RNC Low Risk Neonatal Nursing Exam 328 Questions with Verified Answers,100% CORRECT

RNC Low Risk Neonatal Nursing Exam 328 Questions with Verified Answers Normal skin assessment - CORRECT ANSWER Acrocyanosis with decreased peripheral pulses, facial bruising and/or petechiae Normal head assessment - CORRECT ANSWER Large in relation to body size, cranial molding, caput succedaneum Normal newborn lung assessment - CORRECT ANSWER RR 40-60/min, coarse rales, prolonged expiration phase Normal newborn heart assessment - CORRECT ANSWER HR 120-160, may peak up to 180 bpm when stimulated, loud S2, split S2, soft systolic murmur (L —> R shunt from PDA) Normal newborn GI tract assessment - CORRECT ANSWER Bowel sounds will likely appear within 15 minutes of birth, meconium passage within 24 hrs of birth Normal newborn kidneys - CORRECT ANSWER Urine passage within 24 hrs of birth Normal newborn limb assessment - CORRECT ANSWER Positional oddities from intrauterine positioning (e.g., legs up in frank breech position) Newborn S/S of Hypoglycemia - CORRECT ANSWER Apnea, Pallor, Jittery, Irritability, Weak high-pitched cry, Hypothermia, Labile temps, Lethargy, Poor feeding, Vomiting, Cyanosis, Seizures Causes of Hypoglycemia - CORRECT ANSWER (Other than delayed feeding): IUGR or prematurity, Inborn errors of metabolism or glycogen storage disease, Hypothermia or polycythemia, Adrenal hemorrhage, CHF, Hyperinsulinism HELLP Syndrome - CORRECT ANSWER May be associated with PIH; symptoms: hemolysis, elevated liver enzymes, low platelet count; the client is at risk for hemorrhage, pulmonary edema, and hepatic rupture Gestational Hypertension - CORRECT ANSWER Transient elevation of blood pressure occurring for the first time after mid-pregnancy without proteinuria or other signs of preeclampsia (postpartum period: ends by 12 weeks: Gest HTN. beyond 12 weeks: Chronic HTN). GBS (group B strep) - CORRECT ANSWER Group B streptococcus (GBS) is a type of bacterial infection that can be found in a pregnant woman's vagina or rectum. This bacteria is normally found in the vagina and/or rectum of about 25% of all healthy, adult women. Women who test positive for GBS are said to be colonized The 30-week-gestation fetus of a primagravid mother has been diagnosed in utero with an omphalocele. Which of the following procedures should the nurse anticipate? - CORRECT ANSWER Karyotyping via amniocentesis; Omphalocele and gastroschisis are both commonly associated with accompanying defects or chromosomal abnormalities. An amniocentesis will likely be performed and karyotyping done to identify any chromosomal abnormalities. A 38-week-gestation newborn is vigorous at birth. The infant is dried, wrapped in warm blankets and placed on the mother's chest. At 6 minutes of life, the infant still appears cyanotic. According to recommended practice guidelines, which of the following should the nurse perform FIRST? - CORRECT ANSWER Check the infant's pulse oximeter reading Feedback Recommended practice guidelines for neonatal resuscitation utilize pulse oximeter readings to determine if an infant is within acceptable saturation range for minutes of life. Use of 100% oxygen is discouraged. A 39-week-gestation newborn male weighing 3.3 kg (7.3 lbs.) is admitted to the newborn nursery following a cesarean section. How many kilocalories (kcal) should this infant consume to meet the average daily requirement? - CORRECT ANSWER 330 kcal/day Feedback Term newborns require approximately 100 kcal/kg/day. Premature infants require approximately 120-150 kcal/kg/day. A nurse is developing a teaching plan for the family of an infant being discharged home with a gastrostomy tube (G-tube). Which of the following steps should be taken FIRST? - CORRECT ANSWER Assess the family's current knowledge base Feedback Assessment is the first step in the nursing process. In order to facilitate learning, the learner's knowledge and skills should be assessed before a teaching plan is formed. A client has arrived at the labor and delivery unit in active labor. The nursing assessment reveals a history of genital herpes with active lesions in the genital tract at present. The nurse plans to: - CORRECT ANSWER Prepare the client for a cesarean delivery Feedback A cesarean delivery can reduce the risk of neonatal infection with a mother in labor who has herpetic genital tract lesions. Standard precautions should be maintained. A 3-day-old, former 35-week-gestation female infant born to a mother with a history of methadone use is beginning to show signs of neonatal abstinence syndrome (NAS). Nursing support measures for this infant should include all of the following EXCEPT: - CORRECT ANSWER Encouraging bottle feeding Feedback Breastfeeding is encouraged for bonding, and may also help alleviate some of the infant's symptoms of methadone withdrawal. Bottle feeding should only be encouraged if the infant is not demonstrating adequate weight gain with breastfeeding alone, or if the infant is showing other adverse reactions to breastfeeding. Breastfeeding should not be encouraged when the mother has a history of illicit drug use. A term infant is diagnosed with intrauterine growth restriction. Which of the following would be a primary factor in determining if this infant's growth restriction is symmetrical or asymmetrical? - CORRECT ANSWER Head circumference Feedback Symmetrical growth restriction results in head circumference proportional to infant body size and usually represents fetal etiology that spans all trimesters. Asymmetrical growth restriction is generally head-sparing and infants will have larger head circumference to body size ratios. Asymmetrical growth restriction usually represents maternal etiologies that affect third trimester growth and development. An obstetric practitioner orders an indirect Coombs test to determine the possibility of maternal-fetal blood interaction. The nurse should: - CORRECT ANSWER Draw the mother's blood Feedback An indirect Coombs test performed for obstetric purposes evaluates a mother's blood (usually Rh negative) for free-flowing antibodies against foreign red blood cells (usually those with positive Rh factor). A direct Coombs test is performed on the infant's blood. A nurse is performing an assessment on a 43-week-gestation male infant. Which physical characteristic should the nurse expect to observe? - CORRECT ANSWER Desquamation Feedback The post-term infant (born after the 42nd week of gestation) exhibits dry, peeling, cracked, almost leather-like skin over the body, which is called desquamation. A 39-week gestation newborn, weighing 4.8 kg (10.6 lbs.) with Apgar scores of 8 at 1 minute and 9 at 5 minutes following cesarean delivery, is exhibiting tremors of the hands and feet and an increased respiratory rate. This infant is likely demonstrating: - CORRECT ANSWER Symptoms of hypoglycemia Feedback Large infants require higher caloric intake to maintain their glycogen stores. Symptoms of hypoglycemia can include limb tremors and tachypnea. Based on maternal history and current presentation, a 6-day-old term infant is suspected of having herpes simplex meningitis. Which of the following sets of findings is likely to appear in this patient's cerebrospinal fluid (CSF)? - CORRECT ANSWER Elevated RBCs, normal glucose, elevated protein Feedback Anticipated CSF findings for acute viral encephalitis include elevated WBCs and RBCs, elevated protein, and normal or decreased glucose levels. Viral cultures are rarely positive and should not be relied upon for diagnosis. Which of the following neonatal factors is correlated with a higher risk of disorganized infant behavioral states, developmental delays, and difficulties in mother-infant relationships? - CORRECT ANSWER Lower-than-normal weight for gestational age Feedback Small-for-gestational-age (SGA) infants are at higher risk for behavioral, developmental, and relationship delays than infants at normal weights for their gestational age. Extremely low birth weight (ELBW) infants are at even higher risk. An infant is being placed prone on a radiant warmer. The most appropriate location on the infant for the servocontrol thermistor is on the: - CORRECT ANSWER Left or right flank area Feedback A prone infant should have the radiant warmer thermistor positioned over either flank area. The thermistor should not be positioned over bony areas or under the axilla. A nurse is educating a set of parents on the importance of standard interventions performed during and shortly after delivery of the newborn. Which of the following complications is prevented by routine vitamin K administration to the newborn shortly after delivery? - CORRECT ANSWER A nurse is educating a set of parents on the importance of standard interventions performed during and shortly after delivery of the newborn. Which of the following complications is prevented by routine vitamin K administration to the newborn shortly after delivery? A 2-day-old, former 37-week-gestation infant is diagnosed with congenital pneumonia. When administering the prescribed antibiotic therapy, the nurse knows that this condition is: - CORRECT ANSWER Most likely caused by Staphylococcus epidermidis Feedback Most cases of bacterial neonatal/congenital pneumonia are caused by Staphylococcus epidermidis, Group B Streptococcus, E. coli, and Ureaplasma urealyticum. Congenital pneumonia may also be caused by viruses, the most common of which are herpes simplex (HSV) and human immunodeficiency virus (HIV). A term infant has just been admitted to the NICU after experiencing asphyxia during delivery. The nurse expects the laboratory results for this infant are most likely to show: - CORRECT ANSWER Acidosis, hypobicarbonatemia, and hypoglycemia Feedback Asphyxia causes acidosis, low bicarbonate levels (from being used to buffer acidosis), and hypoglycemia. A nurse is assessing a 38-week-gestation infant at 2 hours of life. Which of the following cardiac assessment details should be reported to the practitioner? - CORRECT ANSWER Cool lower limbs with diminished pulses Feedback Cool, mottled lower extremities with diminished pulses could indicate a coarctation of the aorta or other circulatory obstruction, and should be reported to the practitioner immediately. A term infant is being evaluated for tachypnea following delivery. The nurse caring for the infant educates the parents by stating that the symptoms associated with TTN are best explained by: - CORRECT ANSWER Delayed absorption of residual amniotic fluid from the lungs Feedback In most cases, infants experience transient tachypnea following birth because the amniotic fluid in the lungs has not been fully reabsorbed yet. TTN that continues more than 6 hours past birth may require further investigation into other causes. While bathing a newborn Caucasian infant, the nurse notes several light-brown colored spots over the trunk and back, and three spots on the lower extremities. These spots are varied in size and shape and are not raised. The nurse should document the presence of: - CORRECT ANSWER Café au lait spots Feedback Multiple, flat irregular light brown skin discolorations on an infant may be termed café au lait spots. These spots have been correlated to neurofibromatosis, a genetic, inheritable condition that affects skeletal and neurological development as well as cell proliferation. Café au lait spots may also be associated with another similar, but less severe genetic mutation known as Leguis syndrome. A 36-week pregnant woman was involved in a head-on automobile collision and is determined to need an emergency cesarean section for fetal distress. The infant exhibits hypotension, decreased respiratory effort, and pallor. The nurse suspects: - CORRECT ANSWER Hypovolemic shock Feedback Trauma to the uterus may trigger a placental abruption. Blood loss from the abruption leads to fetal hypovolemic shock, which manifests as delayed capillary refill, tachycardia (early sign), abnormal respiratory effort, hypotension, and pallor. Hypovolemic shock Feedback Trauma to the uterus may trigger a placental abruption. Blood loss from the abruption leads to fetal hypovolemic shock, which manifests as delayed capillary refill, tachycardia (early sign), abnormal respiratory effort, hypotension, and pallor. - CORRECT ANSWER "I can use water to gently remove any yellow crusting that may form." Feedback Yellow crusting is part of the healing process, and should not be disturbed, as that may increase risk of bleeding. A term infant is admitted to the NICU for evaluation of tachypnea. During the course of stay, the nurse suspects that the infant may have a gastrointestinal obstruction. Which of the following signs is most likely to have led to this conclusion? - CORRECT ANSWER Bilious emesis Feedback Greenish-yellow or spinach-colored emesis that is not associated with eating is a classic sign of a bowel obstruction in infants and young children. Many obstructions will also cause abdominal distension. A term infant is diagnosed with an umbilical hernia. The primary nursing intervention for this defect is to: - CORRECT ANSWER Monitor for complications such as local inflammation, bowel obstruction, or diffuse abdominal swelling Feedback Umbilical hernias are rarely associated with serious complications, but large defects do carry a risk of bowel obstruction or strangulation . Most smaller hernias close on their own, and larger ones may be surgically closed after 3 years of age. During the labor of a mother estimated to be 38-weeks pregnant, which of the following fetal heart rate patterns would be most significant for fetal distress? - CORRECT ANSWER Nonremedial late decelerations to 60-80 bpm Feedback Late decelerations with significant bradycardia that are nonremedial (do not correct with position changes and other interventions) indicate utero-placental insufficiency and significant fetal distress. A nurse is performing an initial assessment on a term newborn. Which of the following findings is most often associated with spina bifida occulta? - CORRECT ANSWER Lower lumbar dimple surrounded by dark hair Feedback Spina bifida occulta is a mild neural tube defect characterized by a gap in the spine, but without any spinal opening or sac protrusion. In some cases, a dimple or patch of hair (or both) on the back of an infant is the only indication of this neural tube defect. A clinical nurse educator for a labor and delivery unit is reviewing her notes on congenital heart defects. When teaching about medical closure of a PDA, which of the following medications should be included? - CORRECT ANSWER Indomethacin (Indocin) Feedback Indomethacin is a nonsteroidal anti-inflammatory drug (NSAID) used to close PDAs when other medical treatment for PDA fails after 48 hours. Indomethacin is also known as a COX inhibitor, a group of medications that reduce the action of prostaglandins on the vascular system. Which of the following blood type arrangements is at highest risk for an ABO incompatibility that leads to hemolysis in a neonate? - CORRECT ANSWER Mother type O, infant type A Feedback Hemolytic disease related to ABO incompatibility is most likely with a mother who with type O blood who delivers an infant with type A or B blood. A 30-year veteran neonatal nurse is a member of the ethics committee that meets monthly at the local hospital facility. In reviewing recent court documents, which of the following medicolegal terms most closely sums up the phrase, "First, do no harm"? - CORRECT ANSWER Nonmaleficence Feedback Nonmaleficence indicates, in general, that the actions and treatments provided by medical personnel were meant to provide benefit, not harm, to the recipient(s). A 38-week-gestation infant weighing 4.5 kg (9.9 lbs) is born to a mother with history of gestational diabetes. Approximately two hours after birth, the infant exhibits tremors and seizure-like movements of the upper and lower extremities. The nurse should FIRST: - CORRECT ANSWER Obtain a heelstick glucose level Feedback Signs of infant hypoglycemia include extremity tremors, irritability or lethargy, respiratory distress, poor feeding, and hypothermia. The nurse should first obtain a heelstick glucose, and report the level and patient presentation to the practitioner. Depending on how low the level, breastfeeding or formula may be sufficient to correct the level. A 34-week-gestation male patient is diagnosed with respiratory distress syndrome (RDS) related to prematurity. Which of the following arterial blood gas readings most closely correlates with this patient's condition? - CORRECT ANSWER pH 7. 22, pCO2 70 , pO2 52, HCO3 28 Feedback An infant in acute respiratory distress would be expected to be in uncompensated respiratory acidosis, best represented by low pH, low oxygen, elevated carbon dioxide, and normal bicarbonate levels on an arterial blood gas. Parents of an infant going home with an apnea monitor are requesting more information. Which of the following statements about home apnea monitoring is FALSE? - CORRECT ANSWER Infants with home apnea monitors generally require monitoring for an average of 6 months following hospital discharge Feedback Infant requirement for home apnea monitoring depends on how many true alarms are noted. Generally, monitoring is discontinued 2 to 3 months after discharge, since infant growth corrects most cases of apnea. A nurse is providing teaching to parents of a newborn regarding importance of state-mandated newborn screening tests. Which of the following statements by the nurse would be accurate regarding the PKU screening? - CORRECT ANSWER "A positive test may indicate an inability to process an essential amino acid." Feedback A positive PKU test may indicate an inability to process the essential amino acid phenylalanine. Retesting is usually performed to confirm the diagnosis. A low protein diet is essential to prevent adverse developmental effects from consumption of phenylalanine, but limited breastfeeding is usually allowed for infants. Artificial sweeteners like aspartame should be strictly avoided. One of the primary reasons to use soy formula to feed an infant instead of breast milk or cow milk formula is because of: - CORRECT ANSWER An infant sensitivity to the carbohydrates found in milk Feedback Some infants may have a sensitivity to lactose (or galactose as part of lactose), one of the primary sources of carbohydrates found in breast milk and cow milk. Soy formulas utilize corn syrup, corn syrup solids, or sugars other than lactose to provide the required balance of carbohydrates. Some soy formulas may contain galactose, so labels should be investigated carefully for any infants diagnosed with galactosemia. A nurse performs a head-to-toe assessment on a term newborn. The primary practitioner for the infant should be notified for which of the following findings? - CORRECT ANSWER Bilateral single palmar creases Feedback Single palmar creases may indicate chromosomal abnormalities. This finding is most commonly associated with trisomy 21 (Down's syndrome), but is also associated with trisomy 13 (Patau syndrome). A neonate has received 8 hours of phototherapy for hyperbilirubinemia. The nurse should notify the practitioner if which of the following is noted? - CORRECT ANSWER Absent Moro reflex Feedback An absent Moro (startle) reflex can indicate kernicterus, also known as bilirubin encephalopathy, a rare but life-threatening condition. A practitioner orders an amniocentesis for a patient in preterm labor at 35 weeks gestation. Which of the following findings from the amniocentesis indicates fetal lung maturity? - CORRECT ANSWER Lecithin-sphingomyelin (L/S) ratio of 2:1 Feedback Lecithin and sphingomyelin are two components of lung surfactant. A ratio of lecithin to sphingomyelin of 2:1 or higher in the amniotic fluid indicates fetal lung maturity by indicating an adequate production of lung surfactant. According to current NRP recommendations, naloxone (Narcan) should be administered: - CORRECT ANSWER Narcan is no longer recommended during initial delivery room resuscitation Feedback Narcan is no longer recommended during initial resuscitation efforts in the delivery room. The latest guidelines encourage a focus on effective ventilation. A nurse is caring for several infants. Which of the following infants is likely to have the highest amount of insensible water loss? - CORRECT ANSWER A 34-week-gestation infant under an infant warmer with respirations 60 bpm Feedback Insensible water loss in infants occurs primarily through skin evaporation and through respiration. Premature infants have higher losses than term infants. Intubated infants receive humidified air through the ventilator, so they lose less water through respiration than infants who are not intubated. A multigravida mother with history of oligohydramnios during pregnancy delivers a 39-week-old male infant. The infant manifests significant respiratory distress. Which of the following diagnoses is the MOST LIKELY cause of this infant's presentation? - CORRECT ANSWER Pulmonary hypoplasia Feedback Oligohydramnios can result in pulmonary hypoplasia, along with several other GI, renal, and growth complications. All of the following are maternal contraindications to breastfeeding an infant EXCEPT: - CORRECT ANSWER Bilateral silicone breast implants Feedback According to the CDC, insufficient evidence is available to qualify maternal silicone breast implants as a contraindication for breastfeeding. A nurse is educating a new mother on ways to prevent breast engorgement and reduce risk of a plugged milk duct or mastitis. Which of the following recommendations should the nurse include in the educational plan for this mother? - CORRECT ANSWER Feed the infant or express milk at least 8 times in each 24 hour period Feedback One of the keys to preventing breast engorgement is to feed an infant for at least 15 minutes from both breasts at least 8 times in each 24 hour period. If breastfeeding the infant directly is not feasible, the mother should express breast milk from both breasts on a similar schedule. A nurse is caring for a preterm infant diagnosed with a hydrocele. The nurse knows that this condition places the infant at higher risk for which of the following conditions? - CORRECT ANSWER Inguinal hernia Feedback A hydrocele is a collection of peritoneal fluid in the testicle area due to a patent processus vaginalis. If the defect is large enough, abdominal organs could protrude into the space, forming an inguinal hernia. A 3.1 kg (6.8 lbs) neonate was delivered vaginally at 38 weeks gestation. At one minute of life, the neonate has a heart rate (HR) of 115, respiratory rate (RR) of 65 with intermittent grunting, flaccid tone, no response to stimulus, and acrocyanosis. The infant's one minute Apgar score should be: - CORRECT ANSWER 5 Feedback A perfect Apgar score is 10, with 2 points for each of 5 categories (HR, respirations, muscle tone, response to stimulus, and color). This infant gets 2 points for a HR over 100, 2 points for respirations, 0 points each for muscle tone, stimulus response, and 1 point for color. Therefore, the total Apgar would be 5. A nurse is caring for a preterm infant who has no history of complications related to prematurity. Which of the following tools would increase the comfort level of this infant? - CORRECT ANSWER A developmentally appropriate pacifier Feedback Sucking is a reflexive soothing technique for infants of all gestational ages. Providing sucking opportunities with developmentally appropriate pacifiers is an approved comfort measure that should be included in an infant's plan of care. Results of fetal testing indicate that a 33-week-gestation fetus has experienced intrauterine growth restriction. When creating a plan of care for the mother and her child, which of the following is the MOST important factor for post-delivery survival of the infant? - CORRECT ANSWER Gestational age at birth Feedback Gestational age at birth is the best indicator of survival for an IUGR infant. Several studies have also shown decreased morbidity/mortality rates with the administration of steroids to premature infants prior to delivery; however, interventions should primarily focus on extending intrauterine time as long as umbilical and placental sufficiencies are maintained. A 29-week-gestation infant weighs 1340 gm (3 lbs.) and has a respiratory rate of 60 immediately after delivery. This infant is most likely to lose body heat by: - CORRECT ANSWER Convection and evaporation Feedback Radiation, conduction, convection, and evaporation are the four basic heat transfer mechanisms. Preterm, low birth weight infants lose heat primarily by convection (cooler air) and evaporation (water loss) immediately following delivery. Measures should be taken to reduce all mechanisms of heat loss. Place a hat on the infant's head (radiation), preheat the radiant warmer and all linens (radiation/conduction), wrap ELBW infants in plastic or dry the infant and swaddle as soon as possible (evaporation/convection), and warm the delivery room (convection). A nurse assesses a term infant who appears to be in respiratory distress. Which of the following findings may indicate that this patient has choanal atresia? - CORRECT ANSWER Inability to pass a nasogastric tube down either nare Feedback Choanal atresia is the narrowing or blockage of the nares. A 33-week-gestation neonate has not responded to routine resuscitation efforts. The nurse notes decreased breath sounds on the left side and a scaphoid abdomen. The nurse should prepare for: - CORRECT ANSWER Immediate intubation and insertion of an orogastric tube Feedback A scaphoid abdomen with decreased left-sided breath sounds is highly indicative of a diaphragmatic hernia. Immediate intubation and insertion of an orogastric tube will provide optimal ventilation while decompressing the stomach to maximize left-sided lung inflation. During a continuing education seminar on nursing research, the presenter mentions that a study included participants that were female, age 28 to 48 years of age, and pregnant with a first child. This is an example of: - CORRECT ANSWER Sampling Feedback Sampling describes the means used to target a subset of a population for study, then taking "sample" study participants from that subset. Often, the validity of a study may hinge on the sampling methods used to garner participants. A 39-week-gestation male infant was delivered by cesarean section due to breech position. Upon delivery, the nurse notes that the infant's face is asymmetrical and the head is positioned so that the infant appears to be looking over his left shoulder. This infant most likely has: - CORRECT ANSWER Congenital torticollis Feedback Malposition in the uterus or other congenital complications may cause congenital torticollis, a shortening of the sternocleidomastoid muscle that causes abnormal rotation of the head. Facial asymmetry is the primary sign of congenital causes for this defect. False Labor - CORRECT ANSWER - Contractions decrease in intensity or frequency with ambulation - No lower back pain - Discomfort localized in the abdomen True Labor - CORRECT ANSWER - Pain in the lower back that radiates to the abdomen - Regular rhythmic contractions that intensify with ambulation - Progress cervical dilatation and effacement Right to refuse treatment - CORRECT ANSWER A patient who is of age and is mentally competent always has the right to refuse treatment. The patient's decision along with the rationale and the staff's actions regarding the decision must be documented on the patient's chart. Fetal urine becomes the primary source of the amniotic fluid by: - CORRECT ANSWER The middle of the second trimester. The rate of fetal urine production varies with fetal size and ranges from 400 to 1200 mL/day. Target O2 Sat after birth - CORRECT ANSWER One minute: 60% - 65% 10 min: 85% - 95% Time for circumcision to heal - CORRECT ANSWER 7-10 days Normal newborn findings - CORRECT ANSWER -Mouth has intact palate with midline uvula -Tonic neck reflex present -Suck, root, and gag reflexes -Abdomen is mildly protuberant Whenever an examiner detects a murmur, what is the first quality the examiner must listen for? - CORRECT ANSWER Timing -The timing of the murmur is the first quality the examiner must listen for. To evaluate timing, the examiner must understand what is happening to the heart during systole and diastole. Systole is the period when the heart contracts and the heart chambers eject blood. Diastole occurs following closure of the aortic and pulmonic calves, and it's onset occurs just after S2. Daily increases of bilirubin do not usually exceed: - CORRECT ANSWER 5 mg/dL Which of the following results in an enlarged head caused by excess of cerebrospinal fluid within the ventricles of the brain? - CORRECT ANSWER Hydrocephaly -Hydrocephalus is a condition that occurs when fluid builds up in the skull and causes the brain to swell. The name means "water on the brain." Brain damage can occur as a result of the fluid buildup. This can lead to developmental, physical, and intellectual impairments. It requires treatment to prevent serious complications. An imperforate anus is a congenital defect that can present in all of the following ways EXCEPT: - CORRECT ANSWER relocation of the anus -Imperforate anus is a defect that is present from birth (congenital). The opening to the anus is missing or blocked. Imperforate anus may occur in several forms. The rectum may end in a pouch that does not connect with the colon, the rectum may have openings to other structures that may include the urethra, bladder, base of the penis or scrotum in boys, or vagina in girls, or there may be a narrowing of the anus or no anus. An imperforate anus does not result in relocation of the anus. In term of endocrine system changes postpartum, serum prolactin levels in the non-breastfeeding mother are usually normal in: - CORRECT ANSWER 6 weeks -By six weeks after delivery, the basal serum prolactin concentration is usually normal, even when the mother is breastfeeding. During breastfeeding, local infection around a nipple fissure can lead to mastitis. To expedite healing each of the following steps are recommended EXCEPT: - CORRECT ANSWER Apply ice to nipple directly after feedings. -Ice should not be applied to the nipple. Instead apply dry heat for 20 minutes 4 times per day with a 60-watt bulb held 18 inches away from the nipple. Begin nursing on the side opposite the fissure with the other breast exposed to air to allow the initial letdown to occur automatically. Apply expressed breast milk to nipples and let it dry in between feedings. Hydrogel pads are also available and in some cases it may be necessary to stop breastfeeding temporarily on the affected side. Treatment of neonatal herpes includes: - CORRECT ANSWER use of an intravenous antiviral agent such as acyclovir. -Treatment of neonatal herpes includes use of an intravenous antiviral agent such as acyclovir. Topical ophthalmic antiviral therapy should be used if there is ocular involvement. Other signs, such as seizures, should be treated as they occur. Precautions for blood and body secretions must be observed. Normal axillary temperature - CORRECT ANSWER The normal axillary temperature for a term newborn ranges from 97.7° F to 99.5° F. For the preterm neonate it ranges from 97.3° F to 98.6° F. In educating a new mother who is not able to breast feed about bottle feeding you would tell her what? - CORRECT ANSWER -The amount of formula the infant needs at 0 to 1 month is about 2 - 4 oz. every 3 to 4 hours. -The amount of formula the infant needs at 2 - 4 months is about 5 - 7 oz. every 4 to 5 hours. -Iron-fortified formulas are best. -Only suggest partial hydrolysate formula if the infant is at risk for atopic diseases, for instance a strong family history of atopic disease How would you distinguish jitteriness or tremors in a newborn from seizure activity? - CORRECT ANSWER Seizures are not usually initiated by stimuli and they cannot be stopped by holding. Jitteriness can be stopped by holding, by the infant's sucking on the extremity, or by flexing the involved extremity. Choanal atresia is defined as a: - CORRECT ANSWER A congenital disorder where the back of the nasal passage is blocked, usually by abnormal bony or soft tissue due to failed recanalization of the nasal fossae during fetal development. Assessment of newborn: pink when crying, chest retractions, and cyanosis at rest. Cigarette smoking has been linked to: - CORRECT ANSWER An increased incidence of low birth weight and prematurity. From a preventive perspective, it is not enough to discourage smoking in pregnant women. The focus must be on discouraging smoking in any woman of childbearing age who may potentially become pregnant. Gestational hypertension onset: - CORRECT ANSWER Gestational hypertension generally has an onset after the 20th week of gestation, appearing as a marker of a pregnancy-specific vasospastic condition. Gestational hypertension in clinical practice is a retrospective diagnosis. The spectrum of hypoxicischemic encephalopathy can be divided into these categories: - CORRECT ANSWER mild, moderate, and severe encephalopathy. Resuscitation efforts considerably hampered by a newborn that is wet include: - CORRECT ANSWER -lower oxygen tension -inhibition of surfactant production -increased metabolic acidosis Convection, evaporation, conduction, radiation - CORRECT ANSWER -Convection: Air currents carry heat away from the body surface -Evaporation and heat loss occur as amniotic fluid on the skin of the newborn is converted to a vapor. Drying the newborn immediately after birth and removing wet blankets decreases evaporative losses and prevents further Collin. -Conduction: Occurs through direct contact with a surface with a different temperature -Radiation: The loss or gain of this 'radiant' energy is proportional to the temperature difference between the skin and radiating body; such as heat lost to a nearby wall or window What immunoproperty is responsible for the specific response in the immune system of the newborn that involves antibody production? - CORRECT ANSWER Lymphocytes are responsible for the specific response in the immune system that involve antibody production. When lymphocytes are exposed to pathogens, they become sensitized to them. If repeated exposure occurs, lymphocytes will attempt to destroy the pathogen. Maternal hormone exposure can stimulate a white, mucoid vaginal discharge and/or bleeding (pseudomenses). These findings may persist for up to how long? - CORRECT ANSWER 10 days -Maternal hormone exposure can stimulate a white, mucoid vaginal discharge and/or bleeding (pseudomenses). These findings may persist for up to 10 days. What is true about newborn babies that will help in the resuscitation process? - CORRECT ANSWER Newborns have a have a cartilaginous rib cage that make chest compressions easier and more effective. To determine the integrity of the acoustic nerve (CN VIII) the method of assessment would include what? - CORRECT ANSWER A positive Moro reflex or movement in the direction of sound demonstrates integrity of CN VIII. Another response showing integrity of the acoustic nerve is the newborn quieting to voice. A brainstem auditory evoked response test may also be used. The five criteria graded on the Silverman-Anderson Index of Respiratory Distress: - CORRECT ANSWER Upper Chest: Synch (0), lag on insp. (1), see-saw (2) Lower Chest: None (0), just visible (1), marked (2) Xiphoid Retract: None (0), just visible (1), marked (2) Nares Dilate: None (0), minimal (1), marked (2) Exper. Grunt: None (0), stethos only (1), naked ear (2) Ways to minimize the discomfort of hemorrhoids after a vaginal birth: - CORRECT ANSWER -Side-lying position when laying down -Avoid prolonged sitting can help to decrease swelling and discomfort -Eat a healthy diet and use a stool softener to decrease constipation and ensure greater comfort and bowel movements -Soak in a warm tub of water for 20 minutes at a time. -Use a flush bottle to keep the area clean. -Maintain adequate fluid intake. A large-for-gestational-age (LGA) neonate is one whose weight falls according to what percentile? - CORRECT ANSWER A large-for-gestational-age (LGA) neonate is one whose weight falls above the 90th percentile. LGA neonates weigh more than 4000 g (8 pounds, 13 ounces) due to accelerated growth for length of gestation. Early signs of hydrocephalus in newborns include [blanks] and be caused by [blanks]: - CORRECT ANSWER -bulging fontanel -increase in head circumference -eyes that are fixed downward -vomiting -poor feeding -low muscle tone It can be caused by: -head trauma during or after delivery -bleeding in the brain during or shortly after delivery -central nervous system infections A chromosomal disorder that affects sexual development in males? - CORRECT ANSWER Klinefelter syndrome is a genetic chromosomal condition that affects male physical and cognitive development. Klinefelter syndrome can cause problems with learning and sexual development in males. It happens randomly from an error in cell division when a parent's reproductive cells are being formed. Accepted definitions of shoulder dystocia include: - CORRECT ANSWER -impaction of the anterior shoulder behind the pubic bone -impaction of the posterior shoulder on the sacral promontory -prolonged head-to body delivery time greater than 60 seconds -need for ancillary maneuvers to deliver the shoulders External rotation follows delivery of the head during birth. This is called: - CORRECT ANSWER Restitution. The external rotation of following delivery of the head is called restitution. The head rotates to the position it occupied at engagement. After this, the shoulders descend in a path similar to that traced by the head. For birth of the infant through six months after birth, a woman who is breastfeeding needs approximately how many more calories per day than women who are not breastfeeding? - CORRECT ANSWER 330 From birth through six months after birth, the breastfeeding woman needs approximately 330 calories per day more than women who are not breastfeeding, allowing for gradual loss of the weight gained during pregnancy. This assumes that the infant is fed only breastmilk, and no formula or solid foods. A term infant is defined as: - CORRECT ANSWER -born between the end of week 37 and the completion of week 42 of gestation -approximately 20 inches in length -weighs between 3000 and 3600 grams. Maternal use of narcotics during pregnancy causes what abnormalities in the neonate? - CORRECT ANSWER -increased activity -increased tone -arousal to stimulation -withdraw symptoms. Use of an otoscope for assessing the patency of the ear canal in a newborn is limited because: - CORRECT ANSWER -newborn ear canals contain vernix, mucus, and cellular debris -the ear canals clear spontaneously several days after birth How can a diagnosis for craniosynostosis be done? - CORRECT ANSWER #1 measuring a baby's skull -X-rays check for fused (missing) sutures or ridges along sutures -Genetic tests check for syndromes that cause craniosynostosis -Diagnostic imaging, especially CT scans can be checked for fused sutures or ridges along sutures In a term neonate, the testes measure, on average, how many centimeters? - CORRECT ANSWER 1.4-1.6 cm -They are ovoid shape and usually mobile. Lower cervical and upper thoracic cord lesions result in: - CORRECT ANSWER -flaccidity of the legs and portions of the arms Lower cervical and upper thoracic cord lesions result in flaccidity of the legs and portions of the arms. Lack of perceptible response to pinprick can be demonstrated below the level of spinal cord injury. You have a 32-year-old pregnant patient who is Rh negative. Her baby is Rh positive. Postpartum interventions for this infant include: - CORRECT ANSWER -administration of gamma globulin -phototherapy -transfusion of packed red blood cells Antenatal/Prenatal treatment: -transfusion of the fetus with Rh negative blood Rupture of the superficial cerebral veins results from blood collecting over the cerebral convexities. Three neurologic presentations have been associated with hemorrhage in this area. The first and most common that occurs with minor hemorrhage is: - CORRECT ANSWER -hyperirritability and a hyperalert appearance -The second presentation includes signs of focal cerebral disturbances. -The third presentation is secondary to chronic subdural effusion. The neonate has few or no clinical signs in the neonatal period, but presents months later with an enlarging head. Signs of breast engorgement: - CORRECT ANSWER -nipples appear flattened. The dark area around the nipple may be very firm. This makes it hard for the infant to latch on. -slight fever -tender lymph nodes in armpits -swollen, firm, painful breasts A cephalhematoma is located where? - CORRECT ANSWER -below the periosteum and confined by the cranial sutures. The periosteum of the cranial bone limits the potential space available for blood to expand. Cephalhematoma may contribute to jaundice, but is rarely of clinical significance from a neurological standpoint. Risk factors for mastitis include: - CORRECT ANSWER -incomplete breast emptying -infrequent breastfeeding -plugged milk duct -cracked and bleeding nipples -Both congestive and infectious mastitis are more commonly seen in primigravidas and nursing mothers. Symptoms usually appear between the third and fourth week after birth and are typically unilateral. Signs of mastitis include: - CORRECT ANSWER -warm, red, sensitive area on one breast (almost never both unless both haven't had milk removed in a while) -slight fever -flu-like aches and chills Indications for mastitis include: - CORRECT ANSWER About 1/3 of nursing mothers experience mastitis at some point, usually in the first few months. May last a few hours or up to a week. -Mastitis is inflammation, not infection, and antibiotic won't fix it, simple breast care such as Empty the Breast and Rest (nursing and milk expression) / e.g., comfy bras -Use cold or warmth if it feels good -Antiinflammatory if doctor says ok for breastfeeding -If there IS an infection, see doctor and take whole course of antibiotics completely, and continue breast care -"Bag of Marbles massage", interlace fingers around breast and pretend breast is full of marbles and try to move the marbles around (do this several times a day); assist with lymphatic system and healing process Blood levels of glucose fall after birth. The lowest point occurs at approximately how many hours after birth? - CORRECT ANSWER 1 - 2 hours -The moment the cord is clamped, the newborn must find a way to maintain a serum glucose level that is essential for neonatal brain function. Blood levels of glucose initially fall to a low point at approximately 1 - 2 hours after birth. The physiologic low occurs at approximately 1 to 1.5 hours after birth, with levels subsequently stabilizing at 3 to 4 hours. In terms of interpreting umbilical arterial cord gases, what would indicate respiratory acidemia? - CORRECT ANSWER PCO2: > 65 mm Hg -PCO2: > 65 mm Hg would indicate respiratory acidemia along with pH of < 7.20. Interpretation of ABG: - CORRECT ANSWER Normal: Ph 7.35, PaCO2 35-45, HCO3 22-26 R.Acid: Ph <7.35, PaCO2 >45, HCO3 22-26 R.Alk.: Ph >7.35, PaCO2 <35, HCO3 22-26 M.Acid: Ph <7.35, PaCO2 35-45, <HCO3 22 M.Alk.: Ph >7.35, PaCO2 35-45, >HCO3 26 Eagle-Barrett syndrome is seen almost exclusively in: - CORRECT ANSWER males Rarely seen in females. The process of finding, appraising, and using research findings as the basis for clinical practice is called: - CORRECT ANSWER -evidence-based practice Evidence-based practice is the process of systematically finding, appraising, and using research findings as the basis for clinical practice. Evidence-based practice has become a major driving force in the disciplinary life of clinicians, students, educators, administrators, and policymakers. Infants exposed to tobacco have increased signs of: - CORRECT ANSWER stress, hypertonicity, and excitability Face presentation delivery signs and risks: - CORRECT ANSWER Risk factors: multiparity, macrosomia, cephalopelvic disproportion, polyhydramnios, fetal anomalies (such as anencephaly or cervical mass), preterm delivery, prolonged labor, maternal obesity, fetal presentation anomalies and operative delivery (forceps or vacuum). Soft tissue trauma: -ecchymosis on the skin -petechia -laceration and subcutaneous fat necrosis -severe facial edema -facial bruising -ecchymosis -labial swelling Recover within 24 to 48 hours. -eyelid swelling and ulceration -retinal or subconjunctival hemorrhage (may occur as a result of nasal septum dislocation and ocular trauma may occur due to the pressure of the mother's symphysis pubis or sacral promontorium on the baby's face) -Severe respiratory distress has been reported in certain cases due to a swollen tongue -Facial edema due to soft tissue trauma seen in newborns born with face presentation may be misinterpreted as a sign of a syndrome. An irritating but treatable condition in the mouth of a newborn that presents with raw patches or bleeding may indicate which of the following conditions? - CORRECT ANSWER -thrush If the nurse practitioner touches a newborn's patches gently with a clean finger, and the base of the mouth is raw and possibly bleeding or will only feed for a short time it can be a sign of thrush. Thrush can pass through a baby's digestive system to his bottom and cause diaper rash. Folic acid deficiency is a teratogenic state, leading to an increased risk of neural tube defects (NTDs). Examples of neural tube defects include: - CORRECT ANSWER -spina bifida -anencephaly -encephalocele Pinpoint white papules of keratogenous material usually found on the nose, cheeks or forehead of a newborn are called: - CORRECT ANSWER -milia Milia are small, white bumps that typically appear on the nose and cheeks of affected newborns. These cysts are often found in groups. The cysts occur when keratin becomes trapped beneath the surface of the skin. Keratin is a strong protein that is typically found in skin tissues, hair, and nail cells. Congenital talipes equinovarus is commonly referred to as: - CORRECT ANSWER -club foot Congenital talipes equinovarus (CTEV), often known as club-foot, is a common but little studied developmental disorder of the lower limb. It is defined as fixation of the foot inclined inwards, axially rotated outwards and pointing downwards. Fat content of human milk ranges from: - CORRECT ANSWER Fat content of human milk ranges from 3.5% to 4.5% and contributes 50% of the calories. It varies during a feeding since hindmilk has almost double the fat content when compared to levels in foremilk. Sensory capabilities of a full-term newborn include: - CORRECT ANSWER -At term, the healthy newborn has an ability to fix on and track objects visually. Many studies have shown a strong newborn preference for patterns of stripes. During the first month of life, newborns become preferentially interested in patterns with contours that resemble the human face. Physiological phimosis is best defined as which of the following? - CORRECT ANSWER -nonretractable foreskin In newborns, the prepuce, or foreskin, is adherent to the glands and cannot be retracted without disrupting its natural adherence to the surface of the glands. Therefore, forceful retraction should be avoided. Physiological phimosis, a nonretractable foreskin, is normal in young males and generally resolves in the first few years of life. Tachypnea is usual present by: - CORRECT ANSWER -6 hours after delivery Usually the newborn experiences little or no difficulty at the onset of breathing. However, shortly after birth, respiratory distress may be noted, and there will be an anterior/posterior diameter of the chest that will be observed. Tachypnea is usually present by 6 hours of age, with respiratory rates consistently greater than 60 breaths/min and higher. When the left and right sides of the fetal lip tissue fail to fuse, this results in which of the following? - CORRECT ANSWER -cleft lip Cleft lip is a fissure in the upper lip that is due to failure of the left and right sides of the fetal lip tissue to fuse, an event that should take place by 35 days of fetal age. Cleft lip can be on one side only or on both sides. Because failure of lip fusion can impair the subsequent closure of the palatal shelves, cleft lip often occurs in association with cleft palate. It is one of the most common physical birth defects, and it can be corrected with surgery. The average birth weight for twins is: - CORRECT ANSWER -2330 g The average birth weight for twins is 2330 g. The average gestational age at delivery is 35.3 weeks. For women of ideal body weight, the American College of Obstetrics and Gynecology recommend a weight gain of how much during pregnancy? - CORRECT ANSWER -25 to 35 lbs For women of ideal body weight, the American College of Obstetrics and Gynecology recommend a weight gain of 25 to 35 lbs. Underweight women should gain more weight (28 to 40 lbs), whereas obese women should gain less than 15 to 25 lbs. The ability of the baby to balance between heat production and heat loss in order to maintain body temperature within a certain range is: - CORRECT ANSWER -thermoregulation Thermoregulation is the ability of the baby to balance between heat production and heat loss in order to maintain body temperature within a certain 'normal range'. The ability is very limited in the newborn. In utero, there is little need to thermoregulate because it receives its heat via its mother, with its core and peripheral temperatures remaining slightly higher than its mother. Signs that the second stage of labor has begun: - CORRECT ANSWER -urge to push -FHR in progressively lower locations in the maternal abdomen -rectal bulging -perineal bulging -progressive visibility of the fetal head at the vaginal introitus -increase in bloody show -FHR pattern may demonstrate variable decelerations The cardinal movements of labor describe the movements made by the fetus during labor and immediately before birth to negotiate the diameters of the maternal pelvis. The movement that occurs throughout labor and, therefore, is requisite to and occurs simultaneously with the other cardinal movements is which of the following? - CORRECT ANSWER Descent occurs throughout labor and, therefore, is requisite to and occurs simultaneously with the other cardinal movements. Descent is the result of contractions and maternal pushing efforts during the second stage. Characteristics of the renal system of a newborn: - CORRECT ANSWER -The newborn kidney has an decreased glomerular filtration rate. -The newborn kidney has decreased renal blood flow. -Tubular function in the newborn is immature. -The newborn is unable to concentrate urine very well, which is reflected in a low specific gravity and urine osmolality. The term newborn has structural and functional immaturity in the renal system. Most of this resolves spontaneously during the first month of life. At term, the normal placenta covers how much of the interior portion of the uterus? - CORRECT ANSWER At term, the normal placenta covers one-third of the interior portion of the uterus. It weighs about 500 g. The appearance is of a flat circular disc approximately 2 to 3 cm thick and 15 to 20 cm across. Sinus tachycardia is best defined as: - CORRECT ANSWER heart rate > 180 to 200 bpm Sinus tachycardia is defined as a heart rate greater than normal for age (usually > 180- 200 bpm). It is considered the most common form of rapid heart rate in the neonate. It normally occurs with any stimulus-such as crying, feeding, fever, or activity-that causes increased demands on the heart. High-risk gestational diabetes mellitus (GDM) characteristics include: - CORRECT ANSWER High-risk gestational diabetes mellitus (GDM) characteristics include age > 35 to 40 years, obesity, prior history of GDM, and polycystic ovarian syndrome. Risk assessment for GDM is performed at the first prenatal visit in all women who do not already have diagnosed diabetes. The length of kidneys in a normal-sized neonate is: - CORRECT ANSWER 4.5-5 cm The neonate's kidneys are in a lower position in the abdomen than they will be in later life. Normally, the inferior poles of both kidneys can be felt; the right kidney is usually lower than the left. Normal-sized kidneys, 4.5-5 cm in length in a term neonate, can be palpated in the flank area above the umbilicus. They should be approximately equal in size and smooth in touch. Ureters are not palpable under normal conditions. Enlarges kidneys are easy to detect; this finding should prompt further investigation. In a primiparous patient, maternal perception of fetal movement occurs between: - CORRECT ANSWER In a primiparous patient, maternal perception of fetal movement occurs between 18 and 20 weeks. It occurs between 14 and 18 weeks in the multigravida patient. During pregnancy, the amount of glucose that is filtered by the kidneys increases due to the increased renal plasma flow and the glomerular filtration rate. This can result in: - CORRECT ANSWER glycosuria In pregnancy, the renal tubules increase reabsorption of glucose from the tubules, back into the blood but are unable to match the dramatic increase in filtered glucose. Therefore, glycosuria is common. The glucose tolerance test is normal with most pregnant women with glycosuria, suggesting that this glycosuria is secondary to altered renal function and not abnormal carbohydrate metabolism. In terms of birthmarks, large, flat, reddish-purple marks are called: - CORRECT ANSWER port-wine stains Port wine stains are large, flat, reddish-purple birthmarks, won't disappear on their own. As a child gets older, cosmetic appearance concerns may require the attention of a dermatologist. Postpartum breast engorgement, if it occurs, typically occurs when? - CORRECT ANSWER 2 to 6 days postpartum Postpartum breast engorgement, if it occurs, typically occurs 2 to 6 days postpartum. However, it can occur at a later time up to 2 weeks. The mother might have a fever, which is an indicator of inadequate removal of milk from the breast. What is the most common form of craniosynostosis, occurring when the suture in the midline of the skull that runs right along the top of the head fuses early? - CORRECT ANSWER sagittal Craniosynostosis is a condition in which the sutures close too early, causing problems with normal skull growth. Sagittal craniosynostosis occurs when the suture in the midline of skull that runs right along the top of the head fuses early, resulting in an oblong-shaped head. The term given to each type of craniosynostosis depends on what sutures are affected. Types of craniosynostosis include coronal, metopic and lambdoid. Hyperthyroidism in the newborn is usually caused by which of the following? - CORRECT ANSWER Graves disease in the mother Hyperthyroidism in the newborn is usually caused by Graves disease in the mother. In Graves disease, the mother's body produces antibodies that stimulate the thyroid gland to produce increased amounts of thyroid hormone. These antibodies cross the placenta and cause the fetus's thyroid gland to produce too much thyroid hormone, which can result in death of the fetus or premature birth. Because newborns are no longer exposed to the mother's antibodies after birth, Graves disease in the newborn is usually temporary but may come back. The abnormal accumulation of fluid in the interstitial spaces alveoli, or cells within the lungs that inhibits adequate diffusion of carbon dioxide and oxygen is what? - CORRECT ANSWER pulmonary edema Pulmonary edema is the abnormal accumulation of fluid in the interstitial spaces alveoli, or cells within the lungs that inhibits adequate diffusion of carbon dioxide and oxygen. Physiologic changes of the cardiopulmonary system during pregnancy place the pregnant woman at increased risk for developing pulmonary edema. The occurrence of webbing or fusing together of two or more fingers or toes is known as: - CORRECT ANSWER syndactyly Syndactyly is the webbing or fusing together of two or more fingers or toes. This can also be related to genetic defects, such as Down syndrome or Apert syndrome. Polydactyly and syndactyly are congenital irregularities of the hands and feet. Polydactyly is having extra fingers or toes (6 or more) that occurs on its own. There may not be any other symptoms or disease present. Polydactyly may be passed down in families. This trait involves only 1 gene that can cause several variations. Determining the most morally desirable course of action in health care is applying what? - CORRECT ANSWER bioethics Determining the most morally desirable course of action in health care is applying bioethics. When a conflict of values exists and is inherent in various treatment options, bioethics applies. The occurrence of extra (more than 10) fingers, toes, or parts of these digits is known as: - CORRECT ANSWER polydactyly Polydactyly refers to the occurrence of extra (more than 10) fingers, toes, or parts of these digits. The diagnosis can be divided into 3 classifications: extra digits that occur on the side of the thumb or big toe, extra digits that occur on the side of the little finger or the last toe (most common), and those that involve the fingers or toes in the middle. Maternal use of aspirin during pregnancy has what effect on the baby? - CORRECT ANSWER premature closure of ductus arteriosus Maternal use of aspirin during pregnancy causes premature closure of ductus arteriosus. It can also cause hemorrhage and pulmonary artery hypertension. The ductus arteriosus, also called the ductus Botalli, is a blood vessel in the developing fetus connecting the trunk of the pulmonary artery to the proximal descending aorta. It allows most of the blood from the right ventricle to bypass the fetus's fluid-filled non-functioning lungs. The mean closure time of the ductus arteriosus (DA) in full-term neonates is presumed to be 1-2 days after birth; however, its accurate time is unknown. Herpes rash appears as what? - CORRECT ANSWER vesicles or pustules on an erythematous base The herpes rash appears as vesicles or pustules on an erythematous base. Clusters of lesions are common. The lesions ulcerate and crust over rapidly. Fifty to seventy percent of infants with neonatal herpes eventually develop this characteristic rash, but not always before they exhibit other clinical signs. Absence of vesicles does not rule out the presence of the disease. The fetal thyroid gland becomes functional at which stage of pregnancy? - CORRECT ANSWER by the end of the first trimester The fetal thyroid gland becomes functional by the end of the first trimester. After this time, levels of fetal T3, T4, and TBG increase through the rest of gestation. One problem that may arise in the breasts of breastfeeding mothers is a red or pink shiny skin on the breast skin that usually itches and may flake or peel. This is called: - CORRECT ANSWER thrush Thrush is a form of yeast infection that thrives on milk. I will likely affect both mother and baby. Signs of thrush include red or pink shiny skin that usually itches and may flake or peel. To learn if the baby is infected, look for white spots on the inside of the cheeks, or sometimes a persistent diaper rash. Diagnosis of persistent pulmonary hypertension (PPH) is confirmed by: - CORRECT ANSWER echocardiogram Diagnosis of PPH is confirmed by echocardiogram, which can confirm the presence of elevated pressures in the pulmonary artery and simultaneously can exclude congenital heart disease. On x-ray, lung fields may be normal or may show changes due to the underlying disorder (e.g., meconium aspiration syndrome, neonatal pneumonia, or congenital diaphragmatic hernia). An infant is inactive with mild, agitated vocalizations. The infant is in what awake state? - CORRECT ANSWER active alert An infant is in the active alert state if he/she is inactive with mild, agitated vocalizations. An organized term infant may be able to return to a quiet alert state or calm sleep state by calming himself or herself by sucking on the hands. The respiratory rate of the pregnant woman does what? - CORRECT ANSWER remains unchanged The respiratory rate of the pregnant woman remains unchanged. However, there are many other changes in the respiratory system which are essential to accommodate increased maternal-fetal requirements and to ensure adequate gas exchange to meet maternal and fetal metabolic needs. Decreased birth weight, microcephaly, prematurity, abruptio placentae with possible asphyxia, shock, cerebral hemorrhage, and stillbirth are all effects on the fetus from what drug? - CORRECT ANSWER cocaine Cocaine can have the following effects on the fetus: Decreased birth weight, microcephaly, prematurity, abruptio placentae with possible asphyxia, shock, cerebral hemorrhage, and stillbirth. Cocaine use during pregnancy can have extremely harmful effects on the baby. Most undescended testes will descend by what age? - CORRECT ANSWER 3 months Most undescended testes will descend by 3 months. Spontaneous descent rarely occurs after 9 months of age. Also known as nevus flammeus, which of the following is a birthmark that is usually harmless but can be of concern for certain serious conditions based on the area it is found? - CORRECT ANSWER Port-wine stains (also known as nevus flammeus) are a birthmark that looks like maroon wine was spilled or splashed on the skin. Though they often start out looking pink at birth, port-wine stains tend to become darker (usually reddish-purple or dark red) as kids grow. They usually pose no real threat but can become a risk for other conditions depending on the area of the body they are found. Ejection clicks are always considered abnormal after how many hours of life? - CORRECT ANSWER 24 hours Ejection clicks are commonly heard during the first 24 hours of life and during that time are usually normal (related to the concurrent pulmonary hypertension). They are always considered abnormal after the first 24 hours of life. The most frequent findings associated with these clicks are aortic or pulmonic stenosis, idiopathic dilation of the pulmonary artery, systemic or pulmonary hypertension, truncus arteriosus, or tetralogy of Fallot. Periodic breathing in a newborn is defined as pauses in respiratory movements that last for up to how many seconds? - CORRECT ANSWER 20 seconds -Periodic breathing in a newborn is defined as pauses in respiratory movements that last for up to 20 seconds. These periods of pause alternate with regular breathing. Periodic breathing is rarely associated with differences in skin color or heart rate changes, and it has no prognostic significance The target oxygen saturation reading in a newborn after one minute is which of the following? - CORRECT ANSWER 60% to 65% -The target oxygen saturation reading at one minute is 60% to 65%. The target reading rises to 85% to 95% after 10 minutes. What congenital anomaly is associated with the airway? - CORRECT ANSWER choanal atresia -Choanal atresia is a bony or membranous occlusion that blocks the passageway between the nose and pharynx. The defect is thought to occur during fetal development when the thin tissue that separates the nose and mouth remains after birth. What is the name of the progressive degenerative neurological disease in which collections of abnormal neurons and glia occur in the subependymal and cortical areas of the brain? - CORRECT ANSWER tuberous sclerosis -Tuberous sclerosis is a progressive degenerative neurological disease in which collections of abnormal neurons and glia occur in the subependymal and cortical areas of the brain. Areas of skin depigmentation can be significant because they indicate the earliest manifestation of tuberous sclerosis. The skin lesion is white, macular, and has irregular leaflike borders. One or several lesions may be present. A newborn's vision and response to what he or she sees, develops rapidly during the first year. The normal newborn begins to look directly at and follow objects around by what age? - CORRECT ANSWER 3 months of age -The newborn sees best out of the corner of his or her eyes (peripheral vision) and when objects are about 9 in. (23 cm) to 12 in. (30.5 cm) away. Ne