OB Midterm Newborn

Question 1

Which baby is more likely to develop TTN (Transient tachypnea of Newborn)?

Answer 1

TTN is when a baby has fast labored breathing because they did not get the “squeeze” at birth due to C-section

Question 2

How much weight can a NB lose?

Answer 2

No more than 10% of body weight

Question 3

How many vessels are there in the umbilical cord?

Answer 3

There are 3 vessels=2 arteries and one vein

Question 4

What should you educate mom about Erythema Toxicum on babys skin?

Answer 4

Inform mom that this is a normal way of baby reacting to atmosphere (they look like hives)

Question 5

What conditions cause babies to have elastic skin turgor at birth?

Answer 5

If baby is hypoglycemic, post term, if placenta stopped working and baby is dehydrated, and IGR (intrauterine growth restriction) baby. IF baby has heart problem they will be swollen

Question 6

What information has to be documented at time of birth?

Answer 6

• Time of birth, APGAR score at 1min and 5min,First breath, *Vit K injection administration,
• number of vessels in the cord, *did baby poop or pee, *Ballard Score

Question 7

When checking PKU, what other genetic tests are we looking for?

Answer 7

Hypothyroidism, Cystic fibrosis, and Neuro problems. This test has to be done within 24 hours or more after baby’s first feeding, then again in a few weeks at peds office

Question 8

If baby has a problem with ear shape or size, this may indicate a problem with what system?

Answer 8

renal system (Kidneys develop at same time as ears) Also if baby has extra nipples)

Question 9

During a NB exam you notice baby has an arched back when laying down, this means?

Answer 9

this is called opisthotonos= spasm of the muscles causing backward arching of the head, neck, and spine, as in severe tetanus, means baby has meningitis

Question 10

If baby has excessive spit or bubbling at mouth what condition is suspected

Answer 10

Tracheoesophageal fistula

Question 11

If you notice baby has desquamation of skin during NB assessment what can this indicate?

Answer 11

The baby may be post term, malnutrition, malnutrition, or may have been exposed to herpes

Question 12

What color of skin can indicate hypotension, cold stress, and cardiac problems?

Answer 12

*Grey=hypotension, *Mottled=Cold stress or sepsis, *Red and sticky= premie baby *Harlequin sign= cardiac *problem or sepsis *Ruddy=polycythemia

Question 13

What is a potential complication of polycythemia? (excess RBCs)

Answer 13

Jaundice. (This can be caused if baby is held low when born, Placenta releases blood to NB below)

Question 14

Why is stimulation contraindicated when there is presence of meconium stained fluid?

Answer 14

Baby may aspirate meconium

Question 15

Which vaccine is given to babies when they are born to increase immunity?

Answer 15

Hep B vaccine, If mom is (+) for Hep B, baby will get HBIG, then must have Hep B vaccine within 12 hrs on vastus lateralis

Question 16

What is a normal CBG for a NB?

Answer 16

40mb/dL. If baby is less than 40, feed baby, recheck then call provider

Question 17

Some babies are born with milk in their breast (Witches milk), what is the cause of this?

Answer 17

Moms hormones

Question 18

What does it mean when a NB male has hydro/epi spadeus?

Answer 18

This means the meatus is on the side of the penis (dorsal or ventral) this needs to be surgically corrected

Question 19

What is the normal urine output for a baby?

Answer 19

1-3mL/kg/hr. Baby needs to have voided 60mL in first 24 hrs. (will be light in color and may have uric acid crystals, no odor)

Question 20

Which assessment findings are indicative of respiratory distress?

Answer 20

Flared nostrils, grunting (shutting of glottis), retractions, unequal breath sounds, asymmetrical chest movement (lung collapse)

Question 21

Babys require the “squeeze” during birth to initiate surfactant protein to lubricate alveoli, what can happen if they do not get the “Squeeze”?

Answer 21

They can develop TTN (Trans tachypnea of Newborn) = a respiratory problem that can be seen in the newborn shortly after delivery. It is caused by retained fetal lung fluid due to impaired clearance mechanisms.

Question 22

If baby had a poop with white at the end of it, this indicates what abnormality?

Answer 22

This is called meconium ileus, means baby may have cystic fibrosis

Question 23

What does it mean if baby has grey stools?

Answer 23

They have a blocked bile duct

Question 24

During the NB assessment, what GI conditions warrant investigation?

Answer 24

• Abd distention or hypoactive bowel sounds= bowel obstruction or necrotizing enteral colitis
• Bowel sounds In chest= hernia *Discharge from umbilicus= fistula *abd mass

Question 25

What can an immature liver in an infant lead to?

Answer 25

Decreased glucose, decreased protein and increased bilirubin

Question 26

The normal term infant has difficulty clearing airway after birth, Most secretions are brought up to the oropharynx by the cough reflex. If there is excess secretions, mouth and nasal passages can be cleared with a bulb syringe, What do you suction 1st?

Answer 26

a. Avoid suctioning the nares.
b. Insert the compressed bulb into the center of the mouth.
c. Suction the mouth first.
d. Remove the bulb syringe from the crib when finished.

((ANS: C The mouth should be suctioned first to prevent the infant from inhaling pharyngeal secretions by gasping as the nares are suctioned))

Question 27

As part of Standard Precautions, nurses wear gloves when handling the newborn. The chief reason is:

Answer 27

a. To protect the baby from infection.
b. That it is part of the Apgar protocol.
c. To protect the nurse from contamination by the newborn.
d. the nurse has primary responsibility for the baby during the first 2 hours.

((ANS: C Gloves are worn to protect the nurse from infection until the blood and amniotic fluid are cleaned off the newborn.))

Question 28

The nurse is performing a gestational age and physical assessment on the newborn. The infant appears to have an excessive amount of saliva. The nurse recognizes that this finding:

Answer 28

a. Is normal.
b. Indicates that the infant is hungry.
c. May indicate that the infant has a tracheoesophageal fistula or esophageal atresia.
d. May indicate that the infant has a diaphragmatic hernia.

((ANS: C The presence of excessive saliva in a neonate should alert the nurse to the possibility of tracheoesophageal fistula or esophageal atresia.))

Question 29

A mother expresses fear about changing her infant’s diaper after he is circumcised. What does the woman need to be taught to take care of the infant when she gets home?

Answer 29

a. Cleanse the penis with prepackaged diaper wipes every 3 to 4 hours.
b. Apply constant, firm pressure by squeezing the penis with the fingers for at least 5 minutes if bleeding occurs.
c. Cleanse the penis gently with water and put petroleum jelly around the glans after each diaper change.
d. Wash off the yellow exudate that forms on the glans at least once every day to prevent infection.

(ANS: C Cleansing the penis gently with water and putting petroleum jelly around the glans after each diaper change are appropriate when caring for an infant who has had a circumcision)

Question 30

A new father wants to know what medication was put into his infant’s eyes and why it is needed. The nurse explains to the father that the purpose of the Ilotycin ophthalmic ointment is to:

Answer 30

a. Destroy an infectious exudate caused by Staphylococcus that could make the infant blind.
b. Prevent gonorrheal and chlamydial infection of the infant’s eyes potentially acquired from the birth canal.
c. Prevent potentially harmful exudate from invading the tear ducts of the infant’s eyes, leading to dry eyes.
d. Prevent the infant’s eyelids from sticking together and help the infant see.

((ANS: B The purpose of the Ilotycin ophthalmic ointment is to prevent gonorrheal and chlamydial infection of the infant’s eyes potentially acquired from the birth canal. ))

Question 31

What are modes of heat loss in the newborn (Select all that apply)?

Answer 31

a. Perspiration
b. Convection
c. Radiation
d. Conduction
e. Urination

((ANS: B, C, D Convection, radiation, evaporation, and conduction are the four modes of heat loss in the newborn. Perspiration and urination are not modes of heat loss in newborns.))

Question 32

Infants in whom cephalohematomas develop are at increased risk for:

Answer 32

a. Infection.
b. Jaundice
c. Caput succedaneum.
d. Erythema toxicum

(ANS: B Cephalohematomas are characterized by bleeding between the bone and its covering, the periosteum. Because of the breakdown of the red blood cells within a hematoma, the infants are at greater risk for jaundice. ).

Question 33

A meconium stool can be differentiated from a transitional stool in the newborn because the meconium stool is:

Answer 33

a. Seen at age 3 days.
b. The residue of a milk curd.
c. Passed in the first 12 hours of life.
d. Lighter in color and looser in consistency.

(ANS: C Meconium stool is usually passed in the first 12 hours of life, and 99% of newborns have their first stool within 48 hours. If meconium is not passed by 48 hours, obstruction is suspected. )

Question 34

In administering vitamin K to the infant shortly after birth, the nurse understands that vitamin K is:

Answer 34

a. Important in the production of red blood cells.
b. Necessary in the production of platelets.
c. Not initially synthesized because of a sterile bowel at birth.
d. Responsible for the breakdown of bilirubin and prevention of jaundice

(ANS: C The bowel is initially sterile in the newborn, and vitamin K cannot be synthesized until food is introduced into the bowel. Vitamin K is necessary to activate blood clotting factors. )

Question 35

The nurse should immediately alert the physician when:

Answer 35

a. The infant is dusky and turns cyanotic when crying.
b. Acrocyanosis is present at age 1 hour.
c. The infant’s blood glucose level is 45 mg/dL.
d. The infant goes into a deep sleep at age 1 hour.

((ANS: A An infant who is dusky and becomes cyanotic when crying is showing poor adaptation to extrauterine life.))

Question 36

A first-time dad is concerned that his 3-day-old daughter’s skin looks “yellow.” In the nurse’s explanation of physiologic jaundice, what fact should be included?

Answer 36

a. Physiologic jaundice occurs during the first 24 hours of life.
b. Physiologic jaundice is caused by blood incompatibilities between the mother and infant blood types.
c. The bilirubin levels of physiologic jaundice peak between the second and fourth days of life.
d. This condition is also known as “breast milk jaundice.”

(ANS: C Physiologic jaundice becomes visible when the serum bilirubin reaches a level of 5 mg/dL or greater, which occurs when the baby is approximately 3 days old. This finding is within normal limits for the newborn. Pathologic jaundice occurs during the first 24 hours of life. )

Question 37

Nurses can prevent evaporative heat loss in the newborn by:

Answer 37

a. Drying the baby after birth and wrapping the baby in a dry blanket.
b. Keeping the baby out of drafts and away from air conditioners.
c. Placing the baby away from the outside wall and the windows.
d. Warming the stethoscope and the nurse’s hands before touching the baby.

(ANS: A Because the infant is wet with amniotic fluid and blood, heat loss by evaporation occurs quickly.)

Question 38

What marks on a baby’s skin may indicate an underlying problem that requires notification of a physician?

Answer 38

a. Mongolian spots on the back
b. Telangiectatic nevi on the nose or nape of the neck
c. Petechiae scattered over the infant’s body
d. Erythema toxicum anywhere on the body

((ANS: C Petechiae (bruises) scattered over the infant’s body should be reported to the pediatrician because they may indicate underlying problems. ))

Question 39

The cheeselike, whitish substance that fuses with the epidermis and serves as a protective coating is called:

Answer 39

a. Vernix caseosa. b. Surfactant c. Caput succedaneum. d. Acrocyanosis.

(ANS: A This protection, vernix caseosa, is needed because the infant’s skin is so thin. )

Question 40

With regard to the gastrointestinal (GI) system of the newborn, nurses should be aware that:

Answer 40

a. The newborn’s cheeks are full because of normal fluid retention.
b. The nipple of the bottle or breast must be placed well inside the baby’s mouth because teeth have been developing in utero, and one or more may even be through.
c. Regurgitation during the first day or two can be reduced by burping the infant and slightly elevating the baby’s head.
d. Bacteria are already present in the infant’s GI tract at birth because they traveled through the placenta.

(ANS: C Avoiding overfeeding can also reduce regurgitation)

Question 41

As related to the normal functioning of the renal system in newborns, nurses should be aware that:

Answer 41

a. The pediatrician should be notified if the newborn has not voided in 24 hours.
b. Breastfed infants likely will void more often during the first days after birth.
c. “Brick dust” or blood on a diaper is always cause to notify the physician.
d. Weight loss from fluid loss and other normal factors should be made up in 4 to 7 days.

(ANS: A A newborn who has not voided in 24 hours may have any of a number of problems, some of which deserve the attention of the pediatrician. )

Question 42

A first-time father is changing the diaper of his 1-day-old daughter. He asks the nurse, “What is this black, sticky stuff in her diaper?” The nurse’s best response is:

Answer 42

a. “That’s meconium, which is your baby’s first stool. It’s normal.”
b. “That’s transitional stool.”
c. “That means your baby is bleeding internally.”
d. “Oh, don’t worry about that. It’s okay.”

(ANS: A “That’s meconium, which is your baby’s first stool. It’s normal” is an accurate statement and the most appropriate response. )

Question 43

The nurse enters the room to assess an infant and finds him unwrapped in his crib with the fan blowing over him on “high.” The nurse instructs mom that the fan shouldn’t be directed toward baby and the newborn should be wrapped in a blanket. Rationale?

Answer 43

“Your baby may lose heat by convection, which means that he will lose heat from his body to the cooler ambient air. You should keep him wrapped and prevent cool air from blowing on him.”

(Conduction is the loss of heat from the body surface to cooler surfaces, not air, in direct contact with the newborn. Evaporation is loss of heat that occurs when a liquid is converted into a vapor. In the newborn heat loss by evaporation occurs as a result of vaporization of moisture from the skin. Cold stress may occur from excessive heat loss, but this does not imply that the infant will become stressed if not bundled at all times. Furthermore, excessive bundling may result in a rise in the infant’s temperature.)

Question 44

While assessing the integument of a 24-hour-old newborn, the nurse notes a pink, papular rash with vesicles superimposed on the thorax, back, and abdomen. The nurse should:

Answer 44

a. Notify the physician immediately.
b. Move the newborn to an isolation nursery.
c. Document the finding as erythema toxicum.
d. Take the newborn’s temperature and obtain a culture of one of the vesicles.

(ANS: C Erythema toxicum (or erythema neonatorum) is a newborn rash that resembles flea bites)

Question 45

The nurse assessing a newborn knows that the most critical physiologic change required of the newborn is:

Answer 45

a. Closure of fetal shunts in the circulatory system.
b. Full function of the immune defense system at birth.
c. Maintenance of a stable temperature.
d. Initiation and maintenance of respirations.

(ANS: D The most critical adjustment of a newborn at birth is the establishment of respirations. )

Question 46

A new mother states that her infant must be cold because the baby’s hands and feet are blue. The nurse explains that this is a common and temporary condition called:

Answer 46

a. Acrocyanosis. b. Erythema neonatorum. c. Harlequin color. d. Vernix caseosa.

(ANS: A Acrocyanosis, or the appearance of slightly cyanotic hands and feet, is caused by vasomotor instability, capillary stasis, and a high hemoglobin level. Acrocyanosis is normal and appears intermittently over the first 7 to 10 days)

Question 47

An African-American woman noticed some bruises on her newborn girl’s buttocks. She asks the nurse who spanked her daughter. The nurse explains that these marks are called:

Answer 47

a. Lanugo
b. Vascular nevi.
c. Nevus flammeus d. Mongolian spots.

(ANS: D A Mongolian spot is a bluish black area of pigmentation that may appear over any part of the exterior surface of the body.)

Question 48

A newborn is placed under a radiant heat warmer, and the nurse evaluates the infant’s body temperature every hour. Maintaining the newborn’s body temperature is important for preventing:

Answer 48

a. Respiratory depression.
b. Cold stress
c. Tachycardia.
d. Vasoconstriction.

(ANS: B Loss of heat must be controlled to protect the infant from the metabolic and physiologic effects of cold stress, and that is the primary reason for placing a newborn under a radiant heat warmer. Cold stress results in an increased respiratory rate and vasoconstriction.)

Question 49

While assessing the newborn, the nurse should be aware that the average expected apical pulse range of a full-term, quiet, alert newborn is:

Answer 49

a. 80 to 100 beats/min. b. 100 to 120 beats/min.
c. 120 to 160 beats/min.
d. 150 to 180 beats/min.

(ANS: C The average infant heart rate while awake is 120 to 160 beats/min. )

Question 50

Part of the health assessment of a newborn is observing the infant’s breathing pattern. A full-term newborn’s breathing pattern is predominantly:

Answer 50

a. Abdominal with synchronous chest movements.
b. Chest breathing with nasal flaring.
c. Diaphragmatic with chest retraction.
d. Deep with a regular rhythm.

(ANS: A In normal infant respiration the chest and abdomen rise synchronously, and breaths are shallow and irregular. Breathing with nasal flaring is a sign of respiratory distress. Diaphragmatic breathing with chest retraction is a sign of respiratory distress.)

Question 51

A woman gave birth to a healthy 7-pound, 13-ounce infant girl. The nurse suggests that the woman place the infant to her breast within 15 minutes after birth. The nurse knows that breastfeeding is effective during the first 30 minutes after birth because:

Answer 51

a. Transition period b. First period of reactivity c. Organizational stage.
d. Second period of reactivity.

(ANS: B The first period of reactivity is the first phase of transition and lasts up to 30 minutes after birth. The infant is highly alert during this phase)

Question 52

While evaluating the reflexes of a newborn, the nurse notes that with a loud noise the newborn symmetrically abducts and extends his arms, his fingers fan out and form a “C” with the thumb and forefinger, and he has a slight tremor. This is a (+):

Answer 52

a. Tonic neck reflex. b. Glabellar (Myerson) reflex.
c. Babinski reflex. d. Moro reflex.

(ANS: D The characteristics displayed by the infant are associated with a positive Moro reflex. )

Question 53

How often do you check APGAR score?

Answer 53

1 and 5 min

Question 54

The nurse assisted with the delivery of a newborn. Which nursing action is most effective in preventing heat loss by evaporation?

Answer 54

Drying the infant with a warm blanket

Question 55

At 1 minute after birth, the nurse assesses the infant and notes a heart rate of 80 beats/minute, some flexion of the extremities, a weak cry, grimacing, and a pink body with blue extremities. The nurse would calculate an Apgar score of:

Answer 55

5

The test measures your baby's:
1.)Heart rate
Absent=0
Slow (<100/min)=1
>100/min=2
2.)Breathing 
Absent=0, 
Slow, weak cry=1
Good cry=2
3.) Muscle tone
Flaccid=0 
Some flexion of ext=1
well flexed=2
4.) Reflex response
No response=0
Grimace=1
Cry=2
5.) Color
Blue, pale= 0
Body pink, ext blue=1
Completely pink=2

Question 56

The nurse administers vitamin K to the newborn for which reason?

Answer 56

Bacteria that synthesize vitamin K are not present in the newborn’s intestinal tract.

(ANS: Bacteria that synthesize vitamin K are not present in the newborn’s intestinal tract. Vitamin K is provided because the newborn does not have the intestinal flora to produce this vitamin for the first week.)

Question 57

An Apgar score of 10 at 1 minute after birth would indicate a(n):

Answer 57

Infant having no difficulty adjusting to extrauterine life but who should be assessed again at 5 minutes after birth.
(An initial Apgar score of 10 is a good sign of healthy adaptation; however, it must be repeated at the 5-minute mark.)

Question 58

Early this morning, an infant boy was circumcised using the PlastiBell method. The nurse tells the mother that she and the infant can be discharged after:

Answer 58

a. The bleeding stops completely.
b. Yellow exudate forms over the glans.
c. The PlastiBell rim falls off.
d. The infant voids.

(ANS: D The infant should be observed for urination after the circumcision)

Question 59

The nurse is using the Ballard scale to determine the gestational age of a newborn. Which assessment finding is consistent with a gestational age of 40 weeks?

Answer 59

a. Flexed posture
b. Abundant lanugo
c. Smooth, pink skin with visible veins
d. Faint red marks on the soles of the feet

(ANS: A Term infants typically have a flexed posture. Abundant lanugo usually is seen on preterm infants. Smooth, pink skin with visible veins is seen on preterm infants. Faint red marks usually are seen on preterm infants.)

Question 60

An infant boy was born just a few minutes ago. The nurse is conducting the initial assessment. Part of the assessment includes the Apgar score. The Apgar assessment is performed:

Answer 60

At least twice, 1 minute and 5 minutes after birth.

(ANS: C Apgar scoring is performed at 1 minute and 5 minutes after birth. Scoring may continue at 5-minute intervals if the infant is in distress and requires resuscitation efforts.

Question 61

How will baby develop vit k for blood coagulation?

Answer 61

We have to give an injection at birth (to prevent brain bleed) because their gut has not manufactured it, when baby starts to eat and by day 8 it will develop vit k

Question 62

How long does it take for physiological jaundice to manifest?

Answer 62

usually happens in 2 days, if it happens right away after birth then baby is sick and its pathological jaundice.

Question 63

If the moms H&H is high during pregnancy due to fetal circulation, how will this affect baby at birth?

Answer 63

Byproduct of RBC breakdown is bilirubin, if bilirubin is high because liver cannot dissolve it then baby will be jaundice because it will be stored in skin. This is physiological jaundice. TX= sun light helps break down bilirubin to water soluble, so kidneys and liver can get rid of it through urine and stool.

Question 64

What indicates incomplete closure of shunts?

Answer 64

You’ll hear a murmur on auscultation

Question 65

Where is it normal for baby to have bluish color at birth?

Answer 65

ONLY arms and legs, center must be pink

Question 66

What can cause bradycardia in babies?

Answer 66

Heart block, asphyxia, Increased ICP (vagal response)

Question 67

What can cause tachycardia in a baby?

Answer 67

respiratory problem (low-surfactant)
sepsis
baby too hot or cold
TTN
pneumonia

Question 68

what part of the babies cause the most heat loss?

Answer 68

the baby’s head is 20% of their body, heat is lost through their head

Question 69

what happens when baby burns too much brown fat?

Answer 69

when baby is cold they burn more brown fat leading to ketoacidosis
(keep warm, dry, and stimulate)

Question 70

What does surfactant do?

Answer 70

Surfactant is a protein, it allows lung expansion in alveoli, if baby is cold it reduces surfactant in lungs and impedes lung expansion.

Question 71

what are the 4 ways babies lose heat?

Answer 71

Evaporation
Radiation
Conduction
Convection

Question 72

How do babies keep themselves warm?

Answer 72

Maintenance of temp is accomplished by brown fat metabolism. (When baby cries, kicks and screams it uses up baby’s glucose and increases O2 need) Brown fat helps preserve that to keep baby out of hypoglycemic state.

Question 73

After the C-section what is important to do for a baby?

Answer 73

Suction, dry, warm, and stimulate.

Question 74

what is the contraindication for vacuum assist?

Answer 74

a premature baby. can use forceps if needed to get head under symphysis

Question 75

For a new born premature baby it is important to keep the umbilical cord longer, what is the reasoning for this?

Answer 75

the umbillical vein is used for IV medication and fluids when baby is really sick.