NUR 3500 EXAM 4 REVIEW QUESTIONS
The perinatal nurse explains the cardiopulmonary adaptations that occur in the neonate
to a student nurse. Which of the following statements accurately describes the
sequence of these changes?
A. "As air enters the lungs, the PO2 rises in the alveoli, which causes pulmonary
artery relaxation and results in an increase in pulmonary vascular resistance."
B. "As the pulmonary vascular resistance increases, pulmonary blood flow increases,
reaching 100% by the first 24 hours of life."
C. "Decreased pulmonary blood volume contributes to the conversion from fetal to
newborn circulation."
D. "Once the pulmonary circulation has been functionally established, blood is
distributed throughout the lungs." - Answer -D. "Once the pulmonary circulation has
been functionally established, blood is
distributed throughout the lungs."
New parents are concerned that after initially breastfeeding their baby 2 hours after
being born, she is sleeping soundly and will not awaken. What action by the nurse is
most appropriate?
A. Call the rapid response team.
B. Document the neonate's behavior in the chart.
C. Reassure the parents that this is normal.
D. Stimulate the baby to wake her up. - Answer -C. Reassure the parents that this is
normal.
What action by the nurse is most important to prevent respiratory depression in a newly
born infant?
A. Bathe the infant in warm water before giving to the mother.
B. Dress the infant in warm clothing and place in a warmer.
C. Dry the infant and place on the mother's bare chest.
D. Turn the delivery room temperature up to 85°F (29.4°C). - Answer -C. Dry the infant
and place on the mother's bare chest.
A new mother with a 6-hour-old infant calls the nursing station complaining that her
baby is so cold he is shivering. What action by the nurse is most appropriate?
A. Bring warm blankets to wrap the baby in.
B. Encourage the mother to feed him a warmed bottle.
C. Perform a thorough head-to-toe assessment.
D. Set the room temperature higher. - Answer -C. Perform a thorough head-to-toe
assessment.
What action by the nurse is most important to prevent hemorrhagic disease of the
newborn?
, A. Administer vitamin K1 phytonadione (AquaMEPHYTON).
B. Assess daily hemoglobin and hematocrit levels.
C. Coordinate laboratory sticks to minimize blood loss.
D. Handle the infant gently to prevent injury. - Answer -A. Administer vitamin K1
phytonadione (AquaMEPHYTON).
A nurse is assessing a newborn who is jittery, diaphoretic, and hypothermic, and has
poor feeding. What laboratory value would the nurse correlate with this condition?
A. Bilirubin: 5 mg/dL
B. Blood glucose: 32 mg/dL
C. Hematocrit: 50%
D. White blood cell count: 25,000/mm3 - Answer -B. Blood glucose: 32 mg/dL
A term infant is 22 hours old, has a total serum bilirubin level of 13 mg/dL, and has
visible jaundice. What action by the nurse is most appropriate?
A. Assure the parents that this is temporary.
B. Document the findings in the infant's chart.
C. Have the mother switch to bottle feeding.
D. Review the chart for history of a traumatic birth. - Answer -D. Review the chart for
history of a traumatic birth.
A mother brings her 1-week-old baby to the clinic with complaints that the baby is not
eating well. The mother is attempting to bottle feed about 120 mL every 2 hours. What
action by the nurse is best?
A. Explain that this is too much volume at one time.
B. Have the mother demonstrate her feeding and burping technique.
C. Reassure the mother that the baby is eating fine.
D. Weigh the baby and plot her weight on a graph. - Answer -A. Explain that this is too
much volume at one time.
A mother-baby nurse assesses newborns for their risk of developing hypoglycemia.
Which infant would the nurse assess as being at highest risk?
A. Asian ethnic background
B. Delayed feedings after birth
C. Infant with heat stress
D. Maternal use of terbutaline (Brethine) - Answer -D. Maternal use of terbutaline
(Brethine)
What assessment finding indicates to the nurse that goals for the diagnosis of
ineffective thermoregulation related to newborn's immature temperature regulatory
system have been met?
The perinatal nurse explains the cardiopulmonary adaptations that occur in the neonate
to a student nurse. Which of the following statements accurately describes the
sequence of these changes?
A. "As air enters the lungs, the PO2 rises in the alveoli, which causes pulmonary
artery relaxation and results in an increase in pulmonary vascular resistance."
B. "As the pulmonary vascular resistance increases, pulmonary blood flow increases,
reaching 100% by the first 24 hours of life."
C. "Decreased pulmonary blood volume contributes to the conversion from fetal to
newborn circulation."
D. "Once the pulmonary circulation has been functionally established, blood is
distributed throughout the lungs." - Answer -D. "Once the pulmonary circulation has
been functionally established, blood is
distributed throughout the lungs."
New parents are concerned that after initially breastfeeding their baby 2 hours after
being born, she is sleeping soundly and will not awaken. What action by the nurse is
most appropriate?
A. Call the rapid response team.
B. Document the neonate's behavior in the chart.
C. Reassure the parents that this is normal.
D. Stimulate the baby to wake her up. - Answer -C. Reassure the parents that this is
normal.
What action by the nurse is most important to prevent respiratory depression in a newly
born infant?
A. Bathe the infant in warm water before giving to the mother.
B. Dress the infant in warm clothing and place in a warmer.
C. Dry the infant and place on the mother's bare chest.
D. Turn the delivery room temperature up to 85°F (29.4°C). - Answer -C. Dry the infant
and place on the mother's bare chest.
A new mother with a 6-hour-old infant calls the nursing station complaining that her
baby is so cold he is shivering. What action by the nurse is most appropriate?
A. Bring warm blankets to wrap the baby in.
B. Encourage the mother to feed him a warmed bottle.
C. Perform a thorough head-to-toe assessment.
D. Set the room temperature higher. - Answer -C. Perform a thorough head-to-toe
assessment.
What action by the nurse is most important to prevent hemorrhagic disease of the
newborn?
, A. Administer vitamin K1 phytonadione (AquaMEPHYTON).
B. Assess daily hemoglobin and hematocrit levels.
C. Coordinate laboratory sticks to minimize blood loss.
D. Handle the infant gently to prevent injury. - Answer -A. Administer vitamin K1
phytonadione (AquaMEPHYTON).
A nurse is assessing a newborn who is jittery, diaphoretic, and hypothermic, and has
poor feeding. What laboratory value would the nurse correlate with this condition?
A. Bilirubin: 5 mg/dL
B. Blood glucose: 32 mg/dL
C. Hematocrit: 50%
D. White blood cell count: 25,000/mm3 - Answer -B. Blood glucose: 32 mg/dL
A term infant is 22 hours old, has a total serum bilirubin level of 13 mg/dL, and has
visible jaundice. What action by the nurse is most appropriate?
A. Assure the parents that this is temporary.
B. Document the findings in the infant's chart.
C. Have the mother switch to bottle feeding.
D. Review the chart for history of a traumatic birth. - Answer -D. Review the chart for
history of a traumatic birth.
A mother brings her 1-week-old baby to the clinic with complaints that the baby is not
eating well. The mother is attempting to bottle feed about 120 mL every 2 hours. What
action by the nurse is best?
A. Explain that this is too much volume at one time.
B. Have the mother demonstrate her feeding and burping technique.
C. Reassure the mother that the baby is eating fine.
D. Weigh the baby and plot her weight on a graph. - Answer -A. Explain that this is too
much volume at one time.
A mother-baby nurse assesses newborns for their risk of developing hypoglycemia.
Which infant would the nurse assess as being at highest risk?
A. Asian ethnic background
B. Delayed feedings after birth
C. Infant with heat stress
D. Maternal use of terbutaline (Brethine) - Answer -D. Maternal use of terbutaline
(Brethine)
What assessment finding indicates to the nurse that goals for the diagnosis of
ineffective thermoregulation related to newborn's immature temperature regulatory
system have been met?
