OB exam 2

How long is the neonatal period for a newborn? ____ days

28

Assessment of a newborn reveals microcephaly. The nurse develops a teaching plan for the parents about the need for follow-up care based on the understanding that the newborn is at risk for developing which complication(s)? Select all that apply. a. epilepsy b. cerebral palsy c. hearing disorders d. hydrocephalus e. achondroplasia

a,b,c

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 any frozen milk within 6 months of obtaining it. c. Use microwave ovens to warm the chilled milk. d. Refreeze any unused milk for later use if it has not been out more that 2 hours.

a

A mother points out to the nurse that following three meconium stools, her newborn has had a bright green stool. The nurse would explain to her that: a. this is a normal finding. b. this is most likely a symptom of impending diarrhea. c. her child may be developing an allergy to breast milk. d. her child will need to be isolated until the stool can be cultured.

a

A newborn's cord begins to bleed 1 day following birth. What measures would the nurse take to address this problem? a. Inspect the clamp to insure that it is tightly closed and applied correctly. b. Clean the cord with soap and water, as oozing of blood is a common finding. c. Remove the clamp and replace with another one just above the old one. d. Notify the doctor to come suture the site of the bleeding.

a

A nurse is assessing a newborn with the parents. The nurse explains that which aspect of newborn behavior is an important indication of neurologic development and function? a. reflex b. crying response c. voluntary movements d. orientation to surroundings

a

A nurse is conducting a refresher program for a group of nurses returning to work in the newborn clinic. The nurse is reviewing the protocols for assessing vital signs in healthy newborns and infants. The nurse determines that additional education is needed when the group identifies which parameter as being included in the assessment? a. blood pressure b. pulse c. temperature d. respirations e. pain

a

A nurse is describing the many changes a newborn will go through during his or her first couple of weeks after birth. The nurse explains how the functions of the placenta are taken over by which organ? a. liver b. intestine c. cardiovascular system d. kidneys

a

A nurse is observing the interaction between a new mother and her neonate. The nurse notes that the neonate moves his head and eyes to focus on the mother's voice and smile. The nurse interprets this as which behavioral response? a. orientation b. habituation c. motor maturity d. self-quieting behavior

a

A nursing student will pick which value as a correct laboratory value for a newborn? a. hemoglobin (Hbg) 17 g/dL (170 g/L) b. hematocrit (Hct) 40% (0.4) c. platelet count 75,000/µL (75 ×109/L) d. white blood cell (WBC) count 40,000/mm³ (40 ×109/L)

a

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

a

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

The newborn should have the neurologic status evaluated to determine its maturity and to identify any potential problems. The nurse tests the newborn's Babinski reflex. Which response would the nurse interpret as normal for the newborn? a. Toes fan out when sole of foot is stroked. b. Infant throws arms outward and flexes knees. c. Infant makes stepping motion. d. Infant's toes curl over the nurse's finger.

a

The nurse explains the hospital's home visitation program for new families after discharge from the hospital. Which information will the nurse include regarding this program? a. Caregivers can demonstrate competency in caring for the infant and ask questions. b. The nurse can discuss parenting conflicts with the caregivers to determine which style is best. c. Caregivers use this time to rest or complete errands while the visiting nurse takes care of the infant. d. The nurse will complete any procedures the infant was not able to have performed while in the hospital.

a

The nurse has completed assessing the blood glucose levels of several infants who are 24 hours old. Which result should the nurse prioritize for intervention? a. 30 mg/dl (1.67 mmol/L) b. 50 mg/dl (2.77 mmol/L) c. 70 mg/dl (3.89 mmol/L) d. 90 mg/dl (5.00 mmol/L)

a

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. Obtain a transcutaneous bilirubin level. b. Draw blood for a metabolic panel. c. Prepare the infant for an exchange transfusion. d. Initiate phototherapy.

a

The nurse is assisting with the admission of a newborn to the nursery. The nurse notes what appears to be bruising on the left upper outer thigh of this dark-skinned newborn. Which documentation should the nurse provide? a. Mongolian spot noted on left upper outer thigh. b. Harlequin sign noted on left upper outer thigh. c. Mottling noted on left upper outer thigh. d. Birth trauma noted on left upper outer thigh.

a

The nurse is explaining to new parents that a potential complication of a cesarean birth is transient tachypnea. The nurse explains that this is due to which occurrence? a. lack of thoracic compressions during birth b. loss of blood volume due to hemorrhage c. inadequate suctioning of the mouth and nose of the newborn d. prolonged unsuccessful vaginal birth

a

The nurse is preparing new parents and their infant for discharge by answering questions and presenting basic discharge instruction. Which explanation should the nurse provide when questioned about the infant's yellow hue? a. The tint is due to jaundice. b. Yellow is the normal color for some newborns. c. The infant needs to be in the sunlight to clear the skin. d. It's a mild reaction to the vitamin K injection.

a

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

When instructing a new mom on providing skin care to her newborn, which statement, made by the mother, indicates additional teaching is needed? a. "I can use talc powders to prevent diaper rash." b. " I will change my baby's diapers frequently." c. "I will give sponge baths until the umbilical cord falls off." d. "It is not necessary to give my baby a bath daily."

a

While assessing a newborn, the nurse notes that half the body appears red while the other half appears pale. The nurse interprets this finding as: a. harlequin sign. b. stork bites. c. Mongolian spots. d. erythema toxic.

a

The nurse orienting a student to the nursery determines that teaching has been effective when the student states that the signs of neonate respiratory distress include which findings? Select all that apply. a. Nasal flaring b. Respiratory rate of 64 breaths per minute c. Bluish coloration of hands and feet d. Chest retractions e. Heart rate of 120 beats per minute

a,b,d

What are common risk factors for developing newborn jaundice? Select all that apply. a. fetal-maternal blood group incompatibility b. prematurity c. breastfeeding d. certain drugs e. maternal gestational diabetes f. too frequent feedings

a,b,d,e

A client gives birth to a baby at a local health care facility. The nurse observes that the infant is fussy and begins to move her hands to her mouth and suck on her hand and fingers. How should the nurse interpret these findings? a. The infant is entering the habituation state. b. The infant is attempting self-consoling maneuvers. c. The infant is in a state of hyperactivity. d. The infant is displaying a state of alertness.

b

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 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." c. "Newborns are given vitamin K and erythromycin ointment to help prevent ophthalmia neonatorum." d. This vitamin substitutes for vitamin C for newborns to strengthen their immune systems."

b

A nurse is observing a new parent bottle feeding the newborn. The nurse notices that the newborn begins to get fussy during the feeding. Which action by the nurse would be appropriate? a. Suggest the parent stop the feeding because the newborn is full. b. Encourage the parent to burp the newborn to get rid of air. c. Urge the parent to prop the bottle for the rest of the feeding. d. Instruct the parent to stop feeding for a few minutes and then restart.

b

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. "This is most unusual! Let me get the lactation specialist to assist you in breastfeeding. It should not be a problem though." b. "Precocious teeth can occur at birth but we may need to remove them to prevent aspiration." c. "The teeth will fall out within the first month, so don't worry about them." d. "The teeth will fall out when the newborn's baby teeth come in so this is a blessing."

b

A nursing student is aware that fetal gas exchange takes place in which area? a. uterus b. placenta c. lungs d. bronchioles

b

The heart rate of the newborn in the first few minutes after birth will be in which range? a. 120 to 130 bpm b. 110 to 160 bpm c. 180 to 220 bpm d. 80 to 120 bpm

b

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. "Your newborn should finish a bottle in less than 15 minutes." b. "A sign of good nutrition is when your newborn seems satisfied and is gaining sufficient weight." c. "If your newborn is wetting three to four diapers and producing several stools a day, enough formula is likely being consumed." d. "Your newborn should be taking about 2 oz of formula for every pound of body weight during each feeding."

b

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. Apgar score b. blood sugar c. heart rate d. temperature

b

The nurse is caring for a newborn who was delivered via a planned cesarean delivery. The nurse determines the infant requires closer monitoring than a vaginal delivery infant based on which factor? a. Oxygen was cut off when the umbilical cord was clamped, resulting in decreased oxygen and increased carbon dioxide. b. Excessive fluid in its lungs, making respiratory adaptation more challenging. c. Fetal lungs are uninflated and full of amniotic fluid that must be absorbed. d. Much of the fetal lung fluid is squeezed out in cesarean delivery.

b

The nurse is explaining to new parents the various injections their newborn will receive before being discharged home. Which injection should the nurse teach the parents about that will help decrease the incidence of hepatic disease later in life? a. Vitamin K b. Hep B c. HBV immunoglobin d. HiB

b

The nurse is inspecting the mouth of a newborn and finds small, white cysts on the gums and hard palate. The nurse documents this finding as: a. thrush. b. Epstein pearls. c. milia. d. vernix caseosa.

b

The nurse is teaching the parents of a newborn baby girl the basic discharge instructions. The nurse determines the session is successful after the couple articulate they will contact the primary care provider if their infant shows which sign of diarrhea? a. more than one episode of diarrhea in one day b. more than two episodes of diarrhea in one day c. has any episodes of diarrhea d. has more than four episodes of diarrhea in one day

b

The nurse walks into a client's room and notes a small fan blowing on the mother as she holds her infant. The nurse should explain this can result in the infant losing body heat based on which mechanism? a. Conduction b. Convection c. Radiation d. Evaporation

b

What treatments would the nurse perform in caring for a newly circumcised newborn? Select all that apply. a. Apply talc powder to the diaper area with each diaper change. b. Wash the penis with warm water at each diaper change. c. Fasten the diaper loosely to prevent unnecessary friction as irritation. d. Report if there is a bleeding spot the size of a dime on the diaper. e. Notify the doctor if the newborn does not void after 4 hours.

b,c

The nurse is teaching a couple about the pros and cons of circumcision for their infant son. The nurse knows teaching has been effective when the couple can identify which contraindications to circumcision? Select all that apply. a. Difficult intravenous access b. Preterm infant c. Bleeding disorder d. Congenital genitourinary disorder e. Active infection

b,c,d,e

A nurse is doing an admission assessment on a female infant born to a primipara. Which findings would warrant notification of the physician? Select all that apply. a. Heart rate of 150 b. Scaphoid abdomen c. Episodic breathing d. Head circumference of 38 cm e. overlapping cranial sutures

b,d

A 2-month-old infant is admitted to a local health care facility with an axillary temperature of 96.8° F (36° C). Which observed manifestation would confirm the occurrence of cold stress in this client? a. increased appetite b. increase in the body temperature c. lethargy and hypotonia d. hyperglycemia

c

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. Proceed with the discharge. b. Notify the health care provider. c. Assess the bilirubin level. d. Assist the mother to feed the newborn.

c

A new mother calls her pediatrician's office concerned about her 2-week-old infant "crying all the time." When the nurse explores further, the mother reports that the infant cries at least 2 hours each day, usually in the afternoons. What recommendation would the nurse not make to this mother? a. Rocking and talking to the infant b. Swaddling the infant before returning to the crib c. Feeding the infant more formula whenever she begins to fuss d. Gently patting or stroking the infant's back

c

A newborn's vital signs are documented by the nurse and are as follows: HR 144, RR- 36, BP- 128/78, and T- 98.6℉ (37℃). Which finding would be concerning to the nurse? a. Heart Rate b. Respiratory Rate c. Blood Pressure d. Temperature

c

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 the woman to bring the infant back when the doctor finishes the examination. b. Call the nursery to confirm the doctor does indeed need this infant at this time. c. Ask to see the woman' hospital identification badge. d. Ask how long the infant will be gone since her next feeding is in 30 minutes.

c

Parents tell the nurse they have been told to keep their newborn away from windows. They do not understand why this is necessary. Which rationale will the nurse provide to the parents? a. "Newborns weighing below 8 lb (3630 g) lack enough brown fat to produce heat." b. "Windows can be drafty and placing the newborn by one can result in evaporative heat loss." c. "Newborns cannot shiver to produce heat and need to be kept away from sources of heat loss." d. "Covering the newborn with heavy blankets is the best way to keep your newborn warm."

c

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. Conductive b. Convective c. Evaporative d. Radiating

c

The nurse is assessing a newborn by auscultating the heart and lungs. Which natural phenomenon will the nurse explain to the parents is happening in the cardiovascular system? a. Oxygen is exchanged in the lungs. b. Fluid is removed from the alveoli and replaced with air. c. Pressure changes occur and result in closure of the ductus arteriosus. d. The oxygen in the blood decreases.

c

The nurse is assessing a newborn who appears healthy and at term. Which assessment finding of the feet does the nurse predict to observe to confirm the status of at-term birth? a. Creases covering one fourth of the foot b. Longitudinal but no horizontal creases c. Creases on two-thirds of the foot d. Heel but no anterior creases

c

The nurse is preparing to administer the vitamin K injection to a newborn. Which action would be correct for this client? a. Using a 21-gauge needle b. Injecting 1cc of medication c. Injecting the medication into the vastus lateralis d. Injecting at a 45-degree angle

c

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. Administer an oral dose of vitamin K to the newborn. b. Assume that the parents refused this medication for their infant. c. Call the Labor and Delivery nurse who cared for the newborn to inquire about why the medication was not documented. d. Give the IM dose of vitamin K to prevent the possibility of hemorrhage in the newborn.

c

The primipara tells the nurse, "My baby jumps every time I pick her up. Is she afraid that I will drop her?" Which response by the nurse would be best? a. "No, it is the blink reflex. It is meant to protect the eyes." b. "Yes, she is afraid you will drop her." c. "No, it is the Moro reflex. This reflex simulates the action of warding off an attacker." d. "No, it is the tonic neck reflex. It signifies handedness."

c

Upon assessing the newborn's respirations, which finding would cause the nurse to notify the primary care provider? a. coughing and sneezing in the newborn b. short periods of apnea that last 10 seconds in a pink newborn c. a respiratory rate of 15 breaths per minute with nasal flaring d. a respiratory rate of 45 breaths per minute with acrocyanosis

c

Which intervention would be the best way for the nurse to prevent heat loss in a newborn while bathing? a. Limit the bathing time to 5 minutes. b. Bathe the baby in water between 90 and 93 degrees. c. Bathe the baby under a radiant warmer. d. Postpone breastfeeding until after the initial bath.

c

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. This is an abnormal finding and needs to be reported immediately. b. If the fontanel feels full, then this is normal. c. This finding is normal if the pulsation can also be palpated in the posterior fontanel. d. It is normal to feel pulsations that correlate with the newborn's heart rate over the anterior fontanel.

d

A nurse is caring for a 5-hour-old newborn. The primary care provider has asked the nurse to maintain the newborn's temperature between 97.7° F and 99.5° F (36.5° C and 37.5° C). Which nursing intervention would be the best approach to maintaining the temperature within the recommended range? a. Delay weighing the infant, as the scales may be cold. b. Use the stethoscope over the newborn's garment. c. Place the newborn's crib close to the outer wall in the room. d. Place the newborn skin-to-skin with the mother.

d

A nurse is caring for an infant with an elevated bilirubin level who is under phototherapy. What evaluation data would best indicate that the newborn's jaundice is improving? a. Reticulocyte count is 6%. b. Hematocrit is 38. c. Skin looks less jaundiced. d. Bilirubin level went from 15 to 11.

d

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

The nurse is preparing a teaching plan for new parents about why newborns experience heat loss. Which information about newborns would the nurse include? a. thick skin with deep lying blood vessels b. enhanced shivering ability c. expanded stores of glucose and glycogen d. limited voluntary muscle activity

d

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 nutrition less than body requirement related to limited formula intake c. Altered urinary elimination related to postcircumcision status d. Ineffective airway clearance related to mucus and secretions

d

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. Lower rate of urinary tract infections b. Reduced risk of penile cancer c. Fewer complications than if done later in life d. Anesthetic may not be effective during the procedure

d

What is the first action taken by a nurse caring for a newborn with suspected hypoglycemia? a. Check the client's blood sugar by a venous blood draw. b. Feed the newborn some formula immediately. c. Start an IV to provide intravenous glucose. d. Perform a heel stick to obtain a blood sample for testing for glucose level.

d

Which action will the nurse avoid when performing basic care for a newborn male? a. Inspecting the genital area for irritated skin b. Palpating if testes are descended into the scrotal sac c. Determining the location of the urethral opening d. Retracting the foreskin over the glans to assess for secretions

d