Module 7 Newborn Canvas Quizes

Question 1

Which of the following contributes THE MOST to closure of the ductus arteriosus?

A) Decreased PaO2, increased CO2, and increased prostaglandin
B) Increased PaO2, variation in circulating prostaglandin E2 and bradykinin
C) Increased CO2 and decreased systemic vascular pressure

Answer 1

B) Increased PaO2, variation in circulating prostaglandin E2 and bradykinin

Question 2

The term “gut closure” refers to the time when:

A) The fetal gut maturation is complete.
B) The gut becomes impermeable to antigens.
C) The infant can absorb large molecules.

Answer 2

B) The gut becomes impermeable to antigens.

Question 3

A 38 week 7 pound male infant was born after a spontaneous vaginal birth. Apgars were 9/9. The midwife described normal findings to the parents during the initial exam. The midwife explained that newborns:

A) often have nasal flaring, grunting, and retractions for up to several hours.
B) are primarily diaphragmatic and abdominal breathers.
C) usually have a respiratory rate of 40 to 70 breaths per minute.
D) will primarily breath through their mouths.

Answer 3

B) are primarily diaphragmatic and abdominal breathers.

Question 4

Skin lesions caused by tinea corporis are best described as

A) circular scaling lesions with erythema and clearing centers.
B) red papules, vesicles, and pustules in clusters.
C) vesicles that rupture, creating a thin, flat, honey-colored crust.
D) pink-to-red coalescing maculopapular rash on scalp or trunk.

Answer 4

A) circular scaling lesions with erythema and clearing centers.

Question 5

Which of the following refers to non-shivering thermogenesis?

A) Utilization of brown fat
B) Lipid metabolism
C) Flexed body posture

Answer 5

A) Utilization of brown fat

Question 6

At 24 weeks gestation, lung development is characterized by:

A) Appearance of some terminal sacs at the terminal bronchioles.
B) Type II pneumocytes that secrete detectable surfactant.
C) Lungs change from secretory to gas-exchanging organs.

Answer 6

A) Appearance of some terminal sacs at the terminal bronchioles.

Question 7

A newborn’s renal system may result in a higher risk of the following:

A) Overhydration
B) Highly concentrated urine
C) Voiding large amounts every few hours

Answer 7

A) Overhydration

Question 8

Fluid in newborn lungs is cleared at birth, in part, by the following route:

A) Absorption into the lymphatic system
B) Absorption into limbic system
C) Bulb suctioning of the mouth and nose

Answer 8

A) Absorption into the lymphatic system

Question 9

What is the initial physiologic response in a hypothermic infant?

A) Central cyanosis
B) Increased metabolism
C) Decreased respiratory rate

Answer 9

B) Increased metabolism

Question 10

Newborns do not conserve heat well due to:

A) a large surface area/body weight ratio.
B) an inability to shiver.
C) increased subcutaneous fat.

Answer 10

A) a large surface area/body weight ratio.

Question 11

If oxygenation is not sufficient for the neonate, the pulmonary vasculature:

A) Expands
B) Constricts
C) Remains unchanged

Answer 11

B) Constricts

Question 12

A newborn maintains glucose levels by utilization of glycogen stores and what other method?

A) Decreased insulin response
B) Lipid metabolism
C) Protein metabolism

Answer 12

B) Lipid metabolism

Question 13

Which type of dermatitis is associated with cradle cap in newborns?

A) Irritant
B) Seborrheic
C) Atopic
D) Stasis

Answer 13

B) Seborrheic

Question 14

Which of the following is TRUE regarding neonatal glucose metabolism?

A) Neonatal blood glucose normally falls in the first hour after birth.
B) Glucose metabolism slows after birth in response to hypothermia.
C) Breastfed infants have higher blood glucose levels than bottle fed infants.

Answer 14

A) Neonatal blood glucose normally falls in the first hour after birth.

Question 15

With the initial breath the newborn’s pulmonary vascular pressure

A) increases
B) decreases
C) stays the same
D) rises than falls

Answer 15

B) decreases

Question 16

If the infant does not get enough oxygen the vascular pressure will

A) increase
B) decrease
C) remain the same
D) initially decrease then increase

Answer 16

A) increase

Question 17

Chemical influences that influence the initiation of breathing include:

A) increased oxygen and increased carbon dioxide
B) increased oxygen and decreased carbon dioxide
C) decreased oxygen and decreased carbon dioxide
D) decreased oxygen and increased carbon dioxide

Answer 17

D) decreased oxygen and increased carbon dioxide

Question 18

Grunting assists the newborn’s respiration by

A) assisting with lung expansion by forceful inspiration.
B) decreasing force of inspiration.
C) holding inspired air in the lungs for a few more seconds.
D) promoting a greater opening in the glottis with inspiration.

Answer 18

C) holding inspired air in the lungs for a few more seconds.

Question 19

Fetal lung fluid decreases several days before birth due to:

A) increased stress hormones and decreased circulating plasma proteins
B) decreased stress hormones and decreased circulating plasma proteins
C) increased stress hormones and increased circulating plasma proteins
D) increased stress hormones and stable circulating plasma proteins

Answer 19

C) increased stress hormones and increased circulating plasma proteins

Question 20

Pulmonary surfactant is secreted by

A) Type II alveolar cells
B) Type I alveolar cells
C) respiratory bronchioles
D) alveolocapillary membrane

Answer 20

A) Type II alveolar cells

Question 21

Fluid in the newborn’s lungs is cleared at birth by three routes:

A) nose and mouth, lymphatics and pulmonary vasculature
B) lymphatic system and pulmonary veins
C) nose and mouth, pulmonary vasculature
D) mouth only, pulmonary veins and lymphatics

Answer 21

A) nose and mouth, lymphatics and pulmonary vasculature

Question 22

Auscultation of a newborn’s respiratory and heart sounds during REM sleep reveal 10 – 15 second pauses between respirations. The heart rate is unchanged during these episodes. The newborn is most likely experiencing

A) central apnea.
B) mixed apnea.
C) periodic breathing.
D) obstructive apnea.

Answer 22

C) periodic breathing.

Question 23

Increasing systemic pressure and decreased pulmonary circulation pressure causes increased circulation in the left side of the heart which leads to:

A) closure of the ductus arteriosus
B) closure of the foramen ovale
C) stability of the ductus arteriosus
D) decreased blood flow in the left ventricle

Answer 23

B) closure of the foramen ovale

Question 24

What are two risks to the newborn with delayed cord clamping?

A) jaundice and hyper-viscosity of the blood
B) infection and jaundice
C) polycythemia and hemorrhage
D) hyper-viscosity of the blood and lower RBCs

Answer 24

A) jaundice and hyper-viscosity of the blood

Question 25

Blood flow from the placenta to the newborn stops when:

A) the newborn takes the initial breath
B) the newborn passes through the birth canal
C) the newborn’s umbilical cord is clamped and cut
D) the newborn has stable respiration

Answer 25

C) the newborn’s umbilical cord is clamped and cut

Question 26

Decreased prostaglandin E2 is necessary for

A) closure of the foramen ovale
B) decrease in fetal lung fluid
C) closure of the ductus arteriosus
D) increase in systemic pressure

Answer 26

C) closure of the ductus arteriosus

Question 27

Fetal circulation is characterized by what type of system?

A) high pressure
B) low pressure
C) neutral
D) both depending on time of day

Answer 27

B) low pressure

Question 28

The midwife is concerned that a hypotonic, lethargic newborn may be septic because the laboratory findings reveal

A) decreasing IgM levels.
B) declining C-reactive protein (CRP).
C) a white blood cell (WBC) count of 15,000/mm3
D) a left sided shift with an increased number of immature polymorphonucluear (PMN) cells

Answer 28

D) a left sided shift with an increased number of immature polymorphonucluear (PMN) cells

“Left shift” means there are more immature neutrophils. So, a bunch of mature neutrophils are trying to wall off an infection at a certain location. The bone marrow has to start making more neutrophils. There is an increase in immature neutrophils. (Imagine an arrow pointing to the left. We have moved from mature neutrophils in the blood to more immature neutrophils.) This is concerning. You’ll also see there word “band” or “increase in bands”- these are immature neutrophils.

Question 29

Newborns humoral immune response is decreased because

A) newborns have 55-80% of adult levels of all antibodies.
B) IgG does not cross the placenta.
C) T-lymphocytes require exposure to antigens before recognition occurs.

Answer 29

A) newborns have 55-80% of adult levels of all antibodies.

Question 30

HIV Mother-to-Child Transmission preventative strategies recommended by the American Academy of Pediatrics (AAP) include

A) administration of antiretroviral prophylaxis to HIV exposed newborns for 6 weeks post birth.
B) elective cesarean delivery for a viral load greater than 2000 copies per mL.
C) breastfeeding with a viral load less than 1000 copies per mL.
D) screening pregnant women for HIV according to risk factors.

Answer 30

A) administration of antiretroviral prophylaxis to HIV exposed newborns for 6 weeks post birth.

Question 31

Newborn symptoms of an infection are

A) inflammatory.
B) localized.
C) vague and nonspecfic.

Answer 31

C) vague and nonspecfic.

Question 32

Rubeola is a highly contagious acute disease in children caused by which type of infection?

A) Fungal
B) Yeast
C) Bacterial
D) Viral

Answer 32

D) Viral

Question 33

The newborn has a more difficult time compared to an adult fighting infections because the T lymphocytes

A) are not yet able to recognize infectious organisms (antigens).
B) do not develop until six months of age.
C) do not respond quick enough to contain (“wall off”) infection.
D) are fewer in number at birth then later in life.

Answer 33

A) are not yet able to recognize infectious organisms (antigens).

Question 34

The adaptive immunity system

A) consists of humoral (IgG, IgM, IgA) and cell-mediated (T-lymphocytes,B-lymphocytes) components.
B) involves physical (e.g. skin, mucous membranes, secretions) and biochemical barriers.
C) does not become more vigorous with repeated specific microbe exposures.
D) responds non-specifically to foreign antigens with first encounters.

Answer 34

A) consists of humoral (IgG, IgM, IgA) and cell-mediated (T-lymphocytes,B-lymphocytes) components.

Question 35

Newborn viral infections differ from bacterial infections in that

A) they tend to be less serious in neonates than in older individuals.
B) the immature immune system is more effective against viruses.
C) innate immune responses destroy the virus along with the host cell.
D) symptoms are generally specific.

Answer 35

C) innate immune responses destroy the virus along with the host cell.

Question 36

The phagocytic component of the newborn’s innate immune system

A) is diminished primarily by the decreased availability of neutrophils at the invasion site
B) is fully functional at birth.
C) requires a prior exposure to an antigen for activation.
D) primarily consists of IgG.

Answer 36

A) is diminished primarily by the decreased availability of neutrophils at the invasion site

Blackburn 5e p.455

Because they are slow.

Question 37

Newborns have passive immunity at the time of birth if:

A) S/he exclusively breastfeeds.
B) The mom currently has an infection.
C) The mom responded to the infection in her lifetime.

Answer 37

C) The mom responded to the infection in her lifetime.

Question 38

Breastmilk effects on newborns gastric intestinal (GI) colonization include

A) reduction of Lactobacillus and Bifidobacterium organisms
B) promotion of bacteroides and enterobacteria growth.
C) gram negative enterococci as the dominant gut organism.
D) development of an acidic environment.

Answer 38

D) development of an acidic environment.

Question 39

Assign an Apgar score to this infant: heart rate 110, weak cry, some flexion, acrocyanosis.

Answer 39

6

HR=2, weak cry (reflex irritability)=1, some flexion=1, weak cry(respirations)=1, acrocyanosis=1

Question 40

A pregnant person questions the midwife about what the Apgar score can tell us. The midwife’s best answer is:

A) A high one minute Apgar is indicative of poor oxygenation.
B) A high five minute Apgar score is the best indicator of low oxygenation.
C) A low score on the one and five minute Apgar scores are always indicative of poor oxygenation.
D) A low Apgar score persisting through ten to twenty minutes may be indicative of neurological problems.

Answer 40

D) A low Apgar score persisting through ten to twenty minutes may be indicative of neurological problems.

Question 41

At one minute of age, a newborn has no response to stimulation, no flexion, gasping respirations, a HR of 80 bpm, and is cyanotic. The Apgar score is:

Answer 41

2

Question 42

During the infant’s first breath, the neonate’s pulmonary vascular pressure:

A) Increases
B) Decreases
C) Stays the same

Answer 42

B) Decreases

Question 43

The midwife is attending to an infant born 5 minutes ago. The infant is centrally pink but the limbs have a blue color and a 5 minute Apgar of 9. The labor nurse hands the midwife a bulb syringe. The midwife should respond by

A) suctioning the infant’s nose and throat with the bulb syringe
B) asking for a suction catheter
C) suctioning the infant’s throat with the bulb syringe
D) placing the bulb syringe in the infant’s warmer but not using it at this point

Answer 43

D) placing the bulb syringe in the infant’s warmer but not using it at this point

Question 44

Which of these statements regarding newborn transition is INACCURATE?

A) Skin-to-skin care of the newborn promotes better thermoregulation than infant warmers.
B) Routine suctioning of the infant at birth should be abandoned.
C) Immediate cord clamping, in the event of a nuchal cord with the birth of the head, is suggested to prevent hypoxia.
D) Delayed cord clamping appears to offer protection from anemia.

Answer 44

C) Immediate cord clamping, in the event of a nuchal cord with the birth of the head, is suggested to prevent hypoxia.

Question 45

The midwife has been doing positive pressure ventilation (PPV) for 1 minute on a term newborn after delivery. His heart rate is 80 and climbing. The midwife’s next action is to

A) continue PPV.
B) check for color.
C) start cardiac compressions.
D) Check for tone.

Answer 45

A) continue PPV.

Question 46

Evidence-based management of the infant’s nasopharynx at birth requires

A) nasopharynx bulb syringe suctioning upon delivery of the head.
B) oropharynx suctioning prior to birth of the shoulders when meconium is present.
C) endotracheal intubation with direct suctioning for all meconium-stained newborns.
D) suctioning of copious nasal/oral secretions prior to positive-pressure ventilation (PPV).

Answer 46

D) suctioning of copious nasal/oral secretions prior to positive-pressure ventilation (PPV).

Question 47

Which newborn vital sign would be considered abnormal during transition?

A) HR 158
B) RR 62
C) HR 82
D) RR 46

Answer 47

C) HR 82

Question 48

When discussing circumcision with parents, what would constitute appropriate education?

A) Medical procedure that should be done to prevent infections in newborn/child.
B) The American Academy of Pediatrics reports that the benefits of circumcision outweigh the risks.
C) Recommended by the American Academy of Pediatrics as a necessary procedure for newborn health.
D) Medical procedure that should be done to prevent HIV transmission, as U.S. studies have proven this to be beneficial.

Answer 48

B) The American Academy of Pediatrics reports that the benefits of circumcision outweigh the risks.

Question 48

Newborn cord care should consist of:

A) alcohol
B) triple dye
C) alcohol and triple dye
D) keep dry

Answer 48

D) keep dry

Question 48

Immediately after birth the newborn has a lusty cry, but moderate secretions. The CNM should:

A) DeLee suction until everything is cleared
B) Monitor respirations and assist by bulb suctioning
C) Bulb suction by placing tip in corner of cheek
D) Continue to monitor infant as they clear their airway

Answer 48

D) Continue to monitor infant as they clear their airway

Question 49

Susie is nervous about taking baby Jane home. She asks how she will know if she is breathing. Your education includes:

A) Watching chest to see rise and fall during breathing
B) Watching abdomen to see rise and fall during breathing
C) Applying apnea monitor for her reassurance
D) Using a baby monitor to listen for breathing sounds

Answer 49

B) Watching abdomen to see rise and fall during breathing

Newborns are abdominal breathers and parents need to watch that area to assess for respirations.

Question 50

Auscultation of a newborn’s respiratory and heart sounds during REM sleep reveal 10 – 15 second pauses between respirations. The heart rate is unchanged during these episodes. The newborn is most likely experiencing

A) central apnea.
B) mixed apnea.
C) periodic breathing.
D) obstructive apnea.

Answer 50

C) periodic breathing.

Question 51

SATA: Which of the following findings require physician involvement?

A) no void in the first 24 hours
B) no stool in the first 24 hours
C) eating 8 times in the first 24 hours
D) yellow sclera in the first 24 hours

Answer 51

A) no void in the first 24 hours
D) yellow sclera in the first 24 hours

Question 52

If the newborn has not voided by 24 hours, care should include:

A) catheterization to assess for meatus patency
B) referral to pediatrician
C) increase breastfeeding as baby is dehydrated
D) watchful waiting, as up to 48 hours is normal

Answer 52

B) referral to pediatrician

Question 53

Vitamin K is given to the newborn to prevent:

A) iron deficiency anemia in newborn
B) hemorrhagic disease of the newborn
C) blood coagulation
D) bleeding at the circumcision site

Answer 53

B) hemorrhagic disease of the newborn

Question 54

How can parents best assess for newborn intake?

A) minutes at the breast and time between feeds
B) weight gain and wet/dirty diapers
C) color of urine and time between feedings

Answer 54

B) weight gain and wet/dirty diapers

Question 55

A new mother is discussing infant feeding with the midwife during postpartum day one. During the conversation, which statement indicates that the mother has understood the teaching regarding infant feeding?

A) “As long as my baby is suckling well and wetting the appropriate number of diapers, I don’t have to worry about him getting enough to eat.”
B) “I will know when my baby is getting enough to eat if he sleeps for long periods of time.”
C) “I am going to feed by baby every 2 hours, even if sleeping, to make sure he is getting enough to eat.”
D) “I have decided to bottle feed and know that my baby should have 30-60 ml of formula after the first few days of life.”

Answer 55

A) “As long as my baby is suckling well and wetting the appropriate number of diapers, I don’t have to worry about him getting enough to eat.”

Question 56

Newborn supplementation is needed in which circumstance:

A) newborn receiving phototherapy for jaundice
B) newborn wanting to feed every 2 hours
C) breastfeeding newborn who has lost 17% of birth weight by 3 days of age
D) breastfeeding newborn who has lost 7% of birth weight by 4 days of age

Answer 56

C) breastfeeding newborn who has lost 17% of birth weight by 3 days of age

Question 57

Newborns acquire some immunity via colostrum and breastmilk from which antibody?

A) IgD
B) IgM
C) IgG
D) IgA

Answer 57

D) IgA

Question 58

How often should newborns breastfeed?

A) Newborns should be breastfed on demand anytime they cry, as this is their only method of communication.
B) Newborns should breastfeed every 2-3 hours for at least 15 minutes on each side.
C) Newborns should be breastfed 8-12 times throughout the day and night until they show signs of satiety.

Answer 58

C) Newborns should be breastfed 8-12 times throughout the day and night until they show signs of satiety.

Question 59

The Neonatal Behavioral Assessment Scale (NBAS) was developed to evaluate which of the following EXCEPT:

A) organization of behavioral state
B) decrease in motor activity in response to sensory input
C) ability to self-console
D) level of cry

Answer 59

D) level of cry

The NBAS looks for orientation to stimulation, ability to self-console, regulation of motor activity & organization of states. It DOES NOT check for the Level of cry. Varney p. 1320 6th ed.

Question 60

This is the percentage of the day during which newborns cry:

A) 2-11%
B) 5-10%
C) 10-15%
D) 17-26%

Answer 60

A) 2-11%

Question 61

Staccato crying indicates this:

A) anger
B) fear
C) playfulness
D) discomfort

Answer 61

D) discomfort

Question 62

Predictability of a parent’s response to infants cues results in this:

A) bonding
B) attachment
C) fewer discomforts
D) staccato crying

Answer 62

B) attachment

Question 63

This area of the newborn is most receptive to touch:

A) feet
B) scalp
C) mouth
D) neck

Answer 63

C) mouth

Question 64

The Neonatal Behavioral Assessment Scale (NBAS) begins with the newborn in this state:

A) sleep
B) alert
C) quiet-alert
D) active

Answer 64

A) sleep

Question 65

Organization of states is a part of this type of newborn assessment:

A) 1 month follow up visit
B) Newborn Behavioral Assessment Scale
C) GA assessment
D) Newborn physical exam

Answer 65

B) Newborn Behavioral Assessment Scale

Question 66

Cycles of sleep and wakefulness are regulated by this:

A) anterior pituitary gland
B) hypothalamus
C) variations in movement
D) central nervous system

Answer 66

D) central nervous system

Question 67

Increased cortisol levels in the newborn may result from this:

A) crying with gasping
B) staccato crying
C) weak crying
D) prolonged crying

Answer 67

D) prolonged crying

Question 68

Infants tend to cry more during this time of day:

A) morning
B) noon
C) evening
D) midnight

Answer 68

C) evening

Question 69

This may result in a challenging newborn temperament:

A) maternal caffeine use
B) prenatal bedrest
C) rock music
D) maternal anxiety

Answer 69

D) maternal anxiety

Question 70

At this gestational age the fetus will recognize the mother’s voice:

A) 14 weeks
B) 16 weeks
C) 20 weeks
D) 24 weeks

Answer 70

C) 20 weeks

Question 71

This Neonatal Behavioral Assessment Scale (NBAS) result would be concerning:

A) decreased motor activity in response to sensory input
B) becoming alert in response to auditory stimulation
C) habituation to repeated stimulation
D) inability to self console

Answer 71

D) inability to self console

Question 72

A G2P1001, whose pregnancy is complicated by fetal growth restriction (FGR), undergoes a cesarean operative birth for fetal intolerance of labor. Umbilical cord gases at delivery are

Umbilical artery

pH: 6.95
PCO2 (mm Hg): 65.0
Bicarbonate (HCO3): 17.5
Base deficit (mEq/L): -11.0

Umbilical vein

pH: 7.20
PCO2 (mm Hg): 43.3
Bicarbonate (HCO3): 17.5
Base deficit (mEq/L): -7.5

A) metabolic acidemia.
B) acute respiratory acidemia.
C) neonatal encephalopathy
D) mixed respiratory-metabolic acidemia.

Answer 72

D) mixed respiratory-metabolic acidemia.

Varney 6th edition, p. 933

Question 73

During labor a term G1P0 had a category 1 fetal monitoring strip. During pushing the fetal heart rate pattern developed moderate variable decelerations and terminal bradycardia (HR 60-90) during the last 7 minutes. A tight nuchal cord was discovered at delivery. The baby’s Apgar scores are 5 at one minute and 7 at five minutes. Umbilical cord gas results are

Umbilical artery

pH: 6.98
PCO2 (mm Hg): 102.5
Bicarbonate (HCO3): 19.5
Base deficit (mEq/L): - 6.5

Umbilical vein

pH: 7.30
PCO2 (mm Hg): 42.9
Bicarbonate (HCO3): 18.5
Base deficit (mEq/L): - 5.6

According to the umbilical cord gases at the time of birth the baby had

A) metabolic acidosis.
B) acute respiratory acidosis.
C) mixed respiratory-metabolic acidosis.

Answer 73

B) acute respiratory acidosis.

Question 74

During your physical examination of a 4400 g male infant born vaginally with a shoulder dystocia, there is an unequal Moro reflex and crepitus. These findings suggest a diagnosis of:

A) Fractured clavicle
B) Bell’s palsy
C) Erb’s palsy
D) Torticolis

Answer 74

A) Fractured clavicle

Question 75

At 48 hours of age a newborn’s exam reveals an asymmetric swelling over the parietal bone that does not cross the sagittal suture and has a bluish discoloration. The most likely diagnosis is

A) cephlahematoma
B) subgaleal hemmorrhage
C) caput succedaneum

Answer 75

A) cephlahematoma

Question 76

Clinical signs of a congenital diaphragmatic hernia include

A) respiratory distress with smaller than normal chest cavity
B) respiratory distress with scaphoid abdomen
C) respiratory distress and rounded abdomen
D) respiratory distress only with eating.

Answer 76

B) respiratory distress with scaphoid abdomen

Question 77

A newborn has been diagnosed with atrial septal defect. The infant’s mother is crying, blaming herself, and questioning what caused this heart defect. The midwife’s best response is

A) Many cardiac defects are caused by environmental factors. Do you smoke, drink, use drugs, garden a lot?
B) Many defects are genetic. We asked you questions at your first prenatal visit, but you may not have told us everything. How about the baby’s father?
C) The pediatrician is doing many tests on your baby and will be able to tell you why this happened when the results are back.
D) Most defects are caused by many different factors and it is often hard to determine the exact cause of a defect. Tell me why you think it is your fault?

Answer 77

D) Most defects are caused by many different factors and it is often hard to determine the exact cause of a defect. Tell me why you think it is your fault?

Question 78

Which form of spinal bifida is frequently associated with hydrocephalus and moderate to severe disabilities?

A) Spina bifida meningocele
B) Spina bifida occulta
C) Spina bifida myelomeningocele

Answer 78

C) Spina bifida myelomeningocele

Question 79

Hypospadius is identified by which of the following:

A) Urethra normal, but penis is curved dorsally
B) urethra is on dorsal side
C) Urethra on either ventral or dorsal side of penis
D) urethra on ventral side of penis

Answer 79

D) urethra on ventral side of penis

Question 80

Helpful feeding advice for babies with cleft lip or palate malformations include

A) use a small hole nipple.
B) feed in a side-lying position.
C) feed for no more than 15 minutes at a time.
D) frequently burp the baby.

Answer 80

D) frequently burp the baby.

Question 81

A mother calls the birth center where her exclusively breast fed infant was born four days ago. She reports that he is “a little” jaundiced but otherwise acting fine. What is an appropriate management plan?

A) Provide reassurance and advise her to increase breastfeeding frequency.
B) Ask her to bring the baby to the birth center for a weight and jaundice check.
C) Advise her to come to the birth center and pick up a lab slip to check the baby’s bilirubin level.
D) Refer her to a pediatrician.

Answer 81

B) Ask her to bring the baby to the birth center for a weight and jaundice check.

Question 82

A 40 week gestation newborn at 48 hours of age has a transcutaneous bilirubinometry (TcB) of 8 mg/dL. The nurse-midwife would anticipate this would correlate with a total serum bilirubin (TSB) of

A) 3-4 mg/dL
B) 10-11 mg/dL
C) 12-13 mg/dL
D) 13-14 mg/dL

Answer 82

B) 10-11 mg/dL

Blackburn 5e p. 599 “Current TcB instruments have a correlation that is within 2-3 mg/dL of TSB if the TSB is less than 15 mg/dL in term and late term infants.”

Question 83

Where is bilirubin conjugated?

A) Gut
B) Liver
C) Red Blood Cells

Answer 83

B) Liver

Question 84

The midwife is educating parents about jaundice. What symptoms warrant referral?

A) Yellowness to forehead
B) Stooling two times in the first 24 hours
C) A TCB (transcutaneous bilirubin) of 10 mg/dl
D) Lethargic infant

Answer 84

D) Lethargic infant

Question 85

Why do term healthy babies get jaundice?

A) High red blood cell count, slow digestion and high bilirubin levels
B) Rh incompatibility, anemia, and blocked bile duct
C) Slow glomerular filtration rate, low platelets, Asian descent

Answer 85

A) High red blood cell count, slow digestion and high bilirubin levels

Question 86

SATA: A term newborn is now between 48 and 72 hours old. Which of the following bilirubin levels would likely prompt initiation of phototherapy?

A) 5 mg/dl
B) 10 mg/dl
C) 15 mg/dl
D) 20 mg/dl

Answer 86

C) 15 mg/dl
D) 20 mg/dl

Question 87

SATA: Strategies to prevent breastfed associated hyperbilirubinemia include

A) Initiate breast/chest feeding within 1-3 hours after birth
B) frequent short feedings (8 - 10/24 h)
C) infrequent prolonged feedings
D) supplement with formula
E) monitor weight
F) monitor stools and voiding
G) supplement with dextrose water

Answer 87

A) Initiate breast/chest feeding within 1-3 hours after birth
B) frequent short feedings (8 - 10/24 h)
E) monitor weight
F) monitor stools and voiding

Question 88

A Caucasian newborn has a total serum bilirubin level of 5 mg/dL at 72 hours of age. At 5 days of age the total serum bilirubin level is 2.5mg/dL. This pattern would be consistent with

A) physiologic jaundice
B) pathologic jaundice
C) early (breastfeeding associated) jaundice
D) late (breast milk) jaundice

Answer 88

A) physiologic jaundice

Question 89

A baby boy, 48 hours post spontaneous vaginal birth is bottle feeding, active, alert, voiding appropriately and started stooling today. His mother is AB positive and had Stadol for pain relief during labor. Jaundice is noted on his face and chest, with a total bilirubin of 10mg/dl. The midwife’s diagnosis is:

A) Normal exam
B) Pathologic jaundice
C) Physiologic jaundice

Answer 89

C) Physiologic jaundice

Question 90

A newborn born at 36 weeks gestation with a history of hypothermia is at greater risk for hyperbilirubinemia, bilirubin encephalopathy and kernicterus because their

A) albumin-bilirubin binding capacity is decreased.
B) albumin-bound bilirubin is able to enter the brain.
C) albumin-bound bilirubin can be deposited in the skin, brain, and other organs.
D) albumin-bound bilirubin is increased.

Answer 90

A) albumin-bilirubin binding capacity is decreased.

Question 91

A 96 hours of age a 37 week gestation newborn male has a total bilirubin level of 20 mg/dL. The newborn’s history is complicated by an emergency cesarean birth for fetal bradycardia. Apgars at 1,5, and 10 minutes were 2,5, and 7. The nursery nurse requests the nurse-midwife to evaluate the baby for lethargy, poor breast feeding, and a high pitched cry. Appropriate Assessment (A) and management plan (P) include

A) A: Acute bilirubin encephalopathy; P: refer to pediatrician.
B) A: Kernicterus; P: refer to pediatrician.
C) A: Physiologic hyperbilirubinemia; P: Consult with pediatrician, initiate phototherapy.
D) A: Early (breast feeding associated) jaundice;P consult with pediatrician, interrupt breastfeeding and replace with formula.

Answer 91

A) A: Acute bilirubin encephalopathy; P: refer to pediatrician.

Question 92

At 40 hours of age, a 36 week gestation, breastfed male infant appears jaundiced. The nurses report he is lethargic, hypotonic, feeding poorly, and has a high-pitched cry. What is the appropriate management plan?

A) order total serum bilirubin (TSB), refer to pediatrician
B) order total serum bilirubin (TSB), initiate phototherapy based on lab results
C) order transcutaneous bilirubinometry, consult pediatrician
D) order transcutaneous bilirubinometry, encourage frequent feeds, consult with pediatrician

Answer 92

A) order total serum bilirubin (TSB), refer to pediatrician

Dx: acute bilirubin encephalopathy (ABE). Cerebral symptoms associated with hyperbilirubinemia: irritability, high-pitched cry, hypertonia or hypotonia, seizures, and possibly death if left untreated. Varney, 6th ed. pg. 1327.

Question 93

Which of the following 36 hour-old newborns is most likely to have problematic jaundice?

A) Baby with jaundice on forehead
B) Baby with cephalohematoma
C) Baby who is bottle fed

Answer 93

B) Baby with cephalohematoma

Question 94

A mom, whose baby was diagnosed with CHD is asking you why her baby needs to have further tests and scans. Your best repsonse is:

A) Almost all babies that have CHD also have other things wrong with them, so they are trying to determine what other issues your newborn has.(As the CNM, knowing that about 3/4 of babies who have CHD also have other anomalies)
B) That is a question you should be asking your pediatrician. I am here to assess how you are doing postpartally.
C) It is extremely rare, but occasionally a baby with CHD also has something else wrong with them. Therefore they are doing other tests to try and determine what else is wrong. (As the CNM, knowing that about 1/3 of babies who have CHD also have other anomalies)
D) It is good that they are thoroughly assessing your baby. They are making sure everything else is OK. (As the CNM, knowing that 1/4 of babies with CHD also have other anomalies)

Answer 94

D) It is good that they are thoroughly assessing your baby. They are making sure everything else is OK. (As the CNM, knowing that 1/4 of babies with CHD also have other anomalies)

Question 95

The most common form of atrial-septal defect (ASD) is:

A) Common atrium
B) Ostium secundum defect
C) Sinus venosus defect
D) Patent foramen ovale

Answer 95

D) Patent foramen ovale

Question 96

During auscultation of a newborn’s heart sounds at 2 weeks of age, a continuous machinery sounding murmur that is louder during systole is noted. Brachial and pedal pulses are bounding. Otherwise the infant is asymptomatic. Appropriate assessment (A) and management plan (P) includes

A) A: patent ductus arteriosis; P: order echocardiogram, pediatric referral.
B) A: coartation of the aorta; P: order echocardiogram, pediatric referral.
C) A: patent ductus arteriosis; P: expectant management.
D) A: aortic stenosis; P: order echocardiogram, pediatric referral.

Answer 96

A) A: patent ductus arteriosis; P: order echocardiogram, pediatric referral.

Question 97

Dextrocardia in a newborn is most likely to have no clinical significance if:

A) the abdominal organs are on the same side as the heart
B) the abdominal organs are smaller
C) the abdominal organs remain the same
D) the abdominal organs are transposed to the opposite side

Answer 97

D) the abdominal organs are transposed to the opposite side

Question 98

SATA: A calm newborn has a heart rate of 195 at 2 hours old, nurse-midwifery management includes, check all that apply:

A) abnormal finding, follow up needed
B) ECG evaluation
C) referral
D) normal finding, no follow up needed
E) reassess again in 4 hours

Answer 98

A) abnormal finding, follow up needed
B) ECG evaluation
C) referral

Question 99

SATA: The nurse-midwifery management of babies with CHD is:

A) consult pediatrician when abnormality noted
B) cardiac assessment of newborn to determine abnormality
C) offer information, guidance, and support to parents
D) refer newborn when abnormality noted
E) collaborate with pediatrician when abnormality noted

Answer 99

B) cardiac assessment of newborn to determine abnormality
C) offer information, guidance, and support to parents
D) refer newborn when abnormality noted

Question 100

T/F: Most newborns have risk factors for CHD, so as a midwife I will know ahead of time which babies to assess for cardiac defects.

Answer 100

False

Question 101

All of the following conditions are classified as acyanotic heart disease, EXCEPT:

A) Atrial septal defect
B) Ventral septal defect
C) Patent Ductus Arteriosus
D) Tetrology of Fallot

Answer 101

D) Tetrology of Fallot

Question 102

A gestational diabetic mother gives birth to a 9 lb infant. The initial breastfeeding is delayed. The infant’s first blood sugar taken within 2 hours after delivery is 30 mg/dL. The infant is then successfully breastfed and the blood sugar repeated 30 minutes later with a result of 38 mg/dL. An appropriate assessment (A) and management plan (P) includes

A) A: hyperglycemia; P: confirm with venous sample
B) A: hypoglycemia; P: confirm with venous sample
C) A: euglycemic; P: encourage frequent breastfeeding.

Answer 102

B) A: hypoglycemia; P: confirm with venous sample

Question 103

A term, large for gestational age infant is crying and vigorous and has no signs of hypoglycemia. The mother wants to breastfeed. The baby’s capillary glucose is 43. The midwife should:

A) Supplement with formula.
B) Repeat glucose testing using a venous sample.
C) Assist the mother to breastfeed the baby.
D) Consult with a pediatrician to determine management.

Answer 103

B) Repeat glucose testing using a venous sample.

Question 104

A large for gestational age (LGA), term newborn of a poorly controlled gestational diabetic mother is breastfed within the first hour after birth. Thirty minutes later the initial heel stick glucose is 20 mg/dL. The infant is refed and 1 hour later the heel stick glucose is 35 mg/dL. The appropriate assessment (A) and management plan (P) includes

A) A: Hypoglycemia; P: order a D5W IV and refer to pediatrician.
B) A: Euglycemic; P: encourage frequent breastfeeding.
C) A: Hyperglycemia; P: avoid overfeeding.
D) A: Hypoglycemia; P: confirm with a stat venous sample

Answer 104

D) A: Hypoglycemia; P: confirm with a stat venous sample

Question 105

Increased hypoglycemia, hypoxia, acidosis, and respiratory distress may be secondary to:

A) hyperthermia in the newborn.
B) cold stress in the newborn.
C) patent ductus arteriosus.

Answer 105

B) cold stress in the newborn.

Question 106

During a 28 week prenatal visit, the midwife’s discussion with the patient and father of the baby included the topic of circumcision. It is important that the discussion include:

A) Information on the risks and benefits, as well as the midwife’s personal choice.
B) Information that circumcision puts a child at increased risk for infection later in life.
C) Information about the risks and benefits of circumcision.
D) Information that circumcision prevents sexually transmitted infections.

Answer 106

C) Information about the risks and benefits of circumcision.

Question 107

Any glucose level below the recommended threshold for normal requires intervention. Feeding the infant is the first step. A repeat glucose test is performed ______ minutes after feeding and if the borderline level persists, a venous sample should be checked.

Answer 107

30

Neonatal Hypoglycemia, Chapter 38, p. 1315

Question 108

The cardinal signs of newborn respiratory compromise include

A) tachypnea, nasal flaring, and retractions.
B) bradycardia, rhonchi, and hypoglycemia.
C) tachycardia, low O2 saturation, and grunting.

Answer 108

A) tachypnea, nasal flaring, and retractions.

Question 109

A patient questions the timing of erythomycin eye ointment for her newborn.The best response is:

A) Waiting for 30 minutes to allow for bonding is appropriate.
B) It must be done immediately or it does not work to prevent conjunctivitis.
C) It is fine to wait a few minutes, but this will decrease the efficacy.
D) Timing is of no consequence, as long as it is done before discharge home.

Answer 109

A) Waiting for 30 minutes to allow for bonding is appropriate.

Question 110

A midwife is caring for a newborn who is 6 hours old. What is the MOST EFFECTIVE practice the midwife can do to prevent sepsis in that newborn?

A) Review of the mother’s prenatal record and labs, considering risks.
B) Careful observation of the infant for subtle signs of infection.
C) Wearing clean gloves whenever touching the newborn.
D) Consistent, thorough hand washing when caring for the newborn.

Answer 110

D) Consistent, thorough hand washing when caring for the newborn.

Question 111

Which is the purpose of the nurse-midwife reviewing the newborn’s blood type prior to the physical examination?

A) Monitoring for hypoglycemia
B) Monitoring for maternal substance use
C) Monitoring for isoimmunization
D) Monitoring for hepatitis infection

Answer 111

C) Monitoring for isoimmunization

Check ABO blood type and Rhesus (Rh) type. Varney p. 1286.

Question 112

Neonatal Abstinence Syndrome Scoring Systems (Finnegan Neonatal Abstinence scoring System, Lipsitz tool, Ostrea system) are specific to

A) opioid withdrawal.
B) methamphetamine withdrawal.
C) cocaine withdrawal.
D) benzodiazepines withdrawal.

Answer 112

A) opioid withdrawal.

Question 113

When talking with the new parents about newborn medications, the midwife notes that the primary reason for erythromycin eye ointment in newborns is to prevent blindness from:

A) Herpes simplex virus
B) Gonorrhea
C) Group B strep
D) Rubella

Answer 113

B) Gonorrhea

Question 114

The midwife should obtain a glucose screen on which infant?

A) 6 ½ pound term baby with a two hour second stage who was born at home.
B) 6 pound term infant whose mother received 3 liters of normal saline in labor.
C) 7 ½ pound term baby whose mother received 3 liters of dextrose IV solution in labor.

Answer 114

C) 7 ½ pound term baby whose mother received 3 liters of dextrose IV solution in labor.

Question 115

The nurse-midwife places the neonate on the mother’s chest after birth for skin-to-skin contact (SSC). What is the appropriate time for clamping the newborn’s umbilical cord?

A) 5 minutes after SSC is initiated
B) 12 minutes after SSC is initiated
C) 7 minutes after SSC is initiated
D) 1 minute after SSC is initiated

Answer 115

A) 5 minutes after SSC is initiated

Evidence indicates a minimum of 3-5 minutes is optimal for the newborn. Umbilical-Cord Clamping, Chapter 38, Varney p. 1314.

Question 116

The newborn who is born to the individual who experienced prolonged rupture of membranes is at an increased risk for:

A) neonatal sepsis
B) hyperglycemia
C) meconium aspiration pneumonia
D) cephalahematoma

Answer 116

A) neonatal sepsis

Varney p. 1288 Table 37-2

Question 117

When explaining jaundice signs and symptoms to your home birth patient, any signs in the first 24 hours are:

A) physiologic and warrent close watching
B) pathologic and CNM will closely monitor
C) pathologic and require referral
D) physiologic and increased breastfeeding is needed

Answer 117

C) pathologic and require referral

Question 118

A recovering heroin addict on Methadone has just delivered. Her last Methadone dose was 8 hours prior to birth. The nurse-midwife’s immediate delivery room preparations are based on the knowledge that

A) Narcan is beneficial for quickly reversing opioid effects in the drug dependent neonate.
B) Methadone dependent neonates are at risk for respiratory depression.
C) Methadone has a duration of 8 hours.

Answer 118

B) Methadone dependent neonates are at risk for respiratory depression.

Question 119

During a prenatal visit, the woman explains to the nurse-midwife that she is undecided on whether to consent to giving her baby boy a vitamin K injection at birth. Her medical history is benign. She is planning on breastfeeding and a circumcision. The nurse-midwife replies:

A) “If you prefer not to have the injection, an alternative is to administer the FDA-approved oral vitamin K, 1 mg.”
B) “Since you do not have any known genetic clotting factor disorders, it is unlikely that your baby will need a vitamin K injection at birth.”
C) “ Although newborns have a vitamin K deficiency at birth, it is rare for it to lead to increased bleeding, especially among breastfed infants. Despite the vitamin K deficiency, newborn clotting times are faster than adults”
D) “Newborns do not have a major store of vitamin K and vitamin K levels are low in breastmilk. A vitamin-K injection is recommended for all newborns to prevent hemorrhagic disease of the newborn.”

Answer 119

D) “Newborns do not have a major store of vitamin K and vitamin K levels are low in breastmilk. A vitamin-K injection is recommended for all newborns to prevent hemorrhagic disease of the newborn.”

Varney p. 1316. The oral Vitamin K is not FDA approved and the single oral dose may be subtherapeutic.

Question 120

Describe a currently accepted management approach for prevention of early-onset group B strep infection in newborns.

A) Pretreat women with a positive group B strep (GBS) culture with oral antibiotics prior to labor then treat all infants with antibiotics after birth.
B) Perform a recto-vaginal culture at the first prenatal visit and treat women with positive cultures with antibiotics during labor.
C) Treat women with an unknown group B strep (GBS) status with antibiotics in labor if risk factors are present.
D) Treat women with a positive group B strep (GBS) culture from a previous pregnancy with antibiotics in labor.

Answer 120

C) Treat women with an unknown group B strep (GBS) status with antibiotics in labor if risk factors are present.

Question 121

With delayed cord clamping, what physiologic mechanism prevents the baby from losing blood to the placenta?

A) Umbilical vein constricts at birth
B) Umbilical arteries constrict at birth
C) All 3 vessels constrict at birth

Answer 121

B) Umbilical arteries constrict at birth

Question 122

A mother new to this country is describing infant care practices in her culture. In what circumstance should the midwife provide education?

A) When the mother describes mixing honey with water and using that to soothe infant.
B) When the mother talks about wearing the baby in a sling throughout the day.
C) When the father is unable to be around infant due to maternal lochia.
D) When the father takes the baby aside at the birth and whispers in their ear.

Answer 122

A) When the mother describes mixing honey with water and using that to soothe infant.

Question 123

The midwife examines a breastfed baby who is 12 hours old and the mother expresses concern that the baby has not yet had a wet diaper. The midwife’s response should be to:

A) refer the baby to a pediatrician now.
B) encourage supplementation with bottle feeding to increase fluid intake.
C) consult with a pediatrician by phone to determine management.
D) reassure the mother and advise her to call if the baby has not voided in the next 12-14 hours.

Answer 123

D) reassure the mother and advise her to call if the baby has not voided in the next 12-14 hours

Question 124

According to a Cochrane Collaboration meta-analysis, infants receiving antimicrobial cord care compared with dry cord care are more likely to have:

A) increased cord infections in the dry care group
B) early cord separation in the antimicrobial group
C) no bleeding with cord separation in the dry cord group
D) no statistical difference noted in either group

Answer 124

D) no statistical difference noted in either group

Question 125

A student nurse questions why a newborn needs vitamin K. The midwife responds:

A) Babies that are breastfed will not form these vitamins until they start eating solid food.
B) The baby’s intestines need to be colonized with bacteria before her body can prevent hemorrhagic disease on her own.
C) The baby can form these vitamins on her own after several days.

Answer 125

B) The baby’s intestines need to be colonized with bacteria before her body can prevent hemorrhagic disease on her own.

Question 126

Small for gestational age (SGA)

A) can be used interchangeably with fetal growth restriction (FGR).
B) indicates an infant whose weight falls below the 10th percentile.
C) infants have experienced an intrauterine pathological process.
D) infants are categorized as asymmetric or symmetric.

Answer 126

B) indicates an infant whose weight falls below the 10th percentile.

Question 127

A newborn was just born to a person with a positive hepatitis B surface antigen (HBsAG). Appropriate management includes

A) administer hepatitis B immunoglobulin and hepatitis B vaccine to the newborn within 12 hours of the birth.
B) instruct the mother that breastfeeding is contraindicated since she has chronic hepatitis B.
C) provide routine newborn care recommending hepatitis B vaccine to the newborn within 12 hours of the birth.
D) repeat maternal hepatitis B surface antigen (HBsAG) testing and watch for signs of infection in the newborn.

Answer 127

A) administer hepatitis B immunoglobulin and hepatitis B vaccine to the newborn within 12 hours of the birth.

Varney p. 1322.

Question 128

Vitamin K is usually administered to the newborn for the prevention of:

A) Erythroblastosis fetalis
B) Group B strep infection
C) Hemorrhagic disease
D) Phenylketonuria

Answer 128

C) Hemorrhagic disease

Question 129

Bacterial infection in the newborn most commonly presents with:

A) Hyperreflexia
B) Microcephaly
C) Rash
D) Temperature instability

Answer 129

D) Temperature instability

Question 130

It is important to be aware that

A) neonatal drug withdrawal symptoms are distinct from central nervous system (CNS) irritability caused by metabolic disorders.
B) neonates do not exhibit nicotine withdrawal symptoms.
C) the use of naloxone on an opioid-dependent infant may cause withdrawal seizures.

Answer 130

C) the use of naloxone on an opioid-dependent infant may cause withdrawal seizures.

Question 131

A mother, who is HBsAg negative, wants to know about the Hepatitis B immunization for her infant. Choose what information to share with her at that visit.

A) The CDC does not recommend the Hepatitis immunization unless she is Hepatitis B positive.
B) The first dose of the Hepatitis B vaccine is recommended within 12 hours of birth.
C) Her newborn will receive the Hepatitis B vaccine as well as the Hepatitis B Immune Globulin (HBIG) vaccine within 12 hours of birth.
D) It is unknown whether giving the Hepatitis B vaccine at birth will make the baby immune to Hepatitis B.

Answer 131

B) The first dose of the Hepatitis B vaccine is recommended within 12 hours of birth.

Question 132

Newborn screening for intrauterine drug exposure

A) should use urine testing as the gold standard.
B) should be considered when an infant exhibits neurobehavioral abnormalities.
C) is indicated when an infant experiences meconium ileus.
D) should be considered with a maternal history of multiple therapeutic abortions.

Answer 132

B) should be considered when an infant exhibits neurobehavioral abnormalities.

Question 133

Transient tachypnea of the newborn is a syndrome primarily of the term neonate caused by:

A) A deficiency of surfactant.
B) Exposure to maternal analgesia/anesthesia.
C) Meconium aspiration.
D) Retained lung fluid after birth.

Answer 133

D) Retained lung fluid after birth.

Question 134

A patient gave birth at 1030 am and has decided to begin breastfeeding during the initial period of reactivity. The best time to feed the baby is:

A) 10:30 - 11:00
B) 11:00 - 11:30
C) 11:30 - 12:00
D) 12:00 - 12:30

Answer 134

A) 10:30 - 11:00

Question 135

While examining 39 week, 8 lb. 6 oz. baby boy at 36 hours post birth, a bluish color of his lips, tongue, earlobes and scrotum are noted. Assessment (A) and management plan (P) include

A) A: central cyanosis; P: pulse oximeter, refer to pediatrician.
B) A: circumoral cyanosis; P: pulse oximeter, refer to pediatrician..
C) A: vasomotor instability; P: pulse oximeter, pediatric referral.
D) A: acrocyanosis; P: expectant management.

Answer 135

A) A: central cyanosis; P: pulse oximeter, refer to pediatrician.