OB - Newborn

Phototherapy

Exposure of newborn to high-intensity light. It changes unconjugated bilirubin into conjugated water-solubile bilirubin so it can be excreted and lower the total bilirubin levels & jaundice (this is called conjugation)

Aquamephyton (Vitamin K)

Givin within 1 hr of birth, prevents abnormal bleeding

Erythromycin ointment

Givin within 1-2hrs of birth - can cause mild inflammation. Given as a treatment to prevent ophthalmia neonaturum (possible blindness due to STDs)

Hypothermia

Heat loss occurs in 4 ways Convection: heat moves from warm body to cool air Conduction: heat moves from warm body to direct contact of cooler surfaces Radiation: heat moves from warm body to cooler surfaces not in direct contact Evaporation: heat leaves warm body via evaporation to water vapor **Physiologic mechanisms increase heat production (thermogenesis)•Chemical thermogenesis•Uses brown fat to provide heat•Increased basal metabolic rate•Increases oxygen consumption•Muscular activity•Shivering is a VERY LATE sign, not productive Cold stress can be fatal & can lead to hypoglycemia

The nurse is observing a couple interacting with their 2-day-old child. Which of the mother's statements suggests a potentially abnormal finding in the newborn? "There is some white colored drainage coming out of her vagina." "She looks a little bit cross-eyed." "Her belly looks so round and full." "She has small white specks on the roof of her mouth."

Her belly looks so round and full

Lab values (Hgb, Hct, Blood glucose, WBC)

Hgb: 15-24 g/dL Hct: 44-70% - IF ABOVE 65%, watch for jaundice! WBC: 9000-34000 BG: >40mg/dL

During the initial assessment of a large-for-gestational age (LGA) infant, it is important that the nurse assess for complications that are common for this infant, such as: congenital defects. fractures of the clavicle. thinning of the skin. decreased subcutaneous fat.

B

The finding in the newborn that indicates a need for further assessment is: a. A Babinski reflex b. An umbilical cord with two vessels c. Overriding cranial sutures d. Three second pauses in respirations

B

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 dark green, almost black. She asks the nurse if something is wrong. The nurse should respond to this mother's concern by: suggesting that the mother ask her pediatrician to explain newborn stool patterns to her. explaining that the stool is called meconium and is expected for the first few bowel movements of all newborns. telling her not to worry because all breast-fed babies have this type of stool. asking the mother what she ate at her last meal.

B

The unit manager of the newborn nursery is orienting a group of nursing students. Infection control is one of the manager's major topics. When comparing infection control in a nursery with that in an adult medical unit, one major difference is that: the medical unit has many different organisms brought onto the unit. newborns have a decreased ability to localize infections. adults have a weaker immune system, which makes them more prone to developing infections. all the patients in the nursery are usually in one room.

B

When suctioning a newborn, which technique is correct? The bulb syringe should be used to suction the mouth only. The mouth should be suctioned first and then the nose, with the bulb syringe. The bulb syringe is placed inside the mouth and then depressed. Use of a suction catheter attached to low suction is appropriate for nasal suction.

B

Which reflex normally present in full-term newborns is most helpful with the latching-on process? Moro Rooting Tonic Neck Babinski

B

Which one(s) of the newborns listed are at high risk for hypoglycemia? (Select all that apply.) Average for gestational age Large for gestational age Preterm Infants born to pre-eclamptic mothers Infants experiencing cold stress Postterm Small for gestational age

B,C,E,F,G

Hepatitis B immunization

If mother is hepB negative, administer first dose of 3 shortly after birth If mother is hepB positive, infant will recieve HBIG in addition to hepB vaccine

SGA (small for gestational age)

Newborn who is <10th percentile for weight on growth charts. Increased risk for asphyxia, poor feeding/hypoglycemia, polycythemia, jaundice, hypothermia, respiratory distress

The nurse is assessing a newborn at 1 hour of age. Which finding requires an immediate intervention? Pauses in respiration lasting 30 seconds RR 60, crackeles present bilaterally Pulse 145, systolic murmur heard Axillary temperature 98.2F

Pauses in RR lasting 30 seconds

Which of the following vitals signs is abnormal for an infant at 1 hour of age? Pulse 85 Respiratory Rate 50 SpO2 96% Temp 98.5F

Pulse 85

Which of the following guidelines should the nurse implement to prevent the abduction of a newborn from the hospital? Instructing the parents not to give the baby to anyone except the nurse assigned that day Allowing no visitors in the maternity area except those who have identification bracelets Restricting the amount of time infants are out of the nursery Questioning anyone who is seen walking in the hallways carrying an infant

QUestioning anyone who is seen walking in the hallways carring an infant

NAS -Neonatal Abstinence Syndrome

drug withdrawal that occurs in newborn infants whose mothers were frequent drug users during pregnancy watch out for high pitched cry, poor sleep, convulsions, fever, sneezing, poor feeding, etc.

Hyperbilirubinemia

excessive level of bilirubin (bile pigment) in the blood caused by immature liver, spesis, hematomas from birth injury. this is also jaundice - infant can look yellow, the infant can also have blood tests done to check for levels of bilirubin. Treat with phototherapy & feeding supplements

Macrosomia

large-bodied baby commonly seen in diabetic pregnancies **birthweight >4000g

Infant blood sugar levels

40-60 first day 50-90 after first day

A 38-week newborn is found to be small for gestational age. Which of the following nursing interventions should be included in the care of this newborn? Maintain a warm environment Assess for facial paralysis Monitor for signs of hyperglycemia Monitor for feeding difficulties

A

A neonate of a diabetic mother was assessed to be 38 weeks gestational age, Apgar of 7 and 9, Hct 54, blood glucose of 39, T-98.0°F, and P-120. What is the priority nursing action? Feed the infant formula and then recheck glucose level Place the infant under the warmer until the infant's temperature stabilizes Start an IV to lower the hematocrit and notify the pediatrician Normal infant - no need for nursing action

A

A nurse conducts an infant assessment on the second day after birth. A physical assessment of the newborn reveals the infant has dry lips and a dry oral cavity and has had only one wet diaper rather than the expected two. What is the primary nursing diagnosis for this infant? Imbalanced nutrition: less than body requirements related to dehydration as evidenced by dry mucus membranes and decreased urine output Ineffective breastfeeding related to mother's lack of knowledge about breastfeeding techniques Risk for imbalanced nutrition: less than body requirements related to mother's increased caloric need Risk for infection related to impaired skin integrity

A

At birth, an infant weighed 8 pounds 4 ounces. Three days later, the newborn is being discharged. The parents note that the baby now weighs 7 pounds 15 ounces. What explanation should the nurse give for the change in this newborn's weight? "His weight loss is within normal limits." "His weight is excessive." "His weight loss is unusual." "His weight loss is less than expected."

A

If the meatus is located on the underside of the penis, it is called _______________. hypospadius epispadius lanugo dorsal shaft displacement

A

The nurse is preparing to assess a newborn's neurological status. Which finding would require an immediate intervention? a. The right arm is flaccid while the infant brings her left arm and fist upwards to the head b. At rest, the infant has partially flexed arms and her legs drawn up to the abdomen c. When the corner of the mouth is touched, the infant turns her head that direction d. Blinking occurs when the exam light is turned on over the infant's face and body

A

The nurse notices a soft swollen area over the 1-day-old newborn's skull. It is approximately 3 × 2 cm and has clear edges that stop at the suture line. The nurse may document this finding as being: cephalohematoma caput succedaneum

A

When placing a newborn under a radiant heat warmer to stabilize temperature after birth, the nurse should: prewarm the radiant heat warmer and place the undressed newborn under it. place the probe on the left side of the chest. cover the probe with a nonreflective material. recheck the temperature by periodically taking a rectal temperature.

A

Ballard score

A newborn assessment done within 12 hours of birth to evaluate characteristics of gestation age. Neuromuscular: Posture, square window, arm recoil, popliteal angle, scarf sign, heel to ear Physical characteristics: Skin, lanugo, plantar surface, breasts, eyes/ears, genitalia 2.5 points=1 week gestation

CCHD screening (critical congenital heart disease)

A screen result would be considered positive if any oxygen saturation measures less than 90%, oxygen saturation is less than 95% in both extremities on three measures—each separated by 1 hour, or there is a 3% absolute difference in oxygen saturation between the right hand and foot on three measures, each separated by 1 hour. Any screening that is >95% in either extremity with no more than a 3% absolute difference in oxygen saturation between the upper and lower extremity would be considered a "pass" result, and screening would end.

During the admission history of a mother who is in labor, the nurse ascertains that the mother smoked 1 pack of cigarettes/day during the pregnancy, and appears underweight. Because of this information, the nurse should prepare for the birth of an infant who may be: Appropriate for gestational age Small for gestational age Large for gestational age Postterm

B

A new mother expresses concern to the nurse that her 8-hour-old newborn has developed some edema in both eyes. The best response would be based on the fact that: this is a sign of lack of rest for the newborn during the labor process. the eye medication given at birth may cause a mild inflammation and edema. the edema is a sign of eye infections and will need to be investigated. birth trauma usually will not develop until a few hours after birth.

B

A newborn's pulse/HR should be assessed using which pulse point? Radial Apical Brachial Femoral

B

During a newborn's first assessment a few minutes after birth, the nurse notes moisture in the left lower lung field. The newborn is having no respiratory difficulty. The nurse's next action should be to: administer oxygen document the findings and continue to monitor suction the infant notify the pediatrician

B

Of the following, which is abnormal for a 4 hour old infant? Axillary Temperature 98.9F Acrocyanosis Blood glucose 35 Respiratory rate of 52

Blood glucose 35 (normal is 40-60)

Hypoglycemia

Blood glucose <40-45mg/dL watch for: tremors, jitteriness, apnea, resp. depres., cyanosis, seizures feed & recheck - however, if blood glucose is <30-35, give IV dextrose solution (also give this if infant is in resp. distress or if the body is too unstable to feed)

A mother expresses fear about changing her infant's diaper after he is circumcised. What does the woman need to be taught, so that she can care for the baby at home? A. Cleanse the tip of the penis with diaper wipes every 3-4 hours B. Apply constant, firm pressure by squeezing the penis for at least five minutes, each time bleeding occurs C. Cleanse the penis gently, with water, and put petroleum jelly around the glans after each diaper change D. Scrub off the yellow exudates that forms on the glans at least once per day to prevent infection

C

If the nurse notices one artery and one vein in the cord during the initial assessment of a newborn, which one of the following actions should be carried out? The finding is not normal; however, it has no significance. Notify pediatrician immediately; imminent medical emergency Assess for other anomalies. Document this as a normal finding.

C

On discharge from the birthing center the nurse should assess the type of car seat the new parents are using. For a newborn, the seat should be: Front-facing. Sitting straight up. Rear-facing in the back seat of the car. No car seat is necessary for infants younger than 3 months of age; they can be placed in an adult's lap.

C

One reason that preterm infants are at higher risk for cold stress is the fact that they: cannot nurse as effectively. have a smaller surface area. have a decreased amount of brown fat. cannot buffer the acids in the body as well.

C

The nurse administers Aquamephyton (Vitamin K) to the neonate because: a. It prevents gonorrhea and it is a state law. b. It inhibits the production of prothrombin by the liver. c. The neonate lacks the intestinal flora for vitamin K production. d. The neonate cannot synthesize phenytoin.

C

The nurse has received a shift change report on infants born within the last 4 hours. Which newborn should the nurse see first? a. 37-week male, respiratory rate 45, blood glucose 52 b. 39-week female, pulse 150, temperature 98.2°F c. 40-week male, grunting respirations, molding noted d. 39-week female, temperature 97.9°F, 3 vessel cord

C

The nurse is graphing the weight, length, and head circumference of a newborn in relationship to the gestational age. The newborn falls within the sixth percentile for the weight, fifth percentile for the length, and ninth percentile for the head circumference. This newborn would be classified as: Large for gestational age Unable to determine Small for gestational age Appropriate for gestational age

C

The nurse is instructing the parents of a newborn about car seat safety. Which statement indicates that the parents need additional information? "We need to read the owner's manual before using the car seat." "The baby should be in the back seat." "How the straps go around the baby isn't that important." "Newborns must be in rear-facing car seats."

C

The nurse should assess all newborns for jaundice every 8 to 12 hours. This is done by: ordering the appropriate blood work. monitoring the color and consistency of the stools. blanching the newborn's skin. monitoring intake and output.

C

When assessing the heart rate of a sleeping 1-day-old newborn, the nurse counts a rate of 105 beats/min (bpm). The nurse's next action should be to stimulate the newborn to cry reassess in 10 min document this normal finding. notify the pediatrician

C

When caring for a newborn the nurse must be alert for signs of cold stress, which would include which one of the following? Hyperglycemia Decreased activity level Increased respiratory rate Shivering

C

When caring for an infant in the delivery room, what is the nurse's first priority? a. Apgar score 7 b. Temperature 98.1°F c. Gasping, irregular breathing d. Acrocyanosis

C

A large-for-gestational age infant is born outside of the hospital. The infant is brought to the emergency department 5 hours after birth with tremors, diaphoresis, and respirations of 75 breaths per minute. The nurse's next action should be to assess the: cardiac status. bilirubin level. temperature. blood glucose level.

D

A mother expresses concern about breastfeeding her newborn, who is receiving phototherapy for jaundice. The nurse should teach the mother that: breastfeeding can continue after the newborn has been under the light for 12 hours. breastfeeding can continue after the bilirubin level decreases. breastfeeding is discontinued during phototherapy, but she should pump her breasts. breastfeeding should continue and the newborn can be removed from the light to be fed.

D

A newborn is 2 days old and scheduled for discharge. The hospital stay has been uneventful. The nurse is preparing to assess the newborn's temperature. Which method would be the best choice? Rectal Tympanic Oral Axillary

D

During a newborn's first assessment a few minutes after birth, the nurse notes moisture in the left lower lung field. The newborn is having no respiratory difficulty. The nurse's next action should be to: notify the pediatrician. administer oxygen. suction the infant. document the findings and continue to monitor.

D

If a nurse desires to promote infant-parent attachment, the best time to have the parents spend time with the infant is when the infant is going through which stage? Quiet sleep state Period of sleep Active sleep state Second period of reactivity

D

Neonates born to women infected with Hepatitis B should receive which of the following treatments? a. Hepatitis B vaccine at birth and 1 month b. Hepatitis B immune globulin at birth; no hepatitis B vaccine c. Only hepatitis B vaccine will protect the neonate from contracting the disease from the mother d. Hepatitis B immune globulin within 12 hours of birth and hepatitis B vaccine at birth, 1 month, and 6 months

D

The nurse is planning home visits to the homes of new parents and their newborns. Which client should the nurse see first? a. 3-day-old male who received a hepatitis B vaccine prior to discharge b. 4-day-old female whose parents are both hearing-impaired c. 5-day-old male with whitish adherent discharge on the circumcision site d. 6-day-old female with greenish discharge from the umbilical cord site

D

Which of the following is true regarding the fontanels of the newborn? There are two fontanels: a. The triangular-shaped anterior and diamond-shaped posterior. Both close at 8 to 12 weeks. b. The anterior closes at 8 to 12 weeks, and posterior closes at 18 months. c. The anterior and the posterior, both of which close at 18 months. d. The anterior closes at 12-18 months, and the posterior closes at 8-12 weeks.

D

While performing a newborn assessment, the nurse observes the following: respiratory rate of 44 and irregular, apical heart rate of 148, and bluish hands and feet. How would the nurse interpret this data? a. Possible cardiovascular problem - call the physician b. Respiratory distress - administer oxygen c. Cold stress - place infant in the warmer d. Normal newborn - continue to observe

D

LGA (large for gestational age)

Defined as a newborn who's weight is above the 90th percentile on growth charts Increased risk for birth injury, hypoglycemia, polycythemia

The nurse is assessing a newborn a few minutes after birth. The neonate has overlapping anterior fontanelles and suture lines. The best nursing action is to: Assess for bleeding at umbilical site Document the findings Contact the pediatrician immediately Verify the presence of lanugo

Document the findings

Infection/sepsis

Infants have an immature immune system, infection is the leading cause of morbidity and mortality.

Which information should the nurse teach to new parents regarding the use of a bulb syringe? Use it only once per day Suction the back of the throat vigorously Insert the syringe into the sides of the mouth Throw away after 24 hours of use and open a new syringe

Insert the syringe into the sides of the mouth

PKU screening

It screens for inborn error of metabolism (unable to metabolize phenylalanine) The infant must have had formula/milk 24hrs prior to testing - test repeated at 2wks without treatment - profound mental disability

In providing and teaching cord care, which guidance is most appropriate? Cord care is done only to control bleeding. Keeping the cord dry will decrease bacterial growth. Alcohol is the only agent used for cord care. The cord stump will fall off 2-3 days after birth.

Keeping the cord dry will decrease bacterial growth

The nurse assesses the following in a sleeping 1-hour-old, 39-weeks'-gestation newborn. The assessment data that would be of greatest concern would be: Pulse 146 Temp 97.6F SpO2 97% RR of 68

RR of 68

Normal vitals for newborn

RR: 30-60 HR: 110-160 BP: 65-95/30-60 T: 97.7-99.5

Circumcision

Reduces penile cancer, reduces transmission of STIs

A postpartum client calls the nursery to report that her 3-day-old newborn has passed a bright green stool. The nurse's best response is This is a normal occurence You should take the baby to the pediatrician Your baby has diarrhea It's possible the baby has an allergy

This is a normal occurence

RDS (respiratory distress syndrome)

Usually caused by lack of surfactant, risk is sharply decreased after 37wk gestation. watch for retractions, nasal flaring, grunting, see-saw breathing, >60RR, cyanosis, etc.

Most newborns receive a prophylactic injection of vitamin K soon after birth. Which site is optimal for the newborn? Rectus femoris muscle Vastus lateralis muscle Gluteal muscle Deltoid muscle

Vastus lateralis muscle

Pre-term

before 37 weeks > risk for RDS, IV hemorrhage, jaundace, belly issues, hypoglycemia, infection/sepsis, problems with thermoregulation

Post-term

born after 42 weeks Placental function decreases can lead to placental insufficiency, hypoxia/fetal death, malnurishment Post-maturity syndrome: fluid aspiration, asphyxia, hypoglycemia and polycythemia