NARM Practice Exam 600 Questions - (571-600) Well baby care Flashcards
571 . At what stage would you feel that intervention of some kind was needed?
a) A newborn’s weight gradually moves from the 95th percentile at birth to the 50th percentile over the first few weeks of life?
b) A newborn’s weight gradually moves from the 5th percentile at birth to the 50th percentile over the first few weeks of life?
c) A newborn’s weight remains steady for the first few weeks from birth, at the 95th percentile.
d) A newborn’s weight remains steady for the first few weeks from birth, at the 5th percentile.
A
572 . Which of the following is not in the differential diagnosis for a newborn infection?
a) Respiratory disease
b) Transient tachypnea of the newborn
c) Cardiac problems
d) Hyperglycemia
D
573 . There are many different kinds of birth defect. Which of these lists contains inaccurate information about one such category?
a) Teratogen exposure: Fetal alcohol syndrome (signs: distinctive facial features, deformities of joints/limbs/fingers, small head circumference, signs of heart defect; Differential diagnosis: chromosomal anomaly, exposure to other teratogens, Noonan syndrome). Smoking (signs: prematurity, low birth weight, SIDS, RDS, placenta abruption/previa in pregnancy/labor, cleft lip/palate, shortened or missing limbs, craniofacial abnormalities. Differential diagnosis: abnormal placentation, IUGR from other cause, chromosomal anomaly, unrelated oral cleft). Many other teratogens exist.
b) Chromosomal anomaly: Trisomy 13/18/21, trisomy mosaicism (signs: RDS, apnea, difficulty with feeding, weak cry, hypotonia, malformations of hands/feet/head/facial area/genitals, distinctive characteristics of craniofacial region, cleft lip/palate, neural tube defect, signs of cardiac defect. Differential diagnosis: different trisomy/trisomy mosaicism/other chromosomal anomaly, congenital hypothyroidism, midline defect). Sex chromosome aneuploidy (signs: hypospadias, chryptochordism, hypogonadism, small testes, minor skeletal malformations particularly of hands/feet, high-arched palate, retrognathia, increased arm-to-leg ratio, signs of congenital heart defect. Differential diagnosis: Noonan syndrome, Kallmann syndrome, metabolic disorders). Chromosomal deletion (signs: abnormal cry, hypotonia, low birth weight, microcephaly, distinctive facial features, syndactyly, cleft palate, hypospadias, cryptochordism. Differential diagnosis: teratogenic exposure, tetralogy of Fallot, CHARGE syndrome).
c) Midline defect: Neural tube defect (signs: open lesion/tufts of hair/membranous sac on spine; differential diagnostic: sacral dimple, pilonidal cyst). Oral cleft (signs: visualization/palpation of cleft, blue line through soft palate, RDS, inability to feed; differential diagnosis: amniotic band syndrome). Omphalocele/gastroschisis (signs: defect/mass/intestines/organ visible between rectus muscles; differential diagnosis: umbilical hernia). Esophageal atresia/tracheoesophageal fistula (signs: RDS, feeding/swallowing problems, excess mucous, abdominal distension; differential diagnosis: upper GI obstruction, esophageal stenosis/web, neuromuscular swallowing disorder, air leak to upper airway). Imperforate anus (signs: visualization, no passage of meconium, rectum opening in vagina/close to scrotum visualized or passage of meconium from here; differential diagnosis: colon atresia). Diaphragmatic hernia (signs: RDS, bowel sounds in chest, less full abdomen; differential diagnostic: many other congenital defects, e.g. bronchogenic cyst, cystic teratomas, paraoesophageal hernia).
d) TORCH defect: Intrauterine transmission of Toxoplasmosis, Ophthalmia neonatorum, Rubella, CMV or Herpes simplex virus (signs: IUGR, prematurity, neonatal conjunctivitis, difficulty feeding, lethargy, signs of anemia, petechia, purpura, rash, jaundice, microcephaly, signs of visual/hearing impairment, signs of heart defects; Differential diagnosis: other cause of IUGR or prematurity, metabolic syndrome, genetic syndrome, teratogen exposure in utero).
D
574 . You’re attending the birth of a term baby who died in utero. Which of the following is not best advice for how to deal with the situation?
a) Before the birth, discuss gently with the parents how the baby may look, and help them plan for what they might do with the baby afterwards, depending upon its condition, such as bathing and dressing the baby, and having photographs taken, saving a lock of hair, etc.
b) If the baby is to be born out of hospital, attempt to persuade ambulance crews not to use sirens and to enter the room slowly and peacefully.
c) As soon as the baby is born, tell the parents how very sorry you are for their loss. This is a time for grieving the birth and the baby that they had longed for.
d) Side-lying is generally a good position for birth. There is no rush with the delivery, so take your time and help ensure there is minimal trauma involved in getting the baby out, as the skin and body may be easily damaged. Once the baby has been born, model loving behavior towards the baby.
C
575 . Regardless of findings of newborn assessments and screening results and parental wishes, to which of the following specialists would you not refer your client?
a) Chiropractor or craniosacral therapist
b) Geriatrician open to both vaccinated and unvaccinated patients
c) I would refer to all of these specialists
d) Homeopath or herbalist
B
576 . Which of the following statements regarding the condition of a newborn’s cord is inaccurate?
a) A foul-smelling discharge, pus oozing from around the umbilicus, fever or irritability, or a surrounding area that looks bright red, inflamed or streaked is an umbilical infection. Breastmilk should be used around the umbilicus, or the neonate should be given probiotics with pumped milk or formula.
b) A granuloma is a small, moist, pink or red ball, possibly covered by a thin yellow or white film. It can be treated with silver nitrate.
c) Salt water, goldenseal, echinacea or lavender or myrrh essential oils may be used to help with healing.
d) Keep the area clean and dry. Sponge baths or baths where you keep the area dry are best until the cord falls off. Leave the cord stump outside the diaper.
A
577 . Which of the following would not cause concern if there was no increase in the first month of life?
a) Head circumference of a baby born breech
b) Head circumference of a baby born OP
c) Length
d) Chest circumference
D
578 . You’ve just assisted at the birth of a baby with obvious abnormalities that had not been diagnosed antepartally. Which of the following is not something likely to help the parents?
a) Support the parents through any anxiety or grieving they may have, without judgment, and continue to offer support after the immediate postpartum.
b) Encourage bonding between parents and the newborn, and model loving behavior towards the baby.
c) Give a name to the abnormalities you see, even if you’re not 100% certain of the diagnosis, as this makes it easier for parents to comprehend the situation and to begin dealing with it emotionally.
d) Take time to communicate with the parents about your observations and listen to their opinions about the details of the next steps, unless it is an emergency situation requiring immediate transport.
C
579 . You’re considering buying a pulse oximeter for performing newborn CCHD screening. Which of the following statements is not accurate?
a) The sensors must be placed on the right hand and either the right or left foot. Follow the instructions for placement carefully, including making sure the light emitter and sensor are lined up well. If using only 1 sensor, measure one site immediately after the other.
b) The CCHD pulse oximetry screening has a very high sensitivity of 98%, meaning that you can be very confident that a negative result means there is no CCHD present.
c) Whilst screening done within the first 24 hours of life is more likely to produce a false-positive, parents can be reassured that this is relatively common, and the screening can be repeated after the first 24 hours if the initial result is positive. This increases the chances of picking up severe cases of CCHD early, however, as a positive result in combination with mild signs of cardiac problems would alert you to a possibly significant problem.
d) A positive result occurs immediately if either sensor site records under 90% saturation. If either sensor records under 95% or there is more than 3% difference between the two sensors, repeat the test. If the result of this is unchanged on retesting, the screen is positive.
B
580 . Which of the following is not an accurate description of a normal neonatal skin condition?
a) Desquamation: a crusty, greasy rash that occurs when there is a build-up of sebum that causes skin cells to stick together instead of shedding normally. Can occur on the scalp, diaper, neck, or underarm area.
b) Neonatal acne: pink pimples, mostly on the nose and forehead, that can last for a few weeks or, sometimes, months.
c) Milia: little white bumps on the nose and face caused by blocked oil glands. Spontaneously resolves when the oil glands enlarge and open up.
d) Erythema toxicum: red blotches with ill-defined borders that are slightly raised, and may have a small white or yellow dot in the center. Usually occurs in the first 3-5 days after birth, and resolves spontaneously in a few days or weeks.
A
581 . Other than breathing (and remember that neonates are obligate nose-breathers), which of the following is not a basic need for a neonate?
a) The opportunity to bond with their carer with, for example, eye contact, hearing positive speech, having their needs met promptly by a carer.
b) Breast/chestfeeding (from parent or expressed colostrum/milk in a bottle) or formula.
c) Skin-to-skin contact, clothing or other method for keeping the baby warm.
d) Bathing within the first 24 hours (attempting to keep cord dry) to wash away vaginal secretions. Vernix can be rubbed into the skin first.
D
582 . What is appropriate weight gain in a newborn?
a) 12% weight loss in the first week, and then weight gain of at least 3 oz (90 g) per week.
b) 7% weight loss in the first week, and then weight gain of at least 3 oz (90 g) per week.
c) 7% weight loss in the first week, and then weight gain of at least 5 oz (150 g) per week.
d) 12% weight loss in the first week, and then weight gain of at least 5 oz (150 g) per week.
C
583 . Your client struggled to get enough money together to pay your fee, and tells you she’s thinking about skipping the extra expense of the hearing screening, because she can clearly see that her daughter is responding to noises like a banging door or barking dog. Which of the following responses would not be accurate?
a) Being able to hear well is important for brain development. If hearing impairment is not diagnosed in the first few weeks of life, the lack of intervention can not only impact communication and language skills in early life, but may have lasting effects on academic achievement and social-emotional development.
b) Approximately 1 in 300 to 1 in 1,000 babies born in the US have hearing levels outside the typical range. Although the vast majority of these babies have at least one parent with hearing impairment or deafness, certain maternal infections or medications taken during pregnancy can cause hearing impairment in a baby. Prematurity also has an impact.
c) Babies may respond to sound by startling or turning their head towards it, but that doesn’t mean they can hear well enough to be able to understand spoken language, for example.
d) There are two different tests that could be used. One measures the response of the hearing nerve and brain to sound, and one measures the echo when sounds are played into the baby’s ears. Both are quick (5-10 minutes) and painless, and can be done when the baby is asleep.
B
584 . Which of the following is cause for concern in the first few weeks of life?
a) Transition from meconium and ‘brick dust’ urine to yellow-green (breastmilk) or yellow-brown (formula) stool and clear yellow urine by 2 weeks.
b) Can be stimulated to wake, tracks with eyes, and engages with faces.
c) Sleeps between 10 and 18 hours per day, varying considerably from one day to the next.
d) Nurses 7 or 8 times a day, sometimes more often. Produces 2-4 stools and 4-6 wet diapers each day after the first 3 days.
A
585 . At birth, there are numerous circulatory and respiratory changes in the neonate. Which of the following is not correct?
a) Before birth, some of the oxygen-poor blood entering the descending aorta flows along the umbilical veins to the placenta. Here, oxygen-rich maternal blood flows along uterine arteries and into the intervillous spaces. Deoxygenated maternal blood then flows away via uterine veins. Meanwhile, fetal blood in the terminal villi becomes oxygenated by diffusion of oxygen from maternal blood, and then returns to the fetus through the umbilical artery. After birth, the umbilical veins constrict, and there is a cessation of blood flow from the neonate to the placenta.
b) Before birth, oxygenated blood travels along an umbilical blood vessel. The ductus venosus allows much of this blood to bypass the hepatic portal system and flow directly into the inferior vena cava. After birth, the cessation of placental perfusion causes functional closure of the ductus venosus.
c) Before birth, deoxygenated blood that has been pumped around the body enters the right atrium via the superior vena cava. There is some mixing here with oxygenated blood, but most of the oxygen-poor blood travels to the right ventricle and into the pulmonary artery. However, most of this blood bypasses the lungs through the ductus arteriosus (protecting the lungs from circulatory overload) and hence shunts to the descending aorta and then flows to the lower half of the fetal body. After birth, various factors caused by the cessation of placental blood flow and initiation of breathing cause the ductus arteriosus to close, and deoxygenated blood from the right ventricle travels along the pulmonary artery, is oxygenated at the lungs, and then travels to the left atrium via the pulmonary vein. Blood from here is then pumped by the left ventricle to the aorta, and then around the body, before returning to the vena cava.
d) Before birth, oxygenated blood from the inferior vena cava enters the right atrium, where much of it is shunted to the left atrium through the patent foramen ovale. This blood then flows into the left ventricle and is pumped out the ascending aorta, so oxygen rich blood goes directly to the brain. After birth, decreased pressure in the right atrium caused by decreased umbilical blood flow and increased pulmonary blood flow causes the foramen ovale to functionally close. Blood entering the right atrium now all passes into the left ventricle and is pumped through the pulmonary artery to the lungs.
A
