OB-Newborn-NCLEX Practice Questions

A baby is born precipitously in the ER. The nurses initial action should be to: 1. Establish an airway for the baby. 2. Ascertain the condition of the fundus 3. Quickly tie and cut the umbilical cord 4. Move mother and baby to the birthing unit

1. Establish an airway for the baby. - The nurse should position the baby with head lower than chest and rub the infant's back to stimulate crying to promote oxygenation. There is no haste in cutting the cord.

When performing an assessment on a neonate, which assessment finding is most suggestive of hypothermia? 1. Bradycardia 2. Hyperglycemia 3. Metabolic alkalosis 4. Shivering

1. Bradycardia. Hypothermic neonates become bradycardic proportional to the degree of core temperature. Hypoglycemia is seen in hypothermic neonates.

A nurse in a newborn nursery receives a phone call to prepare for the admission of a 43-week-gestation newborn with Apgar scores of 1 and 4. In planning for the admission of this infant, the nurse's highest priority should be to: 1. Connect the resuscitation bag to the oxygen outlet 2. Turn on the apnea and cardiorespiratory monitors 3. Set up the intravenous line with 5% dextrose in water 4. Set the radiant warmer control temperature at 36.5* C (97.6*F)

1. Connect the resuscitation bag to the oxygen outlet. The highest priority on admission to the nursery for a newborn with low Apgar scores is AIRWAY, which would involve preparing respiratory resuscitation equipment. The other options are also important, although they are of lower priority.

A nurse is assessing a newborn infant following circumcision and notes that the circumcised area is red with a small amount of bloody drainage. Which of the following nursing actions would be most appropriate? 1. Document the findings 2. Contact the physician 3. Circle the amount of bloody drainage on the dressing and reassess in 30 minutes 4. Reinforce the dressing

1. Document the findings - The penis is normally red during the healing process. A yellow exudate may be noted in 24 hours, and this is a part of normal healing. The nurse would expect that the area would be red with a small amount of bloody drainage. If the bleeding is excessive, the nurse would apply gentle pressure with sterile gauze. If bleeding is not controlled, then the blood vessel may need to be ligated, and the nurse would contact the physician. Because the findings identified in the question are normal, the nurse would document the assessment.

A newborn has small, whitish, pinpoint spots over the nose, which the nurse knows are caused by retained sebaceous secretions. When charting this observation, the nurse identifies it as: 1. Milia 2. Lanugo 3. Whiteheads 4. Mongolian spots

1. Milia occur commonly, are not indicative of any illness, and eventually disappear.

To help limit the development of hyperbilirubinemia in the neonate, the plan of care should include: 1. Monitoring for the passage of meconium each shift 2. Instituting phototherapy for 30 minutes every 6 hours 3. Substituting breastfeeding for formula during the 2nd day after birth 4. Supplementing breastfeeding with glucose water during the first 24 hours

1. Monitoring for the passage of meconium each shift - Bilirubin is excreted via the GI tract; if meconium is retained, the bilirubin is reabsorbed.

By keeping the nursery temperature warm and wrapping the neonate in blankets, the nurse is preventing which type of heat loss? 1. Conduction 2. Convection 3. Evaporation 4. Radiation

2. Convection heat loss is the flow of heat from the body surface to the cooler air. Conduction is a loss of heat via direct contact with cold surface like the scales. Evaporation is a loss of heat when the baby's wet skin is exposed to air. Radiation is transfer of heat from body surface to cooler surfaces & objects not in direct contact with the body (incubator).

While assessing a 2-hour old neonate, the nurse observes the neonate to have acrocyanosis. Which of the following nursing actions should be performed initially? 1. Activate the code blue or emergency system. 2. Do nothing because acrocyanosis is normal in the neonate 3. Immediately take the newborn's temperature according to hospital policy 4. Notify the physician of the need for a cardiac consult

2. Do nothing because acrocyanosis is normal in the neonate. Acrocyanosis, or bluish discoloration of the hands and feet in the neonate (also called peripheral cyanosis), is a normal finding and shouldn't last more than 24 hours after birth.

The nurse is aware that a neonate of a mother with diabetes is at risk for what complication? 1. Anemia 2. Hypoglycemia 3. Nitrogen loss 4. Thrombosis

2. Hypoglycemia. Neonates of mothers with diabetes are at risk for hypoglycemia due to increased insulin levels. During gestation, an increased amount of glucose is transferred to the fetus across the placenta. The neonate's liver cannot initially adjust to the changing glucose levels after birth. This may result in an overabundance of insulin in the neonate, resulting in hypoglycemia.

The nurse is aware that a healthy newborns respirations are: 1. Regular, abdominal, 40-50 per minute, deep 2. Irregular, abdominal, 30-60 per minute, shallow 3. Irregular, initiated by chest wall, 30-60 per minute, deep 4. Regular, initiated by the chest wall, 40-60 per minute, shallow

2. Irregular, abdominal, 30-60 per minute, shallow - Normally the newborn's breathing is abdominal and irregular in depth and rhythm; the rate ranges from 30-60 breaths per minute.

A nurse in the newborn nursery is monitoring a preterm newborn infant for respiratory distress syndrome. Which assessment signs if noted in the newborn infant would alert the nurse to the possibility of this syndrome? 1. Hypotension and Bradycardia 2. Tachypnea and retractions 3. Acrocyanosis and grunting 4. The presence of a barrel chest with grunting

2. Tachypnea and retractions - The infant with respiratory distress syndrome may present with signs of cyanosis, tachypnea or apnea, nasal flaring, chest wall retractions, or audible grunts.

A client has just given birth at 42 weeks gestation. When assessing the neonate, which physical finding is expected? 1. A sleepy, lethargic baby 2. Lanugo covering the body 3. Desquamation of the epidermis 4. Vernix caseosa covering the body

3. Desquamation of the epidermis (peeling skin). Postdate fetuses lose the vernix caseosa, and the epidermis may become desquamated . These neonates are usually very alert. Lanugo is missing in the postdate neonate.

When teaching umbilical cord care to a new mother, the nurse would include which information? 1. Apply peroxide to the cord with each diaper change 2. Cover the cord with petroleum jelly after bathing 3. Keep the cord dry and open to air 4. Wash the cord with soap and water each day during a tub bath

3. Keeping the cord dry and open to air helps reduce infection and hastens drying.

When attempting to interact with a neonate experiencing drug withdrawal, which behavior would indicate that the neonate is willing to interact? 1. Gaze aversion 2. Hiccups 3. Quiet alert state 4. Yawning

3. Quiet alert state. When caring for a neonate experiencing drug withdrawal, the nurse needs to be alert for distress signals from the neonate. Stimuli should be introduced one at a time when the neonate is in a quiet and alert state. Gaze aversion, yawning, sneezing, hiccups, and body arching are distress signals that the neonate cannot handle stimuli at that time.

After reviewing the client's maternal history of magnesium sulfate during labor, which condition would the nurse anticipate as a potential problem in the neonate? 1. Hypoglycemia 2. Jitteriness 3. Respiratory depression 4. Tachycardia

3. Respiratory depression. Magnesium sulfate crosses the placenta and adverse neonatal effects are respiratory depression, hypotonia, and bradycardia.

A nurse prepares to administer a vitamin K injection to a newborn infant. The mother asks the nurse why her newborn infant needs the injection. The best response by the nurse would be: 1. "You infant needs vitamin K to develop immunity." 2. "The vitamin K will protect your infant from being jaundiced." 3. "Newborn infants are deficient in vitamin K, and this injection prevents your infant from abnormal bleeding." 4. "Newborn infants have sterile bowels, and vitamin K promotes the growth of bacteria in the bowel."

3. Vitamin K is necessary for the body to synthesize coagulation factors. Vitamin K is administered to the newborn infant to prevent abnormal bleeding. Newborn infants are vitamin K deficient because the bowel does not have the bacteria necessary for synthesizing fat-soluble vitamin K. The infant's bowel does not have support the production of vitamin K until bacteria adequately colonizes it by food ingestion.

A postpartum nurse is providing instructions to the mother of a newborn infant with hyperbilirubinemia who is being breastfed. The nurse provides which most appropriate instructions to the mother? 1. Switch to bottle feeding the baby for 2 weeks 2. Stop the breast feedings and switch to bottle-feeding permanently 3. Feed the newborn infant less frequently 4. Continue to breast-feed every 2-4 hours

4. Continue to breast-feed every 2-4 hours - Breast feeding should be initiated within 2 hours after birth and every 2-4 hours thereafter. The other options are not necessary.

When performing nursing care for a neonate after a birth, which intervention has the highest nursing priority? 1. Obtain a dextrostix 2. Give the initial bath 3. Give the vitamin K injection 4. Cover the neonates head with a cap

4. Covering the neonates head with a cap helps prevent cold stress due to excessive evaporative heat loss from the neonate's wet head and has the highest nursing priority. Vitamin K can be given up to 4 hours after birth. Dextrostix is now widely used as a method of screening for hypoglycemia of the newborn.

A nurse in a delivery room is assisting with the delivery of a newborn infant. After the delivery, the nurse prepares to prevent heat loss in the newborn resulting from evaporation by: 1. Warming the crib pad 2. Turning on the overhead radiant warmer 3. Closing the doors to the room 4. Drying the infant in a warm blanket

4. Drying the infant in a warm blanket - Evaporation of moisture from a wet body dissipates heat along with the moisture. Keeping the newborn dry by drying the wet newborn infant will prevent hypothermia via evaporation.

Which action best explains the main role of surfactant in the neonate? 1. Assists with ciliary body maturation in the upper airways 2. Helps maintain a rhythmic breathing pattern 3. Promotes clearing mucus from the respiratory tract 4. Helps the lungs remain expanded after the initiation of breathing

4. Helps the lungs remain expanded after the initiation of breathing. Surfactant works by reducing surface tension in the lung. Surfactant allows the lung to remain slightly expanded, decreasing the amount of work required for inspiration.

A nurse is assessing a newborn infant who was born to a mother who is addicted to drugs. Which of the following assessment findings would the nurse expect to note during the assessment of this newborn? 1. Sleepiness 2. Cuddles when being held 3. Lethargy 4. Incessant crying

4. Incessant crying - A newborn infant born to a woman using drugs is irritable. The infant is overloaded easily by sensory stimulation. The infant may cry incessantly and posture rather than cuddle when being held.

A neonate has been diagnosed with caput succedaneum. Which statement is correct about this condition? 1. It usually resolves in 3-6 weeks 2. It doesn't cross the cranial suture line 3. It's a collection of blood between the skull and the periosteum 4. It involves swelling of tissue over the presenting part of the presenting head

4. It involves swelling of tissue over the presenting part of the presenting head. Caput succedaneum is the swelling of tissue over the presenting part of the fetal scalp due to sustained pressure; it resolves in 3-4 days. The edema in caput succedaneum crosses the suture lines. It may involve wide areas of the head or it may just be a size of a large egg. A collection of blood between the periosteum of a skull bone and the bone itself is a Cephalhematoma.

A client with group AB blood whose husband has group O has just given birth. The major sign of ABO blood incompatibility in the neonate is which complication or test result? 1. Negative Coombs test 2. Bleeding from the nose and ear 3. Jaundice after the first 24 hours of life 4. Jaundice within the first 24 hours of life

4. Jaundice within the first 24 hours of life. The neonate with ABO blood incompatibility with its mother will have jaundice (pathologic) within the first 24 hours of life. The neonate would have a positive Coombs test result.

Neonates of mothers with diabetes are at risk for which complication following birth? 1. Atelectasis 2. Microcephaly 3. Pneumothorax 4. Macrosomia

4. Macrosomia. Neonates of mothers with diabetes are at increased risk for macrosomia (excessive fetal growth) as a result of the combination of the increased supply of maternal glucose and an increase in fetal insulin. Big baby >8 lb, 13oz (>4,000g)

When performing a newborn assessment, the nurse should measure the vital signs in the following sequence: 1. Pulse, respirations, temperature 2. Temperature, pulse, respirations 3. Respirations, temperature, pulse 4. Respirations, pulse, temperature

4. Respirations, pulse, temperature - This sequence is least disturbing. Touching with the stethoscope and inserting the thermometer increases anxiety and elevates vital signs.