The Neonate: Passpoint Block 3 OB ML8

An infant 5 hours old and weighing 3180 g (7 lb) has a prescription for gentamicin sulfate 13 mg every 36 hours. The pharmacy sends gentamicin 20 mg/2 mL. How many milliliters should the nurse administer? Record your answer using one decimal place.

1.3 mL (20 mg/2 ml) = (13 mg/X). X = 2 ml x (13 mg/20 mg) = 1.3 ml.

A nurse discusses with parents the procedures that will be performed on their neonate immediately after birth. The nurse determines that the instructions have been understood when the parent states that which procedure will be done to the neonate first? A. The neonate will be dried and stimulated to cry. B. The neonate's umbilical cord will be cut. C. The neonate will be suctioned. D. The neonate will be given oxygen.

A The neonate will be simultaneously dried and stimulated to cry immediately upon birth. If the neonate does not cry as a result of these measures, the ABCs (airway, breathing, and circulation) of cardiopulmonary resuscitation will be followed. Positioning the neonate and suctioning or clearing the airway ensures that the airway is clear so that the first breath the neonate takes is air, rather than fluid or particulate matter. Breathing will be stimulated once the airway is clear, and then the heart rate will be validated either apically or through the cord. The cord may be cut to hand the neonate to the birth parent for nursing. In many instances, the infant is placed on the birth parent's abdomen before the cord is cut.

The neonate of a client with type 1 diabetes is at high risk for hypoglycemia. An initial sign the nurse should recognize as indicating hypoglycemia in a neonate is A. jaundice. B. lethargy. C. bradycardia. D. peripheral acrocyanosis.

B Lethargy in the neonate may be seen with hypoglycemia because of a lack of glucose in the nerve cells. Peripheral acrocyanosis is normal in the neonate because of immature capillary function. Tachycardia — not bradycardia — is seen with hypoglycemia. Jaundice isn't a sign of hypoglycemia.

While the nurse is caring for a neonate at 32 weeks' gestation in an isolette with continuous oxygen administration, the neonate's parent asks why the baby's oxygen is humidified. What should the nurse should tell the parent? A. "The humidity helps to prevent viral or bacterial pneumonia." B. "The humidity promotes the expansion of the neonate's immature lungs." C. "Oxygen is drying to the mucous membranes unless it is humidified." D. "Circulation to the baby's heart is improved with humidified oxygen."

C

An alarm signals, indicating that a neonate's security identification band requires attention. The nurse responds immediately and finds that the parents removed the identification bands from the neonate. Which action should the nurse take next? A. Reprimand the parents for allowing the identification bands to come off. B. Obtain the neonate's footprints and compare them with the footprints obtained at birth. C. Compare the information on the neonate's identification bands with that of the mother's, then reattach the identification bands to one of the neonate's extremities. D. Replace the identification bands.

C The nurse should immediately compare the information on the mother's identification band with that of the neonate's and then reattach the neonate's bands. This safety practice prevents infant abduction. Replacing the bands without first verifying identification is irresponsible. Reprimanding the parents will be detrimental to the nurse-parent relationship. The nurse isn't qualified to compare footprints.

Day 1: 3401g Day 2: 3288g Day 3: 3175g The nurse reviews the daily weights of a breastfeeding term newborn. The nurse's best action is to: A. reweigh the newborn. B. provide supplementation. C. continue routine monitoring. D. notify the health care provider.

C Up to a 10% weight loss in the first few days of life is normal in a breastfeeding newborn. This newborn's weight loss is under 10%, so the nurse can assume that breastfeeding is going as expected and just needs routine monitoring. There is no need to reweigh the newborn or notify the health care provider. Best breastfeeding practices do not include supplementation unless there is a medical reason.

A newborn is diagnosed with fetal alcohol syndrome. The nurse is teaching the parent what to expect when they go home with the baby. The nurse determines the parent needs further instruction when they make which statement? A. "I may need some help coping with my newborn." B. "My baby may be irritable as a newborn." C. "The way my baby's face looks now will stay that way." D. "My baby will be fine soon after we are home."

D Changes seen in the facial features of newborns with fetal alcohol syndrome remain that way. These include epicanthal folds, whorls, irregular hair, cleft lip or palate, small teeth, and lack of philtrum. Newborns with fetal alcohol syndrome are usually difficult to calm and frequently cry for long periods of time. Parents do need assistance with caring for themselves and their infants, particularly with continued alcohol use. A supportive family or a support system is essential. The problems seen with this newborn do not go away; they remain with the infant throughout life and are compounded when the child begins to develop mentally.

During the change-of-shift report, it was reported that a neonate was experiencing subcostal retractions. Identify where the nurse would expect to see the retractions.

Subcostal retractions are noted under the rib cage. Intercostal retractions are noted between the ribs. Suprasternal retractions are found above the sternum, and substernal retractions are found below the sternum.

A nurse is eliciting reflexes in a neonate during a physical examination. Identify the area that the nurse would touch to elicit a plantar grasp reflex.

To elicit a plantar grasp reflex, the nurse would touch the sole of the foot near the base of the digits, causing flexion or grasping. This reflex disappears around age 9 months.

A nurse is teaching the parents of a newborn about the timing of fontanel closure. The nurse explains that the anterior fontanel closes by age 18 months. Indicate on the illustration (view figure) the location of the anterior fontanel.

The correct location is indicated in the figure. The anterior fontanel is a diamond-shaped membranous interval located at the intersection of the coronal, sagittal, and metopic sutures. It typically closes by age 18 months.

The nurse observes a darkish blue pigment on the buttocks and back of a neonate of African descent. Which action is most appropriate? A. Advise the mother that the bruising will fade in a few days. B. Assess the child for other areas of cyanosis. C. Ask the obstetrician to assess the child. D. Document this observation in the child's medical record.

D The bluish pigment on the buttocks and back of an infant of African descent is a common finding and should be documented as Mongolian spots in the child's medical record. These spots typically fade by the time the child is 5 or 6 years. Additional assessment by the care provider is not indicated. The marks are not bruises.

After giving birth to a term male neonate vaginally under epidural anesthesia, a primiparous client asks the nurse, "Why are my baby's breasts so swollen?" The nurse responds to the client stating that slight breast engorgement in term neonates is due to which factor? A. maternal hyperthyroidism B. genetic influences from both parents C. maternal hormonal influences D. epidural anesthesia

C Slight breast engorgement in term neonates is related to the maternal hormone elevations that occur during pregnancy. Epidural anesthesia and genetic influences have no effect on breast tissue engorgement in the neonate. Hyperthyroidism in the birth parent is frequently associated with preterm labor and low-birth-weight infants. It is unlikely that a preterm infant would have breast engorgement.

A mother with a history of gestational hypertension gives birth to a neonate at 26 weeks' gestation. After the neonate receives surfactant through an endotracheal tube in the delivery room, a nurse takes the neonate to the neonatal intensive care unit (NICU), places the neonate on an overbed warmer, and provides mechanical ventilation. When the mother arrives in the NICU for the first time, the nurse's priority should be to A. explain the NICU visiting policy for the mother and family. B. obtain a family medical history. C. enhance bonding by pointing out the neonate's features. D. question the mother about her preterm labor.

C Pointing out neonate's features to the mother enables the mother to begin to bond with him. The nurse should encourage this important activity from the time of the neonate's admission to the NICU. Explaining the NICU visiting policy, obtaining a family medical history, and questioning the mother about her preterm labor don't take priority over enhancing maternal bonding.

When the nurse accidentally bumps the bassinet, the neonate throws out their arms, opens their hands, and begins to cry. The nurse interprets this reaction as indicative of which reflex? A. tonic neck reflex B. Babinski reflex C. grasping reflex D. Moro reflex

D The Moro, or startle, reflex occurs when the neonate responds to stimuli by extending the arms, hands open, and then moving the arms in an embracing motion. The Moro reflex, present at birth, disappears at about age 3 months.The Babinski reflex is elicited by stroking the neonate's foot resulting in the fanning of the toes. This reflex is normal in the neonate until approximately 3 months of age.The grasping reflex is demonstrated when the neonate grasps an object placed in the hand.The tonic neck reflex (or fencing reflex) is demonstrated when the neonate, lying supine, turns the head to one side.