OB CH 23

During a neonate resuscitation attempt, the neonatologist has ordered 0.1 mL/kg IV epinephrine (adrenaline) in a 1:10,000 concentration to be given stat. The neonate weighs 3000 grams and is 38 centimeters long. How many millimeters (mL) should the nurse administer? Record your answer using one decimal place.

ANS: 0.3

A client has given birth to a full-term infant weighing 10 pounds 5 ounces (4678 grams). What priority assessment should be completed by the nurse? A. Blood glucose B. Temperature control C. Feeding difficulty D. Perfusion

ANS: A

A nurse is developing the plan of care for a small-for-gestational-age newborn. Which action would the nurse determine as a priority? A. Preventing hypoglycemia with early feedings B. Observing for newborn reflexes C. Promoting bonding between the parents and the newborn D. Monitoring vital signs every 2 hours

ANS: A

A preterm newborn has received large concentrations of oxygen therapy during a 3-month stay in the NICU. As the newborn is prepared to be discharged home, the nurse anticipates a referral st for which specialist? A. ophthalmologist B. nephrologist C. cardiologist D. neurologist

ANS: A

Evidence-based practice refers to the use of which of the following to validate your practice? a. Research findings b. Written guidelines c. Traditional practices d. Institutional policies

ANS: A

SGA and LGA newborns have an excessive number of red blood cells related to a. hypoxia. b. hypoglycemia. c. hypocalcemia. d. hypothermia.

ANS: A

A premature, 36-week-gestation neonate is admitted to the observational nursery and placed under bili-lights with evidence of hyperbilirubinemia. Which assessment findings would the neonate demonstrate? Select all that apply. A. increased serum bilirubin levels B. clay-colored stools C. tea-colored urine D. cyanosis E. Mongolian spots

ANS: A, B, C

The nurse is providing care to several newborns with variations in gestational age and birth weight. When developing the plan of care for these newborns, the nurse focuses on energy conservation to promote growth and development. Which measures would the nurse include in the nursing plans of care? Select all that apply. a. Keeping the handling of the newborn to a minimum b. Maintaining a neutral thermal environment c. Decreasing environmental stimuli d. Initiating early oral feedings e. Using thermal warmers in all cribs

ANS: A, B, C

A 20-hour-old neonate is suspected of having polycythemia. Which nursing intervention(s) will the nurse utilize to provide care for this neonate? Select all that apply. A. Obtain hemoglobin and hematocrit laboratory tests B. Provide early feedings to prevent hypoglycemia C. Maintain oxygen saturation parameters D. Monitor urinary output E. Insert a peripheral IV

ANS: A, B, C, D

A client expresses concerns that her grandmothers had complicated pregnancies. What principle(s) should the nurse discuss to allay the fears of the client? Select all that apply. A. "We work to ensure that birth of high-risk infants happens in settings where we are able to care for them." B. "We will work with you to identify prenatal risk factors early and take actions to reduce their impact." C. "We support those at risk of having a preterm births with the goal of delaying early births." D. "We work to ensure care for mothers and infants to reduce infant illnesses, disabilities, and death." E. "We allow families to grieve the loss of a newborn, should it occur."

ANS: A, B, C, D

A macrosomic infant in the newborn nursery is being observed for a possible fractured clavicle. For which would the nurse assess? Select all that apply. A. facial grimacing with movement B. bruising over area C. asymmetrical movement D. edema present E. positive Babinski reflex

ANS: A, B, C, D

A neonate is born at 42 weeks' gestation weighing 4.4 kg (9 lb, 7 oz) with satisfactory Apgar scores. Two hours later birth the neonate's blood sugar indicates hypoglycemia. Which symptoms would the baby demonstrate? Select all that apply. A. poor sucking B. respiratory distress C. weak cry D. jitteriness E. blood glucose >40 mg/dl

ANS: A, B, C, D

A term neonate has been admitted to the observational newborn nursery with the diagnosis of being small for gestational age. Which factors would predispose the neonate to this diagnosis? Select all that apply. A. The mother had chronic placental abruption. B. At birth the placenta was noted to be decreased in weight. C. On assessment the placenta had areas of infarction D. At birth the placenta was a shiny Schultz presentation. E. Placental talipes was present at birth.

ANS: A, B, C, D

A neonate is admitted to the newborn observation nursery with the possible diagnosis of polycythemia. The nurse would be observing for which findings? Select all that apply. A. ruddy skin color B. respiratory distress C. cyanosis D. pink gums and tongue E. jitteriness

ANS: A, B, C, E

A 42-year-old woman is 26 weeks' pregnant. She lives at a shelter for female victims of st intimate partner violence. Her blood pressure is 170/90 mm Hg, the fetal heart rate is 140 bpm, TORCH studies are positive, and she is bleeding vaginally. What findings put her at risk of giving birth to a small-for-gestational-age (SGA) infant? Select all that apply. A. the age of the client B. living in a shelter for victims of intimate partner violence C. vaginal bleeding D. fetal heart rate E. blood pressure F. positive test for TORCH

ANS: A, B, C, E, F

A small-for-gestational age infant is admitted to the observational care unit with the nursing diagnosis of ineffective thermoregulation related to lack of fat stores as evidenced by persistent low temperatures. Which are appropriate nursing interventions? Select all that apply. A. Assess the axillary temperature every hour. B. Review maternal history. C. Assess environment for sources of heat loss. D. Bathe the neonate with warmer water. E. Minimize kangaroo care. F. Encourage skin-to-skin contact

ANS: A, B, C, F

A 22-year-old woman experiencing homelessness arrives at a walk-in clinic seeking pregnancy confirmation. The nurse notes on assessment her uterus suggests 12 weeks' gestation, tes t a blood pressure of 110/70 mm Hg, and a BMI of 17.5. The client admits to using cocaine a few times. The client has been pregnant before and indicates she "loses them early." What characteristic(s) place the client in the high-risk pregnancy category? Select all that apply. A. BMI 17.5 B. blood pressure 110/70 mm Hg C. prenatal history D. homelessness E. age F. prenatal care

ANS: A, C, D, F

A late preterm newborn is being prepared for discharge to home after being in the neonatal t intensive care unit for 4 days. The nurse instructs the parents about the care of their newborn and emphasizes warning signs that should be reported to the pediatrician immediately. The nurse determines that additional teaching is needed based on which parental statement? A. "We will call 911 if we start to see that our newborn's lips or skin are looking bluish." B. "If our newborn's skin turns yellow, it is from the treatments and our newborn is okay." C. "If our newborn does not have a wet diaper in 12 hours, we will call our pediatrician." D. "We will let the pediatrician know if our newborn's temperature goes above 100.4°F (38°C)."

ANS: B

A neonate born at 40 weeks' gestation, weighing 2300 grams (5 lb, 1 oz) is admitted to the newborn nursery for observation only. What is the nurse's first observation about the infant? A. The neonate is average for its gestational age. B. The neonate is small for its gestational age C. The neonate is large for its gestational age. D. The neonate is fetal growth restricted.

ANS: B

A nurse is reviewing the maternal history of a large-for-gestational-age (LGA) newborn. Which factor, if noted in the maternal history, would the nurse identify as possibly contributing to the birth of this newborn? A. substance use disorder B. diabetes C. preeclampsia D. infection

ANS: B

A one-day-old neonate born at 32 weeks' gestation is in the neonatal intensive care unit under a radiant overhead warmer. The nurse assesses the morning axilla temperature as 95 degrees F (35 degrees C). What could explain the assessment finding? A. Conduction heat loss is a problem in the baby. B. The supply of brown adipose tissue is not developed. C. Axillary temperatures are not accurate. D. This is a normal temperature.

ANS: B

Because subcutaneous and brown fat stores were used for survival in utero, the nurse would assess an SGA newborn for which of the following? a. Hyperbilirubinemia b. Hypothermia c. Polycythemia d. Hypoglycemia

ANS: B

The nurse is providing care to a newborn who was born at 36 weeks' gestation. Based on the nurse's understanding of gestational age, the nurse identifies this newborn as: A. preterm. B. late preterm. C. term. D. postterm.

ANS: B

The nurse prepares to assess a newborn who is considered to be large-for-gestational-age (LGA). Which characteristic would the nurse correlate with this gestational age variation? A. strong, brisk motor skills B. difficulty in arousing to a quiet alert state C. birthweight of 7 lb, 14 oz (3,572 g) D. wasted appearance of extremities

ANS: B

Which intervention would be most appropriate for the nurse to do when assisting parents who have experienced the loss of their preterm newborn? A. Avoid using the terms "death" or "dying." B. Provide opportunities for them to hold the newborn. C. Refrain from initiating conversations with the parents. D. Quickly refocus the parents to a more pleasant topic.

ANS: B

A set of newborn twins has been admitted to the neonatal intensive care unit with the diagnosis of fetal growth restriction (FGR). Which maternal factors would predispose the newborn to this diagnosis? Select all that apply. A. hemoglobin 15 g/dl (150 g/l) B. A1C levels of 8% (0.08) C. heroin use disorder D. blood pressure baseline of 170/90 mm Hg E. age 39 years F. multiple gestation

ANS: B, C, D, E, F

A couple has just given birth to a baby who has low Apgar scores due to asphyxia from prolonged cord compression. The neonatologist has given a poor prognosis to the newborn, who is not expected to live. Which interventions are appropriate at this time? Select all that apply. A. Advise the parents that the hospital can make the arrangements. B. Offer to pray with the family if appropriate. C. Leave the parents to talk through their next steps. D. Initiate spiritual comfort by calling the hospital clergy, if appropriate. E. Respect variations in the family's spiritual needs and readiness.

ANS: B, D, E

A nurse is assessing a postterm newborn. Which finding would the nurse correlate with this gestational age variation? A. moist, supple, plum skin appearance B. abundant lanugo and vernix C. thin umbilical cord D. absence of sole creases

ANS: C

The nurse documents that a newborn is postterm based on the understanding that he was born after a. 38 weeks' gestation. b. 40 weeks' gestation. c. 42 weeks' gestation. d. 44 weeks' gestation

ANS: C

The parents of a preterm newborn being cared for in the neonatal intensive care unit (NICU) are coming to visit for the first time. The newborn is receiving mechanical ventilation, intravenous fluids and medications and is being monitored electronically by various devices. Which action by the nurse would be most appropriate? A. Suggest that the parents stay for just a few minutes to reduce their anxiety. B. Reassure them that their newborn is progressing well. C. Encourage the parents to touch their preterm newborn. D. Discuss the care they will be giving the newborn upon discharge.

ANS: C

When caring for parents experiencing a perinatal loss, which of the following nursing interventions would be most appropriate? a. Sheltering the parents from the bad news b. Making all the decisions regarding care c. Encouraging them to participate in the newborn's care d. Leaving them by themselves to allow time to grieve

ANS: C

Which of the following concepts would the nurse incorporate into the plan of care when assessing pain in a newborn with special needs? a. Newborns experience pain primarily with surgical procedures. b. Preterm newborns in the NICU are at least risk for pain. c. Pain assessment needs to be comprehensive and frequent. d. A newborn's facial expression is the primary indicator of pain.

ANS: C

A jaundiced neonate must have heel sticks to assess bilirubin levels. Which assessment findings would indicate that the neonate is in pain? SATA A. There is flaccid muscle tone of the affected limb. B. Respiration rate is 52 breaths per minute. C. Heart rate is 180 beats per minutes. D. Oxygen saturation level is 88%. E. The infant has facial grimacing and quivering chin.

ANS: C, D, E

A nurse is assessing a preterm newborn. Which finding would alert the nurse to suspect that a preterm newborn is in pain? A. bradycardia B. oxygen saturation level of 94% C. decreased muscle tone D. sudden high-pitched cry

ANS: D

A thin newborn has a respiratory rate of 80 breaths/min, nasal flaring with sternal retractions, a heart rate of 120 beats/min, temperature of 36° C (96.8° F) and persisting oxygen saturation of <87%. The nurse interprets these findings as: A. cardiac distress. B. respiratory alkalosis. C. bronchial pneumonia. D. respiratory distress.

ANS: D

Rapid assessment of a newborn indicates the need for resuscitation. The newborn has copious t secretiohs. The newborn is dried and placed under a radiant warmer. Which action would do next? A. Intubate with an appropriate-sized endotracheal tube. B. Give chest compressions at a rate of 80 times per minute. C. Administer epinephrine intravenously. D. Clear the airway with a bulb syringe

ANS: D

The nurse is teaching a group of parents who have preterm newborns about the differences between a full-term newborn and a preterm newborn. Which characteristic would the nurse describe as associated with a preterm newborn but not a term newborn? A. fewer visible blood vessels through the skin B. more subcutaneous fat in the neck and abdomen C. well-developed flexor muscles in the extremities D. greater body surface area in proportion to weight

ANS: D

When assessing a preterm newborn, which of the following findings would be of greatest concern? a. Milia over the bridge of the nose b. Thin transparent skin c. Poor muscle tone d. Heart murmur

ANS: D