OB ch 23

A newborn male, estimated to be 39 weeks of gestation, exhibits: 1. Testes descended into the scrotum 2. Extended posture when at rest 3. Abundant lanugo over his entire body 4. Ability to move his elbow past his sternum

1

A nurse caring for a newborn should be aware that the sensory system least mature at the time of birth is what? 1. vision. 2. hearing. 3. smell. 4. taste.

1

The nurse is assessing a neonate born by vacuum extraction. What assessment does the nurse perform to detect possible subgaleal hemorrhage? 1. Measure serial head circumference. 2. Monitor the neonate for bradycardia. 3. Inspect the frontal aspect of the head. 4. Look for backward positioning of the ears.

1

The nurse is assessing digestion and elimination in a newborn. Which enzyme helps the newborn convert starch into maltose? 1. Amylase in colostrum 2. Mammary lipase in breast milk 3. Amylase in the salivary glands 4. Lactase in the digestive system

1

The nurse is caring for a preterm infant whose cord was clamped 2 minutes after birth. What are the effects of late cord clamping on the infant? 1. Improvement in iron status 2. Decreased risk of jaundice 3. Decreased risk of polycythemia 4. Risk of intraventricular bleeding

1

The nurse is caring for an infant born through cesarean delivery. Upon assessment, the nurse finds that the infant has a high respiratory rate and its skin has a bluish tint. What can the nurse infer from these findings? The infant has what? 1. Low levels of catecholamines. 2. High levels of catecholamines. 3. Increased surfactant production. 4. decreased surfactant production.

1

The nurse notices that a newborn has difficulty breathing. What infant behavior might have led to the nurse to this conclusion? 1. The infant did not cry after birth. 2. The infant had improper bowel sounds. 3. The infant moved its head from side to side. 4. The infant had increased blood pressure (BP).

1

The nurse performs nasal and oral suctioning of a newborn immediately after birth. What is the reason for this nursing intervention? 1. To stimulate respiration 2. Assist in stimulating cardiac activity 3. Removal of fluid from the lungs 4. To increase pulmonary blood flow

1

What is a warning sign of ineffective adaptation to extrauterine life if noted when assessing a 24-hour-old breastfed newborn before discharge? 1. Apical heart rate of 90 beats/minute, slightly irregular, when awake and active 2. Acrocyanosis 3. Harlequin color sign 4. Weight loss representing 5% of the newborn's birth weight

1

With regard to the respiratory development of the newborn, of what should nurses be aware? 1. Crying increases the distribution of air in the lungs 2. Newborns must expel the fluid in utero from the respiratory system within a few minutes of birth 3. Newborns are instinctive mouth breathers 4. Seesaw respirations are no cause for concern in the first hour after birth

1

The nurse is caring for a full-term neonate born by cesarean. What is the effect of cesarean birth on the respiratory function of the neonate? 1. Retention of fluid in the lungs 2. Incidence of transient bradypnea 3. Exhaustion from the effort of breathing 4. Episodes of periodic breathing

1 Before the onset of labor, and during labor, a catecholamine surge promotes fluid clearance from the lungs. This is absent during birth by cesarean when the mother does not go into labor.

What findings might the nurse expect in a neonate within 30 minutes of birth? 1. Tremors 2. Nasal flaring 3. Audible grunting 4. Pinkish skin color 5. Quick respiration

1, 2, 3

The nurse is caring for an infant with early-onset jaundice. What are the causes of early-onset jaundice? 1. Incompatible fetomaternal blood group 2. Delay in clamping the umbilical cord 3. Disorders of amino acid metabolism 4. Delay in the elimination of bilirubin 5. Congenital abnormality of red blood cells

1, 2, 5

What physiologic changes are most common neonates in the sixth hour after birth? 1. Production of mucus 2. Increased muscle tone 3. Retractions of the chest 4. Brief periods of bradypnea 5. Brief periods of tachycardia

1, 2, 5

The nurse is assisting a client during delivery. What measures does the nurse take to protect the infant from heat loss? 1. Ensure the infant is dried immediately after birth. 2. Place the naked infant on bare scales for accuracy. 3. Place the naked infant on the mother's bare chest and cover with a blanket. 4. Ensure the nursery temperature is 27° C (80.6° F). 5. Wrap the infant and cover the head with a cap.

1, 3, 5

A client tells the nurse, "While crying, my baby often moves its hand towards its mouth and also gets startled by the sound of the rattle." What statement given by the nurse best explains this behavior? "The baby: 1. "Is hungry." 2. "Is consoling itself." 3. "Wants to interact with you." 4. "Is frightened by some noise."

2

The client reports to the nurse that the newborn swallows milk very slowly and often vomits. In which condition is this finding consistent in the newborn? 1. The infant is premature. 2. The mother took analgesics. 3. The infant has cerebral palsy. 4. The mother underwent a cesarean delivery.

2

The nurse helps a breastfeeding mother change the diaper of her 16-hour-old newborn after the first bowel movement. The mother expresses concern because the large amount of thick, sticky stool is very dark green, almost black in color. She asks the nurse if something is wrong. The nurse should respond to this mother's concern by: 1. telling the mother not to worry because breastfed babies have this type of stool. 2. explaining to the mother that the stool is called meconium and is expected of all newborns for the first few bowel movements. 3. asking the mother what she ate at her last meal. 4. suggesting that the mother ask her pediatrician to explain newborn stool patterns to her.

2

The nurse is caring for a neonate immediately after delivery. What does the nurse expect to find while assessing the neonate during the first 30 minutes after birth? 1. Heart rate increases from 100 to 120 beats/minute. 2. Fine crackles may be present on auscultation. 3. Peristaltic waves may benoted over the abdomen. 4. Respirations are shallow and may reach up to 60 breaths/minute.

2

The nurse is caring for an infant experiencing cold stress. Which complication does the nurse suspect in the infant? 1. Hyperglycemia 2. Hyperbilirubinemia 3. Respiratory alkalosis 4. Decreased metabolic rate

2

The nurse is caring for an infant with breathing difficulty. Upon auscultating, the infant the nurse finds that the infant has a murmur. What suggestion does the nurse give to the parents about infant care? 1. "Use formula milk." 2. "Additional cardiac testing is necessary." 3. "The infant should be wrapped in a thick blanket." 4. "Maintain skin-to-skin contact with the mother."

2

The nurse notes that, when placed on the scale, the newborn immediately abducts and extends the arms, and the fingers fan out with the thumb and forefinger forming a "C." This response is known as what? 1. Tonic neck reflex. 2. Moro reflex. 3. Cremasteric reflex. 4. Babinski reflex.

2

What intervention should the nurse perform when measuring the blood pressure of a neonate? 1. Use an oscillometric device to measure blood pressure when the neonate is awake. 2. Ensure the cuff covers 75% of the distance between the axilla and the elbow. 3. Report a drop in systolic blood pressure of about 15 mm Hg in the first hour of life. 4. Report if the systolic pressure is the same in the upper and lower extremities.

2

What is the basic mechanism for conserving internal heat within infants? 1. Shivering 2. Vasoconstriction 3. Metabolism of brown fat 4. Decrease in muscle activity

2

When caring for a newborn, the nurse must be alert for signs of cold stress, including: 1. decreased activity level. 2. increased respiratory rate. 3. hyperglycemia. 4. shivering.

2

While the infant is sleeping the nurse finds that the infant's heart rate is 80 beats per minute. What should the nurse do in this situation? 1. Immediately wake the infant. 2. Reassess the heart rate after 30 minutes. 3. Advise the mother to stop breastfeeding. 4. Inform the parents that the infant has bradycardia.

2

An examiner who discovers unequal movement or uneven gluteal skinfolds during the Ortolani maneuver: 1. tells the parents that one leg may be longer than the other, but they will equal out by the time the infant is walking. 2. alerts the physician that the infant may have a dislocated hip. 3. informs the parents and physician that molding has not taken place. 4. suggests that if the condition does not change, surgery to correct vision problems might be needed.

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The newborn's nurse knows which newborn reflex assessment findings are normal? 1. Newborn turns head toward stimulus with mouth open when eliciting rooting reflex. 2. Newborn's fingers fan out when palmar reflex checked. 3. Newborn forces tongue outward when tongue touched. 4. Newborn exhibits symmetric abduction and extension of arms, and fingers form "C" when Moro reflex elicited. 5. Newborn's toes hyperextend with dorsiflexion of big toe when sole of foot stroked upward along lateral aspect.

2, 3, 4, 5

Which findings would lead to increased bilirubin levels in the newborn? 1. Cord clamped immediately following delivery of newborn 2. Meconium passed after 24 hours 3. Initiation of newborn feedings were delayed following birth 4. Hyperglycemia 5. Twin to twin transfusion syndrome

2, 3, 5

In most healthy newborns, blood glucose levels stabilize at what mg/dl during the first hours after birth? 1. 80 to 100 2. Less than 40 3. 50 to 60 4. 60 to 70

3

The nurse clamps the umbilical cord of a preterm infant after 3 minutes of birth. What would be the possible effect in the newborn associated with this action? 1. Epispadias 2. Polydactyly 3. Polycythemia 4. Hyperbilirubinemia

3

The nurse is assessing an infant with a scaphoid abdomen. On further assessment, the nurse notes bowel sounds in the chest, and the infant also shows signs of respiratory distress. What does the nurse suspect from this finding? 1. Distended bladder 2. Abdominal wall defect 3. Diaphragmatic hernia 4. Gastrointestinal disorder

3

The nurse is caring for a baby who is 4 weeks old. The nurse finds that the newborn is breathing through the mouth. What does the nurse expect to be the most likely clinical condition for this observation? 1. Hypoxemia. 2. Cardiac disorder. 3. Nasal obstruction. 4. Laryngeal obstruction.

3

The nurse is caring for a healthy caucasian neonate who was born at 37 weeks of gestation. What does the nurse find while performing the skin assessment of the newborn immediately after the birth? 1. Bluish-black areas on the body 2. Desquamation of the epidermis 3. Vernix caseosa covering the body 4. Dark red-colored swellings on the body

3

The nurse is caring for a neonate in the nursery. What behavior in the neonate does the nurse recognize as thermogenesis? 1. Starts shivering incessantly 2. Assumes position of extension 3. Cries and appears restless 4. Develops pallor and seizures

3

The nurse is caring for an infant after a forceps-assisted birth. Which feature does the nurse attribute to a forceps-assisted birth? 1. Erythematous skin 2. Blotchy or mottled skin 3. Edema and ecchymosis 4. Cyanotic discoloration

3

The nurse observes that the lips, feet, and palms of a newborn are pale blue even 48 hours after birth. What can the nurse suspect from this observation about the newborn's clinical condition? 1. Acrocyanosis. 2. Polycythemia. 3. Central cyanosis. 4. Transient tachypnea.

3

The nurse observes the infant communicating with the caregiver by crying and then being consoled. What is the behavioral level of this infant? 1. Regulation of physiologic functions 2. Control of motor behavior 3. Regulation of state 4. Attention and social interaction

3

Vitamin K is given to the newborn to do what? 1. Reduce bilirubin levels. 2. Increase the production of red blood cells. 3. Enhance ability of blood to clot. 4. Stimulate the formation of surfactant.

3

While assessing a 1-week-old infant, the nurse observes that the newborn has apnea, lethargy, jitteriness, and feeding problems. What could be the possible reason for the infant's symptoms? 1. Heart rate of 120 beats/min. 2. Body temperature of 99.5° F. 3. Blood glucose level of 38 mg/dl. 4. Blood pressure (BP) of 80/40 mm Hg.

3

A mother of a newborn reports to the nurse that the child has bluish pigmentation on the back. What could be the reason for this condition? 1. Infection 2. Hypothermia 3. Polycythemia 4. Mongolian spots

4

A mother reports that her baby's skin always appears flushed. What does the nurse suspect to be the reason for this condition in the infant? 1. Loss of water and fluids 2. Increased acid production 3. Increased heat production 4. Loss of heat from the body

4

The nurse is assessing a newborn for the presence of seizure activity. What action by the newborn does the nurse document as a sign of seizure activity? 1. Tremor is easily elicited by a sound or motion. 2. Tremor ceases with gentle restraint of the extremity. 3. Tremor reduces or stops with passive flexion. 4. Tremor is accompanied by ocular changes.

4

The nurse is assessing an infant for plantar reflex. What action by the nurse elicits the plantar reflex? 1. Touch the corner of the infant's mouth with a finger. 2. Tap over the bridge of the infant's nose when awake. 3. Place a finger at the base of the infant's toes. 4. Place a finger in the palm of the infant's hand.

4

The nurse is caring for a neonate during the first hour after birth. Which observation by the nurse is a cause for concern? 1. Rise of the abdomen with each inspiration 2. Bluish discoloration of hands and feet 3. Transient periods of duskiness while crying 4. Discoloration of the mucous membranes

4

The nurse is caring for a neonate immediately after birth. Which finding would require the nurse to notify the primary health care provider during the first 2 days after birth? 1. The neonate's diaper has pink-tinged stains. 2. The neonate's urine is cloudy after the first voiding. 3. The neonate voids eight times during the day. 4. The neonate has not voided for 24 hours.

4

The nurse is caring for a patient who is breastfeeding a term newborn. What does the nurse teach the patient about how normal stool should appear on the fourth day after birth? 1. Greenish-black stool 2. Greenish-brown stool 3. Pale yellow to brown stool 4. Pasty yellow to golden stool

4

The nurse is examining the external genitalia of a female infant. What finding must the nurse report? 1. Slight bloody spotting 2. Presence of hymenal tag 3. Mucoid vaginal discharge 4. Fecal discharge from vagina

4

Upon assessment, the nurse finds that a newborn has reduced lung elastic tissue recoil. The newborn also has a tendency to breathe through its mouth. What does the nurse understand from these findings? The infant has: 1. A risk of ductal shunting and hypoxemia. 2. Respiratory distress syndrome and apnea. 3. A risk of respiratory insufficiency and apnea. 4. Increased risk of atelectasis and nasal obstruction.

4

While caring for an infant, which method should the nurse adapt to prevent heat loss due to evaporation? 1. Wrap the infant in a cloth. 2. Place the infant in a warm crib. 3. Place the crib away from the windows. 4. Dry the infant immediately after the bath.

4

While evaluating the reflexes of a male newborn, the nurse notes that with a loud noise, the newborn symmetrically abducts and extends his arms, his fingers fan out and form a "C" with the thumb and forefinger, and he has a slight tremor. What finding does the nurse document? 1. Positive tonic neck reflex 2. Positive Glabellar (Myerson) reflex 3. Positive Babinski reflex 4. Positive Moro reflex

4

While reviewing the blood labs of a 3-day-old infant, the nurse finds that the infant has neutrophilia. What might be the cause of the neutrophilia? 1. Epispadias. 2. Polydactyly. 3. cephalhematoma. 4. Meconium aspiration syndrome.

4

The nurse is caring for a male infant who has been circumcised. Which is the most important detail for the nurse to be aware of? 1. The infant has effective feeding. 2. The infant has passed adequate urine. 3. The infant has passed normal stool. 4. The infant has excessive bleeding.

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