OB Midterm Newborn Flashcards
1
Q
Which baby is more likely to develop TTN (Transient tachypnea of Newborn)?
A
TTN is when a baby has fast labored breathing because they did not get the “squeeze” at birth due to C-section
2
Q
How much weight can a NB lose?
A
No more than 10% of body weight
3
Q
How many vessels are there in the umbilical cord?
A
There are 3 vessels=2 arteries and one vein
4
Q
What should you educate mom about Erythema Toxicum on babys skin?
A
Inform mom that this is a normal way of baby reacting to atmosphere (they look like hives)
5
Q
What conditions cause babies to have elastic skin turgor at birth?
A
If baby is hypoglycemic, post term, if placenta stopped working and baby is dehydrated, and IGR (intrauterine growth restriction) baby. IF baby has heart problem they will be swollen
6
Q
What information has to be documented at time of birth?
A
- Time of birth, APGAR score at 1min and 5min,First breath, *Vit K injection administration,
- number of vessels in the cord, *did baby poop or pee, *Ballard Score
7
Q
When checking PKU, what other genetic tests are we looking for?
A
Hypothyroidism, Cystic fibrosis, and Neuro problems. This test has to be done within 24 hours or more after baby’s first feeding, then again in a few weeks at peds office
8
Q
If baby has a problem with ear shape or size, this may indicate a problem with what system?
A
renal system (Kidneys develop at same time as ears) Also if baby has extra nipples)
9
Q
During a NB exam you notice baby has an arched back when laying down, this means?
A
this is called opisthotonos= spasm of the muscles causing backward arching of the head, neck, and spine, as in severe tetanus, means baby has meningitis
10
Q
If baby has excessive spit or bubbling at mouth what condition is suspected
A
Tracheoesophageal fistula
11
Q
If you notice baby has desquamation of skin during NB assessment what can this indicate?
A
The baby may be post term, malnutrition, malnutrition, or may have been exposed to herpes
12
Q
What color of skin can indicate hypotension, cold stress, and cardiac problems?
A
*Grey=hypotension, *Mottled=Cold stress or sepsis, *Red and sticky= premie baby *Harlequin sign= cardiac *problem or sepsis *Ruddy=polycythemia
13
Q
What is a potential complication of polycythemia? (excess RBCs)
A
Jaundice. (This can be caused if baby is held low when born, Placenta releases blood to NB below)
14
Q
Why is stimulation contraindicated when there is presence of meconium stained fluid?
A
Baby may aspirate meconium
15
Q
Which vaccine is given to babies when they are born to increase immunity?
A
Hep B vaccine, If mom is (+) for Hep B, baby will get HBIG, then must have Hep B vaccine within 12 hrs on vastus lateralis
16
Q
What is a normal CBG for a NB?
A
40mb/dL. If baby is less than 40, feed baby, recheck then call provider
17
Q
Some babies are born with milk in their breast (Witches milk), what is the cause of this?
A
Moms hormones
18
Q
What does it mean when a NB male has hydro/epi spadeus?
A
This means the meatus is on the side of the penis (dorsal or ventral) this needs to be surgically corrected
19
Q
What is the normal urine output for a baby?
A
1-3mL/kg/hr. Baby needs to have voided 60mL in first 24 hrs. (will be light in color and may have uric acid crystals, no odor)
20
Q
Which assessment findings are indicative of respiratory distress?
A
Flared nostrils, grunting (shutting of glottis), retractions, unequal breath sounds, asymmetrical chest movement (lung collapse)
21
Q
Babys require the “squeeze” during birth to initiate surfactant protein to lubricate alveoli, what can happen if they do not get the “Squeeze”?
A
They can develop TTN (Trans tachypnea of Newborn) = a respiratory problem that can be seen in the newborn shortly after delivery. It is caused by retained fetal lung fluid due to impaired clearance mechanisms.
22
Q
If baby had a poop with white at the end of it, this indicates what abnormality?
A
This is called meconium ileus, means baby may have cystic fibrosis
23
Q
What does it mean if baby has grey stools?
A
They have a blocked bile duct
24
Q
During the NB assessment, what GI conditions warrant investigation?
A
- Abd distention or hypoactive bowel sounds= bowel obstruction or necrotizing enteral colitis
- Bowel sounds In chest= hernia *Discharge from umbilicus= fistula *abd mass
25
What can an immature liver in an infant lead to?
Decreased glucose, decreased protein and increased bilirubin
26
The normal term infant has difficulty clearing airway after birth, Most secretions are brought up to the oropharynx by the cough reflex. If there is excess secretions, mouth and nasal passages can be cleared with a bulb syringe, What do you suction 1st?
a. Avoid suctioning the nares.
b. Insert the compressed bulb into the center of the mouth.
c. Suction the mouth first.
d. Remove the bulb syringe from the crib when finished.
((ANS: C The mouth should be suctioned first to prevent the infant from inhaling pharyngeal secretions by gasping as the nares are suctioned))
27
As part of Standard Precautions, nurses wear gloves when handling the newborn. The chief reason is:
a. To protect the baby from infection.
b. That it is part of the Apgar protocol.
c. To protect the nurse from contamination by the newborn.
d. the nurse has primary responsibility for the baby during the first 2 hours.
((ANS: C Gloves are worn to protect the nurse from infection until the blood and amniotic fluid are cleaned off the newborn.))
28
The nurse is performing a gestational age and physical assessment on the newborn. The infant appears to have an excessive amount of saliva. The nurse recognizes that this finding:
a. Is normal.
b. Indicates that the infant is hungry.
c. May indicate that the infant has a tracheoesophageal fistula or esophageal atresia.
d. May indicate that the infant has a diaphragmatic hernia.
((ANS: C The presence of excessive saliva in a neonate should alert the nurse to the possibility of tracheoesophageal fistula or esophageal atresia.))
29
A mother expresses fear about changing her infant’s diaper after he is circumcised. What does the woman need to be taught to take care of the infant when she gets home?
a. Cleanse the penis with prepackaged diaper wipes every 3 to 4 hours.
b. Apply constant, firm pressure by squeezing the penis with the fingers for at least 5 minutes if bleeding occurs.
c. Cleanse the penis gently with water and put petroleum jelly around the glans after each diaper change.
d. Wash off the yellow exudate that forms on the glans at least once every day to prevent infection.
(ANS: C Cleansing the penis gently with water and putting petroleum jelly around the glans after each diaper change are appropriate when caring for an infant who has had a circumcision)
30
A new father wants to know what medication was put into his infant’s eyes and why it is needed. The nurse explains to the father that the purpose of the Ilotycin ophthalmic ointment is to:
a. Destroy an infectious exudate caused by Staphylococcus that could make the infant blind.
b. Prevent gonorrheal and chlamydial infection of the infant’s eyes potentially acquired from the birth canal.
c. Prevent potentially harmful exudate from invading the tear ducts of the infant’s eyes, leading to dry eyes.
d. Prevent the infant’s eyelids from sticking together and help the infant see.
((ANS: B The purpose of the Ilotycin ophthalmic ointment is to prevent gonorrheal and chlamydial infection of the infant’s eyes potentially acquired from the birth canal. ))
31
What are modes of heat loss in the newborn (Select all that apply)?
a. Perspiration
b. Convection
c. Radiation
d. Conduction
e. Urination
((ANS: B, C, D Convection, radiation, evaporation, and conduction are the four modes of heat loss in the newborn. Perspiration and urination are not modes of heat loss in newborns.))
32
Infants in whom cephalohematomas develop are at increased risk for:
a. Infection.
b. Jaundice
c. Caput succedaneum.
d. Erythema toxicum
(ANS: B Cephalohematomas are characterized by bleeding between the bone and its covering, the periosteum. Because of the breakdown of the red blood cells within a hematoma, the infants are at greater risk for jaundice. ).
33
A meconium stool can be differentiated from a transitional stool in the newborn because the meconium stool is:
a. Seen at age 3 days.
b. The residue of a milk curd.
c. Passed in the first 12 hours of life.
d. Lighter in color and looser in consistency.
(ANS: C Meconium stool is usually passed in the first 12 hours of life, and 99% of newborns have their first stool within 48 hours. If meconium is not passed by 48 hours, obstruction is suspected. )
34
In administering vitamin K to the infant shortly after birth, the nurse understands that vitamin K is:
a. Important in the production of red blood cells.
b. Necessary in the production of platelets.
c. Not initially synthesized because of a sterile bowel at birth.
d. Responsible for the breakdown of bilirubin and prevention of jaundice
(ANS: C The bowel is initially sterile in the newborn, and vitamin K cannot be synthesized until food is introduced into the bowel. Vitamin K is necessary to activate blood clotting factors. )
35
The nurse should immediately alert the physician when:
a. The infant is dusky and turns cyanotic when crying.
b. Acrocyanosis is present at age 1 hour.
c. The infant’s blood glucose level is 45 mg/dL.
d. The infant goes into a deep sleep at age 1 hour.
((ANS: A An infant who is dusky and becomes cyanotic when crying is showing poor adaptation to extrauterine life.))
36
A first-time dad is concerned that his 3-day-old daughter’s skin looks “yellow.” In the nurse’s explanation of physiologic jaundice, what fact should be included?
a. Physiologic jaundice occurs during the first 24 hours of life.
b. Physiologic jaundice is caused by blood incompatibilities between the mother and infant blood types.
c. The bilirubin levels of physiologic jaundice peak between the second and fourth days of life.
d. This condition is also known as “breast milk jaundice.”
(ANS: C Physiologic jaundice becomes visible when the serum bilirubin reaches a level of 5 mg/dL or greater, which occurs when the baby is approximately 3 days old. This finding is within normal limits for the newborn. Pathologic jaundice occurs during the first 24 hours of life. )
37
Nurses can prevent evaporative heat loss in the newborn by:
a. Drying the baby after birth and wrapping the baby in a dry blanket.
b. Keeping the baby out of drafts and away from air conditioners.
c. Placing the baby away from the outside wall and the windows.
d. Warming the stethoscope and the nurse’s hands before touching the baby.
(ANS: A Because the infant is wet with amniotic fluid and blood, heat loss by evaporation occurs quickly.)
38
What marks on a baby’s skin may indicate an underlying problem that requires notification of a physician?
a. Mongolian spots on the back
b. Telangiectatic nevi on the nose or nape of the neck
c. Petechiae scattered over the infant’s body
d. Erythema toxicum anywhere on the body
((ANS: C Petechiae (bruises) scattered over the infant’s body should be reported to the pediatrician because they may indicate underlying problems. ))
39
The cheeselike, whitish substance that fuses with the epidermis and serves as a protective coating is called:
a. Vernix caseosa. b. Surfactant c. Caput succedaneum. d. Acrocyanosis.
(ANS: A This protection, vernix caseosa, is needed because the infant’s skin is so thin. )
40
With regard to the gastrointestinal (GI) system of the newborn, nurses should be aware that:
a. The newborn’s cheeks are full because of normal fluid retention.
b. The nipple of the bottle or breast must be placed well inside the baby’s mouth because teeth have been developing in utero, and one or more may even be through.
c. Regurgitation during the first day or two can be reduced by burping the infant and slightly elevating the baby’s head.
d. Bacteria are already present in the infant’s GI tract at birth because they traveled through the placenta.
(ANS: C Avoiding overfeeding can also reduce regurgitation)
41
As related to the normal 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. Breastfed infants likely will void more often during the first days after birth.
c. “Brick dust” or blood on a diaper is always cause to notify the physician.
d. Weight loss from fluid loss and other normal factors should be made up in 4 to 7 days.
(ANS: A A newborn who has not voided in 24 hours may have any of a number of problems, some of which deserve the attention of the pediatrician. )
42
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’s meconium, which is your baby’s first stool. It’s normal.”
b. “That’s transitional stool.”
c. “That means your baby is bleeding internally.”
d. “Oh, don’t worry about that. It’s okay.”
(ANS: A “That’s meconium, which is your baby’s first stool. It’s normal” is an accurate statement and the most appropriate response. )
43
The nurse enters the room to assess an infant and finds him unwrapped in his crib with the fan blowing over him on “high.” The nurse instructs mom that the fan shouldn't be directed toward baby and the newborn should be wrapped in a blanket. Rationale?
“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.”
(Conduction is the loss of heat from the body surface to cooler surfaces, not air, in direct contact with the newborn. Evaporation is loss of heat that occurs when a liquid is converted into a vapor. In the newborn heat loss by evaporation occurs as a result of vaporization of moisture from the skin. Cold stress may occur from excessive heat loss, but this does not imply that the infant will become stressed if not bundled at all times. Furthermore, excessive bundling may result in a rise in the infant’s temperature.)
44
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. Notify the physician immediately.
b. Move the newborn to an isolation nursery.
c. Document the finding as erythema toxicum.
d. Take the newborn’s temperature and obtain a culture of one of the vesicles.
(ANS: C Erythema toxicum (or erythema neonatorum) is a newborn rash that resembles flea bites)
45
The nurse assessing a newborn knows that the most critical physiologic change required of the newborn is:
a. Closure of fetal shunts in the circulatory system.
b. Full function of the immune defense system at birth.
c. Maintenance of a stable temperature.
d. Initiation and maintenance of respirations.
(ANS: D The most critical adjustment of a newborn at birth is the establishment of respirations. )
46
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. Acrocyanosis. b. Erythema neonatorum. c. Harlequin color. d. Vernix caseosa.
(ANS: A Acrocyanosis, or the appearance of slightly cyanotic hands and feet, is caused by vasomotor instability, capillary stasis, and a high hemoglobin level. Acrocyanosis is normal and appears intermittently over the first 7 to 10 days)
47
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:
a. Lanugo
b. Vascular nevi.
c. Nevus flammeus d. Mongolian spots.
(ANS: D A Mongolian spot is a bluish black area of pigmentation that may appear over any part of the exterior surface of the body.)
48
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. Respiratory depression.
b. Cold stress
c. Tachycardia.
d. Vasoconstriction.
(ANS: B Loss of heat must be controlled to protect the infant from the metabolic and physiologic effects of cold stress, and that is the primary reason for placing a newborn under a radiant heat warmer. Cold stress results in an increased respiratory rate and vasoconstriction.)
49
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. 80 to 100 beats/min. b. 100 to 120 beats/min.
c. 120 to 160 beats/min.
d. 150 to 180 beats/min.
(ANS: C The average infant heart rate while awake is 120 to 160 beats/min. )
50
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. Abdominal with synchronous chest movements.
b. Chest breathing with nasal flaring.
c. Diaphragmatic with chest retraction.
d. Deep with a regular rhythm.
(ANS: A In normal infant respiration the chest and abdomen rise synchronously, and breaths are shallow and irregular. Breathing with nasal flaring is a sign of respiratory distress. Diaphragmatic breathing with chest retraction is a sign of respiratory distress.)
51
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:
a. Transition period b. First period of reactivity c. Organizational stage.
d. Second period of reactivity.
(ANS: B The first period of reactivity is the first phase of transition and lasts up to 30 minutes after birth. The infant is highly alert during this phase)
52
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. This is a (+):
a. Tonic neck reflex. b. Glabellar (Myerson) reflex.
c. Babinski reflex. d. Moro reflex.
(ANS: D The characteristics displayed by the infant are associated with a positive Moro reflex. )
53
How often do you check APGAR score?
1 and 5 min
54
The nurse assisted with the delivery of a newborn. Which nursing action is most effective in preventing heat loss by evaporation?
Drying the infant with a warm blanket
55
At 1 minute after birth, the nurse assesses the infant and notes a heart rate of 80 beats/minute, some flexion of the extremities, a weak cry, grimacing, and a pink body with blue extremities. The nurse would calculate an Apgar score of:
5
```
The test measures your baby's:
1.)Heart rate
Absent=0
Slow (<100/min)=1
>100/min=2
2.)Breathing
Absent=0,
Slow, weak cry=1
Good cry=2
3.) Muscle tone
Flaccid=0
Some flexion of ext=1
well flexed=2
4.) Reflex response
No response=0
Grimace=1
Cry=2
5.) Color
Blue, pale= 0
Body pink, ext blue=1
Completely pink=2
```
56
The nurse administers vitamin K to the newborn for which reason?
Bacteria that synthesize vitamin K are not present in the newborn’s intestinal tract.
(ANS: Bacteria that synthesize vitamin K are not present in the newborn’s intestinal tract. Vitamin K is provided because the newborn does not have the intestinal flora to produce this vitamin for the first week.)
57
An Apgar score of 10 at 1 minute after birth would indicate a(n):
Infant having no difficulty adjusting to extrauterine life but who should be assessed again at 5 minutes after birth.
(An initial Apgar score of 10 is a good sign of healthy adaptation; however, it must be repeated at the 5-minute mark.)
58
Early this morning, an infant boy was circumcised using the PlastiBell method. The nurse tells the mother that she and the infant can be discharged after:
a. The bleeding stops completely.
b. Yellow exudate forms over the glans.
c. The PlastiBell rim falls off.
d. The infant voids.
(ANS: D The infant should be observed for urination after the circumcision)
59
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. Flexed posture
b. Abundant lanugo
c. Smooth, pink skin with visible veins
d. Faint red marks on the soles of the feet
(ANS: A Term infants typically have a flexed posture. Abundant lanugo usually is seen on preterm infants. Smooth, pink skin with visible veins is seen on preterm infants. Faint red marks usually are seen on preterm infants.)
60
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:
At least twice, 1 minute and 5 minutes after birth.
(ANS: C Apgar scoring is performed at 1 minute and 5 minutes after birth. Scoring may continue at 5-minute intervals if the infant is in distress and requires resuscitation efforts.
61
How will baby develop vit k for blood coagulation?
We have to give an injection at birth (to prevent brain bleed) because their gut has not manufactured it, when baby starts to eat and by day 8 it will develop vit k
62
How long does it take for physiological jaundice to manifest?
usually happens in 2 days, if it happens right away after birth then baby is sick and its pathological jaundice.
63
If the moms H&H is high during pregnancy due to fetal circulation, how will this affect baby at birth?
Byproduct of RBC breakdown is bilirubin, if bilirubin is high because liver cannot dissolve it then baby will be jaundice because it will be stored in skin. This is physiological jaundice. TX= sun light helps break down bilirubin to water soluble, so kidneys and liver can get rid of it through urine and stool.
64
What indicates incomplete closure of shunts?
You'll hear a murmur on auscultation
65
Where is it normal for baby to have bluish color at birth?
ONLY arms and legs, center must be pink
66
What can cause bradycardia in babies?
Heart block, asphyxia, Increased ICP (vagal response)
67
What can cause tachycardia in a baby?
```
respiratory problem (low-surfactant)
sepsis
baby too hot or cold
TTN
pneumonia
```
68
what part of the babies cause the most heat loss?
the baby's head is 20% of their body, heat is lost through their head
69
what happens when baby burns too much brown fat?
when baby is cold they burn more brown fat leading to ketoacidosis
(keep warm, dry, and stimulate)
70
What does surfactant do?
Surfactant is a protein, it allows lung expansion in alveoli, if baby is cold it reduces surfactant in lungs and impedes lung expansion.
71
what are the 4 ways babies lose heat?
Evaporation
Radiation
Conduction
Convection
72
How do babies keep themselves warm?
Maintenance of temp is accomplished by brown fat metabolism. (When baby cries, kicks and screams it uses up baby's glucose and increases O2 need) Brown fat helps preserve that to keep baby out of hypoglycemic state.
73
After the C-section what is important to do for a baby?
Suction, dry, warm, and stimulate.
74
what is the contraindication for vacuum assist?
a premature baby. can use forceps if needed to get head under symphysis
75
For a new born premature baby it is important to keep the umbilical cord longer, what is the reasoning for this?
the umbillical vein is used for IV medication and fluids when baby is really sick.
