol abuse
d. Family history, BMI, drug and alcohol abuse
Certain changes stimulate chemoreceptors in the aorta and carotid bodies to prepare the fetus for initiating respirations immediately after birth. Which change in fetal physiologic activity is not part of this process? a. Fetal lung fluid is cleared from the air passages during labor and vaginal birth. b. Fetal partial pressure of oxygen (PO2) decreases. c. Fetal partial pressure of carbon dioxide in arterial blood (PaCO2) increases. d. Fetal respiratory movements increase during labor.
d. Fetal respiratory movements increase during labor.
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 nurses first priority? a. Leave the infant in the room with the mother. b. Immediately take the infant to the nursery. c. Perform a gestational age assessment to determine whether the infant is large for gestational age. d. Frequently monitor blood glucose levels, and closely observe the infant for signs of hypoglycemia.
d. Frequently monitor blood glucose levels, and closely observe the infant for signs of hypoglycemia.
What bacterial infection is definitely decreasing because of effective drug treatment? a. Escherichia coli infection b. Tuberculosis c. Candidiasis d. Group B streptococci (GBS) infection
d. Group B streptococci (GBS) infection
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 infants nutritional needs? a. Sleeps for 6 hours at a time between feedings b. Has at least one breast milk stool every 24 hours c. Gains 1 to 2 ounces per week d. Has at least six to eight wet diapers per day
d. Has at least six to eight wet diapers per day
The nurse is assigned a home care visit of a 5-day-old infant for the treatment of jaundice. A thorough assessment is completed, and a health history is obtained. Which sign or symptom indicates that the infant may be displaying the initial phase of encephalopathy? a. High-pitched cry b. Severe muscle spasms (opisthotonos) c. Fever and seizures d. Hypotonia, lethargy, and poor suck
d. Hypotonia, lethargy, and poor suck
The perinatal nurse realizes that an FHR that is tachycardic, bradycardic, has late decelerations, or loss of variability is nonreassuring and is associated with which condition? a. Hypotension b. Cord compression c. Maternal drug use d. Hypoxemia
d. Hypoxemia
Nurses should be able to teach breastfeeding mothers the signs that the infant has correctly latched on. Which client statement indicates a poor latch? a. I feel a firm tugging sensation on my nipples but not pinching or pain. b. My baby sucks with cheeks rounded, not dimpled. c. My babys jaw glides smoothly with sucking. d. I hear a clicking or smacking sound.
d. I hear a clicking or smacking sound.
The nurse is evaluating the EFM tracing of the client who is in active labor. Suddenly, the FHR drops from its baseline of 125 down to 80 beats per minute. The mother is repositioned, and the nurse provides oxygen, increased IV fluids, and performs a vaginal examination. The cervix has not changed. Five minutes have passed, and the FHR remains in the 80s. What additional nursing measures should the nurse take next? a. Call for help. b. Insert a Foley catheter. c. Start administering Pitocin. d. Immediately notify the care provider.
d. Immediately notify the care provider.
Which nursing diagnosis is most appropriate for a newborn diagnosed with a diaphragmatic hernia? a. Risk for impaired parent-infant attachment b. Imbalanced nutrition, related to less than body requirements c. Risk for infection d. Impaired gas exchange
d. Impaired gas exchange
As part of the infant discharge instructions, the nurse is reviewing the use of the infant car safety seat. Which information is the highest priority for the nurse to share? a. Infant carriers are okay to use until an infant car safety seat can be purchased. b. For traveling on airplanes, buses, and trains, infant carriers are satisfactory. c. Infant car safety seats are used for infants only from birth to 15 pounds. d. Infant car seats should be rear facing and placed in the back seat of the car.
d. Infant car seats should be rear facing and placed in the back seat of the car.
What is the most critical physiologic change required of the newborn after birth? a. Closure of fetal shunts in the circulatory system b. Full function of the immune defense system c. Maintenance of a stable temperature d. Initiation and maintenance of respirations
d. Initiation and maintenance of respirations
Which FHR finding is the most concerning to the nurse who is providing care to a laboring client? a. Accelerations with fetal movement b. Early decelerations c. Average FHR of 126 beats per minute d. Late decelerations
d. Late decelerations
Nurses should be aware of the strengths and limitations of various biochemical assessments during pregnancy. Which statement regarding monitoring techniques is the most accurate? a. Chorionic villus sampling (CVS) is becoming more popular because it provides early diagnosis. b. MSAFP screening is recommended only for women at risk for NTDs. c. PUBS is one of the triple-marker tests for Down syndrome. d. MSAFP is a screening tool only; it identifies candidates for more definitive diagnostic procedures.
d. MSAFP is a screening tool only; it identifies candidates for more definitive diagnostic procedures.
An African-American woman noticed some bruises on her newborn daughters buttocks. The client asks the nurse what causes these. How would the nurse best explain this integumentary finding to the client? a. Lanugo b. Vascular nevus c. Nevus flammeus d. Mongolian spot
d. Mongolian spot
The nurse has evaluated a client with preeclampsia by assessing DTRs. The result is a grade of 3+. Which DTR response most accurately describes this score? a. Sluggish or diminished b. Brisk, hyperactive, with intermittent or transient clonus c. Active or expected response d. More brisk than expected, slightly hyperactive
d. More brisk than expected, slightly hyperactive
While evaluating the reflexes of a newborn, the nurse notes that with a loud noise the newborn symmetrically abducts and extends his arms, his fingers fan out and form a C with the thumb and forefinger, and he has a slight tremor. The nurse would document this finding as a positive _____ reflex. a. tonic neck b. glabellar (Myerson) c. Babinski d. Moro
d. Moro
As part of their teaching function at discharge, nurses should educate parents regarding safe sleep. Based on the most recent evidence, which information is incorrect and should be discussed with parents? a. Prevent exposure to people with upper respiratory tract infections. b. Keep the infant away from secondhand smoke. c. Avoid loose bedding, water beds, and beanbag chairs. d. Place the infant on his or her abdomen to sleep.
d. Place the infant on his or her abdomen to sleep.
Which basic type of pelvis includes the correct description and percentage of occurrence in women? a. Gynecoid: classic female pelvis; heart shaped; 75% b. Android: resembling the male pelvis; wide oval; 15% c. Anthropoid: resembling the pelvis of the ape; narrow; 10% d. Platypelloid: flattened, wide, and shallow pelvis; 3%
d. Platypelloid: flattened, wide, and shallow pelvis; 3%
Group B Streptococcus (GBS) is part of the normal vaginal flora in 20% to 30% of healthy pregnant women. GBS has been associated with poor pregnancy outcomes and is an important factor in neonatal morbidity and mortality. Which finding is not a risk factor for neonatal GBS infection? a. Positive prenatal culture b. Preterm birth at 37 weeks or less of gestation c. Maternal temperature of 38 C or higher d. Premature rupture of membranes (PROM) 24 hours or longer before the birth
d. Premature rupture of membranes (PROM) 24 hours or longer before the birth
How does the nurse document a NST during which two or more FHR accelerations of 15 beats per minute or more occur with fetal movement in a 20-minute period? a. Nonreactive b. Positive c. Negative d. Reactive
d. Reactive
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 newborns distress? a. Hypoglycemia b. Phrenic nerve injury c. Respiratory distress syndrome d. Sepsis
d. Sepsis
A pregnant woman is at 38 weeks of gestation. She wants to know whether there are any signs that labor is getting close to starting. Which finding is an indication that labor may begin soon? a. Weight gain of 1.5 to 2 kg (3 to 4 lb) b. Increase in fundal height c. Urinary retention d. Surge of energy
d. Surge of energy
Which statement regarding hemolytic diseases of the newborn is most accurate? a. Rh incompatibility matters only when an Rh-negative child is born to an Rh-positive mother. b. ABO incompatibility is more likely than Rh incompatibility to precipitate significant anemia. c. Exchange transfusions are frequently required in the treatment of hemolytic disorders. d. The indirect Coombs test is performed on the mother before birth; the direct Coombs test is performed on the cord blood after birth.
d. The indirect Coombs test is performed on the mother before birth; the direct Coombs test is performed on the cord blood after birth.
How should the nurse interpret an Apgar score of 10 at 1 minute after birth? a. The infant is having no difficulty adjusting to extrauterine life and needs no further testing. b. The infant is in severe distress and needs resuscitation. c. The nurse predicts a future free of neurologic problems. d. The infant is having no difficulty adjusting to extrauterine life but should be assessed again at 5 minutes after birth.
d. The infant is having no difficulty adjusting to extrauterine life but should be assessed again at 5 minutes after birth.
A primiparous woman is delighted with her newborn son and wants to begin breastfeeding as soon as possible. How should the client be instructed to position the infant to facilitate correct latch-on? a. The infant should be positioned with his or her arms folded together over the chest. b. The infant should be curled up in a fetal position. c. The woman should cup the infants head in her hand. d. The infants head and body should be in alignment with the mother.
d. The infants head and body should be in alignment with the mother.
A nursing student is helping the nursery nurses with morning vital signs. A baby born 10 hours ago by cesarean section is found to have moist lung sounds. What is the best interpretation of these data? a. The nurse should immediately notify the pediatrician for this emergency situation. b. The neonate must have aspirated surfactant. c. If this baby was born vaginally, then a pneumothorax could be indicated. d. The lungs of a baby delivered by cesarean section may sound moist during the first 24 hours after childbirth.
d. The lungs of a baby delivered by cesarean section may sound moist during the first 24 hours after childbirth.
A newly delivered mother who intends to breastfeed tells her nurse, I am so relieved that this pregnancy is over so that I can start smoking again. The nurse encourages the client to refrain from smoking. However, this new mother is insistent that she will resume smoking. How will the nurse adapt her health teaching with this new information? a. Smoking has little-to-no effect on milk production. b. No relationship exists between smoking and the time of feedings. c. The effects of secondhand smoke on infants are less significant than for adults. d. The mother should always smoke in another room.
d. The mother should always smoke in another room.
In comparing the abdominal and transvaginal methods of ultrasound examination, which information should the nurse provide to the client? a. Both require the woman to have a full bladder. b. The abdominal examination is more useful in the first trimester. c. Initially, the transvaginal examination can be painful. d. The transvaginal examination allows pelvic anatomy to be evaluated in greater detail.
d. The transvaginal examination allows pelvic anatomy to be evaluated in greater detail.
Human immunodeficiency virus (HIV) may be transmitted perinatally or during the postpartum period. Which statement regarding the method of transmission is most accurate? a. Only in the third trimester from the maternal circulation b. From the use of unsterile instruments c. Only through the ingestion of amniotic fluid d. Through the ingestion of breast milk from an infected mother
d. Through the ingestion of breast milk from an infected mother
In which situation would the nurse be called on to stimulate the fetal scalp? a. As part of fetal scalp blood sampling b. In response to tocolysis c. In preparation for fetal oxygen saturation monitoring d. To elicit an acceleration in the FHR
d. To elicit an acceleration in the FHR
A woman with preeclampsia has a seizure. What is the nurses highest priority during a seizure? a. To insert an oral airway b. To suction the mouth to prevent aspiration c. To administer oxygen by mask d. To stay with the client and call for help
d. To stay with the client and call for help
A 21-year-old client exhibits a greenish, copious, and malodorous discharge with vulvar irritation. A speculum examination and wet smear are performed. Which condition is this client most likely experiencing? a. Bacterial vaginosis b. Candidiasis c. Yeast infection d. Trichomoniasis
d. Trichomoniasis
The nurse is using intermittent auscultation (IA) to locate the fetal heartbeat. Which statement regarding this method of surveillance is accurate? a. The nurse can be expected to cover only two or three clients when IA is the primary method of fetal assessment. b. The best course is to use the descriptive terms associated with EFM when documenting results. c. If the heartbeat cannot be immediately found, then a shift must be made to EFM. d. Ultrasound can be used to find the FHR and to reassure the mother if the initial difficulty is a factor.
d. Ultrasound can be used to find the FHR and to reassure the mother if the initial difficulty is a factor.
Which infant response to cool environmental conditions is either not effective or not available to them? a. Constriction of peripheral blood vessels b. Metabolism of brown fat c. Increased respiratory rates d. Unflexing from the normal position
d. Unflexing from the normal position
Early this morning, an infant boy was circumcised using the PlastiBell method. Based on the nurses evaluation, when will the infant be ready for discharge? a. When the bleeding completely stops b. When yellow exudate forms over the glans c. When the PlastiBell plastic rim (bell) falls off d. When the infant voids
d. When the infant voids
The .... can be assessed at home and it is noninvasive, inexpensive, and simple to understand and does not usually interfere with the daily routine
daily fetal movement count (DFMC, also called the kick count)
Fetal evaluation includes....
daily fetal movement counts and nonstress testing or a biophysical profile once or twice weekly until birth
Fetal complications of amniocentesis:
death, hemorrhage, infection, and direct injury from the needle
Bicarbonate concentration and buffering capacity are...
decreased
Overhydration can result in...
decreased milk production
Rapid weight is loss is not recommended for breastfeeding moms especially because it could result in...
decreased milk production
There is an increase in fetal and neonatal mortality in postmature infants compared with those born at term because of fetal distress associated with....
decreasing efficiency of the placenta, macrosomia, and meconium aspiration syndrome
US provides earlier diagnoses, allowing therapy to be instituted earlier in the pregnancy, thereby...
decreasing the severity and duration of morbidity, both physical and emotional for the family
use finger instead of percussion hammer to elicit patellar, or knee jerk, newborn must be relaxed; reflex jerk is present even with newborn being relaxed
deep tendon reflex
reflect the balance between the cerebral cortex and spinal cord
deep tendon reflexes
Polycythemia can occur in term and preterm infants as a result of...
delayed cord clamping, maternal hypertension or diabetes, or intrauterine growth restriction
Maternal indications for possible supplementation include...
delayed lactogenesis and intolerable pain while feeding
Women who are overweight or obese are likely to experience...
delayed onset of lactogenesis stage II and reduced milk production compared to women of average weight
Once the infant is feeding well and gaining weight adequately, going to .... is appropriate, which means that the infant determines the frequency of feedings
demand feeding
Transvaginal ultrasonography is useful in the first trimester for...
detecting ectopic pregnancies, monitor the developing embryo, help identify abnormalities, and help establish gestational age
Close monitoring of the infant's vital signs is important in...
detecting impending problems early
Women with preeclampsia also have an increased risk of...
developing chronic hypertension and CVD later in life
The most common musculoskeletal anomalies in neonates are...
developmental dysplasia of the hip and congenital clubfoot
Neonates at high risk for hypoglycemia usually have...
dextrose support through an IV
An appropriate gender assignment is based on...
diagnosis, genital development and surgical options, cultural pressures, most likely adult gender identity, potential for mature sexual function, potential fertility, and the long-term physiologic and intellectual effect in the child and family
The anterior fontanel is _ shaped. It encloses within _____ after birth
diamond; 18 months
Because neonatal respiratory function is a matter of...
diaphragmatic contraction
the enlargement or widening of the cervical opening and the cervical canal that occurs once labor begun
dilation
Muscle tone and strength are...
directly related
Smoking and alcohol use are ... during breastfeeding
discouraged
Secondary NTDs are due to...
disruption in development of the lower sacral or coccygeal segments during secondary neurulation between 26 days and 8 weeks of gestation
Neonatal HSV infections can be classified as...
disseminated infections, CNS disease, or localized infection of the skin, eye, or mouth
Fullness below the umbilicus can indicate a...
distended bladder
Edema is assessed for...
distribution, degree, and pitting
Clinical signs that demonstrate the resolution of preeclampsia include...
diuresis and decreased edema
Blood flow to the breasts nearly .... during pregnancy
doubles
The umbilical cord begins to...
dry, shrivel, and blacken by the second or third day of life
What are the most common causes of neonatal intestinal obstruction?
duodenal atresia, midgut malrotation and volvulus, jejunoileal atresia, necrotizing enterocolitis, and meconium ileus
The major adaptations to extrauterine life occur...
during the first 6-8 hours after birth
Early decelerations usually occur...
during the first stage of labor when the cervix is dilated 4-7 cm but can occur during the second stage when the woman is pushing
The hip joint is maintained by...
dynamic splinting in a safe position with the proximal femur centered in the acetabulum in an attitude of flexion and abduction
Human papillomavirus (HPV) maternal effects:
dystocia from large lesions and excessive bleeding from lesions after birth trauma
Breast milk changes in composition with...
each stage of lactogenesis, during each feeding, and as the infant grows
Accurate measurement of BP is essential for the...
early detection of hypertensive disorders
Intrapartum care is directed toward...
early identification of fetal heart rate abnormalities and the prevention of maternal complications
The ideal method for promoting warmth and maintaining neonatal body temperature is...
early skin to skin contact
born 37 0/7 through 38 6/7 weeks
early term
FHR decelerations may be categorized as...
early, late, variable, or prolonged
onset of seizure activity or coma in a woman with preeclampsia who has no history of preexisting pathology that can result in seizure activity
eclampsia
Assessing ..... is important for preeclampsia
edema
External female genitalia are usually...
edematous and increasingly pigmented
The key to encouraging mothers to breastfeed is...
education and anticipatory guidance
the shortening and thinning of the cervix during the first stage of labor
effacement
The primary powers are responsible for the...
effacement and dilation of the cervix and descent of the fetus
Absent or minimal variability is classified as...
either abnormal or indeterminate
After the first period of reactivity the newborn...
either sleeps or has a marked decrease in motor activity
A recent increase in the number of early term infants is associated with...
elective inductions and elective cesarean births that are scheduled before 39 weeks
Examples of psychosocial risks:
emotional distress, disturbed interpersonal relationships, inadequate social support, smoking, caffeine, alcohol, drugs, psychologic status, and unsafe cultural practices
A major obstacle for women is...
employment and the need to return to work after birth
During the first trimester, differentiation between the .... is difficult
endometrium and small placenta
The brain requires glucose for....
energy
used to indicate that the largest transverse diameter of the presenting part has passed through the maternal pelvic brim or inlet into the true pelvis and usually corresponds to station 0
engagement
Corticosteroids are ordered to .... for gestations less than 34 weeks
enhance fetal lung maturation
The psychological benefits of breastfeeding for the mother include...
enhanced bonding and attachment and gives a sense of empowerment in the ability to provide nutrition for the infant
Montgomery glands on the areola...
enlarge
The goals of therapy for women with mild gestational hypertension and preeclampsia without severe features are to...
ensure maternal safety and to deliver a healthy newborn as close to term as possible
The goals of treatment for a woman with severe preeclampsia are...
ensuring maternal safety, assess the degree of maternal and fetal risk, formulate a plan for giving birth, and prevent serious complications from occurring (eclampsia, HELLP syndrome, placental abruptions, fetal growth restriction, and fetal demise)
hazards in the workplace and the woman's general environment and may include environmental chemicals, anesthetic gases, and radiation
environmental factors
Normal variation for eyes:
epicanthal folds which is characteristic to some ethnicities, edema if eye prophylaxis drops or ointment instilled, some discharge if silver nitrate is used, occasional presence of tears, subconjunctival hemorrhage, transient strabismus or nystagmus until third or fourth month
changes that are not associated with UCs
episodic changes
What is a newborn rash, or flea bite dermatitis where eosinophils are found in the vesicles?
erythema toxicum, a transient rash, is also called erythema neonatorum
The skin of the infant is ... for the first few hours after birth and then fades to the normal color
erythematous
Severe Rh incompatibility results in marked fetal hemolytic anemia because the fetal erythrocytes are destroyed by maternal Rh-positive antibodies and fetal bilirubin levels increase, which results in fetal jaundice, also known as icterus gravis and the fetus then compensates for the anemia by producing large numbers of immature erythrocytes to replace those hemolyzed, which is called...
erythroblastosis fetalis
What are the behavioral tasks of the neonatal period?
establishing a regulated behavioral tempo independent of the mother, which involves self-regulating arousal, self-monitoring changes in state, and patterning sleep; processes, storing, and organizing multiple stimuli; and establishing a relationship with caregivers and the environment
What are the physiologic adjustments of the neonatal period?
establishing and maintaining respirations, adjusting to circulatory changes, regulating temperature, ingesting, retaining, and digesting nutrients, eliminating waste, and regulating weight
The loss of heat that occurs when a liquid is converted to a vapor
evaporation
Drying the infant with vigorous rubbing removes moisture to prevent...
evaporative heat loss and provides tactile stimulation to stimulate respiratory effort
Esophageal atresia with or without TEF results in...
excessive oral secretions, drooling, and feeding tolerance
includes the use of oral antihypertensive medications to maintain a BP less than 160/100 mmHg and assessment to search for indicators or worsening condition in the mom or fetus
expectant management
In the US, risk factors for toxoplasmosis include..
exposure to contaminated soil and consumption of raw or undercooked meats or seafood
The most common bladder anomaly is ..., which results from the abnormal development of the bladder, abdominal wall, and pubic symphysis
exstrophy
The two modes of EFM are the...
external and internal modes
Using noninvasive technology, newborn hearing screening provides information about the pathways from the...
external ear to the cerebral cortex
touch or depress tip of tongue, newborn should force tongue outward
extrusion reflex
Average findings for eyes:
eyes and space between eyes each one third the distance from the inner to outer canthus, symmetric in size and shape, blink reflex present, no discharge, no tears, both present and of equal size, both round and firm. Pupils are equal in size and reactive to light. Eyeball movement is random, jerky, uneven focus possible briefly, following to midline, eyebrows are distinct
Newborns can imitate...
facial expressions and motions such as protruding the tongue
Encephalocele and anencephaly are abnormalities resulting from...
failure of the anterior end of the neural tube to close
Primary NTDs are the result of...
failure of the anterior neuropore to close or a disruption of an already closed neural tube between 18 and 25 days of gestation
Spina bifida results from the...
failure of the neural tube to close at some point
Decreased placental perfusion and hypoxia result from the...
failure of vascular remodeling
MER can be inhibited by...
fear, stress, and alcohol consumption
The infant's output is highly indicative of...
feeding adequacy
Before hospital discharge, nurses provide anticipatory guidance for parents regarding...
feeding and elimination patterns; positioning and holding; comfort measures; car seat safety; bathing, skin care, cord care, and nail care; and signs of illness
Infants should be fed whenever they exhibit....
feeding cues
Signs that can show the development of congestive heart failure are...
feeding difficulties and increasing respiratory distress
Common side effects of magnesium sulfate
feelings of warmth, flushing, diaphoresis, and burning at the IV site
Average findings for weight:
female 3400 g, male 3500 g and regaining of birth weight within the first two weeks
Cleft palate alone is more common in...
female infants and occurs more frequently as a constituent of certain syndromes
the maternal urge to bear down because of the release of endogenous oxytocin
ferguson reflex
AFP is produced in the...
fetal GI tract and liver
US provides critical information to health care providers regarding...
fetal activity and gestational age, normal versus abnormal fetal growth curves, fetal and placental anatomy, fetal well-being, and visual assistance with which invasive tests can be performed more safely
PUBS can be used to assess for...
fetal anemia, infection, and thrombocytopenia
First and second trimester antepartum assessment is directed primarily at the diagnosis of....
fetal anomalies
An elevated NT shows an increased risk for...
fetal cardiac disease
The CST provides an earlier warning of...
fetal compromise than the NST and produces fewer false-positive results
Sever rubella infection can result in...
fetal death
Preeclampsia in the fetus
fetal growth restriction, decreased amniotic fluid volume, abnormal fetal oxygenation, low birth weight, and preterm birth
The fetus should be monitored closely for the development of ... using serial ultrasound examinations if the mom has contracted parvovirus
fetal hydrops
Absent or minimal variability can result from...
fetal hypoxemia and metabolic acidemia, CNS depressants, congenital anomalies, preexisting neurologic injury
True bradycardia rarely occurs and is not specifically related to...
fetal oxygenation
During labor, the palpation of the fontanels and sutures during vaginal examination reveals...
fetal presentation, position, and attitude
Accelerations can be elicited by...
fetal scalp stimulation or vibroacoustic stimulation
Moderate variability indicates that FHR regulation is not significantly affected by...
fetal sleep cycles, tachycardia, prematurity, congenital anomalies, preexisting neurologic injury, or CNS depressant medications
With MRI, the examiner can evaluate...
fetal structure and overall growth, the placenta, and the quantity of amniotic fluid
Reactive NSTs and negative CSTs suggest...
fetal well-being
Accelerations are considered an indication of...
fetal well-being and normal fetal acid-base balance
The infant infected with HIV can have...
fever, chronic diarrhea, chronic dermatitis, interstitial pneumonitis, persistent thrush, and AIDS-defining opportunistic infections
Symptoms of enteroviruses in neonates:
fever, irritability, lethargy, poor feeding, rash, respiratory symptoms, and GI symptoms
HIV-infected neonates develop opportunistic infections (Candida albicans and pneumocystis jirovecii pneumonia) and experience rapid progression of immunodeficiency that often results in death during the...
first 1-2 years of life
Most infants pass meconium within the .... after birth.
first 12-24 hours
Postnatal surgery for myelomeningocele usually occurs within the...
first 24 hours of life
The process of accommodation is not present at birth but improves over the...
first 3 months of life
Varicella transmission to the fetus can occur across the placenta when the disease is contracted in the ... but is relatively infrequent
first half of pregnancy
Eye prophylaxis is usually done within the...
first hour after birth
The ideal time to begin breastfeeding is within the..
first hour after birth
Infants should be breastfed within the...
first hour after birth and 8-12 times every 24 hours thereafter.
The treatment for sore nipples is to...
first identify the cause and then attempt to correct the problem
The first stage of the transition period is called the...
first period of reactivity
Abnormalities due to rubella infection are most severe if the mother contracts the virus during the...
first trimester and rare if the disease occurs after that time
Term newborns assume a position of ___ to conserve heat because it helps guard against heat loss since it diminishes the amount of body surface exposed to the environment.
flexion
The loss of fluid in diarrhea can rapidly lead to...
fluid and electrolyte imbalance
The water used to mix either powered or concentrated liquid formula need not contain any...
fluoride, especially in the first 6 months of life
The traditional positions for breastfeeding are the...
football or clutch hold, modified cradle, cross-cradle or across the lap, cradle, and side-lying
Average findings for male genitalia:
foreskin covers glans if uncircumcised, meatus at the tip of the penis, prepuce covering glans penis and not retractable, scrotum is large, edematous, pendulous in term infant and covered in rugae, testes are palpable on each side, voiding within 24 hours, stream is adequate, voiding 2-6 times per 24 hr four first 1-2 days, voiding 6-8 times per day by day 4 or 5, testes retracted, especially when newborn is chilled
Feeding is difficult because the cleft palate renders the infant unable to...
form a vacuum to maintain suction while feeding
Who gains weight faster: breastfed or formula-fed infants?
formula fed
People who have immigrated from poorer countries to the US often choose to...
formula feed their infants because they believe it is a better, more modern method
The apical impulse in the newborn is at the...
fourth intercostal space and to the left of the midclavicular line
Unequal movement of the upper extremities or crepitus over the clavicular area can indicate...
fracture
To treat early-onset jaundice, breastfeeding is evaluated in terms of...
frequency and length of feedings, positioning, latch, and milk transfer
Terms used to describe involuntary contractions include:
frequency, duration, and intensity
We should auscultate for a...
full minute and RR should be taken for a full minute
born 39 0/7 through 40 6/7 weeks
full term
Treatment of the CMV infected newborn with .... is effective in decreasing neurologic sequelae
ganciclovir
When surgically repairing a CHD, what happens?
gastric contents are aspirated, and suction is applied to decompress the GI tract and prevent further cardiothoracic compromise
The neonate's maturity level can be gauged by assessing...
general appearance including posture, activity, any overt signs of anomalies that can cause initial distress, presence of bruising or other birth trauma, and state of alertness
The normal resting position of the neonate is...
general flexion
Average findings for skin:
generally pink, skin pigmentation begins to deepen right after birth in the basal layer of epidermis, acrocyanosis common after birth, no jaundice at birth, edema confined to eyelid, opacity of skin; few large blood vessels visible indistinctly over the abdomen, skin turgor is instant, whitish, cheesy, odorless vernix caseosa, and lanugo is found over shoulders, pinnae of ears, and forehead
Examples of biophysical risks:
genetic disorders, nutritional and general health status, and medical or obstetric-related illnesses
Tremors or jitteriness cease with...
gentle restraint of the body part, whereas seizure activity continues
What are the high risk factors for severe hyperbilirubinemia?
gestational age less than 37 weeks, exclusive breastfeeding, previous sibling who required phototherapy, pre-discharge transcutaneous bilirubin (TcB) or total serum bilirubin (TSB) level in the high-risk zone, cephalohematoma or other significant bruising, blood incompatibility with positive direct antiglobulin test, other known hemolytic disease such as G6PD, and East Asian race
Normal bilirubin levels are determined by...
gestational age, days of life, and the baby's general physical condition
Other factors that influence newborn behavior:
gestational age, time, stimuli, and medication
Pregnancy-onset snoring is a risk factor for...
gestational hypertension and preeclampsia
tap over forehead, bridge of nose, or maxilla of newborn whose eyes are open, newborn blinks for first four or five taps
glabellar reflex
Successive casts allow for...
gradual stretching of skin and tight structures on the medial site of the foot
The heart rate is assessed by...
grasping the base of the cord or by auscultating the left chest with a stethoscope
Immediately after birth, the heart rate can be palpated by...
grasping the base of the umbilical cord
Most secretions are removed by...
gravity and brought by the cough reflex to the oropharynx to be drained or swallowed or wiped away
The earlier in pregnancy that fetal infection with toxoplasmosis gondii occurs, the...
greater the severity of congenital disease
By day 2 or 3, the stools become...
greener, thinner, and less sticky
The first 2 days, infants pass meconium stools that are...
greenish black, thick, and sticky
Touch and motion are essential to....
growth and development
The presenting signs and symptoms of HIV infection vary from severe immunodeficiency to nonspecific findings such as...
growth failure, parotitis, and recurrent or persistent upper respiratory tract infections
Breasts increase in size due to...
growth of glandular and adipose tissue
HSV infected infants have...
growth restriction, skin lesions, scarring, severe psychomotor delays, intracranial calcifications, microcephaly, hypertonicity, seizures, microphthalmos, cataracts, chorioretinitis, blindness, retinal dysplasia, patent ductus arteriosus, limb anomalies, and recurrent skin vesicles, with a short life expectancy
Knowledge of biologic and behavioral characteristics is essential for...
guiding assessment and interpreting data
The four types of pelves:
gynecoid (the classic female type), android (resembling a male pelvis), anthropoid (oval shaped, with a wider anteroposterior diameter), and platypelloid (the flat pelvis)
Different responses to environmental stimuli:
habituation, consolability, cuddliness, irritability, and crying
Infants exhibit feeding-readiness cues or early signs of hunger, which include:
hand to mouth or hand to hand movements, sucking motions, rooting reflex, and mouthing
Each full-term newborn has a predisposed capacity to...
handle the multitude of stimuli in the external world
Jaundice goes from...
head to toe
CNS irritability symptoms:
headaches, hyperreflexia, positive ankle clonus, and seizures
Term newborns can ... among various sounds
hear and differentiate
With auscultation of a patent ductus arteriosus can be detected as a...
heart murmur
The APGAR score permits a rapid assessment of the newborn's transition to extrauterine life based on five signs that indicate the physiologic state of the neonate:
heart rate, respiratory effort (based on observed movement of the chest wall), muscle tone (based on degree of flexion and movement of the extremities), reflex irritability (based on response to suctioning of the nares or nasopharynx), and generalized skin color
Infants are monitored closely during and after the exchange transfusion, esp
heart rate, rhythm, respirations, blood pressure, temperature, and perfusion
All examinations and activities are performed with the newborn under a...
heat panel
What are critical to the newborn's survival?
heat regulation and establishing respirations and adequate circulation
Infants should be .... at all feedings
held
Negative intrathoracic pressure can be used to....
help draw air into the lungs
When maternal IgG class crosses the placenta, it causes...
hemolysis of the fetal RBCs, resulting in hyperbilirubinemia and jaundice
Fullness of the abdomen above the umbilicus can indicate...
hepatomegaly, duodenal atresia, or distention
Primary maternal infections after 32 weeks of gestation present a .... risk for the fetus and newborn than early or recurrent infections
higher
Women diagnosed with severe preeclampsia should be...
hospitalized immediately; they are placed on magnesium sulfate to prevent seizures; are assessed for BP, urine output, cerebral status, presence of epigastric pain, tenderness, labor, or vaginal bleeding; lab evals include platelet count, liver enzymes, and serum creatinine
Commercial formula is designed to resemble ... as closely as possible
human milk
Newborns who have galactosemia should not receive...
human milk
Clinical features ascribed to T. gondii infection include:
hydrocephalus, chorioretinitis, and cerebral calcifications
Nearly all female infants are born with...
hymenal tags
Preeclampsia in the mom
hypertension, proteinuria, and could cause multisystem dysfunction
Early term birth is associated with higher risk of...
hypoglycemia, respiratory problems, learning deficits, and a greater likelihood of NICU admission
Circumcision is contraindicated in the presence of .... because foreskin is used to repair this anomalies
hypospadias or epispadias
There is a correlation between...
hypospadias, testicular cancer, and cryptorchidism
Drying the infant quickly after birth is essential to prevent...
hypothermia
What thermoregulation issue is a common and dangerous problem?
hypothermia from excessive heat loss
Transient periods of duskiness while crying are common immediately after birth, but central cyanosis is abnormal and signifies...
hypoxemia
Category III FHR tracings:
i. Absent baseline variability and any of the following: 1. Recurrent late decelerations 2. Recurrent variable decelerations 3. Bradycardia ii. Sinusoidal pattern
Category II FHR tracings:
i. Baseline rate 1. Bradycardia not accompanied by absent baseline variability 2. Tachycardia ii. Baseline FHR variability 1. Minimal baseline variability 2. Absent baseline variability not accompanied by recurrent decelerations 3. Marked baseline variability iii. Accelerations 1. No acceleration produced in response to fetal stimulation iv. Periodic or episodic decelerations 1. Recurrent variable decelerations accompanied by minimal or moderate baseline variability 2. Prolonged decelerations (greater than or equal to 2 minutes but less than 10 minutes) 3. Recurrent late decelerations with moderate baseline variability 4. Variable decelerations with other characteristics, such as slow return to baseline, "overshoots" or "shoulders"
Category I FHR tracings include all of the following:
i. Baseline rate 110 to 160 bpm ii. Baseline FHR variability: moderate iii. Late or variable decelerations: absent iv. Early decelerations: either present or absent v. Accelerations: either present or absent
Management of Abnormal Fetal Heart Rate Patterns:
i. Basic interventions: 1. Administer oxygen by nonrebreather mask at a rate of 10 L/in for approximately 15-30 minutes. 2. Assist the woman to a side-lying (lateral) position. 3. Increase maternal blood volume by increasing the rate of the primary IV infusion.
Major uses of US during third trimester:
i. Confirm gestational age ii. Confirm viability iii. Detect macrosomia iv. Detect congenital abnormalities v. Detect IUGR vi. Determine fetal position vii. Detect placental previa or placental abruption viii. Use of visualization during amniocentesis, external version ix. Biophysical profile x. Amniotic fluid volume assessment xi. Doppler flow studies xii. Detect placental maturity
Major uses of US during first trimester:
i. Confirm pregnancy ii. Confirm viability iii. Determine gestational age iv. Rule out ectopic pregnancy v. Detect multiple gestation vi. Determine cause for vaginal bleeding vii. Use for visualization during chorionic villi sampling viii. Detect maternal abnormalities such as bicornuate uterus, ovarian cysts, an fibroids
Cause of late decelerations:
i. Disruption of oxygen transfer from environment to fetus caused by the following: 1. Uterine tachysystole 2. Maternal supine hypotension 3. Epidural or spinal anesthesia 4. Placental previa 5. Placental abruption 6. Hypertensive disorders 7. Postmaturity 8. Intrauterine growth restriction 9. DM 10. Intraamniotic infection
Major uses of US during second trimester:
i. Establish or confirm dates ii. Confirm viability iii. Detect polyhydramnios, oligohydramnios iv. Detect congenital anomalies v. Detect IUGR vi. Assess placental location vii. Use for visualization during amniocentesis
Causes of early decelerations:
i. Head compression resulting from the following: 1. Uterine contractions 2. Vaginal examination 3. Fundal pressure 4. Placement of internal mode of monitoring
Causes of prolonged decelerations:
i. Maternal hypotension ii. Uterine tachysystole or rupture iii. Extreme placental insufficiency iv. Prolonged cord compression or prolapse
Common risk factors for preeclampsia:
i. Primigravida younger than 19 or older than 40 ii. Preeclampsia with severe features in a previous pregnancy iii. Family history (mother or sister) with preeclampsia iv. Paternal history (partner previously fathered a preeclamptic pregnancy in another woman) v. African descent vi. Multifetal gestation vii. Maternal infection/inflammation in current pregnancy viii. Preexisting medical or genetic conditions
The fetal oxygen supply can decrease in a number of ways, including:
i. Reduction of blood flow through the maternal vessels as a result of maternal hypertension, hypotension, or hypovolemia. ii. Reduction of the oxygen content in the maternal blood as a result of hemorrhage or severe anemia. iii. Alterations in fetal circulation, occurring with compression of the umbilical cord, placental separation or complete abruption, or head compression. iv. Reduction in blood flow to the intervillous space in the placental secondary to deterioration of the placental vasculature associated with post-term gestation or maternal disorders such as hypertension or DM.
Causes of accelerations:
i. Spontaneous fetal movement ii. Vaginal examination iii. Electrode application iv. Fetal scalp stimulation v. Fetal reaction to external sounds vi. Breech presentation vii. Occiput posterior position viii. Uterine contractions ix. Fundal pressure x. Abdominal palpation
Cause of variable decelerations:
i. Umbilical cord compression caused by the following: 1. Maternal position with cord between fetus and maternal pelvis 2. Cord around fetal neck, arm, leg, or other body part 3. Short cord 4. Knot in cord 5. Prolapsed cord
The goals of intrapartum FHR monitoring are to...
identify and differentiate the normal (reassuring) patterns from the abnormal (nonreassuring) patterns, which can be indicative of fetal compromise
Breastfeeding should be discontinued temporarily when the mother undergoes...
imaging procedures that use radiopharmaceuticals
Eclampsia is not an indication for...
immediate cesarean birth
Decreased liver perfusion can lead to...
impaired liver function and elevated liver enzymes
VD are most commonly found...
in the transition phase of the first stage of labor or the second stage of labor as a result of umbilical cord compression and stretching during fetal descent
Teeth begin developing...
in utero
With central cyanosis, the lips and mucus membranes are blueish and can be a result of...
inadequate delivery of oxygen to the alveoli, poor perfusion of the lungs that inhibits gas exchange, or cardiac dysfunction
Biochemical analysis of enzymes in amniotic fluid can detect...
inborn errors of metabolism or fetal structural anomalies
Anencephaly is...
incompatible with life; most infants are stillborn or die within a few days of birth
Sore nipples are most often caused by...
incorrect latch
Crying and movement may ____ the systolic BP.
increase
In most instances, the solution to slow weight gain is to...
increase feeding frequency and to improve the feeding technique
Using alternate breast massage during feedings can help...
increase the amount of milk going to the infant
Normal variations for female genitalia:
increased pigmentation caused by pregnancy hormones, edema and ecchymosis after breech birth, some vernix caseosa between labia possible, blood tinged discharge from pseudomenstruation caused by pregnancy hormones, rust stained urine from uric acid crystals
Normal variations for male genitalia:
increased size and pigmentation caused by pregnancy hormones, wide variation in size of genitalia, prepuce removed if circumcised, scrotal edema and ecchymosis if breech birth, hydrocele, small, noncommunicating, bulge palpable in inguinal canal, rust-stained urine from uric acid crystals
Sensitivity of the breasts ..., and veins become more prominent
increases
The basal metabolic rate ..... with cold stress
increases
Soon after birth, blood flow...
increases to the lungs, heart, kidney, and GI tract
The infant can react to cold stress by...
increasing respirations and can become cyanotic
In tandem nursing, be sure to feed the ... first
infant
All parents should receive instructions in...
infant CPR
An electronic infant security tag or abduction system alarm should be placed on all newborns to aid in protecting against...
infant abduction
Possible indications for supplemental feeding include...
infant factors such as hypoglycemia, dehydration, weight loss more than 7% associated with delayed lactogenesis, delayed passage of bowel movements or meconium stool continued to day 5, poor milk transfer, or hyperbilirubinemia
Cultural factors influence...
infant feeding decisions
Prolactin is produced in response to...
infant suckling and emptying of the breasts
Breastfeeding frequency varies based on...
infant's age, weight, maturity level, stomach capacity and gastric emptying time, and capacity of the breast
At birth, the neonate's cord blood is sent to the laboratory to determine the...
infant's blood type and Rh status
ASAP after birth, the nurse places numbered bands on the...
infant's wrist and ankle, on the mother, and on the father or significant other
Screening for respiratory congenital anomalies is necessary even in...
infants who are apparently normal at birth
All newborns are at an increased risk for ... in the first few months of life
infection
Pregnancy confers most immunity against infection, and both mother and fetus must be considered when the pregnant woman contracts an...
infection
Other infections: Hepatitis B (serum hepatitis; virus) fetal effects:
infection occurs during birth, maternal vaccination during pregnancy should pose no risk to the fetus
Fetal and neonatal factors for microcephaly include...
inflammation, birth trauma, and sequelae of hypoxic-ischemic encephalopathy
The infant is footprinted with...
ink or a scanning device within 2 hours of birth
Newborn infant's chest and abdomen rise simultaneously with...
inspiration
Breastfeeding infants can develop early-onset jaundice or breastfeeding-associated jaundice, which is associated with...
insufficient feeding and infrequent early passage of meconium
What are the most common reasons for breastfeeding cessation?
insufficient milk supply, painful nipples, and problems getting the infant to feed
Subcutaneous fat accumulated during the first trimester acts as....
insulation
Herpes simplex virus maternal effects:
intrauterine contraction (rare)
The goal of the third trimester testing is to determine whether the...
intrauterine environment continues to support the fetus
Positive CST results have been associated with...
intrauterine fetal death, late FHR decelerations in labor, IUGR, and meconium-stained amniotic fluid
Fetal growth is determined by both..
intrinsic growth potential and environmental factors
The infant liver plays an important role in...
iron storage, carbohydrate metabolism, conjugation of bilirubin, and coagulation
Breastfeeding infants can benefit from a source of iron like an...
iron-fortified cereal or meat
If the infant is weaned from breast-feeding before the first birthday...
iron-fortified formula should be given
Variability of the FHR can be described as...
irregular waves or fluctuations in the baseline FHR of two cycles per minute or greater
If there is no bone involvement with polydactyly, then...
it is tied with a silk suture soon after birth
The technique of continuous internal FHR or UA monitoring provides a more accurate appraisal of fetal well-being during labor than external monitoring because....
it isn't interrupted by movement or affected by maternal size.
Polycythemia that occurs with delayed clamping is usually not harmful, although there can be an increased risk of...
jaundice that requires phototherapy
a yellowish discoloration of the skin, mucous membranes, sclera, and various organs
jaundice/icterus
Assess for signs of hypocalcemia in the infant...
jitteriness, irritability, convulsions, tachycardia, and electrocardiogram changes
Fetal cells can be cultured for...
karyotyping of chromosomes
The breastfeeding mother's normal routine bathing is all that is necessary to...
keep your breasts clean
chronic and permanent results of bilirubin toxicity
kernicterus
The key competencies for professionals regarding breastfeeding include...
knowledge, skills, and attitudes to promote and support breastfeeding
Some of the most common minor malformations include the...
lack of a helical fold of the pinna, simian creases, absent philtrum, or clinodactyly of the fifth finger
Examples of sociodemographic risks:
lack of prenatal care, low income, marital status, age, parity, residence, and ethnicity
The nipple-erection reflex is an important part of...
lactation
Lactase is necessary for digestion of...
lactose
A common practice for Mexican women is...
las dos cosas (both things) and is about mixing breastfeeding and formula feeding
Signs of effective breastfeeding in infant:
latches without difficulty, has bursts of 15-20 sucks/swallows at a time, audible swallowing, easily releases breast at end of feeding, infant appears content after feeding, and has at least three substantive bowel movements and six to eight wet diapers every 24 hours after day 4
Tachycardia can be an early sign for fetal hypoxemia, esp. when associated with...
late decelerations and minimal or absent variability
What can put the neonate at risk for congenital syphilis?
late or no prenatal care, maternal substance abuse, crack cocaine use in the mother or partner, multiple sexual partners, history of STI, poverty homelessness, and HIV infection
born 34 0/7 through 36 6/7 weeks
late preterm
Elective vaginal and cesarean births before 39 weeks have contributed significantly to...
late preterm birth rates in the US
The BPP is used frequently in the .... for antepartum fetal testing because it is reliable predictor of fetal well-being
late second and the third trimester
Maternal complications of amniocentesis:
leakage of amniotic fluid, hemorrhage, fetomaternal hemorrhage with possible maternal Rh isoimmunization, infection, labor, placental abruption, inadvertent damage to the intestine or bladder, and amniotic fluid embolism
Maternal risks associated with severe hypertension include...
left ventricular failure, cerebral hemorrhage, and placental abruption
Women who are overweight are ... likely to breastfeed than women who are underweight or average weight
less
Normal variations for chest circumference:
less than or equal to 30 cm
The manifestations of CNS disease caused by HSV include...
lethargy, poor feeding, irritability, and local or generalized seizures
the relation of the long axis (spine) of the fetus to the long axis (spine) of the mother
lie
Management of chronic hypertension in pregnancy:
lifestyle changes made prior to conception, diet that includes a maximum of 2.4 mg of sodium a day
Babies are more likely to feed if they are awakened from a...
light or active sleep state
Varicella effects on the fetus include...
limb atrophy, neurologic abnormalities, and eye abnormalities
Postterm or postmature infants are likely to have...
little if any vernix caseosa, absence of lanugo, abundant scalp hair, and long fingernails
Other infections: Hepatitis A (infectious hepatitis; virus) maternal effects:
liver failure (extremely rare), low-grade fever, malaise, poor appetite, right upper quadrant pain and tenderness, jaundice, and light-colored stools
The two primary lies are...
longitudinal (vertical) and transverse (horizontal)
Bilirubin breakdown increases gastric motility, which results in...
loose stools that can cause skin excoriation and breakdown
The epidermis and dermis are...
loosely bound and extremely thin
The first sound (S1) is typically...
louder and duller than the second sound (S2)
Chlamydia fetal effects:
low birth weight
Late preterm infants are at risk for feeding difficulties because of their...
low energy stores and high energy demands
The ductus arteriosus can open in response to...
low oxygen levels in association with hypoxia, asphyxia, or prematurity
Immediately after the convulsion...
lower the head of the bed and turn the woman onto her side to prevent aspiration
Surfactant _____ surface tension.
lowers
Nadir
lowest point
SB manifesta occurs in the...
lumbar or lumbosacral region and includes meningocele and myelomeningocele
The infant with symptomatic congenital syphilis should have a ... prior to treatment
lumbar puncture, CBC, and long-bone radiography
Pulmonary hypertension can occur as a result of the...
lung hypoplasia
A fractured clavicle often occurs in...
macrosomic infants and in those who had a difficult birth
place infant in supine position, partially flex both lower extremities and apply light pressure with fingers to soles of feet; both lower limbs should extend against examiner's pressure
magnet reflex
Nursing actions during an eclamptic convulsion:
maintain a patent airway and client safety
Feeding is difficult because the cleft lip renders the newborn unable to...
maintain a seal around a nipple
A woman with severe preeclampsia is...
maintained on bed rest with the side rails up in a quiet, darkened room
Nursing care immediately after birth includes...
maintaining an open airway, preventing heat loss, and promoting parent-infant interaction
The goals of surgery for hypospadias is to...
make it possible for the child to urinate standing up, improve the appearance of the genitalia, and have a sexually adequate organ
Average findings for head:
making up ¼ of the size of the body length, molding, anterior fontanel 5 cm diamond that increases as molding resolves, posterior fontanel triangle and smaller than the anterior, palpable and separated sutures, silky strands of hair lying flat, growth pattern of hair toward face and neck
In hydrops fetalis, the severe form of the disease, the fetus has...
marked anemia, cardiac decompensation, cardiomegaly, and hepatosplenomegaly which leads to hypoxia
The route of birth depends on...
maternal and fetal condition, fetal gestational age, presence of labor, and cervical Bishop score
The Monica AN24 uses five electrodes placed on the woman's abdomen to directly monitor the electrocardiogram from the...
maternal and fetal hearts and the electromyogram from the uterine muscle
Hemolytic disorders occur when...
maternal antibodies are present naturally or form in response to an antigen from the fetal blood crossing the placenta and entering the maternal circulation
Chronic hypertension in pregnancy is associated with...
maternal complications such as superimposed preeclampsia, stroke, acute kidney injury, heart failure, placental abruption, and death
The risk of transmission is increased with...
maternal enterovirus illness around the time of birth and a lack of maternal antibodies to the specific type of enterovirus
Fetal tachycardia can result from...
maternal or fetal infection, maternal hyperthyroidism or fetal anemia, or in response to certain drugs (atropine, hydroxyzine, terbutaline, or illicit drugs like cocaine or methamphetamines)
The process of antibody formation is called..
maternal sensitization
Hyperbilirubinemia is caused by a variety of factors, including...
maternal-fetal Rh and ABO incompatibility
Lactogenesis stage III is when...
mature milk is established around 10 days post-birth
Women who have had an augmentation mammoplasty...
may be able to breastfeed successfully
Other infections: Hepatitis B (serum hepatitis; virus) maternal effects:
may be transmitted sexually, approximately 10% of clients become chronic carriers, some people with chronic hepatitis B eventually develop severe chronic liver disease, such as cirrhosis or hepatocellular carcinoma
Initial lab values for women with preeclampsia without severe features include...
measurement of serum creatinine, platelet count, liver enzymes, and a 24-hour urine protein assessment
If the bulb syringe does not clear mucus interfering with respiratory effort, ... may be used
mechanical suction
Average findings for stools:
meconium followed by transitional and soft yellow stool
No supplements should be given to babies without...
medical indication
Examples of secondary NTDs are...
meningocele and sacral agenesis or dysgenesis
Parenteral doses of morphine or butorphanol are preferred over ... for breastfeeding mothers
meperidine
Most commonly prescribed galactagogues are...
metoclopramide and domperidone
Average findings for nose:
midline, some mucus but no drainage, preferential nose breather, and sneezing to clear nose
The contraction intensity is described as...
mild, moderate, or strong
distended, small, white sebaceous glands on the face
milia
The milk ducts dilate and expand at
milk ejection
Reduction mammoplasty causes problems with....
milk production and transfer because of interference with milk ducts, removal of glandular tissue, and nerve damage
The frequency of contractions is measured in...
minutes, from the beginning of one contraction to the beginning of another
Syphilis maternal effects:
miscarriage and preterm labor
During pregnancy, infection with parvovirus can result in...
miscarriage, fetal anemia, hydrops fetalis, IUGR, or stillbirth
Gonorrhea maternal effects:
miscarriage, premature ROM, preterm labor, amniotic infection syndrome, chorioamnionitis, postpartum endometritis, postpartum sepsis
APGAR scores of 4-6 indicate...
moderate difficulty
bluish black areas of pigmentation that can appear over any part of the exterior surface of the body
mongolian spots
As the volume of breast milk increases, urine should become...
more dilute and be a light-yellow color
Most TORCH infections provide influenza-like symptoms in the mother but produce...
more serious effects in the neonate and the fetus
Minor anomalies can point to the presence of a...
more serious major anomaly and aid in its diagnosis
hold infant in semi-sitting position, allow head and trunk to fall backward to angle of at least 30 degrees, place infant supine on flat surface perform sharp hand clap; symmetric abduction and extension of arms are seen, fingers fan out and form a C with thumb and forefinger, slight tremor might be noted, arms are adducted in embracing motion and return to relaxed flexion and movement; legs may follow similar pattern of response; preterm infant does not complete "embrace"' instead arms fall backward because of weakness
moro reflex
Birth weight influences...
mortality
Gestational age influences...
mortality
Cytomegalovirus (CMV; a herpesvirus) maternal effects:
most adults are asymptomatic or have mild influenza-like symptoms, the presence of CMV antibodies does not totally prevent reinfection
Orofacial clefts are among the...
most common congenital anomalies
Toxoplasmosis maternal effects:
most infections asymptomatic, acute infection is similar to mononucleosis, and woman immune after the first episode
Newborns can recognize the...
mother's face
Tremors or jitteriness are easily elicited by...
motions or voice
After learning to regulate physiologic and autonomic system, they establish...
motor organization
Normal variations for skin:
mottling, harlequin sign, plethora, telangiectasias, erythema toxicum/neonatorum, milia, petechiae over presenting part, ecchymoses from forceps, physiologic jaundice in up to 60% of term infants in first week of life, Mongolian spots, slightly skin, superficial cracking of skin, peeling of skin, variation in amount of subcutaneous fat, vernix caseosa found more in the creases and folds, variation in amount of lanugo
An increase in estrogen during pregnancy followed by a drop after birth results in a...
mucoid vaginal discharge and even some slight bloody spotting
The etiology of congenital heart diseases is...
multifactorial, chromosomal and/or genetic, and due to environmental teratogens
Deaths from enteroviruses are usually due to...
multiorgan involvement
In CNS disease, blood-borne seeding of the brain results in...
multiple lesions of cortical hemorrhagic necrosis
Clinical manifestations of enterovirus in neonates can be severe and include...
myocarditis, meningitis, respiratory distress, and hepatitis
Respiratory distress symptoms:
nasal flaring, retractions, stridor, gasping, chin tug
Deeper suctioning may be needed to remove mucus from the newborn's...
nasopharynx or posterior oropharynx
After 10 minutes of tracing is observed the approximate mean rate is rounded to the...
nearest 5 bpm interval
Soon after birth, cardiac output...
nearly doubles
The most serious complication of an infant heel stick is ... resulting from lancet penetration of the bone
necrotizing osteochondritis
If no late decelerations are observed, then the CST is considered...
negative
CST results are...
negative, positive, equivocal, suspicious, or unsatisfactory
Early term infants have higher...
neonatal, postnatal, and infant mortality rates
The MAP should approximate the...
neonate's week of gestation
Polyhydramnios is associated with...
neural tube defects, obstruction of the fetal GI tract, multiple fetuses, and fetal hydrops
Hyperthermia can result in...
neurologic injury or increased risk of seizures
The ... system is almost completely developed at birth
neuromuscular
Sucking behavior is influenced by...
neuromuscular maturity, maternal medications received during labor and birth, and the type of initial feeding
Potential complications of syphilis include...
neurosyphilis, deafness, Hutchinson teeth, saber shins, joint involvement, saddle nose, gummas over the skin and other organs, interstitial keratitis, rhagades, frontal bossing, and mulberry molars
Sepsis can be accompanied by a concomitant rise in...
neutrophils
What are small, flat, pink, and easily blanched?
nevus simplex
The two methods of CST are the...
nipple-stimulated contraction test and the more commonly used oxytocin-stimulated contraction test
O blood
no antigens, antibodies to type AB blood
Accurate and complete documentation of fetal status and uterine activity is especially important when IA and palpation are being used because...
no paper tracing record or computer storage of these assessments is provided as it is with EFM
Moderate intake of caffeine by breastfeeding mothers appears to pose...
no risk to normal full-term infants
Use of the .... helps determine which newborns might need further evaluation for hyperbilirubinemia after discharge.
nomogram
The lowest breastfeeding rates are among...
non-Hispanic black women
Human papillomavirus (HPV) fetal effects:
none known
Contraceptives least likely to affect breastfeeding:
nonhormonal methods, barrier methods, and IUDs
No vaccine for...
nonpolio enteroviruses; immunoglobulin can treat symptoms in neonates
Newborns produce heat through...
nonshivering thermogenesis
Acrocyanosis is a ... finding at birth
normal
Colostrum is important in establishing...
normal Lactobacillus bifidus flora in the infant's digestive tract
US permits the confirmation of...
normal anatomy and detection of major fetal malformations
Moderate variability is considered...
normal and is highly predictive of a normal fetal acid-base balance
Newborn infants are ____ breathers.
nose
The third and fourth heart sounds are..
not auscultated in newborns
Petechiae and ecchymoses will...
not blanch
Goals of care for the late preterm infant are...
nourishing the infant and protecting the mother's milk supply
The head is measured from the widest part, which is the...
occipitofrontal diameter
The hypogastric arteries also...
occlude and become ligaments
Seizure activity is associated with...
ocular changes and autonomic changes
What are not associated with jitteriness or tremors?
ocular changes and autonomic changes
Heart sounds during the neonatal period are... (3)
of higher pitch, shorter duration, and greater intensity
missing digits
oligodactyly
Reduced kidney perfusion due to preeclampsia decreases GFR and can lead to...
oliguria and degenerative glomerular changes; albumin is lost in the urine, uric acid clearance is decreased, serum uric acid is increased, sodium and water are retained
Breastfeeding moms are encouraged to consume 200-300 mg of the...
omega-3 long-chain polyunsaturated fatty acids daily
Average findings for anus:
one anus with good sphincter tone, passage of meconium within 24 hours after birth, anal wink present, anal opening patent
Treatment lasts ... for toxoplasmosis gondii
one year
Repair of cleft palate is usually performed by...
one year of age in order to optimize speech development
The purpose of electronic FHR monitoring is the...
ongoing assessment of fetal oxygenation
Signs of effective breastfeeding for the mother:
onset of copious milk production by day 3 or 4, firm tugging sensation on nipple as infant sucks but no pain, uterine contractions and increased vaginal bleeding while feeding (first week or less), feels relaxed and drowsy while feeding, increased thirst, breasts soften or feel lighter while feeding, and with milk ejection they can feel a warm rush or tingling in breasts or have leakage of milk from the other breast
Spina bifida manifesta is known as...
open SB
Eye prophylaxis with erythromycin is administered within the first hour after birth to prevent...
ophthalmia neonatorum
Good nutrition in infancy fosters...
optimal growth and development
After completing the course of IV acyclovir, an ... is given for six months to prevent HSV recurrence
oral acyclovir
After ROM, ascending infection can result in ... of the fetus
orogastric contamination
The measurement of BP is best accomplished with an...
oscillometric device while the infant is at rest
If BP is measured, an ... calibrated for neonatal pressure is preferred
oscillometric monitor
Initial hearing screening is done with...
otoacoustic emissions (EOAE) test
Teach parents to look for cues that the baby is done feeding to avoid...
overfeeding, which can lead to obesity
Interventions for infants suffering from CCHDs:
oxygen, administering cardiotonic and other medications like diuretics, decreasing the workload of the heart by maintaining a thermoneutral environment, feeding with the gavage method, and preventing crying if it causes cyanosis
The CST is an invasive procedure if...
oxytocin stimulation is required
place finger in the palm of the hand; infant's fingers should curl around examiner's fingers
palmar grasp reflex
When using IA, uterine activity is assessed by...
palpation
There is no vaccine or medication to treat...
parvovirus
Normal variations for anus:
passage of meconium within 48 hours of birth
birth canal which is composed of the mother's rigid bony pelvis and soft tissues of the cervix, the pelvic floor, the vagina, and the introitus
passageway
the fetus
passenger
The five factors that affect pregnancy:
passenger, passageway, powers, position, and psychological response
A major reason that a mom stops breastfeeding is...
perceived or actual insufficient milk supply
Direct access to the fetal circulation during the second and third trimesters is possible through...
percutaneous umbilical blood sampling (PUBS, cordocentesis)
While on restricted activity, women are encouraged to...
perform gentle exercises to maintain muscle tone, blood flow, regular bowel function, and a sense of well-being
Other infections: Hepatitis A (infectious hepatitis; virus) fetal effects:
perinatal transmission virtually never occurs
a maternal fetal medicine specialist
perinatologist
changes that occur with UC
periodic changes
Changes in FHR from the baseline are categorized as....
periodic or episodic
In the early newborn period infants tend to alternate...
periods of sleep and wakefulness that resemble their fetal inactivity and activity patterns
Setting sun eyes can indicate...
permanent damage to the brain tissue
Excessive fluoride can...
permanently stain teeth once they appear
Portable telemetry monitors allow observation of the FHR and UC patterns by means of centrally located electronic display stations which...
permits woman to walk around during electronic monitoring
Circumcision is a matter of...
personal parental choice
Predisposing factors for DDH:
physiologic factors, which include female sex and maternal hormone secretion causing pelvic relaxation during birth and intrauterine positioning; mechanical factors such as breech presentation, multiple gestation, oligohydramnios, and large infant size; genetic factors, including a family history if DDH and generalized ligamentous laxity
Newborns first must be able to regulate their...
physiologic or autonomic system
Labor is a period of ... on the fetus so frequent monitoring of fetal status is a part of the nursing care during labor
physiologic stress
In an adequately hydrated newborn, the mucus membranes are...
pink and moist and the hard and soft palates are intact
Sometimes ... appear in the diaper and are okay during the first week
pink-tinged uric acid crystals
Preeclampsia is a progressive disorder, with the ____ as the root cause
placenta
If placental previa is diagnosed during the second trimester, repeated US should be performed as pregnancy progresses until the....
placenta moves away from the cervical os or it becomes clear that the previa will persist
place finger at base of toes, infant's toes curl downward
plantar grasp reflex
Common secondary opportunistic infections include...
pneumonia, candidiasis, CMV, cryptosporidiosis, herpes simplex or herpes zoster, and disseminated varicella
Enteroviruses include...
poliovirus, coxsackievirus, and echovirus
extra digits
polydactyly
GI obstruction is suspected when...
polyhydramnios is present in pregnancy
Conditions that require US assessment of fetal growth include...
poor maternal weight gain or pattern of weight gain, previous pregnancy with intrauterine growth restriction (IUGR), chronic infections, ingestion of drugs, maternal diabetes, hypertension, multifetal pregnancy, and other medical or surgical complications
Related risk factors for polyhydramnios: (2)
poorly controlled DM and fetal congenital anomalies
What can be pink and flat but progresses to red or purple in color and pebbly in consistency and does not blanch?
port wine stain
the relationship of a reference point on the presenting part to the four quadrants of the mother's pelvis; made up of a three-letter abbreviation: first letter denotes the location of the presenting part in the right or left side of the mother's pelvis, middle letter stands for the specific presenting part of the fetus, and the last letter stands for the location of the presenting part in relation to the anterior, posterior, or transverse portion of the maternal pelvis
position
Normal variations for facies:
positional deformities
Clubfoot is described as...
positional or congenital
Breastfeeding is contraindicated for mothers who are...
positive for human T-cell lymphotropic virus types I or II and those with untreated brucellosis
A person with the Rh factor is ..., and someone who doesn't have the Rh factor is...
positive; negative
Passage of meconium from the vagina or urinary meatus is a sign of a...
possible fistulous tract from the rectum
born after completion of week 42 of gestation and showing the effects of progressive placental insufficiency
postmature
Mothers who breastfeed are at a lower risk for...
postpartum hemorrhage
bron 41 0/7 though 41 6/7 weeks
postterm
Commercial formulas are available in three forms:
powder, concentrate, and ready to feed
Involuntary and voluntary powers that expel the fetus and the placenta from the uterus
powers
Around week 16 of gestation, the alveoli begin producing...
pre-partum milk, or colostrum
Growth of the brain after birth follows a ... pattern of rapid growth during infancy and early childhood
predictable
Infants go through...
predictable growth spurts
Gestational age assessment provides important information for...
predicting risks and guiding care management
Acute tubular necrosis and renal failure could occur due to...
preeclampsia
An abnormal uterine artery in the first and second trimester has been a good screening test to predict...
preeclampsia
Glomerular endotheliosis is unique to...
preeclampsia
Hemoconcentration, increased blood viscosity, and tissue edema can occur in...
preeclampsia
Non-Hispanic black women are much more likely to have a...
pregnancy complicated by chronic hypertension than women of other ethnicities
Chlamydia maternal effects:
premature ROM, preterm labor, postpartum endometritis
Twice as many mothers with HBV give birth ... compared with noninfected mothers
prematurely
Potential causes of pathologic hyperbilirubinemia in neonates (fetal/newborn):
prematurity, hepatic cell damage by infection or drugs, neonatal hyperthyroidism, polycythemia, intestinal obstruction such as meconium ileus, pyloric stenosis, biliary atresia, sequestered blood, maternal blood swallowed by neonate, G6PD deficiency, and thalassemia
Eclampsia is usually preceded by...
premonitory signs and symptoms, including persistent headache, blurred vision, severe epigastric pain or right upper quadrant abdominal pain, and altered mental status
Assessment of the newborn requires data from the...
prenatal, intrapartal, and postnatal periods
A woman should be taught the significance of the...
presence or absence of fetal movements, the procedure for counting, how to record findings on a daily fetal movement record, and when to notify the healthcare provider
the part of the fetus that enters the pelvic inlet first and leads through the birth canal during labor
presentation
The IUPC has a ... that measures changes in intrauterine pressure.
pressure sensitive tip
born before completion of 37 weeks of gestation, regardless of birth weight
preterm
Group B streptococci fetal effects:
preterm birth
Gonorrhea fetal effects:
preterm birth and IUGR
Severe toxoplasmosis is associated with...
preterm birth, growth restriction, microcephaly or hydrocephaly, microphthalmos, chorioretinitis, CNS calcification, thrombocytopenia, jaundice, petechiae or a maculopapular rash, and fever
Human milk is ideal for...
preterm infants
The goal of care for the infant with hyperbilirubinemia is to...
prevent acute bilirubin encephalopathy and kernicterus
Administration of vitamin K IM can be used to..
prevent bleeding disorders or hemorrhage from occurring
The fetal oxygen supply must be maintained during labor to...
prevent fetal compromise and to promote newborn health after birth
The weight scale should be covered with a disposable pad or cloth to...
prevent heat loss via conduction and to prevent cross-infection
Mothers can wear breast pads to...
prevent leakage between feedings
The goal of cord care is to...
prevent or decrease the risk for hemorrhage and infection
The intent of emergency interventions for eclampsia is to...
prevent self-injury, enhance oxygenation, reduce aspiration risk, and establish control with magnesium sulfate
What do all of the major immunoglobulins in human milk have a specific role in?
preventing localized and systemic bacterial and viral infections
Events that could cause a woman to develop antibodies include:
previous pregnancy with a Rh-positive fetus, transfusion with Rh-positive blood, miscarriage or induced abortion after 8 weeks' gestation, amniocentesis performed for any reason, premature separation of the placenta, external version, and trauma
Herpes genitalis (herpes simplex virus, type 1 or type 2) maternal effects:
primary infection with painful blisters, tender inguinal lymph nodes, fever, viral meningitis; and recurrent infections are much milder and shorter
More than 90% of women with chronic hypertension have...
primary or essential hypertension
Transmission during ... is the most common
primary or secondary stage of syphilis
Involuntary uterine contractions are called...
primary powers and signal the beginning of labor
The complications that affect newborns can stem from three basic problems:
problems relating to gestational age or intrauterine growth that do not follow normal patterns, such as preterm birth; acquired problems resulting from maternal or newborn physiologic factors, such as ABO incompatibility or infection; and congenital defects
Repeated trauma to the walking surface of the heel can cause fibrosis and scarring that can lead to...
problems with walking later in life
In lactogenesis stage I, beginning at approximately 16-18 weeks of pregnancy, the breasts prepare for milk production by...
producing pre-partum milk, or colostrum
Lactogenesis stage II begins at birth as...
progesterone levels drop sharply when the placenta is removed
The fall in progesterone triggers the release of ... from the anterior pituitary gland
prolactin
What can all cause neutrophilia in the newborn?
prolonged crying, maternal hypertension, asymptomatic hypoglycemia, hemolytic disease, meconium aspiration syndrome, labor induction with oxytocin, surgery, difficult labor, high altitude, and maternal fever
In preterm infants the clitoris is...
prominent
Various reflexes serve to...
promote safety and adequate food intake
The first six weeks of life involve a steady decrease in the...
proportion of active REM sleep to total sleep
The most common combination is a...
proximal EA and with a distal TEF
consist of maternal behaviors and adverse lifestyles that have a negative effect on the health of the mother or fetus
psychosocial risks
pull infant up by the wrists from supine position with head in midline; head lags until infant is in upright position, then the head is held in the same plane with chest and shoulder momentarily before falling forward, infant then attempts to right head
pull-to-sit reflex
Arteriolar vasospasm can lead to endothelial damage and increased capillary permeability, predisposing the woman to...
pulmonary edema
Tetralogy of Fallot is characterized by the combination of four defects:
pulmonary stenosis, ventricular septal defect, overriding aorta, and hypertrophy of the right ventricle
Infants with congenital toxoplasmosis are treated with ..., combined with oral sulfadiazine.
pyrimethamine
The optimal state of arousal is the...
quiet alert state
risk factors for chronic hypertension in pregnancy
race, older age, and obesity
The loss of heat from the body surface to a cooler solid surface not in direct contact with the infant but in relative proximity
radiation
Manipulation and casting are repeated frequently to accommodate the...
rapid growth of early infancy
Rubella (3-day or German measles; virus) maternal effects:
rash, fever, mild symptoms such as headache, malaise, myalgias and arthralgias, postauricular lymph nodes may be swollen, mild conjunctivitis
Common symptoms of neonates with CMID:
rash, jaundice, hepatosplenomegaly, anemia, thrombocytopenia, and hyperbilirubinemia
NST results are either...
reactive or nonreactive
Fecal discharge from the vagina can indicate a...
rectovaginal fistula
Low dose aspirin has been found to...
reduce preeclampsia and adverse outcomes in some high-risk women
The purpose of phototherapy is to...
reduce the level of circulating unconjugated bilirubin or keep it from increasing
What is still one of the most frequent conditions associated with stillbirth?
reduced fetal growth
Passive flexion and repositioning of the tremulous extremity ... the movement
reduces or stops
Normal variations for abdomen:
reducible umbilical hernia, some diastasis recti, linea nigra possibly apparent and caused by hormone influence during pregnancy
Surfactant lowers surface tension, therefore...
reducing the pressure required to keep the alveoli open with inspiration and prevents total alveolar collapse on exhalation leading to maintenance of alveolar stability
The ultrasound transducer works by...
reflecting high-frequency sound waves off a moving interface: fetal heart and valves.
Magnesium sulfate, the anticonvulsant of choice for preventing or controlling eclamptic seizures, requires careful monitoring of...
reflexes, respirations, and renal function
Women with preeclampsia can have a...
regular diet with adequate protein, calcium, zinc, sodium, and 600 mcg of folic acid
Because the GI system is immature, the infant is prone to...
regurgitation, vomiting, and GER
The activation of chemoreceptors in the carotid arteries and aorta results from the...
relative state of hypoxia associated with labor
Frequent changes in position...
relieve fatigue, increase comfort, and improve circulation
Rapid healing of sore nipples is critical to..
relieve the mother's discomfort, maintain breastfeeding, and prevent mastitis
In external monitoring, the woman is asked to...
remain in a semi-fowler or lateral position and she is confined to the bed/chair.
Related risk factors for oligohydramnios:
renal agenesis, premature ROM, prolonged pregnancy, uteroplacental insufficiency, severe intrauterine growth restriction, maternal hypertensive disorders
Recurrent variable decelerations indicate...
repetitive disruption of the fetal oxygen supply, which can result in hypoxemia and metabolic acidemia
Prolonged cyanosis other than in the hands or feet can indicate...
respiratory and/or cardiac problems
Changes in infant's color can indicate...
respiratory distress
Characteristic symptoms of a large CDH include...
respiratory distress, cyanosis, heart sounds shifted to the right, and low blood pressure
Late preterm infants are at increased risk for...
respiratory distress, temperature instability, hypoglycemia, apnea, feeding difficulties, and hyperbilirubinemia
Cardiac disease can be manifested by....
respiratory signs and symptoms
The breastfeeding mother should...
rest as much as possible, esp. in the first two weeks after birth
The infant with CCHD can be...
restless to lethargic, have bradycardia or tachycardia, have abnormal cardiac rhythm with murmurs, and could have signs of congestive heart failure and decreased tissue perfusion
Liver pain in a pregnant woman is felt in the...
right upper quadrant
Average findings for facies:
rounded and symmetric, influenced by birth type, molding or both
The most widespread use of postnatal testing for congenital disorders is the...
routine screening of newborns for IEMs such as PKU and galactosemia, hemoglobinopathies, and hypothyroidism
The most widespread use of postnatal testing for genetic disorders is the...
routine screening of newborns for inborn errors of metabolism
Maternal factors known to be associated with a higher incidence of CHDs:
rubella and cytomegalovirus; ingestion of lithium, warfarin, or anticonvulsants; alcohol intake; poor nutrition; radiation exposure; metabolic disorders like DM and phenylketonuria; SLE; and maternal age greater than 40
Retinal and subconjunctival hemorrhages result from...
rupture of capillaries caused by increased pressure during birth
CVS is relatively...
safe
Beginning at six months, infants can receive...
safe and nutritionally adequate complementary foods
Commercial infant formulas provide...
satisfactory nutrition for most infants
The BP increases by the...
second day of life, with minor variations noted in the first month of life
Voluntary bearing down efforts by the mom are....
secondary powers
Duration is measured in...
seconds, from the beginning to the end of the contraction
Prolactin prepares the breasts to...
secrete milk and during lactation to synthesize and secrete milk
Biological nurturing approach is encouraged by assist the mother to breastfeed in a...
semi-reclining position with the newborn lying prone, skin-to-skin on the mother's bare chest and allow the baby to use inborn reflexes to latch onto the breast and feed effectively
Newborns have a highly developed...
sense of smell and can detect and discriminate distinct odors
Breast milk enhances retinal maturation in the preterm infant and improves neurocognitive outcomes and decreases the risk of...
sepsis and necrotizing enterocolitis
A sinusoidal pattern has been associated with...
sepsis, chorioamnionitis, and administration of narcotic analgesics
More than 2/3 of rubella infected infants show no apparent symptoms at birth, but ... can develop years later
sequelae
What findings warrant further investigation for jaundice?
serum bilirubin concentrations of greater than 5 mg/dL in cord blood, clinical jaundice evident within 24 hours of birth, total serum bilirubin levels increasing by more than 5 mg/dL in 24 hours or increasing at a rate of 0.5 mg/dL/hr, a serum bilirubin, a serum bilirubin in a term newborn that exceeds 12.9 mg/dL at any time, a serum bilirubin level in a preterm newborn that exceeds 15 mg/dL at any time, and any case of visible jaundice that persists for more than 14 days of life in a term infant
Some children with CMV are at risk for a tooth enamel defect, which can result in...
several caries
APGAR scores of 0-3 indicate...
severe distress
Symptoms of kernicterus:
severe dystonia with or without athetosis, deafness or severe hearing impairment, impaired oculomotor function, and dental enamel dysplasia
Abnormal FHR patterns are those associated with fetal hypoxemia, which can lead to...
severe fetal hypoxia
Severe features of preeclampsia:
severe frontal headaches, epigastric pain (heartburn), right upper quadrant abdominal pain, or visual disturbances such as scotoma, photophobia, or double vision
Neonatal respirations are....
shallow and irregular
The second heart sound (S2) is...
sharp
If it is taking a long time to find the FHB, the nurse can tell the mom that...
she is trying to find the spot where the sounds are the loudest
Average findings for neck:
short, thick, surrounded by skin folds, no webbing, head held midline, no masses, freedom of movement from side to side and flexion and extension, no movement of chin past the shoulder, thyroid not palpable
Early term infants are at greater risk for...
short- and long-term health problems
Other signs of DDH include:
shortening of the limb on the affected side, asymmetric thigh and gluteal folds, and broadening of the perineum
Since central cyanosis is a late sign of distress, newborns usually have...
significant hypoxemia when cyanosis appears
STIs in pregnancy are responsible for...
significant morbidity and mortality
The first recommended foods are...
single-grain cereals, followed by fruits and veggies
What heart pattern is common in newborns?
sinus dysrhythmia
The AAP recommends exclusive breastfeeding for the first ... months of life and that breastfeeding continues as complementary foods are introduced
six
What is an effective means of reducing conductive and radiant heat loss and enhancing newborn temperature control and maternal-infant interaction?
skin to skin contact
Variations in the state of consciousness of infants are called...
sleep-wake states
Normal variations for nose:
slight deformity from passage through birth canal
In the preterm fetus the baseline is...
slightly higher
An increase in the PNS response produces a...
slowing of the FHR
At birth a ... quantity of urine is usually present in the bladder of a full-term infant
small
In preterm infants the labia majora are...
small and widely separated
Normal variations for ears:
small, large, floppy ears, Darwin tubercle, state influencing response to noises
Infant feeding is more than providing nutrition; it is an opportunity for...
social, psychologic, and even educational interaction between parent and infant
arise from the mother and her family which may place the mother or fetus at risk
sociodemographic risks
Initially preterm milk contains higher concentrations of .... than term milk
sodium, energy, protein, chloride, potassium, iron, and magnesium
Resting tone between contractions is usually described as...
soft or hard
MRI provides a good view of....
soft tissue
Bradycardia is usually caused by...
some type of fetal cardiac problem like structural defects involving the pacemakers or conduction system or fetal heart failure
An active rectal wink reflex is a good sign of...
sphincter tone
The most common NTD is....
spina bifida
Spina bifida has two categories:
spina bifida occulta and spina bifida manifesta
Maternal obesity is linked to....
spina bifida, cardiac defects, diaphragmatic hernia, hypospadias, omphalocele, anorectal atresia, and limb reductions
Average findings for back:
spine straight and easily flexed, infant able to raise and support head momentarily when prone, shoulders, scapulae, and iliac crests lining up in same plane, trunk flexed and pelvis swings to stimulated side, lower limbs extend as pressure applied to feet with legs in semiflexed position
Three levels of US:
standard, limited, and specialized
Where does jaundice start?
starts in face and moves down and then dissipates in reverse order
The ability to make smooth transitions between states is called...
state modulation
The RR varies with the...
state of alertness and activity after birth
After establishing motor organization, then they progress to...
state regulation
relationship of the presenting fetal part to an imaginary line drawn between the maternal ischial spines and is a measure of the degree of descent of the presenting fetal part of the fetus through the birth canal
station
hold infant vertically under arms or on trunk, allowing one foot to touch table surface; infant will stimulate walking, alternating flexion and extension of feet; term infants walk on soles of their feet, and preterm infants walk on their toe
stepping or walking reflex
The neonate's intestines are ... at birth
sterile
As the baby begins sucking, the milk ejection reflex is...
stimulated
The profound change in environmental temperature stimulates receptors in the skin resulting in...
stimulation of the respiratory center in the medulla
The newborn's spine appears...
straight and can be flexed easily
Normal urine is usually...
straw-colored and odorless
At birth, the eye is...
structurally incomplete, and the muscles are immature
What is the result of traction or application of shearing forces to the scalp, commonly associated with difficulty operative vaginal birth?
subgaleal hemorrhage
touch the infant's lip, cheek, or corner of mouth with nipple or finger, infant usually turns head toward stimulus and opens mouth
sucking and rooting reflex
Newborns must learn to coordinate...
sucking, swallowing, and breathing as they feed
Women with chronic hypertension may develop...
superimposed preeclampsia
Milk is produced on a...
supply-meets-demand system
To promote latch, the mother...
supports her breast in one hand with the thumb on top and four fingers underneath at the back edge of the areola
The goal in the administration of antivirals is to...
suppress the virus to undetectable concentrations; but they do not cure the disease
Alveoli are lined with...
surfactant
Treatment of encephalocele incudes...
surgical repair and shunting to relieve hydrocephalus, unless a major brain malformation is present
One of the most common nonpharmacologic measures for neonatal pain is...
swaddling or snugly wrapping the infant with a blanket
feed infant; swallowing usually follows sucking and obtaining fluids, swallowing is usually coordinated with sucking and breathing and usually occurs without gagging, coughing, apnea, or vomiting
swallowing reflex
The full-term newborn is capable of...
swallowing, digesting, metabolizing and absorbing proteins and simple carbohydrates and emulsifying fats
A milk duct can become clogged or plugged which causes an area of the breast to become...
swollen and tender
IUGR may be...
symmetric or asymmetric
Macrosomia can be...
symmetric or asymmetric
Average findings for mouth:
symmetry of lip movement, pink gums, tongue not protruding, freely movable, symmetric in shape and movement, sucking pads inside the cheeks, soft and hard palates intact, uvula in midline, distinct chin, mouth moist and pink, the rooting, sucking, and extrusion reflexes are present
If syphilis is untreated during pregnancy, about 50% of neonates born will have..
symptomatic congenital syphilis
digits that are fused
syndactyly
Nurses may obtain 4 extremity BPs in the presence of any cardiovascular symptoms, such as...
tachycardia, murmur, abnormal pulses, poor perfusion, or abnormal precordial activity
Minimal variability can also occur with...
tachycardia, prematurity, or when the fetus is temporarily sleeping
.... can be the first sign of respiratory, cardiac, metabolic, or infectious illnesses
tachypnea
Normal variations for back:
temporary minor positional deformities correction with passive manipulation, trunk incurvation may not be apparent in first few days but is usually present in 5-6 days, weak or exaggerated response with breech presentation
The two traditional methods for sterilization are...
terminal heating and the aseptic method
A bluish discoloration of the testes could indicate...
testicular torsion
The predictable series of events during transition are mediated by .... and result in changes that involve...
the SNS; heart rate, respirations, temperature, and GI function
State regulation refers to...
the ability to modulate the state of consciousness
What is a safe, accurate measurement of temperature?
the axillary temperature
Weaning from the bottle should be attempted gradually because...
the baby has earned to rely on the comfort that sucking provides
What does IA give us?
the baseline FHR, rhythm, and increases and decreases from baseline
A standard set of measurements has been accepted as being the most useful for determining gestational age:
the crown-rump length (after 10 weeks), the biparietal diameter (BPD, after 12 weeks), the femur length (after 12 weeks), the head circumference, and the abdominal circumference
The presence and degree of hypoxia are thought to correlate with...
the depth and duration of the deceleration, how abruptly it returns to the baseline, how much variability is lost during the deceleration, and whether rebound tachycardia and loss of variability occur after the deceleration
What is the most critical adaptation to extrauterine life?
the establishment of effective respirations
Cytomegalovirus (CMV; a herpesvirus) fetal effects:
the fetus can be infected trans-placentally, infection is much more likely with a primary maternal infection, the most common indications of congenital infection include hepatosplenomegaly, intracranial calcifications, jaundice, growth restriction, microcephaly, chorioretinitis, hearing loss, thrombocytopenia, hyperbilirubinemia, and hepatitis
In the term infant, the ductus arteriosus closes within...
the first 24 hours after birth
Term infants usually do not sweat for...
the first 24 hours of life
Screening to detect fetal chromosomal abnormalities (esp. trisomy 21) is available beginning in...
the first trimester of pregnancy at 11-14 weeks
The fetal head is composed of two parietal bones:
the frontal bone and the occipital bone, which are united by membranous sutures
Swelling of the breast tissue in term infants of both sexes is caused by...
the hyperestrogenism of pregnancy
It takes longer for the maximal concentration of bilirubin to be reached in the preterm infant because of..
the immature liver and slower metabolic processes
Hyperthermia can result from... (3)
the inappropriate use of external heat sources such as radiant warmers, phototherapy, sunlight, increased environmental temperature, and the use of excessive clothing or blankets
Laryngeal web results from...
the incomplete separation of the two sides of the larynx and is most common between the vocal cords
What happens during the first period of reactivity to neurologic system?
the infant is alert and may have spontaneous startles, tremors, crying, and head movement from side to side
APGAR scores of 7-10 indicate...
the infant is having minimal or no difficulty adjusting to extrauterine life
The number of feedings a day decreases as...
the infant matures and consumes more at each feeding
Pregnancies can be considered high risk when...
the life or health of the mother, fetus, or newborn was jeopardized by circumstances coincidental with or unique to the pregnancy
The oily substance secreted by these sebaceous glands helps provide protection against...
the mechanical stress of sucking and invasion by pathogens
Breast milk production is based on a supply-meets-demand principle:
the more the infant nurses, the greater the milk supply
The following show that the milk ejection reflex has occurred:
the mother may feel a tingling sensation in the nipples and breasts, the baby's suck changes from quick and shallow sucks to slower sucking patterns, audible swallowing is present as the baby sucks, mother feels uterine cramping and can have increased lochia (early postpartum period), mother feels relaxed or drowsy, and the opposite breast may leak
Early deceleration is sometimes called the mirror image of the contraction because...
the nadir, peek, and end of the contraction corresponds to the deceleration
the time from birth through day 28 of life, the neonate must make many physiologic and behavioral adaptations to extrauterine life
the neonatal period
What happens during the first period of reactivity to HR?
the newborn's heart rate increases rapidly to 160 to 180 bpm but gradually falls after 30 minutes or so to a baseline rate of 100-120 bpm
During the first trimester, US is performed to obtain information regarding...
the number, size, and location of gestational sacs, the presence of or absence of fetal cardiac and body movements, the presence or absence of uterine abnormalities or adnexal masses, and pregnancy dating
Abdominal US is more useful after the first trimester when...
the pregnant uterus becomes an abdominal organ
The preterm infant has a higher blood volume than the term newborn, because...
the preterm infant has a proportionately greater plasma volume, not a greater RBC mass
The way the fetus moves through the birth canal is determined by...
the size of the fetal head, fetal presentation, fetal lie, fetal attitude, and fetal position
Women delay seeking treatment in STIs, because of...
the social stigma, have little accessibility to health care services, are asymptomatic, or are unaware that they have an infection
US images reflect...
the strength of the sending beam, the strength of the returning echo, and the density of the medium through which the beam is sent and returned
Mastitis is characterized by...
the sudden onset of influenza-like symptoms, including fever, chills, body aches, and headache
Antihypertensive medications are indicated when...
the systolic BP exceeds 160 mmHg, or the diastolic BP exceeds 110 mmHg
Factors that influence heat loss to the environment include...
the temperature and humidity of the air, and the temperature of surfaces in contact with the infant
The PMI is often visible and easily palpable because of...
the thin chest wall and can be called precordial activity
When the cord is clamped and severed...
the umbilical arteries, the umbilical vein, and the ductus venosus are functionally closed
Treatments for engorgement include:
the use of cold after breastfeeding, chilled cabbage leaves, warmth before breastfeeding, anti-inflammatory medications, breast massage, and pumping
What is the recommendation for monitoring healthy neonates at 35 weeks of gestation or more before discharge from the hospital?
the use of hour specific bilirubin levels to predict newborns at risk for rapidly rising levels
Prevention of mother-to-newborn HIV transmission is most effective when...
the woman receives antiretroviral drugs during pregnancy and labor and birth, and the infant receives the drugs after birth
Immediate birth is ordered if...
there is uncontrollable severe hypertension, eclampsia, pulmonary edema, placental abruption, DIC, evidence of non-reassuring fetal status, or intrapartum fetal demise
Generate heat by increasing muscle activity
thermogenesis
the maintenance of balance between heat loss and heat production
thermoregulation
NSAIDs should be administered with caution when hypertension persists for more than 1 day because...
these agents can contribute to an increase in BP
Alternate milk sources should not be used because...
they are inadequate to support growth and can contain excess protein or an inadequate calcium to phosphorus ratio, which can cause seizures
Some mothers find that their babies are less fussy when...
they are placed in a sling or carrier
Women with active TB can breastfeed when...
they have been treated for at least 2 weeks and been deemed noninfectious
Late preterm infants have been known as the great imposters because...
they so closely resemble full term babies
The MER can be triggered by...
thoughts, sights, sounds, or odors that the mother associates with the baby and during sexual activity (orgasm).
Infants should have at least .... stools a day for the first month
three
How is non shivering thermogenesis accomplished?
through metabolism of brown fat and by increased metabolic activity in the brain, heart, and liver
Delayed effects of rubella infection include...
thyroid dysfunction, diabetes mellitus, growth restriction, myocarditis, and glaucoma
Antepartum testing has two major goals:
to identify fetuses at risk for injury caused by acute and chronic interruption of oxygenation so permanent injury or death might be prevented and to identify appropriately oxygenated fetuses so unnecessary intervention can be avoided
with infant in supine neutral position, turn head quickly to one side; with infant facing left side, arm and leg on that side extend; opposite arm and leg flex and vice versa for the right side
tonic neck or fencing reflex
The ... of breastfeeding in HIV-positive women is promoted in the US
total avoidance
ABE is directly related to the...
total serum bilirubin level
The infant is responsive to...
touch on all parts of the body
Changing cat litter is a known risk for...
toxoplasmosis
TORCH:
toxoplasmosis, other infections (syphilis, measles, hepatitis B, gonorrhea, and HIV), rubella virus, cytomegalovirus (CMV), and herpes simplex virus
CVS can be done...
transcervically or transabdominally
Normal variations for mouth:
transient circumoral cyanosis, inclusion cysts, short lingual frenulum, anatomic groove in palate to accommodate nipple disappearing by 3-4 years of age, Epstein pearls, and reflexes dependent on state of wakefulness and hunger
Normal variations for extremities:
transient positional deformities, slight tremors sometimes apparent, some acrocyanosis in arms and hands, palmar grasp may occur spontaneously when sucking, feet appearing to turn in but can be easily rotated externally, positional defects tending to correct while infant is crying, acrocyanosis of lower extremities
Normal variations for chest:
transient positional deformity apparent when newborn is at rest: passive movement of head possible, tip of the sternum possibly prominent, occasional retractions, especially when crying, breast nodule: 3-10 mm, and secretion of witch's milk
Normal variations for neck:
transient positional deformity apparent when newborn is at rest; passive movement of the head possible
Universal HIV testing for all pregnant women allows for early identification and treatment of HIV-positive women during pregnancy, which decreases the risk of...
transmission to the fetus
The fetus is infected with syphilis in utero by ..., but infection of the amniotic fluid can occur
transplacental infection
Herpes genitalis (herpes simplex virus, type 1 or type 2) fetal effects:
transplacental infection resulting in congenital infection is rare and usually occurs with primary maternal infection and the risk mainly exists with infection late in pregnancy
Transmission of HIV from the mother to the fetus can occur..
transplacentally at various gestational ages
The neonate can acquire herpes...
transplacentally, ascending infection by the way of the birth canal, direct contamination during passage through an infected canal, direct contamination from infected personnel or family
HBV is transmitted...
transplacentally, serum to serum, and by contact with contaminated urine, feces, saliva, semen, or vaginal secretions during birth, or through breast milk
At birth, most of the circulating antibodies in the newborn are IgG that were...
transported across the placenta from the maternal circulation
Macrosomic infants are at risk for...
traumatic injury and asphyxia during birth
Neonatal exchange transfusion with type O, Rh-negative RBCs serves to...
treat anemia and acidosis and remove bilirubin, maternal antibodies, and fetal RBCs that are beginning to hemolyze
The posterior fontanel is ___ shaped. The posterior fontanel closes ___ after birth
triangle; 6 to 8 weeks
Assessment of the fetal nasal bone by US during the first trimester provides another way to predict...
trisomy 21
In the second trimester triple screening and quad screening are available to screen for fetuses with...
trisomy 21 and trisomy 18
place infant prone on a flat surface, run finger down back about 4-5 cm lateral to the spine, first on one side and then down the other, trunk is flexed, and pelvis is swung toward stimulated side
truncal incurvation reflex
Teach parents signs of stress during feeding, including...
turning the head, arching the back, choking, sputtering, changing color, moving the arms, and tensing the fists
Average findings for abdomen:
two arteries, one vein, whitish gray, definite demarcation between cord and skin, no intestinal structures within cord, dry around base, drying, odorless, cord clamp in place for 24-48 hr; rounded, prominent, dome shaped because abdominal musculature not fully developed, liver possibly palpable 1-2 cm below right costal margin, no other masses palpable and distention, few visible veins o abdominal surface, sounds present within minutes after birth in healthy term infant, meconium stool passing within 24-48 hr after birth, respirations primarily diaphragmatic, abdominal and chest movement synchronous
The six states form a continuum from deep sleep to extreme irritability:
two sleep states (deep sleep and light sleep) and four wake states: (drowsy, quiet alert, active alert, and crying)
Parents should be educated about the...
types of infant formulas, proper preparation for feeding, and correct feeding technique
Doppler ultrasound and ultrasound stethoscopes transmit .... which are converted into an electronic signal that is counted
ultra-high-frequency sound waves
Physiologic jaundice occurs in ... of healthy term newborns and almost all preterm infants
up to 60%
Young infants are particularly oriented toward the...
use of their mouths, for meeting nutritional needs and for releasing tension through sucking
UA means...
uterine activity
The tocotransducer measures...
uterine activity transabdominally.
Oxytocin is the same hormone that is responsible for...
uterine contraction during labor
The examiner should keep his or her hand on the fundus after the contraction is over to evaluate...
uterine resting tone or relaxation between contractions
An edematous placenta or fetus can cause...
uterine rupture
The most common cause of late decelerations is...
uterine tachysystole that can be caused by oxytocin administration
Late decelerations have been associated with...
uteroplacental insufficiency
The newborn is capable of producing a protective immune response to...
vaccines
absence of hymenal tags can indicate...
vaginal agenesis
a visually abrupt decrease in FHR below the baseline; it is a decrease in at least 15 bpm, lasts for 15 seconds, and returns to baseline in less than 2 minutes from the time of onset
variable decelerations of the FHR
In the absence of severe immunosuppression, children with HIV-1 can receive...
varicella vaccine
The labia majora and minora cover the...
vestibule
In an NST, sometimes the provider will use...
vibroacoustic stimulation to stimulate fetal activity or suggest that the woman drinks something sugary to increase blood sugar and stimulate fetal movements
Diagnosis of HBV is made by...
viral culture of amniotic fluid, as well as by the presence of HBsAg and IgM in the cord blood or infant serum
Other causes of bradycardia include...
viral infections, maternal hypoglycemia, and maternal hypothermia
Average findings for vital signs:
visible pulsations in left midclavicular line, fifth intercostal space; apical pulse in fourth intercostal space, 110-160 bpm when awake. Quality - first sound and second sound sharp and clear. Peripheral pulses equal and strong. Axillary temp 37 C. Temperature stabilized by 8-10 hours of age. 40 respirations per minute. Breaths tend to be shallow and irregular in rate, rhythm, and depth when infant is awake. Crackles may be heard after birth; no adventitious sounds audible on inspiration or expiration. Breath sounds are bronchial, loud, and clear. 60-80/40-50 mmHg at birth and 68-88/40-60 mmHg at two weeks
What are the physiologic responses of acute pain in the neonate?
vitals, oxygenation, skin, lab evidence of metabolic or endocrine changes, and other observations
Coagulation factors are activated by...
vitamin K
What are the behavioral responses of acute pain in the neonate?
vocalizations facial expression body movement and posture changes in state
Classic signs of increasing intracranial pressure like...
vomiting, lethargy, and irritability can be attributed to feeding intolerance
Early symptoms of galactosemia include...
vomiting, weight loss, persistent jaundice, and CNS symptoms
Postterm infants can have a ... physical appearance that reflects intrauterine deprivation
wasted
CCHDs can be obvious with the first cry, which could be...
weak and muffled or loud and breathless
The fetus can produce IgM by...
week 8 of gestation
The MAP should be equal to...
weeks of gestational age
The breastfeeding mother should be eating a...
well-balanced diet
If a mother needs breast support, she should wear a...
well-fitting bra that provides nonbinding support
When does ABO incompatibility occur?
when the fetal blood type is A, B, or AB and the mother's blood type is O
The strongest risk factors for preeclampsia:
when the woman is < 19 years or > 40 years old, a pregnancy with a new partner, and a history of preeclampsia with severe features
Neither test is definitive in diagnosing hearing loss, but they are used to determine...
whether further investigation is necessary
Infants with hydrocephalus have...
widened sutures and full/bulging fontanels
the umbilical arteries, the umbilical vein, and the ductus venosus are functionally closed are converted into ligaments...
within 2-3 months
A folic acid supplement is recommended for...
women of childbearing age
Preeclampsia happens in 2-7% of healthy nulliparous pregnant women and more frequently in..
women with multifetal gestation, a history or preeclampsia, chronic hypertension, and preexisting diabetes
HELLP symptoms tend to...
worsen at night
By the end of the first week, the infant's stools are...
yellow, soft, and seedy
The head at term is approximately ... of the total body length.
¼
