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MATERNAL AND CHILD NURSING

(NEONATAL CARE)

Prepared by: Dennis N. Muoz, PT, RN, RM, MANc

1) After birth, the newborns circulation converts from a fetal to a neonatal circulation. The nurse understands that the increase in the infants Po2 causes which shunt to close? a. Foramen ovale b. Ductus arteriosus c. Ductus venosus d. Ventricular septum

2) The nurse is assessing the breath sounds of a preterm newborn. Which of the following processes must occur so that the alveoli remain partially expanded at the end of exhalation? a. b. c. d. The lungs must be overinflated The diaphragm must be elevated The surface tension must decrease The abdomen must be flat

3) Before administering Rh0 (D) immune globulin (Rh0GAM) to her patient, which of the following nursing actions must be the nurse implement? a. Start an I.V. line with normal saline b. Ensure that the patient is Rh-negative and the neonate is Rh-positive c. Ensure that the patient has had nothing by mouth d. Obtain a syringe and needle appropriate for the subcutaneous injection

4) The nurse performs a gestational age assessment on a newborn admitted to the nursey and notes the following findings: lanugo covers the entire body, soles are smooth and without creases, the pinna is soft and stays folded, and testes are palpable in the inguinal canal. The nurse should assess that this newborn is approximately: a. 30 to 32 weeks b. 33 to 35 weeks c. 36 to 38 weeks d. 39 to 41 weeks

5) Which of the following symptoms would the nurse expect to observe in a newborn diagnosed with respiratory distress syndrome? a. Inspiratory grunting b. Expiratory grunting c. Inspiratory stridor d. Expiratory wheezing

6) As the newborn initiate respiration after birth, which of the following chemical changes occurs to stimulate breathing? a. Metabolic alkalosis b. Respiratory acidosis c. Decreasing Pco2 d. Increasing Pco2

7) A 1-hour-old newborn is transferred to the nursery because hes cyanotic. His vital signs are as follows: heart rate 170, respiratory rate66, blood pressure 59/40. He isnt exhibiting nasal flaring, grunting, or retractions. Breath sounds are equal and bilateral. His oxygen saturation is 85%. The first action of the nurse is to: a. Call the doctor b. Put the baby under an oxygen hood of 30% oxygen c. Give the baby flow by oxygen d. Prepare the baby for chest tube insertion

8) Baby McClure was born severely asphyxiated. Now intubated with adequatebag-and-mask ventilation, his heart rate is 100, his color is pale, and his tone is floppy. His blood gas levels are as follows: pH 7.22, Po2 49, HCO318, and base excess 3. The next step the nurse should take in resuscitation is to: a. Administer epinephrine b. Administer sodium bicarbonate c. Take him to the neonatal intensive care unit d. Increase his ventilatory rate

9) Baby Ellis was born to a mother addicted to cocaine. Which symptom should the nurse anticipate in this newborn? a. Seizures b. Hypoglycemia c. Poor feeding d. Hyperthermia

10) Baby Johnson, who was born at 28 weeks gestation, is now 3 months old. He has been diagnosed with bronchopulmonary dysplasia and is on 23% oxygen. Each time hes removed from oxygen, his oxygen saturation falls to 60 within 5 minutes. His mother has just told the nurse, I wont take him home on oxygen. The best response of the nurse is: a. Youll have to b. Ill call a social worker to talk to you and husband c. Let me call the neonatologist to talk to d. Let me arrange for another mother who a baby home on oxygen to talk to you

your you took

11) The nurse is assessing a newborn an observes that the baby has minimal lanugo and vernix, a wide-eyed appearance, and cracked skin. Which of the following questions should arise because of these assessment findings? a. Is this the mothers first baby? b. What was the mothers estimated date of confinement? c. Has the mother received narcotics during her labor? d. Has the newborn been breast-fed yet?

12) The nurse assesses a newborn with absent femoral pulses. This physical finding is associated with which neonatal problem? a. Patent ductus arteriosus b. Tetralogy of Fallot c. Ventral septal defect d. Coarctation of the aorta

13) The nurse is preparing a newborn for a circumcision. Which of the following medications should be administered before a circumcision is done? a. b. c. d. Phytonadione (AquaMEPHYTON) Erythromycin ointment Triple dye solution Hepatitis B vaccine

SITUATION: Alyssa Green gave birth to a 3,203.5-g (7lb, 1 oz) male infant 20 minutes ago. She had completed 39 weeks of a healthy pregnancy. She and her husband, Patrick, are now ready to hold their son.
Questions 14 to 18 refer to this SITUATION

14) When the nurse touches Baby Greens shoulders, the skin feels warm. The nurse knows Baby Green is keeping warm by burning: a. Glucose b. Brown fat c. Glycogen d. Oxygen

15) To keep her son warm, the nurse reminds Mrs. Green to keep a blanket wrapped around him. Thermoregulation is a problem for the newborn because:

a. The liver isnt fully developed b. The flexed position of the newborn encourage heat loss c. The thin layer of subcutaneous fat provides poor insulation d. The production of glucose is inadequate

16) Baby Green had an Apgar score of 8 at 1 minute and a score of 9 at 5 minutes. How should these scores be interpreted?

a. Full resuscitation is indicated b. Oxygen is needed c. Another Apgar score at 10 minutes is indicated d. Transition to extrauterine life is progressing adequately

17) Mr. and Mrs. Green ask the nurse why shes giving an injection to their newborn son. The nurse responds that the most important reason that Baby Green needs vitamin K is that: a. Formula or breast milk doesnt supply vitamin K b. Vitamin K doesnt cross the placenta c. Bacteria that synthesize vitamin K arent present in the intestinal tract at birth d. The newborns liver is incapable of synthesizing vitamin K

18) The nurse is preparing the parents for discharge by teaching care of the umbilical cord. Correct information includes wiping the cord and surrounding the skin with: a. Peroxide b. Alcohol c. Lanolin d. Water

SITUATION: Barbara and Lee Woods are parents of a baby girl who was born at 36 weeks gestation and is now 30 minutes old. Mrs. Woods had episodes of preterm labor since 30 weeks of pregnancy and was treated with terbutaline until the previous evening, when her membranes ruptured and her labor began. Questions 19 to 23 refer to this SITUATION

19) The nursery nurse should anticipate that Baby Woods is at risk for which nursing diagnosis on admission to the nursery? a. Aspiration related to diminishes suck swallow reflex b. Altered body temperature related to gestational age c. Fluid volume deficit related to gestational age d. Injury related to adverse effects of terbutaline and

20) The nurse assesses Baby Woods and determines that she has nasal flaring and grunting on exhalation. What nursing action should the nurse take?
a. b. c. d. Assess oxygenation with pulse oximeter Resuscitate the baby immediately Feed the baby with formula Take the baby to the mother

21) The nurse administers erythromycin ointment in each of Baby Woods eyes after birth to prevent which type of infection? a. Chlamydial b. Staphylococcal c. Streptococcal d. Gonorrhea

22) Mrs. Woods wants to breast-feed her newborn. The nurse should encourage Mrs. Woods to: a. Wait to attempt breast-feeding in 2 weeks b. Not attempt breast-feeding because the infant is sick c. Not attempt breast-feeding because the infant is too small d. Pump her breast and freeze the breast milk until the infant is allowed to begin oral feedings

23) Baby Woods is now 5 days old and her condition is stable. Which of the following indicates that her nutritional status is normal?
a. Urine output of 2ml/kg/day b. Urine specific gravity of 1.001 c. Glucose by glucometer reading is 35 mg/dl d. Weight loss of 70g over 2 days

SITUATION: Maria Martinez is a 17-year-old primigravida who gave birth to a son yesterday. Ms. Martinez is a junior in high school, and her mother will help her raise the baby.
Questions 24 to 29 refer to this SITUATION

24) Ms. Martinez tells the nurse she thinks she wants to breast-feed because she has read that breast milk is easier to digest and provides immunity for her baby. The nurse knows that Ms. Martinez should succeed in breast-feeding because shes: a. Obviously educated b. Informed c. Young d. Obviously motivated

25) Ms. Martinezs mother notices a purple color on the babys umbilical cord and asks the nurse what this means. The nurse explains that triple dye is put on the cord to prevent: a. Hemorrhage b. Infection c. Heat loss d. Jaundice

26) Ms. Martinezs son is 1 day old. Shes upset because the baby sleeps most of the day and doesnt look at her often. Her interpretation is that the baby doesnt like her. The nurses best response is:
a. Babies have no likes or dislikes; hell like you later as his mother b. Babies sleep up to 20 hours a day. Youll notice him staying awake longer each week c. Babies sleep when they are getting sick; Ill take him to the nursery for the pediatrician to examine d. Dont worry; hes just a baby

27) Ms. Martinezs mother asks the nurse why the nursery staff isnt putting powder on the newborn. The grandmother states that she put powder on all her children. The nurses best response is:
a. Recently, shaking powder has been shown to cause pneumonia because the powder enters the babys lungs. This wasnt known when you had your children b. its dangerous for the baby; you cant do that now c. Its been all over the news: shaking powder is bad for the baby d. Studies have shown babies get pneumonia; Im surprised you havent read that in a magazine

28) As shes preparing to take her newborn home, Ms. Martinez asks the nurse if its true that her newborn should sleep on his back instead of his stomach. The nurse teaches Ms. Martinez that the correct position to aid in preventing sudden infant death syndrome is to place the baby on his: a. Stomach to prevent aspiration b. Right side only to promote digestion c. Back to decrease oropharyngeal obstruction d. Back and upright to prevent aspiration

29) Ms. Martinez brings her newborn to the clinic for a wellbaby examination when hes 1 month old. She tells the nurse that he feeds every 2 to 3 hours; his stools are yellow and not watery. Ms. Martinezs mother insists that he isnt getting enough to eat. Assessment findings show that the baby is in the middle of the growth chart, his skin is warm and dry, and capillary refill is less than 3 seconds. The nurses best response is: a. You can change to formula feeding if you wish b. Your baby is eating and having bowel movements normally for a breast-feed baby c. Dont listen to you mother listen to your doctor d. If your baby continues to eat every 2 hours, hell have to be placed on formula supplement

SITUATION: The nursery nurse is preparing a small-group teaching session to new parents in preparation for their discharge from the hospital. She uses demonstrations, pamphlets, and videotapes to ensure that all the parents understand how to care for their newborns.
Questions 30 to 33 refer to this SITUATION

30) The nurse demonstrates appropriate bottlefeeding techniques. Later, the nurse observes a mother whos bottle-feeding. Which behavior by the mother indicates a good understanding of the feeding techniques? a. Keeps the nipple full of formula b. Props the bottle in the infants mouth c. Burps after the infant drinks 1 to 2 oz of formula d. Puts the nipple halfway in the infants mouth

31) To comply with the law, the nurse instructs the parents that for the automobile trip home, the newborn should be in an approved car seat in the: a. Back seat facing the front b. Front seat facing the back c. Back seat facing the back d. Front seat facing the front

32) Which of the following reflexes should the nurse discuss and demonstrate to educate the parents about providing a safe environment for their newborn? a. Babinskis b. Stepping c. Tonic neck d. Prone crawl

33) Which statement by one of the parents indicates that the nurse needs to provide further discharge teaching about care of the circumcision? a. The newborn may cry when he urinates b. A whitish-yellow exudates is a sign of infection c. The circumcision site may ooze a few drops of blood d. Petroleum gauze placed around the circumcision site prevents it from adhering to the diaper

SITUATION: Mary Watson is a 36 weeks gestation and has been diagnosed as positive for the human immunodeficiency virus. She has had a healthy pregnancy to date but has many questions about how her health problems will affect her newborn. Questions 34 to 38 refer to this SITUATION

34) Ms. Watson asks the nurse if she can breast feed her baby. Which of the following statements is the basis for the nurses response? a. Because Ms. Watson probably wont live to raise this child, breast-feeding will provide closeness and bonding between mother and child. b. Because the baby is likely to be positive for the human immunodeficiency virus (HIV), breastfeeding will provide immunity to other infections. c. Because Ms. Watson doesnt have symptoms of acquired immunodeficiency syndrome (AIDS), she can breast feed d. Because HIV may be transmitted through breast milk, breast feeding isnt recommended for Ms. Watson

35) Ms. Watson has delivered a baby girl at 38 weeks gestation. At 4 hours of age, the newborn has shallow respirations at 54 breaths/minute with periods of apnea lasting for 5 to 7 seconds. The nurses priority action would be too: a. b. c. d. Continue routine monitoring Notify the doctor immediately Request an order to administer oxygen. Prepare equipment for a respiratory arrest

36) The nurse is preparing to initiate formula feeding for Ms. Watsons newborn when shes 2 hours old. Which of the following neonatal conditions would contraindicate initiation of the feeding? a. b. c. d. Presence of the sucking reflex Jitteriness of the extremities Axillary temperatory rate of 65 to 70 Continuing respiratory rate of 97.2F (36.2C)

37) Ms. Watsons newborn is jaundiced because of an ABO blood group incompatibility and is receiving phototherapy. Which of the following nursing interventions is most appropriate for her newborn?

a. Reposition the infant every 4 hours b. Limit the infants oral intake to 1 oz every 4 hours c. Remove the eye patches every 24 hours to assess for conjunctivitis d. Turn the phototherapy unit off when drawing blood for bilirubin levels

38) Before discharging Ms. Watsons newborn on the 2nd day of life, the nurse complete her discharge examination. Which of the following findings would the nurse report to the doctor? a. A black, dry umbilical core b. A dark greenish-black stool c. Petechiae covering the chest and abdomen d. Bluish purple discoloration in the lumbosacral area

SITUATION: Sonia Baker and her partner, John, have delivered their newborn daughter at 29 weeks gestation. Ms. Baker had a complete placenta previa requiring cesarean delivery. Questions 39 to 43 refer to this SITUATION

39) Which of the following nursing diagnoses would be the highest priority for this newborn delivered by a cesarean birth?
a. b. c. d. Risk of infection Impaired gas exchange Ineffective thermoregulation Altered nutrition: less than body requirements

40) The nurse is administering oxygen to Ms. Bakers newborn by bag and mask. In which position should the newborn be placed?
a. b. c. d. Trendelenburgs position Semi-Fowler position Supine with the neck slightly extended Prone with the neck slightly flexed

41) At birth, Ms. Bakers newborn has Apgar scores of 2 and 4. To ensure preparation for a safe environment for admission to the nursery, the nurses priority action should be to:

a. Turn on the radiant warmer b. Check the light on the laryngoscope c. Prepare an I.V. infusion of dextrose 10% in water d. Attach the electrocardiography (ECG) leads to the cardiorespiratory monitor

42) Ms. Baker is Rh-negative. Which of the following laboratory tests will probably be ordered for the newborn? a. Direct coombs b. Indirect Coombs c. Blood culture d. Platelet count

43) Ms. Bakers newborn is now 1 week old and is experiencing periodic apnea. The apnea monitor is set to sound the alarm 15 seconds after cessation of respirations. When the alarm sounds, which of the following interventions should the nurse perform first? a. b. c. d. Assess the respirations and skin color Turn off the alarm on the apnea monitor Apply tactile stimuli by flicking the feet Begin respiratory resuscitation with a mask and bag

SITUATION: Katie Johnson is a 19-year-old primigravida with few support systems who gives birth at 38 weeks gestation. Her newborn girl is only 2,324.7g (5lb, 2 oz) and is evaluated as small for gestational age. Ms. Johnson has no experience caring for a newborn and is shy about asking the nurse for information.
Questions 44 to 47 refer to this SITUATION

44) Because Ms. Johnsons newborn is small for gestational age (SGA), which of the following interventions would have the highest priority?
a. Initiate oxygen therapy b. Assess for jaundice c. Obtain a blood sample from the heel to determine serum glucose level d. Examine the cord for meconium staining

45) Which of these problems is least likely to be encountered by Ms. Johnsons newborn?

a. Hypoglycemia b. Polycythemia c. Brachial plexus palsy d. Perinatal asphyxia

46) Which protocol should the nurse follow when administering a hepatitis B vaccine to Ms. Johnsons newborn? a. Administration of Hepatitis B vaccine should begin at 1 month of age to newborns to hepatitis B surface antigen (HBsAg)- positive mother b. Infants delivered to HBsAg-negative mothers should receive the vaccine before discharge c. The Hepatitis B-positive newborn should be given hepatitis immune globulin, not hepatitis B vaccine d. Hepatitis B vaccine is necessary only in highincidence areas such as Alaska

47) Ms. Johnson wishes to breast-feed her newborn and has listened carefull to her discharge instructions. Which of the following statements indicates that Ms. Johnson needs further teaching? a. Ill consult my doctor before taking any medications b. Ill drink a glass of fluid each time I breast - feed my baby c. Ill count my babys wet diapers to make sure shes getting adequate breast milk d. Ill decrease my calorie intake because I want to begin to lose weight

SITUATION: Marnie Sell has given birth to her fourth baby at 39 weeks gestation. The newborn has been diagnosed with a congenital diaphragmatic hernia and requires immediate surgery. Questions 48 to 49 refer to this SITUATION

48) In assessing Ms. Sells newborn the nurse will observe which of the following?

a. A sunken abdomen with prominent bowel sounds b. Improved Apgar scores at 10 minutes c. Increased cardiac output d. Circumoral pallor but pink extremities

49) Ms. Sell is concerned about her newborns pain after surgery. The nurses best response is: a. Babies dont feel pain; medication doesnt need to be given after surgery b. Babies dont remember painful experiences; medication for pain may cause respiratory problems c. Nonpharmacologic pain relief measures will be taken d. Babies do feel pain; your baby will receive pain medication after surgery

SITUATION: Following a healthy pregnancy and labor, Dolores Creighton gave birth to her third daughter yesterday after her membranes were ruptured for 36 hours. She plans to bottle-feed her newborn. Questions 50 to 51 refer to this SITUATION

50) The nurse assesses Ms. Creightons newborn and finds that shes lethargic, has a temperature of 97.2F (36.2C), and has vomited a large amount of curdled formula twice after each of the last two feedings. Which nursing diagnosis is the highest priority? a. b. c. d. Alteration in nutrition Risk for infection Alteration in temperature Risk for fluid volume deficit

51) Which of the following factors is most related to the newborns current status?
a. The mothers poor nutrition b. An internal spiral electrode used during labor c. Prolonged rupture of membranes d. The mothers multiparity

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