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ORIGINAL 2024-2025 VERSION QUARANTEE PASS EXAM(OB Final Exam AQ) ( Question & ANSWERS 100%CORRECT)
What should be included in a plan of care to limit the development of hyperbilirubinemia in the breastfed neonate?
- Encouraging more frequent breastfeeding during the first 2 days
- Instituting phototherapy for 30 minutes every 6 hours for 3 days
- Substituting formula feeding for breastfeeding on the second day
- Supplementing breastfeeding with glucose water during the first day
- Encouraging more frequent breastfeeding during the first 2 days
More frequent breastfeeding stimulates more frequent evacuation of meconium, thereby preventing resorption of bilirubin into the circulatory system. Phototherapy is the treatment for hyperbilirubinemia, and it is maintained continuously; it does not prevent the development of hyperbilirubinemia. It is not necessary to feed the infant formula. Early breastfeeding tends to keep the bilirubin level low by stimulating gastrointestinal activity. Increasing water intake does not limit the development of hyperbilirubinemia, because only small amounts of bilirubin are excreted by the kidneys.
The nurse is preparing to discharge a 3-day-old infant who weighed 7 lb (3175 g) at birth. Which finding should be reported immediately to the healthcare provider?
- Weight of 6 lb 4 oz (2835 g)
- Hemoglobin of 16.2 g/dL (162 mmol/L)
- Three wet diapers over the last 12 hours
- Total serum bilirubin of 10 mg/dL (171 μmol/L)
- Weight of 6 lb 4 oz (2835 g)
A loss of 12 oz (340 g) since birth, or more than 10%, is higher than the acceptable figure of 5% to 6%. Hemoglobin of 16.2 g/dL (162 mmol/L), total serum bilirubin of 10 mg/dL (171 μmol/L), and three wet diapers over the last 12 hours are all normal and expected findings.
Which finding in a newborn whose temperature over the last 4 hours has fluctuated between 98.0° F (36.7° C) and 97.4° F (36.3° C) would be considered critical?
- Respiratory rate of 60 breaths/min
- White blood count greater than 15,000 mm
- Serum calcium level of 8 mg/dL (2 mmol/L)
- Blood glucose level of 36 mg/dL (3.8 mmol/L)
- Blood glucose level of 36 mg/dL (3.8 mmol/L)
Instability of the newborn's temperature is an indication of hypoglycemia. A glucose level below 40 mg/dL (1. mmol/L) does not provide enough energy to maintain the body temperature at a normal level. A serum calcium level of 8 mg/dL (2 mmol/L), respiratory rate of 60 breaths/min, and a white blood cell count greater than 15,000 mm are all normal findings and do not affect body temperature.
The most appropriate method for a nurse to evaluate the effects of the maternal blood glucose level in the infant of a diabetic mother is by performing a heel stick blood test on the newborn. What specifically does this test determine?
- Blood acidity
- Glucose tolerance
- Serum glucose level
- Glycosylated hemoglobin level
- Serum glucose level
Obtaining a blood glucose level is a simple, cost-effective method of testing newborns for suspected hypoglycemia. Although the acidity of the blood will indicate whether the newborn has metabolic acidosis as a result of hypoglycemia, it is more important to determine whether the newborn has hypoglycemia so it can be corrected before acidosis develops. The glucose tolerance test and glycosylated hemoglobin level test are not used in newborns.
Five minutes after birth, a newborn is given an Apgar score of 8. Twelve hours later the newborn becomes hyperactive and jittery, sneezes frequently, and has difficulty swallowing. What does the nurse suspect is the cause of these clinical findings?
- Cerebral palsy
- Neonatal syphilis
- Opioid drug withdrawal
SGA infants may exhibit hypoglycemia, especially during the first 2 days of life, because of depleted glycogen stores and inhibited gluconeogenesis. These are not signs of hypervolemia. Hypervolemia is usually the result of excessive intravenous infusion. It is unlikely that a full-term SGA infant will need intravenous supplementation. Hypercalcemia is uncommon in newborns. These signs are unrelated to hypothyroidism; signs of hypothyroidism are difficult to identify in the newborn.
A neonate born at 39 weeks' gestation is small for gestational age. Which commonly occurring problem should the nurse anticipate when planning care for this infant?
- Anemia
- Hypoglycemia
- Protein deficiency
- Calcium deficiency
- Hypoglycemia
Hypoglycemia is common in newborns who are small for gestational age because of malnutrition in utero; the nurse can detect this with a blood glucose test and notify the primary healthcare provider. Polycythemia, not anemia, is more likely to occur. Although a protein deficiency may occur, it is not life threatening at this time. Although hypocalcemia may occur, it is not as common as hypoglycemia.
Five minutes after birth, a newborn is pale; has irregular, slow respirations; has a heart rate of 120 beats/min; displays minimal flexion of the extremities; and has minimal reflex responses. What is this newborn's Apgar score? Record your answer using a whole number. _____
5
The Apgar score is 5. According to the Apgar scoring system, the newborn receives 2 points for heart rate, 0 for color, 1 for respiratory effort, 1 for muscle tone, and 1 for reflex irritability. An Apgar score of 3 is low. Scores of 5 and 6 are higher, but the newborn may still require stimulation and oxygen.
A client has delivered her infant by cesarean birth. The nurse monitors the newborn's respiration closely, because infants born via the cesarean method are prone to atelectasis. Why does this occur?
- The ribcage is not compressed and released during birth.
- The sudden temperature change at birth causes aspiration.
- There is usually oxygen deprivation after a cesarean birth.
- There is no gravity during the birth to promote drainage from the lungs.
- The ribcage is not compressed and released during birth.
The release following compression of the chest during a vaginal birth is the mechanism for expansion of the newborn's lungs; because this does not occur during a cesarean birth, lung expansion may be incomplete, and atelectasis may result. Temperature change is not implicated in aspiration. The infant is monitored closely to prevent oxygen deprivation. The newborn's head may be held lower than the chest to allow gravity to promote drainage from the lungs after a cesarean birth.
Phototherapy is prescribed for a preterm neonate with hyperbilirubinemia. Which nursing intervention is appropriate to reduce the potentially harmful side effects of the phototherapy?
- Covering the trunk to prevent hypothermia
- Using shields on the eyes to protect them from the light
- Massaging vitamin E oil into the skin to minimize drying
- Turning after each feeding to reduce exposure of each surface area
- Using shields on the eyes to protect them from the light
The lights used for phototherapy can damage the infant's eyes, and eye shields are standard equipment. Maximal effectiveness is achieved when the infant's entire skin surface is exposed to the light. Vitamin E oil massage is contraindicated, because it can cause burns and result in an overdose of the vitamin. The infant should be turned every 2 hours regardless of feeding times so that all body surfaces are exposed to the light and no single body surface is overexposed.
A mother asks the neonatal nurse why her infant must be monitored so closely for hypoglycemia when her type 1 diabetes was in excellent control during the entire pregnancy. How should the nurse best respond?
- "A newborn's glucose level drops after birth, so we're being especially cautious with your baby because of your diabetes."
- "A newborn's pancreas produces an increased amount of insulin during the first day of birth, so we're checking to see whether hypoglycemia has occurred."
- "Babies of mothers with diabetes do not have large stores of glucose at birth, so it's difficult for them to maintain the blood glucose level within an acceptable range."
SGA infants are prone to hypoglycemia, because they have little subcutaneous fat or glycogen stores. Intestinal bleeding is not common in SGA infants. Placing an SGA infant in the Trendelenburg position is of no therapeutic value. Hydrocephalus or microcephaly is not a characteristic of SGA infants.
The nurse is caring for a newborn with a caput succedaneum. What is the priority nursing action?
- Supporting the parents
- Recording neurologic signs
- Applying a hard protective cap on the head
- Applying ice packs to the hematoma
- Supporting the parents
Parents need support and reassurance that their newborn is not permanently damaged. Caput succedaneum does not cause impaired neurologic function. No special protection of the head is required; routine safety measures are adequate.
A preterm newborn is admitted to the neonatal intensive care unit (NICU). Which concern is most commonly expressed by NICU parents?
- Fear of handling the infant
- Delayed ability to bond with the infant
- Prolonged hospital stay needed by the infant
- Inability to provide breast milk for the infant
- Fear of handling the infant
Because these infants are so tiny and frail, parents most commonly fear handling or touching them; they should be encouraged to do so by the NICU staff. The primary concern is the infant's fragility, not bonding; however, bonding should be encouraged. Although there may be concerns about a long hospital stay, they are not commonly expressed by mothers. The primary concern is the infant's fragility, not breast-feeding. Breasts may be pumped and breast milk given in gavage feedings.
A neonate born at 32 weeks' gestation and weighing 3 lb (1361 g) is admitted to the neonatal intensive care unit. When should the nurse take the neonate's mother to visit the infant?
- When the infant's condition has stabilized
- When the infant is out of immediate danger
- When the primary healthcare provider has provided written permission
- When the mother is well enough to be taken to the intensive care unit
- When the mother is well enough to be taken to the intensive care unit
The mother should see her infant as soon as possible so that she may acknowledge the reality of the birth and begin bonding. A delay impedes maternal-infant bonding. A prescription is not needed, because this is an independent nursing action. The infant's condition is not a controlling factor in determining when the mother initially visits.
The nurse is testing newborns' heel blood for the level of glucose. Which newborn does the nurse anticipate will experience hypoglycemia? Select all that apply.
- Preterm infant
- Infant with Down syndrome
- Small-for-gestational-age infant
- Large-for-gestational-age infant
- Appropriate-for-gestational-age infant
- Preterm infant
- Small-for-gestational-age infant
- Large-for-gestational-age infant
Preterm infants have low glycogen stores. Small-for-gestational-age infants also have low glycogen stores. Large-for- gestational-age infants are prone to hyperinsulinemia; often they are born to mothers who have diabetes, meaning that they are exposed to a high circulating glucose level while in utero. After prolonged exposure to a high glucose level, hyperplasia of the pancreas occurs, resulting in hyperinsulinemia. Infants with Down syndrome are not at risk for hypoglycemia but are at risk for congenital cardiac defects. Appropriate-for-gestational-age infants are not at risk for hypoglycemia.
The nurse assessing a newborn suspects Down syndrome. Which characteristics support this conclusion? Select all that apply.
- Spina bifida
- Imperforate anus
- Tracheoesophageal fistula
- Intrauterine growth restriction (IUGR)
- Intrauterine growth restriction (IUGR)
Oligohydramnios is associated with IUGR; risk factors for IUGR include inadequate maternal nutrition and other high-risk conditions such as diabetes and preeclampsia. Spina bifida does not affect amniotic fluid volume; it is associated with an increased alpha-fetoprotein level. Imperforate anus does not affect amniotic fluid volume. Tracheoesophageal fistula is often associated with polyhydramnios, which is excessive amniotic fluid.
Based on the assessment of a full-term infant, the nurse suspects a cardiac anomaly. Which clinical manifestation does the nurse identify that indicates a cardiac anomaly?
- Projectile vomiting
- Irregular respiratory rhythm
- Hyperreflexia of the extremities
- Unequal peripheral blood pressures
- Unequal peripheral blood pressures
A discrepancy in blood pressures from the arms to the legs indicates arterial stenosis caused by coarctation of the aorta. Projectile vomiting commonly results from pyloric stenosis; it is not of cardiac origin and does not occur immediately after birth. An irregular respiratory rhythm is common and expected in the healthy newborn. Hyperreflexia of the extremities may be indicative of a neurologic, not cardiac, problem.
An infant is admitted to the nursery after a difficult shoulder dystocia vaginal birth. Which condition should the nurse carefully assess this newborn for?
- Facial paralysis
- Cephalhematoma
- Brachial plexus injury
- Spinal cord syndrome
- Brachial plexus injury
Brachial plexus paralysis (Erb-Duchenne palsy) is the most common injury associated with dystocia related to a shoulder presentation; it is caused by pressure and traction on the brachial plexus during the birth process. The newborn's face is not involved with a shoulder presentation. Cephalhematoma is a soft-tissue injury of the head and is not related to shoulder dystocia. Spinal cord syndrome is associated with a breech presentation and is not related to shoulder dystocia.
- The nurse is assessing the newborn of a known opioid user for signs of withdrawal. What clinical manifestations does the nurse expect to identify? Select all that apply.
- Sneezing
- Hyperactivity
- High-pitched cry
- Exaggerated Moro reflex
- Reduced deep tendon reflexes
- Sneezing
- Hyperactivity
- High-pitched cry
- Exaggerated Moro reflex
Neurologic signs of withdrawal in the neonate of an opioid-addicted mother are manifested by sneezing, hyperactivity, jitteriness, and a shrill, high-pitched cry. The Moro reflex usually becomes exaggerated as the signs of withdrawal become apparent. The deep tendon reflexes are exaggerated during opioid withdrawal.
*The nurse is caring for the newborn of a mother with diabetes. For which signs of hypoglycemia should the nurse assess the newborn? Select all that apply.
- Pallor
- Irritability
- Hypotonia
- Obtaining a prescription for an antidepressant to help the client cope with the depressing news
- Assisting the client with the grieving process
Grieving is expected and necessary whenever a newborn is born less than healthy. More information is needed to conclude that frequent neurologic assessments are warranted; the frequency of assessments depends on the severity and type of the neurologic problem. Arranging for social services to discuss possible placement of the newborn may be done later; however, it is not the priority at this time. Obtaining a prescription for an antidepressant to help the client cope with the depressing news could result in a delay in the client's ability to actively participate in dealing with feelings.
*A new mother's laboratory results indicate the presence of cocaine and alcohol. Which craniofacial characteristics indicate to the nurse that the newborn has fetal alcohol syndrome (FAS)? Select all that apply.
- Thin upper lip
- Wide-open eyes
- Small upturned nose
- Larger-than-average head
- Smooth vertical ridge in the upper lip
- Thin upper lip
- Small upturned nose
- Smooth vertical ridge in the upper lip
The abnormal facial characteristics associated with FAS include: a thin upper lip (vermilion), a small upturned nose, and a smooth vertical ridge (philtrum) in the upper lip, all of which are distinctive in these infants. Infants with FAS have small eyes with epicanthic folds, rather than wide-open eyes, as well as microcephaly (head circumference less than the tenth percentile), rather than a larger-than-average head.
- The nurse is caring for a neonate who is undergoing phototherapy. What specific care should the nurse plan for this infant?
- Applying mineral oil to the skin to prevent excoriation
- Covering the infant's head with a cap to minimize heat loss
- Regulating radiant heat to maintain optimum skin temperature
- Discontinuing therapy during feeding to meet the infant's emotional needs
- Discontinuing therapy during feeding to meet the infant's emotional needs
Discontinuing therapy during feedings is necessary to ensure psychosocial contact. Mineral oil may block light rays from acting on bilirubin deposits; cleansing after each voiding and defecation will prevent skin excoriation. All parts of the body may contain bilirubin deposits and should be exposed to the light. Radiant heaters are not used; a fluorescent light source is used.
*A neonate born at 35 weeks' gestation has Apgar scores of 8 and 9. At 4 hours of age the newborn begins to experience respiratory distress, has a below-normal temperature in a warm environment, and has a low blood glucose level. What problem does the nurse suspect?
- Hypoglycemia
- Bacterial sepsis
- Cocaine withdrawal
- Meconium aspiration
- Bacterial sepsis
Preterm neonates react to infection with respiratory distress and subnormal temperatures. Although hypothermia is one sign of hypoglycemia, the newborn is not exhibiting other signs, such as tremors and lethargy. The data do not indicate that meconium was present at birth. Four hours of age is too early for signs of cocaine withdrawal to occur.
The nurse is caring for a client who is admitted to the birthing unit with a diagnosis of abruptio placentae. Which complication associated with a placental abruption should the nurse carefully monitor this client for?
- Cerebral hemorrhage
- Pulmonary edema
- Impending seizures
- Hypovolemic shock
- Hypovolemic shock
A 16-year-old primigravida who appears to be at or close to term arrives at the emergency department stating that she is in labor and complaining of pain continuing between contractions. The nurse palpates the abdomen, which is firm and shows no sign of relaxation. What problem does the nurse conclude that the client is experiencing?
- Placenta previa
- Precipitous birth
- Abruptio placentae
- Breech presentation
- Abruptio placentae
Abruptio placentae indicates a premature placental separation; the classic signs are abdominal rigidity, a tetanic uterus, and dark-red bleeding. Placenta previa occurs with a low-lying placenta and is manifested by painless bright- red bleeding. Information on cervical effacement, dilation, and station is required before the nurse can come to a conclusion regarding precipitous birth. Fetal presentation is not related to the client's signs and symptoms.
When entering the room of a client in active labor to answer the call light, the nurse sees that she is ashen gray, dyspneic, and clutching her chest. What should the nurse do immediately after pressing the emergency light in the client's room?
- Administer oxygen by facemask
- Check for rupture of the membranes
- Begin cardiopulmonary resuscitation (CPR)
- Increase the rate of intravenous (IV) fluids
- Administer oxygen by facemask
The client is exhibiting signs and symptoms of an amniotic fluid embolism; increasing oxygen intake is essential. The client is experiencing an emergency situation; checking for rupture of membranes is irrelevant at this time. The client is breathing and conscious; CPR is not indicated, but it may become necessary if her condition worsens. It is not necessary to increase the IV fluid rate, although the current rate should be maintained.
