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NM 705 Postpartum and Newborn > Module 2 Practice Questions > Flashcards

Module 2 Practice Questions Flashcards

1
Q

A G1P1 nervous about taking her baby home. She wonders how to tell if the baby is breathing. How should the midwife manage her concerns?

A

Explain how to watch the abdomen to see the rise and fall during breathing

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2
Q

Immediately after birth the newborn has a lusty cry, but moderate secretions. What is the best management?

A

Continue to monitor infant as they clear their airway

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3
Q

Which newborn vital sign would be considered abnormal during transition?
HR 158
RR 62
HR 82
RR 46

A

HR 82

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4
Q

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

A

pathologic requiring a physician referral

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5
Q

Assign an Apgar score to this infant: heart rate 110, weak cry, some flexion, acrocyanosis. (Remember there are 5 criteria in the Apgar and that a strong cry can count 2 points in BOTH the respirations and reflex irritability criteria).

A

6

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6
Q

What is the recommendation for cord care in developed (high-income) countries?

A

keep it clean and dry

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7
Q

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

A

reassure may be normal and evaluate

No documented void is considered normal up to 48 hours after birth. Almost all babies will have voided by that time.

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8
Q

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

A

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

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9
Q

Vitamin K is given to the newborn to prevent:

A

vitamin K deficiency bleeding

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10
Q

Which of the following findings require physician involvement?
no void in the first 24 hours
no stool in the first 24 hours
eating 8 times in the first 24 hours
yellow sclera in the first 24 hours

A

yellow sclera in the first 24 hours

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11
Q

At which gestational age will the fetus begin to recognize the mother’s voice?

A

20 weeks

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12
Q

What percentage of time during a 24-hour day does a newborn typically spend crying?

A

2-11%

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13
Q

What does staccato crying indicate?

A

discomfort

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14
Q

Which assessment includes an evaluation of the newborn’s organization of states?

A

Neonatal Behavioral Assessment Scale

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15
Q

This may result in a challenging newborn temperament:

A

maternal anxiety

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16
Q

Which newborn area is most receptive to touch?

A

mouth

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17
Q

Which state does the Neonatal Behavioral Assessment Scale begin?

A

sleep

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18
Q

What Neonatal Behavioral Assessment finding would be concerning?

A

Inability to self console

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19
Q

Which time of the day do infants tend to cry more?

A

Evening

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20
Q

Increased cortisol levels in the newborn may result from this:

A

prolonged crying

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21
Q

Cycles of sleep and wakefulness are regulated by this:

A

CNS

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22
Q

Predictability of mothers response to infants cues results in this:

A

attachment

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23
Q

95% of newborns lose ____% of their weight after delivery.

A

7-10%

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24
Q

Newborns are expected to begin to regain weight by day ___

A

Day 4

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25
Q

What are some reasons for newborn weight loss?

Note: do not need to memorize all answers

A

Water loss (especially if they received IVF during labor)
Breastfeeding
Cesarean Section
PP Hemorrhage or Anemia
Breast Surgeries
Maternal Medications
Hypothyroid

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26
Q

When should a baby have regained its birth weight?

A

2 weeks

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27
Q

What are the normal vital signs for a newborn?

A

RR: 40-60
HR: 110-160

28
Q

Do you have the stages of reactivity memorized? Talk through it

A

…

29
Q

What respiratory signs would be concerning aside from RR?

A

Color: central cyanosis (acrocyanosis is normal)
Retracting, flaring, grunting

30
Q

What are some benefits associated with skin to skin?

A

Thermoregulation
Bonding
Blood glucose maintenance
Respiratory regulation
Decreased cortisol=less crying
Airway clearance

31
Q

Is there an alternative to maternal skin to skin, does it have the same benefits?

A

Partner or family member can do it, the mom does not get the maternal benefits but baby does still benefit.

32
Q

How does maternal anxiety affect baby?

A

If the mom is stressed, the baby has increased cortisol levels, and fetal development is affected as well.

33
Q

When does the umbilical cord normally separate? What is the recommended care?

A

Naturally detaches in 5-15 days. Should be left dry and open to air if in a clean environment. Alcohol and triple dye is no longer recommended.

34
Q

What signs should we watch/educate about as signs of infection in the umbilical cord?

A

Redness, swelling, baby crying if it is touched, foul smell, drainage.

35
Q

What is the AAP recommendation for circumcision?

A

The benefits outweigh the risks, but it is a personal decision.

It is beneficial to those at risk of UTIs and HIV but is not recommended for everyone.

36
Q

What pain relief techniques can be used during a circumcision?

A

**Ring block, **Emla cream, sweeteese, and Tylenol

Recommendation is block and Emla cream together

37
Q

What position is recommended for babies to sleep in? What does it prevent?

A

Sleeping on their back with nothing in the crib. Room sharing but not bed sharing. Firm mattress. Pacifiers. Avoid overheating.

Prevents SIDs

38
Q

What is the current recommendations with routine suctioning at delivery?

A

It is not recommended to be routinely done due to the risk of bradycardia and arrhythmias. There is no evidence to support that it benefits the baby. It is recommended to let the baby clear their lungs and wipe the fluid off the face instead. Suctioning should be done only if PPV is needed.

39
Q

What are some causes of Jaundice?

A

Physiologic jaundice: shorter RBC life span, slow processing (immature liver and slow gut emptying)
Breastfeeding jaundice
Pathologic Jaundice: it is noted within 24 hours or at high levels. (>17/20)

40
Q

What level of TSB is associated with Kernicterus?

A

25
Kernicterus is when neurological damage is done from the elevated bilirubin

41
Q

At what TSB value should we start to intervene?

A

15

42
Q

When should a baby with an elevated TSB be referred?

A

Lethargy, poor feeding

43
Q

What is the mean peak of TSB?

A

72-96 hours

44
Q

What is the mean peak of TSB?

A

72-96 hours. This is when breast milk typically begins to come in.

45
Q

Why do we give erythromycin?

A

Effective for Gonorrhea
Is the only medication we have as prophylaxis but it is not proven effective for Chlamydia

46
Q

What does the CCHD test for? Describe it.

A

Pulse ox applied to two extremities (right hand and either foot) to assess levels and compare extremities. Only checks for 7 critical congenital heart defects. A SPO2 of <90%=positive. SPO2 90-95% and/or a difference >3% between extremities=retest up to two more times 1 hour apart.

Negative result= >95% and <3% difference

47
Q

What babies need Vitamin D supplementation? How much?

A

Exclusively breastfed babies. Formula-fed babies receive vitamin D from the formula.

Supplementation is 400 iu daily. Mom or baby can receive the supplementation

48
Q

What does PKU test for, and when should it be done?

A

It tests for inborn errors of metabolism. It should be done after 24 hours of **successful feeding.

49
Q

What does the Neonatal behavior assessment scale assess?

A

Communication/interaction with the parents is done at 2 weeks of age. Newborns’ communication responses to stimuli help parents interpret and respond to their baby’s cues.

Usually done at a few weeks old.

50
Q

What is the New Ballard scale, and what does it assess? What is its purpose?

A

This test is done within the first 12-24 hours to assess babies’ developmental gestational age. Helps determine any potential problems that need to be addressed.

Accurately assigns gestational age within 2 weeks

51
Q

Do you have the APGAR chart memorized? What is its purpose?

A

Assesses success of resuscitation *Does not assess asphyxia/wellbeing of baby

Appearance: Color
Pulse: Heart Rate
Grimace: Reflex Irritability
Activity: Tone
Respiration: Breathing

52
Q

What are the two hearing screens? If the baby fails the test, what is the POC?

A

-ABR and OAE
-Failure results in a need for a repeat test at **1-2 weeks to ensure quick treatment
-It is fairly common to have a false failure due to fluid in the ear, crying, etc.

53
Q

What is the normal amount of crying?

A

2-11% of the day (2.6 hours per day max)
More common in the evening

54
Q

What signs are the reasons for patients to bring the baby back to the hospital?

A

Lethargy, dehydration, poor feeding, jaundice

55
Q

Why do we do hearing screens on babies even though there are a lot of false failures?

A

Hearing loss most often occurs in babies without risk factors (half of the babies with hearing loss have no risk factors). Early treatment can help.

56
Q

What six tasks does the NBAS assess?

A

-Organization of behavioral state
-Decrease in motor activity in an attempt to cope with sensory input
-Ability to become alert and oriented to auditory and visual stimuli
-Interaction with a caregiver through cuddling
-Ability for self-consoling
-Habituation to repeated stimulation

57
Q

Why is it no longer recommended to clean/treat the umbilical cord?

A

Some evidence suggests that treatment with an antiseptic solution may prolong adherence of the cord.

Note: these studies were done in developed countries with clean conditions. Chlorhexidine is recommended in countries with poor sanitation.

58
Q

Within what timeframe should a newborn receive the Hep B vaccine?

A

12 hours of life

Note: HBIG is given if the mother is HepB positive

59
Q

What are the benefits of circumcision?

A

Lower incidence of medical problems including cancer of the penis, urinary tract infection (UTI), and sexually transmitted infection (STI).

60
Q

What are the main benefits discussed in this course of skin to skin?

A

Skin-to-skin has many benefits and minimal risks. Creates a thermoneutral environment Encourages longer duration of exclusive breastfeeding Enhances glucose stabilization Improves cardio-respiratory stability

61
Q

What development is more mature in a newborn; sensory or motor?

A

SENSORY

62
Q

Can a CNM perform circumcisions?

A

Yes, but additional training is required

63
Q

Is the PKU/Metabolic screening done at the same time on all infants? When is it done?

A

No, it is done after 24 hours of SUCCESSFUL feeding

64
Q

What are some causes for neonatal hearing loss?

A

Low birth weight, APGAR score <6 at 5 minutes, craniofacial anomalies, sepsis, and ototoxic exposure

65
Q

What type of cry signals a baby in distress?

A

The cry of discomfort is initially staccato-like, then intermittent, with a monotonous pitch. A cry signaling pain rises in pitch. The cry of rage lasts longer than the cry of discomfort and the infant may hold its breath and make gasping sounds. This cry stimulates one of the most primitive areas of the adult brain, causing us to take action or want to.

NM 705 Postpartum and Newborn (13 decks)

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