OB Exam 2 Pt 2

Question 1

When is the newborn’s first period of reactivity?

Answer 1

Up to 30 minutes after birth. ch 23

Question 2

Page 530 (10th ed.) notes that Once respirations are established, breaths are shallow and irregular, ranging from _____ to ______.

Answer 2

30 – 60. ch 23

Question 3

Apneic periods longer than ____ seconds should be evaluated.

Answer 3

20 seconds. ch 23

Question 4

List several signs of respiratory distress in the immediate newborn period.

Answer 4

Nasal flaring; retractions; grunting with exhalation; increased use intercostal muscles, see-saw respiration, rate less than 30 or more than 60. ch 23

Question 5

Rapid increase in body temperature, hypothermia, hypocalcemia or sepsis.

Answer 5

Name 4 things that can contribute to apnea (Pg. 530). ch 23

Question 6

The average newborn has 300 ml of blood. This can be increased by ____ ml if the cord is not cut immediately but “placental transfusion” is allowed to occur, in which the blood in the cord and placenta is allowed to flow into the baby.

Answer 6

100 ml. (Pg. 532) ch 23

Question 7

Persistent tachycardia may be associated with which disorders?

Answer 7

Anemia, hypervolemia, hyperthermia or sepsis. ch 23

Question 8

Persistent bradycardia may be associated with which disorders?

Answer 8

Congenital heart block or hypoxemia. ch 23

Question 9

Name the four modes of heat loss. (These are often on tests.)

Answer 9

Convection, radiation, evaporation, conduction. ch 23

Question 10

The nurse alert makes the point that the infant must void within ___ hours after birth.

Answer 10

24 ch 23

Question 11

What is the source of bilirubin, which can build up in the blood and cause neurotoxicity?

Answer 11

Breakdown of RBCs and the newborn liver’s inability to process this. ch 23

Question 12

How does feeding help to reduce the serum bilirubin?

Answer 12

Feeding stimulates peristalsis, which then causes less bilirubin to be reabsorbed by the gut. ch 23

Question 13

By what age should infants be able to concentrate their urine?

Answer 13

By three months. Pg.535 ch 23

Question 14

What are Epstein’s pearls and where are they found?

Answer 14

Retention cysts, on gum margins and at the juncture of hard and soft palate. ch 23

Question 15

The intestines are free of bacteria after birth. Once bacteria are established, which 3 vitamins do they help to synthesize?

Answer 15

Vitamin K, folate and biotin. ch 23

Question 16

What is the capacity of the stomach of the newborn in milliliters?

Answer 16

30 – 90 ml. ch 23

Question 17

What color is meconium?

Answer 17

Greenish black ch 23

Question 18

Describe the stools of breast-fed babies

Answer 18

Breastfed infants have more frequent and liquid stools; they are yellow and contain small yellow curds. They often smell like sour milk. ch 23

Question 19

Describe the stools of bottle-fed babies

Answer 19

Bottle-fed infants have larger green-brown stool (book says may even be pale yellow) harder or more formed and have a more offensive odor. ch 23

Question 20

Most normal, term infants pass meconium within ____ to ____ hours.

Answer 20

12, 24. Pg. 536 ch 23

Question 21

How long should the iron stores last in a full-term breast-fed infant vs. in a preterm infant?

Answer 21

4 – 6 months vs. 2 – 3 months. ch 23

Question 22

What is a normal blood glucose level for a newborn in the first several hours after birth?

Answer 22

50 – 60 mg.dl. Pg. 537. ch 23

Question 23

What should blood glucose levels be by the third day of life?

Answer 23

60 – 70 mg/dl ch 23

Question 24

Page 538 in the paragraph beneath the nurse alert, states, “Jaundice is considered to be pathologic if it: _______ (list the 3 criteria given).”

Answer 24

(1.) appears before 24 hours of age. (2.) increases more than 5 mg/dl/ in a 24 hour period. (3.) peaks at greater than 15 mg/dl at any time ch 23

Question 25

Which is the worst of the long-term disorders involving hyperbilirubinemia?

Answer 25

Kernicterus. ch 23

Question 26

Newborns are at high risk for infection, yet do not typically have fevers. What are signs of infection in newborns?

Answer 26

Lethargy, irritability, poor feeding, vomiting, diarrhea, decreased reflexes, pale and mottled skin, apnea, tachypnea, grunting or retracting ch 23

Question 27

What is vernix caseosa? Do term or preterm infants have more of it?

Answer 27

Cheese-like whitish substance found on newborn skin that is protective; preterm ch 23

Question 28

Acrocyanosis is a normal finding in newborns, unlike central cyanosis. How does an infant with acrocyanosis look?

Answer 28

Hands and feet appear slightly cyanotic and blue ch 23

Question 29

What is lanugo?

Answer 29

Fine hair on an infant’s face, shoulders and back. ch 23

Question 30

What do the nevi known as “stork bites” look like and when do they usually fade?

Answer 30

Pink, easily blanched; on eyelids, nose, occiput, neck and fades by second year. ch 23

Question 31

What does erythema toxicum look like and when does it usually fade?

Answer 31

Rash-like, red macules, papules or vesicles anywhere on body. It fades by 3 weeks. ch 23

Question 32

Which hormone is responsible for mucoid vaginal discharge and pseudo menstruation in neonatal girls and breast swelling and “witches milk” in either gender?

Answer 32

Estrogen, from the mother’s blood. Pg. 541. ch 23

Question 33

How does the scrotum of a term male differ from that of a preterm male?

Answer 33

Term: testicles palpable, many rugae present. Preterm: testes may not have fully descended; few or no rugae. ch 23

Question 34

Describe the differences between caput succedaneum and cephal hematoma.

Answer 34

Caput succedaneum is edema of the scalp and crosses suture lines. Cephal hematoma is bleeding between the periosteum and skull. It does not cross suture lines. ch 23

Question 35

Which two tests are used to determine if a newborn has hip dysplasia?

Answer 35

Barlow test and Ortolani’s maneuver. ch 23

Question 36

Your book notes that some crying is actually normal (and does not mean that the caregiver is doing something “wrong” as new parents often think).At what age does the crying peak?

Answer 36

At about 2 months of age. Pg. 551. ch 23

Question 37

Why is the newly admitted baby from L& D considered a source of contamination and handled with gloves? (See the study guide and Pg. 553.)

Answer 37

Because they have blood and amniotic fluid, vernix and vaginal bacteria on the skin until bathed. ch 24

Question 38

What 5 areas are assessed in generating an Apgar Score?

Answer 38

Heart rate, respiratory rate, muscle tone, reflex irritability, color. ch 24

Question 39

When is the all-important alarming ID bracelet attached to the infant’s ankle?(see the study guide.)

Answer 39

Before mom and baby are separated after birth. ch 24

Question 40

After the thorough assessment by the newborn nursery admitting nurse, which assessment is done to determine gestational age?

Answer 40

New Ballard Scoring. ch 24

Question 41

What two medications may be used to prevent ophthalmia neonatorum?

Answer 41

Erythromycin or tetracycline eye ointment. ch 24

Question 42

Injury to the baby may occur when health care providers use which delivery techniques?

Answer 42

Forceps-assisted births, vacuum extractors, version and extraction, cesarean sections. Pg. 574. ch 24

Question 43

How well do the new TcB monitors correlate with the serum bilirubin levels?

Answer 43

Very well, within 2 – 3 mg/dl. ch 24

Question 44

What is the normal range for total serum bilirubin?

Answer 44

1 – 12 mg/dl. Pg. 575. ch 24

Question 45

What glucose measurements in a neonate indicate hypoglycemia? (use values from page 575.)

Answer 45

Blood glucose levels of less than 40 - 50mg/dl ch 24

Question 46

List signs/symptoms of hypoglycemia?

Answer 46

Jitteriness, irregular respiratory effort, respiratory distress, apnea, hypotonia, feeding difficulties, lethargy, seizures, or no signs at all. Pg. 576. ch 24

Question 47

List signs/symptoms of hypocalcemia?

Answer 47

Jitteriness, high-pitched cry, irritability, apnea, intermittent cyanosis, abdominal distension, laryngospasm, or no signs at all. Pg. 576. ch 24

Question 48

What is the best treatment for both hypoglycemia and hypocalcemia?

Answer 48

Feeding, as early as possible. Pg. 687 ch 24

Question 49

Where should the infant’s heel be punctured when collecting blood for a lab test?

Answer 49

Only on the sides of the heel. Pg. 580 ch 24

Question 50

Which 2 injections should all infants in the NN receive?

Answer 50

Vitamin K and Hepatitis B. ch 24

Question 51

Which size needle is used for IM injections in newborns?

Answer 51

25 gauge, 5/8 inch needles. ch 24

Question 52

Which muscle is used for injections in newborns?

Answer 52

Vastus lateralis ch 24

Question 53

Hyperbilirubinemia can best be prevented by early feeding. But if this is not enough, what treatment modality may be used?

Answer 53

Photo therapy ch 24

Question 54

Which methods of circumcision requires use of Vaseline for post care?

Answer 54

Gomco or Yellen. (Also Mogen). ch 24

Question 55

How soon should the plastic ring fall off when the plastibell method of circumcision has been used?

Answer 55

5 – 7 days. ch 24

Question 56

How long does the yellow exudate on the glans after circumcision last?

Answer 56

2 -3 days. Pg. 746. ch 24

Question 57

What is the recommendation regarding immersion baths of a newborn before the cord has fallen off?

Answer 57

Sponge baths until cord falls off. ch 24

Question 58

Which position for sleeping is currently recommended?

Answer 58

Back to sleep. ch 24

Question 59

What are current cord care recommendations regarding what to clean the cord with?

Answer 59

Water or soap and water cleansing. Pg. 597 ch 24

Question 60

What is colic and why do babies get it?

Answer 60

We do not have the answers to this question. Pg. 601. ch 24

Question 61

What occurs in the baby before each spurt in development? (according to Dr. Brazleton, a noted authority on child development and treatment)

Answer 61

A period of disorganization. Pg. 755. ch 24

Question 62

For how many months should an infant be breastfed exclusively?

Answer 62

6 months ch 25

Question 63

Which conditions in the mother or infant are contraindications to breastfeeding?

Answer 63

Infants with galactosemia, mothers with HIV or TB or Human T-cell lymphotrophic virus type I or II; mothers receiving radiation or chemotherapy, and mothers using street drugs and certain other meds Pg. 608. ch 25

Question 64

How many calories does human milk contain per ounce?

Answer 64

20 Kcal. ch 25

Question 65

Decreased calcium absorption is a problem when cow’s milk is used. Why is this?

Answer 65

Because the calcium to phosphorus ratio is low. ch 25

Question 66

Is it true that women with large breasts can produce more milk than those with smaller breasts?

Answer 66

No! Size has no bearing and is not an accurate indicator of milk-producing ability. Small breasts have the glands that are necessary. ch 25

Question 67

At how many weeks gestation do the breast begin making colostrum?

Answer 67

16 weeks. ch 25

Question 68

How does the body “know” when to make more milk?

Answer 68

Increased milk supply is made on a supply-meets-demand basis. More feeding = more milk production. Pg. 612. ch 25

Question 69

Mothers who breastfeed are at decreased risk for which serious postpartum complication?

Answer 69

PPH (postpartum hemorrhage). ch 25

Question 70

Why does breastfeeding cause increased afterpains?

Answer 70

Increased release of oxytocin with breastfeeding causes more uterine contractions. ch 25

Question 71

Which two hormones prevalent in the postpartum time affect women’s emotions?

Answer 71

Prolactin and oxytocin. ch 25

Question 72

When does real milk as opposed to colostrum “come in”?

Answer 72

3 – 5 days ch 25

Question 73

Does foremilk contain more fat or protein?

Answer 73

Protein (also lactose and vitamins.) ch 25

Question 74

After the first few days, now many wet diapers and stools should an infant have?

Answer 74

6 wet diapers and 3 – 6 stools. ch 25

Question 75

What are the 4 breastfeeding positions?

Answer 75

Football hold, cradle, modified cradle or across lap, and side-lying. ch 25

Question 76

How much of the areola should the baby’s mouth cover if properly “latched on”?

Answer 76

2 – 3 cm. all around areola. ch 25

Question 77

What is demand feeding?

Answer 77

The infant determines when feedings occur, i.e., “feed him when he’s hungry.” ch 25

Question 78

How long will the mother feed the baby on each breast once lactation is established?

Answer 78

15 – 20 minutes on each side. ch 25

Question 79

How can nursing staff, mothers, and families prevent nipple confusion from occurring?

Answer 79

Don’t give supplementary feedings until breast feeding is well-established, about 3 – 4 weeks, and the same for pacifiers. ch 25

Question 80

List 3 benefits of breast milk for preterm infants, given on page 621.

Answer 80

Enhances retinal maturation, improves neurocognitive outcomes, and decreases risk of NEC. ch 25

Question 81

How long can breast milk be stored: at room temperature, in the refrigerator, in the freezer, and in the deep-freeze?

Answer 81

8 hours; 8 days; up to 6 months; up to12 months. Pg. 623 ch 25

Question 82

How should frozen breast milk be thawed?

Answer 82

Either place in refrigerator or in warm water.

Question 83

How soon should breast milk be used after thawing? Should it be re-frozen?

Answer 83

Use within 24 hours, do not re-freeze. ch 25

Question 84

Which common appliance should never be used to thaw or heat breast milk, according to the nurse alert?

Answer 84

Microwave. ch 25

Question 85

How many additional Kcal does a breastfeeding woman need over her non-pregnant needs?

Answer 85

300 - 500 Kcal./day. ch 25

Question 86

True or false? Breastfeeding women should take multivitamin supplements.

Answer 86

True ch 25

Question 87

Women with flat or inverted nipples have internal adhesions that make sucking more difficult for babies. Which product may help this, and may even be started early in pregnancy?

Answer 87

Breast Shells ch 25

Question 88

Which type of oral contraceptive is not likely to interfere with milk supply? (See the study guide for information on this)

Answer 88

POPs (Progesterone-only pills) and other progesterone-based contraceptives. ch 25

Question 89

Can women with breast augmentation surgery breastfeed successfully?

Answer 89

Usually they can. ch 25

Question 90

What are signs and symptoms of engorgement?

Answer 90

Painful overfilling of breast; breast are firm, tender, hot, shiny, taut, nipples may flatten. ch 25

Question 91

When is engorgement likely to occur?

Answer 91

3 – 5 days after birth when milk has “come in”. ch 25

Question 92

How often should the mother with engorgement breastfeed?

Answer 92

Frequently, q 2 hours ch 25

Question 93

What interventions are recommended for engorgement?

Answer 93

Feed every 2 hours, massage breasts, use breast pump if infant not emptying breast, cold compresses, raw cabbage leaves. ch 25

Question 94

What are causes of sore nipples?

Answer 94

Poor positioning, incorrect latch-on, improper suck, monolial infection. ch 25

Question 95

List signs and symptoms of mastitis.

Answer 95

Flu-like signs and symptoms like fever, shills aches, headache, along with localized redness and swelling, especially in one quadrant of the breast. ch 25

Question 96

What are the treatments for mastitis?

Answer 96

Antibiotics, analgesics, antipyretics, frequent feeding/pumping, warm compresses, rest. ch 25

Question 97

What are the implications/risks of propping a baby bottle rather than holding it for the baby to drink?

Answer 97

They can choke and it deprives them of parental interaction. ch 25