OB Prep U Ch. 23

The neonate's respirations are gasping and irregular with a rate of 24 bpm. Which circulatory alteration will the nurse assess for in this infant? A. Blood flows from the aorta to the pulmonary artery. B. Blood flows from the lungs to the left ventricle. C. Blood flows from the right atrium to the left atrium. D. Blood flows from the pulmonary vein to the alveoli.

A. Blood flows from the aorta to the pulmonary artery.

The nurse has admitted a small-for-gestational-age infant (SGA) to the observation nursery from the birth room. Which action would the nurse prioritize in the newborn's care plan? A. Closely monitor temperature. B. Observe feeding tolerance. C. Monitor intake and output. D. Assess for hyperglycemia.

A. Closely monitor temperature.

When examining a neonate, which characteristic would indicate to the nurse that the infant is preterm? Select all that apply. A. elevated breast bud B. extended extremities C. absence of sole creases D. bulging posterior fontanel (fontanelle) E. covered with vernix caseosa

A. elevated breast bud B. extended extremities C. absence of sole creases

An obese woman with diabetes has just given birth to a term, large-for-gestational-age (LGA) newborn. Which condition should the nurse most expect to find in this infant? A. hypoglycemia B. hyperglycemia C. hypotension D. hypertension

A. hypoglycemia

A 35-year-old client has just given birth to a healthy newborn during her 43rd week of gestation. What should the nurse expect when assessing the condition of the newborn? A. meconium aspiration in utero or at birth B. tremors, irritability, and high-pitched cry C. yellow appearance of the newborn's skin D. seizures, respiratory distress, cyanosis, and shrill cry

A. meconium aspiration in utero or at birth

The nurse is weighing a newborn and documents AGA (appropriate for gestational age) on the newborn record. Which weight percentile is anticipated? A. 5th B. 20th C. 9th D. 95th

B. 20th

A nurse is caring for a preterm infant. Which intervention will prepare the newborn's gastrointestinal tract to better tolerate feedings when initiated? A. Administer dextrose intravenously. B. Administer vitamin D supplements. C. Administer iron supplements. D. Administer 0.5 ml/kg/hr of breast milk enterally.

D. Administer 0.5 ml/kg/hr of breast milk enterally.

A nurse is assessing a term newborn and finds the blood glucose level is 23 mg/dl (1.28 mmol/L). The newborn has a weak cry, is irritable, and exhibits bradycardia. Which intervention is most appropriate? A. Monitor the infant's hematocrit levels closely. B. Place the infant on a radiant warmer. C. Administer PO glucose water immediately. D. Administer dextrose intravenously.

D. Administer dextrose intravenously.

What is a consequence of hypothermia in a newborn? A. respirations of 46 B. skin pink and warm C. heart rate of 126 D. holds breath 25 seconds

D. holds breath 25 seconds

The nurse needs to conduct a procedure on a preterm newborn. Which measures would be most effective in reducing pain? Select all that apply. A. encouraging skin-to-skin (kangaroo) care during procedures B. offering a pacifier prior to a procedure C. removing tape quickly from the skin D. increasing the volume on device alarms E. swaddling the newborn closely

A. encouraging skin-to-skin (kangaroo) care during procedures B. offering a pacifier prior to a procedure E. swaddling the newborn closely

At a prenatal class the nurse describes the various birth weight terms that may be used to describe a newborn at birth. The nurse feels confident learning has occurred when a participant makes which statement? A. "Appropriate-for-gestational-age means a newborn is born with a weight that falls in the 10th percentile." B. "Infants who are larger-for-gestational-age at birth have fewer complications than the other groups." C. "Newborns who are appropriate-for-gestational-age at birth have lower chance of complications than others." D. "Appropriate-for-gestational-age describes a newborn with a weight over the 90th percentile at birth."

C. "Newborns who are appropriate-for-gestational-age at birth have lower chance of complications than others."

At birth, a term infant has irregular respirations and a weak cry. What is the sequence of events initiated by the nurse when caring for this infant? A. Open the airway, initiate respirations, and dry the infant. B. Dry the infant, administer blow-by oxygen, and keep the infant warm. C. Dry the infant, stimulate the infant, and keep the infant warm. D. Open the airway, suction the trachea, and administer oxygen.

C. Dry the infant, stimulate the infant, and keep the infant warm.

The nurse examines a 26-week-old premature neonate. The skin temperature is lowered. What could be a consequence of the infant being cold? A. sleepiness B. crying C. apnea D. tachycardia

C. apnea

A newborn does not breathe spontaneously at birth. The nurse administers oxygen by bag and mask. If oxygen is entering the lungs, the nurse should notice that the: A. infant's neck veins become prominent and palpable. B. abdomen rises while the chest falls with bag compressions. C. chest rises with each bag compression. D. infant's pupils dilate after 3 minutes.

C. chest rises with each bag compression.

A nurse completes the initial assessment of a newborn. According to the due date on the antenatal record, the baby is 12 days' postmature. Which physical finding does not confirm that this newborn is 12 days' postmature? A. hypoglycemia B. meconium aspiration C. absence of lanugo D. increased amounts of vernix

D. increased amounts of vernix

The nurse assesses a post-term newborn. What finding corresponds with this gestational age diagnosis? A. Wharton's jelly B. abundant vernix caseosa and lanugo C. few creases on soles D. meconium-stained skin and fingernails

D. meconium-stained skin and fingernails

A premature infant develops respiratory distress syndrome. With this condition, circulatory impairment is likely to occur because, with increased lung tension,: A. there are aortic valve strictures. B. the pulmonary artery closes. C. the foramen ovale closes prematurely. D. the ductus arteriosus remains open.

D. the ductus arteriosus remains open.

The nurse is caring for a small-for-gestational-age infant at 1 hour old, after a difficult birth, with a glucose level of 40 mg/dL (2.5 mmol/L). Which nursing action would be the priority? A. Ensure feedings are on demand. B. Initiate early oral feedings. C. Initiate daily newborn weights. D. Monitor the infant at feedings.

B. Initiate early oral feedings.

A preterm newborn has just received synthetic surfactant through an endotracheal tube by a syringe. Which intervention should the nurse implement at this point? A. Immediately suction the infant's airway. B. Place the infant supine in a radiant heat warmer. C. Take a blood sample. D. Place the infant in an elevated position.

D. Place the infant in an elevated position.

A 20-year-old client gave birth to a baby boy at 43 weeks' gestation. What might the nurse observe in the newborn during routine assessment? A. The testes in the child may be undescended. B. The infant may have excess of lanugo and vernix caseosa. C. The newborn may have short nails and hair. D. The newborn may look wrinkled and old at birth.

D. The newborn may look wrinkled and old at birth.

The small-for-gestational-age neonate is at increased risk for which complication during the transitional period? A. polycythemia, probably due to chronic fetal hypoxia B. hyperglycemia due to decreased glycogen stores C. anemia probably due to chronic fetal hypoxia D. hyperthermia due to decreased glycogen stores

A. polycythemia, probably due to chronic fetal hypoxia

When reviewing the medical record of a newborn who is large-for-gestational-age (LGA), which factor would the nurse identify as having increased the newborn's risk of being LGA? A. low weight gain during pregnancy B. fetal exposure to low estrogen levels C. maternal pregravid obesity D. low maternal birth weight

C. maternal pregravid obesity

A nurse is caring for an infant. A serum blood sugar of 40 was noted at birth. What care should the nurse provide to this newborn? A. Give dextrose intravenously before oral feedings. B. Focus on decreasing blood viscosity by introducing feedings. C. Place infant on radiant warmer immediately. D. Begin early feedings either by the breast or bottle.

D. Begin early feedings either by the breast or bottle.

A preterm infant will be hospitalized for an extended time. Assuming the infant's condition is improving, which environment would the nurse feel is most suitable for the child? A. Place the infant's Isolette near the window so the child can see outside. B. Bring the child's open bassinet near the desk area so the infant sees people. C. Keep the environment free of color to reduce eye straining. D. Provide a mobile the child can see no matter how he or she is turned.

D. Provide a mobile the child can see no matter how he or she is turned.

A newborn's condition is not improving after intubation. What assessment by the nurse would identify a possible problem? A. Palpate for crepitus. B. Inspect for retractions. C. Obtain a blood gas. E. Auscultate breath sounds.

E. Auscultate breath sounds.

A newborn is being monitored for retinopathy of prematurity. Which condition predisposes an infant to this condition? A. esophageal atresia B. respiratory distress syndrome C. hydrocephalus D. Down syndrome

B. respiratory distress syndrome

A newborn is designated as very-low-birth-weight. When weighing this newborn, the nurse would expect to find which weight? A. less than 1,500 g B. approximately 2,500 g C. more than 4,000 g D. less than 1,000 g

A. less than 1,500 g

The nurse recognizes that maternal factors can increase the chance of a large-for-gestational-age newborn. When reviewing maternal history, the nurse would interpret which factors as placing a newborn at risk for being LGA? Select all that apply. A. female fetus B. multiparity C. diabetes D. history of microsomic infant E. history of postdates gestation

B. multiparity C. diabetes E. history of postdates gestation

What is a classic sign of neonatal respiratory distress syndrome? Select all that apply. A. bradypnea B. nasal flaring C. tachypnea D. retractions E. expiratory grunting

B. nasal flaring C. tachypnea D. retractions E. expiratory grunting

A nurse initiates bag and mask ventilation with an anesthesia bag on a newborn with no spontaneous respiratory effort. What controls the pressure of breaths delivered by an anesthesia bag? A. the pressure setting on the dial at the point where the mask connects to the bag B. the pressure the nurse uses when the hand squeezes against the bag C. the blow-off valve, which limits the pressure in the apparatus D. the flow rate of air into the inflatable bag on the apparatus

B. the pressure the nurse uses when the hand squeezes against the bag

A nursing student, observing care of a 30-week-gestation infant in the neonatal intensive care unit, asks the nurse, "Are premature infants more susceptible to infection as I have to wash my hands so often in this department?" What is the nurse's best response? A. "Yes, as they lack the antibody called IdD that acts as protection from infections." B. "Not really, as premature infants are cared for in an isolate, protecting them from infection." C. "That is correct; a 30-week-gestation infant lacks the protective antibody called IgG." D. "Feeding premature infants breast milk establishes the best protective mechanisms."

C. "That is correct; a 30-week-gestation infant lacks the protective antibody called IgG."

The nurse is concerned that a newborn is hypoglycemic. Which blood glucose level would support the nurse's intervention? A. 30 mg/dl (1.67 mmol/l) B. 60 mg/dl (3.33 mmol/l) C. 50 mg/dl (2.77 mmol/l) D. 40 mg/dl (2.25 mmol/l)

A. 30 mg/dl (1.67 mmol/l)

Which safety precautions should a nurse take to prevent infection in a newborn? Select all that apply. A. Initiate universal precautions when caring for the infant. B. Avoid coming to work when ill. C. Use sterile gloves for an invasive procedure. D. Cover jewelry while washing hands. E. Avoid using disposable equipment.

A. Initiate universal precautions when caring for the infant. B. Avoid coming to work when ill. C. Use sterile gloves for an invasive procedure.

During the newborn's assessment, which finding would lead the nurse to suspect that a large-for-gestational-age newborn has experienced birth trauma? A. asymmetrical movement B. temperature instability C. feeble sucking D. seizures

A. asymmetrical movement

A client has given birth to a small-for-gestational-age (SGA) newborn. Which finding would the nurse expect to assess? A. head larger than body B. protuberant abdomen C. round flushed face D. brown lanugo body hair

A. head larger than body

The nurse realizes the educational session conducted on due dates was successful when a participant is overheard making which statement? A. "The ability of my body to provide adequate oxygen and nutrients to my baby after 42 weeks' gestation is thought to be increased." B. "The ability of my placenta to provide adequate oxygen and nutrients to my baby after 42 weeks' gestation is thought to be compromised." C. "The ability of my amniotic fluid to provide adequate oxygen and nutrients to my baby after 42 weeks' gestation is thought to be compromised." D. "The ability of my umbilical cord to provide adequate oxygen and nutrients to my baby after 42 weeks' gestation is thought to be compromised."

B. "The ability of my placenta to provide adequate oxygen and nutrients to my baby after 42 weeks' gestation is thought to be compromised."

A premature infant is admitted to the neonatal intensive care unit with respiratory distress syndrome and requires assisted ventilation. The parents asks the nurse, "Why won't our baby breath on its own?" What is the nurse's best response? A. "Your infant's cardiovascular system is not developed yet in order to sustain respiration." B. "Your infant cannot sustain respirations yet due to the lack of assistance from surfactant." C. "Most preterm infants require additional oxygen through ventilation to sustain respiration." D. "Premature infants have a respiratory system that takes time to adjust to extrauterine life."

B. "Your infant cannot sustain respirations yet due to the lack of assistance from surfactant."

The nurse in the NICU is caring for preterm newborns. Which guidelines are recommended for care of these newborns? Select all that apply. A. Give the newborn a warm bath immediately. B. Dress the newborn in ways to preserve warmth. C. Take the newborn's temperature often. D. Supply oxygen for the newborn, if necessary. E. Discourage contact with parents to maintain asepsis. F. Handle the newborn as much as possible.

B. Dress the newborn in ways to preserve warmth. C. Take the newborn's temperature often. D. Supply oxygen for the newborn, if necessary.

The neonatal intensive care nurse admits an infant of a mother with diabetes to the unit with symptoms of respiratory distress. The infant is jaundiced with a ruddy skin color. Which action would be a priority? A. Continue to monitor blood glucose levels q6h. B. Prepare for repeat hematocrit levels q12h. C. Review maternal history for bleeding disorders. D. Prepare for continued positive airway pressure (CPAP).

B. Prepare for repeat hematocrit levels q12h.

At birth, the newborn was at the 8th percentile with a weight of 2350 g and born at 36 weeks' gestation. Which documentation is most accurate? A. The infant was a preterm, very-low-birthweight and small-for-gestational-age B. The infant was a preterm, low-birth-weight and small-for-gestational-age C. The infant was born at term but at a low birth weight and small-for-gestational age D. The infant was born at term but at a very low birth weight and small-for-gestational-age

B. The infant was a preterm, low-birth-weight and small-for-gestational-age

When documenting the newborn's weight on a growth chart, the nurse recognizes the newborn is large-for-gestational-size based on which percentile on growth charts? A. above 80th percentile B. above 90th percentile C. above 95th percentile D. above 85th percentile

B. above 90th percentile

During the newborn's assessment, which finding would lead the nurse to suspect that a large-for-gestational-age newborn has experienced birth trauma? A. temperature instability B. asymmetrical movement C. feeble sucking D. seizures

B. asymmetrical movement

A nurse is administering prescribed enteral feedings to assist in preparing the gut of a preterm newborn. Which type of solution would the nurse most likely administer for the feeding? A. formula B. breast milk C. sterile water D. normal saline

B. breast milk

A nurse is assessing the fluid status of a preterm newborn. Which parameter would be most appropriate for the nurse to assess? A. urinary output B. fontanels (fontanelles) C. fluid intake D. skin turgor

B. fontanels (fontanelles)

A client asks the nurse what surfactant is. Which explanation would the nurse give as the main role of surfactant in the neonate? A. promotes clearing of mucus from the respiratory tract B. helps the lungs remain expanded after the initiation of breathing C. helps maintain a rhythmic breathing pattern D. assists with ciliary body maturation in the upper airways

B. helps the lungs remain expanded after the initiation of breathing