obgyn 3 – newborn.doc

8/14/2019 OBGYN 3 Newborn.doc

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OB/GYN 3 Newborn

1) A nurse in a delivery room is assisting with the delivery of a

newborn infant. After the delivery, the nurse prepares to prevent

heat loss in the newborn resulting from evaporation by:

1. Warming the crib pad

2. Turning on the overhead radiant warmer

. !losing the doors to the room

". #rying the infant in a warm blan$et

2) A nurse is assessing a newborn infant following circumcision

and notes that the circumcised area is red with a small amount of

bloody drainage. Which of the following nursing actions would be

most appropriate%

1. #ocument the findings

2. !ontact the physician

. !ircle the amount of bloody drainage on the dressing and

reassess in & minutes

". 'einforce the dressing

) A nurse in the newborn nursery is monitoring a preterm

newborn infant for respiratory distress syndrome. Which

assessment signs if noted in the newborn infant would alert the

nurse to the possibility of this syndrome%

1. (ypotension and radycardia

2. Tachypnea and retractions

. Acrocyanosis and grunting

". The presence of a barrel chest with grunting

") A nurse in a newborn nursery is performing an assessment of

a newborn infant. The nurse is preparing to measure the head

circumference of the infant. The nurse would most appropriately:

1. Wrap the tape measure around the infant*s head and

measure +ust above the eyebrows.2. lace the tape measure under the infants head at the base

of the s$ull and wrap around to the front +ust above the eyes

. lace the tape measure under the infants head, wrap

around the occiput, and measure +ust above the eyes

". lace the tape measure at the bac$ of the infant*s head,

wrap around across the ears, and measure across the infant*s

mouth.

-) A postpartum nurse is providing instructions to the mother

of a newborn infant with hyperbilirubinemia who is being

breastfed. The nurse provides which most appropriate instructions

to the mother%

1. witch to bottle feeding the baby for 2 wee$s

2. top the breast feedings and switch to bottle/feeding

permanently

. 0eed the newborn infant less freuently

". !ontinue to breast/feed every 2/" hours

) A nurse on the newborn nursery floor is caring for a neonate.

3n assessment the infant is e4hibiting signs of cyanosis,

tachypnea, nasal flaring, and grunting. 'espiratory distress

syndrome is diagnosed, and the physician prescribes surfactant

replacement therapy. The nurse would prepare to administer this

therapy by:

1. ubcutaneous in+ection

2. 5ntravenous in+ection

. 5nstillation of the preparation into the lungs through an

endotracheal tube

". 5ntramuscular in+ection

6) A nurse is assessing a newborn infant who was born to a

mother who is addicted to drugs. Which of the following

assessment findings would the nurse e4pect to note during the

assessment of this newborn%

1. leepiness

2. !uddles when being held

. 7ethargy

". 5ncessant crying8) A nurse prepares to administer a vitamin 9 in+ection to a

newborn infant. The mother as$s the nurse why her newborn

infant needs the in+ection. The best response by the nurse would

be:

1. ;ou infant needs vitamin 9 to develop immunity.6.@0)

1&) Bitamin 9 is prescribed for a neonate. A nurse prepares to

administer the medication in which muscle site%

1. #eltoid

2. Triceps

. Bastus lateralis

". iceps

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11) A nursing instructor as$s a nursing student to describe the

procedure for administering erythromycin ointment into the eyes if

a neonate. The instructor determines that the student needs to

research this procedure further if the student states:

1. 5 will cleanse the neonate*s eyes before instilling

ointment.) A newborn has small, whitish, pinpoint spots over the nose,

which the nurse $nows are caused by retained sebaceous

secretions. When charting this observation, the nurse identifies it

as:

1. Eilia

2. 7anugo

. Whiteheads

". Eongolian spots

2&) When newborns have been on formula for /"8 hours, they

should have a:

1. creening for 9F

2. Bitamin 9 in+ection

. Test for necrotiGing enterocolitis

". (eel stic$ for blood glucose level

21) The nurse decides on a teaching plan for a new mother and

her infant. The plan should include:

1. #iscussing the matter with her in a non/threatening

manner

2. howing by e4ample and e4planation how to care for theinfant

. etting up a schedule for teaching the mother how to care

for her baby

". upplying the emotional support to the mother and

encouraging her independence

22) Which action best e4plains the main role of surfactant in the

neonate%

1. Assists with ciliary body maturation in the upper airways

2. (elps maintain a rhythmic breathing pattern

. romotes clearing mucus from the respiratory tract

". (elps the lungs remain e4panded after the initiation ofbreathing

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-.

2) While assessing a 2/hour old neonate, the nurse observes the

neonate to have acrocyanosis. Which of the following nursing

actions should be performed initially%

1. Activate the code blue or emergency system

2. #o nothing because acrocyanosis is normal in the

neonate

. 5mmediately ta$e the newborn*s temperature according

to hospital policy

". =otify the physician of the need for a cardiac consult

2") The nurse is aware that a neonate of a mother with diabetes is

at ris$ for what complication%

1. Anemia

2. (ypoglycemia

. =itrogen loss

". Thrombosis

2-) A client with group A blood whose husband has group 3 has+ust given birth. The ma+or sign of A3 blood incompatibility in

the neonate is which complication or test result%

1. =egative !oombs test

2. leeding from the nose and ear

. Haundice after the first 2" hours of life

". Haundice within the first 2" hours of life

2) A client has +ust given birth at "2 wee$s* gestation. When

assessing the neonate, which physical finding is e4pected%

1. A sleepy, lethargic baby

2. 7anugo covering the body . #esuamation of the epidermis

". Berni4 caseosa covering the body

26) After reviewing the client*s maternal history of magnesium

sulfate during labor, which condition would the nurse anticipate as

a potential problem in the neonate%

1. (ypoglycemia

2. Hitteriness

. 'espiratory depression

". Tachycardia

28) =eonates of mothers with diabetes are at ris$ for which

complication following birth%

1. Atelectasis

2. Eicrocephaly

. neumothora4

". Eacrosomia

2>) y $eeping the nursery temperature warm and wrapping the

neonate in blan$ets, the nurse is preventing which type of heat

loss%

1. !onduction

2. !onvection

. Cvaporation

". 'adiation

&) A neonate has been diagnosed with caput succedaneum.

Which statement is correct about this condition%

1. 5t usually resolves in / wee$s

2. 5t doesn*t cross the cranial suture line

. 5t*s a collection of blood between the s$ull and the

periosteum

". 5t involves swelling of tissue over the presenting part of

the presenting head

1) The most common neonatal sepsis and meningitis infections

seen within 2" hours after birth are caused by which organism%

1. Candida albicans

2. Chlamydia trachomatis

3. Escherichia coli

". Iroup beta/hemolytic streptococci

2) When attempting to interact with a neonate e4periencing

drug withdrawal, which behavior would indicate that the neonate

is willing to interact%

1. IaGe aversion

2. (iccups

. Duiet alert state

". ;awning

) When teaching umbilical cord care to a new mother, the nurse

would include which information%

1. Apply pero4ide to the cord with each diaper change

2. !over the cord with petroleum +elly after bathing

. 9eep the cord dry and open to air

". Wash the cord with soap and water each day during a tub

bath

") A mother of a term neonate as$s what the thic$, white, cheesy

coating is on his s$in. Which correctly describes this finding%

1. 7anugo

2. Eilia

. =evus flammeus". Berni4

-) Which condition or treatment best ensures lung maturity in

an infant%

1. Eeconium in the amniotic fluid

2. Ilucocorticoid treatment +ust before delivery

. 7ecithin to sphingomyelin ratio more than 2:1

". Absence of phosphatidylglycerol in amniotic fluid

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) When performing nursing care for a neonate after a birth,

which intervention has the highest nursing priority%

1. 3btain a de4trosti4

2. Iive the initial bath

. Iive the vitamin 9 in+ection

". !over the neonates head with a cap

6) When performing an assessment on a neonate, which

assessment finding is most suggestive of hypothermia%

1. radycardia

2. (yperglycemia

. Eetabolic al$alosis

". hivering

8) A woman delivers a .2-& g neonate at "2 wee$s* gestation.

Which physical finding is e4pected during an e4amination if this

neonate%

1. Abundant lanugo

2. Absence of sole creases

. reast bud of 1/2 mm in diameter

". 7eathery, crac$ed, and wrin$led s$in

>) A healthy term neonate born by !/section was admitted to the

transitional nursery & minutes ago and placed under a radiant

warmer. The neonate has an a4illary temperature of >>.-@0, a

respiratory rate of 8& breathsJminute, and a heel stic$ glucose

value of & mgJdl. Which action should the nurse ta$e%

1. Wrap the neonate warmly and place her in an open crib

2. Administer an oral glucose feeding of 1&? de4trose in

water

. 5ncrease the temperature setting on the radiant warmer

". 3btain an order for 5B fluid administration

"&) Which neonatal behavior is most commonly associated with

fetal alcohol syndrome 0A)%

1. (ypoactivity

2. (igh birth weight

. oor wa$e and sleep patterns

". (igh threshold of stimulation

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-.

A=WC'

1. . Cvaporation of moisture from a wet body dissipates heat

along with the moisture. 9eeping the newborn dry by drying

the wet newborn infant will prevent hypothermia via

evaporation.

2. 1. The penis is normally red during the healing process. A

yellow e4udate may be noted in 2" hours, and this is a part of

normal healing. The nurse would e4pect that the area would

be red with a small amount of bloody drainage. 5f the bleeding

is e4cessive, the nurse would apply gentle pressure with sterile

gauGe. 5f bleeding is not controlled, then the blood vessel may

need to be ligated, and the nurse would contact the physician.

ecause the findings identified in the uestion are normal, the

nurse would document the assessment.

. 2. The infant with respiratory distress syndrome may

present with signs of cyanosis, tachypnea or apnea, nasal

flaring, chest wall retractions, or audible grunts.

4. . To measure the head circumference, the nurse should

place the tape measure under the infant*s head, wrap the tape

around the occiput, and measure +ust above the eyebrows so

that the largest area of the occiput is included. The "thoption

was pretty damn funny though.)

-. ". reast feeding should be initiated within 2 hours after

birth and every 2/" hours thereafter. The other options are

not necessary.

. . The aim of therapy in '# is to support the disease

until the disease runs its course with the subseuent

development of surfactant. The infant may benefit from

surfactant replacement therapy. 5n surfactant replacement, an

e4ogenous surfactant preparation is instilled into the lungs

through an endotracheal tube.

6. ". A newborn infant born to a woman using drugs isirritable. The infant is overloaded easily by sensory

stimulation. The infant may cry incessantly and posture rather

than cuddle when being held.

8. . Bitamin 9 is necessary for the body to synthesiGe

coagulation factors. Bitamin 9 is administered to the newborn

infant to prevent abnormal bleeding. =ewborn infants are

vitamin 9 deficient because the bowel does not have the

bacteria necessary for synthesiGing fat/soluble vitamin 9. The

infant*s bowel does not have support the production of

vitamin 9 until bacteria adeuately coloniGes it by food

ingestion.

>. 1. The highest priority on admission to the nursery for anewborn with low Apgar scores is airway, which would involve

preparing respiratory resuscitation euipment. The other

options are also important, although they are of lower

priority.

1&. .

11. 2. Cye prophyla4is protects the neonate againstNeisseria

gonorrhoeaeand Chlamydia trachomatis. The eyes are not

flushed after instillation of the medication because the flush

will wash away the administered medication.

12. 1. The nurse should position the baby with head lower

than chest and rub the infant*s bac$ to stimulate crying to

promote o4ygenation. There is no haste in cutting the cord.

1. 1. The heart rate is vital for life and is the most critical

observation in Apgar scoring. 'espiratory effect rather than

rate is included in the Apgar scoreK the rate is very erratic.

1". ". This seuence is least disturbing. Touching with the

stethoscope and inserting the thermometer increase an4iety

and elevate vital signs.

1-. . The heart rate varies with activityK crying will increase

the rate, whereas deep sleep will lower itK a rate between 12&

and 1& is e4pected.

1. 2. The respiratory rate is associated with activity and can

be as rapid as & breaths per minuteK over & breaths per

minute are considered tachypneic in the infant.

16. 2. =ormally the newborn*s breathing is abdominal and

irregular in depth and rhythmK the rate ranges from &/&

breaths per minute.

18. 1. ilirubin is e4creted via the I5 tractK if meconium is

retained, the bilirubin is reabsorbed.

1>. 1. Eilia occur commonly, are not indicative of any illness,

and eventually disappear.2&. 1. y now the newborn will have ingested an ample

amount of the amino acid phenylalanine, which, if not

metaboliGed because of a lac$ of the liver enGyme, can deposit

in+urious metabolites into the blood stream and brainK early

detection can determine if the liver enGyme is absent.

21. 2. Teaching the mother by e4ample is a non/threatening

approach that allows her to proceed at her own pace.

22. ". urfactant wor$s by reducing surface tension in the

lung. urfactant allows the lung to remain slightly e4panded,

decreasing the amount of wor$ reuired for inspiration.

2. 2. Acrocyanosis, or bluish discoloration of the hands and

feet in the neonate also called peripheral cyanosis), is anormal finding and shouldn*t last more than 2" hours after

birth.

2". 2. =eonates of mothers with diabetes are at ris$ for

hypoglycemia due to increased insulin levels. #uring

gestation, an increased amount of glucose is transferred to the

fetus across the placenta. The neonate*s liver cannot initially

ad+ust to the changing glucose levels after birth. This may

result in an overabundance of insulin in the neonate, resulting

in hypoglycemia.

2-. ". The neonate with A3 blood incompatibility with its

mother will have +aundice pathologic) within the first 2"

hours of life. The neonate would have a positive !oombs test

result.

2. . ostdate fetuses lose the verni4 caseosa, and the

epidermis may become desuamated. These neonates are

usually very alert. 7anugo is missing in the postdate neonate.

26. . Eagnesium sulfate crosses the placenta and adverse

neonatal effects are respiratory depression, hypotonia, and

radycardia.

28. ". =eonates of mothers with diabetes are at increased

ris$ for macrosomia e4cessive fetal growth) as a result of the

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combination of the increased supply of maternal glucose and

an increase in fetal insulin.

2>. 2. !onvection heat loss is the flow of heat from the body

surface to the cooler air.

&. ". !aput succedaneum is the swelling of tissue over the

presenting part of the fetal scalp due to sustained pressureK it

resolves in /" days.

1. ". transmission of Iroup beta/hemolytic streptococci

to the fetus results in respiratory distress that can rapidly lead

to septic shoc$.

2. . When caring for a neonate e4periencing drug

withdrawal, the nurse needs to be alert for distress signals

from the neonate. timuli should be introduced one at a time

when the neonate is in a uiet and alert state. IaGe aversion,

yawning, sneeGing, hiccups, and body arching are distress

signals that the neonate cannot handle stimuli at that time.

. . 9eeping the cord dry and open to air helps reduce

infection and hastens drying.

". ".

-. . 7ecithin and sphingomyelin are phospholipids that

help compose surfactant in the lungsK lecithin pea$s at

wee$s and sphingomyelin concentrations remain stable.. ". !overing the neonates head with a cap helps prevent

cold stress due to e4cessive evaporative heat loss from the

neonate*s wet head. Bitamin 9 can be given up to " hours after

birth.

6. 1. (ypothermic neonates become bradycardic

proportional to the degree of core temperature. (ypoglycemia

is seen in hypothermic neonates.

8. ". =eonatal s$in thic$ens with maturity and is often

peeling by post term.

>. ". Assessment findings indicate that the neonate is in

respiratory distressLmost li$ely from transient tachypnea,

which is common after cesarean delivery. A neonate with arate of 8& breaths a minute shouldn*t be fed but should

receive 5B fluids until the respiratory rate returns to normal.

To allow for close observation for worsening respiratory

distress, the neonate should be $ept unclothed in the radiant

warmer.

"&. . Altered sleep patterns are caused by disturbances in

the != from alcohol e4posure in utero. (yperactivity is a

characteristic generally noted. 7ow birth weight is a physical

defect seen in neonates with 0A. =eonates with 0A

generally have a low threshold for stimulation.

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obgyn 3 – newborn.doc

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