maternal and child nursing - neonatal care

7/30/2019 Maternal and Child Nursing - Neonatal Care

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

MATERNAL AND CHILDNURSING

(NEONATAL CARE)


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1) After birth, the newborns circulation convertsfrom a fetal to a neonatal circulation. Thenurse understands that the increase in the

infants Po2 causes which shunt to close?

a. Foramen ovaleb. Ductus arteriosusc. Ductus venosusd. Ventricular septum


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2) The nurse is assessing the breath sounds of apreterm newborn. Which of the followingprocesses must occur so that the alveoli

remain partially expanded at the end ofexhalation?

a. The lungs must be overinflated

b. The diaphragm must be elevatedc. The surface tension must decreased. The abdomen must be flat


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3) Before administering Rh0 (D) immune globulin

(Rh0GAM) to her patient, which of thefollowing nursing actions must be the nurseimplement?

a. Start an I.V. line with normal salineb. Ensure that the patient is Rh-negative andthe neonate is Rh-positivec. Ensure that the patient has had nothing

by mouthd. Obtain a syringe and needle

appropriate for the subcutaneousinjection


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4) The nurse performs a gestational age

assessment on a newborn admitted to thenursey and notes the following findings:lanugo covers the entire body, soles aresmooth and without creases, the pinna is soft

and stays folded, and testes are palpable inthe inguinal canal. The nurse should assessthat this newborn is approximately:

a. 30 to 32 weeksb. 33 to 35 weeksc. 36 to 38 weeksd. 39 to 41 weeks


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5) Which of the following symptoms would thenurse expect to observe in a newborndiagnosed with respiratory distress

syndrome?

a. Inspiratory gruntingb. Expiratory grunting

c. Inspiratory stridord. Expiratory wheezing


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6) As the newborn initiate respiration after birth,which of the following chemical changesoccurs to stimulate breathing?

a. Metabolic alkalosisb. Respiratory acidosisc. Decreasing Pco2

d. Increasing Pco2


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7) A 1-hour-old newborn is transferred to the

nursery because hes cyanotic. His vital signsare as follows: heart rate 170, respiratoryrate66, blood pressure 59/40. He isnt exhibiting

nasal flaring, grunting, or retractions. Breath

sounds are equal and bilateral. His oxygensaturation is 85%. The first action of the nurseis to:

a. Call the doctorb. Put the baby under an oxygen hood of 30%oxygenc. Give the baby flow by oxygen

d. Prepare the baby for chest tube insertion


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8) Baby McClure was born severely asphyxiated.

Now intubated with adequatebag-and-maskventilation, his heart rate is 100, his color ispale, and his tone is floppy. His blood gaslevels are as follows: pH 7.22, Po2 49, HCO3-

18, and base excess 3. The next step thenurse should take in resuscitation is to:

a. Administer epinephrine

b. Administer sodium bicarbonatec. Take him to the neonatal intensive care

unitd. Increase his ventilatory rate


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9) Baby Ellis was born to a mother addicted tococaine. Which symptom should the nurseanticipate in this newborn?

a. Seizuresb. Hypoglycemiac. Poor feeding

d. Hyperthermia


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10)Baby Johnson, who was born at 28 weeks

gestation, is now 3 months old. He has beendiagnosed with bronchopulmonary dysplasia and ison 23% oxygen. Each time hes removed from

oxygen, his oxygen saturation falls to 60 within 5minutes. 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 yourhusbandc. Let me call the neonatologist to talk to youd. Let me arrange for another mother who took

a baby home on oxygen to talk to you


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11) The nurse is assessing a newborn an

observes that the baby has minimal lanugoand vernix, a wide-eyed appearance, andcracked skin. Which of the followingquestions 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?


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12) The nurse assesses a newborn with absentfemoral pulses. This physical finding is

associated with which neonatal problem?

a. Patent ductus arteriosusb. Tetralogy of Fallot

c. Ventral septal defectd. Coarctation of the aorta


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13) The nurse is preparing a newborn for acircumcision. Which of the followingmedications should be administered before a

circumcision is done?

a. Phytonadione (AquaMEPHYTON)b. Erythromycin ointment

c. Triple dye solutiond. Hepatitis B vaccine


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SITUATION: Alyssa Green gave birth to a3,203.5-g (7lb, 1 oz) male infant 20 minutes

ago. She had completed 39 weeks of a healthypregnancy. She and her husband, Patrick, arenow ready to hold their son.

Questions 14 to 18 refer to this SITUATION


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14) When the nurse touches Baby Greensshoulders, the skin feels warm. The nurseknows Baby Green is keeping warm by

burning:

a. Glucoseb. Brown fat

c. Glycogend. Oxygen


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15) To keep her son warm, the nurse remindsMrs. Green to keep a blanket wrapped aroundhim. Thermoregulation is a problem for thenewborn because:

a. The liver isnt fully developedb. The flexed position of the newborn

encourage heat loss

c. The thin layer of subcutaneous fatprovides poor insulation

d. The production of glucose isinadequate


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

a. Full resuscitation is indicatedb. Oxygen is neededc. Another Apgar score at 10 minutes is

indicatedd. Transition to extrauterine life isprogressing adequately


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17) Mr. and Mrs. Green ask the nurse why shesgiving an injection to their newborn son. Thenurse responds that the most important reasonthat Baby Green needs vitamin K is that:

a. Formula or breast milk doesnt supplyvitamin K

b. Vitamin K doesnt cross the placenta

c. Bacteria that synthesize vitamin K arentpresent in the intestinal tract at birthd. The newborns liver is incapable of

synthesizing vitamin K


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18) The nurse is preparing the parents fordischarge by teaching care of the umbilicalcord. Correct information includes wiping the

cord and surrounding the skin with:

a. Peroxideb. Alcohol

c. Lanolind. Water


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SITUATION: Barbara and Lee Woods areparents of a baby girl who was born at 36weeks gestation and is now 30 minutes old.

Mrs. Woods had episodes of preterm laborsince 30 weeks of pregnancy and was treatedwith terbutaline until the previous evening,when her membranes ruptured and her labor

began.



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19) The nursery nurse should anticipate thatBaby Woods is at risk for which nursingdiagnosis on admission to the nursery?

a. Aspiration related to diminishes suck andswallow reflexb. Altered body temperature related to

gestational age

c. Fluid volume deficit related togestational age

d. Injury related to adverse effects ofterbutaline


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20) The nurse assesses Baby Woods anddetermines that she has nasal flaring and

grunting on exhalation. What nursing actionshould the nurse take?

a. Assess oxygenation with pulse oximeter

b. Resuscitate the baby immediatelyc. Feed the baby with formulad. Take the baby to the mother


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21) The nurse administers erythromycinointment in each of Baby Woods eyes after

birth to prevent which type of infection?

a. Chlamydialb. Staphylococcal

c. Streptococcald. Gonorrhea


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22) Mrs. Woods wants to breast-feed her

newborn. The nurse should encourage Mrs.Woods to:

a. Wait to attempt breast-feeding in 2

weeksb. Not attempt breast-feeding because theinfant is sickc. Not attempt breast-feeding because the

infant is too smalld. Pump her breast and freeze the breast milk

until the infant is allowed to begin oralfeedings


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23) Baby Woods is now 5 days old and hercondition is stable. Which of the followingindicates that her nutritional status is normal?

a. Urine output of 2ml/kg/dayb. Urine specific gravity of 1.001

c. Glucose by glucometer reading is 35mg/dld. Weight loss of 70g over 2 days


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SITUATION: Maria Martinez is a 17-year-oldprimigravida who gave birth to a son

yesterday. Ms. Martinez is a junior in highschool, and her mother will help her raise thebaby.



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24) Ms. Martinez tells the nurse she thinks shewants to breast-feed because she has readthat breast milk is easier to digest andprovides immunity for her baby. The nurse

knows that Ms. Martinez should succeed inbreast-feeding because shes:

a. Obviously educated

b. Informedc. Youngd. Obviously motivated


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25) Ms. Martinezs mother notices a purplecolor on the babys umbilical cord and asks

the nurse what this means. The nurse

explains that triple dye is put on the cord toprevent:

a. Hemorrhage

b. Infectionc. Heat lossd. Jaundice


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26) Ms. Martinezs son is 1 day old. Shes upsetbecause the baby sleeps most of the day and

doesnt look at her often. Her interpretation is thatthe baby doesnt like her. The nurses best

response is:

a. Babies have no likes or dislikes; hell likeyou later as his motherb. Babies sleep up to 20 hours a day. Youll

notice him staying awake longer eachweek

c. Babies sleep when they are getting sick; Illtake him to the nursery for the pediatrician toexamined. Dont worry; hes just a baby


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27)Ms. Martinezs mother asks the nurse why thenursery staff isnt putting powder on the newborn.

The grandmother states that she put powder on allher children. The nurses best response is:

a. Recently, shaking powder has been shownto cause pneumonia because the powderenters the babys lungs. This wasnt known

when you had your childrenb. its dangerous for the baby; you cant do thatnow

c. Its been all over the news: shaking powderis bad for the baby

d. Studies have shown babies get pneumonia;Im surprised you havent read that in a

magazine


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28) As shes preparing to take her newborn

home, Ms. Martinez asks the nurse if its truethat her newborn should sleep on his backinstead of his stomach. The nurse teaches Ms.Martinez that the correct position to aid in

preventing sudden infant death syndrome isto place the baby on his:

a. Stomach to prevent aspiration

b. Right side only to promote digestionc. Back to decrease oropharyngeal

obstructiond. Back and upright to prevent aspiration


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29) Ms. Martinez brings her newborn to the clinic for a well-baby examination when hes 1 month old. She tells thenurse that he feeds every 2 to 3 hours; his stools areyellow 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 skinis warm and dry, and capillary refill is less than 3seconds. The nurses best response is:

a. You can change to formula feeding if you wish

b. Your baby is eating and having bowel movementsnormally for a breast-feed baby

c. Dont listen to you mother listen to your doctord. If your baby continues to eat every 2 hours, hell

have to be placed on formula supplement


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SITUATION: The nursery nurse is preparing asmall-group teaching session to new parents

in preparation for their discharge from thehospital. She uses demonstrations,pamphlets, and videotapes to ensure that allthe parents understand how to care for their

newborns.



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30) The nurse demonstrates appropriate bottle-feeding techniques. Later, the nurse observesa mother whos bottle-feeding. Whichbehavior by the mother indicates a good

understanding of the feeding techniques?

a. Keeps the nipple full of formulab. Props the bottle in the infants mouth

c. Burps after the infant drinks 1 to 2 oz offormulad. Puts the nipple halfway in the infants

mouth


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31) To comply with the law, the nurse instructsthe parents that for the automobile trip home,the newborn should be in an approved car

seat in the:

a. Back seat facing the frontb. Front seat facing the back

c. Back seat facing the backd. Front seat facing the front


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32) Which of the following reflexes should thenurse discuss and demonstrate to educate theparents about providing a safe environment

for their newborn?

a. Babinskisb. Stepping

c. Tonic neckd. Prone crawl


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33) Which statement by one of the parents

indicates that the nurse needs to providefurther discharge teaching about care of thecircumcision?

a. The newborn may cry when he urinatesb. A whitish-yellow exudates is a sign of

infectionc. The circumcision site may ooze a few

drops of bloodd. Petroleum gauze placed around the

circumcision site prevents it fromadhering to the diaper


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SITUATION: Mary Watson is a 36 weeksgestation and has been diagnosed as positive

for the human immunodeficiency virus. Shehas had a healthy pregnancy to date but hasmany questions about how her healthproblems will affect her newborn.



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34) Ms. Watson asks the nurse if she can breastfeed her

baby. Which of the following statements is the basis forthe nurses response?

a. Because Ms. Watson probably wont live to raisethis 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), breast-feeding will provide immunity to other infections.

c. Because Ms. Watson doesnt have symptoms of

acquired immunodeficiency syndrome (AIDS), shecan breast feedd. Because HIV may be transmitted through breast

milk, breast feeding isnt recommended for Ms.

Watson


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35) Ms. Watson has delivered a baby girl at 38weeks gestation. At 4 hours of age, the

newborn has shallow respirations at 54

breaths/minute with periods of apnea lastingfor 5 to 7 seconds. The nurses priority action

would be too:

a. Continue routine monitoringb. Notify the doctor immediatelyc. Request an order to administer oxygen.d. Prepare equipment for a respiratory arrest


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36) The nurse is preparing to initiate formulafeeding for Ms. Watsons newborn when shes

2 hours old. Which of the following neonatalconditions would contraindicate initiation ofthe feeding?

a. Presence of the sucking reflexb. Jitteriness of the extremitiesc. Axillary temperatory rate of 65 to 70d. Continuing respiratory rate of 97.2F

(36.2C)


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37) Ms. Watsons newborn is jaundiced

because of an ABO blood groupincompatibility and is receiving phototherapy.Which of the following nursing interventionsis most appropriate for her newborn?

a. Reposition the infant every 4 hoursb. Limit the infants oral intake to 1 oz

every 4 hours

c. Remove the eye patches every 24 hoursto assess for conjunctivitis

d. Turn the phototherapy unit off whendrawing blood for bilirubin levels


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38) Before discharging Ms. Watsons newbornon the 2nd day of life, the nurse complete herdischarge examination. Which of the following

findings would the nurse report to the doctor?

a. A black, dry umbilical coreb. A dark greenish-black stool

c. Petechiae covering the chest andabdomen

d. Bluish purple discoloration in thelumbosacral area


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SITUATION: Sonia Baker and her partner,John, have delivered their newborn daughter

at 29 weeks gestation. Ms. Baker had acomplete placenta previa requiring cesareandelivery.



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39) Which of the following nursing diagnoseswould be the highest priority for this newborndelivered by a cesarean birth?

a. Risk of infectionb. Impaired gas exchangec. Ineffective thermoregulationd. Altered nutrition: less than body

requirements


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40) The nurse is administering oxygen to Ms.Bakers newborn by bag and mask. In which

position should the newborn be placed?

a. Trendelenburgs positionb. Semi-Fowler position

c. Supine with the neck slightly extendedd. Prone with the neck slightly flexed


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41) At birth, Ms. Bakers newborn has Apgar

scores of 2 and 4. To ensure preparation for asafe environment for admission to thenursery, the nurses priority action should be

to:

a. Turn on the radiant warmerb. Check the light on the laryngoscopec. Prepare an I.V. infusion of dextrose 10%

in waterd. Attach the electrocardiography (ECG)

leads to the cardiorespiratory monitor


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42) Ms. Baker is Rh-negative. Which of thefollowing laboratory tests will probably beordered for the newborn?

a. Direct coombsb. Indirect Coombsc. Blood cultured. Platelet count


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43) Ms. Bakers newborn is now 1 week old andis experiencing periodic apnea. The apneamonitor is set to sound the alarm 15 secondsafter cessation of respirations. When the

alarm sounds, which of the followinginterventions should the nurse perform first?

a. Assess the respirations and skin color

b. Turn off the alarm on the apnea monitorc. Apply tactile stimuli by flicking the feetd. Begin respiratory resuscitation with a

mask and bag


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SITUATION: Katie Johnson is a 19-year-oldprimigravida with few support systems whogives birth at 38 weeks gestation. Her

newborn girl is only 2,324.7g (5lb, 2 oz) and isevaluated as small for gestational age. Ms.Johnson has no experience caring for a

newborn and is shy about asking the nursefor information.



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44) Because Ms. Johnsons newborn is smallfor gestational age (SGA), which of thefollowing interventions would have thehighest priority?

a. Initiate oxygen therapy

b. Assess for jaundicec. Obtain a blood sample from the heel todetermine serum glucose level

d. Examine the cord for meconium staining


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

a. Hypoglycemiab. Polycythemiac. Brachial plexus palsy

d. Perinatal asphyxia


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46) Which protocol should the nurse follow whenadministering a hepatitis B vaccine to Ms.Johnsons newborn?

a. Administration of Hepatitis B vaccine shouldbegin at 1 month of age to newborns to

hepatitis B surface antigen (HBsAg)- positivemother

b. Infants delivered to HBsAg-negative mothersshould receive the vaccine before discharge

c. The Hepatitis B-positive newborn should begiven hepatitis immune globulin, not hepatitis Bvaccined. Hepatitis B vaccine is necessary only in high-

incidence areas such as Alaska


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47) Ms. Johnson wishes to breast-feed her

newborn and has listened carefull to herdischarge instructions. Which of the followingstatements indicates that Ms. Johnson needsfurther teaching?

a. Ill consult my doctor before taking anymedications

b. Ill drink a glass of fluid each time Ibreast - feed my baby

c. Ill count my babys wet diapers to make sureshes getting adequate breast milkd. Ill decrease my calorie intake because I wantto begin to lose weight


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SITUATION: Marnie Sell has given birth to herfourth baby at 39 weeks gestation. The

newborn has been diagnosed with a

congenital diaphragmatic hernia and requiresimmediate surgery.



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

a. A sunken abdomen with prominentbowel sounds

b. Improved Apgar scores at 10 minutes

c. Increased cardiac outputd. Circumoral pallor but pink extremities


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49) Ms. Sell is concerned about her newborns

pain after surgery. The nurses best responseis:

a. Babies dont feel pain; medication

doesnt need to be given after surgeryb. Babies dont remember painfulexperiences; medication for pain maycause respiratory problems

c. Nonpharmacologic pain relief measureswill be takend. Babies do feel pain; your baby will

receive pain medication after surgery


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SITUATION: Following a healthypregnancy and labor, DoloresCreighton gave birth to her third

daughter yesterday after hermembranes were ruptured for 36hours. She plans to bottle-feed her

newborn.

Questions 50 to 51 refer to thisSITUATION


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50) The nurse assesses Ms. Creightonsnewborn and finds that shes lethargic, has a

temperature of 97.2F (36.2C), and hasvomited a large amount of curdled formula

twice after each of the last two feedings.Which nursing diagnosis is the highestpriority?

a. Alteration in nutritionb. Risk for infectionc. Alteration in temperatured. Risk for fluid volume deficit


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51) Which of the following factors is mostrelated to the newborns current status?

a. The mothers poor nutritionb. An internal spiral electrode used during

laborc. Prolonged rupture of membranes

d. The mothers multiparity

maternal and child nursing - neonatal care

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