Unit VIII - Newborn Flashcards Preview

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Flashcards in Unit VIII - Newborn Deck (114):
1

The Thinking Nurse - Caring for the Infant

What medication is administered soon after birth to prevent transient deficiency of clotting factors?

A. Erythromycin
B. Vitamin A
C. Vitamin C
D. Vitamin K

D. Vitamin K

2

The Thinking Nurse - Caring for the Infant

When performing a gestational age assessment on a healthy term newborn, what would the nurse expect to find in relation to neuromuscular tone at rest?

A. Limbs flexed and legs partially abducted
B. Flexed, abducted hips and extended knees
C. Relaxed extending extremities
D. Hypertonicity

A. Limbs flexed and legs partially abducted

3

The Thinking Nurse - Caring for the Infant

Which intervention will most likely decrease transmission of infection in the newly-born infant?

A. Wearing a protective gown and gloves when handling the infant
B. Administering hepatitis B vaccine within an hour after birth
C. Providing immunoglobulin therapy to infants at highest risk for infection
D. Washing hands before and after providing care

D. Washing hands before and after providing care

4

The Thinking Nurse - Caring for the Infant

Which medication can decrease alveolar surface tension in the lungs of a preterm infant?

A. Adenosine
B. Indomethacin
C. Surfactant
D. Ventolin

C. Surfactant

5

The Thinking Nurse - Caring for the Infant

What word describes a heart rate of 56 BPM in a term newborn?

A. Barchycephaly
B. Bradycardia
C. Tachycardia
D. Tachypnea

B. Bradycardia

6

The Thinking Nurse - Caring for the Infant

What is the most likely cause of tachypnea lasting for a few hours to days after birth?

A. Retained lung fluid
B. Inadequate surfactant
C. Oxygen toxicity
D. Pulmonary hypertension

A. Retained lung fluid

7

The Thinking Nurse - Caring for the Infant

What is the normal resting heart rate for a sleeping term newborn?

A. 50 to 90 BPM
B. 70 to 110 BPM
C. 80 to 160 BPM
D. 120 to 220 BPM

C. 80 to 160 BPM

8

The Thinking Nurse - Caring for the Infant

Immediate care in the delivery room is based upon which assessment findings?

A. APGAR score
B. Blood pressure and heart rate
C. Oxygen saturation
D. Respirations, heart rate, and color

D. Respirations, heart rate, and color

9

The Thinking Nurse - Caring for the Infant

Which statement is NOT a true statement about breastfeeding?

A. Reduces incidence of allergies
B. Promotes transfer of maternal antibodies
C. Allows more accurate measure of intake
D. Reduces incidence of a maternal breast cancer

C. Allows more accurate measure of intake

10

The Thinking Nurse - Caring for the Infant

What characteristics and their cause are most commonly found in jaundice?

A. A ruddy discoloration of the skin due to excess red blood cells
B. A yellow discoloration of the skin associated with RBC breakdown
C. A yellow discoloration of the skin due to altered renal function
D. A blue discoloration of the hands and feet, while the remaining body is pink, due to poor perfusion.

B. A yellow discoloration of the skin associated with RBC breakdown

RATIONALE:
The life of RBC is shorter in infants than in adults. This, in addition to injury and bruising at birth, can result in hyperbillirubinemia and jaundice, a yellow discolor to the skin.

11

The Thinking Nurse - Caring for the Infant

Which term best describes a large gray macule commonly seen over the buttocks, flanks, or shoulders of dark skinned infants?

A. Erythema toxicum
B. Milaria
C. Mongolian spot
D. Pustular melanosis

C. Mongolian spot

12

The Thinking Nurse - Caring for the Infant

Which reflex can be elicited by holding the neonate upright with the feet touching a flat surface resulting in dancing type movements?

A. Babinski's reflex
B. Moro's reflex
C. Stepping reflex
D. Tonic neck reflex

C. Stepping reflex

13

The Thinking Nurse - Caring for the Infant

Which injury is considered to be the most common injury of birth?

A. Brachial palsy
B. Fractured clavicle
C. Fractured Femur
D. Phrenic nerve paralysis

B. Fractured clavicle

14

The Thinking Nurse - Caring for the Infant

After a newborn takes the first breath, which of the physiologic response is expected?

A. Decreased pulmonary vascular resistance
B. Increased pulmonary vascular resistance
C. No change in pulmonary vascular resistance
D. Decreased systemic vascular resistance

A. Decreased pulmonary vascular resistance

15

The Thinking Nurse - Caring for the Infant

Which complication can occur in the infant due to maternal cigarette smoking?

A. Increased birth weight
B. Decreased birth weight
C. Narcotic withdrawal
D. Hypertonia

B. Decreased birth weight

16

The Thinking Nurse - Caring for the Infant

During delivery of an infant, why is the mouth and nose suctioned prior to delivery of the body?

A. To stimulate the baby to cry
B. To remove all amniotic fluid from the mouth
C. To remove particulate matter and minimize aspiration
D. To begin teaching parents how to use a bulb syringe.

C. To remove particulate matter and minimize aspiration

17

The Thinking Nurse - Caring for the Infant

Which term describes the initial liquid of lactation cycle?

A. Colostrum
B. Hind milk
C. Transitional
D. Whey

A. Colostrum

18

The Thinking Nurse - Caring for the Infant

What is the expected response when testing the Babinski reflex in the first 18 months of life?

A. A rapid withdrawal at the knee
B. Plantar flexion
C. No response
D. Tightly curled toes.

B. Plantar flexion

19

The Thinking Nurse - Caring for the Infant

What characteristics best describe the female genitalia of a normal term newborn?

A. Labia minor and clitoris are very prominent
B. Labia majora is small and lacks adipose tissue
C. Labia majora covers minora and clitoris
D.Labia minor covers the majora and the clitoris

C. Labia majora covers minora and clitoris

20

The Thinking Nurse - Caring for the Infant

Which world best describes the assessment finding of asymmetry of the skill result from overriding cranial sutures after delivery?

A. Caput succedaneum
B. Cephalhematoma
C. Craniosyntosis
D. Molding

D. Molding

21

The Thinking Nurse - Caring for the Infant

Which scale is not used to perform a gestational age assessment?

A. Ballard scale
B. Dubowitz scale
C. Kernig
D. Simplified Assessment of Gestational Age

C. Kernig

RATIONALE:
Kernig is a sign indicating meningitis

22

The Thinking Nurse - Caring for the Infant

How many blood vessels are in a normal umbilical cord?

A. One artery and one vein
B. One artery and two veins
C. Two arteries and one vein
D. Two arteries and two veins

C. Two arteries and one vein

23

The Thinking Nurse - Caring for the Infant

Which organisms can cause a bacterial infection in infants? Select all that apply.

A. Candida
B. Escherichia coli
C. Listeria
D. Pseudomonas
E. Rubella
F. Staphylococcus
G. Toxoplasma

B. Escherichia coli
C. Listeria
D. Pseudomonas
F. Staphylococcus

24

The Thinking Nurse - Caring for the Infant

A one-month old infant weighing 1200 grams has an infection and needs ampicillin. The nurse knows the recommended dose is 100 milligrams/kilogram/day in equal doses q8h. How many milligrams should this infant receive with each dose?

____________

120 milligrams/day

Remember:
1000 grams = 1 kilograms (divide 1200 g / 1000)

25

The Thinking Nurse - Caring for the Infant

An infant weighs 1600 grams and needs a dose of furosemide (Lasix). The recommended dose is 1 (one) milligram/kilogram/dose. How many milligrams will this infant receive?

1.6 milligrams

26

The Thinking Nurse - Caring for the Infant

An infant weighing 2700 grams has an infection and needs gentamicin. The nurse knows the recommended dose of gentamicin is 2.5 milligrams/kilogram/dose q12h. How many milligrams should this infant receive with each dose?

_________

6.75 milligrams

27

The Thinking Nurse - Caring for the Infant

What are the common causes of respiratory distress syndrome in the newborn? Select all that apply.

A. Maternal diabetes mellitus
B. Maternal prenatal corticosteroids
C. Post-term delivery
D. Prematurity
E. Prolonged rupture of membranes
F. Pulmonary hypoperfusion

A. Maternal diabetes mellitus
D. Prematurity
F. Pulmonary hypoperfusion

28

The Thinking Nurse - Caring for the Infant

Which factors may contribute to increased insensible water loss in newborns? Select all that apply.

A. Hyperthermia
B. Incubator use
C. Extreme prematurity
D. Neutral thermal environment
E. Phototherapy
F. Radiant warmer use
G. Skin ointments

A. Hyperthermia
C. Extreme prematurity
E. Phototherapy
F. Radiant warmer use

29

The Thinking Nurse - Caring for the Infant

Which statements are true regarding Meconium Aspiration Syndrome? Select all that apply.

A. It occurs most commonly in preterm infants.
B. It occurs most commonly in term and near-term infants.
C. Respiratory distress may range from mild to severe.
D. Respiratory alkalosis is common.
E. The chest may appear hyperinflated or barrel shaped.
F. Chest x-ray will primarily show underinflation.

B. It occurs most commonly in term and near-term infants.
C. Respiratory distress may range from mild to severe.
E. The chest may appear hyperinflated or barrel shaped.

30

The Thinking Nurse - Caring for the Infant

Which complications are associated with respiratory distress syndrome in the newborn? Select all apply.

A. Acidosis
B. Air leaks
C. Alkalosis
D. Bronchopulmonary dysplasia
E. Rectinopathy of prematurity

A. Acidosis
B. Air leaks
D. Bronchopulmonary dysplasia
E. Rectinopathy of prematurity

31

The Thinking Nurse - Caring for the Infant

An infant is born to a mother who experienced abruptio placentae. The infant is pale and tachycardic. What immediate care is anticipated for this infant?

A. Administration of epinephrine
B. Administration of naloxone
C. Blood transfusion
D. None, this is a maternal complication.

C. Blood transfusion

32

The Thinking Nurse - Caring for the Infant

What will the nurse teach parents regarding the prevention of SIDs?

A. Infants should be positioned on either their left or right side to sleep.
B. SIDs is inheritable and not preventable.
C. Infants should be placed on a soft mattress or sheepskin when sleeping.
D. Infants should be position supine when sleeping.

D. Infants should be position supine when sleeping.

33

The Thinking Nurse - Caring for the Infant

In anticipating ongoing care of an infant born after abruptio placentae, which question will the nurse ask the mother?

A. Does she use cocaine?
B. When did she last drink an alcoholic beverage?
C. When did she last eat?
D. Did she sustain any injuries in the first trimester.

A. Does she use cocaine?

34

The Thinking Nurse - Caring for the Infant

The nurse is caring for a cold stressed infant. What intervention will help prevent thermal heat loss?

A. Place the infant in a position of extension
B. Provide increased intravenous fluids
C. Place under bright lights to provide heat
D. Pre-warm hands and stethoscope before touching infant

D. Pre-warm hands and stethoscope before touching infant

35

The Thinking Nurse - Caring for the Infant

What information will the nurse include on a teaching plan for the parents of an uncircumcised infant?

A. Wash the penis with soap and water just as with a circumcised infant
B. Clean in a back to front motion
C. Cleanse by moving the foreskin back and then return it to its normal position after cleaning
D. Fewer infections will occur if the parents would consent to circumcision

C. Cleanse by moving the foreskin back and then return it to its normal position after cleaning

36

The Thinking Nurse - Caring for the Infant

What is the most reliable method for obtaining pulse in children under the age of two years.

A. Apical
B. Femoral
C. Posterior tibial
D. Radial

A. Apical

37

The Thinking Nurse - Caring for the Infant

Which best describes lanugo in the newly-born, term infant?

A. No lanugo is present
B. Lanugo is abundant
C. Lanugo is long and thick over the entire back
D. Lanugo is thinning with bald areas.

D. Lanugo is thinning with bald areas.

38

The Thinking Nurse - Caring for the Infant

When examining the lungs and respiratory status of an infant, which assessment technique is performed first?

A. Auscultation
B. Inspection
C. Palpation
D. Percussion

B. Inspection

39

The Thinking Nurse - Caring for the Infant

What assessment data is included in the APGAR score?

A. Apical pulse, blood, pressure, abdominal girth and respiration
B. Heart rate, blood pressure, muscle tone, and respiration.
C. Heart rate, respiratory effort, muscle tone, reflex irritability and color.
D. Heart rate, respirations, and color.

C. Heart rate, respiratory effort, muscle tone, reflex irritability and color.

40

The Thinking Nurse - Caring for the Infant

Which characteristics most accurately describe the first bowel movement in a newborn?

A. Greenish brown and thick
B. Dark brown or black and sticky
C. Golden yellow and pasty
D. Yellowish brown and firm

B. Dark brown or black and sticky

41

The Thinking Nurse - Caring for the Infant

What best describes the size of an infant born to a mother with diabetes mellitus?

A. Large for gestational age
B. Small for gestational age
C. Appropriate for gestational age
D. There is no affect on size.

A. Large for gestational age

42

The Thinking Nurse - Caring for the Infant

Which immunization should be administered to the newborn prior to discharge from the hospital?


A. Diphtheria, tetanus, and pertussis
B. Hepatitis A
C. Hepatitis B
D. Influenza

C. Hepatitis B

43

The Thinking Nurse - Caring for the Infant

What is the most accurate description of weight loss and gain in the newly-born infant?

A. Newborns lose approximately 10% of birth weight in the first few days of life, but usually regain it within 10 days.

B. Newborns gain 10% of their birth weight in the first few days of life, then gain 1% every week until 6 months of age.

C. Newborns lose approximately 20% of birth weight in the first few days of life, but regain it within one month.

D. Newborns start gaining weight within the first few days of life.

C. Newborns lose approximately 20% of birth weight in the first few days of life, but regain it within one month.

44

Newborn Powerpoint

What is convection?

It is the loss of heat from body surface to air.

"Key Words" = Air

45

Newborn Powerpoint

What is radiation?

Body surface to cooler object not in contact (Cold walls or window).

Heat pulled from baby's body surface to a cold surface.

46

Newborn Powerpoint

What is evaporation?

Conversion from a liquid to a vapor (dry skin)

"Think" wet skin.

47

Newborn Powerpoint

How does a baby first lose heat after it is born?

Through evaporation.

48

Newborn Powerpoint

What is conduction?

Body surface to cooler object in contact with baby (warm surface)

"Key Words" = In contact with...

49

Newborn Powerpoint

What is Cold Stress? What does it cause?

It is a temperature change that causes:
*Increased metabolism
*Increased need for oxygen
*Increased respiratory rate
*Anaerobic metabolism
* Metabolic acidosis, fatigue and cardiovascular collapse.

Causes the baby to generate heat by nonshivering thermogensis, which causes the baby to burn stored brown fat.

50

Newborn Powerpoint

How would a nurse treat Cold Stress?

*Provide warm blankets
*Provide O2
*Skin-to-skin contact
*Avoid drafts
*Intervene early

51

Newborn Powerpoint

What does the Apgar Score evaluate?

The newborn's adaption to lie outside the uterus

52

Newborn Powerpoint

When is the Apgar Scoring usually completed?

It is typically completed at 1 and 5 minutes, but it can be used anytime the newborn's condition is in question.

53

Newborn Powerpoint

What does the Apgar Scoring assess?

*Muscle tone
*Pulse
*Reflex irritability
*Appearance (Color)
*Respirations

54

Newborn Powerpoint

What does an Apgar score of 0-3 indicate?

Indicates the infant is in needs immediate resuscitation.

55

Newborn Powerpoint

What does an Apgar score of 4-7 indicate?

The infant is in need of oxygen and stimulation

56

Newborn Powerpoint

What does an Apgar score of 8 to 10 require?

It requires no special attention.

57

Newborn Powerpoint

When is the ideal time to initiate bonding and breastfeeding?

During the initial period of reactivity (birth to 30 minutes)

58

Newborn Powerpoint

In the Ballard of Dubowitz scale what does a newborn lying in an extended position indicate?

The baby is premature

59

Newborn Powerpoint

In the Ballard of Dubowitz scale what does a newborn lying in a flexed position indicate?

A full-term newborn.

60

Newborn Powerpoint

In the Ballard of Dubowitz scale what is a "Square Window"

It is when the examiner compresses the newborn's hand and fingers to determine the angle.

61

Newborn Powerpoint

In the Ballard of Dubowitz scale what does a square window of 0-30º indicate?

A full-term newborn

62

Newborn Powerpoint

In the Ballard of Dubowitz scale what does a square window of 90º indicate?

A premature newborn.

63

Newborn Powerpoint

In the Ballard of Dubowitz scale what is the "Arm Recoil"?

It is exhibited when the newborn's arms are held in extension next to the body for 5 seconds and released.

64

Newborn Powerpoint

In the Ballard of Dubowitz scale what is the an arm returning to the flexed position during the arm recoil assessment indicate?

A full-term newborn.

65

Newborn Powerpoint

In the Ballard of Dubowitz scale what is the "Popliteal Angle"?

It is flexing and holding the newborn's thigh while extending the leg at the knee.

66

Newborn Powerpoint

In the Ballard of Dubowitz scale what does an angle of 180º in the "Popliteal Angle" test indicate?

A premature infant.

67

Newborn Powerpoint

In the Ballard of Dubowitz scale what does an angle of less than 90º in the "Popliteal Angle" test indicate?

a healthy termed newborn.

68

Newborn Powerpoint

In the Ballard of Dubowitz scale what is the "Scarf Sign"?

It is exhibited by moving the newborn's arm in front or the neck.

69

Newborn Powerpoint

In the Ballard of Dubowitz scale what is shown in a normal newborn in the "Scarf Sign" test?

The elbow will reach the midline.

70

Newborn Powerpoint

In the Ballard of Dubowitz scale what is shown in a premature newborn in the "Scarf Sign" test?

The elbow will move past the midline.

71

Newborn Powerpoint

What is considered prematurity?

A baby born before 38 weeks of gestation.

72

Newborn Powerpoint

What is the average birth weight of a healthy newborn?

2500-4000 g (2.5-4 kg or 5.5-8.8 lbs)

"Remember"
1 gram = 0.001 kg
1 kg = 2.2 lbs

73

Newborn Powerpoint

How much body weight does a baby lose in the first 3-4 days?

5% to 10%

74

Newborn Powerpoint

Why does a baby lose body weight in the first 3-4 days?

Because fluid shifts, withdrawal of maternal hormones, and loss of urine and feces and little intake.

75

Newborn Powerpoint

When will a baby regain weight?

By day 10

76

Newborn Powerpoint

What does a 10-90th percentile indicate?

Average for gestational age (AGA)

77

Newborn Powerpoint

What does <10th percentile indicate?

Small for gestational age (SGA)

78

Newborn Powerpoint

What does >90th percentile indicate?

Large for gestational age (LGA)

79

Newborn Powerpoint

What is Caput Succedaneum?

Occurs from pressure during the delivery. It is edema above the periosteum. It crosses suture lines. No treatment is necessary; it will resolve itself in a few days.

80

Newborn Powerpoint

What is Cephalhematoma?

Hemorrhage (bleeding) between the bone and periosteum. Caused by pressure on the fetal head (prolonged labor, use of forcepts). DOES NOT cross suture lines. Will resolve in 2 weeks to 3 months (avg. = 6 wks)

81

Newborn Powerpoint

What is Acrocyanosis? Is this a normal occurance?

It is the bluish discoloration of the hands and feet. This is common for several hours after delivery.

82

Newborn Powerpoint

What is the newborn's skin covered in (especially in the body folds) and is absorbed; keeping the baby's skin soft?

Vernix caseosa

83

Newborn Powerpoint

What is Brachial Palsy? How does it occur?

It is nerve damage to the brachial plexus. It comes from pulling/stretching of the shoulder away from the head.

84

Newborn Powerpoint

What are the signs and symptoms of brachial palsy?

*Limp arm
*Extended elbow
*Internally rotated arm
*Decreased or no reflexes

85

Newborn Powerpoint

How would a nurse treat brachial palsy?

*Provide a splint to correct alignment
*Proper positioning
*Gentle massage and ROM (in mild cases)

86

Newborn Powerpoint

What is bilirubin?

It is an orange-yellow pigment formed in the liver. It is formed by the breakdown of hemoglobin.

87

Newborn Powerpoint

Why does jaundice occur after the first 24h in newborns?

Hemoglobin breaks down faster in newborns. A newborn's hemoglobin has a lifespan of 80 days compared to 120 days for adult hemoglobin.

88

Newborn Powerpoint

What are signs of jaundice in a newborn?

When bilirubin is >5mg/dL in the first 24h or >12mg/dL at anytime.

89

Newborn Powerpoint

What is meconium?

It is a dark-green substance forming the first feces of a newborn. It contains bilirubin and bile.

90

Newborn Powerpoint

What should the nurse do when jaundice is noticed within the first 24h of a newborn?

RN or physician should be notified immediately.

91

Newborn Powerpoint

Explain the Rh factor mothers and fetus.

In a Rh negative mother and Rh positive fetus, RhoGAM must be administered at 28 weeks, then again within a 72 hr window after delivery to the newborn.

It is important to note that Rh/- and Rh/+ does not affect the 1st child; however antibodies will attack the 2nd child and children thereafter.

92

Newborn Powerpoint

How does RhoGAM work?

It stops the mother's body from developing antibodies.

93

Newborn Powerpoint

What is the test performed to determine the Rh factor?

Coomb's Test

A positive Coomb's Test is an abnormal finding.

94

Newborn Powerpoint

How is hyperbilirubin treated in a newborn?

Phototherapy is initiated.

95

Newborn Powerpoint

What is important to remember when administering phototherapy treatment to a newborn?

*Infant should be naked
*Infant's eyes should be covered (blind folded)
*Must be kept under bilirubin light s much as possible
*Baby's stool will be darker as it is excreting myconium.
*Urine will be more concentrated
*DO NOT use ointment or lotions as this can cause burning.

96

Newborn Powerpoint

When is the PKU test usually performed?

Must be administered after feeding.

97

Newborn Powerpoint

What are normal levels of blood glucose in newborns?

50 to 100

98

Newborn Powerpoint

When should a newborn's glucose be checked?

* In SGA
* In LGA
* If the mother has any type of diabetes
* If baby shows s/s of hypoglycemia

99

Newborn Powerpoint

What are the s/s of hypoglycemia in newborns?

* Tremors (easiest to see)
* Weak cry
* Apnea
* Cyanosis
* Lethargy
* Cardiac Arrest
* Feeding problems
* Seizures
* Hypothermia

100

Newborn Powerpoint

How would a nurse treat hypoglycemia in a newborn?

*ID those at risk
*AccuCheck
*Administer D5W or breastfeed within 30 minutes after birth
*Feed q2-3h
*Administer IV of D10W (Dextrose 10%)

101

Newborn Powerpoint

What are the nursing interventions to a newborn immediately after birth? (List in priority)

* Airway
* Suctioning
* Oxygenation
* Thermoregulation
* Bonding
* Identification
* Security

102

Newborn Powerpoint

When does bottle feeding occur in a newborn?

During the second period of reactivity(2-6 hours after)

103

Newborn Powerpoint

When does initial breastfeeding normally occur?

During initial period of reactivity (birth- 30 minutes after)

104

Newborn Powerpoint

How much is a newborn's intake when being bottlefed?

15 mL (1/2 oz)

105

Newborn Powerpoint

How many times a day should a newborn be breastfed?

10-12 times a day.

106

Newborn Powerpoint

How much kcal/kg/day is required for a newborn to meet nutritional needs?

110-120 kcal (560 mL or 20 oz a day)

107

Newborn Powerpoint

How much should a newborn gain weight in six months?

A newborn's weight should double.

108

Newborn Powerpoint

How much should a newborn gain weight in one year?

A newborn's weight should triple in a year.

109

Newborn Powerpoint

How many stools per day should a bottle fed newborn have?

1-2 stools per day

110

Newborn Powerpoint

How many stools per day should a breastfed newborn have?

Up to 10 per day or 1in 10 days.

111

Newborn Powerpoint

How many wet diapers should a newborn have per day?

6-8 per day.

112

Newborn Powerpoint

When are newborns given a tub bath?

When the cord has fallen off and healed completely.

113

Newborn Powerpoint

How many time should the baby's cord be cleaned per day?

At least 4 times a day.

114

Newborn Powerpoint

How should the a newborn's cord be cleaned?

Cord should be cleaned with alcohol with every diaper change. Alcohol should not be applied to the skin.