OB exam 3

A certified nurse-midwife places a neonate under the radiant heat unit for the nurse's initial assessment. The initial assessment includes heart rate 110 beats/minute and an irregular respiratory effort. The neonate is moving all extremities and his body is pink. He also has a vigorous cry. The nurse notes copious amounts of clear mucus present both orally and nasally. Based on these assessment findings, what should the nurse do next? Answers: a. Assign an Apgar score of 10, place in the neonate in modified Trendelenburg's position, and suction the neonate's nose. b. Assign an Apgar score of 6, place the neonate in modified Trendelenburg's position, and initiate a code to gain assistance from the code team. c. Assign an Apgar score of 7, place the neonate in modified Trendelenburg's position, and begin artificial respirations. d. Assign an Apgar score of 9, place the neonate in modified Trendelenburg's position, and suction the neonate's nose and oropharynx.

d. Assign an Apgar score of 9, place the neonate in modified Trendelenburg's position, and suction the neonate's nose and oropharynx.

A multiparous client who has a neonate diagnosed with hemolytic disease of the newborn asks the nurse why the neonate has developed this problem. Which response by the nurse would be most appropriate? Answers: a. "You and the baby are both Rh-negative." b. "The baby and you are both Rh-positive." c. "You are Rh-negative and the baby is Rh-positive." d. "You are Rh-positive, and the baby is Rh-negative."

c. "You are Rh-negative and the baby is Rh-positive."

Nurses can prevent evaporative heat loss in the newborn by Answers: a. Keeping the baby out of drafts and away from air conditioners b. Placing the baby away from the outside wall and the windows c. Warming the stethoscope and nurse's hands before touching the baby d. Drying the baby after birth and wrapping the baby in a dry blanket

d. Drying the baby after birth and wrapping the baby in a dry blanket

What are modes of heat loss in the newborn? (Choose all that apply.) Answers: a. Perspiration b. Conduction c. Convection d. Radiation e. Urination

Radiation Convection Conduction Evaporation

Pain should be assessed regularly in all newborn infants. If the infant is displaying physiologic or behavioral cures indicating pain, measures should be taken to manage the infant's pain. Examples of nonpharmacologic pain management techniques include (select all that apply) Answers: a. Sucrose b. Skin-to-skin contact with the mother c. Acetaminophen d. Nonnutritive sucking (pacifier) e. Swaddling

Swaddling. Nonnutritive sucking. Skin-to-skin contact with the mother. Sucrose.

Examples of appropriate techniques to wake a sleepy infant for breastfeeding include (select all that apply) Answers: a. Slap the infant's hands and feet. b. Apply a cold towel to the infant's abdomen. c. Unwrap the infant. d. Change the diaper. e. Talk to the infant.

Unwrapping the infant. Changing the diaper. Talking to the infant.

A new father indicates he feels left out of the new family relationship since he is not able to bond the same way as the breastfeeding mother. What is the most appropriate response by the nurse? Answers: a. "Holding, talking to, and playing with the infant will facilitate bonding between baby and Dad." b. "Maternal-infant bonding takes priority over paternal-infant bonding." c. "This is normal, and these feelings will go away within a few days." d. "Bonding occurs later in the first year of life, and Dad can become involved when the infant is better able to recognize him."

a. "Holding, talking to, and playing with the infant will facilitate bonding between baby and Dad."

A nurse assesses the vital signs of a healthy newborn infant. What respiratory rate could be expected based on the developmental level of this client? Answers: a. 30 to 55 breaths/minute b. 20 to 44 breaths/minute c. 15 to 25 breaths/minute d. 16 to 20 breaths/minute

a. 30 to 55 breaths/minute

An unfortunate but essential role of the nurse is protecting the infant from abduction. Which statement regarding the profile of a potential abductor is the most accurate? Answers: a. A young woman who has had a previous pregnancy loss b. A middle-aged woman past childbearing age c. A female with a number of children of her own d. Male gender

a. A young woman who has had a previous pregnancy loss

A male neonate underwent circumcision. What nursing intervention is part of the initial care of a circumcised neonate? Answers: a. Apply petroleum gauze to the site for 24 hours. b. Change the diaper as needed. c. Apply alcohol to the site. d. Keep the neonate in the supine position.

a. Apply petroleum gauze to the site for 24 hours.

A full-term neonate is admitted to the normal newborn nursery. When lifting the baby out of the crib the nurse notes the baby's arms move sideways with the palms up and the thumbs flexed. What should the nurse do next? Answers: a. Identify this reflex as a normal finding. b. Start supplemental oxygen. c. Place the neonate on seizure precautions. d. Call a code.

a. Identify this reflex as a normal finding.

As the nurse assists a new mother with breastfeeding, she asks, "If formula is prepared to meet the nutritional needs of the newborn, what is in breast milk that makes it better?" The nurse's best response is that it contains Answers: a. Important immunoglobulins b. More calcium c. More calories d. Essential amino acids

a. Important immunoglobulins

Which of the following conditions is a part of normal newborn screening? Answers: a. Phenylketonuria b. Sickle cell anemia c. Cystic fibrosis d. Down syndrome

a. Phenylketonuria

Hearing loss occurs in 9% of newborns. Auditory screening of all newborns within the first month of life is recommended by the American Academy of Pediatrics. Reasons for having this testing performed include (select all that apply) Answers: a. To prevent or reduce developmental delay b. Early identification and treatment c. To achieve one of the Healthy People 2020 goals d. Reassurance for concerned new parents e. To help the child communicate better

a. Prevention or reduction of developmental delay. b. Early identification and treatment. e. Helping the child communicate better. e. Recommendation by the Joint Committee on Infant Hearing.

A yellow crust has formed over the circumcision site. The mother calls the hotline at the local hospital, 5 days after her son was circumcised. She is very concerned. On which rationale should the nurse base her reply? Answers: a. The yellow crust should not be removed. b. After circumcision, the diaper should be changed frequently and fastened snugly. c. This yellow crust is an early sign of infection. d. Discontinue the use of petroleum jelly to the tip of the penis.

a. The yellow crust should not be removed.

Twenty-four hours after cesarean birth, a neonate at 30 weeks' gestation is diagnosed with respiratory distress syndrome (RDS). When explaining to the parents about the cause of this syndrome, the nurse should include a discussion about an alteration in the body's secretion of which substance? Answers: a. surfactant b. testosterone c. somatotropin d. progesterone

a. surfactant

A woman gave birth to a healthy 7-pound, 13-ounce infant girl. The nurse suggests that the woman place the infant to her breast within 15 minutes after birth. The nurse knows that breastfeeding is effective during the first 30 minutes after birth because this is the Answers: a. Transition period b. First period of reactivity c. Organizational stage d. Second period of reactivity

b. First period of reactivity

Infants in whom cephalhematomas develop are at increased risk for Answers: a. Caput succedaneum b. Jaundice c. Erythema toxicum d. Infection

b. Jaundice

A laboring mother asks the nurse if the baby will have immunity to some illnesses when born. What type of immunity does the nurse understand that the newborn will have? Answers: a. There is no immunity passed down from mother to child. b. Passive immunity transferred by the mother c. Naturally acquired active immunity d. Artificially acquired active immunity

b. Passive immunity transferred by the mother

Which nursing action is designed to avoid unnecessary heat loss in the newborn? Answers: a. Maintain room temperature at 70° F. b. Place a blanket over the scale before weighing the infant. c. Take the rectal temperature every hour to detect early changes. d. Undress the infant completely for assessments so they can be finished quickly.

b. Place a blanket over the scale before weighing the infant.

The nurse's initial action when caring for an infant with a slightly decreased temperature is to Answers: a. Tell the mother that the infant must be kept in the nursery and observed for the next 4 hours. b. Place a cap on the infant's head and have the mother perform kangaroo care. c. Notify the physician immediately. d. Change the formula, as this is a sign of formula intolerance.

b. Place a cap on the infant's head and have the mother perform kangaroo care.

When caring for the neonate weighing 4,564 g (10 lb, 1 oz) born vaginally to a woman with diabetes, the nurse should assess the neonate for fracture of the: Answers: a. rib cage. b. clavicle. c. skull. d. wrist.

b. clavicle.

When obtaining a blood sample to screen a neonate for phenylketonuria (PKU), the nurse should obtain the sample from the: Answers: a. scalp vein. b. heel. c. radial artery. d. brachial artery.

b. heel.

A multigravida client has given birth to a large-for-gestational age infant with Apgar scores of 8 and 9. The priority nursing assessment for this infant is for: Answers: a. jaundice b. hypoglycemia c. passage of meconium d. failure to thrive

b. hypoglycemia

A nurse is assessing a newborn at the healthcare facility when the mother of the child asks the nurse why the body temperature of her baby is unstable. Which response by the nurse would be most appropriate? Answers: a. "It is because of the closely woven, dark fabric wrapped around the baby" b. "The baby is showing how it is adapting to the environmental temperature. c. "It is because of the immature ability to regulate temperature in general." d. "It is common for newborns to have body temperatures less than 36.4C (97.6°F)"

c. "It is because of the immature ability to regulate temperature in general."

A nurse places a neonate with hyperbilirubinemia under a phototherapy lamp, covering the eyes and gonads for protection. The parents asked the nurse to tell them how their baby will benefit from having phototherapy done. Which statement by the nurse is the most appropriate response about phototherapy? Answers: a. "Phototherapy prevents hypothermia." b. "Phototherapy promotes respiratory stability." c. "Phototherapy decreases the serum unconjugated bilirubin level." d. "Phototherapy increases the baby's iron level."

c. "Phototherapy decreases the serum unconjugated bilirubin level."

According to the antenatal record, a newborn is 12 days post-mature. A nurse completes the initial assessment of the newborn and notes increased amounts of vernix. The mother asks why the nurse seems concerned about the presence of the vernix. Which of the following statements by the nurse is most appropriate? Answers: a. "The vernix should be a thicker coating for a newborn." b. "The presence of vernix affects the newborn's immune system." c. "The vernix indicates a different gestational age than expected." d. "The vernix is difficult and painful to remove from a newborn."

c. "The vernix indicates a different gestational age than expected."

For almost an hour after birth, a neonate was awake, alert, and startled and cried easily. Respirations rose to 70 breaths/minute, and heart rate on two occasions was 160 beats/minute. After sleeping quietly for about 2 hours, the neonate then awoke with a start, cried, extended and flexed all four extremities, and then choked, gagged, and regurgitated some thick mucus. What should the nurse do next? a. Place the neonate under a radiant warmer because these signs suggest chilling. b. Wrap the neonate in a blanket and offer sips of glucose water. c. Change the neonate's position and aspirate mucus as necessary. d. Call the primary care provider because the neonate appears to be choking.

c. Change the neonate's position and aspirate mucus as necessary.

During the nurse's assessment, the newborn wakes and is in a quiet-alert state. The nurse counts the apical pulse to be 157 beats per minute. Which of the following is the most appropriate nursing action? Answers: a. Call the pediatrician because this finding is dangerously high. b. Notify the charge nurse because this finding is on the low end of the normal range given the newborn's quiet-alert state. c. Document this finding as on the high end of the normal range and plan to reassess. d. Document this finding as on the low end of the normal range and plan to reassess.

c. Document this finding as on the high end of the normal range and plan to reassess.

Cardiovascular changes that cause the foramen ovale to close at birth are a direct result of Answers: a. Changes in the hepatic blood flow b. Increased pressure in the right atrium c. Increased pressure in the left atrium d. Decreased blood flow to the left ventricle

c. Increased pressure in the left atrium

During an assessment, a newborn's temperature drops from 98°F ( 36.7°C) to 96.9°F (36.1°C). The nurse knows that which of the following characteristics predisposes the newborn to temperature instability? Answers: a. Immature central control by the hypothalamus b. Lack of glycogen stores and macrosomic birth weight c. Large surface area to body mass ratio d. Excessive subcutaneous brown fat stores

c. Large surface area to body mass ratio

1 out of 1 points A new mother asks if she should feed her newborn colostrum, because it is not "real milk." The nurse's best answer is that Answers: a. Colostrum is unnecessary for newborns. b. Giving colostrum is important in helping the mother learn how to breastfeed before she goes home. c. Colostrum is lower in calories than milk and should be supplemented by formula. d. Colostrum is high in antibodies, protein, vitamins, and minerals.

d. Colostrum is high in antibodies, protein, vitamins, and minerals.

The best reason for recommending formula over breastfeeding is that Answers: a. The mother sees bottle-feeding as more convenient. b. Other family members or care providers also need to feed the baby. c. The mother has a medical condition or is taking drugs that could be passed along to the infant via breast milk. d. The mother lacks confidence in her ability to breastfeed.

c. The mother has a medical condition or is taking drugs that could be passed along to the infant via breast milk.

A nurse is performing a neurologic assessment on a 1-day-old neonate in the nursery. Which findings indicate possible asphyxia in utero? Select all that apply. Answers: a. The neonate grasps the nurse's finger when she puts it in the palm of his hand. b. The neonate does stepping movements when held upright with sole of foot touching a surface. c. The neonate displays weak, ineffective sucking. d. The neonate's toes do not fan out when soles of the feet are stroked. e. The neonate turns toward the nurse's finger when she touches his cheek. f. The neonate doesn't respond when the nurse claps her hands above him.

c. The neonate displays weak, ineffective sucking. d. The neonate's toes do not fan out when soles of the feet are stroked. f. The neonate doesn't respond when the nurse claps her hands above him.

The newborn nurse administers erythromycin eye ointment to prevents opthalmia neonatorum and eye infections related to other bacteria that the infant picks up as it goes through the birth canal. What are the two most common bacteria that causes neonatal conjunctivitis? Answers: a. chlamydia and HIV b. gonorrhea and Strep B c. chlamydia and gonorrhea d. HIV and gonorrhea

c. chlamydia and gonorrhea

A client who just gave birth to her first baby is preparing for discharge and states that she does not know how to bathe the infant. The best response by the nurse is to demonstrate how to bathe the infant and: Answers: a. recommend newborn care classes. b. assess if the client has questions. c. have the client return demonstrate how to bathe the infant. d. refer the client to the hospital's newborn care booklet.

c. have the client return demonstrate how to bathe the infant.

The nurse is teaching the mother of a newborn to develop her baby's sensory system. To further improve the infant's most developed sense, the nurse should instruct the mother to: Answers: a. give infant formula with a sweetened taste to stimulate feeding. b. speak in a high-pitched voice to get the newborn's attention. c. stroke the newborn's cheek with her nipple to direct the baby's mouth to nipple. d. place the newborn about 12 inches (30.5 cm) from maternal face for best sight.

c. stroke the newborn's cheek with her nipple to direct the baby's mouth to nipple.

A nurse is teaching a client who gave birth to a full-term female neonate how to change the neonate's diaper. Which of the following statement by the client would indicate to the nurse that learning has taken place? Answers: a. "I will position the neonate so that urine will fall to the back of the diaper." b. "I will fold a cloth diaper so that a double thickness covers the front." c. "I will place a disposable diaper over a cloth diaper to provide extra protection." d. "I will clean and dry the neonate's perineal area from front to back."

d. "I will clean and dry the neonate's perineal area from front to back."

The nurse is preparing to administer vitamin K intramuscularly to a term neonate of a primipara who has just given birth. After explaining the purpose of the drug to the mother, which statement by the mother indicates effective teaching? Answers: a. "Vitamin K will prevent my baby from becoming jaundiced." b. "Vitamin K will prevent my baby from developing an infection." c. "Vitamin K will help my baby breathe easier." d. "Vitamin K will help my baby's blood to clot properly."

d. "Vitamin K will help my baby's blood to clot properly."

A 6-lb, 8-oz (2,948 g) neonate was born vaginally at 38 weeks' gestation. At 5 minutes of life, the neonate has the following signs: heart rate 110, intermittent grunting with respiratory rate of 70, flaccid tone, no response to stimulus, and overall pale white in color. The Apgar score is: Answers: a. 6 b. 3 c. 2 d. 4

d. 4

The nurse from the nursery is bringing a newborn to a mother's room. The nurse took care of the mother yesterday and knows the mother and baby well. The nurse should implement which action to ensure the safest transition of the infant to the mother? Answers: a. Ask the mother if there is anything else she needs for the care of her baby. b. Check the crib to determine if there are enough diapers and formula. c. Assess whether the mother is able to ambulate to care for the infant. d. Complete the hospital identification procedure with mother and infant.

d. Complete the hospital identification procedure with mother and infant.

While gently abducting the hips during a newborn assessment, the nurse hears a "click" as the femoral head slip into the acetabulum. The nurse interprets this positive finding as: Answers: a. Galeazzi sign. b. Trendelenburg's sign. c. Barlow's test. d. Ortolani's sign.

d. Ortolani's sign.

What is the quickest and most common method to obtain neonatal blood for glucose screening 1 hour after birth? Answers: a. Obtain a laboratory chemical determination. b. Puncture a fingertip. c. Obtain a sample from the umbilical cord. d. Puncture the lateral pad of the heel.

d. Puncture the lateral pad of the heel.

A nurse is preparing discharge teaching for a client being discharged with a newborn baby. What is the highest priority item that must be included in the teaching plan? Answers: a. Lock all cabinets that contain cleaning supplies. b. Keep all pots and pans in lower cabinets. c. Give warm bottles of formula to the baby. d. Restrain the baby in a car seat.

d. Restrain the baby in a car seat.

A nursing student is helping the nursery nurses with morning vital signs. A baby born 10 hours ago via cesarean section is found to have moist lung sounds. What is the best interpretation of these data? Answers: a. If this baby was born vaginally, it could indicate a pneumothorax. b. The nurse should notify the pediatrician stat for this emergency situation. c. The neonate must have aspirated surfactant. d. The lungs of a baby delivered by cesarean section may sound moist for 24 hours after birth.

d. The lungs of a baby delivered by cesarean section may sound moist for 24 hours after birth.

A neonate receives an Apgar score at 1 and 5 minutes of age. The 1-minute Apgar score is a good indication of: Answers: a. how well the neonate has adapted to extrauterine life. b. how well the neonate stabilizes his temperature after birth. c. gestational age of the neonate. d. how well the neonate tolerated labor.

d. how well the neonate tolerated labor.

After giving birth to a viable term male neonate vaginally under epidural anesthesia, a primiparous client asks the nurse, "Why are my baby's breasts so swollen?" The nurse responds to the client stating that slight breast engorgement in term neonates is due to which factor? Answers: a. maternal hyperthyroidism b. genetic influences from both parents c. epidural anesthesia d. maternal hormonal influences

d. maternal hormonal influences