Exam 3 - Practice Questions (High Risk Newborn)

Question 1

1. A 1-day-old neonate, 32 weeks’ gestation, is in an overhead warmer. The nurse assesses
   the morning axillary temperature as 96.9ºF. Which of the following could explain
   this assessment finding?
2. This is a normal temperature for a preterm neonate.
3. Axillary temperatures are not valid for preterm babies.
4. The supply of brown adipose tissue is incomplete.
5. Conduction heat loss is pronounced in the baby.

Answer 1

3. Preterm babies are born with an insufficient
   supply of brown adipose tissue
   that is needed for thermogenesis,
   or heat generation.

TEST-TAKING TIP: It is important for the
test taker not to read into questions.
Even though conduction can be a means
of heat loss in the neonate and, more
particularly, in the premature, there are
three other means by which neonates
lose heat—radiation, convection, and
evaporation. Conduction could only be
singled out as a cause of the hypothermia
if it were clear from the question that
that were the cause of the problem.

Question 2

2. Which of the following neonates is at highest risk for cold stress syndrome?
3. Infant of diabetic mother.
4. Infant with Rh incompatibility.
5. Postdates neonate.
6. Down syndrome neonate.

Answer 2

3. Postdates babies are at high risk for
   cold stress syndrome because while
   still in utero they often metabolize
   the brown adipose tissue for nourishment
   when the placental function deteriorates.

TEST-TAKING TIP: The test taker must
know that cold stress syndrome results
from a neonate’s inability to create heat
through metabolic means. Brown adipose
tissue (BAT) and glycogen stores in the
liver are the primary substances used for
thermogenesis. The test taker must then
deduce that the infant most likely to have
poor supplies of BAT and glycogen is the
postdates infant

Question 3

3. Which of the following would lead the nurse to suspect cold stress syndrome in a
   newborn with a temperature of 96.5ºF?
4. Blood glucose of 50 mg/dL.
5. Acrocyanosis.
6. Tachypnea.
7. Oxygen saturation of 96%.

Answer 3

3. Babies who have cold stress syndrome
   will develop respiratory distress. One
   symptom of the distress is tachypnea.

TEST-TAKING TIP: It is important for the
test taker to know the normal variations
seen in the neonate—for example, normal
blood glucoses are lower in neonates
than in the older child and adult and
acrocyanosis is normal for a neonate’s
first day or two.

Question 4

4. Four babies are in the newborn nursery. The nurse pages the neonatalogist to see
   the baby who exhibits which of the following?
5. Intracostal retractions.
6. Erythema toxicum.
7. Pseudostrabismus.
8. Vernix caseosa.

Answer 4

1. Intracostal retractions are symptomatic
   of respiratory distress syndrome.

TEST-TAKING TIP: It is important for the
test taker to be familiar with the signs of
respiratory distress in the neonate. Babies
who are stressed by, for example,
cold, sepsis, or prematurity will often exhibit
signs of respiratory distress. The
neonatologist should be called promptly.

Question 5

5. A baby is grunting in the neonatal nursery. Which of the following actions by the
   nurse is appropriate?
6. Place a pacifier in the baby’s mouth.
7. Check the baby’s diaper.
8. Have the mother feed the baby.
9. Assess the respiratory rate.

Answer 5

4. Grunting is often accompanied by
   tachypnea, another sign of respiratory
   distress.
   TEST-TAKING TIP: If the test taker were to
   attempt to grunt, he or she would feel
   the respiratory effort that the baby is creating.
   Essentially, the baby is producing
   his or her own positive end-expiratory
   pressure (PEEP) in order to maximize his
   or her respiratory function.

Question 6

6. A 6-month-old child developed kernicterus immediately after birth. Which of the
   following tests should be done to determine whether or not this child has developed
   any sequelae to the illness?
7. Blood urea nitrogen and serum creatinine.
8. Alkaline phosphotase and bilirubin.
9. Hearing and vision assessments.
10. Peak expiratory flow and blood gas assessments.

Answer 6

3. Because the central nervous system
   (CNS) may have been damaged by the
   high bilirubin levels, testing of the
   senses as well as motor and cognitive
   assessments are appropriate.

TEST-TAKING TIP: The test taker must be
aware that kernicterus is the syndrome
that develops when a neonate is exposed
to high levels of bilirubin over time. The
bilirubin crosses the blood-brain barrier,
often leading to toxic changes in the CNS.

Question 7

7. A baby with hemolytic jaundice is being treated with fluorescent phototherapy. To
   provide safe newborn care, which of the following actions should the nurse perform?
8. Cover the baby’s eyes with eye pads.
9. Turn the lights on for ten minutes every hour.
10. Clothe the baby in a shirt and diaper only.
11. Tightly swaddle the baby in a baby blanket.

Answer 7

1. When phototherapy is administered,
   the baby’s eyes must be protected
   from the light source.

TEST-TAKING TIP: There is a difference
between phototherapy administered by
fluorescent light and phototherapy administered
via fiber optic tubing to a biliblanket.
When a bili-blanket is used, the
baby can be clothed and the baby’s eyes
do not need to be protected.

Question 8

8. A baby is born with erythroblastosis fetalis. Which of the following signs/symptoms
   would the nurse expect to see?
9. Ruddy complexion.
10. Anasarca.
11. Alopecia.
12. Erythema toxicum.

Answer 8

2. Babies born with erythroblastosis
   fetalis often are in severe congestive
   heart failure and, therefore, exhibit
   anasarca.

TEST-TAKING TIP: A baby with erythroblastosis
fetalis has marked red blood cell
destruction in utero secondary to the
presence of maternal antibodies against
the baby’s blood. The severe anemia that
results often leads to congestive heart
failure of the fetus in utero.

Question 9

9. Which of the following laboratory findings would the nurse expect to see in a baby
   diagnosed with erythroblastosis fetalis?
10. Hematocrit 24%.
11. Leukocyte count 45,000 cells/mm3.
12. Sodium 125 mEq/L.
13. Potassium 5.5 mEq/L.

Answer 9

1. The baby with erythroblastosis fetalis
   would exhibit signs of severe anemia,
   which a hematocrit of 24% reflects.

TEST-TAKING TIP: The test taker must be
familiar with the pathophysiology of Rh
incompatibility. If a mother who is Rh
negative has been sensitized to Rh positive
blood, she will produce antibodies
against the Rh positive blood. If she then
becomes pregnant with an Rh positive
baby, her anti-Rh antibodies will pass directly
through the placenta into the fetal
system. Hemolysis of fetal red blood cells
results, leading to severe fetal anemia.

Question 10

10. A baby’s blood type is B negative. The baby is at risk for hemolytic jaundice if the
    mother has which of the following blood types?
11. Type O negative.
12. Type A negative.
13. Type B positive.
14. Type AB positive.

Answer 10

1. ABO incompatibility can arise when
   the mother is type O and the baby is
   either type A or type B.

TEST-TAKING TIP: A mother whose blood
type is O, the blood type that is antigen
negative, will produce anti-A and/or anti-
B antibodies against blood types A and/or
B, respectively. The anti-A (and/or anti-B)
that passes into the baby’s bloodstream
via the placenta can attack the baby’s red
blood cells if he or she is type A or B. As a
result of the blood cell destruction, the
baby becomes jaundiced.

Question 11

11. A newborn admitted to the nursery has a positive direct Coombs’ test. Which of
    the following is an appropriate action by the nurse?
12. Monitor the baby for jitters.
13. Assess the blood glucose level.
14. Assess the rectal temperature.
15. Monitor the baby for jaundice.

Answer 11

4. When the neonatal bloodstream
   contains antibodies, hemolysis of the
   red blood cells occurs and jaundice
   develops.
   TEST-TAKING TIP: The indirect Coombs’
   test is performed on the pregnant
   woman to detect whether or not she carries
   antibodies against her fetus’ red
   blood cells. The direct Coombs’ test is
   performed on the newborn to detect
   whether or not he or she carries maternal
   antibodies in his or her blood.

Question 12

12. An 18-hour-old baby is placed under the bili-lights with an elevated bilirubin level.
    Which of the following is an expected nursing action in these circumstances?
13. Give the baby oral rehydration therapy after all feedings.
14. Rotate the baby from side to back to side to front every two hours.
15. Tightly swaddle in baby blankets to maintain normal temperature.
16. Administer intravenous fluids via pump per doctor orders.

Answer 12

2. Rotating the baby’s position maximizes
   the therapeutic response because the
   more skin surface that is exposed to
   the light source, the better the results.

TEST-TAKING TIP: Bilirubin levels decrease
with exposure to a light source.
The more skin surface that is exposed,
the more efficient the therapy. Although
fluids are needed to maintain hydration
and to foster stooling, oral rehydration
therapy is nutritionally insufficient.

Question 13

13. A jaundice neonate must have a heel stick to assess bilirubin levels. Which of the
    following actions should the nurse make during the procedure?
14. Cover the foot with an iced wrap for one minute prior to the procedure.
15. Avoid puncturing the lateral heel to prevent damaging sensitive structures.
16. Blot the site with a dry gauze after rubbing it with an alcohol swab.
17. Grasp the calf of the baby during the procedure to prevent injury.

Answer 13

3. Alcohol can irritate the punctured
   skin and can cause hemolysis.

TEST-TAKING TIP: The test taker must be
aware of the physiological structures in
the body. In the case of a heel stick, if the
posterior surface of the heel is punctured,
the posterior tibial nerve and artery
could be injured.

Question 14

14. A newborn nursery nurse notes that a baby’s body is jaundiced at 36 hours of life.
    Which of the following nursing interventions will be most therapeutic?
15. Maintain a warm ambient environment.
16. Have the mother feed the baby frequently.
17. Have the mother hold the baby skin to skin.
18. Place the baby naked by a closed sunlit window.

Answer 14

2. Bilirubin is excreted through the
   bowel. The more the baby consumes,
   the more stools, and therefore the
   more bilirubin the baby will expel.

TEST-TAKING TIP: This is one example of
a change in practice that has occurred
because of updated knowledge. In the
past, babies have been placed in sunlight
in order to reduce their bilirubin levels,
but that practice is no longer considered
to be safe. It is important, therefore, for
the test taker to have as current knowledge
as possible.

Question 15

15. A neonate is under phototherapy for elevated bilirubin levels. The baby’s stools are
    now loose and green. Which of the following actions should the nurse take at this
    time?
16. Discontinue the phototherapy.
17. Notify the health care practitioner.
18. Take the baby’s temperature.
19. Assess the baby’s skin integrity.

Answer 15

4. The stools can be very caustic to the
   baby’s delicate skin. The nurse should
   cleanse the area well and inspect the
   skin for any sign that the skin is
   breaking down.
   TEST-TAKING TIP: The test taker must
   know the difference between signs that
   are normal and those that reflect a possible
   illness. Although green stools can be
   seen with diarrheal illnesses, in this situation,
   the green stools are expected. The
   green stools are due to the increased
   bilirubin excreted and not related to an
   infectious state.

Question 16

16. A nursing diagnosis for a 5-day-old newborn under phototherapy is: Risk for fluid
    volume deficit. For which of the following client outcomes should the nurse plan to
    monitor the baby?
17. 6 saturated diapers in 24 hours.
18. Breastfeeds 6 times in 24 hours.
19. 12% weight loss since birth.
20. Apical heart rate of 176 bpm.

Answer 16

1. Healthy, hydrated neonates saturate
   their diapers a minimum of 6 times in
   24 hours

TEST-TAKING TIP: This is an evaluation
question. The test taker is being asked to
identify signs that would indicate a baby that is fully hydrated. It is important for
the test taker to know the expected intake
and output of the neonate and to
understand the evaluation phase of the
nursing process.

Question 17

17. There is a baby in the neonatal intensive care unit (NICU) who is exhibiting
    signs of neonatal abstinence syndrome. Which of the following medications is
    contraindicated for this neonate?
18. Morphine.
19. Opium.
20. Narcan.
21. Phenobarbital.

Answer 17

3. Narcan is an opiate. If it were to be
   given to the neonate with neonatal
   abstinence syndrome, the baby would
   go into a traumatic withdrawal

TEST-TAKING TIP: Neonatal abstinence syndrome
is the term used to describe the
many behaviors exhibited by neonates
who are born drug addicted. The behaviors
range from hyperreflexia to excessive
sneezing and yawning to loose diarrheal
stools. Medications may or may not be
administered to control the many
signs/symptoms of the syndrome.

Question 18

18. A baby is in the NICU whose mother was addicted to heroin during the pregnancy.
    Which of the following nursing actions would be appropriate?
19. Tightly swaddle the baby.
20. Place the baby prone in the crib.
21. Provide needed stimulation to the baby.
22. Feed the baby half-strength formula.

Answer 18

1. Tightly swaddling drug-addicted
   babies often helps to control the hyperreflexia
   that they may exhibit.

TEST-TAKING TIP: Drug-exposed babies
exhibit signs of neonatal abstinence syndrome:
hyperactivity, hyperreflexia, and
the like. The test taker should look for a
nursing intervention that would minimize
those behaviors. Tightly swaddling
the baby would help to reduce the baby’s
behavioral responses.

Question 19

19. A newborn in the nursery is exhibiting signs of neonatal abstinence syndrome.
    Which of the following signs/symptoms is the nurse observing? Select all that
    apply.
20. Hyperphagia.
21. Lethargy.
22. Prolonged periods of sleep.
23. Hyporeflexia.
24. Persistent shrill cry.

Answer 19

1 and 5 are correct.
1. Babies with signs of neonatal abstinence
syndrome repeatedly exhibit
signs of hunger.

5. Babies with signs of neonatal abstinence
   syndrome often have a shrill
   cry that may continue for prolonged
   periods.
   TEST-TAKING TIP: The baby who is exhibiting
   signs of neonatal abstinence syndrome
   is craving an addicted drug. The
   baby’s body is agitated because the illicit
   narcotics he or she has been exposed to
   are central nervous system depressants
   and their removal has agitated him or
   her. The test taker, therefore, should
   consider symptoms that reflect central
   nervous stimulation as correct responses.

Question 20

20. Based on maternal history of alcohol addiction, a baby in the neonatal nursery is
    being monitored for signs of fetal alcohol syndrome (FAS). The nurse should assess
    this baby for which of the following?
21. Poor suck reflex.
22. Ambiguous genitalia.
23. Webbed neck.
24. Absent Moro reflex.

Answer 20

1. FAS babies usually have a very weak
   suck.

TEST-TAKING TIP: The characteristic
facial signs of fetal alcohol syndrome—
shortened palpebral (eyelid) fissures, thin
upper lip, and hypoplastic philtrum
(median groove on the external surface
of the upper lip)—are rarely evident in
the neonatal period. They typically appear
later in the child’s life. Rather the
behavioral characteristics of the FAS
baby, such as weak suck, irritability,
tremulousness, and seizures, are present
at birth.

Question 21

21. A baby born addicted to cocaine is being given paregoric. The nurse knows that
    which of the following is a rationale for its use?
22. Paregoric is nonaddictive.
23. Paregoric corrects diarrhea.
24. Paregoric is nonsedating.
25. Paregoric suppresses the cough reflex.
    324 MATERNAL AND NEWBORN SUCCESS
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Answer 21

2. Paregoric does help to control the diarrhea
   seen in drug-addicted neonates

TEST-TAKING TIP: Paregoric, a liquid
form of morphine, is an especially effective
therapy for a baby who is experiencing
severe neonatal abstinence syndrome.
The narcotic relieves the cravings that
the baby has for the addicted drug, while,
in addition, paregoric is effective against the diarrhea that many addicted baby’s
experience

Question 22

22. A baby was born 24 hours ago to a mother who received no prenatal care. The
    infant has tremors, sneezes excessively, constantly mouths for food, and has a shrill,
    high-pitched cry. The baby’s serum glucose levels are normal. For which of the
    following should the nurse request an order from the pediatrician?
23. Urine drug toxicology test.
24. Biophysical profile test.
25. Chest and abdominal ultrasound evaluations.
26. Oxygen saturation and blood gas assessments.

Answer 22

1. The symptoms are characteristic
   of neonatal abstinence syndrome.
   A urine toxicology would provide
   evidence of drug exposure

TEST-TAKING TIP: It is important for the
test taker to attend to the fact that this
child has normal serum glucose levels.
When babies exhibit tremors, the first
thing the nurse should consider is hypoglycemia.
Once that has been ruled out,
and since the baby is exhibiting other
signs of drug withdrawal, the nurse
should consider drug exposure.

Question 23

23. A nurse makes the following observations when admitting a full-term, breastfeeding
    baby into the neonatal nursery: 9 lbs 2 oz, 21 inches long, TPR: 96.6ºF, 158, 62,
    jittery, pink body with bluish hands and feet, crying. Which of the following actions
    should the nurse perform first?
24. Swaddle the baby to provide warmth.
25. Assess the glucose level of the baby.
26. Take the baby to the mother for feeding.
27. Administer the neonatal medications.

Answer 23

2. The glucose level should be assessed
   to determine whether or not this baby
   is hypoglycemic

TEST-TAKING TIP: The test taker should
note that this baby is macrosomic and
hypothermic, both of which make the
baby at high risk for hypoglycemia. Plus,
jitters are a classic symptom in hypoglycemic
babies. In order to make an accurate
assessment of the problem, the
baby’s glucose level must be assessed.

Question 24

24. An infant admitted to the newborn nursery has a blood glucose level of 35 mg/dL.
    The nurse should monitor this baby carefully for which of the following?
25. Jaundice.
26. Jitters.
27. Erythema toxicum.
28. Subconjunctival hemorrhages

Answer 24

2. Babies who are hypoglycemic will often
develop jitters (tremors).

TEST-TAKING TIP: The test taker should
remember that the normal glucose level
for neonates in the immediate postdelivery
period—approximately 45 to
90 mg/dL—is less than that seen in older
babies and children

Question 25

25. A full-term infant admitted to the newborn nursery has a blood glucose level of 35 mg/dL. Which of the following actions should the nurse perform at this time? 1. Feed the baby formula or breast milk. 2. Assess the baby’s blood pressure. 3. Tightly swaddle the baby. 4. Monitor the baby’s urinary output.

Answer 25

1. A baby with a blood glucose of 35 mg/dL is hypoglycemic. The action of choice is to feed the baby either formula or breast milk. TEST-TAKING TIP: Although the test taker may believe that glucose water should be fed to the baby at this time, the substance of choice is either formula or breast milk. The sugars in the milk will elevate the baby’s blood values in the short term and the proteins and fats in the milk will help to maintain the glucose values in the normal range.

Question 26

26. A nurse is inserting a gavage tube into a preterm baby who is unable to suck and swallow. Which of the following actions must the nurse take during the procedure? 1. Measure the distance from the tip of the ear to the nose. 2. Lubricate the tube with an oil-based solution. 3. Insert the tube quickly if the baby becomes cyanotic. 4. Inject a small amount of sterile water to check placement.

Answer 26

1. The gavage tubing must be measured to approximate the length of the insertion TEST-TAKING TIP: The placement of gavage tubing is potentially dangerous. Not only must the distance between the nose and the ear be measured, but also the length from the ear to the point midway between the ear and the xiphoid process. This entire distance is the tubing insertion length. To assess placement, air should be injected into the tubing rather than water because the tubing may mistakenly have been inserted into the trachea.

Question 27

27. A neonate is in the warming crib for poor thermoregulation. Which of the following sites is appropriate for the placement of the skin thermal sensor? 1. Xiphoid process. 2. Forehead. 3. Abdominal wall. 4. Great toe.

Answer 27

3. The abdominal wall is the appropriate placement for the skin thermal sensor TEST-TAKING TIP: It is essential that the test taker be prepared safely to perform relatively simple procedures for the premature infant. To monitor the temperature of the premature, the probes should be placed on a nonbony and wellperfused tissue site. The abdominal wall is the site of choice.

Question 28

28. The nurse must perform nasopharyngeal suctioning of a newborn with profuse secretions. Place the following nursing actions for nasopharyngeal suctioning in chronological order. 1. Slowly rotate and remove the suction catheter. 2. Place thumb over the suction control on the catheter. 3. Assess type and amount of secretions. 4. Insert free end of the tubing through the nose.

Answer 28

4, 2, 1, and 3 is the correct order. 4. Inserting the free end of the tubing through the nose is the first step in nasopharyngeal suctioning process 1. Rotation and removal of the suction catheter should be done after the tubing has been inserted through the nose and a thumb placed over the suction control on the catheter. 2. The nurse should place a thumb over the suction control on the catheter after inserting the free end of the tubing through the nose—and before the other two steps are taken. 3. Assessing the type and amount of secretions in the last step in the process. TEST-TAKING TIP: It is important for the test taker to remember that once the suction control is covered, the baby is unable to take in air. It is important, therefore, not to cover the suction control until the catheter is being removed.

Question 29

29. A neonate is being given intravenous fluids through the dorsal vein of the wrist. Which of the following actions by the nurse is essential? 1. Tape the arm to an arm board. 2. Change the tubing every 24 hours. 3. Monitor the site every 5 minutes. 4. Infuse the fluid intermittently.

Answer 29

1. Neonates are incapable of controlling their movements. In order to maintain a safe IV site, it is essential to tape the baby’s arm to an arm board TEST-TAKING TIP: Although restraints and arm boards are often unnecessary when caring for older children and adults, to be assured that the intravenous remains intact, the use of restraints and/or arm boards is often necessary when caring for infants, toddlers, and other young children

Question 30

30. A Roman Catholic couple has just delivered a baby with an Apgar of 1 at 1 minute, 2 at 5 minutes, and 2 at 10 minutes. Which of the following interventions is appropriate at this time? 1. Advise the parents that they should pray very hard so that everything turns out well. 2. Ask the parents whether they would like the nurse to baptize the baby. 3. Leave the parents alone to work through their thoughts and feelings. 4. Inform the parents that a priest will listen to their confessions whenever they are ready.

Answer 30

2. This baby’s Apgar is very low. There is a chance that the baby will not survive. It is appropriate to ask the parents, since they are known to be Roman Catholic, if they would like their baby baptized TEST-TAKING TIP: When a baby is doing very poorly during the first minutes after delivery, there is a possibility that the baby may not survive. Couples who are Roman Catholic often wish to have their babies baptized in such situations. Because a priest is not present, it is appropriate for a nurse, of any religious faith, to perform the baptism at that time.

Question 31

31. The nurse assesses a newborn as follows: heart rate: 70 respirations: weak and irregular tone: flaccid color: pale baby grimaces when a pediatrician attempts to insert an endotracheal tube What should the nurse calculate the baby’s Apgar score to be?

Answer 31

The baby’s Apgar score is 3. TEST-TAKING TIP: Assessing the Apgar score is often a nursing function. The test taker, therefore, should know the criteria for the Apgar score. The score is traditionally performed at 1 and 5 minutes after birth. A total score of 7 to 10 means that the baby is having little to no difficulty transitioning to extrauterine life. With a total score of 4 to 6, the baby is having moderate difficulty transitioning to extrauterine life. Resuscitative measures may need to be instituted. With a total score of 0 to 3, the baby is in severe distress. Resuscitative measures must be instituted.

Question 32

32. A neonate is in the neonatal intensive care nursery with a diagnosis of large-forgestational age. The baby was born at 38 weeks’ gestation and weighed 3 1. The diagnosis is inaccurate because the baby’s weight is too high for a diagnosis of appropriate-for-gestational age. 2. The diagnosis is inaccurate because the baby’s weight needs to be higher than 3500 grams. 3. The diagnosis is inaccurate because the baby’s weight needs to be lower than 3500 grams. 4. The diagnosis is inaccurate because full-term babies are never large-forgestational age.

Answer 32

2. A baby who is large-for-gestational age is defined as a baby whose weight is above the 90th percentile. According to the graph, at 38 weeks’ gestation, a 3500-gram baby is below the 90th percentile for weight. Therefore, the diagnosis is inaccurate. TEST-TAKING TIP: It is important for the test taker to become comfortable with reading and interpreting graphs. The gestational age graph—weight in grams on the y-axis and weeks of gestation on the x-axis—is cut by 2 curves. The upper curve shows the weight at the 90th percentile for babies at differing gestational ages, while the lower curve shows the weight at the 10th percentile for babies of differing gestational ages. Those babies who fall above the upper curve—that is, whose weights are above the 90th percentile—are defined as large-forgestational age (LGA). Those babies who fall below the lower curve—those with weights that are below the 10th percentile—are defined as small-forgestational age (SGA). Those babies who fall between the upper and lower curves are defined as appropriate-for-gestational age (AGA).

Question 33

33. A neonate has been admitted to the neonatal intensive care unit with the following findings: completely flaccid posturing square window sign of 60º arm recoil of 180º popliteal angle of 160º full scarf sign heel that touches the ear skin that is red and translucent sparse lanugo faint red marks on the plantar surface barely perceptible breast tissue eye lids that are open but flat ear pinnae prominent clitoris and small labia minora Using the Ballard scale, what is the gestational age of this neonate estimated to be? \_\_\_\_\_\_\_\_\_\_\_\_\_ weeks

Answer 33

24 weeks TEST-TAKING TIP: There are six characteristics on the neuromuscular maturity chart and six characteristics on the physical maturity chart (see charts on next page). The baby is given a score for each characteristic and the scores are added together to get a total score. The total score is compared to the maturity rating chart. The baby in the question had a total score of 0, which relates to a gestational age score of 24 weeks.

Question 34

34. A neonate is in the neonatal intensive care unit. The baby is 28 weeks’ gestation and weighs 1000 grams. Which of the following is correct in relation to this baby’s growth? 1. Weight is appropriate-for-gestational age. 2. Weight is below average for gestational age. 3. Baby experienced intrauterine growth restriction. 4. Baby experienced congenital growth hypertrophy

Answer 34

1. The baby’s weight is appropriatefor- gestational age. The baby’s weight of 1000 grams falls between the upper and lower curves for 28 weeks’ gestation. TEST-TAKING TIP: Even if the test taker did not know the definitions of intrauterine growth restriction and congenital growth hypertrophy, if the individual words are understood, the test taker would be able to deduce the meanings of the terms by defining each word in the terms and then putting the definitions together. Intrauterine means in the uterus and restriction is a limitation. Intrauterine growth restriction, therefore, means limited growth in the uterus. The term congenital refers to conditions that are present at or before birth and hypertrophy means enlargement or overgrowth. Congenital growth hypertrophy, therefore, refers to a baby that is larger than expected.

Question 35

35. A neonate, 40 weeks by dates, has been admitted to the nursery. Place an “X” on the graph where the baby would be labeled large-for-gestational age.

Answer 35

TEST-TAKING TIP: The test taker should locate the 40-week-gestation line on the x-axis and follow it up to the second curve. Babies whose weights are above the second curve are labeled large-forgestational age (see figure below).

Question 36

36. A 42-week-gestation baby, 2400 grams, whose mother had no prenatal care, is admitted into the NICU. The neonatalogist orders blood work. Which of the following laboratory findings would the nurse expect to see? 1. Blood glucose 30 mg/dL. 2. Leukocyte count 1000 cells/mm3. 3. Hematocrit 30%. 4. Serum pH 7.8.

Answer 36

1. This baby is small-for-gestational age. Full-term babies (40 weeks’ gestation) should weigh between 2500 and 4000 grams. It is very likely that this baby used up his glycogen stores in utero because of an aging placenta. An aging placenta is unable to deliver sufficient nutrients to the fetus. As a result the fetus must use its glycogen stores to sustain life and, therefore, is high risk for hypoglycemia after birth. TEST-TAKING TIP: The test taker must attend carefully to the gestational age in any question relating to neonates. Postterm and preterm babies are at high risk for certain problems. Postterm babies are especially at high risk for hypoglycemia and chronic hypoxia because the aging placenta has not supplied sufficient quantities of oxygen and nutrients.

Question 37

37. A woman who received an intravenous analgesic 4 hours ago has had prolonged late decelerations in labor. She will deliver her baby shortly. Which of the following is the priority action for the delivery room nurse to take? 1. Preheat the overhead warmer. 2. Page the neonatalogist on call. 3. Draw up Narcan (naloxone) for injection. 4. Assemble the neonatal eye prophylaxis.

Answer 37

2. The neonatalogist must be called to the delivery room so that he or she arrives before the baby is delivered TEST-TAKING TIP: This is a prioritizing question. Although all of these actions may be performed by the nurse, only one is a priority. This baby is showing signs of fetal distress—prolonged late decelerations. The baby may need to be resuscitated. The nurse must, therefore, page the neonatalogist so that he or she is present for the birth of the baby.

Question 38

38. A baby has been admitted to the neonatal intensive care unit with a diagnosis of postmaturity. The nurse expects to find which of the following during the initial newborn assessment? 1. Abundant lanugo. 2. Flat breast tissue. 3. Prominent clitoris. 4. Wrinkled skin.

Answer 38

4. The postterm baby does have dry, wrinkled, and often desquamating skin. The baby’s dehydration is secondary to a placenta that progressively deteriorates after 40 weeks’ gestation. TEST-TAKING TIP: The test taker should be familiar with the characteristic presentations of preterm and postmature neonates. Studying the items on the New Ballard Scale and the corresponding gestational ages when the items are seen are excellent ways to associate certain characteristics with dysmature babies.

Question 39

39. A 42-week-gestation baby has been admitted to the neonatal intensive care unit. At delivery, thick green amniotic fluid was noted. Which of the following actions by the nurse is critical at this time? 1. Bath to remove meconium-contaminated fluid from the skin. 2. Ophthalmic assessment to check for conjunctival irritation. 3. Rectal temperature to assess for septic hyperthermia. 4. Respiratory evaluation to monitor for respiratory distress.

Answer 39

4. Meconium aspiration syndrome (MAS) is a serious complication seen in postterm neonates who are exposed to meconium-stained fluid. Respiratory distress would indicate that the baby has likely developed MAS. TEST-TAKING TIP: Although meconium appears black in a newborn’s diaper, it is actually a very dark green color. When diluted in the amniotic fluid, therefore, the fluid takes on a greenish tinge. Because meconium is a foreign substance, when aspirated by the baby, a chemical and, secondarily, a bacterial pneumonia often develop

Question 40

40. A 42-week gravida is delivering her baby. A nurse and pediatrician are present at the bith. The amniotic fluid is green and thick. The baby fails to breathe spontaneously. Which of the following actions should the nurse take next? 1. Stimulate the baby to breathe. 2. Assess neonatal heart rate. 3. Assist with intubation. 4. Place the baby in the prone position.

Answer 40

3. Before breathing, the baby must be intubated so that the meconiumcontaminated fluid can be aspirated from the baby’s airway. TEST-TAKING TIP: It is actually a positive fact that the baby has not breathed immediately after delivery because the airway can then be aspirated to remove the meconium. The nurse, once the fluid was seen, should have paged the appropriate health care professional who would perform the intubation. The nurse would then assist with the procedure.

Question 41

41. At 1 minute of life a baby, who appears preterm, has exhibited no effort to breathe even after being stimulated. Which of the following actions should the nurse perform first? 1. Perform a gestational age assessment. 2. Inflate the lungs with positive pressure. 3. Provide external chest compressions. 4. Palpate the base of the umbilical cord.

Answer 41

2. The baby’s airway should be established by inflating the lungs with an ambu bag. TEST-TAKING TIP: Although the steps of a neonatal resuscitation are slightly different than those for an older baby, child, or adult, the basic principles of resuscitation still apply: ABC. A, the airway must first be established; B, artificial breathing is then begun, and after that, C, chest compressions are performed to establish an artificial circulation

Question 42

42. A neonatalogist requests Narcan (naloxone) during a neonatal resuscitation effort. Which of the following dosages would the nurse expect to prepare? 1. 1 microgram/kg. 2. 10 microgram/kg. 3. 0.1 milligrams/kg. 4. 1 milligram/kg.

Answer 42

3. 0.1 milligram/kg is the correct dosage. This dosage can also be expressed as 100 microgram/kg TEST-TAKING TIP: The test taker must not confuse micrograms and milligrams. There are 1000 micrograms in 1 milligram. The correct answer, therefore, could have been stated as 0.1 milligram/kg or 100 microgram/kg.

Question 43

43. During neonatal cardiopulmonary resuscitation, which of the following actions should be performed? 1. Provide assisted ventilation at 40 to 60 breaths per minute. 2. Begin chest compressions when heart rate is 0 to 20 beats per minute. 3. Compress the chest using the three-finger technique. 4. Administer compressions and breaths in a 5 to 1 ratio.

Answer 43

1. Assisted ventilations should be administered at a rate of 40 to 60 per minute. TEST-TAKING TIP: The correct answer could be deduced by the test taker by remembering the normal respiratory rate of the neonate (30 to 60 breaths per minute). During a resuscitation, the nurses and other health care practitioners would be attempting to simulate normal functioning

Question 44

44. The staff on the maternity unit is developing a protocol for nurses to follow after a baby is delivered who fails to breathe spontaneously. Which of the following should be included in the protocol as the first action for the nurse to take? 1. Prepare epinephrine for administration. 2. Provide positive pressure oxygen. 3. Administer chest compressions. 4. Rub the back and feet of the baby.

Answer 44

4. The first interventions when a neonate fails to breathe include providing tactile stimulation. TEST-TAKING TIP: When a neonate fails to breathe, the nurse should: dry the baby and provide tactile stimulation, place the child in the “sniff ” position under a radiant warmer, and suction the mouth and nose of any mucus. Only after these initial actions fail—since the vast majority of the time the baby will respond— should further intervention be begun.

Question 45

45. A nurse in the newborn nursery suspects that a new admission, 42 weeks’ gestation, was exposed to meconium in utero. What would lead the nurse to suspect this? 1. The baby is bradycardic. 2. The baby’s umbilical cord is green. 3. The baby’s anterior fontanel is sunken. 4. The baby is desquamating

Answer 45

2. Because meconium is a dark green color, when it is expelled in utero, the baby can be stained green. TEST-TAKING TIP: The test taker may choose “4” because he or she remembers that there is a relationship between babies who expel meconium and those who desquamate. That is true, but it is not a direct relationship. The fact that the baby is postdates is the common denominator between the two. The test taker should choose the response that is clearly correct: because meconium is green it can stain the baby’s tissues green. Desquamation is merely a fancy term for skin peeling.

Question 46

46. The birth of a baby, weight 4500 grams, was complicated by shoulder dystocia. Which of the following neonatal complications should the nursery nurse observe for? 1. Leg deformities. 2. Brachial palsy. 3. Fractured radius. 4. Buccal abrasions

Answer 46

2. During a difficult delivery with shoulder dystocia, the brachial nerve can become stretched and may even be severed. The nurse should, therefore, observe the baby for signs of palsy TEST-TAKING TIP: The key to answering this question is understanding the terminology. A shoulder dystocia is a difficult delivery when the shoulder fails to pass easily through the pelvis. Deformities are disfigurements or malformations. Although the arm and shoulder may be injured, the baby is not disfigured. A buccal abrasion would occur on the inside of the cheek.

Question 47

47. During a health maintenance visit at the pediatrician’s office, the nurse notes that a breastfeeding baby has thrush. Which of the following actions should the nurse take? 1. Nothing because thrush is a benign problem. 2. Advise the mother to bottlefeed until the thrush is cured. 3. Obtain an order for antifungals for both mother and baby. 4. Assess for other evidence of immunosuppression.

Answer 47

3. Candida is a fungal infection, and it is important to treat both the mother’s breasts and the baby’s mouth to prevent the infection from being transmitted back and forth between the two. TEST-TAKING TIP: It is important to keep from confusing pathology with the normal processes of birth and growth and development. Thrush, which is often seen in the mouth of immunosuppressed patients, is also a normal flora in the vagina of women. The baby may have contracted the fungus in his or her mouth during delivery or from his or her mother’s poorly washed hands.

Question 48

48. A neonate, whose mother is HIV positive, is admitted to the NICU. A nursing diagnosis: Risk for infection related to perinatal exposure to HIV/AIDS is made. Which of the following interventions should the nurse make in relation to the diagnosis? 1. Monitor daily viral load laboratory reports. 2. Check the baby’s viral antibody status. 3. Obtain an order for antiviral medication. 4. Place the baby on strict precautions.

Answer 48

3. The standard of care for neonates born to mothers with HIV/AIDS is to begin them on anti-AIDS medication in the nursery. The mother will be advised to continue to give the baby the medication after discharge. TEST-TAKING TIP: The test taker should be aware that neonates must be followed after delivery because of the viral exposure in utero. The best way to prevent vertical transmission from the mother to the newborn is to administer antiviral medications to the mother during pregnancy and delivery and for 6 weeks to the newborn following delivery.

Question 49

49. A baby was just born to a mother who had positive vaginal cultures for group B streptococcus. The mother was admitted to the labor room 2 hours before the birth. For which of the following should the nursery nurse closely observe this baby? 1. Hypothermia. 2. Mottling. 3. Omphalocele. 4. Stomatitis.

Answer 49

1. Hypothermia in a neonate may be indicative of sepsis. TEST-TAKING TIP: Group B streptococci can seriously adversely affect neonates. In fact, group B strep has been called “the baby killer.” To prevent a severe infection from the bacteria, mothers are given intravenous antibiotics every 4 hours from admission, or from rupture of membranes, until delivery. A minimum of 2 doses is considered essential to protect the baby. Since this woman arrived only 2 hours prior to the delivery, there was not enough time for 2 doses to be administered.

Question 50

50. A baby in the newborn nursery was born to a mother with spontaneous rupture of membranes for 14 hours. The woman has Candida vaginitis. For which of the following should the baby be assessed? 1. Papular facial rash. 2. Thrush. 3. Fungal conjunctivitis. 4. Dehydration.

Answer 50

2. Thrush is commonly seen in babies whose mothers have Candida vaginitis. TEST-TAKING TIP: The test taker should be familiar with the various presentations of common fungi and bacteria. Candida is a fungus that is a normal vaginal flora. During pregnancy, it is not uncommon for the vaginal flora to shift and the woman to develop Candida vaginitis.

Question 51

51. A baby has been admitted to the neonatal nursery whose mother is hepatitis B–surface antigen positive. Which of the following actions by the nurse should be taken at this time? 1. Monitor the baby for signs of hepatitis B. 2. Place the baby on contact isolation. 3. Obtain an order for the hepatitis B vaccine and the immune globulin. 4. Advise the mother that breastfeeding is absolutely contraindicated.

Answer 51

3. Babies exposed to hepatitis B in utero should receive the first dose of hepatitis B vaccine as well as hepatitis B immune globulin (HBIG) within 12 hours of delivery to reduce transmission of the virus TEST-TAKING TIP: Although breastfeeding is contraindicated when a mother is HIV positive, hepatitis B transmission rates do not change significantly when a mother breastfeeds. The mother should, however, take care to prevent any cracking and bleeding from her breasts since the virus is bloodborne

Question 52

52. Four full-term babies were admitted to the neonatal nursery. The mothers of each of the babies had labors of 4 hours or less. The nursery nurse should carefully monitor which of the babies for hypothermia? 1. The baby whose mother cultured positive for group B strep during her third trimester. 2. The baby whose mother had gestational diabetes. 3. The baby whose mother was hospitalized for 3 months with complete placenta previa. 4. The baby whose mother previously had a stillbirth.

Answer 52

1. Group B streptococcus causes severe infections in the newborn. A sign of neonatal sepsis is hypothermia. TEST-TAKING TIP: It is important for the test taker not to confuse terms. Babies with neonatal sepsis often become hypothermic, while babies born to mothers with GDM become hypoglycemic. The two conditions are very different, although the prefix—hypo—is the same.

Question 53

53. Four 38-week-gestation gravidas have just delivered. Which of the babies should be monitored closely by the nurse for respiratory distress? 1. The baby whose mother has diabetes mellitus. 2. The baby whose mother has lung cancer. 3. The baby whose mother has hypothyroidism. 4. The baby whose mother has asthma.

Answer 53

1. The lung maturation of infants of diabetic mothers is often delayed. These babies must be monitored at birth for respiratory distress. TEST-TAKING TIP: Two answers to this question relate to maternal pulmonary diagnoses, i.e., lung cancer and asthma. Simply because a mother has a pulmonary problem does not mean, however, that her neonate will have a similar problem. Even if the neonate has respiratory distress, it may not be related to the mother’s problem. The test taker should not be swayed by this association. Babies born to diabetic mothers, however, are at risk for delayed lung maturation and should be monitored for respiratory distress.

Question 54

54. A client is seeking preconception counseling. She has type 1 diabetes mellitus and is found to have an elevated glycosylated hemoglobin (HgbA1c) level. Before actively trying to become pregnant, she is strongly encouraged to stabilize her blood glucose to reduce the possibility of her baby developing which of the following? 1. Port wine stain. 2. Cardiac defect. 3. Hip dysplasia. 4. Intussusception.

Answer 54

2. The incidence of cardiac defects and neural tube defects is high in infants born to diabetic mothers. TEST-TAKING TIP: The test taker should be familiar with maternal diseases that can seriously impact pregnancy. One of the most significant of the chronic diseases is diabetes. When a woman is in poor diabetic control during the first trimester, the incidence of birth defects is quite high.

Question 55

55. A baby is born with caudal agenesis. Which of the following maternal complications is associated with this defect? 1. Poorly controlled myasthenia gravis. 2. Poorly controlled diabetes mellitus. 3. Poorly controlled splenic syndrome. 4. Poorly controlled hypothyroidism

Answer 55

2. Poorly controlled maternal diabetes mellitus is one of the most important predisposing factors for caudal agenesis in the fetus. TEST-TAKING TIP: Women with diabetes must be in excellent glucose control before becoming pregnant. Because fetal deformities develop during the organogenic period in the first trimester, it is too late to educate diabetic women to control their disease when they are already pregnant.

Question 56

56. A macrosomic infant of a non–insulin dependent diabetic mother has been admitted to the neonatal nursery. The baby’s glucose level on admission to the nursery is 25 mg/dL and after a feeding of mother’s expressed breast milk is 35 mg/dL. Which of the following actions should the nurse take at this time? 1. Nothing because the glucose level is normal for an infant of a diabetic mother. 2. Administer intravenous glucagon slowly over five minutes. 3. Feed the baby a bottle of dextrose and water and reassess the glucose level. 4. Notify the neonatalogist of the abnormal glucose levels.

Answer 56

4. If the glucose level has not risen to normal as a result of the feeding, the nurse should notify the physician and anticipate that the doctor will order an intravenous of dextrose and water. TEST-TAKING TIP: The test taker should be aware that the normal glucose level of a neonate after delivery—40 mg/dL to 90 mg/L—is much lower than the adult normal of 60 to 110 mg/dL. Hypoglycemia is a common problem seen in infants, especially macrosomic infants and infants of diabetic mothers. Protocols to monitor for hypoglycemia in infants of diabetic mothers exist in all well-baby nurseries and NICUs

Question 57

57. A baby has just been born to a type 1 diabetic mother with retinopathy and nephropathy. Which of the following neonatal findings would the nurse expect to see? 1. Hyperalbuminemia. 2. Polycythemia. 3. Hypercalcemia. 4. Hypoinsulinemia

Answer 57

2. Because the placenta is likely to be functioning less than optimally, it is highly likely that the baby will be polycythemic. The increase in red blood cells would improve the baby’s oxygenation in utero. TEST-TAKING TIP: The test taker must be familiar with the pathology of diabetes and its effect on pregnancy. Although infants of diabetic mothers (IDMs) are usually macrosomic as a result of increased plasma glucose levels, when mothers have vascular damage, the placenta functions poorly. The IDM consequently may be small-for-gestational age with intrauterine growth restriction and polycythemia from the poor nourishment and oxygenation.

Question 58

58. A baby is born to a type 1 diabetic mother. Which of the following lab values would the nurse expect the neonate to exhibit? 1. Plasma glucose 30 mg/dL. 2. Red blood cell count 1 million/mm3. 3. White blood cell count 2000/mm3. 4. Hemoglobin 8 g/dL.

Answer 58

1. The nurse should anticipate that the plasma glucose levels would be low TEST-TAKING TIP: The fetus, responding to elevated glucose levels from the mother, produces large quantities of insulin. After the birth, however, the placenta no longer is providing the baby with the mother’s glucose. It takes the baby some time to adjust his or her extrauterine insulin production to be in synchrony with the sugars provided by the breast milk or formula feedings. Until the baby makes the adjustment, he or she will exhibit hypoglycemia (40 mg/dL).

Question 59

59. A baby has just been admitted into the neonatal intensive care unit with a diagnosis of intrauterine growth restriction (IUGR). Which of the following maternal factors would predispose the baby to this diagnosis? Select all that apply. 1. Hyperopia. 2. Gestational diabetes. 3. Substance abuse. 4. Chronic hypertension. 5. Advanced maternal age.

Answer 59

3, 4, and 5 are correct. 3. Placental function is affected by the vasoconstrictive properties of many illicit drugs, as well as by cigarette smoke. 4. Placental function is diminished in women who have chronic hypertension. 5. Placental function has been found to be diminished in women of advanced maternal age. TEST-TAKING TIP: The test taker should be reminded that any condition that inhibits the flow of blood, including illicit drug use, hypertension, cigarette smoking, and the like, can lead to fetal IUGR—that is, a fetus smaller than expected for the gestational period.

Question 60

60. A baby has been admitted to the neonatal intensive care unit with a diagnosis of symmetrical intrauterine growth restriction. Which of the following pregnancy complications would be consistent with this diagnosis? 1. Severe preeclampsia. 2. Chromosomal defect. 3. Infarcts in an aging placenta. 4. Premature rupture of the membranes.

Answer 60

2. Chromosomal abnormalities are associated with symmetrical IUGR. TEST-TAKING TIP: There is a distinct difference between symmetrical and asymmetrical IUGR. Babies with chromosomal defects often grow poorly from the time of conception. Their entire bodies, therefore, will grow poorly and will be small. Babies that are exposed to complications like preeclampsia or an aging placenta during the pregnancy will grow normally during the beginning of the pregnancy but start to grow poorly at the time of the insult. Their growth, therefore, will be disproportionally affected

Question 61

61. A neonate has intrauterine growth restriction secondary to placental insufficiency. Which of the following signs/symptoms should the nurse expect to observe at delivery? 1. Thrombocytopenia. 2. Neutropenia. 3. Polycythemia. 4. Hyperglycemia.

Answer 61

3. Babies who have lived in utero with an aging placenta usually are born with polycythemia. TEST-TAKING TIP: Even if the test taker were unfamiliar with the expected lab findings of a neonate that had been born after living with an aging placenta, deductive reasoning could assist the test taker to choose the correct response. Aging placentas function poorly, and therefore the fetuses receive less nutrition and oxygenation. The baby’s body, therefore, must compensate for the losses by metabolizing glycogen stores in the liver and producing increased numbers of red blood cells. The neonate, therefore, is often polycythemic and hypoglycemic.

Question 62

62. A woman is visiting the NICU to see her 26-week-gestation baby for the first time. Which of the following methods would the nurse expect the mother to use when first making physical contact with her baby? 1. Fingertip touch. 2. Palmar touch. 3. Kangaroo hold. 4. Cradle hold.

Answer 62

1. Most mothers, even those of full-term babies, usually use finger-tip touch during their first physical contact with their babies. TEST-TAKING TIP: The delivery of a preterm infant is very stressful and frightening. In fact, the appearance of the premature can be overwhelming to new parents. In order to become familiar with their baby, all parents proceed through a pattern of touch behaviors. When the baby is preterm, the procession through touch responses is often slowed.

Question 63

63. A 6-month-old child is being seen in the pediatrician’s office. The child was born preterm and remained in the neonatal intensive care unit for the first 5 months of life. The child is being monitored for 5 chronic problems. Which of the following problems are directly related to the prematurity? Select all that apply. 1. Bronchopulmonary dysplasia. 2. Cerebral palsy. 3. Retinopathy. 4. Hypothyroidism. 5. Seizure disorders.

Answer 63

1, 2, 3, and 5 are correct. 1. Bronchopulmonary dysplasia often is a consequence of the respiratory therapy that preemies receive in the NICU. 2. Cerebral palsy results from a hypoxic insult that likely occurred as a result of the baby’s prematurity. 3. Retinopathy of the premature is a disease resulting from the immaturity of the vascular system of the eye. 5. Seizure disorders can result either from a hypoxic insult to the brain or from a ventricular bleed. Both of these conditions likely occurred as a result of the prematurity. TEST-TAKING TIP: Many parents are of the opinion that babies, even when born many weeks prematurely, will be healthy as they mature because there are so many machines and medications that can be given to the babies. Unfortunately, many babies suffer chronic problems as a result of their prematurity even when they receive excellent medical and nursing care

Question 64

64. A neonatalogist prescribes Garamycin (gentamicin) for a 2-day-old, septic preterm infant who weighs 1653 grams and is 38 centimeters long. The drug reference states: Neonatal dosage of Garamycin for babies less than 1 week of age is 2.5 mg/kg q 12–24 hours. Calculate the safe daily dosage of this medication. \_\_\_\_\_\_\_\_\_\_\_\_\_ mg q 24 hours.

Answer 64

4.13 mg q 24 hours The formula for calculating the safe dosage (per weight) is: Known dosage Needed dosage 1 kg Weight of the child in kg 2.5 mg x mg 1 kg 1.653 kg x 4.13 mg q 24 hours TEST-TAKING TIP: When calculating the safe dosage of a medication for a child, the test taker must first note whether the recommended dosage for the medication is written per kg or per meters squared. If the dosage is written per kg, then the denominator of the ratio and proportion equation is in kg. If the dosage is written per m2, the denominator of the ratio and proportion equation is in m2.

Question 65

65. The neonatalogist has ordered 12.5 micrograms of digoxin po for a neonate in congestive heart failure. The medication is available in the following elixir— 0.05 mg/mL. How many milliliters (mL) should the nurse administer? \_\_\_\_\_\_\_\_\_\_\_\_\_ mL.

Answer 65

0.25 mL 0.05 mg/mL 12.5 microgram/x mL (0.05 mg 50 microgram) 50/1 12.5/x 50 x 12.5 x 0.25 mL TEST-TAKING TIP: Digoxin is administered in very small dosages to infants and neonates. If the nurse calculates a quantity that is larger than 1 mL, it is very likely that the calculation is incorrect. The nurse should recalculate the quantity and, for safety safe, ask another nurse to check the arithmetic.

Question 66

66. A neonatalogist prescribes Platinol-AQ (cisplatin) for a neonate born with a neuroblastoma. The baby’s current weight is 3476 grams and the baby is 57 centimeters long. The drug reference states: Children: IV 30 mg/m2 q week. Calculate the safe dosage of this medication. \_\_\_\_\_\_\_\_\_\_\_\_ mg q week.

Answer 66

6.9 mg q week The formula for calculating the safe dosage per body surface area in meters squared is: Known dosage Needed dosage 1 m2 Body surface area of the child To calculate the body surface area for this baby the test taker must take the square root of the product of the baby’s weight times its length. 3.476 57 0.23 m2 3600 Then, to calculate the safe dosage, a ratio and proportion equation must be solved. 30 mg x mg 1 m2 0.23 m2 x 6.9 mg q week TEST-TAKING TIP: When calculating a safe dosage for a child using the body surface area formula, it is important for the test taker to note whether the child’s statistics are written in the metric system or the English system. If in the metric system, the divisor for the formula is 3600. If the statistics are in the English system, however, the divisor is 3131. And it is important for the test taker to remember to take the square root of the calculation. It is very easy to forget that step.

Question 67

67. A preterm baby is to receive 4 mg Garamycin (gentamicin) IV every 24 hours. The medication is being injected into an IV soluset. A total of 5 cc is to be administered via IV pump over 90 minutes. The pump should be set at what rate? \_\_\_\_\_\_\_\_\_\_\_\_\_ mL/hr.

Answer 67

3.33 mL/hr 5 mL/90 min 5 mL/1.5 hours 3.33 mL/hr TEST-TAKING TIP: Whenever a pump is used to deliver intravenous fluids, the rate should be set in mL/hr units. Pumps should always be used to deliver IV fluids to preterm neonates since, because of their small size, they can so easily become fluid overloaded.

Question 68

68. A mother of a preterm baby is performing kangaroo care in the neonatal nursery. Which of the following responses would the nurse evaluate as a positive neonatal outcome? 1. Respiratory rate of 70. 2. Temperature of 97.0ºF. 3. Licking the mother’s nipples. 4. Flaring of the baby’s nares.

Answer 68

3. The baby is showing signs of interest in breastfeeding. This is a positive sign. TEST-TAKING TIP: Kangaroo care, when mothers hold their babies skin-to-skin, is a technique that has been shown to benefit preterm infants. The vital signs of babies who kangaroo with their mothers have been shown to stabilize more quickly. The babies also have been shown to nipple feed earlier and to have shorter lengths of stay in the NICUs.

Question 69

69. A neonate is being assessed for necrotizing enterocolitis (NEC). Which of the following actions by the nurse is appropriate? Select all that apply. 1. Perform hemoccult test on stools. 2. Monitor for an increase in abdominal girth. 3. Measure gastric contents before each feed. 4. Assess bowel sounds before each feed. 5. Assess for anal fissures daily.

Answer 69

1, 2, 3, and 4 are correct. 1. Babies with necrotizing enterocolitis (NEC) have blood in their stools. 2. The abdominal girth measurements of babies with NEC increase. 3. When babies have NEC, they have increasingly larger undigested gastric contents after feeds. 4. The neonates’ bowel sounds are diminished with NEC. TEST-TAKING TIP: NEC is an acute inflammatory disorder seen in preterm babies. It appears to be related to the shunting of blood from the gastrointestinal tract, which is not a vital organ system, to the vital organs. The baby’s bowel necroses with the shunting and the baby’s once normal flora become pathological. Resection of the bowel is often necessary.

Question 70

70. A woman whose 32-week-gestation neonate is to begin oral feedings is expressing breast milk (EBM) for the baby. The neonatalogist is recommending that fortifier be added to the milk because which of the following needs of the baby are not met by EBM? 1. Need for iron and zinc. 2. Need for calcium and phosphorus. 3. Need for protein and fat. 4. Need for sodium and potassium.

Answer 70

2. Calcium and phosphorus in EBM are in quantities that are less than body requirements for the very low birth weight baby. Therefore, a fortifier may need to be added to the EBM. TEST-TAKING TIP: Premature babies who are breastfed have fewer complications than bottlefed babies, especially necrotizing enterocolitis. Unfortunately, very low birth weight babies do not receive sufficient quantities of calcium and phosphorus from the EBM. The breast milk, then, is enriched with a milk fortifier that contains the needed elements

Question 71

``` 71. A 1000-gram neonate is being admitted to the neonatal intensive care unit. The surfactant Survanta (beractant) has just been prescribed to prevent respiratory distress syndrome. Which of the following actions should the nurse take while administering this medication? 1. Flush the intravenous line with normal saline solution. 2. Assist the neonatalogist during the intubation procedure. 3. Inject the medication deep into the vastus lateralis muscle. 4. Administer the reconstituted liquid via an oral syringe. ```

Answer 71

2. Surfactant is administered intratracheally. The baby must first be intubated. The nurse would assist the doctor with the procedure. TEST-TAKING TIP: Surfactant is a slippery substance that is needed to prevent the alveoli from collapsing during expiration. It is prescribed for preterm babies who are so immature that they do not produce sufficient quantities of the substance in their lung fields. The medication is used to prevent and/or to treat respiratory distress syndrome (RDS).

Question 72

72. A 30-week-gestation neonate, 2 hours old, has received Survanta (beractant). Which of the following would indicate a positive response to the medication? 1. Axillary temperature 98.0ºF. 2. Oxygen saturation 96%. 3. Apical heart rate 154 bpm. 4. Serum potassium 4.0 mEq/L.

Answer 72

2. A normal oxygen saturation level would be considered a positive result of the medication TEST-TAKING TIP: The medication is given to provide the baby with lung surfactant. The drug is given to treat RDS. When preterm babies have RDS, they are having respiratory difficulty that leads to poor gas exchange. When there is poor gas exchange, the oxygen saturation drops. A normal O2 saturation level,which is 96%, therefore, indicates a positive outcome.

Question 73

73. For which of the following reasons would a nurse in the well baby nursery report to the neonatalogist that a newborn appears to be preterm? 1. Baby has a square window angle of 90º. 2. Baby has leathery and cracked skin. 3. Baby has popliteal angle of 90º. 4. Baby has pronounced plantar creases.

Answer 73

1. A baby whose square window sign is 90° is preterm TEST-TAKING TIP: A number of neonatal characteristics are assessed to determine the gestational age of a neonate. Four of those characteristics are square window sign, appearance of the skin, popliteal angle, and presence of plantar creases. The test taker should be familiar with the Ballard Scale and the many characteristics on which gestational age is measured.

Question 74

74. A full-term neonate in the NICU has been diagnosed with congestive heart failure secondary to a cyanotic heart defect. Which of the following activities is most likely to result in a cyanotic episode? 1. Feeding. 2. Sleeping in the supine position. 3. Rocking in an infant swing. 4. Swaddling.

Answer 74

1. Babies who have cardiac defects frequently feed poorly. And when they do feed, they frequently become cyanotic. TEST-TAKING TIP: Any activity that requires an increased oxygen demand can trigger a cyanotic spell in a neonate with a heart defect. The two activities that require the greatest amount of oxygen and energy are feeding and crying. In fact, because feeding demands that the baby be able to suck, swallow, and breathe rhythmically and without difficulty, many sick babies refuse to eat because it is such a demanding activity.

Question 75

75. The nurse is providing discharge teaching to the parents of a baby born with a cleft lip and palate. Which of the following should be included in the teaching? 1. Correct technique for the administration of a gastrostomy feeding. 2. Need to watch for the appearance of blood-stained mucus from the nose. 3. Optimal position for burping after nasogastric feedings. 4. Need to give the baby sufficient time to rest during each feeding.

Answer 75

4. Cleft lip and palate babies require additional time to rest as well as to suck and swallow when being fed. TEST-TAKING TIP: Although cleft lips and palates do impact feeding, virtually all of the affected babies are able to feed orally and some are even able to breastfeed. But, feeding from a standard bottle and/or breastfeeding may prove to be impossible for some babies with clefts and/or palates. In those cases, there are a number of bottles that have been designed to facilitate their feeding so that neither gastrostomy tubes nor nasogastric tubes are needed. The Haberman feeder is one example. Either expressed breast milk or formula can be put in the feeder

Question 76

76. A baby is suspected of having esophageal atresia. The nurse would expect to see which of the following signs/symptoms? 1. Frequent vomiting. 2. Excessive mucus. 3. Ruddy complexion. 4. Abdominal distention

Answer 76

2. Babies with esophageal atresia would be expected to expel large amounts of mucus from the mouth TEST-TAKING TIP: With esophageal atresia, the esophagus ends in a blind pouch. In addition, there is usually a fistula connecting the stomach to the trachea. These babies are at high risk for respiratory compromise because they can aspirate the large quantity of oral mucus. The neonatalogist should be notified whenever esophageal atresia is suspected.

Question 77

77. The nurse is teaching a couple about the special health care needs of their newborn child with Down syndrome. The nurse knows that the teaching was successful when the parents state that the child will need which of the following? 1. Yearly three-hour glucose tolerance testing. 2. Immediate intervention during bleeding episodes. 3. A formula that is low in lactose and phenylalanine. 4. Prompt treatment of upper respiratory infections.

Answer 77

4. Because of the hypotonia of the respiratory accessory muscles, Down babies often need medical intervention when they have respiratory infections. TEST-TAKING TIP: Down syndrome babies not only have a characteristic appearance but also have physiological characteristics that the nurse must be familiar with. One of those characteristics is hypotonia. Because of this problem, Down babies are often difficult to feed during the neonatal period, have delayed growth and development, and have difficulty fighting upper respiratory illnesses.

Question 78

78. An infant in the neonatal nursery has low set ears, Simian creases, and slanted eyes. The nurse should monitor this infant carefully for which of the following signs/symptoms? 1. Blood-tinged urine. 2. Hemispheric paralysis. 3. Cardiac murmur. 4. Hemolytic jaundice.

Answer 78

3. Cardiac anomalies occur much more frequently in Down babies than in other babies. TEST-TAKING TIP: Babies with Down syndrome have the following characteristic anomalies: low set ears, simian creases, and slanted eyes. Because they are at high risk for internal anomalies as well, in particular cardiac defects, the nurse should carefully evaluate the baby for a heart murmur.

Question 79

79. Which of the following actions would the NICU nurse expect to perform when caring for a neonate with esophageal atresia and tracheoesophageal fistula (TEF)? 1. Position the baby flat on the left side. 2. Maintain low nasogastric suction. 3. Give small frequent feedings. 4. Place on hypothermia blanket.

Answer 79

2. Low nasogastric suction is usually maintained to minimize the amount of the baby’s oral secretions. TEST-TAKING TIP: Because TEF babies’ esophagi end in a blind pouch, they excrete large quantities of mucus from their mouths, placing them at high risk for aspiration. To decrease the potential for respiratory insult until surgery can take place, nasogastric suctioning is started and the babies’ heads are elevated

Question 80

80. A nurse is assisting a mother to feed a baby born with cleft lip and palate. Which of the following should the nurse teach the mother? 1. The baby is likely to cry from pain during the feeding. 2. The baby is likely to expel milk through the nose. 3. The baby will feed more quickly than other babies. 4. The baby will need milk with added calories.

Answer 80

2. It is likely that milk will be expelled from the baby’s nose during feedings TEST-TAKING TIP: This question asks about the feeding of a baby with a cleft palate. Although the lip is intact, a cleft in the palate means that there is direct communication between the mouth and the sinuses. Because of the opening, milk is often expelled from the nose. Plus, the milk frequently enters the eustachian tubes. These babies, therefore, are at high risk for ear infections.

Question 81

81. A neonate that is admitted to the neonatal nursery is noted to have a 2-vessel cord. The nurse notifies the neonatalogist to get an order for which of the following assessments? 1. Renal function tests. 2. Echocardiogram. 3. Glucose tolerance test. 4. Electroencephalogram

Answer 81

1. Babies with 2-vessel cords are at high risk for renal defects. TEST-TAKING TIP: The umbilical cord is developed in fetal life at approximately the same time as the renal system. Because of this fact, when a defect is seen in the umbilical cord, there may also be a defect in the renal system.

Question 82

82. In the delivery room, which of the following infant care interventions must a nurse perform when a neonate with a meningomyelocele is born? 1. Perform nasogastric suctioning. 2. Place baby in the prone position. 3. Administer oxygen via face mask. 4. Swaddle the baby in warm blankets.

Answer 82

2. The baby should be lain prone to prevent injury to the sac. TEST-TAKING TIP: The baby with meningomyelocele is born with an opening at the base of the spine through which a sac protrudes. The sac contains cerebral spinal fluid and nerve endings from the spinal cord. It is essential that the nurse not injure the sac; therefore, the baby should be placed in a prone position immediately after birth.

Question 83

83. A baby in the NICU, who is exhibiting signs of congestive heart failure from an atrioventricular canal defect, is receiving a diuretic. In the plan of care, the nurse should include that the desired outcome for the child will be which of the following? 1. Loss of body weight. 2. Drop in serum sodium level. 3. Rise in urine specific gravity. 4. Increase in blood pressure.

Answer 83

1. A diuretic will increase urinary output which in turn will lead to weight loss TEST-TAKING TIP: The heart is pumping inefficiently when a baby has congestive heart failure. Because of this pathology, the kidneys are poorly perfused leading to fluid retention and weight gain. Diuretics are administered to improve the excretion of the fluid. When the urinary output is increased, the weight will drop and the urine will be less concentrated.

Question 84

84. The nurse caring for a neonate with congestive heart failure identifies which of the following nursing diagnoses as highest priority? 1. Fatigue. 2. Activity intolerance. 3. Sleep pattern disturbance. 4. Altered tissue perfusion.

Answer 84

4. Altered tissue perfusion is the priority diagnosis. TEST-TAKING TIP: Whenever the test taker is asked to identify the priority response, it is important to remember the hierarchy of needs. Respiratory issues almost always take precedence. Although the answer to this question does not refer to the respiratory system, it does relate to the oxygenation of the tissues. None of the other responses relates to critical physiological processes.

Question 85

85. The nurse administers Lanoxin (digoxin) to a baby in the NICU that has a cardiac defect. The baby vomits shortly after receiving the medication. Which of the following actions should the nurse perform next? 1. Give a repeat dose. 2. Notify the physician. 3. Assess the apical and brachial pulses concurrently. 4. Check the vomitus for streaks of blood.

Answer 85

2. The nurse should notify the physician that the baby has vomited the digoxin TEST-TAKING TIP: Vomiting is a sign of digoxin toxicity. This baby needs to have a digoxin level drawn. Because the nurse needs an order for the test, the nurse must notify the doctor of the problem.

Question 86

86. A baby is born with a meningomyelocele at L2. In assessing the baby, which of the following would the nurse expect to see? 1. Sensory loss in all four extremities. 2. Tuft of hair over the lumbosacral region. 3. Flaccid paralysis of the legs. 4. Positive Moro reflex.

Answer 86

3. With a defect at L2, the nurse would expect to see paralysis of the legs. TEST-TAKING TIP: If the test taker remembers that a sac with cerebral spinal fluid and nerves is seen at the base of the spine in a baby with myelomeningocele and that L2 innervates the motor nerves of the legs, the answer becomes obvious. This is an example of the importance of carefully studying normal anatomy and physiology and the pathophysiology of important diseases

Question 87

87. When examining a nenonate in the well-baby nursery, the nurse notes that the sclerae of both of the baby’s eyes is visible above the iris of the eyes. Which of the following assessments is highest priority for the nurse to make next? 1. Babinski and tonic neck reflexes. 2. Evaluation of bilateral eye coordination. 3. Blood type and Coombs’ test results. 4. Circumferences of the head and chest

Answer 87

4. The baby should be assessed for signs of hydrocephalus, especially a disparity between the circumferences of the neonatal head and the neonatal chest. TEST-TAKING TIP: Setting sun sign— when the sclera of the eye is visible above the iris of the eye—is one sign of hydrocephalus. An additional indication of hydrocephalus would be if the head circumference of the baby were found to be greater than 2 cm larger than the baby’s chest circumference.

Question 88

88. A baby is born with a suspected coarctation of the aorta. Which of the following assessments should be done by the nurse? 1. Check blood pressures in all four limbs. 2. Palpate the anterior fontanel for bulging. 3. Assess hematocrit and hemoglobin values. 4. Monitor for harlequin color changes.

Answer 88

1. The blood pressures in all four quadrants should be assessed TEST-TAKING TIP: The pathophysiology of coarctation of the aorta provides the rationale for the assessment of the blood pressures. Since the narrowing of the aorta is usually distal to the ascending aorta, blood is able to pass unimpeded into the upper body but is unable to pass through the descending aorta toward the lower body. The blood pressures of the upper body, therefore, are much higher than the blood pressures in the lower extremities.

Question 89

89. The nurse is developing a teaching plan for parents of an infant with a tetralogy of Fallot. Which of the following positions should parents be taught to place the infant during a “blue,” or “tet,” spell? 1. Supine. 2. Prone. 3. Knee-chest. 4. Semi-Fowler’s

Answer 89

3. Parents should place an infant during a “tet” spell into the knee-chest position. TEST-TAKING TIP: The four defects that are present in tetralogy of Fallot— ventricular septal defect, overriding aorta, pulmonary stenosis, and hypertrophied right ventricle—create a circulatory system in which much of the blood bypasses the lungs. As a result, a baby with tetralogy is predisposed to cyanotic, or “tet,” spells. When a baby is placed in a squatting or knee-chest position, the femoral arteries are constricted, decreasing the amount of blood perfusing the lower body. This leads to improved perfusion to the upper body and the vital organs. With this action, the cyanotic spell will likely resolve.

Question 90

90. A child has been diagnosed with a small ventricular septal defect (VSD). Which of the following symptoms would the nurse expect to see? 1. Cyanosis and clubbing of the fingers. 2. Respiratory distress and extreme fatigue. 3. Systolic murmur with no other obvious symptoms. 4. Feeding difficulties with marked polycythemia.

Answer 90

3. This response is correct TEST-TAKING TIP: The VSD—an opening between the ventricles of the heart—is the most common acyanotic heart defect seen. The defect leads to a left-to-right shunt since the left side of the heart is more powerful than the right side of the heart, causing a murmur. Small VSDs rarely result in severe symptoms and, in fact, often close over time without any treatment.

Question 91

91. A newborn in the NICU has just had a ventriculoperitoneal shunt inserted. Which of the following signs indicates that the shunt is functioning properly? 1. Decrease of the baby’s head circumference. 2. Absence of cardiac arrhythmias. 3. Rise of the baby’s blood pressure. 4. Appearance of setting sun sign.

Answer 91

1. Ventriculoperitoneal (VP) shunts are inserted for the treatment of hydrocephalus. A positive finding, therefore, would be decreasing head circumferences. TEST-TAKING TIP: One of the first signs of hydrocephalus in the neonate is increasing head circumferences because, since the fetal head is unfused, excess fluid in the brain forces the skull to expand. Once the diagnosis of hydrocephalus has been made, a ventriculoperitoneal (VP) shunt is usually inserted. The shunt is designed to remove excess cerebral spinal fluid from the ventricles of the brain. With the reduction in fluid, the size of the baby’s head decreases.

Question 92

92. A neonate has just been born with a meningomyelocele. Which of the following nursing diagnoses should the nurse identify as related to this medical diagnosis? 1. Deficient fluid volume. 2. High risk for infection. 3. Ineffective breathing pattern. 4. Imbalanced nutrition: less than body requirements.

Answer 92

2. If the fragile sac is injured, the baby is very high risk for infection. TEST-TAKING TIP: Babies with meningomyelocele, a form of spina bifida, are at very high risk for infection in the central nervous system until the defect is corrected. In addition, the vast majority of babies with myelomeningocele also have hydrocephalus for which they will receive a VP shunt. Plus, the most common problem associated with VP shunts is infection. Nurses, therefore, must care for these affected babies using strict aseptic technique.

Question 93

93. The neonatalogist assesses a newborn for Hirschsprung’s disease after the baby exhibited which of the following signs/symptoms? 1. Passed meconium at 50 hours of age. 2. Apical heart rate of 200 beats per minute. 3. Maculopapular rash. 4. Asymmetrical leg folds.

Answer 93

1. Babies who have delayed meconium excretion may have Hirshsprung’s disease. TEST-TAKING TIP: Hirshsprung’s disease is defined as a congenital lack of parasympathetic innervation to the distal colon. Peristalsis, therefore, ceases at the end of the intestine. Because of the absence of peristalsis, the passage of meconium is delayed

Question 94

94. The nurse assessed four newborns admitted to the neonatal nursery and called the neonatalogist for a consult on the baby who exhibited which of the following? 1. Excessive amounts of frothy saliva from the mouth. 2. Blood-tinged discharge from the vaginal canal. 3. Secretion of a milk-like substance from both breasts. 4. Heart rate that sped during inhalation and slowed with exhalation

Answer 94

1. Excessive amounts of frothy saliva may indicate that the child has esophageal atresia. TEST-TAKING TIP: If the test taker is familiar with the characteristics of the normal neonate, the answer to this question is obvious. A baby whose esophagus ends in a blind pouch is unable to swallow his or her saliva. Instead, the mucus bubbles and drools from the mouth. Healthy babies, on the other hand, swallow without difficulty.

Question 95

95. The nurse is caring for a baby diagnosed with developmental dysplasia of the hip (DDH). Which of the following therapeutic interventions should the nurse expect to perform? 1. Place the baby’s legs in abduction. 2. External rotation of the baby’s hips. 3. Assist with bilateral leg casting. 4. Monitor pedal pulses bilaterally

Answer 95

1. To treat developmental dysplasia of the hip, babies’ legs are maintained in a state of abduction. TEST-TAKING TIP: Since the pathology of DDH is related to the laxity of the hip joint, the rationale for the therapy is to maintain physiological positioning of the hip joint until the ligaments strengthen and mature. Keeping the legs in a state of abduction, the hip joint is maintained with the trochanter centered in the acetabulum.

Question 96

96. A baby has been diagnosed with developmental dysplasia of the hip. Which of the following findings would the nurse expect to see? 1. Pronounced hip abduction. 2. Swelling at the site. 3. Asymmetrical leg folds. 4. Weak femoral pulses.

Answer 96

3. The leg folds of the baby, both anteriorally and posteriorly, are frequently asymmetrical. TEST-TAKING TIP: Because of the subluxation of the hip, the gluteal and thigh folds of the baby usually appear asymmetrical. In addition to this finding, the nurse would expect to see reduced abduction of the hip and/or asymmetrical knee heights when the legs are flexed.

Question 97

97. The nurse suspects that a newborn in the nursery has a clubbed right foot because the foot is plantar flexed and because the nurse also notices which of the following? 1. Inability to move the foot into proper alignment. 2. Notes positive Ortolani sign on the right. 3. Notes shortened right metatarsal arch. 4. Elicits positive Babinski reflex on the right

Answer 97

1. During the neonatal physical assessment, the nurse is unable to move a club foot into proper alignment TEST-TAKING TIP: The most common form of clubfoot is talipes equinovarus, when the baby’s foot is in a state of inversion and plantar flexion. It is important for the nurse to distinguish between positional clubfoot that occurs from the baby’s position in utero and resolves spontaneously, and pathology that requires orthopedic therapy.

Question 98

98. The parents of a baby born with bilateral talipes equinovarus ask the nurse what medical care the baby will likely need. Which of the following should the nurse tell the parents? 1. Need a series of leg casts until the correction is accomplished. 2. Have a Harrington rod inserted when the child is about three years old. 3. Have a Pavlik harness fitted before discharge from the nursery. 4. Need to wear braces on both legs until the child begins to walk.

Answer 98

1. The initial treatment plan for clubfoot usually includes a series of casts that slowly move the foot into proper alignment. TEST-TAKING TIP: This is an example of a question that may include a term that the test taker is unfamiliar with. If the test taker slowly breaks down the words into their component parts, the meaning of the term will become clear. The word “bilateral,” of course, means that “both sides” of the body are affected. The word “talipes” is a word that contains two roots: talis, meaning “ankle” and pes, meaning “foot.” The word, therefore, refers to a deformity of the foot and ankle—clubfoot. The term “equinovarus” specifically defines the type of clubfoot but, since the therapy is the same no matter which type of clubfoot the child suffers from, further analysis is not necessary to answer this question. (Talipes equinovarus clubfoot refers to a foot that is plantar flexed and turned inward.)

Question 99

99. The nurse caring for an infant with a congenital cardiac defect is monitoring the child for which of the following early signs of congestive heart failure? 1. Hypertension, cyanosis, bradycardia. 2. Irritability, hypotension, palpitations. 3. Tachypnea, tachycardia, diaphoresis. 4. Angina, oliguria, dysrhythmias.

Answer 99

3. No matter whether a baby or an adult is developing CHF, the early signs that the nurse would note are tachypnea, tachycardia, and diaphoresis. TEST-TAKING TIP: The term that is most descriptive in the phrase congestive heart failure is the word failure. If the test taker remembers that, because of poor functioning, the heart is failing to oxygenate the body effectively, the test taker can remember the symptoms of the disease. When the body is being starved of oxygen, the body compensates by increasing respirations to take in more oxygen and the pulse rate speeds up to move the oxygenated blood more quickly through the body. Sweating is also a component of the early stages of the disease.

Question 100

100. The nurse assessed four newborns in the neonatal nursery. The nurse called the neonatalogist for a cardiology consult on the baby who exhibited which of the following signs/symptoms? 1. Setting sun sign. 2. Anasarca. 3. Flaccid extremities. 4. Polydactyly

Answer 100

2. Anasarca refers to overall, systemic edema. It is seen is severe cardiovascular disease. A cardiac consult would be appropriate for this baby as would, perhaps, a renal consult. TEST-TAKING TIP: Although each of the answer options is abnormal, there is only one option that describes a symptom of a cardiac disease. The test taker must carefully discern what is being asked in each question in order to choose the one answer that relates specifically to the stem.

Question 101

101. A preterm infant has a patent ductus arteriosus (PDA). Which of the following explanations should the nurse give to the parents about the condition? 1. Hole has developed between the left and right ventricles. 2. Hypoxemia occurs as a result of the poor systemic circulation. 3. Oxygenated blood is reentering the pulmonary system. 4. Blood is shunting from the right side of the heart to the left.

Answer 101

3. There is a left to right shunt of blood with a patent ductus arteriosus (PDA) resulting in oxygenated blood reentering the pulmonary system. TEST-TAKING TIP: The ductus arteriosus is a fetal circulatory duct that connects the pulmonary artery with the aorta. In utero, the blood is being oxygenated through the placenta precluding the need for the blood to enter the lungs. In extrauterine life, however, the duct should close in order to create a one-way, intact system. When a ductus arteriosus stays open, a left to right shunt develops (because the left side of the heart is stronger than the right side of the heart) forcing the blood to reenter the lungs.

Question 102

102. A nurse hears a heart murmur on a full-term neonate in the well baby nursery. The baby’s color is pink while at rest and while feeding. The baby most likely has which of the following cardiac defects? 1. Transposition of the great vessels. 2. Tetralogy of Fallot. 3. Pulmonic stenosis. 4. Patent ductus arteriosus.

Answer 102

4. Patent ductus arteriosus (PDA) is a very common cardiac defect in preterm babies. It is an acyanotic defect with a left to right shunt. Already oxygenated blood reenters the pulmonary system. TEST-TAKING TIP: The names of cardiac defects are very descriptive. Once the test taker remembers the pathophysiology of each of the defects, it becomes clear how the blood flow is affected. Of the choices in this question, the only defect that is an acyanotic defect, i.e., a defect that allows blood to enter the lungs to be oxygenated, is the PDA

Question 103

103. Four babies are born with distinctive skin markings. Identify which marking matches its description: 1. Café au lait spot A. Raised, blood vessel-filled tumor. 2. Hemangioma B. Flat, sharply demarcated red-to-purple lesion. 3. Mongolian spots C. Multiple grayish blue hyperpigmented skin areas. 4. Port wine stain D. Pale tan- to coffee-colored marking.

Answer 103

The term in column 1 is matched to the description in column 2. 1. Café au lait spot matches with D. A café au lait spot is a pale tan to coffee- colored skin marking. 2. Hemangioma matches with A. A hemangioma is a raised blood vessel–filled lesion. 3. Mongolian spot matches with C. Mongolian spots are multiple grayish blue hyperpigmented skin areas. 4. Port wine stain matches with B. A port wine stain is a flat, sharply demarcated red-to-purple lesion. TEST-TAKING TIP: This is simply a matching question. The test taker is asked to match the lesion that is seen in neonates with the description of the lesion. In the NCLEX-RN, this would be a drag and drop type of question. The test taker will be asked to drag the corresponding definition and drop it next to the name of the lesion.

Question 104

104. A baby, admitted to the nursery, was diagnosed with galactosemia from an amniocentesis. Which of the following actions must the nurse take? 1. Feed the baby a specialty formula. 2. Monitor the baby for central cyanosis. 3. Do hemoccult testing on every stool. 4. Monitor baby for signs of abdominal pain.

Answer 104

1. Galactosemia is one of the few diseases that is a contraindication for the intake of breast milk or any milkbased formula TEST-TAKING TIP: There are many genetic metabolic diseases that may affect the neonate. Galactosemia, an autosomal recessive disease, is characterized by an inability to digest galactose, a by-product of lactose digestion. Since breast milk and milk-based formulas are very high in lactose, affected babies must be switched to a soy-based formula.

Question 105

105. On admission to the nursery, a baby’s head and chest circumferences are 39 cm and 32 cm, respectively. Which of the following actions should the nurse take next? 1. Assess the anterior fontanel. 2. Measure the abdominal girth. 3. Check the apical pulse rate. 4. Monitor the respiratory effort.

Answer 105

1. Because the head circumference is significantly larger than the chest circumference, the nurse should assess for another sign of hydrocephalus. A markedly enlarged or bulging fontanel is one of those signs. TEST-TAKING TIP: The test taker must remember that the head circumference should be approximately 2 cm larger than the chest circumference at birth. When the head circumference is markedly larger than expected, there is a possibility of hydrocephalus. The nurse should assess for other signs of the problem like enlarged fontanel size, setting sun sign, and bulging fontanels.

Question 106

106. A neonate is found to have choanal atresia on admission to the nursery. Which of the following physiological actions will be hampered by this diagnosis? 1. Feeding. 2. Digestion. 3. Immune response. 4. Glomerular filtration.

Answer 106

1. Choanal atresia will impact the baby’s ability to feed. TEST-TAKING TIP: Choanal atresia, a congenital narrowing of the nasal passages, seriously affects babies’ ability to feed. Babies are obligate nose breathers to enable them to suck-swallow-breathe in a rhythmic manner during feeding. If their nares are blocked, they are unable to breathe through their noses and, therefore, must stop feeding in order to breathe.

Question 107

107. A baby is born to a mother who was diagnosed with oligohydramnios during her pregnancy. The nurse notifies the neonatalogist to order tests to assess the functioning of which of the following systems? 1. Gastrointestinal. 2. Hepatic. 3. Endocrine. 4. Renal

Answer 107

4. Some defects of the renal system can lead to oligohydramnios. TEST-TAKING TIP: The test taker must remember that most of the amniotic fluid produced during a pregnancy is produced by the fetal kidneys and is fetal urine. If there is a defect in the renal system, there may be a resulting decrease in the amount of fetal urine produced. Oligohydramnios would then result.

Question 108

108. A baby is born with esophageal atresia and tracheoesophageal fistula. Which of the following complications of pregnancy would the nurse expect to note in the mother’s history? 1. Preeclampsia. 2. Idiopathic thrombocytopenia. 3. Polyhydramnios. 4. Severe iron deficiency anemia

Answer 108

3. Polyhydramnios is often seen in pregnancies complicated by a fetus with a digestive blockage TEST-TAKING TIP: Babies swallow amniotic fluid in utero. When there is a blockage in the digestive system, they are unable to swallow the fluid. The fluid builds up in the uterus and polyhydramnios is noted.

Question 109

109. A baby is born with a diaphragmatic hernia. Which of the following signs/symptoms would the nurse observe in the delivery room? 1. Projectile vomiting. 2. High-pitched crying. 3. Respiratory distress. 4. Fecal incontinence

Answer 109

3. The baby will develop respiratory distress very shortly after delivery. TEST-TAKING TIP: Abdominal organs are displaced into the thoracic cavity when a baby is born with a diaphragmatic hernia. Because of the defect, the respiratory tree does not develop completely. The newly delivered baby, therefore, is unable to breathe effectively.

Question 110

110. A woman, who has recently received Demerol (meperidine) 100 mg IM for labor pain, is about to deliver. Which of the following medications is highest priority for the nurse to prepare in case it must be administered to the baby following the delivery? 1. Oxytocin (Pitocin). 2. Xylocaine (Lidocaine). 3. Naloxone (Narcan). 4. Butorphanol (Stadol).

Answer 110

3. Narcan is an opiate antagonist. It may be administered to a depressed baby at delivery TEST-TAKING TIP: It is important for the nurse to anticipate the needs of his or her clients. In this situation, since the mother has recently received an opioid analgesic, it is possible that the baby will experience central nervous system depression. In anticipation of this problem, the nurse, then, should have the opioid antagonist available for administration if the neonatalogist should order it.

Question 111

111. A newborn in the well baby nursery is noted to have a chignon. The nurse concludes that the baby was born via which of the following methods? 1. Cesarean section. 2. High forceps delivery. 3. Low forceps delivery. 4. Vacuum extraction.

Answer 111

4. Babies born via vacuum extraction often do develop chignons. TEST-TAKING TIP: In common language, a chignon is a hairstyle that is characterized by a bun or knot of hair worn on the back of the head or nape of the neck. In obstetrics, a chignon is a round, bruised caput seen on the crown of the baby’s head. It results from the pressure exerted on the scalp during a vacuumassisted delivery.

Question 112

112. A baby born by vacuum extraction has been admitted to the well baby nursery. The nurse should assess this baby for which of the following? 1. Pedal abrasions. 2. Hypobilirubinemia. 3. Hyperglycemia. 4. Cephalhematoma.

Answer 112

4. Babies born via vacuum are at high risk for cephalhematoma. TEST-TAKING TIP: Babies born either via vacuum or via forceps are at high risk for cephalhematoma, as well as subdural hematoma. During mechanically assisted births, there often is trauma to the neonate’s head and scalp. A cephalhematoma develops as a result of injury to superficial blood vessels. The blood loss accumulates in the subcutaneous space above the periosteum. The test taker should remember that babies born with cephalhematomas are at high risk for hyperbilirubinemia.

Question 113

113. A macrosomic baby in the nursery is suspected of having a fractured clavicle from a traumatic delivery. Which of the following signs/symptoms would the nurse expect to see? Select all that apply. 1. Pain with movement. 2. Hard lump at the fracture site. 3. Malpositioning of the arm. 4. Asymmetrical Moro reflex. 5. Marked localized ecchymosis.

Answer 113

1, 2, 3, and 4 are correct. 1. The baby will complain of pain at the site. 2. If not in the immediate period after the injury, within a few days there will be a palpable lump on the bone at the site of the break. 3. Because of the break, the baby is likely to position the arm in an atypical posture. 4. Because of the injury to the bone, the baby is unable to respond with symmetrical arm movements. TEST-TAKING TIP: Clavicle breaks are a fairly common injury seen after a delivery. They usually result from a disproportion between the sizes of the maternal pelvis and the fetal body. Because shoulder dystocia is an obstetric emergency, threatening the life of the baby, obstetricians may purposefully break a baby’s clavicle in order to enable the baby to be birthed as rapidly as possible.

Question 114

114. Four babies in the well baby nursery were born with congenital defects. Which of the babies’ complications developed as a result of the delivery method? 1. Club foot. 2. Brachial palsy. 3. Gastroschisis. 4. Hydrocele.

Answer 114

2. Brachial palsy can result from either a traumatic vertex or breech delivery. TEST-TAKING TIP: When babies are born with unexpected findings, the nurse must be familiar not only with the implications of the anomalies but also with an understanding of the etiology of the anomalies. If the anomaly were a result of birth trauma, the nurse must be able to clearly and accurately communicate to the parents the source of the birth injury without communicating an opinion on any potential blame for the problem.

Question 115

115. Monochorionic twins, whose gestation was complicated by twin-to-twin transfusion, are admitted to the neonatal intensive care unit. Which of the following characteristic findings would the nurse expect to see in the smaller twin? 1. Pallor. 2. Jaundice. 3. Opisthotonus. 4. Hydrocephalus

Answer 115

1. In twin-to-twin transfusion, the smaller twin has “donated” part of his or her blood supply to the larger twin. TEST-TAKING TIP: Twin-to-twin transfusion may occur in monochorionic twins because they share the same placenta. The blood from one twin, therefore, is able to be “transfused” into the cardiovascular system of the second twin. As a result, because of decreased oxygenation and nourishment, the donor develops intrauterine growth restriction and becomes anemic. Conversely, the recipient grows much larger and becomes hyperemic. Interestingly, the larger twin is the twin at highest risk for injury because of the potential for formation of thrombi and/or hyperbilirubinemia.

Question 116

116. Monochorionic twins, whose gestation was complicated by twin-to-twin transfusion, are admitted to the neonatal intensive care unit. Which of the following characteristic findings would the nurse expect to see? 1. Recipient twin has petechial rash. 2. Recipient twin is 20% larger than the donor twin. 3. Donor twin has 30% higher hematocrit than recipient twin. 4. Donor twin is ruddy and plethoric.

Answer 116

2. The recipient is likely to be at least 20% larger than the donor twin TEST-TAKING TIP: The word plethora refers to a red coloration. Because the recipient twin receives a “transfusion” from the donor, the recipient’s skin color becomes dark pink, especially when crying. The donor, on the other hand, is pale and small.

Question 117

117. A nurse working with a 24-hour-old neonate in the well baby nursery has made the following nursing diagnosis: Risk for altered growth. Which of the following assessments would warrant this diagnosis? 1. The baby has lost 8% of weight since birth. 2. The baby has not urinated since birth. 3. The baby weighed 3000 grams at birth. 4. The baby exhibited signs of torticollis.

Answer 117

1. A baby who has lost 8% of his or her weight after only 24 hours of life is very high risk for altered growth. TEST-TAKING TIP: The normal weight loss for newborn babies is between 5% and 10%. An 8% loss during the first 24 hours, therefore, places this baby at high risk for altered growth. (The term “risk for” is very important. It does not mean that altered growth has already occurred, but rather that there is a strong possibility that altered growth will develop.) It is also important for the test taker to remember not to choose the option with an unfamiliar term, such as torticollis, simply because it is unfamiliar.

Question 118

118. A baby exhibits weak rooting and sucking reflexes. Which of the following nursing diagnoses would be appropriate? 1. Risk for deficient fluid volume. 2. Activity intolerance. 3. Risk for aspiration. 4. Feeding self-care deficit

Answer 118

1. When a baby roots and sucks poorly, the baby is unable to transfer milk effectively. Since milk intake is the baby’s source of fluid, the baby is high risk for fluid volume deficit TEST-TAKING TIP: The obvious nursing diagnosis related to poor rooting and sucking is “Deficient nutrition: less than body requirements.” The test taker, however, is not given that choice. The test taker, therefore, must determine, of the 4 available options, which is the best. Since dehydration is a consequence of altered fluid intake, that answer is the best response.

Question 119

119. A baby, born at 3199 grams, now weighs 2746 grams. The baby is being monitored for dehydration because of the following percent weight loss? \_\_\_\_\_\_\_\_\_\_%

Answer 119

14.16% The formula for percentage of weight loss is: Original weight minus current weight divided by original weight: 3199 2746 453 453/3199 0.1416 14.16% TEST-TAKING TIP: Unless otherwise noted, the test taker should carry the math to the nearest hundredth place when performing calculations for infants and children. Because babies are very small, a fraction of a milligram (mg), kilogram (kg), and the like, can make a significant difference.