prepu ch 18 ob
The mother of a formula-fed newborn asks how she will know if her newborn is receiving enough formula during feedings. Which response by the nurse is correct?
"A sign of good nutrition is when your newborn seems satisfied and is gaining sufficient weight."
A newborn's parents ask the nurse how to prevent the newborn from becoming ill. What is the best response by the nurse?
"Always wash your hands before you pick up or provide care to your newborn."
The primipara tells the nurse, "My baby jumps every time I pick her up. Is she afraid that I will drop her?" Which response by the nurse would be best?
"No, it is the Moro reflex. This reflex simulates the action of warding off an attacker."
A nurse teaches new parents how to soothe a crying newborn. Which statement by the parents indicates to the nurse the teaching was effective?
"We will turn the mobile on that's hanging on our baby's crib."
New parents are getting ready to go home from the hospital and have received information to help them learn how best to care for their new infant. Which statement indicates that they need additional teaching about how to soothe their newborn if he becomes upset?
"We'll hold off on feeding him for a while because he might be too full."
The charge nurse hears the call, "Shoulder dystocia in room 4." What resources will the charge nurse dispatch to room 4 to assist with this situation? Select all that apply.
Anesthesia Surgeon Pediatrician
A 36-hour-old newborn is ready for discharge from the hospital and the nurse notices that the skin looks yellow. What action will the nurse take?
Assess the bilirubin level.
The nurse notices that there is no vitamin K administration recorded on a newborn's medical record upon arrival to the newborn nursery. What would be the nurse's first action?
Call the Labor and Delivery nurse who cared for the newborn to inquire about why the medication was not documented.
A 30-minute-old newborn starts crying in a high-pitched manner and cannot be consoled by the mother. Which action should the nurse prioritize if jitteriness is also noted and the infant is unable to breastfeed?
Check blood glucose.
The nurse is teaching a prenatal class illustrating the steps that are used to keep families safe. The nurse determines the session is successful when the parents correctly choose which precaution to follow after the birth of their infant?
Check the identification badge of any health care worker before releasing baby from room.
The nurse is preparing discharge instructions for the parents of a male newborn who is to be circumcised before discharge. Which instruction should the nurse prioritize?
Cover the glans generously with petroleum jelly.
The parents are bonding with their newborn when the nurse notes the infant's axillary temperature is 97.2oF (36.2oC) an hour after birth. Which intervention should the nurse prioritizefor this family?
Help the mother provide skin-to-skin (kangaroo) care.
The nurse is explaining to new parents the various vaccinations their newborn will receive before being discharged home. Which immunization should the nurse teach the parents about that will help decrease the incidence of hepatic disease later in life?
Hep B
A woman who is about to be discharged after a vaginal birth notices a flea-like rash on her newborn's chest. The rash has tiny red lesions all across the nipple line. What does this rash indicate?
It is a normal skin finding in a newborn.
The nurse orienting a student to the nursery determines that teaching has been effective when the student states that the signs of neonate respiratory distress include which findings? Select all that apply.
Nasal flaring Respiratory rate of 64 breaths per minute Chest retractions
The nurse is teaching new parents how to clear the secretions from their infant's mouth and nose. The nurse determines they are prepared when they correctly perform which initial step?
Position the newborn on side with head slightly below body; use a bulb syringe to clear mouth.
A nurse is caring for a newborn with transient tachypnea. What nursing interventions should the nurse perform while providing supportive care to the newborn? Select all that apply.
Provide oxygen supplementation. Ensure the newborn's warmth. Observe respiratory status frequently.
The newborn should have the neurologic status evaluated to determine its maturity and to identify any potential problems. The nurse tests the newborn's Babinski sign. Which response would the nurse interpret as normal for the newborn?
Toes fan out when sole of foot is stroked.
Following delivery, a newborn has a large amount of mucus coming out of his mouth and nose. What would be the nurse's first action?
Using a bulb syringe, suction the mouth then the nose.
The infant has Apgar scores of 7 at 1 minute and 9 at 5 minutes. What is the indication of this assessment finding?
adjusting to extrauterine life
A Black couple are spending time with their newborn after the nurse brings the newborn back from the transition nursery. The parents note that their newborn's buttocks appear bruised and ask what happened. The nurse should explain this is related to which factor?
congenital dermal melanocytosis (slate gray nevi)
A nurse is teaching new parents about keeping follow-up appointments and calling their health care provider if they notice signs of illness in their newborn. The nurse determines that the teaching was successful when the parents identify which signs as needing to be reported? Select all that apply.
temperature of 38.3° C (101° F) or higher refuse feeding abdominal distention
While assessing a newborn, the nurse notes that half the body appears red while the other half appears pale. The nurse interprets this finding as:
harlequin sign.
After completing a class for new parents, the nurse notes the session is successful when the class recognizes the newborn should be bathed how often?
two or three times per week
The nurse is assisting with the admission of a newborn to the nursery. The nurse notes what appears to be bruising on the left upper outer thigh of this dark-skinned newborn. Which documentation should the nurse provide?
Congenital dermal melanocytosis (slate gray nevi) noted on left upper outer thigh.
When assessing infant reflexes, the nurse documents a startled response and extension of the arms and legs as which reflex?
Moro
A nursing mother calls the nurse and is upset. She states that her newborn son just bit her when he was nursing. Upon examining the newborn's mouth, two precocious teeth are noted on the lower central portion of the gums. What would be the nurse's best response?
"Precocious teeth can occur at birth but we may need to remove them to prevent aspiration."
The nurse is preparing to administer the vitamin K injection to a newborn. Which action would be correct for this client?
Injecting the medication into the vastus lateralis
A nurse does an initial assessment on a newborn and notes a pulsation over the anterior fontanel (fontanelle) that corresponds with the newborn's heart rate. How would the nurse interpret this finding?
It is normal to feel pulsations that correlate with the newborn's heart rate over the anterior fontanel (fontanelle).
As a part of the newborn assessment, the nurse examines the infant's skin. Which nursing observation would warrant further investigation?
bright red, raised bumpy area noted above the right eye
The nurse is assessing the abdomen of the neonate. When inspecting the umbilical cord area of a newborn, the nurse would expect which finding?
two arteries and one vein
A woman who is about to be discharged after a vaginal birth notices a flea-like rash on her newborn's chest that consists of tiny red lesions all across the nipple line. What is the bestresponse from the nurse when explaining this to the woman?
"It is a normal skin finding in a newborn."
Which action will the nurse avoid when performing basic care for a newborn male?
Retracting the foreskin over the glans to assess for secretions
The nurse records a newborn's Apgar score at birth. A normal 1-minute Apgar score is:
7 to 10.
A nurse is conducting a parenting class on infant skin care. What information should the nurse include when preparing materials on the characteristics of the skin of infants? Select all that apply.
It is thinner and more fragile than an adult's Substances are easily absorbed.
The nursery nurse notes that one of the newborn infants has white patches on his tongue that look like milk curds. What action would be appropriate for the nurse to take?
Report the finding to the pediatrician.
The nurse is admitting a 10-pound (4.5-kg) newborn to the nursery. What is important for the nurse to monitor during the transition period?
blood sugar
When examining a newborn's eyes, the nurse would expect which assessment?
follows a light to the midline
When examining a newborn female, the nurse notices a small pinkish discharge from the vaginal area. What should the nurse suspect?
pseudomenstruation, a normal finding
The nurse is preparing the delivery room before the birth occurs. What supplies would the nurse have available to care for the newborn? Select all that apply.
Warmer bed Suction equipment Identification bands
The nurse is assessing a male neonate in the presence of the parents and notes that the neonate has hypospadias. How should the nurse respond when questioned by the parents as to what this means?
"The opening of his urethra in located on the under surface of the tip of the penis."
The nurse explains the hospital's home visitation program for new families after discharge from the hospital. Which information will the nurse include regarding this program?
Caregivers can demonstrate competency in caring for the infant and ask questions.
The mother of a newborn observes a diaper rash on her newborn's skin. Which intervention should the nurse instruct the parent to implement to treat the diaper rash?
Expose the newborn's bottom to air several times a day.
A new mother calls her pediatrician's office concerned about her 2-week-old infant "crying all the time." When the nurse explores further, the mother reports that the infant cries at least 2 hours each day, usually in the afternoons. What recommendation would the nurse not make to this mother?
Feeding the infant more formula whenever she begins to fuss
