Question 1

Julia gave birth to a baby girl who is 2,930 grams in weight. The baby was admitted at the NICU due to a low APGAR score because her mother had a prolonged second stage of labor. As a result, the neonate had asphyxia. Which of the following would a nurse expect to find in a newborn with asphyxia?

Accepted Answer

A nurse would expect to find acidosis in a newborn with asphyxia. Asphyxia leads to acidosis, hypoxia, hypoxemia, and tissue anoxia. This results in hypercapnia (not hypocapnia) due to the increase in carbonic acid concentration in the fetal circulation because the carbon dioxide fails to get eliminated from the infant's lungs due to inadequate respiration. Ketosis is seen in diabetic ketoacidosis.

Question 2

Sixteen hours after birth, the nurse noticed that the neonate is jittery, hyperactive, sneezes frequently, produces a high-pitched cry, and is having difficulty sucking. Evaluation reveals that the neonate has increased deep tendon reflexes and a decreased Moro reflex. The nurse should suspect a case of:

Accepted Answer

The nurse should suspect a case of opiod drug withdrawal. The signs are indicative of opiod drug withdrawal in which typical changes occur in the central nervous system; it is a must to observe the neonate during the first 24-48 hours of life.

Question 3

Baby Boy Mcintosh was immediately transferred from the birthing center to the neonatal intensive care unit because of myelomeningocele. The nurse assigned at the unit should immediately:

Accepted Answer

The nurse at the unit should immediately apply a sterile saline dressing. This nursing intervention will help in the prevention of infection while keeping the membrane moist.

Question 4

During the assessment, the nurse noticed that one of the admitted neonates, who is small-for-gestational-age, is jittery, has a high-pitched cry, and has irregular respirations. The nurse must be aware that these signs could be an indication of:

Accepted Answer

The nurse must be aware that the signs presented are indicative of hypoglycemia. Neonates who are small-for-gestational-age may exhibit hypoglycemia (especially during the first 2 hours of life) due to depletion in glycogen storage, as well as inhibited gluconeogenesis.

Question 5

Nurse Dolores is caring for a fifteen-day-old neonate who has a necrotizing enterocolitis (NEC). What nursing care plan should be included for the neonate?

Accepted Answer

A nursing care plan should include measuring of the abdominal girth every two hours. Neonates who have NEC have prolonged gastric emptying; therefore, any increase in abdominal girth (>1 cm in 4 hours) is significant and it needs immediate intervention.

Question 6

A neonate was admitted at the hospital due to hydrocephalus. After the insertion of a shunt to treat the disease, the nurse should evaluate the function of the shunt by:

Accepted Answer

After the insertion of a shunt to treat the disease, the nurse should evaluate the function of the shunt by palpation of the anterior fontanel. A bulging fontanel will be an indication of increased intracranial pressure. Other options are not significant indicators of increased intracranial pressure.

Question 7

A one-week-old infant was admitted at the neonatal intensive care unit after surgery to treat esophageal atresia. What would be an immediate postoperative nursing priority for this patient?

Accepted Answer

An immediate postoperative nursing priority for this patient is checking for the patency of nasogastric tube. Postoperatively, the nasogastric tube is useful in decompression of the stomach and limits tension at the suture line.

Question 8

A nurse is caring for a pregnant patient and is assessing the fetal heart rate. The nurse notes that the fetal heart rate is abnormal for the third time; this is made known to the physician to order a fetal scalp pH sample. The nurse is aware that the fetus may be compromised if the fetal pH is:

Accepted Answer

The nurse is aware that the fetus may be compromised if the fetal pH is 7.17. This value is indicative of fetal hypoxia; any reading that is less than 7.20 is dangerous and requires an emergency birth. Any reading higher than 7.2 is not life-threatening.

Question 9

The nurse is caring for several infants who are forty-eight hours old. Among the following infants, which should be given highest priority by the nurse?

Accepted Answer

The infant that should be given highest priority by the nurse is a bottle-fed infant who takes 1-ounce of milk every three to five hours. The patient exhibits poor feeding (1 ounce = 30 ml), which indicates specific problems. The infant normally loses weight during the first week of life and he/she usually gains weight in the second week.

Question 10

When caring for a neonate in acute respiratory distress from laryngotracheobronchitis who has a body temperature of 38.7 ºC, the nurse should give priority to:

Accepted Answer

When caring for a neonate in acute respiratory distress from laryngotracheobronchitis who has a body temperature of 38.7 ºC, the nurse should give priority to monitor the neonate's respiratory status continuously. In this case, patency of the airway is determined by continuous monitoring for signs of respiratory distress as laryngeal spasms can occur abruptly.

Question 11

The nurse is checking for cervical dilation of a patient who is in labor, when the nurse observes that the umbilical cord has prolapsed. The nurse's initial action would be to:

Accepted Answer

The nurse's initial action would be to place the patient in Trendelenburg's position. Placing the patient in this position will prevent further prolapse and relieves pressure on the cord.

Question 12

A clinical nurse specialist is monitoring the blood glucose level of a neonate who was born to a diabetic mother. The nurse determined that the blood glucose level is 50 mg/dL. What would be the action of the nurse?

Accepted Answer

The action of the nurse should be to monitor the neonate continuously for the next twenty-four hours. The blood glucose level is within the normal range for neonates, so it doesn't require any measure aside from continuously monitoring the patient for the next twenty-four hours.

Question 13

A nurse is caring for a patient who is receiving magnesium sulfate therapy intravenously for preeclampsia. The patient gives birth to a baby weighing 4.2 pounds in the 36?? week of gestation. The nurse is aware that a finding in the newborn that may indicate magnesium sulfate toxicity is:

Accepted Answer

The nurse is aware that a finding in the newborn that may indicate magnesium sulfate toxicity is hypotonia. Hypotonia occurs with magnesium sulfate toxicity because of skeletal and smooth muscle relaxation.

Question 14

A clinical nurse specialist is caring for a neonate who develops hyperbilirubinemia. The physician ordered phototherapy BID. During the therapy, the nurse should include which plan of care:

Accepted Answer

During the therapy, the nurse should include a plan of care to give fluids at least every two hours. During phototherapy, there is an increase in insensible and interstitial fluid losses, therefore extra fluids are needed to prevent dehydration.

Question 15

Prior to discharge from the newborn nursery at forty-eight hours old, the nurse knows that murmurs are frequently assessed and are most often due to which factor?

Accepted Answer

The nurse knows that murmurs are frequently assessed and are most often due to transition from fetal to pulmonic circulation. As the transition occurs, the murmurs may become loud and then resolve.

Question 16

A clinical nurse specialist is planning a nursing care for a pregnant patient who is admitted with a diagnosis of abruption placenta. The nurse should include a careful observation for signs and symptoms of:

Accepted Answer

The nurse should include a careful observation for signs and symptoms of hypovolemic shock. In this case, uterine bleeding can lead to a massive internal hemorrhage that can cause hypovolemic shock.

Question 17

A neonate with cardiac disease has been admitted to the nursery from the delivery room. Which finding helps the nurse to differentiate between a cyanotic and an acyanotic defect?

Accepted Answer

A finding that helps the nurse to differentiate between a cyanotic and an acyanotic defect is that the pulse oximeter does not read above 93%. Cyanotic heart diseases are unlikely to produce a reading above 93%.

Question 18

A child ingested twenty maximum strength acetaminophen tablets thirty minutes ago and is seen at the emergency department. The ER nurse calls one of the staff nurses at the NICU to identify which physician's order should be done first. The NICU nurse should state that it must be:

Accepted Answer

The ER nurse calls one of the staff nurses at the NICU to identify which physician's order should be done first. The NICU nurse should state that it must be gastric lavage PRN. The nurse must remove the drug as much as possible through a gastric lavage. The next would be the activated charcoal and lastly, the IV fluids.

Question 19

A newborn was admitted to the neonatal intensive care unit. His diagnosis is febrile seizures. In preparing for his admission, which of the following is the most important nursing action?

Accepted Answer

In preparing for his admission, the most important nursing action is to pad the side rails of his bed. The patient has a diagnosis of febrile seizures. Precautions to prevent injury and
promote safety should take precedence.

Question 20

A nurse is caring for a neonate with a suspected diagnosis of rheumatic fever. The nurse reviews the laboratory results, knowing that which laboratory study would assist in confirming the diagnosis?

Accepted Answer

The nurse reviews the laboratory results, knowing that a laboratory study that would assist in confirming the diagnosis is antistreptolysin O titer. A diagnosis of rheumatic fever is confirmed by the presence of two major manifestations or one major and two minor manifestations from the Jones criteria. In addition, evidence of a recent streptococcal infection is confirmed by a positive antistreptolysin O titer, streptozyme assay, or an anti-DNase B assay.

Quiz 2: Neonatal