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$et 2) A nurse is assessing a newborn infant following circumcision and notes that the circumcised area is red with a small amount of bloody drainage. Which of the following nursing actions would be most appropriate% 1. 2. . #ocument the findings !ontact the physician !ircle the amount of bloody drainage on the dressing and reassess in & minutes ". 'einforce the dressing ) A nurse in the newborn nursery is monitoring a preterm newborn infant for respiratory distress syndrome. Which assessment signs if noted in the newborn infant would alert the nurse to the possibility of this syndrome% 1. (ypotension and )radycardia 2. Tachypnea and retractions . Acrocyanosis and grunting ". The presence of a barrel chest with grunting ") A nurse in a newborn nursery is performing an assessment of a newborn infant. The nurse is preparing to measure the head circumference of the infant. The nurse would most appropriately: 1. Wrap the tape measure around the infant*s head and measure +ust above the eyebrows. 2. ,lace the tape measure under the infants head at the base of the s$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. 2. . ". .witch to bottle feeding the baby for 2 wee$s .top the breast feedings and switch to bottle/feeding permanently 0eed the newborn infant less fre1uently !ontinue to breast/feed every 2/" hours

2) 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. 2. . .ubcutaneous in+ection 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 crying 8) A nurse prepares to administer a vitamin 9 in+ection to a newborn infant. The mother as$s the nurse why her newborn infant needs the in+ection. The best response by the nurse would be: 1. 2. :;ou infant needs vitamin 9 to develop immunity.< :The vitamin 9 will protect your infant from being +aundiced.< . :=ewborn infants are deficient in vitamin 9, and this in+ection prevents your infant from abnormal bleeding.< ". :=ewborn infants have sterile bowels, and vitamin 9 promotes the growth of bacteria in the bowel.< >) A nurse in a newborn nursery receives a phone call to prepare for the admission of a " /wee$/gestation newborn with Apgar scores of 1 and ". 5n planning for the admission of this infant, the nurse*s highest priority should be to: 1. 2. . ". !onnect the resuscitation bag to the o4ygen outlet Turn on the apnea and cardiorespiratory monitors .et up the intravenous line with -? de4trose in water .et the radiant warmer control temperature at 2.-@ ! A>6.2@0) 1&) Bitamin 9 is prescribed for a neonate. A nurse prepares to administer the medication in which muscle site% 1. 2. . ". #eltoid Triceps Bastus lateralis )iceps

11) A nursing instructor as$s a nursing student to describe the procedure for administering erythromycin ointment into the eyes if a neonate. The instructor determines that the student needs to research this procedure further if the student states: 1. :5 will cleanse the neonate*s eyes before instilling ointment.< 2. :5 will flush the eyes after instilling the ointment.< . :5 will instill the eye ointment into each of the neonate*s con+unctival sacs within one hour after birth.< ". :Administration of the eye ointment may be delayed until an hour or so after birth so that eye contact and parent/infant attachment and bonding can occur.< 12) A baby is born precipitously in the C'. The nurses initial action should be to: 1. Cstablish an airway for the baby 2. Ascertain the condition of the fundus . Duic$ly tie and cut the umbilical cord ". Eove mother and baby to the birthing unit 1 ) The primary critical observation for Apgar scoring is the: 1. (eart rate 2. 'espiratory rate . ,resence of meconium ". Cvaluation of the Eoro refle4 1") When performing a newborn assessment, the nurse should measure the vital signs in the following se1uence: 1. ,ulse, respirations, temperature 2. Temperature, pulse, respirations . 'espirations, temperature, pulse ". 'espirations, pulse, temperature 1-) Within minutes after birth the normal heart rate of the infant may range between: 1. 1&& and 18& 2. 1 & and 16& . 12& and 12& ". 1&& and 1 & 12) The e4pected respiratory rate of a neonate within birth may be as high as:

18) To help limit the development of hyperbilirubinemia in the neonate, the plan of care should include: 1. 2. Eonitoring for the passage of meconium each shift 5nstituting phototherapy for & minutes every 2 hours .ubstituting breastfeeding for formula during the 2 nd day

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after birth .upplementing breastfeeding with glucose water during the first 2" hours 1>) A newborn has small, whitish, pinpoint spots over the nose, which the nurse $nows are caused by retained sebaceous secretions. When charting this observation, the nurse identifies it as: 1. Eilia 2. 7anugo . Whiteheads ". Eongolian spots 2&) When newborns have been on formula for 2/"8 hours, they should have a: 1. .creening for ,9F 2. Bitamin 9 in+ection . Test for necrotiGing enterocolitis ". (eel stic$ 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 the infant . .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. 2. . ". Assists with ciliary body maturation in the upper airways (elps maintain a rhythmic breathing pattern ,romotes clearing mucus from the respiratory tract (elps the lungs remain e4panded after the initiation of breathing

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1. -& 2. 2& . 8& ". 1&& 16) The nurse is aware that a healthy newborn*s respirations are: 1. 2. . ". 'egular, abdominal, "&/-& per minute, deep 5rregular, abdominal, &/2& per minute, shallow 5rregular, initiated by chest wall, &/2& per minute, deep 'egular, initiated by the chest wall, "&/2& per minute, shallow

-. 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. 2. . ". Activate the code blue or emergency system #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>) )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. 2. . 5t usually resolves in /2 wee$s 5t doesn*t cross the cranial suture line 5t*s a collection of blood between the s$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%

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 A)3 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 22) A client has +ust given birth at "2 wee$s* gestation. When assessing the neonate, which physical finding is e4pected% 1. A sleepy, lethargic baby 2. 7anugo covering the body . #es1uamation of the epidermis ". Berni4 caseosa covering the body 26) After reviewing the client*s maternal history of magnesium sulfate during labor, which condition would the nurse anticipate as a potential problem in the neonate% 1. (ypoglycemia 2. Hitteriness . 'espiratory depression ". Tachycardia 28) =eonates of mothers with diabetes are at ris$ for which complication following birth% 1. 2. . ". Atelectasis Eicrocephaly ,neumothora4 Eacrosomia

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Candida albicans Chlamydia trachomatis 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. 2. . ". IaGe aversion (iccups Duiet alert state ;awning ) When teaching umbilical cord care to a new mother, the nurse would include which information% 1. 2. . ". Apply pero4ide to the cord with each diaper change !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. 2. . ". Eeconium in the amniotic fluid Ilucocorticoid treatment +ust before delivery 7ecithin to sphingomyelin ratio more than 2:1 Absence of phosphatidylglycerol in amniotic fluid

2) 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. 2. . ". Abundant lanugo 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 2& mgJdl. Which action should the nurse ta$e% 1. 2. . ". Wrap the neonate warmly and place her in an open crib 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 A0A.)% 1. 2. . ". (ypoactivity (igh birth weight ,oor wa$e and sleep patterns (igh threshold of stimulation

-. 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. 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 1uestion 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. . To measure the head circumference, the nurse should

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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. AThe " th option 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. 2. . The aim of therapy in '#. is to support the disease until the disease runs its course with the subse1uent 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 is irritable. 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 ade1uately coloniGes it by food ingestion. >. 1. The highest priority on admission to the nursery for a newborn with low Apgar scores is airway, which would involve preparing respiratory resuscitation e1uipment. The other options are also important, although they are of lower priority. 1&. .

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2. Cye prophyla4is protects the neonate against Neisseria gonorrhoeae and Chlamydia trachomatis. The eyes are not flushed after instillation of the medication because the flush will wash away the administered medication. 28.

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. 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. ". This se1uence is least disturbing. Touching with the stethoscope and inserting the thermometer increase an4iety and elevate vital signs. . The heart rate varies with activityK crying will increase the rate, whereas deep sleep will lower itK a rate between 12& and 12& is e4pected. 2. The respiratory rate is associated with activity and can be as rapid as 2& breaths per minuteK over 2& breaths per minute are considered tachypneic in the infant. 2. =ormally the newborn*s breathing is abdominal and irregular in depth and rhythmK the rate ranges from &/2& breaths per minute. 1. )ilirubin is e4creted via the I5 tractK if meconium is retained, the bilirubin is reabsorbed. 1. Eilia occur commonly, are not indicative of any illness, and eventually disappear. 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. 2. Teaching the mother by e4ample is a non/threatening approach that allows her to proceed at her own pace. ". .urfactant wor$s by reducing surface tension in the lung. .urfactant allows the lung to remain slightly e4panded, decreasing the amount of wor$ re1uired for inspiration. 2. Acrocyanosis, or bluish discoloration of the hands and feet in the neonate Aalso called peripheral cyanosis), is a normal finding and shouldn*t last more than 2" hours after birth. 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. ". The neonate with A)3 blood incompatibility with its mother will have +aundice Apathologic) within the first 2" hours of life. The neonate would have a positive !oombs test result. . ,ostdate fetuses lose the verni4 caseosa, and the epidermis may become des1uamated. These neonates are usually very alert. 7anugo is missing in the postdate neonate. . Eagnesium sulfate crosses the placenta and adverse neonatal effects are respiratory depression, hypotonia, and )radycardia. ". =eonates of mothers with diabetes are at increased ris$ for macrosomia Ae4cessive 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. !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. ". transmission of Iroup ) beta/hemolytic streptococci to the fetus results in respiratory distress that can rapidly lead to septic shoc$. . When caring for a neonate e4periencing drug withdrawal, the nurse needs to be alert for distress signals from the neonate. .timuli should be introduced one at a time when the neonate is in a 1uiet and alert state. IaGe aversion, yawning, sneeGing, hiccups, and body arching are distress signals that the neonate cannot handle stimuli at that time. . 9eeping the cord dry and open to air helps reduce infection and hastens drying. ". . 7ecithin and sphingomyelin are phospholipids that help compose surfactant in the lungsK lecithin pea$s at 2 wee$s and sphingomyelin concentrations remain stable. ". !overing the neonates head with a cap helps prevent cold stress due to e4cessive evaporative heat loss from the neonate*s wet head. Bitamin 9 can be given up to " hours after birth. 1. (ypothermic neonates become bradycardic proportional to the degree of core temperature. (ypoglycemia is seen in hypothermic neonates. ". =eonatal s$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 a rate 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.