Module 7 Kelsey Chapter 10 Flashcards
At her 6-month well-child checkup, a baby weighs 12 lb, compared to a birth weight of 6 lb. The parent says that she seems to breastfeed well but frequently spits up afterward. The midwife:
A) obtains a consultation with the pediatrician.
B) recommends supplementation of formula in addition to continuing breastfeeding.
C) orders metabolic screening, including screening for PKU.
D) reassures the parent that the baby’s weight gain is normal and reinforces the parent’s breastfeeding technique.
D) reassures the parent that the baby’s weight gain is normal and reinforces the parent’s breastfeeding technique.
Regurgitation is common in infants. The infant is thriving well and gaining weight appropriately.
Relatively mature capabilities of the newborn’s GI system include:
A) suckling, swallowing, and gag reflex.
B) ability to digest fats and proteins.
C) absorption of complex sugars.
D) cardiac sphincter tone.
A) suckling, swallowing, and gag reflex.
Sucking, swallowing, and gag reflexes are all relatively mature in the term neonate.
The patient has just given birth, and the midwife’s initial impression is that resuscitation may be necessary. The infant is limp, blue, and not crying. According to American Academy of Pediatrics (AAP) and American Heart Association (AHA) guidelines, the midwife’s initial steps are, in sequential order:
A) place the infant under a radiant heater, clear secretions if needed, dry the infant and remove wet linen, and provide tactile stimulation while assessing the heart rate and the presence or absence of spontaneous respirations.
B) place the infant under a radiant heater, clear secretions if needed, and evaluate the heart rate by palpating the base of the umbilical cord or femoral pulse.
C) place the infant under a radiant heater, evaluate the heart rate by palpating the base of the umbilical cord or femoral pulse, dry the infant and remove wet linen, clear secretions if needed, and continue to provide tactile stimulation.
D) place the infant under a radiant heater, clear secretions if needed, evaluate the heart rate and the presence or absence of spontaneous respirations, and dry the infant and remove wet linen.
A) place the infant under a radiant heater, clear secretions if needed, dry the infant and remove wet linen, and provide tactile stimulation while assessing the heart rate and the presence or absence of spontaneous respirations.
The midwife’s discussion about circumcision with the infant’s parents should acknowledge that:
A) there are no medical benefits from circumcision.
B) the risks of circumcision, while rare, are potentially serious.
C) research has proven that circumcision has a negative impact on long-term psychological and sexual functioning.
D) although circumcision may offer some modest benefit in reducing potential UTIs and STIs, decisions about circumcision are largely based on personal, cultural, and religious considerations.
D) although circumcision may offer some modest benefit in reducing potential UTIs and STIs, decisions about circumcision are largely based on personal, cultural, and religious considerations.
It appears that there is some benefit of reduced STIs, UTIs, and cancer of the penis in men who are circumcised, but opponents of this procedure maintain that modern sanitary conditions and hygienic practices are more important factors in reducing the incidence of these diseases in comparison to the benefits from circumcision.
Prominent vasculature of the anterior lens capsule is most suggestive of which condition?
A) Herpes virus exposure in the intrapartum period
B) Relatively immature gestational age
C) Gonococcal or chlamydial conjunctivitis
D) Elevated total serum bilirubin concentration
B) Relatively immature gestational age
The vasculature of the anterior capsule of the ocular lens is more prominent with early gestational ages.
Normal newborn respiratory findings include:
A) nasal flaring, expiratory grunting, and retractions.
B) diaphragmatic and abdominal breathing.
C) respiratory rate of 40 to 80 breaths per minute.
D) ventilation primarily through the mouth.
B) diaphragmatic and abdominal breathing.
Diaphragmatic and abdominal breathing are normal respiratory findings, whereas the other answer choices are incorrect.
In the initial examination of a male infant, the midwife notes drainage of urine from the stump of the umbilical cord. The newborn’s condition is most likely:
A) patent urachus.
B) epispadias.
C) hypospadias.
D) exstrophy of the bladder.
A) patent urachus.
A patent urachus is the persistence of a fetal opening between the bladder and the umbilical cord.
With respect to question 4, how would the midwife proceed differently if meconium staining of the amniotic fluid had been noted on rupture of membranes?
A) Suction the trachea after drying the infant and remove wet linen.
B) Suction the trachea on the perineum before delivery of the thorax.
C) ET suctioning is not indicated; care guidelines for further intervention are unchanged.
D) Suction the trachea after drying the infant and providing tactile stimulation.
C) ET suctioning is not indicated; care guidelines for further intervention are unchanged.
Care guidelines for further intervention are based on inadequate respiratory effort (gasping, labored breathing, or poor oxygenation) or heart rate (< 100 bpm) for both infants born to clear fluid and those born to meconium-stained fluid.
At 1 minute of age, Baby P exhibits a strong cry, some flexion of the arms and legs, a heart rate of 136 beats per minute, and acrocyanosis. Baby P’s 1-minute Apgar score is:
A) 6
B) 7
C) 8
D) 9
C) 8
A perfect score for Apgar is 10. This infant receives only 1 point (out of 2) for color, 1 point (out of 2) for partial flexion of the extremities, 2 points for heart rate (> 100), and 2 points each for respiratory effort and reflex irritability (strong cry).
The midwife wishes to estimate a newborn’s gestational age. Which standard instrument is appropriate?
A) Denver II
B) New Ballard
C) Erikson
D) Erb–Duchenne
B) New Ballard
The New Ballard instrument is the only one of the choices provided that estimates a newborn’s gestational age.
Evaluation of the newborn begins:
A) before the infant is born.
B) when the presenting part is crowning.
C) at the moment of birth.
D) after initial stabilization and resuscitation, if necessary.
A) before the infant is born.
The infant’s evaluation is begun even before birth by considering maternal history, risk factors, fetal testing results, and intrapartum factors.
Which of the following newborn assessment findings is (are) least likely to be related to gestational diabetes?
A) High-pitched cry, plethora, tachypnea, and inconsolability
B) Weak cry, jitteriness, cyanosis, apnea, poor feeding, and lethargy
C) Serum glucose level below 40 mg/dL
D) Absent Moro reflex on right side, and palpable crepitus between the right shoulder and neck
A) High-pitched cry, plethora, tachypnea, and inconsolability
The other answers list findings that are more typically present in infants of diabetic mothers.
Which of the following best describes the appearance and behavior of an overstimulated infant?
A) Tremors, tachycardia, non-nutritive sucking, nasal flaring, and grunting
B) Color changes, irregular respiration, irritability or lethargy, and vomiting
C) Lethargy, flaccid tone, pallor, and inability to maintain alert active state
D) Habituation to noxious stimuli and attempts to self-console
B) Color changes, irregular respiration, irritability or lethargy, and vomiting
Infants may become fatigued or stressed when overstimulated. Color changes, irregular respiration, irritability or lethargy, and vomiting can be signs of such stress.
Visible gastric peristalsis on observation of the abdomen is most suggestive of:
A) pyloric stenosis.
B) esophageal fistula.
C) colic.
D) a normal finding.
A) pyloric stenosis.
Visible gastric peristalsis, vomiting, and constipation are common features that present with pyloric stenosis.
The partner is concerned about the pregnant patient’s positive tuberculosis screening result. While awaiting results from the patient’s chest radiograph and sputum culture, the midwife tells the partner that:
A) even if the chest radiograph is negative, the parent’s exposure will necessitate a period of isolation from the newborn that may interfere with the initiation of breastfeeding.
B) congenital tuberculosis is unlikely to be a problem for the newborn because the pregnant parent shows no signs of active disease.
C) if the newborn acquires tuberculosis in utero, the most serious risk is for respiratory problems in the neonatal period.
D) subclinical maternal tuberculosis infection is associated with a number of congenital malformations.
B) congenital tuberculosis is unlikely to be a problem for the newborn because the pregnant parent shows no signs of active disease.
Congenital disease is rare unless the parent has untreated, advanced tuberculosis.
Increased oxygen consumption, hypoglycemia, hypoxia, acidosis, and respiratory distress can be caused in the immediate newborn period by:
A) congenital bacterial infections.
B) maternal opioid abuse.
C) patent ductus arteriosus.
D) cold stress in the birthing room.
D) cold stress in the birthing room.
Cold stress can result in all of the consequences listed, thus emphasizing the importance of thermoregulation of the neonate.
The normal newborn’s sensory capacities are most limited in:
A) color perception.
B) hearing.
C) taste sensation.
D) near-vision focus.
A) color perception.
The normal newborn’s sensory capacity is most limited in color perception.
Which of the following assessment findings are most consistent with prematurity?
A) Translucent skin; sparse lanugo; flat areolae; prominent clitoris and labia minora; and highly flexible, nonrecoiling ear tissue
B) Scant rugation of scrotum; undescended testes; and wrinkled, cracked, peeling skin
C) Extended posture, flaccid tone, little resistance to flexion of extremities, and increased recoil of ear tissue
D) Abundant lanugo, flexed posture, skin creases covering entire plantar surface, and relatively low-set position of ears
A) Translucent skin; sparse lanugo; flat areolae; prominent clitoris and labia minora; and highly flexible, nonrecoiling ear tissue
The other answers offer conflicting findings regarding gestational age assessment. This answer lists all of the features that are consistent with prematurity.
Which of the following statements is true about newborn metabolic disorders?
A) Federal law mandates testing for PKU, galactosemia, and cystic fibrosis.
B) For early-discharge neonates, screening at 8 hours of life is acceptably reliable.
C) Most of these disorders are characterized by enzyme deficiency, resulting in toxic accumulation of metabolites.
D) Breastfeeding is strongly recommended for infants with galactosemia.
C) Most of these disorders are characterized by enzyme deficiency, resulting in toxic accumulation of metabolites.
All newborns in the United States receive a PKU test. PKU results from the absence or deficiency of the enzyme phenylalanine hydroxylase, and prevents the correct break down of phenylalanine. The health risk is from the resulting accumulation of phenylalanine. Additionally, breastfeeding is contraindicated for infants with galactosemia; 8 hours of life is too soon to perform newborn screening; and while the U.S. Department of Health and Human Services does have a recommended universal newborn screening panel for newborns, newborn screening requirements are set by the individual states.
