High Risk OB

Question 1

A NB with severe meconium aspiration syndrome (MAS) is not responding to conventional treatment. Which measure would the nurse anticipate as possibly necessary for this newborn?

A. Extracorporeal membrane oxygenation (ECMO)
B. Respiratory support with a ventilator
C. Insertion of a laryngoscope for deep suctioning
D. Replacement of an ET tube via x-ray

Answer 1

A. Extracorporeal membrane oxygenation (ECMO)

Rationale: If conventional measures are ineffective, then the nurse would need to prepare the newborn for ECMO. Hyperoxygenation, ventilatory support, and direct tracheal suctioning are typically used initially to promote tissue perfusion. However, if these are ineffective, ECMO would be the next step

Question 2

A nurse is providing care to a newborn. The nurse suspects that the newborn is developing sepsis based on which assessment finding?

A. Increased urinary output
B. Interest in feeding
C. Temperature instability
D. Wakefulness

Answer 2

C. Temperature instability

Rationale: Manifestations of sepsis are typically nonspecific and may include hypothermia, oliguria or anuria, lack of interest in feeding, and lethargy

Question 3

A nurse is providing care to a newborn who is receiving phototherapy. Which action would the nurse most likely include in the plan of care?

A. Keeping the newborn in the supine position
B. Covering the newborn’s eyes while under the bililights
C. Ensuring that the newborn is covered or clothed
D. Reducing the amount of fluid intake to 8 oz daily

Answer 3

B. Covering the newborn’s eyes while under the bililights

Rationale: During phototherapy, the newborn’s eyes are covered to protect them from the lights. The newborn is turned every 2 hours to expose all areas of the body to the lights and is kept undressed, except for the diaper area, to provide maximum body exposure to the lights. Fluid intake is increased to allow for added fluid, protein, and calories

Question 4

A newborn has been diagnosed with a group B streptococcal infection shortly after birth. The nurse understands that the newborn most likely acquired this infection from which cause?

A. Improper hand washing
B. Contaminated formula
C. Non-sterile catheter insertion
D. Mother’s birth canal

Answer 4

D. Mother’s birth canal

Rationale: Most often, a newborn develops a group B streptococcus infection during the birthing process when the newborn comes into contact with an infected birth canal. Improper hand washing, contaminated formula, and non-sterile catheter insertion would most likely lead to a late-onset infection, which typically occurs in the nursery due to horizontal transmission

Question 5

Which action would be most appropriate for the nurse to take when a newborn has an unexpected anomaly at birth?

A. Show the newborn to the parents as soon as possible while explaining the defect
B. Remove the newborn from the birthing area immediately
C. Inform the parents that there is nothing wrong at the moment
D. Tell the parents that the newborn must go to the nursery immediately

Answer 5

A. Show the newborn to the parents as soon as possible while explaining the defect

Rationale: When an anomaly is identified at or after birth, parents need to be informed promptly and given a realistic appraisal of the severity of the condition, the prognosis, and treatment options so that they can participate in all decisions concerning their child. Removing the newborn from the area or telling them that the newborn needs to go to the nursery immediately is inappropriate and would only add to the parents’ anxieties and fears. Telling them that nothing is wrong is inappropriate because it violates their right to know

Question 6

The nurse prepares to administer a gavage feeding for a newborn with transient tachypnea based on the understanding that this type of feeding is necessary because

A. Lactase enzymatic activity is not adequate
B. Oxygen demands need to be reduced
C. Renal solute lead must be considered
D. Hyperbilirubinemia is likely to develop

Answer 6

B. Oxygen demands need to be reduced

Rationale: For the newborn with transient tachypnea, the newborn’s respiratory rate is high, increasing the oxygen demand. Thus, measures are initiated to reduce this demand. Garage feedings are one way to do so. With transient tachypnea, enzyme activity and kidney function are not affected. This condition typically resolves within 72 hours. The risk for hyperbilirubinemia is not increased

Question 7

Which information would the nurse include when teaching a new mother about the difference between pathologic and physiologic jaundice?

A. Physiologic jaundice results in kernicterus
B. Pathologic jaundice appears within 24 hours after birth
C. Both are treated with exchange transfusions of maternal O- blood
D. Physiologic jaundice requires transfer to the NICU

Answer 7

B. Pathologic jaundice appears within 24 hours after birth

Rationale: Pathologic jaundice appears within 24 hours after birth whereas physiologic jaundice commonly appears around the third or fourth days of life. Kernicterus is more commonly associated with pathologic jaundice. An exchange transfusion is used only if the total serum bilirubin level remains elevated after intensive phototherapy. With this procedure, the newborn’s blood is removed and replaced with non-hemolyses RBCs from a donor. Physiologic jaundice often is treated at home

Question 8

A nurse is teaching the mother of a newborn experiencing cocaine withdrawal about caring for the neonate at home. The mother stopped using cocaine near the end of her pregnancy. The nurse determines that additional teaching is needed when the mother identifies which action as appropriate for her newborn?

A. Wrapping the newborn snuggly in a blanket
B. Waking the newborn every hour
C. Checking the newborn’s fontanels
D. Offering a pacifier

Answer 8

B. Waking the newborn every hour

Rationale: Stimuli need to be decreased. Waking the newborn every hour would most likely be too stimulating. Measures such as swaddling the newborn tightly and offering a pacifier help to decrease irritable behaviors. A pacifier also helps to satisfy the newborn’s need for non-nutritive sucking. Checking the fontanels provides evidence of hydration

Question 9

A newborn is suspected of having fetal alcohol syndrome. Which finding would the nurse expect to assess?

A. Bradypnea
B. Hydrocephaly
C. Flattened maxilla
D. Hypoactivity

Answer 9

C. Flattened maxilla

Rationale: A newborn with fetal alcohol syndrome exhibits characteristic facial features such as microcephaly, small palpebral fissures, and abnormally small eyes, flattened or absent maxilla, epicanthic folds, thin upper lip, and missing vertical groove in the median portion of the upper lip. Bradypnea is not typically associated with fetal alcohol syndrome. Fine and gross motor development is delayed, and the newborn shows poor hand-eye coordination but not hypoactivity

Question 10

After teaching the parents of a newborn with pet ventricular hemorrhage about the disorder and treatment, which statement by the parents indicates that the teaching was successful?

A. “We’ll make sure to cover both of his eyes to protect them”
B. “Our newborn could develop a learning disability later on”
C. “Once the bleeding ceases, there won’t be any more worries”
D. “We need to get family members to donate blood for transfusion”

Answer 10

B. “Our newborn could develop a learning disability later on”

Rationale: Perventricular hemorrhage has long-term sequels such as seizures, hydrocephalus, periventricular leukomalacia, cerebral palsy, learning disabilities, vision or hearing deficits, and phototherapy. The bleeding in the brain can lead to serious long-term effects. Blood transfusion aren’t used to treat periventricular hemorrhage

Question 11

A newborn has an Apgar score of 6 at 5 minutes. Which action would be the priority?

A. Initiating IV fluid therapy
B. Beginning resuscitative measures
C. Promoting kangaroo care
D. Obtaining a blood culture

Answer 11

B. Beginning resuscitative measures

Rationale: An Apgar score below 7 at 1 or 5 minutes indicates the need for resuscitation. IVF therapy and blood cultures may be done once resuscitation is started. Kangaroo care would be appropriate once the newborn is stable

Question 12

While reviewing a newborn’s medical record, the nurse notes that the CXR shows a ground glass pattern. The nurse interprets this as indicative of

A. Respiratory distress syndrome
B. Transient tachypnea of the NB
C. Asphyxia
D. Persistent pulmonary HTN

Answer 12

A. Respiratory distress syndrome

Rationale: The CXR of a NB with RDS reveals a reticular pattern. For TTN, the CXR shows lung overaeration and prominent perihilar interstitial markings and streakings. A CXR for asphyxia would reveal possible structural abnormalities that might interfere with respiration, but the results are highly variable. An echocardiogram would be done to evaluate persistent pulmonary HTN

Question 13

A NB is suspected of developing persistent pulmonary HTN. The nurse would expect to prepare the newborn for which procedure to confirm the suspicion?

A. CXR
B. Blood cultures
C. Echocardiogram
D. Stool for occult blood

Answer 13

C. Echocardiogram

Rationale: an echocardiogram is used to reveal right-to-left shunting of blood to confirm the Dx of persistent pulmonary HTN. CXR would be most likely used to aid in the Dx of RDS or TTN. Blood cultures would be helpful in evaluating for neonatal sepsis. Stool for occult blood may be done to evaluate for NEC

Question 14

A preterm newborn is receiving enteral feedings. Which finding would alert the nurse to suspect that the newborn is developing NEC?

A. Irritability
B. Sunken abdomen
C. Clay-colored stools
D. Feeding intolerance

Answer 14

D. Feeding intolerance

Rationale: The newborn with NEC may exhibit feeding intolerance with lethargy, abdominal distention and tenderness, and bloody stools

Question 15

The nurse frequently assesses the respiratory status of a preterm newborn based on the understanding that the newborn is at increased risk for respiratory distress syndrome because of

A. Inability to clear fluids
B. Immature respiratory control center
C. Deficiency of surfactant
D. Smaller respiratory passages

Answer 15

C. Deficiency of surfactant

Rationale: A preterm newborn is at increased risk for respiratory distress syndrome because of a surfactant deficiency. Surfactant helps to keep the alveoli open and maintain lung expansion. With a deficiency, the alveoli collapse, predisposing the newborn to RDS. An inability to clear fluids can lead to transient tachypnea. Immature respiratory control centers lead to an increased risk for apnea. Smaller respiratory passages led to an increased risk for obstruction

Question 16

At a preconception counseling class, a client expresses concern and wonders how Healthy People 2030 will improve maternal-infant outcomes. Which response(s) by the nurse is appropriate? SATA.

A. Healthy people 2030 will reduce the rate of fetal and infant deaths
B. Healthy people 2030 will decrease the number of all infant deaths (within 1 year)
C. Healthy people 2030 will decrease the number of neonatal deaths (within the first year)
D. Healthy people 2030 will foster early and consistent prenatal care

Answer 16

A. Healthy people 2030 will reduce the rate of fetal and infant deaths
B. Healthy people 2030 will decrease the number of all infant deaths (within 1 year)
C. Healthy people 2030 will decrease the number of neonatal deaths (within the first year)
D. Healthy people 2030 will foster early and consistent prenatal care

Rationale: One of the leading health indicators as identified by Healthy People 2030 refers to decreasing the number of infant deaths. Acquired and congenital conditions account for a significant percentage of infant deaths. Specific objectives include reducing the rate of fetal deaths at 20 or more weeks of gestation though the nursing action of fostering early and consistent prenatal care; reducing the rate of all infant deaths (within 1 year) through the nursing actions of including education to place infants on their backs for naps and sleep to prevent SIDS, avoiding exposing newborns to cigarette smoke, and ensuring that infants with birth defects receive health care needed in order to thrive; and reducing the occurrence of fetal alcohol syndrome (FAS) through the nursing actions or counseling girls and women to avoid alcohol use during pregnancy, and participating in programs for at-risk groups, including adolescents, about the effects of substance use, especially alcohol, during pregnancy

Question 17

A neonate is exhibiting signs of neonatal abstinence syndrome. Which findings would confirm this Dx? SATA.

A. Adequate rooting and sucking
B. Frequent sneezing
C. Persistent fever
D. Shrill, high-pitched cry
E. Hypotonic reflexes
F. Frequent yawning

Answer 17

B. Frequent sneezing
C. Persistent fever
D. Shrill, high-pitched cry
F. Frequent yawning

Rationale: Manifestations of neonatal abstinence syndrome include a shrill, high-pitched cry; persistent fever; frequent yawning; and frequent sneezing. Rather than adequate rooting and sucking these actions will be frantic in a neonate with abstinence syndrome. In addition, these neonates will have hypertonic muscle tone, not hypotonic reflexes

Question 18

A pregnant woman gives birth to a SGA neonate who is admitted to the NICU with seizure activity. The neonate appears to have abnormally small eyes and a thin upper lip. The infant is noted to be microcephalic. Based on these findings, which substance would the nurse suspect the women of using during pregnancy?

A. Alcohol
B. Cocaine
C. Heroin
D. Methamphetamine

Answer 18

A. Alcohol

Rationale: this child’s features match those of FAS, including microcephaly, small palpebral (eyelid) fissures, abnormally small eyes, and fetal growth restriction

Question 19

The nurse is developing a plan of care for a neonate experiencing symptoms of drug withdrawal. What should be included in this plan?

A. Administer glucose between feedings
B. Schedule feedings Q4-6h
C. Swaddle the infant between feedings
D. Rock horizontally

Answer 19

C. Swaddle the infant between feedings

Rationale: Supportive interventions to promote comfort include swaddling, low lighting, gentle handling, quiet environment with minimal stimulation, use of soft voices, pacifiers to promote “self-soothing” frequent small feedings, and vertical rocking, which will soothe the newborn’s neurological system

Question 20

A neonate born addicted to cocaine is now being treated with medication for acute neonatal abstinence syndrome. Which medication will be prescribed to relieve withdrawal symptoms?

A. Meperidine
B. Adrenaline
C. Naloxone
D. Morphine sulfate

Answer 20

D. Morphine sulfate

Rationale: Pharmacologic treatment is warranted if conservative measures aren’t adequate. Common medications used in the management of newborn withdrawal include an opioid and phenobarbital as a second drug if the opiate doesn’t adequately control symptoms. The other drugs aren’t used in NAS treatment

Question 21

The pediatrician prescribe morphine sulfate 0.2 mg/kg orally Q4h for a neonate suffering from drug withdrawal. The neonate weighs 3800 g. How much of drug will the nurse give in 24 hours? Record your answer using two decimal places.

Answer 21

4.56

Question 22

The nurse admitting a term, LGA neonate weighing 4610 g (10 lb 2 oz), born vaginally with a mid-forceps assist, to a 15-year old primipara. What would the nurse anticipate as a result of the birth?

A. Fracture of the tibia
B. Fracture of the femur
C. Fracture of the rib
D. Mid-clavicular fracture

Answer 22

D. Mid-clavicular fracture

Rationale: Trauma to the newborn may result from the use of mechanical forces, such as forceps during birth. Primarily injuries are found in large babies and babies with shoulder dystocia. Associated traumatic injuries include fracture of the clavicle or humerus or subluxations of the shoulder or cervical spine

Question 23

A 33 weeks’ gestation neonate is being assessed for necrotizing enterocolitis (NEC). Which nursing actions would the nurse implement? SATA.

A. Perform hemoccult tests on stools
B. Monitor abdominal girth
C. Measure gastric residual before feeds
D. Assess bowel sounds before each feed
E. Assess urine output

Answer 23

A. Perform hemoccult tests on stools
B. Monitor abdominal girth
C. Measure gastric residual before feeds
D. Assess bowel sounds before each feed

Rationale: Always keep the possibility of NEC in mind when dealing with preterm newborns, especially when enteral feedings are being administered. Note feeding intolerance, diarrhea, bile-stained emesis, or grossly bloody stools. Perform hemoccult tests on the bloody stool. Assess the neonate’s abdomen for distention, tenderness, and visible loops of bowel. Measure the abdominal circumference, noting an increase. Listen to bowel sounds before each feeding. Determine residual gastric volume prior to feeding; when it is elevated, be suspicious for NEC. Assessing urine output is not essential

Question 24

A 30 weeks’ gestation neonate born with low Apgar scores is in the NICU with respiratory distress syndrome and underwent an exchange transfusion for anemia. Which factors place the neonate at risk for necrotizing enterocolitis? SATA.

A. Preterm birth
B. Respiratory distress syndrome
C. Low Apgar scores
D. Hyperthermia
E. Hyperglycemia
F. Exchange transfusion

Answer 24

A. Preterm birth
B. Respiratory distress syndrome
C. Low Apgar scores
F. Exchange transfusion

Rationale: The predisposing factors for the development of necrotizing enterocolitis include preterm labor, respiratory distress syndrome, exchange transfusion, and low birth weight. Low Apgar scores, hypothermia, and hypoglycemia are also risk factors

Question 25

A preterm newborn is admitted to the NICU with the Dx of an omphalocele. What nursing actions would the nurse perform? SATA.

A. The abdominal contents are protected
B. Fluid loss of the neonate will be minimized
C. Perfusion to the exposed abdominal contents will be maintained
D. Neonatal weight loss will be prevented
E. Assessment of hyperbilirubinemia will be monitored

Answer 25

A. The abdominal contents are protected
B. Fluid loss of the neonate will be minimized
C. Perfusion to the exposed abdominal contents will be maintained

Rationale: Nursing management of newborns with omphalocele or gastroschisis focuses on preventing hypothermia, maintaining perfusion to the eviscerated abdominal contents by minimizing fluid loss, and protecting the exposed abdominal contents from trauma and infection. Weight loss at this point is not a priority, and neither is assessing bilirubin

Question 26

The nurse is in the NICU is caring for a neonate she suspects is at risk for an intraventricular hemorrhage. Which nursing actions would be priorities? SATA.

A. Maintain fetal flexed position
B. Administer fluids slowly
C. Assess of bulging fontanel
D. Measure head circumference daily
E. Assess Moro reflex
F. Measure intake and output

Answer 26

A. Maintain fetal flexed position
B. Administer fluids slowly
C. Assess of bulging fontanel
D. Measure head circumference daily

Rationale: Care of the newborn with IVH is primarily supportive. Correct anemia, acidosis, and hypotension with fluids and medications. Administer fluids slowly to prevent fluctuations in BP. Avoid rapid volume expansion to minimize changes in cerebral blood flow. Keep the newborn in a flexed, contained position with the head elevated to prevent or minimize fluctuations in intracranial pressure. Continuously monitor the newborn for signs of hemorrhage, such as changes in the LOC, bulging fontanel, seizures, apnea, and reduced activity levels. Also, measuring head circumference daily to assess for expansion in size is essential in identifying complications early. Moro reflex and intake and output are routine and not associate with IVH

Question 27

At the breech forceps birth a 32 weeks’ gestation neonate, the nurse notes oligohydraminos with green thick amniotic fluid. The maternal history reveals a mother of Hispanic ethnicity with marked HTN, who admits to using cocaine daily. Which factor(s) may contribute to meconium aspiration syndrome (MAS)? SATA.

A. The preterm pregnancy
B. The forceps breech birth
C. Maternal cocaine use
D. Maternal HTN
E. Hispanic ethnicity
F. Oligohydraminos present

Answer 27

B. The forceps breech birth
C. Maternal cocaine use
D. Maternal HTN
F. Oligohydraminos present

Rationale: The presdisposing factors for meconium aspiration syndrome include post term pregnancy and breech presentation with forceps. Ethnicity (Pacific islander, indigenous Australian, Black) is a factor. Postterm neonates are at risk for MAS, but preterm neonates aren’t. Exposure to drugs during pregnancy, especially tobacco and cocaine, predispose the neonate to MAS. Maternal HTN and oligohydraminos also contribute to MAS

Question 28

A 2-hour-old neonate born via c-section has begun having a RR of 110 breaths/min and is in respiratory distress. What interventions is a priority for the nurse to include in this neonate’s care? SATA.

A. Keep the head in a “sniff” position
B. Administer oxygen
C. Insert an orogastric tube
D. Ensure thermoregulation
E. Obtain an ABG

Answer 28

A. Keep the head in a “sniff” position
B. Administer oxygen
D. Ensure thermoregulation

Rationale: This neonate is experiencing manifestations of transient tachypnea of the newborn (TTN). It occurs from delayed clearing of the lungs from fluid, and can be seen in neonates born via c-section, because they haven’t had the experience of the compression of the thorax during vaginal delivery. This starts within the first 6 hours of life and can last up to 72 hours. The priority interventions for this neonate are oxygen, thermoregulation and minimal stimulation. Keeping the head in a neutral of “sniff” positio allows for optimal airway. If the neonate becomes cold, then respiratory distress and or sepsis can develop. Minimal stimulation conserves the neonate’s respiratory and heat requirements. The neonate may need placement of a peripheral IV for hydration and/or a feeding tube for formula or breast milk. The neonate should not be nipple fed until the RR are under 60 breaths/min. A CXR and an ABG may be needed also, but they would only be necessary if the neonate is in severe distress. The ABG results would show mild hypoxemia, a mildly elevated CO2 level, and a normal pH

Question 29

A newborn infant has been diagnosed with persistent pulmonary HTN of the newborn. In providing care for this newborn what intervention should be the nurse’s priority?

A. Measure BP
B. Obtain ABG
C. Monitor oxygen saturation
D. Suction the newborn

Answer 29

A. Measure BP

Rationale: PPHN occurs when here is persistent fetal circulation after birth. The pulmonary pressures don’t decrease at birth when the newborn begins breathing causing hypoxemia, acidosis and vasoconstriction of the pulmonary artery. This newborn requires much care and possible ECMO. The nurse should monitor the newborn’s BP regularly, because hypotension can occur from ensuing HF and the persistent hypoxemia. Vasopressors may be need for this newborn. The newborn shouldn’t be suctioned. Doing so causes more stimulation and worsens respiratory issues. ABG will be obtained regularly, but they a priority nursing intervention. Oxygen saturation should always be monitored in a NB with respiratory distress

Question 30

A newborn is exhibiting symptoms of withdrawal and toxicology test have been prescribed. Which type of specimen should the nurse collect to obtain the most accurate results?

A. Meconium
B. Blood
C. Urine
D. Sputum

Answer 30

A. Meconium

Rationale: Toxicology screening of a newborn can include testing from blood, urine and meconium. These tests identify which drugs the newborn has been exposed to in utero. A meconium sample can detect which drugs the mother has been using from the second trimester of pregnancy until birth. It is the preferred method of testing. A urine screen identifies only the drugs the mother has used recently. The nurse should be careful not to mix the meconium sample with urine as it alters the results of the test. Blood samples can be taken and they will yield results of current drugs in the newborn’s system, but they are invasive and non-invasive testing will provide the same results. If possible, testing on the mother is preferred. This testing provides quick results of what drugs the mother has been exposing the fetus to in utero. This will help in planning and providing care for the drug-exposed newborn. Sputum is not used for toxicology studies

Question 31

A neonate is diagnosed with Erb’s palsy after birth. The parents are concerned about their neonate’s limp arm. The nurse explains the neonate will be schedule to receive what recommended treatment for this condition first?

A. Physical therapy to the joint and extremity
B. Nothing but time and let nature take its course
C. Surgery to correct the joint and muscle alignment
D. Immobilization of the shoulder and arm

Answer 31

D. Immobilization of the shoulder and arm

Rationale: Treatment for a neonate with web palsy usually involves immobilization of the upper arm across the upper abdomen/chest to protect the shoulder from excessive motion for the first week; then gently PROM exercises are performed daily to prevent contractures. Surfer isn’t need to regain function since there is no structural injury. Doing nothing will not help the neonate regain function in the extremity

Question 32

Knowing the risks of diabetes to the mother, the nurse would perform the following assessments on a hospitalized gestational diabetic patient? SATA

A. Continuous pad counts. (r/t risk of postpartum hemorrhage)
B. Calorie counts. (no research to show this benefits anything - from article)
C. Fundal height checks. (Found in book - guess we monitor for macrosomia; can also indicate polyhydramnios)
D. Monitor daily urine tests for the presence of protein. (monitor for preeclampsia)
E. Frequent blood pressure monitoring. (HTN, preeclampsia)

Answer 32

A. Continuous pad counts. (r/t risk of postpartum hemorrhage)
C. Fundal height checks. (Found in book - guess we monitor for macrosomia; can also indicate polyhydramnios)
D. Monitor daily urine tests for the presence of protein. (monitor for preeclampsia)
E. Frequent blood pressure monitoring. (HTN, preeclampsia)

Question 33

The nurse explains symptoms of neonatal drug withdrawal to a mother who used heroin during the pregnancy. The nurse determines the client needs further teaching when she says that the neonate will likely exhibit…

Answer 33

Lethargy → infant has a hard time falling asleep and displays wakefulness