OB Unit IV Individual application questions
For approximately what length of time do you recommend exclusive breastfeeding? 1 month 2 months 4 months 6 months 9 months
6 mo
The addition of complementary foods for the infant is recommended at about: 2 months 4 months 6 months 9 months 12 months
6 mo
An expectant client plans on breastfeeding and asks the nurse when to start breastfeeding. When should the client start breastfeeding? A.In the first hour after birth B. Allow the infant to rest and begin breastfeeding in the second period of reactivity C. Allow the client to rest and begin breastfeeding 2 hours after birth D. Encourage breastfeeding to begin after vitamin k and erythromycin administered
A
The nurse is providing teaching regarding medications and breastfeeding. Which of the following medications would be a concern for a breastfeeding client of a newborn infant? A. Fluoxetine B. Technetium-99m C. Cefoxitin D. Prednisone E. Ibuprofen D. Estrogen/Progestin contraceptive pill
A B D
A newborn in the nursery is exhibiting signs of neonatal abstinence syndrome. Which of the following signs/symptoms is the nurse observing? A. Hyperphagia B. Lethargy C. Hyporeflexia D. Persistent shrill cry
A + D
A neonate is being assessed for necrotizing enterocolitis (NEC). Which of the following actions by the nurse is appropriate? Select all that apply. A. Perform hemoccult test on stools. B. Monitor for an increase in abdominal girth. C. Measure gastric contents before each feed. D. Assess bowel sounds before each feed. E. Maintain a strict every 3 hour feeding schedule
A,B,C,D,
A 2-day old breastfeeding baby born via normal spontaneous vaginal delivery has just been weighed in the newborn nursery. The nurse determines that the baby has lost 3.5% of the birth weight. Which of the following nursing actions is appropriate? A. Continue to monitor, as this is a normal weight loss. B. Notify the neonatologist of the significant weight loss. C. Advise the mother to bottle feed the baby at the next feed. D. Assess the baby for hypoglycemia with a glucose monitor.
A.
A baby is in the NICU whose mother is addicted to heroin during the pregnancy. Which of the following nursing actions would be appropriate? A. Tightly swaddle the baby. B. Place the baby prone in the crib. C. Provide needed stimulation to the baby. D. Feed the baby half-strength formula.
A.
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? A. Urine drug toxicology. B. Biophysical profile test. C. Chest and abdominal ultrasound evaluations. D. Oxygen saturation and blood gas assessments.
A.
A breastfeeding client is 5 weeks postpartum and calls the clinic reports feeling achy all over, has a temperature of 100.2 degrees F. , and has pain and tenderness in the right breast. What is the nurse's best response? A. "You need to come to the clinic to be evaluated, as your symptoms indicate a breast infection B. "You are having normal engorgement that can occur with breastfeeding. More frequent feeding will relieve your symptoms." C. "Please stop breastfeeding until you can come to see the provider, as you may have a breast infection" D. "You may be experienced sleep deprivation, which can make you feel achy and sore. Try to sleep when the newborn sleeps."
A.
A full term infant admitted to the newborn nursery has a blood glucose level of 35mg/dl. Which of the following actions should the nurse perform at this time? A. Feed the baby formula or breastmilk. B. Assess the baby's blood pressure. C. Tightly swaddle the baby. D. Monitor the baby's urinary output.
A.
A full-term newborn was just born. Which nursing intervention is important for the nurse to perform first? A. Remove wet blankets B. Assess APGAR score C. Insert eye prophylaxis D. Elicit the Moro reflex
A.
A new client has just started breastfeeding; the client wants to know how often to feed the baby. The nurse tells the client to: A. breastfeed on demand B. offer breast every 2-3 hours, then alternate with formula C. offer breast every 4 hours or on demand; baby will need less milk at night, so every 6 hours is fine D. baby needs to be trained to drink at set times, so mother should find a schedule that suits her; as long as baby is fed at least 3 times a day, baby will be healthy
A.
Breastfeeding is contraindicated in which of the following conditions: A. Infants with galactosemia B. Maternal Hepatitis B C. Maternal Hepatitis C D.Maternal mastitis E. Infants with Cystic Fibrosis
A.
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? A. The baby whose mother cultured positive for group B strep during her third trimester. B. The baby whose mother had gestational diabetes C. The baby whose mother was hospitalized for 3 months with complete placenta previa. D. The baby whose mother previously had a stillbirth.
A.
The nurse make a home visit to a family with a 3-day old breastfeeding infant full term neonate who weighed 3,912 gms today the neonate weighs 3,672 gms Which of the following instructions should the nurse give to the client? A. continue feeding infant on demand B. contact the healthcare provider C. supplement with iron fortified formula D. supplement with glucose water
A.
To reduce the risk of hypoglycemia in a full-term newborn weighing 2900 grams, what should the nurse do? A. Maintain the infant's temperature above 97.7 degrees F. B. Feed the infant glucose water every 3 hours until breastfeeding well. C. Assess blood glucose levels every 3 hours for the first 12 hours. D. Encourage the mother to breastfeed every 4 hours.
A.
A 40 week gestation neonate is in the first period of reactivity. Which of the following actions should the nurse take at this time? (Select all that apply). A. Encourage the parents to bond with their baby. B. Notify the neonatologist of the finding. C. Encourage and support parents in feeding their baby. D. Perform the gestational age assessment. E. Place the baby under the overhead warmer. F. Swaddle the infant snuggly and sway, hoping to help settle the infant to sleep. G. Encourage extended family to visit so they can see the baby while awake.
A. Encourage the parents to bond with their baby C. Encourage and support parents in feeding their baby.
The nurse is working with a breastfeeding client with complaint of low milk supply. The nurse is aware that the following situations can cause a decreased milk supply. Select all that apply: A. Retained placental fragments B. Maternal smoking C. Maternal fatigue and stress D. Excessive maternal caloric intake E. Diuretic medications F. Hyperthyroidism
A. Retained placental fragments B. Maternal smoking C. Maternal fatigue + stress E. Diuretic meds
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? A. Feeding. B. Digestion. C. Immune response. D. Glomerular filtration.
A. feeding
Which of the following behaviors should nurses know are characteristic of infant abductors? (Select all that apply). A. Act on the spur of the moment. B. Create a diversion on the unit. C. Ask questions about the routine of the unit. D. Choose rooms near stairwells. E. Wear over-sized clothing.
B,C,D,E
A 1000 gram neonate is being admitted to the NICU. The surfactant Survanta (beractant) has just been prescribed to prevent respiratory distress syndrome. Which of the following actions should the nurse take while administering this medication? A. Flush the intravenous line with normal saline solution. B. Assist the neonatologist during the intubation procedure. C. Inject the medication deep into the vastus lateralis muscle. D. Administer the reconstituted liquid via an oral syringe.
B.
A 42-week gravida is delivering her baby. A nurse and a pediatrician are present at the birth. The amniotic fluid is green and thick. The baby fails to breathe spontaneously. Which of the following actions should the nurse take next? A. Stimulate the baby to breathe. B. Assist with intubation. C. Place the baby in the prone position.
B.
A full-term neonate has brown adipose fat tissue (BAT) stores that were deposited during the latter part of the third trimester. What does the nurse understand is the function of BAT stores? A. To promote melanin production in the neonatal period. B. To provide heat production when the baby is hypothermic. C. To protect the bony structures of the body from injury. D. To provide calories for neonatal growth between feedings.
B.
A mother questions why the ophthalmic medication is given to the baby. Which of the following responses by the nurse would be appropriate to make at this time? A. I am required by law to give the medicine." B. "The medication is given to prevent eye infections." C. "The medicine promotes neonatal health." D. "All babies receive the medicine at delivery."
B.
A neonate has an elevated bilirubin and is slightly jaundiced on day 3 of life. What is the probable reason for these changes? A. Hemolysis of neonatal red blood cells by the maternal antibodies. B. Physiological destruction of fetal red blood cells during the extrauterine period. C. Pathological liver function resulting from hypoxemia during the birthing process. D. Delayed meconium excretion resulting in the production of direct bilirubin
B.
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? A. The baby is likely to cry from pain during the feeding. B. The baby is likely to expel milk through the nose. C. The baby will feed more quickly than other babies. D. The baby will need to be fed high calorie formula
B.
The most common cause of poor weight gain among breastfed infants during the first 4 weeks after birth is: A. Infant metabolic disorders B. Infrequent or ineffective feedings C. Low fat content of breast milk D. Maternal endocrine problems E. Maternal nutritional deficiencies
B.
The nurse is preparing a client and newborn for discharge. Which statement indicates learning has occurred? A. "I will add occassional water to supplement during the summer." B. "I will exclusively breastfeed my newborn every 2-3 hrs. C. "I will supplement feedings with formula until my breastmilk comes in E. "Iron fortified formula will be needed after my newborn is 6 months of age
B.
Thirty seconds after birth a baby, who appears preterm, has exhibited no effort to breathe even after being stimulated. The heart rate is assessed at 68 bpm. Which of the following actions should the nurse perform first? A. Perform a gestational age assessment. B. Inflate the lungs with positive pressure. C. Provide external chest compressions. D. Assess the oxygen saturation level.
B.
Mongolian spot
Blue or purple areas found on buttocks or lower extremities
A 1-day old neonate, 32 weeks gestation, is in an overhead warmer. The nurse assesses the morning axillary temperature as 96.9 F. Which of the following could explain this assessment finding? A. This is a normal temperature for a preterm neonate. B. Axillary temperatures are not valid for preterm babies. C. The supply of brown adipose tissue is incomplete. D. Conduction heat loss is pronounced in the baby.
C.
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? A. Preeclampsia. B. Idiopathic thrombocytopenia. C. Polyhydramnios. D. Severe iron deficiency anemia.
C.
A neonate is being admitted to the well-baby nursery. Which of the following findings should be reported to the neonatologist? A. Umbilical cord with three vessels B. Diamond-shaped anterior fontanelle C. Cryptorchidism D. A café au lait spot
C.
A nurse is assessing the bonding of the father with his newborn baby. Which of the following actions by the father would be of concern to the nurse? A. He holds the baby in the en face position. B. He calls the baby by a full name rather than a nickname. C. He tells the mother to pick up the crying baby. D. He falls asleep in the chair with the baby on his chest.
C.
A nurse notes that a 6 hour old neonate has cyanotic hands and feet. Which of the following actions by the nurse is appropriate? A. Place child in an isolette. B. Administer oxygen. C. Swaddle baby in a blanket. D. Apply pulse oximeter.
C.
All of the following are recommended to encourage successful breastfeeding EXCEPT: A. Initiation of breastfeeding within 1 hour of birth B. Avoiding the use of pacifiers Continuous rooming in with breastfeeding on demand C. Breastfeed and alternate breasts frequently to prevent nipple soreness and engorgement D. Avoiding use of supplemental formula during the early stages of milk production
C.
An infant in the neonatal nursery has low-set ears and Simian creases. The nurse should monitor this infant for which of the following signs/symptoms? A. Blood-tinged urine. B. Hemispheric paralysis. C. Cardiac murmurs. D. Hemolytic jaundice.
C.
Four newborns are in the nursery, none of whom are crying or in distress. Which of the babies should the nurse report to the neonatologist? A. 16 hour old baby who has yet to pass meconium. B. 16 hour old baby whose blood glucose is 50 mg/dL. C. 2 day old baby who is breathing irregularly at 70 breaths per minute. D. 2 day old baby who is excreting a milky discharge from both nipples.
C.
Signs of milk ejection in the first few weeks include all of the following EXCEPT: A. Milk leaking from the other breast B. Uterine cramping C. Breast erythema D. Audible swallowing E. "Pins and needles" sensation in the breast
C.
Which of the following is a correct statement about the latch during breastfeeding? A. The baby must take all of the areola into the mouth to achieve a good latch B. A narrow angle at the corner of the infant's mouth is indicative of a good latch C.The baby needs to be latched so that he compresses the milk sinuses when suckling at the breast D. The baby needs to be latched so that he compresses the base of the nipple when feeding E. Clients who have had previous breastfeeding experience rarely require assessment of the baby's latch in the hospital or birthing center
C.
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? A. Morphine. B. Opium. C. Narcan. D. Phenobarbital.
C. NARCAN
A baby has been admitted to the NICU 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. A. Hyperopia B. Gestational diabetes. C. Substance abuse. D. Chronic hypertension. E. Advanced maternal age.
C. Substance abuse. D. Chronic hypertension. E. Advanced maternal age.
A 2 day old infant received a vitamin K injection at birth. Which of the following signs/symptoms in the baby would indicate that the treatment was effective? A. Skin color is pink. B. Vital signs are normal. C. Glucose levels are stable. D. Blood clots after heel sticks.
D.
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 25mg/dl and after a feeding of mother's expressed breastmilk is 35mg/dl. Which of the following actions should the nurse take at this time? A. Nothing, because the glucose level is normal for an infant of a diabetic mother. B. Administer intravenous glucagon slowly over five minutes C. Feed the baby a bottle of dextrose and water and reassess the glucose level. D. Notify the neonatologist of the abnormal glucose levels.
D.
Four newborns were admitted into the neonatal nursery 1 hour ago. They are all sleeping in overhead warmers. Which of the babies should the nurse ask the neonatologist to evaluate? A. The neonate with T 98.9 degrees F and weight of 3000 grams. B. The neonate with white spots on the bridge of the nose. C. The neonate with raised white specks on the gums. D. The neonate with respirations of 72 and heartrate of 166.
D.
Hospital policies that support breastfeeding include all of the following: Select all that apply A. Moving the infant to the nursery for the night to allow mother to rest and build up her milk supply B. Feedings scheduled every 4 hours to allow mother's breasts to make more milk C. Use of pacifiers to prevent the infant using mother as a pacifier and giving her sore nipples D. Showing all clients how to express or pump breast milk in case they are separated from their infants E. Routine water supplementation by dropper to prevent dehydration
D.
In which of the following circumstances should it be necessary to delay the initiation of breastfeeding after delivery (for more than 1 hour): A. C-section with spinal anesthesia B. Client fatigued due to a long and difficult labor C. Client receiving MgSO4 for preeclampsia D. Client delivered a 32 week infant needing respiratory support
D.
The hormone primarily responsible for milk ejection ("let-down") is: A. Estrogen B. Progesterone C. Prolactin D. Oxytocin E. Transferrin
D.
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 firstaction for the nurse to take? A. Prepare epinephrine for administration. B. Provide positive pressure oxygen. C. Administer chest compressions. D. Rub the back and feet of the baby.
D.
When a baby is born and takes its first breath, the change in pulmonary pressure causes which embryonic vessel to constrict? A. umbilical vein B. umbilical artery C. ductus venosis D. ductus arteriosus
D.
A baby born by vacuum extraction has been admitted to the well-baby nursery. The nurse should assess this baby for which of the following? A. Pedal abrasions. B. Hypobilirubinemia. C. Hyperglycemia. D. Cephalohematoma.
D. cephalohematoma
A client with a 3-day-old baby presents with sore nipples. The problem began with the first feeding and has persisted with every feeding. The most likely source of the problem is: A. Baby's suck is too strong B. Feeding time is too long C. Lack of nipple preparation during pregnancy D. Inverted nipples E. Poor attachment to the breast
E.
Which of the following factors should be considered when choosing drug therapy for a nursing client? A. Age of the infant B. Experience with the drug in infants C. Relative concentration of the drug in mother's milk and plasma D. Potential long-term effects in the infant E. All of the above
E.
Molding
Elongated shaping of the infant's head to allow passage through birth canal
The nurse is discussing the neonatal blood screening test with a new mother. The nurse knows that the teaching was successful when the mother states that the test screens for the presence of which of the following diseases in the newborn? (Select all that apply). A. Hypothyroidism B. Sickle cell disease C. Galactosemia D. Cerebral palsy E. Cystic fibrosis
Everything except D.
Which of the following are important topics to educate parents on prior to discharge? (Select all that apply). A. Feeding, Bathing, and Elimination B. Cord and Circ (if applicable) care C. Safe Infant Travel in appropriate care seat D. Holding and Positioning E. Sleep Patterns F. Follow-up care and Danger Signs G. Introduction of infant cereal
Everything except G
How frequently do you usually recommend that infants be breastfed during the first month of life? Every hour Every 2 hours Every 3 hours Every 4 hours on demand
On demand
What are the 4 consequences of Cold Stress? (Select all that apply). A. Respiratory distress and Hypoxemia B. Hypoglycemia C. Hyperglycemia D. Babinski E. Hyperbilirubinemia F. Erythema toxicum neonatorum G. Metabolic acidosis
Resp distress + hypoxemia Hypoglycemia Hyperbilirubinemia Metabolic acidosis
Cephalohematoma
Well demarcated swelling. Collection of blood. Does NOT cross suture lines.
Which of the following neonates is at highest risk for cold stress syndrome? A. Infant of diabetic mother. B. Infant with Rh incompatibility. C. Postdates neonate. D. Down syndrome neonate.
c
Erythema toxicum
general transient rash that looks like flea bites
caput succedaneum
poorly demarcated soft tissue swelling/ localized edema. can cross suture line.
Stork bite
superficial vascular pink areas found at nape of neck, eyelids
Vernix caseosa
thick white substance that provides protection for newborn's skin in utero
milia
unopened sebaceous glands many times found on infant nose