MATERNAL AND NEWBORN SUCCESS chap 10 high risk infant

13. A jaundice neonate must have a heel stick to assess bilirubin levels. Which of the following actions should the nurse make during the procedure? 1. Cover the foot with an iced wrap for one minute prior to the procedure. 2. Avoid puncturing the lateral heel to prevent damaging sensitive structures. 3. Blot the site with a dry gauze after rubbing it with an alcohol swab. 4. Grasp the calf of the baby during the procedure to prevent injury.

. 3. Alcohol can irritate the punctured skin and can cause hemolysis.

73. For which of the following reasons would a nurse in the well baby nursery report to the neonatalogist that a newborn appears to be preterm? 1. Baby has a square window angle of 90º. 2. Baby has leathery and cracked skin. 3. Baby has popliteal angle of 90º. 4. Baby has pronounced plantar creases.

1. A baby whose square window sign is 90˚ is preterm.

83. A baby in the NICU, who is exhibiting signs of congestive heart failure from an atrio ventricular canal defect, is receiving a diuretic. In the plan of care, the nurse should include that the desired outcome for the child will be which of the following? 1. Loss of body weight. 2. Drop in serum sodium level. 3. Rise in urine specific gravity. 4. Increase in blood pressure.

1. A diuretic will increase urinary output which in turn will lead to weight loss.

74. A full-term neonate in the NICU has been diagnosed with congestive heart failure secondary to a cyanotic heart defect. Which of the following activities is most likely to result in a cyanotic episode? 1. Feeding. 2. Sleeping in the supine position. 3. Rocking in an infant swing. 4. Swaddling.

1. Babies who have cardiac defects frequently feed poorly. And when they do feed, they frequently become cyanotic.

93. The neonatalogist assesses a newborn for Hirschsprung's disease after the baby ex hibited which of the following signs/symptoms? 1. Passed meconium at 50 hours of age. 2. Apical heart rate of 200 beats per minute. 3. Maculopapular rash. 4. Asymmetrical leg folds.

1. Babies who have delayed meconium excretion may have Hirshsprung's disease.

81. A neonate that is admitted to the neonatal nursery is noted to have a 2-vessel cord. The nurse notifies the neonatalogist to get an order for which of the following assessments? 1. Renal function tests. 2. Echocardiogram. 3. Glucose tolerance test. 4. Electroencephalogram.

1. Babies with 2-vessel cords are at high risk for renal defects.

105. On admission to the nursery, a baby's head and chest circumferences are 39 cm and 32 cm, respectively. Which of the following actions should the nurse take next? 1. Assess the anterior fontanel. 2. Measure the abdominal girth. 3. Check the apical pulse rate. 4. Monitor the respiratory effort.

1. Because the head circumference is significantly larger than the chest circumference, the nurse should assess for another sign of hydrocephalus. A markedly enlarged or bulging fontanel is one of those signs.

94. The nurse assessed four newborns admitted to the neonatal nursery and called the neonatalogist for a consult on the baby who exhibited which of the following? 1. Excessive amounts of frothy saliva from the mouth. 2. Blood-tinged discharge from the vaginal canal. 3. Secretion of a milk-like substance from both breasts. 4. Heart rate that sped during inhalation and slowed with exhalation.

1. Excessive amounts of frothy saliva may indicate that the child has esophageal atresia.

52. Four full-term babies were admitted to the neonatal nursery. The mothers of each of the babies had labors of 4 hours or less. The nursery nurse should carefully monitor which of the babies for hypothermia? 1. The baby whose mother cultured positive for group B strep during her third trimester. 2. The baby whose mother had gestational diabetes. 3. The baby whose mother was hospitalized for 3 months with complete placenta previa. 4. The baby whose mother previously had a stillbirth.

1. Group B streptococcus causes severe infections in the newborn. A sign of neonatal sepsis is hypothermia.

88. A baby is born with a suspected coarctation of the aorta. Which of the following as sessments should be done by the nurse? 1. Check blood pressures in all four limbs. 2. Palpate the anterior fontanel for bulging. 3. Assess hematocrit and hemoglobin values. 4. Monitor for harlequin color changes.

1. The blood pressures in all four quadrants should be assessed.

98. The parents of a baby born with bilateral talipes equinovarus ask the nurse what medical care the baby will likely need. Which of the following should the nurse tell the parents? 1. Need a series of leg casts until the correction is accomplished. 2. Have a Harrington rod inserted when the child is about three years old. 3. Have a Pavlik harness fitted before discharge from the nursery. 4. Need to wear braces on both legs until the child begins to walk.

1. The initial treatment plan for clubfoot usually includes a series of casts that slowly move the foot into proper alignment.

53. Four 38-week-gestation gravidas have just delivered. Which of the babies should be monitored closely by the nurse for respiratory distress? 1. The baby whose mother has diabetes mellitus. 2. The baby whose mother has lung cancer. 3. The baby whose mother has hypothyroidism. 4. The baby whose mother has asthma.

1. The lung maturation of infants of diabetic mothers is often delayed. These babies must be monitored at birth for respiratory distress.

95. The nurse is caring for a baby diagnosed with developmental dysplasia of the hip (DDH). Which of the following therapeutic interventions should the nurse expect to perform? 1. Place the baby's legs in abduction. 2. External rotation of the baby's hips. 3. Assist with bilateral leg casting. 4. Monitor pedal pulses bilaterally.

1. To treat developmental dysplasia of the hip, babies' legs are maintained in a state of abduction.

91. A newborn in the NICU has just had a ventriculoperitoneal shunt inserted. Which of the following signs indicates that the shunt is functioning properly? 1. Decrease of the baby's head circumference. 2. Absence of cardiac arrhythmias. 3. Rise of the baby's blood pressure. 4. Appearance of setting sun sign.

1. Ventriculoperitoneal (VP) shunts are inserted for the treatment of hydrocephalus. A positive finding, therefore, would be decreasing head circumferences.

10. A baby's blood type is B negative. The baby is at risk for hemolytic jaundice if the mother has which of the following blood types? 1. Type O negative. 2. Type A negative. 3. Type B positive. 4. Type AB positive.

10. 1. ABO incompatibility can arise when the mother is type O and the baby is either type A or type B.

103. Four babies are born with distinctive skin markings. Identify which marking matches its description: 1. Café au lait spot A. Raised, blood vessel-filled tumor. 2. Hemangioma B. Flat, sharply demarcated red-to-purple lesion. 3. Mongolian spots C. Multiple grayish blue hyperpigmented skin areas. 4. Port wine stain D. Pale tan- to coffee-colored marking.

103. The term in column 1 is matched to the description in column 2. 1. Café au lait spot matches with D. A café au lait spot is a pale tan to cof fee-colored skin marking. 2. Hemangioma matches with A. A hemangioma is a raised blood vessel-filled lesion. 3. Mongolian spot matches with C. Mongolian spots are multiple grayish blue hyperpigmented skin areas. 4. Port wine stain matches with B. A port wine stain is a flat, sharply de marcated red-to-purple lesion.

104. A baby, admitted to the nursery, was diagnosed with galactosemia from an amnio centesis. Which of the following actions must the nurse take? 1. Feed the baby a specialty formula. 2. Monitor the baby for central cyanosis. 3. Do hemoccult testing on every stool. 4. Monitor baby for signs of abdominal pain.

104. 1. Galactosemia is one of the few dis eases that is a contraindication for the intake of breast milk or any milk based formula.

106. A neonate is found to have choanal atresia on admission to the nursery. Which of the following physiological actions will be hampered by this diagnosis? 1. Feeding. 2. Digestion. 3. Immune response. 4. Glomerular filtration.

106. 1. Choanal atresia will impact the baby's ability to feed.

11. A newborn admitted to the nursery has a positive direct Coombs' test. Which of the following is an appropriate action by the nurse? 1. Monitor the baby for jitters. 2. Assess the blood glucose level. 3. Assess the rectal temperature. 4. Monitor the baby for jaundice.

11 4. When the neonatal bloodstream contains antibodies, hemolysis of the red blood cells occurs and jaundice develops.

12. An 18-hour-old baby is placed under the bili-lights with an elevated bilirubin level. Which of the following is an expected nursing action in these circumstances? 1. Give the baby oral rehydration therapy after all feedings. 2. Rotate the baby from side to back to side to front every two hours. 3. Tightly swaddle in baby blankets to maintain normal temperature. 4. Administer intravenous fluids via pump per doctor orders.

12. 2. Rotating the baby's position maximizes the therapeutic response because the more skin surface that is exposed to the light source, the better the results.

14. A newborn nursery nurse notes that a baby's body is jaundiced at 36 hours of life. Which of the following nursing interventions will be most therapeutic? 1. Maintain a warm ambient environment. 2. Have the mother feed the baby frequently. 3. Have the mother hold the baby skin to skin. 4. Place the baby naked by a closed sunlit window.

14. 2. Bilirubin is excreted through the bowel. The more the baby consumes, the more stools, and therefore the more bilirubin the baby will expel.

16. A nursing diagnosis for a 5-day-old newborn under phototherapy is: Risk for fluid volume deficit. For which of the following client outcomes should the nurse plan to monitor the baby? 1. 6 saturated diapers in 24 hours. 2. Breastfeeds 6 times in 24 hours. 3. 12% weight loss since birth. 4. Apical heart rate of 176 bpm.

16. 1. Healthy, hydrated neonates saturate their diapers a minimum of 6 times in 24 hours.

18. A baby is in the NICU whose mother was addicted to heroin during the pregnancy. Which of the following nursing actions would be appropriate? 1. Tightly swaddle the baby. 2. Place the baby prone in the crib. 3. Provide needed stimulation to the baby. 4. Feed the baby half-strength formula.

18. 1. Tightly swaddling drug-addicted babies often helps to control the hy perreflexia that they may exhibit.

19. A newborn in the nursery is exhibiting signs of neonatal abstinence syndrome. Which of the following signs/symptoms is the nurse observing? Select all that apply. 1. Hyperphagia. 2. Lethargy. 3. Prolonged periods of sleep. 4. Hyporeflexia. 5. Persistent shrill cry.

19. 1 and 5 are correct. 1. Babies with signs of neonatal abstinence syndrome repeatedly exhibit signs of hunger. 5. Babies with signs of neonatal abstinence syndrome often have a shrill cry that may continue for prolonged periods.

32. A neonate is in the neonatal intensive care nursery with a diagnosis of large-for gestational age. The baby was born at 38 weeks' gestation and weighed 3500 grams. Based on this information, which of the following responses is correct? 1. The diagnosis is inaccurate because the baby's weight is too high for a diagnosis of appropriate-for-gestational age. 2. The diagnosis is inaccurate because the baby's weight needs to be higher than 3500 grams. 3. The diagnosis is inaccurate because the baby's weight needs to be lower than 3500 grams. 4. The diagnosis is inaccurate because full-term babies are never large-for gestational age.

2. A baby who is large-for-gestational age is defined as a baby whose weight is above the 90th percentile. According to the graph, at 38 weeks' gestation, a 3500-gram baby is below the 90th percentile for weight. Therefore, the diagnosis is inaccurate.

72. A 30-week-gestation neonate, 2 hours old, has received Survanta (beractant). Which of the following would indicate a positive response to the medication? 1. Axillary temperature 98.0ºF. 2. Oxygen saturation 96%. 3. Apical heart rate 154 bpm. 4. Serum potassium 4.0 mEq/L.

2. A normal oxygen saturation level would be considered a positive result of the medication.

100. The nurse assessed four newborns in the neonatal nursery. The nurse called the neonatalogist for a cardiology consult on the baby who exhibited which of the fol lowing signs/symptoms? 1. Setting sun sign. 2. Anasarca. 3. Flaccid extremities. 4. Polydactyly.

2. Anasarca refers to overall, systemic edema. It is seen is severe cardiovas cular disease. A cardiac consult would be appropriate for this baby as would, perhaps, a renal consult.

24. An infant admitted to the newborn nursery has a blood glucose level of 35 mg/dL. The nurse should monitor this baby carefully for which of the following? 1. Jaundice. 2. Jitters. 3. Erythema toxicum. 4. Subconjunctival hemorrhages.

2. Babies who are hypoglycemic will of ten develop jitters (tremors).

76. A baby is suspected of having esophageal atresia. The nurse would expect to see which of the following signs/symptoms? 1. Frequent vomiting. 2. Excessive mucus. 3. Ruddy complexion. 4. Abdominal distention.

2. Babies with esophageal atresia would be expected to expel large amounts of mucus from the mouth.

45. A nurse in the newborn nursery suspects that a new admission, 42 weeks' gestation, was exposed to meconium in utero. What would lead the nurse to suspect this? 1. The baby is bradycardic. 2. The baby's umbilical cord is green. 3. The baby's anterior fontanel is sunken. 4. The baby is desquamating.

2. Because meconium is a dark green color, when it is expelled in utero, the baby can be stained green.

57. A baby has just been born to a type 1 diabetic mother with retinopathy and nephropathy. Which of the following neonatal findings would the nurse expect to see? 1. Hyperalbuminemia. 2. Polycythemia. 3. Hypercalcemia. 4. Hypoinsulinemia.

2. Because the placenta is likely to be functioning less than optimally, it is highly likely that the baby will be polycythemic. The increase in red blood cells would improve the baby's oxygenation in utero.

96. A baby has been diagnosed with developmental dysplasia of the hip. Which of the following findings would the nurse expect to see? 1. Pronounced hip abduction. 2. Swelling at the site. 3. Asymmetrical leg folds. 4. Weak femoral pulses.

3. The leg folds of the baby, both anteri orally and posteriorly, are frequently asymmetrical.

70. A woman whose 32-week-gestation neonate is to begin oral feedings is expressing breast milk (EBM) for the baby. The neonatalogist is recommending that fortifier be added to the milk because which of the following needs of the baby are not met by EBM? 1. Need for iron and zinc. 2. Need for calcium and phosphorus. 3. Need for protein and fat. 4. Need for sodium and potassium.

2. Calcium and phosphorus in EBM are in quantities that are less than body requirements for the very low birth weight baby. Therefore, a fortifier may need to be added to the EBM.

60. A baby has been admitted to the neonatal intensive care unit with a diagnosis of symmetrical intrauterine growth restriction. Which of the following pregnancy complications would be consistent with this diagnosis? 1. Severe preeclampsia. 2. Chromosomal defect. 3. Infarcts in an aging placenta. 4. Premature rupture of the membranes.

2. Chromosomal abnormalities are associated with symmetrical IUGR.

46. The birth of a baby, weight 4500 grams, was complicated by shoulder dystocia. Which of the following neonatal complications should the nursery nurse observe for? 1. Leg deformities. 2. Brachial palsy. 3. Fractured radius. 4. Buccal abrasions.

2. During a difficult delivery with shoul der dystocia, the brachial nerve can become stretched and may even be severed. The nurse should, therefore, observe the baby for signs of palsy.

92. A neonate has just been born with a meningomyelocele. Which of the following nursing diagnoses should the nurse identify as related to this medical diagnosis? 1. Deficient fluid volume. 2. High risk for infection. 3. Ineffective breathing pattern. 4. Imbalanced nutrition: less than body requirements.

2. If the fragile sac is injured, the baby is very high risk for infection.

80. A nurse is assisting a mother to feed a baby born with cleft lip and palate. Which of the following should the nurse teach the mother? 1. The baby is likely to cry from pain during the feeding. 2. The baby is likely to expel milk through the nose. 3. The baby will feed more quickly than other babies. 4. The baby will need milk with added calories.

2. It is likely that milk will be expelled from the baby's nose during feedings.

79. Which of the following actions would the NICU nurse expect to perform when caring for a neonate with esophageal atresia and tracheoesophageal fistula (TEF)? 1. Position the baby flat on the left side. 2. Maintain low nasogastric suction. 3. Give small frequent feedings. 4. Place on hypothermia blanket.

2. Low nasogastric suction is usually maintained to minimize the amount of the baby's oral secretions.

21. A baby born addicted to cocaine is being given paregoric. The nurse knows that which of the following is a rationale for its use? 1. Paregoric is nonaddictive. 2. Paregoric corrects diarrhea. 3. Paregoric is nonsedating. 4. Paregoric suppresses the cough reflex.

2. Paregoric does help to control the di arrhea seen in drug-addicted neonates.

55. A baby is born with caudal agenesis. Which of the following maternal complica tions is associated with this defect? 1. Poorly controlled myasthenia gravis. 2. Poorly controlled diabetes mellitus. 3. Poorly controlled splenic syndrome. 4. Poorly controlled hypothyroidism.

2. Poorly controlled maternal diabetes mellitus is one of the most important predisposing factors for caudal agene sis in the fetus.

71. A 1000-gram neonate is being admitted to the neonatal intensive care unit. The surfactant Survanta (beractant) has just been prescribed to prevent respiratory dis tress syndrome. Which of the following actions should the nurse take while admin istering this medication? 1. Flush the intravenous line with normal saline solution. 2. Assist the neonatalogist during the intubation procedure. 3. Inject the medication deep into the vastus lateralis muscle. 4. Administer the reconstituted liquid via an oral syringe.

2. Surfactant is administered intra tracheally. The baby must first be in tubated. The nurse would assist the doctor with the procedure.

82. In the delivery room, which of the following infant care interventions must a nurse perform when a neonate with a meningomyelocele is born? 1. Perform nasogastric suctioning. 2. Place baby in the prone position. 3. Administer oxygen via face mask. 4. Swaddle the baby in warm blankets.

2. The baby should be lain prone to pre vent injury to the sac.

41. At 1 minute of life a baby, who appears preterm, has exhibited no effort to breathe even after being stimulated. Which of the following actions should the nurse per form first? 1. Perform a gestational age assessment. 2. Inflate the lungs with positive pressure. 3. Provide external chest compressions. 4. Palpate the base of the umbilical cord.

2. The baby's airway should be estab lished by inflating the lungs with an ambu bag.

23. A nurse makes the following observations when admitting a full-term, breastfeeding baby into the neonatal nursery: 9 lbs 2 oz, 21 inches long, TPR: 96.6ºF, 158, 62, jittery, pink body with bluish hands and feet, crying. Which of the following actions should the nurse perform first? 1. Swaddle the baby to provide warmth. 2. Assess the glucose level of the baby. 3. Take the baby to the mother for feeding. 4. Administer the neonatal medications.

2. The glucose level should be assessed to determine whether or not this baby is hypoglycemic.

54. A client is seeking preconception counseling. She has type 1 diabetes mellitus and is found to have an elevated glycosylated hemoglobin (HgbA1c) level. Before actively trying to become pregnant, she is strongly encouraged to stabilize her blood glu cose to reduce the possibility of her baby developing which of the following? 1. Port wine stain. 2. Cardiac defect. 3. Hip dysplasia. 4. Intussusception.

2. The incidence of cardiac defects and neural tube defects is high in infants born to diabetic mothers.

37. A woman who received an intravenous analgesic 4 hours ago has had prolonged late decelerations in labor. She will deliver her baby shortly. Which of the following is the priority action for the delivery room nurse to take? 1. Preheat the overhead warmer. 2. Page the neonatalogist on call. 3. Draw up Narcan (naloxone) for injection. 4. Assemble the neonatal eye prophylaxis.

2. The neonatalogist must be called to the delivery room so that he or she arrives before the baby is delivered.

85. The nurse administers Lanoxin (digoxin) to a baby in the NICU that has a cardiac defect. The baby vomits shortly after receiving the medication. Which of the fol lowing actions should the nurse perform next? 1. Give a repeat dose. 2. Notify the physician. 3. Assess the apical and brachial pulses concurrently. 4. Check the vomitus for streaks of blood.

2. The nurse should notify the physician that the baby has vomited the digoxin.

30. A Roman Catholic couple has just delivered a baby with an Apgar of 1 at 1 minute, 2 at 5 minutes, and 2 at 10 minutes. Which of the following interventions is appro priate at this time? 1. Advise the parents that they should pray very hard so that everything turns out well. 2. Ask the parents whether they would like the nurse to baptize the baby. 3. Leave the parents alone to work through their thoughts and feelings. 4. Inform the parents that a priest will listen to their confessions whenever they are ready.

2. This baby's Apgar is very low. There is a chance that the baby will not survive. It is appropriate to ask the parents, since they are known to be Roman Catholic, if they would like their baby baptized.

50. A baby in the newborn nursery was born to a mother with spontaneous rupture of membranes for 14 hours. The woman has Candida vaginitis. For which of the fol lowing should the baby be assessed? 1. Papular facial rash. 2. Thrush. 3. Fungal conjunctivitis. 4. Dehydration.

2. Thrush is commonly seen in babies whose mothers have Candida vaginitis.

20. Based on maternal history of alcohol addiction, a baby in the neonatal nursery is being monitored for signs of fetal alcohol syndrome (FAS). The nurse should assess this baby for which of the following? 1. Poor suck reflex. 2. Ambiguous genitalia. 3. Webbed neck. 4. Absent Moro reflex.

20. 1. FAS babies usually have a very weak suck.

22. A baby was born 24 hours ago to a mother who received no prenatal care. The infant has tremors, sneezes excessively, constantly mouths for food, and has a shrill, high-pitched cry. The baby's serum glucose levels are normal. For which of the following should the nurse request an order from the pediatrician? 1. Urine drug toxicology test. 2. Biophysical profile test. 3. Chest and abdominal ultrasound evaluations. 4. Oxygen saturation and blood gas assessments.

22. 1. The symptoms are characteristic of neonatal abstinence syndrome. A urine toxicology would provide evidence of drug exposure.

25. A full-term infant admitted to the newborn nursery has a blood glucose level of 35 mg/dL. Which of the following actions should the nurse perform at this time? 1. Feed the baby formula or breast milk. 2. Assess the baby's blood pressure. 3. Tightly swaddle the baby. 4. Monitor the baby's urinary output.

25. 1. A baby with a blood glucose of 35 mg/dL is hypoglycemic. The action of choice is to feed the baby either formula or breast milk.

26. A nurse is inserting a gavage tube into a preterm baby who is unable to suck and swallow. Which of the following actions must the nurse take during the procedure? 1. Measure the distance from the tip of the ear to the nose. 2. Lubricate the tube with an oil-based solution. 3. Insert the tube quickly if the baby becomes cyanotic. 4. Inject a small amount of sterile water to check placement.

26. 1. The gavage tubing must be measured to approximate the length of the insertion.

28. The nurse must perform nasopharyngeal suctioning of a newborn with profuse secretions. Place the following nursing actions for nasopharyngeal suctioning i chronological order. 1. Slowly rotate and remove the suction catheter. 2. Place thumb over the suction control on the catheter. 3. Assess type and amount of secretions. 4. Insert free end of the tubing through the nose.

28. 4, 2, 1, and 3 is the correct order. 1. Rotation and removal of the suction catheter should be done after the tubing has been inserted through the nose and a thumb placed over the suction control on the catheter. 2. The nurse should place a thumb over the suction control on the catheter after in serting the free end of the tubing through the nose—and before the other two steps are taken. 3. Assessing the type and amount of secre tions in the last step in the process. 4. Inserting the free end of the tubing through the nose is the first step in na sopharyngeal suctioning process.

29. A neonate is being given intravenous fluids through the dorsal vein of the wrist. Which of the following actions by the nurse is essential? 1. Tape the arm to an arm board. 2. Change the tubing every 24 hours. 3. Monitor the site every 5 minutes. 4. Infuse the fluid intermittently.

29. 1. Neonates are incapable of controlling their movements. In order to main tain a safe IV site, it is essential to tape the baby's arm to an arm board.

42. A neonatalogist requests Narcan (naloxone) during a neonatal resuscitation effort. Which of the following dosages would the nurse expect to prepare? 1. 1 microgram/kg. 2. 10 microgram/kg. 3. 0.1 milligrams/kg. 4. 1 milligram/kg.

3. 0.1 milligram/kg is the correct dosage. This dosage can also be ex pressed as 100 microgram/kg

51. A baby has been admitted to the neonatal nursery whose mother is hepatitis B-surface antigen positive. Which of the following actions by the nurse should be taken at this time? 1. Monitor the baby for signs of hepatitis B. 2. Place the baby on contact isolation. 3. Obtain an order for the hepatitis B vaccine and the immune globulin. 4. Advise the mother that breastfeeding is absolutely contraindicated.

3. Babies exposed to hepatitis B in utero should receive the first dose of hepati tis B vaccine as well as hepatitis B immune globulin (HBIG) within 12 hours of delivery to reduce transmission of the virus. See http:// www.cdc.gov/breastfeeding/disease/ hepatitis.htm

3. Which of the following would lead the nurse to suspect cold stress syndrome in a newborn with a temperature of 96.5ºF? 1. Blood glucose of 50 mg/dL. 2. Acrocyanosis. 3. Tachypnea. 4. Oxygen saturation of 96%

3. Babies who have cold stress syndrome will develop respiratory distress. One symptom of the distress is tachypnea.

61. A neonate has intrauterine growth restriction secondary to placental insufficiency. Which of the following signs/symptoms should the nurse expect to observe at delivery? 1. Thrombocytopenia. 2. Neutropenia. 3. Polycythemia. 4. Hyperglycemia.

3. Babies who have lived in utero with an aging placenta usually are born with polycythemia.

6. A 6-month-old child developed kernicterus immediately after birth. Which of the following tests should be done to determine whether or not this child has developed any sequelae to the illness? 1. Blood urea nitrogen and serum creatinine. 2. Alkaline phosphotase and bilirubin. 3. Hearing and vision assessments. 4. Peak expiratory flow and blood gas assessments

3. Because the central nervous system (CNS) may have been damaged by the high bilirubin levels, testing of the senses as well as motor and cognitive assessments are appropriate.

40. A 42-week gravida is delivering her baby. A nurse and pediatrician are present at the bith. The amniotic fluid is green and thick. The baby fails to breathe sponta neously. Which of the following actions should the nurse take next? 1. Stimulate the baby to breathe. 2. Assess neonatal heart rate. 3. Assist with intubation. 4. Place the baby in the prone position.

3. Before breathing, the baby must be intubated so that the meconiumcontaminated fluid can be aspirated from the baby's airway. (http:// pediatrics.aappublications.org/cgi/ content/full/117/5/e1029)

47. During a health maintenance visit at the pediatrician's office, the nurse notes that a breastfeeding baby has thrush. Which of the following actions should the nurse take? 1. Nothing because thrush is a benign problem. 2. Advise the mother to bottlefeed until the thrush is cured. 3. Obtain an order for antifungals for both mother and baby. 4. Assess for other evidence of immunosuppression.

3. Candida is a fungal infection, and it is important to treat both the mother's breasts and the baby's mouth to prevent the infection from being transmitted back and forth between the two.

78. An infant in the neonatal nursery has low set ears, Simian creases, and slanted eyes. The nurse should monitor this infant carefully for which of the following signs/symptoms? 1. Blood-tinged urine. 2. Hemispheric paralysis. 3. Cardiac murmur. 4. Hemolytic jaundice.

3. Cardiac anomalies occur much more frequently in Down babies than in other babies.

17. There is a baby in the neonatal intensive care unit (NICU) who is exhibiting signs of neonatal abstinence syndrome. Which of the following medications is contraindicated for this neonate? 1. Morphine. 2. Opium. 3. Narcan. 4. Phenobarbital.

3. Narcan is an opiate. If it were to be given to the neonate with neonatal abstinence syndrome, the baby would go into a traumatic withdrawal.

99. The nurse caring for an infant with a congenital cardiac defect is monitoring the child for which of the following early signs of congestive heart failure? 1. Hypertension, cyanosis, bradycardia. 2. Irritability, hypotension, palpitations. 3. Tachypnea, tachycardia, diaphoresis. 4. Angina, oliguria, dysrhythmias.

3. No matter whether a baby or an adult is developing CHF, the early signs that the nurse would note are tachy pnea, tachycardia, and diaphoresis.

89. The nurse is developing a teaching plan for parents of an infant with a tetralogy of Fallot. Which of the following positions should parents be taught to place the in fant during a "blue," or "tet," spell? 1. Supine. 2. Prone. 3. Knee-chest. 4. Semi-Fowler's.

3. Parents should place an infant during a "tet" spell into the knee-chest position.

108. A baby is born with esophageal atresia and tracheoesophageal fistula. Which of the following complications of pregnancy would the nurse expect to note in the mother's history? 1. Preeclampsia. 2. Idiopathic thrombocytopenia. 3. Polyhydramnios. 4. Severe iron deficiency anemia.

3. Polyhydramnios is often seen in pregnancies complicated by a fetus with a digestive blockage.

2. Which of the following neonates is at highest risk for cold stress syndrome? 1. Infant of diabetic mother. 2. Infant with Rh incompatibility. 3. Postdates neonate. 4. Down syndrome neonate.

3. Postdates babies are at high risk for cold stress syndrome because while still in utero they often metabolize the brown adipose tissue for nourish ment when the placental function de teriorates.

1. A 1-day-old neonate, 32 weeks' gestation, is in an overhead warmer. The nurse as sesses the morning axillary temperature as 96.9ºF. Which of the following could ex plain this assessment finding? 1. This is a normal temperature for a preterm neonate. 2. Axillary temperatures are not valid for preterm babies. 3. The supply of brown adipose tissue is incomplete. 4. Conduction heat loss is pronounced in the baby.

3. Preterm babies are born with an in sufficient supply of brown adipose tis sue that is needed for thermogenesis, or heat generation.

27. A neonate is in the warming crib for poor thermoregulation. Which of the follow ing sites is appropriate for the placement of the skin thermal sensor? 1. Xiphoid process. 2. Forehead. 3. Abdominal wall. 4. Great toe.

3. The abdominal wall is the appropriate placement for the skin thermal sensor.

68. A mother of a preterm baby is performing kangaroo care in the neonatal nursery. Which of the following responses would the nurse evaluate as a positive neonatal outcome? 1. Respiratory rate of 70. 2. Temperature of 97.0ºF. 3. Licking the mother's nipples. 4. Flaring of the baby's nares.

3. The baby is showing signs of interest in breastfeeding. This is a positive sign.

48. A neonate, whose mother is HIV positive, is admitted to the NICU. A nursing diagnosis: Risk for infection related to perinatal exposure to HIV/AIDS is made. Which of the following interventions should the nurse make in relation to the diagnosis? 1. Monitor daily viral load laboratory reports. 2. Check the baby's viral antibody status. 3. Obtain an order for antiviral medication. 4. Place the baby on strict precautions.

3. The standard of care for neonates born to mothers with HIV/AIDS is to begin them on anti-AIDS medication in the nursery. The mother will be advised to continue to give the baby the medication after discharge.

101. A preterm infant has a patent ductus arteriosus (PDA). Which of the following ex planations should the nurse give to the parents about the condition? 1. Hole has developed between the left and right ventricles. 2. Hypoxemia occurs as a result of the poor systemic circulation. 3. Oxygenated blood is reentering the pulmonary system. 4. Blood is shunting from the right side of the heart to the left.

3. There is a left to right shunt of blood with a patent ductus arteriosus (PDA) resulting in oxygenated blood reen tering the pulmonary system.

90. A child has been diagnosed with a small ventricular septal defect (VSD). Which of the following symptoms would the nurse expect to see? 1. Cyanosis and clubbing of the fingers. 2. Respiratory distress and extreme fatigue. 3. Systolic murmur with no other obvious symptoms. 4. Feeding difficulties with marked polycythemia.

3. This response is correct.

86. A baby is born with a meningomyelocele at L2. In assessing the baby, which of the following would the nurse expect to see? 1. Sensory loss in all four extremities. 2. Tuft of hair over the lumbosacral region. 3. Flaccid paralysis of the legs. 4. Positive Moro reflex.

3. With a defect at L2, the nurse would expect to see paralysis of the legs.

31. The nurse assesses a newborn as follows: heart rate: 70 respirations: weak and irregular tone: flaccid color: pale baby grimaces when a pediatrician attempts to insert an endotracheal tube What should the nurse calculate the baby's Apgar score to be? ____________

31. The baby's Apgar score is 3.

33. A neonate has been admitted to the neonatal intensive care unit with the following findings: completely flaccid posturing square window sign of 60º arm recoil of 180º popliteal angle of 160º full scarf sign heel that touches the ear skin that is red and translucent sparse lanugo faint red marks on the plantar surface barely perceptible breast tissue eye lids that are open but flat ear pinnae prominent clitoris and small labia minora

33. 24 weeks

34. A neonate is in the neonatal intensive care unit. The baby is 28 weeks' gestation and weighs 1000 grams. Which of the following is correct in relation to this baby's growth?

34. 1. The baby's weight is appropriate for-gestational age. The baby's weight of 1000 grams falls between the upper and lower curves for 28 weeks' gestation.

35. A neonate, 40 weeks by dates, has been admitted to the nursery. Place an "X" on the graph where the baby would be labeled large-for-gestational age. 1. Weight is appropriate-for-gestational age. 2. Weight is below average for gestational age. 3. Baby experienced intrauterine growth restriction. 4. Baby experienced congenital growth hypertrophy.

35. TEST-TAKING TIP: The test taker should locate the 40-week-gestation line on the x-axis and follow it up to the second curve. Babies whose weights are above the second curve are labeled large-forgestational age (see figure below)

36. A 42-week-gestation baby, 2400 grams, whose mother had no prenatal care, is ad mitted into the NICU. The neonatalogist orders blood work. Which of the follow ing laboratory findings would the nurse expect to see? 1. Blood glucose 30 mg/dL. 2. Leukocyte count 1000 cells/mm3. 3. Hematocrit 30%. 4. Serum pH 7.8.

36. 1. This baby is small-for-gestational age. Full-term babies (40 weeks' gestation) should weigh between 2500 and 4000 grams. It is very likely that this baby used up his glycogen stores in utero because of an aging placenta. An ag ing placenta is unable to deliver suffi cient nutrients to the fetus. As a re sult the fetus must use its glycogen stores to sustain life and, therefore, is high risk for hypoglycemia after birth.

4. Four babies are in the newborn nursery. The nurse pages the neonatalogist to see the baby who exhibits which of the following? 1. Intracostal retractions. 2. Erythema toxicum. 3. Pseudostrabismus. 4. Vernix caseosa.

4. 1. Intracostal retractions are symptomatic of respiratory distress syndrome.

84. The nurse caring for a neonate with congestive heart failure identifies which of the following nursing diagnoses as highest priority? 1. Fatigue. 2. Activity intolerance. 3. Sleep pattern disturbance.

4. Altered tissue perfusion is the priority diagnosis.

77. The nurse is teaching a couple about the special health care needs of their newborn child with Down syndrome. The nurse knows that the teaching was successful when the parents state that the child will need which of the following? 1. Yearly three-hour glucose tolerance testing. 2. Immediate intervention during bleeding episodes. 3. A formula that is low in lactose and phenylalanine. 4. Prompt treatment of upper respiratory infections.

4. Because of the hypotonia of the respi ratory accessory muscles, Down ba bies often need medical intervention when they have respiratory infections.

75. The nurse is providing discharge teaching to the parents of a baby born with a cleft lip and palate. Which of the following should be included in the teaching? 1. Correct technique for the administration of a gastrostomy feeding. 2. Need to watch for the appearance of blood-stained mucus from the nose. 3. Optimal position for burping after nasogastric feedings. 4. Need to give the baby sufficient time to rest during each feeding.

4. Cleft lip and palate babies require ad ditional time to rest as well as to suck and swallow when being fed.

5. A baby is grunting in the neonatal nursery. Which of the following actions by the nurse is appropriate? 1. Place a pacifier in the baby's mouth. 2. Check the baby's diaper. 3. Have the mother feed the baby. 4. Assess the respiratory rate.

4. Grunting is often accompanied by tachypnea, another sign of respiratory distress.

56. A macrosomic infant of a non-insulin dependent diabetic mother has been admitted to the neonatal nursery. The baby's glucose level on admission to the nursery is 25 mg/dL and after a feeding of mother's expressed breast milk is 35 mg/dL. Which of the following actions should the nurse take at this time? 1. Nothing because the glucose level is normal for an infant of a diabetic mother. 2. Administer intravenous glucagon slowly over five minutes. 3. Feed the baby a bottle of dextrose and water and reassess the glucose level. 4. Notify the neonatalogist of the abnormal glucose levels.

4. If the glucose level has not risen to normal as a result of the feeding, the nurse should notify the physician and anticipate that the doctor will order an intravenous of dextrose and water.

39. A 42-week-gestation baby has been admitted to the neonatal intensive care unit. At delivery, thick green amniotic fluid was noted. Which of the following actions by the nurse is critical at this time? 1. Bath to remove meconium-contaminated fluid from the skin. 2. Ophthalmic assessment to check for conjunctival irritation. 3. Rectal temperature to assess for septic hyperthermia. 4. Respiratory evaluation to monitor for respiratory distress.

4. Meconium aspiration syndrome (MAS) is a serious complication seen in postterm neonates who are exposed to meconium-stained fluid. Respira tory distress would indicate that the baby has likely developed MAS.

102. A nurse hears a heart murmur on a full-term neonate in the well baby nursery. The baby's color is pink while at rest and while feeding. The baby most likely has which of the following cardiac defects? 1. Transposition of the great vessels. 2. Tetralogy of Fallot. 3. Pulmonic stenosis. 4. Patent ductus arteriosus.

4. Patent ductus arteriosus (PDA) is a very common cardiac defect in preterm babies. It is an acyanotic de fect with a left to right shunt. Already oxygenated blood reenters the pul monary system.

107. A baby is born to a mother who was diagnosed with oligohydramnios during her pregnancy. The nurse notifies the neonatalogist to order tests to assess the func tioning of which of the following systems? 1. Gastrointestinal. 2. Hepatic. 3. Endocrine. 4. Renal.

4. Some defects of the renal system can lead to oligohydramnios.

87. When examining a nenonate in the well-baby nursery, the nurse notes that the scle rae of both of the baby's eyes is visible above the iris of the eyes. Which of the fol lowing assessments is highest priority for the nurse to make next? 1. Babinski and tonic neck reflexes. 2. Evaluation of bilateral eye coordination. 3. Blood type and Coombs' test results. 4. Circumferences of the head and chest.

4. The baby should be assessed for signs of hydrocephalus, especially a dispar ity between the circumferences of the neonatal head and the neonatal chest.

44. The staff on the maternity unit is developing a protocol for nurses to follow after a baby is delivered who fails to breathe spontaneously. Which of the following should be included in the protocol as the first action for the nurse to take? 1. Prepare epinephrine for administration. 2. Provide positive pressure oxygen. 3. Administer chest compressions. 4. Rub the back and feet of the baby.

4. The first interventions when a neonate fails to breathe include pro viding tactile stimulation.

38. A baby has been admitted to the neonatal intensive care unit with a diagnosis of postmaturity. The nurse expects to find which of the following during the initial newborn assessment? 1. Abundant lanugo. 2. Flat breast tissue. 3. Prominent clitoris. 4. Wrinkled skin.

4. The postterm baby does have dry, wrinkled, and often desquamating skin. The baby's dehydration is sec ondary to a placenta that progres sively deteriorates after 40 weeks' gestation.

15. A neonate is under phototherapy for elevated bilirubin levels. The baby's stools are now loose and green. Which of the following actions should the nurse take at this time? 1. Discontinue the phototherapy. 2. Notify the health care practitioner. 3. Take the baby's temperature. 4. Assess the baby's skin integrity.

4. The stools can be very caustic to the baby's delicate skin. The nurse should cleanse the area well and inspect the skin for any sign that the skin is breaking down.

43. During neonatal cardiopulmonary resuscitation, which of the following actions should be performed? 1. Provide assisted ventilation at 40 to 60 breaths per minute. 2. Begin chest compressions when heart rate is 0 to 20 beats per minute. 3. Compress the chest using the three-finger technique. 4. Administer compressions and breaths in a 5 to 1 ratio.

43. 1. Assisted ventilations should be administered at a rate of 40 to 60 per minute.

49. A baby was just born to a mother who had positive vaginal cultures for group B streptococcus. The mother was admitted to the labor room 2 hours before the birth. For which of the following should the nursery nurse closely observe this baby? 1. Hypothermia. 2. Mottling. 3. Omphalocele. 4. Stomatitis.

49. 1. Hypothermia in a neonate may be in dicative of sepsis.

58. A baby is born to a type 1 diabetic mother. Which of the following lab values would the nurse expect the neonate to exhibit? 1. Plasma glucose 30 mg/dL. 2. Red blood cell count 1 million/mm3. 3. White blood cell count 2000/mm3. 4. Hemoglobin 8 g/dL.

58. 1. The nurse should anticipate that the plasma glucose levels would be low.

59. A baby has just been admitted into the neonatal intensive care unit with a diagnosis of intrauterine growth restriction (IUGR). Which of the following maternal factors would predispose the baby to this diagnosis? Select all that apply. 1. Hyperopia. 2. Gestational diabetes. 3. Substance abuse. 4. Chronic hypertension. 5. Advanced maternal age.

59. 3, 4, and 5 are correct. 1. Hyperopia, another name for farsighted ness, is unrelated to placental function. 2. If the mother had gestational diabetes, the nurse would expect the baby to be macrosomic, not to have IUGR. 3. Placental function is affected by the vasoconstrictive properties of many illicit drugs, as well as by cigarette smoke. 4. Placental function is diminished in women who have chronic hypertension. 5. Placental function has been found to be diminished in women of advanced maternal age.

62. A woman is visiting the NICU to see her 26-week-gestation baby for the first time. Which of the following methods would the nurse expect the mother to use when first making physical contact with her baby? 1. Fingertip touch. 2. Palmar touch. 3. Kangaroo hold. 4. Cradle hold.

62. 1. Most mothers, even those of full-term babies, usually use finger-tip touch during their first physical contact with their babies.

63. A 6-month-old child is being seen in the pediatrician's office. The child was born preterm and remained in the neonatal intensive care unit for the first 5 months of life. The child is being monitored for 5 chronic problems. Which of the following problems are directly related to the prematurity? Select all that apply. 1. Bronchopulmonary dysplasia. 2. Cerebral palsy. 3. Retinopathy. 4. Hypothyroidism. 5. Seizure disorders.

63. 1, 2, 3, and 5 are correct. 1. Bronchopulmonary dysplasia often is a consequence of the respiratory ther apy that preemies receive in the NICU. 2. Cerebral palsy results from a hypoxic insult that likely occurred as a result of the baby's prematurity. 3. Retinopathy of the premature is a dis ease resulting from the immaturity of the vascular system of the eye. 4. Hypothyroidism is one of the diseases as sessed for in the neonatal screen. It is very unlikely that this problem resulted from the baby's stay in the NICU. 5. Seizure disorders can result either from a hypoxic insult to the brain or from a ventricular bleed. Both of these conditions likely occurred as a result of the prematurity.

64. A neonatalogist prescribes Garamycin (gentamicin) for a 2-day-old, septic preterm infant who weighs 1653 grams and is 38 centimeters long. The drug reference states: Neonatal dosage of Garamycin for babies less than 1 week of age is 2.5 mg/kg q 12-24 hours. Calculate the safe daily dosage of this medication. _____________ mg q 24 hours.

64. 4.13 mg q 24 hours

65. The neonatalogist has ordered 12.5 micrograms of digoxin po for a neonate in congestive heart failure. The medication is available in the following elixir— 0.05 mg/mL. How many milliliters (mL) should the nurse administer? _____________ mL.

65. 0.25 mL

66. A neonatalogist prescribes Platinol-AQ (cisplatin) for a neonate born with a neuro blastoma. The baby's current weight is 3476 grams and the baby is 57 centimeters long. The drug reference states: Children: IV 30 mg/m2 q week. Calculate the safe dosage of this medication. ____________ mg q week.

66. 6.9 mg q week

67. A preterm baby is to receive 4 mg Garamycin (gentamicin) IV every 24 hours. The medication is being injected into an IV soluset. A total of 5 cc is to be administered via IV pump over 90 minutes. The pump should be set at what rate? _____________ mL/hr.

67. 3.33 mL/hr

69. A neonate is being assessed for necrotizing enterocolitis (NEC). Which of the fol lowing actions by the nurse is appropriate? Select all that apply. 1. Perform hemoccult test on stools. 2. Monitor for an increase in abdominal girth. 3. Measure gastric contents before each feed. 4. Assess bowel sounds before each feed. 5. Assess for anal fissures daily.

69. 1, 2, 3, and 4 are correct. 1. Babies with necrotizing enterocoliti (NEC) have blood in their stools. 2. The abdominal girth measurements of babies with NEC increase. 3. When babies have NEC, they have i creasingly larger undigested gastric contents after feeds. 4. The neonates' bowel sounds are diminished with NEC.

7. A baby with hemolytic jaundice is being treated with fluorescent phototherapy. To provide safe newborn care, which of the following actions should the nurse perform? 1. Cover the baby's eyes with eye pads. 2. Turn the lights on for ten minutes every hour. 3. Clothe the baby in a shirt and diaper only. 4. Tightly swaddle the baby in a baby blanket.

7. 1. When phototherapy is administered, the baby's eyes must be protected from the light source.

A baby is born with erythroblastosis fetalis. Which of the following signs/symptoms would the nurse expect to see? 1. Ruddy complexion. 2. Anasarca. 3. Alopecia. 4. Erythema toxicum.

8. 2. Babies born with erythroblastosis fetalis often are in severe congestive heart failure and, therefore, exhibit anasarca.

9. Which of the following laboratory findings would the nurse expect to see in a baby diagnosed with erythroblastosis fetalis? 1. Hematocrit 24%. 2. Leukocyte count 45,000 cells/mm3. 3. Sodium 125 mEq/L. 4. Potassium 5.5 mEq/L.

9. 1. The baby with erythroblastosis fetalis would exhibit signs of severe anemia, which a hematocrit of 24% reflects.

97. The nurse suspects that a newborn in the nursery has a clubbed right foot because the foot is plantar flexed and because the nurse also notices which of the following? 1. Inability to move the foot into proper alignment. 2. Notes positive Ortolani sign on the right. 3. Notes shortened right metatarsal arch. 4. Elicits positive Babinski reflex on the right.

97. 1. During the neonatal physical assess ment, the nurse is unable to move a club foot into proper alignment.