NCM 109 FINALLSSS

Question 1

The most common cause of jaundice in newborns

Answer 1

Physiologic jaundice

Question 2

A major risk factor for jaundice in a newborn is

Answer 2

prematurity (35-36 week’s gestation)

Question 3

A correct statement about physiologic jaundice in a newborn is that the jaundice:

Answer 3

May develop 2-3 days after birth

Question 4

The primary goal of treatment for RDS:

Answer 4

Dilate the bronchioles

Question 5

part of the respiratory system primarily affected by RDS

Answer 5

Nasopharynx

Question 6

Condition is not associated with respiratory distress in children

Answer 6

Respiratory syncytial virus (RSV)

Question 7

The nurse is caring for a newborn on phototherapy.
What nursing intervention(s) is appropriate to include
in the plan of care to prevent the side effects of
phototherapy in a newborn with hyperbilirubinemia:

Answer 7

*Assess temperature frequently.
*Monitor intake and output.

Question 8

A neonatal nurse admits a preterm infant with the
diagnosis of respiratory distress syndrome and
reviews the maternal labor and birth record. Which
factors in the record would the nurse correlate with
this diagnosis

Answer 8

 32 weeks’ gestation
 cesarean birth
 male gender
 maternal diabetes

Question 9

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

Answer 9

deficiency of surfactant.

Question 10

The nurse assessing a 15-hour-old term neonate
notes the skin color in the face is yellow. The nurse
obtains a transcutaneous bilirubin reading per a
standing order and the result is 9. What is the priority
action the nurse needs to take:

Answer 10

Notify the health care
provider of the finding.

Question 11

A preterm neonate is transferred to a NICU. When the
parents visit, which action would be most important for
the nurse to urge them to do:

Answer 11

do:.Touch firmly and, if
possible, hold the baby

Question 12

The cause of conjugated hyperbilirubinemia is
Impairment in

Answer 12

hepatic excretion or an extrahepatic
obstruction

Question 13

Jaundice in a newborn with hyperbilirubinemia initially
appears on the face and progresses in which pattern:

Answer 13

Cephalocaudal

Question 14

The average bilirubin production in newborns is

Answer 14

2 to 3
times more than adults

Question 15

Elevation of serum bilirubin is also affected by the rate
of excretion. In a newborn, excretion of bilirubin is
complicated by

Answer 15

Decreased transit time in the intestines
and decreased enterohepatic circulation time

Question 16

Jaundice is considered pathological if it occurs In the
first

Answer 16

24 hours after birth

Question 17

Phototherapy is a treatment for jaundice. The
mechanism of phototherapy is T

Answer 17

Transforming
unconjugated bilirubin into photoproducts that can be
excreted

Question 18

Potential complications for a newborn being treated
with phototherapy include all of the following except

Answer 18

Decreased stooling

Question 19

When providing discharge education to the family of a
newborn treated for hyperbilirubinemia, they should be
instructed to contact the provider if they notice

Answer 19

Decreased voiding or stooling

Question 20

Newborns are least likely to develop jaundice if they
are

Answer 20

Breastfed with less than 38 weeks’ gestation

Question 21

An accurate level assessment of hyperbilirubinemia
can be performed by

Answer 21

Measuring serum bilirubin

Question 22

An early sign of bilirubin toxicity in newborns is

Answer 22

Hypotonia

Question 23

A condition characterized by staining of the brainstem
nuclei and cerebellum is known as

Answer 23

Kernicterus

Question 24

Pulmonary stenosis in Tetralogy of Fallot is dangerous
because

Answer 24

it can lead to inadequate passage of blood to
the Lungs

Question 25

What finding would you expect when measuring blood pressure on all four extremities of a child with a coarctation of the aorta is blood pressure that is:

Answer 25

Lower in the legs than the arms

Question 26

Why does a child who is diagnosed with tetralogy of fallot favor the squatting position:

Answer 26

It increases the return of venous blood back to the heart

Question 27

What does a chest x-ray of a patient with tetralogy of fallot typically reveal:

Answer 27

Boot-shaped heart

Question 28

What is often the first sign(s) of tetralogy of fallot:

Answer 28

 Heart murmur  Cyanosis

Question 29

You're providing an in-service to a group of new nurses who will be caring for patients who have Tetralogy of Fallot. Which statement below is INCORRECT concerning how the blood normally flows through the heart:

Answer 29

Unoxygenated blood enters through the superior and inferior vena cava and travels to the left atrium.

Question 30

As the nurse you know which statements are TRUE about Tetralogy of Fallot:

Answer 30

"Tetralogy of Fallot is a cyanotic heart defect."

Question 31

While feeding a 3-month-old infant, who has Tetralogy of Fallot, you notice the infant's skin begins to have a bluish tint and the breathing rate has increased. Your immediate nursing action is to?

Answer 31

Stop feeding the infant and place the infant in the knee-to-chest position and administer oxygen.

Question 32

You are assessing the heart sounds of a patient with a severe case of Tetralogy of Fallot. You would expect to hear a __________ murmur at the _______ of the sternal border?

Answer 32

systolic; left

Question 33

As the registered nurse you are developing a plan of care for a patient with Tetralogy of Fallot. Select all the appropriate nursing diagnoses below that would be specific to this patient:

Answer 33

 Activity Intolerance  Failure to thrive

Question 34

A family member, who is caring for a 2-year-old with Tetralogy of Fallot, asks you why the child will periodically squat when playing with other children. Your response is:

Answer 34

"Squatting helps to normalize systemic vascular resistance, which will increase the left to right shunt that is occurring in the ventricles and this helps increase oxygen levels."

Question 35

Which of the following represents an effective nursing intervention to reduce cardiac demands and decrease cardiac workload

Answer 35

 Clustering nursing care to provide for periods of uninterrupted rest.  Developing and implementing a developmentally appropriate plan of care as tolerated.

Question 36

Defects associated with tetralogy of Fallot include

Answer 36

ventricular septal defect, overriding aorta, pulmonic stenosis, and right ventricular hypertrophy.

Question 37

the most common early complication of cardiac catheterization:

Answer 37

Cardiac dysrhythmias

Question 38

The nurse is assessing an infant who is admitted for congestive heart failure. Which sign would the nurse most likely find:

Answer 38

Dyspnea

Question 39

Deoxygenated blood flows from the right ventricle to the left ventricle. What defect does this most likely describe:

Answer 39

Tetralogy of Fallot

Question 40

A newborn infant is diagnosed as having a patent ductus arteriosus. The knowledgeable pediatric nurse understands that this congenital heart defect involves:

Answer 40

persistence of the fetal opening between the pulmonary artery and the aorta.

Question 41

drugs are most often given to children with congenital heart disease (CHD)to specifically decrease the workload of the heart:

Answer 41

Diuretics

Question 42

The nurse is preparing to discuss a congenital heart defect that increases pulmonary blood flow. Which condition should the nurse include

Answer 42

Patent ductus arteriosus

Question 43

The nurse is helping a mom breastfeed a newborn who has a defect that decreases pulmonary flow. The nurse observes that the newborn has difficulty breathing and becomes cyanotic during the feeding. Which instruction should the nurse provide:

Answer 43

Periodically stop the newborn from sucking

Question 44

The nursing assessment of a newborn reveals cyanosis, a continuous murmur over the pulmonic area, and a harsh systolic murmur in the tricuspid area. Which condition should the nurse suspect

Answer 44

Pulmonary atresia

Question 45

The nurse is teaching women about vaccinations they should have before becoming pregnant. Which should the nurse include that will minimize the risk of having a child with a congenital heart disorder

Answer 45

Rubella

Question 46

The nurse is assessing a toddler with uncorrected cyanotic heart disease. Which question to the parent is most appropriate

Answer 46

Does your child often squat?

Question 47

The assessment that would lead the nurse to suspect that a newborn infant has a ventricular septal defect is:

Answer 47

a loud, harsh murmur with a systolic tremor.

Question 48

Esophageal Atresia can be best described by which of the following passages

Answer 48

An incomplete passageway from the mouth to the stomach present at birth

Question 49

A newborn who presents with which of the following symptoms could have Esophageal Atresia with a Tracheoesophageal Fistula?

Answer 49

A baby who is drooling and has abnormal respiratory sounds at one hour old.

Question 50

Tracheoesophageal Fistula is best described by which of the following statements:

Answer 50

A passageway joining the trachea and esophagus present at birth

Question 51

The nurse observes a newborn become cyanotic when feeding. What procedure will the nurse perform as prescribed to assess for a tracheoesophageal fistula (TEF)?

Answer 51

Attempt to pass a nasogastric tube (NG tube)

Question 52

A newborn had a repair of Type I tracheoesophageal fistula (TEF). Which statement would be correct in educating the family of what to expect in the immediate post-operative period?

Answer 52

 “Frequent suctioning with a pre-measured catheter is required.”  “The head of bed should be elevated 30-45 degrees.”  “If there is no leak 5-7 days after the surgical repair, oral feedings will be started.”  “The baby will be on acid suppression therapy using a proton pump inhibitor (PPI), such as Lansoprazole postoperatively.”

Question 53

The finding the nurse would expect when measuring blood pressure on all four extremities of a child with coarctation of the aorta is blood pressure that is:

Answer 53

lower in the legs than in the arms.

Question 54

When a father asks why his child with tetralogy of Fallot seems to favor a squatting position, the nurse would explain that squatting:

Answer 54

increases the return of venous blood back to the heart.

Question 55

A child develops carditis from rheumatic fever. The nurse knows that the areas of the heart affected by carditis are the:

Answer 55

heart muscle and the mitral valve.