MATERNAL CHILD EXAMS SETS ANSWERS AND
QUESTIONS SET A+
✔✔While assessing the newborn's 5 minute APGAR score the nurse notes the infant's
hands and feet to be blue heart rate at 154 beats per minute crying vigorously and
actively moving arms and legs. What score would she assign to this infant? - ✔✔9
✔✔A nurse is caring for a client who has just delivered her first newborn. The infant has
been diagnosed with hyperbilirubeninemia. While providing education to the client on
this condition, the nurse should include which of the following as potential causes of this
condition? (select all that apply) - ✔✔allergy to breast milk
biliary atresia
✔✔While inspecting a newborn's head, the nurse identifies a swelling of the scalp on
the right posterior side of the head that does not cross the suture line. Which term
describes this finding? - ✔✔cephalohematoma
✔✔Which of the following actions should the nurse take to prepare the preschool aged
child for a physical examination? - ✔✔allow the child to role play
✔✔A postpartum woman (gravida 1, para 1) asks the nurse immediately after delivery if
she should request rooming-in with her infant. Which of the following response by the
nurse would be correct? - ✔✔"rooming-in allows increased maternal-newborn contact"
✔✔After delivery, a client is diagnosed with postpartum preeclampsia. What care will
the nurse provide to this client? (select all that apply) - ✔✔monitor urine output and daily
weights
instruct on the need for a fluid bolus
administer magnesium sulfate as prescribed
administer antihypertensive medication as prescribed
✔✔The nurse is assessing a term newborn. Which finding should the nurse expect
when assessing the patterns of sole creases? - ✔✔creases on two thirds of the foot
, ✔✔In caring for the postpartum client, the nurse will include assessment and
observation for signs of postpartum hemorrhage. Which of the following would increase
the risk for postpartum hemorrhage? (select all that apply) - ✔✔macrosomic infant
dysfunctional or prolonged labor
multiparity
history of iron deficiency anemia
✔✔During a home visit, the nurse determines that a toddler has a difficult temperament.
What did the nurse observe in this toddler? (select all that apply) - ✔✔withdrawing
intense mood
minimal adaptability
✔✔Which technique is used to palpate the fundal height on a postpartum client? -
✔✔placing one hand at the base of the uterus, one on the fundus
✔✔The nurse in the pediatric clinic is recording anthropometric data in the 12 month old
childs chart. The father asks, "Is my son growing the way that he should?" Which of the
following nurse's response is based on the knowledge of expected growth of a 12 month
old? - ✔✔the child's weight will be equal to birth weight x 3 at 12 months (triple)
✔✔A nurse is assessing a newborn that was admitted to the newborn nursery 28 hours
ago. Mother's history includes addiction to recreational drugs. Which finding would the
nurse expect to note during the assessment of this newborn? - ✔✔incessant crying
✔✔A preterm infant is placed in a radiant heat warmer immediately after birth. Which of
the following nursing diagnosis is this intervention addressing? - ✔✔ineffective
thermoregulation related to immaturity
✔✔A newborn is jaundiced and receiving phototherapy via ultraviolet bank lights. Which
of the following is an appropriate intervention when caring for an infant with
hyperbilirubinemia and receiving phototherapy? - ✔✔place eye shields over the
newborn's closed eyes
✔✔At birth the infant has dry, cracked skin, absence of vernix, lack of subcutaneous fat,
fingernail extending beyond the fingertips, and poor skin turgor. Based on these
findings, how would the nurse classify this neonate? - ✔✔post term
✔✔The nurse is teaching new parents how to calculate the amount of formula to feed
their newborn each day. The baby weighs 8 lbs. How much formula should the nurse
teach the patient to provide each day? - ✔✔42 to 54 oz
QUESTIONS SET A+
✔✔While assessing the newborn's 5 minute APGAR score the nurse notes the infant's
hands and feet to be blue heart rate at 154 beats per minute crying vigorously and
actively moving arms and legs. What score would she assign to this infant? - ✔✔9
✔✔A nurse is caring for a client who has just delivered her first newborn. The infant has
been diagnosed with hyperbilirubeninemia. While providing education to the client on
this condition, the nurse should include which of the following as potential causes of this
condition? (select all that apply) - ✔✔allergy to breast milk
biliary atresia
✔✔While inspecting a newborn's head, the nurse identifies a swelling of the scalp on
the right posterior side of the head that does not cross the suture line. Which term
describes this finding? - ✔✔cephalohematoma
✔✔Which of the following actions should the nurse take to prepare the preschool aged
child for a physical examination? - ✔✔allow the child to role play
✔✔A postpartum woman (gravida 1, para 1) asks the nurse immediately after delivery if
she should request rooming-in with her infant. Which of the following response by the
nurse would be correct? - ✔✔"rooming-in allows increased maternal-newborn contact"
✔✔After delivery, a client is diagnosed with postpartum preeclampsia. What care will
the nurse provide to this client? (select all that apply) - ✔✔monitor urine output and daily
weights
instruct on the need for a fluid bolus
administer magnesium sulfate as prescribed
administer antihypertensive medication as prescribed
✔✔The nurse is assessing a term newborn. Which finding should the nurse expect
when assessing the patterns of sole creases? - ✔✔creases on two thirds of the foot
, ✔✔In caring for the postpartum client, the nurse will include assessment and
observation for signs of postpartum hemorrhage. Which of the following would increase
the risk for postpartum hemorrhage? (select all that apply) - ✔✔macrosomic infant
dysfunctional or prolonged labor
multiparity
history of iron deficiency anemia
✔✔During a home visit, the nurse determines that a toddler has a difficult temperament.
What did the nurse observe in this toddler? (select all that apply) - ✔✔withdrawing
intense mood
minimal adaptability
✔✔Which technique is used to palpate the fundal height on a postpartum client? -
✔✔placing one hand at the base of the uterus, one on the fundus
✔✔The nurse in the pediatric clinic is recording anthropometric data in the 12 month old
childs chart. The father asks, "Is my son growing the way that he should?" Which of the
following nurse's response is based on the knowledge of expected growth of a 12 month
old? - ✔✔the child's weight will be equal to birth weight x 3 at 12 months (triple)
✔✔A nurse is assessing a newborn that was admitted to the newborn nursery 28 hours
ago. Mother's history includes addiction to recreational drugs. Which finding would the
nurse expect to note during the assessment of this newborn? - ✔✔incessant crying
✔✔A preterm infant is placed in a radiant heat warmer immediately after birth. Which of
the following nursing diagnosis is this intervention addressing? - ✔✔ineffective
thermoregulation related to immaturity
✔✔A newborn is jaundiced and receiving phototherapy via ultraviolet bank lights. Which
of the following is an appropriate intervention when caring for an infant with
hyperbilirubinemia and receiving phototherapy? - ✔✔place eye shields over the
newborn's closed eyes
✔✔At birth the infant has dry, cracked skin, absence of vernix, lack of subcutaneous fat,
fingernail extending beyond the fingertips, and poor skin turgor. Based on these
findings, how would the nurse classify this neonate? - ✔✔post term
✔✔The nurse is teaching new parents how to calculate the amount of formula to feed
their newborn each day. The baby weighs 8 lbs. How much formula should the nurse
teach the patient to provide each day? - ✔✔42 to 54 oz
