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A first-time father is changing the diaper of his 1-day-old daughter. He asks the nurse, “What is this black, sticky stuff in her diaper?” The nurse’s best response is:
a) “That means your baby is bleeding internally.”
b) Oh, don’t worry about that. It’s okay.”
c) “That’s meconium, which is your baby’s first stool. It’s normal.”
d) “That’s transitional stool.”
A new mother states that her infant must be cold because the baby’s hands and feet are blue. The nurse explains that this is a common and temporary condition called:
a) Vernix caseosa
c) Harlequin color.
d) Erythema neonatorum
A woman gave birth to a healthy 7-pound, 13-ounce infant girl. The nurse suggests that the woman place the infant to her breast within 15 minutes after birth. The nurse knows that breastfeeding is effective during the first 30 minutes after birth because this is the:
a) First period of reactivity
b) Transition period.
c) Organizational stage.d) Second period of reactivity
First period of reactivity
An African-American woman noticed some bruises on her newborn girl’s buttocks. She asks the nurse who spanked her daughter. The nurse explains that these marks are called
b) Vascular nevi
c) Mongolian spots.
d) Nevus flammeus.
A collection of blood between the skull bone and its periosteum is known as a cephalhematoma. To reassure the new parents whose infant develops such a soft bulge, it is important that the nurse be aware that this condition:
a) Will rapidly absorb over the first few days of life.
b) Is present immediately after birth.
c) Only happens as the result of a forceps or vacuum delivery.d) May occur with spontaneous vaginal birth
The cheeselike, whitish substance that fuses with the epidermis and serves as a protective coating is called:
a) Caput succedaneum
b) Vernix caseosa
A client is warm and asks for a fan in her room for her comfort. The nurse enters the room to assess the mother and her infant and finds the infant unwrapped in his crib with the fan blowing over him on “high.” The nurse instructs the mother that the fan should not be directed toward the newborn and the newborn should be wrapped in a blanket. The mother asks why. The nurse’s best response is:
a) “Your baby may lose heat by evaporation, which means that he will lose heat from his body to the cooler ambient air. You should keep him wrapped and prevent cool air from blowing on him.”
b) “Your baby may lose heat by conduction, which means that he will lose heat from his body to the cooler ambient air. You should keep him wrapped and prevent cool air from blowing on him.”
c) “Your baby may lose heat by convection, which means that he will lose heat from his body to the cooler ambient air. You should keep him wrapped and prevent cool air from blowing on him.”
d) “Your baby will get cold stressed easily and needs to be bundled up at all times.”
During life in utero oxygenation of the fetus occurs through transplacental gas exchange. When birth occurs, four factors combine to stimulate the respiratory center in the medulla. The initiation of respiration then follows. Which is NOT one of these essential factors?
All of these statements about physiologic jaundice are true EXCEPT:
a) Neonatal jaundice is common, but kernicterus is rare.
b) The appearance of jaundice during the first 24 hours or beyond day 7 indicates a pathologic process
c) Because jaundice may not appear before discharge, parents need instruction on how to assess it and when to call for medical help.
d) Breastfed babies have a lower incidence of jaundice.
What marks on a baby’s skin may indicate an underlying problem that requires notification of a physician?
a) Erythema toxicum anywhere on the body
b) Petechiae scattered over the infant’s body
c) Telangiectatic nevi on the nose or nape of the neck
d) Mongolian spots on the back
The nurse assessing a newborn knows that the most critical physiologic change required of the newborn is:
a) Initiation and maintenance of respirations
b) Maintenance of a stable temperature
c) Closure of fetal shunts in the circulatory system
d) Full function of the immune defense system at birth
A newborn is placed under a radiant heat warmer, and the nurse evaluates the infant’s body temperature every hour. Maintaining the newborn’s body temperature is important for preventing:
a) Cold stress
c) Respiratory depressionVasoconstriction
While assessing the newborn, the nurse should be aware that the average expected apical pulse range of a full-term, quiet, alert newborn is:
a) 150 to 180 beats/min.
b) 80 to 100 beats/min.
c) 100 to 120 beats/min
d) 120 to 160 beats/min.
Part of the health assessment of a newborn is observing the infant’s breathing pattern. A full-term newborn’s breathing pattern is predominantly:
a) Diaphragmatic with chest retraction.
b) Abdominal with synchronous chest movements
c) Chest breathing with nasal flaring.
d) Deep with a regular rhythm.
Abdominal with synchronous chest movements
While assessing the integument of a 24-hour-old newborn, the nurse notes a pink, papular rash with vesicles superimposed on the thorax, back, and abdomen. The nurse should:
a) Move the newborn to an isolation nursery
b) Take the newborn’s temperature and obtain a culture of one of the vesicles
c) Document the finding as erythema toxicum.Notify the physician immediately
While evaluating the reflexes of a newborn, the nurse notes that with a loud noise the newborn symmetrically abducts and extends his arms, his fingers fan out and form a “C” with the thumb and forefinger, and he has a slight tremor. The nurse would document this finding as a positive:
a) Glabellar (Myerson) reflex.
b) Babinski reflex.
c) Tonic neck reflexd) Moro reflex
The parents of a newborn ask the nurse how much the newborn can see. The parents specifically want to know what type of visual stimuli they should provide for their newborn. The nurse responds to the parents by telling them:
a) “Infants can track their parent’s eyes and distinguish patterns; they prefer complex patterns.”
b) “The infant’s eyes must be protected. Infants enjoy looking at brightly colored stripes.”
c) “Infants can see very little until about 3 months of age.”
d) “It’s important to shield the newborn’s eyes. Overhead lights help them see better.”
“Infants can track their parent’s eyes and distinguish patterns; they prefer complex patterns.”
One reason the brain is vulnerable to nutritional deficiencies and trauma in early infancy is the:
a) Primitive reflex system.
b) Presence of various sleep-wake states.
c) Incompletely developed neuromuscular system.d) Cerebellum growth spurt
While examining a newborn, the nurse notes uneven skin folds on the buttocks and a click when performing the Ortolani maneuver. The nurse recognizes these findings as a sign that the newborn probably has:
c) Hip dysplasiad) Polydactyly
With regard to the functioning of the renal system in newborns, nurses should be aware that:
a) The pediatrician should be notified if the newborn has not voided in 24 hours.
b) “Brick dust” or blood on a diaper is always cause to notify the physician.
c) Breastfed infants likely will void more often during the first days after birth.d) Weight loss from fluid loss and other normal factors should be made up in 4 to 7 days
With regard to the respiratory development of the newborn, nurses should be aware that:
a) Newborns are instinctive mouth breathers
b) Seesaw respirations are no cause for concern in the first hour after birth
c) The first gasping breath is an exaggerated respiratory reaction within 1 minute of birth.d) Newborns must expel the fluid from the respiratory system within a few minutes of birth.
An infant boy was born just a few minutes ago. The nurse is conducting the initial assessment. Part of the assessment includes the Apgar score. The Apgar assessment is performed:
a) Once by the obstetrician, just after the birth.
b) At least twice, 1 minute and 5 minutes after birth.
c) Only if the newborn is in obvious distress.
d) Every 15 minutes during the newborn’s first hour after birth.
At 1 minute after birth the nurse assesses the infant and notes: a heart rate of 80 beats/min, some flexion of extremities, a weak cry, grimacing, and a pink body but blue extremities. The nurse would calculate an Apgar score of:
The nurse is using the Ballard scale to determine the gestational age of a newborn. Which assessment finding is consistent with a gestational age of 40 weeks?
a) Smooth, pink skin with visible veins
b) Abundant lanugo
c) Faint red marks on the soles of the feetd) Flexed posture
The normal term infant has little difficulty clearing its airway after birth. Most secretions are brought up to the oropharynx by the cough reflex. However, if the infant has excess secretions, the mouth and nasal passages can be cleared easily with a bulb syringe. When instructing parents on the correct use of this piece of equipment, it is important that the nurse teach them to:
a) Suction the mouth first.
b) Avoid suctioning the nares.
c) Insert the compressed bulb into the center of the mouth.
d) Remove the bulb syringe from the crib when finished.
In the classification of newborns by gestational age and birth weight, the appropriate for gestational age (AGA) weight would:
a) Fall between the 10th and 90th percentiles for the infant’s age.
b) Depend on the infant’s length and the size of the head.
c) Fall between the 25th and 75th percentiles for the infant’s age.
d) Be modified to consider intrauterine growth restriction (IUGR).
With regard to laboratory tests and diagnostic tests in the hospital after birth, nurses should be aware that:
a) Federal law prohibits newborn genetic testing without parental consent.
b) genetic screening should be repeated at age 1 to 2 weeks.
c) Hearing screening is now mandated by federal law.
d) All states test for phenylketonuria (PKU), hypothyroidism, cystic fibrosis, and sickle cell diseases.
As part of Standard Precautions, nurses wear gloves when handling the newborn. The chief reason is:
a) To protect the nurse from contamination by the newborn.
b) To protect the baby from infection
c) That it is part of the Apgar protocol
d) Because the nurse has primary responsibility for the baby during the first 2 hours.
With regard to umbilical cord care, nurses should be aware that:
a) The average cord separation time is 5 to 7 days.
b) A nurse noting bleeding from the vessels of the cord should immediately call for assistance.
c) The stump can easily become infected.
d) The cord clamp is removed at cord separation.
According to the recommendations of the American Academy of Pediatrics on infant nutrition:
a) Infants fed on formula should be started on solid food sooner than breastfed infants.
b) After 6 months mothers should shift from breast milk to cow’s milk.
c) If infants are weaned from breast milk before 12 months, they should receive cow’s milk, not formula.
d) Infants should be given only human milk for the first 6 months of life.
Benefits to the mother associated with breastfeeding include all EXCEPT:
a) It increases bone density.
b) It may enhance postpartum weight loss.
c) It is an effective method of birth control.d) They have a decreased risk of breast cancer
What statement concerning the benefits or limitations of breastfeeding is NOT accurate?
a) Long-term studies have shown that the benefits of breast milk continue after the infant is weaned.
b) Breastfeeding increases the risk of childhood obesity.
c) Breast milk changes over time to meet changing needs as infants grow.
d) Breast milk/breastfeeding may enhance cognitive development.
A new mother wants to be sure that she is meeting her daughter’s needs while feeding her commercially prepared infant formula. The nurse should evaluate the mother’s knowledge about appropriate infant care. The mother meets her child’s needs when she:
a) Refrigerates any leftover formula for the next feeding.
b) Burps her infant during and after the feeding as needed.
c) Warms the bottles using a microwave oven.Adds rice cereal to her formula at 2 weeks of age to ensure adequate nutrition.
A newly delivered mother who intends to breastfeed tells her nurse, “I am so relieved that this pregnancy is over so I can start smoking again.” The nurse encourages the client to refrain from smoking. However, this new mother insists that she will resume smoking. The nurse will need to adapt her health teaching to ensure that the client is aware that:
a) There is no relation between smoking and the time of feedings
b) The effects of secondhand smoke on infants are less significant than for adults.
c) Smoking has little or no effect on milk production.
d) The mother should always smoke in another room.
Nurses should tell breastfeeding mothers that all of these are signs that the infant has latched on correctly to her breast except:
a) The baby’s jaw glides smoothly with sucking.
b) She hears a clicking or smacking sound
c) The baby sucks with cheeks rounded, not dimpled.
d) She feels a firm tugging sensation on her nipples but not pinching or pain.
A primiparous woman is delighted with her newborn son and wants to begin breastfeeding as soon as possible. The nurse can facilitate the infant’s correct latch-on by helping the woman hold the infant:
a) With his head cupped in her hand.
b) Curled up in a fetal position.
c) With his arms folded together over his chest.
d) With his head and body in alignment.
A postpartum woman telephones about her 4-day-old infant. She is not scheduled for a weight check until the infant is 10 days old, and she is worried about whether breastfeeding is going well. Effective breastfeeding is indicated by the newborn who:
a) Gains 1 to 2 ounces per week.
b) Has at least one breast milk stool every 24 hours.
c) Sleeps for 6 hours at a time between feedings.d) Has at least six to eight wet diapers per day.
A breastfeeding woman develops engorged breasts at 3 days’ postpartum. What action would help this woman achieve her goal of reducing the engorgement? The woman:
a) Breastfeeds her infant every 2 hours.
b) Avoids using a breast pump.
c) Reduces her fluid intake for 24 hours.
d) Skips feedings to let her sore breasts rest.
A pregnant woman wants to breastfeed her infant, but her husband is not convinced that there are any scientific reasons to do so. The nurse can give the couple printed information comparing breastfeeding and bottle-feeding. What statement is true? Bottle-feeding using commercially prepared infant formulas:
a) Requires that multivitamin supplements be given to the infant.
b) Helps the infant sleep through the night.
c) Increases the risk that the infant will develop allergies.Ensures that the infant is getting iron in a form that is easily absorbed.
At a 2-month well-baby examination, it was discovered that a breastfed infant had only gained 10 ounces in the past 4 weeks. The mother and the nurse agree that, to gain weight faster, the infant needs to:
a) Have a bottle of formula after every feeding.
b) Begin solid foods.
c) Add at least one extra breastfeeding session every 24 hours.
d) Start iron supplements.
In helping the breastfeeding mother position the baby, nurses should keep in mind that:
a) Women with perineal pain and swelling prefer the modified cradle position.
b) While supporting the head, the mother should push gently on the occiput.
c) The cradle position usually is preferred by mothers who had a cesarean birth.
d) Whatever the position used, the infant is “belly to belly” with the mother.
Whatever the position used, the infant is “belly to belly” with the mother.
The best reason for recommending formula over breastfeeding is that:
a) The mother lacks confidence in her ability to breastfeed.
b) The mother sees bottle feeding as more convenient.
c) Other family members or care providers also need to feed the baby.
d) The mother has a medical condition or is taking drugs that could be passed along to the infant via breast milk.
A nurse is discussing the signs and symptoms of mastitis with a mother who is breastfeeding. What signs and symptoms should the nurse include in her discussion? Choose all that apply.
a) Breast tenderness
b) A small white blister on the tip of the nipple
c) An area of redness on the breast often resembling the shape of a pie wedge
d) Fever and flulike symptomse) Warmth in the breast
The nurse is discussing storage of breast milk with a mother whose infant is preterm and in the special care unit. What statement would indicate that the mother needs additional teaching?
a) “I can store my breast milk in the freezer for 3 months.”
b) “I can store my breast milk at room temperature for 8 hours.”
c) “I can store my breast milk in the refrigerator for 3 months.”
d) “I can store my breast milk in the refrigerator for 3 to 5 days.”
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