OB PrepU Chapter 18

The mother of a formula-fed newborn asks how she will know if her newborn is receiving enough formula during feedings. Which response by the nurse is correct? a. "A sign of good nutrition is when your newborn seems satisfied and is gaining sufficient weight." b. "If your newborn is wetting three to four diapers and producing several stools a day, enough formula is likely being consumed." c. "Your newborn should be taking about 2 oz of formula for every pound of body weight during each feeding." d. "Your newborn should finish a bottle in less than 15 minutes."

a. "A sign of good nutrition is when your newborn seems satisfied and is gaining sufficient weight."

The nurse records a newborn's Apgar score at birth. A normal 1-minute Apgar score is: a. 7 to 10. b. 5 to 9. c. 1 to 2. d. 12 to 15.

a. 7 to 10.

A 36-hour-old newborn is ready for discharge from the hospital and the nurse notices that the skin looks yellow. What action will the nurse take? a. Assess the bilirubin level. b. Proceed with the discharge. c. Assist the mother to feed the newborn. d. Notify the health care provider.

a. Assess the bilirubin level.

Which action would be priority for the nurse to complete immediately after the delivery of a 40-week gestation newborn? a. Dry the newborn and place it skin-to-skin on mother. b. Swaddle the infant and place in the bassinet. c. Complete a full head-to-toe assessment. d. Assess the newborn's glucose level.

a. Dry the newborn and place it skin-to-skin on mother.

The mother of a newborn observes a diaper rash on her newborn's skin. Which intervention should the nurse instruct the parent to implement to treat the diaper rash? a. Expose the newborn's bottom to air several times a day. b. Use only baby wipes to cleanse the perianal area. c. Use products such as talcum powder with each diaper change. d. Place the newborn's buttocks in warm water after each void or stool.

a. Expose the newborn's bottom to air several times a day.

A nurse does an initial assessment on a newborn and notes a pulsation over the anterior fontanel (fontanelle) that corresponds with the newborn's heart rate. How would the nurse interpret this finding? a. It is normal to feel pulsations that correlate with the newborn's heart rate over the anterior fontanel. b. This finding is normal if the pulsation can also be palpated in the posterior fontanel. c. This is an abnormal finding and needs to be reported immediately. d. If the fontanel feels full, then this is normal.

a. It is normal to feel pulsations that correlate with the newborn's heart rate over the anterior fontanel.

A woman wearing hospital scrubs comes to the nursery and states "Mrs. Smith is ready for her baby. I will be glad to take the baby to her." What will the nursery nurse do next? a. Look at the woman's hospital identification badge. b. Determine which hospital unit the woman works on. c. Ask if the client actually sent the woman. d. Inform the woman she cannot transport the baby.

a. Look at the woman's hospital identification badge.

A nurse is preparing to administer Vitamin K to a newborn. The nurse would administer the drug: a. intramuscularly. b. intravenously. c. subcutaneously. d. orally.

a. intramuscularly.

A new mother asks the nurse why newborns receive an injection of vitamin K after delivery. What will be the best response from the nurse? a. "Newborns are given vitamin K and erythromycin ointment to help prevent ophthalmia neonatorum." b. "Newborns lack the intestinal flora needed to produce vitamin K, so it is given to prevent bleeding episodes." c. This vitamin substitutes for vitamin C for newborns to strengthen their immune systems." d. "Newborns are given vitamin K to help with the digestion to help them absorb fat-soluble vitamins."

b. "Newborns lack the intestinal flora needed to produce vitamin K, so it is given to prevent bleeding episodes."

A newborn's parents ask the nurse how to prevent the newborn from becoming ill. What is the best response by the nurse? a. "Be sure to keep the newborn's umbilical cord stump clean and dry." b. "Be sure to keep all scheduled doctor appointments for vaccinations." c. "Always wash your hands before you pick up or provide care to your newborn." d. "Keep your newborn at home and do not allow visitors for the first month."

c. "Always wash your hands before you pick up or provide care to your newborn."

A nurse is giving discharge education to a group of new parents before they are discharged home with their infants. What information will the nurse include in the teaching? a. "Change the newborn's diaper every four hours while awake." b. "You need to give your newborn a bath everyday." c. "Place the newborn on the back to sleep and stomach to play." d. "Newborns can sleep on a couch to allow constant visual monitoring."

c. "Place the newborn on the back to sleep and stomach to play."

The nursery nurse notes that one of the newborn infants has white patches on his tongue that look like milk curds. What action would be appropriate for the nurse to take? a. Rinse the tongue off with sterile water and a cotton swab. b. Since it looks like a milk curd, no action is needed. c. Report the finding to the pediatrician. d. Wipe the tongue off vigorously to remove the white patches.

c. Report the finding to the pediatrician.

A woman has just given birth vaginally to a newborn. Which action will the nurse do first? a. Assess an apical heart rate. b. Apply identification bracelets. c. Suction the mouth and nose. d. Determine the rectal temperature.

c. Suction the mouth and nose.

The nurse is admitting a 10-pound (4.5-kg) newborn to the nursery. What is important for the nurse to monitor during the transition period? a. temperature b. Apgar score c. blood sugar d. heart rate

c. blood sugar

Which statement made by a new nurse indicates additional teaching is needed on the topic of hyperbilirubinemia (physiologic jaundice) in newborns? a. "Physiologic jaundice usually begins in the first week after birth." b. "The problem is a result of the shortened lifespan of the newborn's red blood cells (RBCs)." c. "Placing the infant in direct sunlight for short periods helps in eliminating the bilirubin." d. "Breastfed babies need supplements of glucose water to help lower bilirubin levels."

d. "Breastfed babies need supplements of glucose water to help lower bilirubin levels."

The nurse is preparing discharge instructions for the parents of a male newborn who is to be circumcised before discharge. Which instruction should the nurse prioritize? a. Notify the primary care provider if it appears red and sore. b. Cleanse the glans daily with alcohol. c. Soak the penis daily in warm water. d. Cover the glans generously with petroleum jelly.

d. Cover the glans generously with petroleum jelly.

What measures can a nurse take to reduce the risk of hypoglycemia in a newborn? Select all that apply. a. Begin skin-to-skin (kangaroo) care for the newborn. b. Feed the newborn formula every 4 hours, starting 8 hours after birth. c. Feed only glucose water for the first 24 hours following birth. d. Initiate early and frequent breastfeeding. e. Dry the newborn off immediately after birth to prevent chilling.

a. Begin skin-to-skin (kangaroo) care for the newborn. d. Initiate early and frequent breastfeeding. e. Dry the newborn off immediately after birth to prevent chilling.

A first-time mother informs the nurse that she is unable to breastfeed her newborn through the day as she is usually away at work. She adds that she wants to express her breast milk and store it for her newborn to have later. What instruction would be correct to offer the mother to ensure the safety of the stored expressed breast milk? a. Use the sealed and chilled milk within 24 hours. b. Use microwave ovens to warm the chilled milk. c. Refreeze any unused milk for later use if it has not been out more that 2 hours. d. Use any frozen milk within 6 months of obtaining it.

a. Use the sealed and chilled milk within 24 hours.

A nursing mother calls the nurse and is upset. She states that her newborn son just bit her when he was nursing. Upon examining the newborn's mouth, two precocious teeth are noted on the lower central portion of the gums. What would be the nurse's best response? a. "The teeth will fall out within the first month, so don't worry about them." b. "Precocious teeth can occur at birth but we may need to remove them to prevent aspiration." c. "This is most unusual! Let me get the lactation specialist to assist you in breastfeeding. It should not be a problem though." d. "The teeth will fall out when the newborn's baby teeth come in so this is a blessing."

b. "Precocious teeth can occur at birth but we may need to remove them to prevent aspiration."

The parents of a 2-day-old newborn are preparing for discharge from the hospital. Which teaching is most important for the nurse to include regarding sleep? a. The infant may sleep through the night around 2 months of age. b. Place the infant on the back when sleeping. c. Caregivers need to sleep while the baby is sleeping. d. Newborns usually sleep for 16 or more hours each day.

b. Place the infant on the back when sleeping.

The nurse is teaching discharge instructions to the young parents of a healthy newborn boy whose vital signs are stable and whose circumcision appears clean and intact. The nurse should encourage the parents to call the health care provider if which situation is discovered? a. A yellowish crusty substance on the circumcision site b. Redness at the base of the umbilical cord c. Straining when he is passing stools d. Crying for 2 hours or more each day

b. Redness at the base of the umbilical cord

The nurse measures a newborn's temperature immediately after birth and finds it to be 99°F (37.2°C). An hour later, it has dropped several degrees. The nurse understands that this heat loss can be explained in part by which factor in the newborn? a. constriction of blood vessels b. lack of subcutaneous fat c. continual kicking d. continual crying

b. lack of subcutaneous fat

The Ballard scoring system evaluates newborns on which two factors? a. body maturity and cranial nerve maturity b. physical maturity and neuromuscular maturity c. tone maturity and extremities maturity d. skin maturity and reflex maturity

b. physical maturity and neuromuscular maturity

A nurse is teaching new parents about keeping follow-up appointments and calling their health care provider if they notice signs of illness in their newborn. The nurse determines that the teaching was successful when the parents identify which signs as needing to be reported? Select all that apply. a. approximately eight wet diapers a day b. temperature of 38.3° C (101° F) or higher c. refuse feeding d. abdominal distention e. general fussiness

b. temperature of 38.3° C (101° F) or higher c. refuse feeding d. abdominal distention

The parents of a newborn male are questioning the nurse concerning the pros and cons of a circumcision. Which disadvantage should the nurse point out to these parents? a. Fewer complications than if done later in life b. Reduced risk of penile cancer c. Anesthetic may not be effective during the procedure d. Lower rate of urinary tract infections

c. Anesthetic may not be effective during the procedure

What is priority for the nurse to do when transporting a newborn back to the mother after completing the hearing test? a. Determine if it is time for the mother to breastfeed the newborn and assist as needed. b. Explain the procedure completed on the newborn to the mother. c. Compare the identification bracelets prior to leaving the newborn with the mother. d. Inform the mother of the results of the hearing test completed on the newborn.

c. Compare the identification bracelets prior to leaving the newborn with the mother.

The newborn has been placed in skin-to-skin contact with his mother. A blanket covers all of his body except his head. His hair is still wet with amniotic fluid, etc. What is the most likely type of heat loss this baby may experience? a. Radiating b. Conductive c. Evaporative d. Convective

c. Evaporative

A nurse is preparing to administer phytonadione to a newborn. After confirming the order, what will the nurse do next? a. Determine the newborn's weight. b. Administer the medication. c. Identify the newborn. d. Assess the newborn for bleeding.

c. Identify the newborn.

A woman who is about to be discharged after a vaginal birth notices a flea-like rash on her newborn's chest. The rash has tiny red lesions all across the nipple line. What does this rash indicate? a. It is an indication that the woman has mistreated her newborn. b. It is a sign of a group beta-streptococcus skin infection. c. It is a normal skin finding in a newborn. d. It is a self-limiting virus that does not require treatment.

c. It is a normal skin finding in a newborn.

New parents are getting ready to go home and have received information to help them learn how best to care for the new infant. Which statement indicates that they need additional teaching about how to soothe their newborn if he becomes upset? a. "We'll turn the mobile on that's hanging above his head in his crib." b. "We'll lightly rub his back as we talk to him softly." c. "We'll swaddle him snuggly to make him feel secure." d. "We'll hold off on feeding him for a while because he might be too full."

d. "We'll hold off on feeding him for a while because he might be too full."

The nurse is preparing the nursing care plan for a newborn who was born via a cesarean delivery. Which diagnosis should the nurse prioritize? a. Ineffective thermoregulation related to heat loss to the environment b. Altered urinary elimination related to postcircumcision status c. Altered nutrition less than body requirement related to limited formula intake d. Ineffective airway clearance related to mucus and secretions

d. Ineffective airway clearance related to mucus and secretions

The nurse is caring for a newborn after the parents have spent time bonding. As the nurse performs the assessment and evidence-based care, which eye care will the nurse prioritize? a. Instill 0.5% ophthalmic silver nitrate. b. Instill 0.5% ophthalmic tetracycline. c. Watch for signs of eye irritation. d. Instill 0.5% ophthalmic erythromycin.

d. Instill 0.5% ophthalmic erythromycin.

The nurse is assessing a 3-day-old infant. The infant's sclerae have a yellow tinge as does the infant's forehead and nose. What would the nurse do next? a. Draw blood for a metabolic panel. b. Initiate phototherapy. c. Prepare the infant for an exchange transfusion. d. Obtain a transcutaneous bilirubin level.

d. Obtain a transcutaneous bilirubin level.

A nurse determines that a newborn has a 1-minute Apgar score of 5 points. What conclusion would the nurse make from this finding? a. The infant probably has either a congenital heart defect or an immature respiratory system. b. The infant requires immediate and aggressive interventions for survival. c. The infant is adjusting well to extrauterine life. d. The infant is experiencing moderate difficulty in adjusting to extrauterine life.

d. The infant is experiencing moderate difficulty in adjusting to extrauterine life.

On examination, the hands and feet of a 12-hour-old infant are cyanotic without other signs of distress. The nurse should document this as: a. potential for respiratory distress. b. poor oxygenation. c. cold stress. d. acrocyanosis.

d. acrocyanosis.

As a part of the newborn assessment, the nurse examines the infant's skin. Which nursing observation would warrant further investigation? a. blue or purplish splotches on buttocks b. fine red rash noted over the chest and back c. small pink or red patches on the baby's eyelids and back of the neck d. bright red, raised bumpy area noted above the right eye

d. bright red, raised bumpy area noted above the right eye

To indicate that the infant is making a successful transition immediately after birth, the nurse checks the heart rate. The newborn is 4 hours old. Which rate would the nurse identify as a cause for concern? a. 108 beats/minute b. 122 beats/minute c. 132 beats/minute d. 140 beats/minute

a. 108 beats/minute

The nurse notices that there is no vitamin K administration recorded on a newborn's medical record upon arrival to the newborn nursery. What would be the nurse's first action? a. Call the Labor and Delivery nurse who cared for the newborn to inquire about why the medication was not documented. b. Give the IM dose of vitamin K to prevent the possibility of hemorrhage in the newborn. c. Assume that the parents refused this medication for their infant. d. Administer an oral dose of vitamin K to the newborn.

a. Call the Labor and Delivery nurse who cared for the newborn to inquire about why the medication was not documented.

A woman in scrubs enters a mother's room while the nurse is completing an assessment. The woman states the doctor is in the nursery and has requested the infant be brought back for an examination. What will the nurse do? a. Ask how long the infant will be gone since her next feeding is in 30 minutes. b. Ask to see the woman' hospital identification badge. c. Ask the woman to bring the infant back when the doctor finishes the examination. d. Call the nursery to confirm the doctor does indeed need this infant at this time.

b. Ask to see the woman' hospital identification badge.