NR 327 Quiz 1 (Latest): NR327 Quiz 1 (Latest): MATERNAL CHILD NURSING : Chamberlain (Already graded A)

CHAMBERLAIN UNIVERSITY NR 327 MATERNAL CHILD NURSING QUIZ 1 (DETAILED ANSWERS & RATIONALES) 1. 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 this is the: 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. The transition period is the phase between intrauterine and extra uterine existence. There is no such phase as the organizational stage. The second period of reactivity occurs roughly between 4 and 8 hours after birth, after a period of prolonged sleep. 2. 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. Infant breaths are not deep with a regular rhythm. 3. TRUE/FALSE One reason hyperthermia develops more rapidly in the newborn than in the adult is that sweat glands have not formed yet. ANS: FALSE Newborns have six times as many sweat glands per unit area as adults, but they do not function. 4. A collection of blood between the skull bone and its periosteal is known as a cephalhematoma. To reassure the new parents whose infant develops such a soft bulge, it is important that the nurse be aware that this condition: a. May occur with spontaneous vaginal birth. b. Only happens as the result of a forceps or vacuum delivery. c. Is present immediately after birth. d. Will gradually absorb over the first few months of life. ANS: A Bleeding may occur during a spontaneous vaginal delivery as a result of the pressure against the maternal bony pelvis. The soft, irreducible fullness does not pulsate or bulge when the infant cries. Low forceps and other difficult extractions may result in bleeding. However, these can also occur spontaneously. The swelling may appear unilaterally or bilaterally and is usually minimal or absent at birth. It increases over the first 2 to 3 days of life. Cephalhematomas disappear gradually over 2 to 3 weeks. A less common condition results in calcification of the hematoma, which may persist for months. 5. During life in utero oxygenation of the fetus occurs through Trans placental gas exchange. When birth occurs, four factors combine to stimulate the respiratory center in the medulla. The initiation of respiration then follows. Which is NOT one of these essential factors? a. Chemical b. Mechanical c. Thermal d. Psychological ANS: D A psychological factor is not one of the essential factors in the initiation of breathing; the fourth factor is sensory. The sensory factors include handling by the provider, drying by the nurse, lights, smells, and sounds. Chemical factors are essential for the initiation of breathing. During labor decreased levels of oxygen and increased levels of carbon dioxide seem to have a cumulative effect that is involved in the initiation of breathing. Clamping of the cord may also contribute to the start of respirations. Prostaglandins are known to inhibit breathing. Clamping of the cord results in a drop in the level of prostaglandins. Mechanical factors also are necessary to initiate respirations. As the infant passes through the birth canal, the chest is compressed. With birth the chest is relaxed, which allows for negative intra-thoracic pressure that encourages air to flow into the lungs. The profound change in temperature between intrauterine and extra uterine life stimulates receptors in the skin to communicate with the receptors in the medulla. This also contributes to the initiation of breathing. 6. The nurse caring for the newborn should be aware that the sensory system least mature at the time of birth is: a. Vision. b. Hearing. c. Smell. d. Taste. ANS: A The visual system continues to develop for the first 6 months. As soon as the amniotic fluid drains from the ear (minutes), the infant’s hearing is similar to that of an adult. Newborns have a highly developed sense of smell. The newborn can distinguish and react to various tastes. 7. One reason the brain is vulnerable to nutritional deficiencies and trauma in early infancy is the: a. incompletely developed neuromuscular system. b. Primitive reflex system. c. Presence of various sleep-wake states. d. Cerebellum growth spurt. ANS: 8. All of these statements about physiologic jaundice are true except: a. Neonatal jaundice is common, but kernicterus is rare. b. The appearance of jaundice during the first 24 hours or beyond day 7 indicates a pathologic process. c. Because jaundice may not appear before discharge, parents need instruction on how to assess it and when to call for medical help. d. Breastfed babies have a lower incidence of jaundice. ANS: 9. An examiner who discovers unequal movement or uneven gluteal skin folds during the Ortolani maneuver would then: a. Tell the parents that one leg may be longer than the other, but they will equal out by the time the infant is walking. b. Alert the physician that the infant has a dislocated hip. c. Inform the parents and physician that molding has not taken place. d. Suggest that, if the condition does not change, surgery to correct vision problems might be needed. ANS: 10. What are modes of heat loss in the newborn? Choose all that apply. a. Perspiration b. Convection c. Radiation d. Conduction e. Urination ANS: 11. The cheese like, 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: 12. 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. Telangiectasia nevi on the nose or nape of the neck c. Petechial scattered over the infant’s body d. Erythema toxicum anywhere on the body ANS: 13. 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: 14. What infant response to cool environmental conditions is either NOT effective or NOT available to them? a. Constriction of peripheral blood vessels b. Metabolism of brown fat c. Increased respiratory rates d. Unflexing from the normal position ANS: 15. With regard to the 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: 16. By knowing about variations in infants’ blood count, nurses can explain to their clients that: a. A somewhat lower than expected red blood cell count could be the result of delay in clamping the umbilical cord. b. The early high white blood cell (WBC) count is normal at birth and should decrease rapidly. c. Platelet counts are higher than in adults for a few months. d. Even a modest vitamin K deficiency means a problem with the ability of the blood to clot properly. ANS: 17. With regard to the newborn’s developing cardiovascular system, nurses should be aware that: a. The heart rate of a crying infant may rise to 120 beats/min. b. Heart murmurs heard after the first few hours are cause for concern. c. The point of maximal impulse (PMI) often is visible on the chest wall. d. Persistent bradycardia may indicate respiratory distress syndrome (RDS). ANS: 18. With regard to the respiratory development of the newborn, nurses should be aware that: a. The first gasping breath is an exaggerated respiratory reaction within 1 minute of birth. b. Newborns must expel the fluid from the respiratory system within a few minutes of birth. c. Newborns are instinctive mouth breathers. d. Seesaw respirations are no cause for concern in the first hour after birth. ANS: 19. The shivering mechanism of heat production is rarely functioning in the newborn. No shivering ____________________ is accomplished primarily by metabolism of brown fat, which is unique to the newborn, and by increased metabolic activity in the brain, heart, and liver. ANS: 20. 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: 21. 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: 22. The transition period between intrauterine and extra uterine existence for the newborn: a. Consists of four phases, two reactive and two of decreased responses. b. Lasts from birth to day 28 of life. c. Applies to full-term births only. d. Varies by socioeconomic status and the mother’s age. ANS: 23. 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: 24. 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: 25. A client is warm and asks for a fan in her room for her comfort. The nurse enters the room to assess the mother and her infant and finds the infant unwrapped in his crib with the fan blowing over him on “high.” The nurse instructs the mother that the fan should not be directed toward the newborn and the newborn should be wrapped in a blanket. The mother asks why. The nurse’s best response is: a. “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.” b. “Your baby may lose heat by conduction, 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.” c. “Your baby may lose heat by evaporation, 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.” d. “Your baby will get cold stressed easily and needs to be bundled up at all times.” ANS: 26. All of these statements describe the first phase of the transition period except: a. It lasts no longer than 30 minutes. b. It is marked by spontaneous tremors, crying, and head movements. c. It includes the passage of meconium. d. It may involve the infant suddenly sleeping briefly. ANS: 27. 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. The nurse would document this finding as a positive: a. Tonic neck reflex. b. Glabella (Myerson) reflex. c. Babinski reflex. d. Moro reflex. ANS: 28. The parents of a newborn ask the nurse how much the newborn can see. The parents specifically want to know what type of visual stimuli they should provide for their newborn. The nurse responds to the parents by telling them: a. “Infants can see very little until about 3 months of age.” b. “Infants can track their parent’s eyes and distinguish patterns; they prefer complex patterns.” c. “The infant’s eyes must be protected. Infants enjoy looking at brightly colored stripes.” d. “It’s important to shield the newborn’s eyes. Overhead lights help them see well.” ANS: 29. 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: 30. 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: 31. 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: 32. While examining a newborn, the nurse notes uneven skin folds on the buttocks and a click when performing the Ortolani maneuver. The nurse recognizes these findings as a sign that the newborn probably has: a. Polydactyl. b. Clubfoot. c. Hip dysplasia. d. Webbing ANS: 33. 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: a. Only if the newborn is in obvious distress. b. Once by the obstetrician, just after the birth. c. At least twice, 1 minute and 5 minutes after birth. d. Every 15 minutes during the newborn’s first hour after birth. ANS: 34. 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: 35. 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: 36. The normal term infant has little difficulty clearing its airway after birth. Most secretions are brought up to the oropharynx by the cough reflex. However, if the infant has excess secretions, the mouth and nasal passages can be cleared easily with a bulb syringe. When instructing parents on the correct use of this piece of equipment, it is important that the nurse teach them to: 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: ain should be assessed regularly in all newborn infants. If the infant is displaying physiologic or behavioral cues indicating pain, measures should be taken to manage the pain. Examples of Nonpharmacologic pain management techniques include (choose all that apply): a. Swaddling. b. Nonnutritive sucking. c. Skin-to-skin contact with the mother. d. Sucrose. e. Acetaminophen. ANS: 38. As part of their teaching function at discharge, nurses should tell parents that the baby’s respiration should be protected by all of the following procedures except: a. Preventing exposure to people with upper respiratory tract infections. b. Keeping the infant away from secondhand smoke. c. Avoiding loose bedding, water beds, and beanbag chairs. d. Not letting the infant sleep on his or her back. ANS: 39. The nurse is discussing infant care as part of the mother-infant’s couplet discharge planning. The mother asks the nurse, “When will my baby’s cord fall off?” The nurse responds, “Your baby’s cord should fall off by ____________________ (weeks/days) after birth.” ANS: 40. With regard to laboratory tests and diagnostic tests in the hospital after birth, nurses should be aware that: a. All states test for phenylketonuria (PKU), hypothyroidism, cystic fibrosis, and sickle cell diseases. b. Federal law prohibits newborn genetic testing without parental consent. c. If genetic screening is done before the infant is 24 hours old, it should be repeated at age 1 to 2 weeks. d. Hearing screening is now mandated by federal law. ANS: 41. During the complete physical examination 24 hours after birth: a. The parents are excused to reduce their normal anxiety. b. The nurse can gauge the neonate’s maturity level by assessing its general appearance. c. Once often neglected, blood pressure is now routinely checked. d. When the nurse listens to the heart, the S1 and S2 sounds can be heard; the first sound is somewhat higher in pitch and sharper than the second. ANS: 42. The nurse is performing a blood glucose test every 4 hours on an infant born to a diabetic mother. This is to assess the infant’s risk of hypoglycemia. The nurse becomes concerned if the infant’s blood glucose concentration falls below _____ mg/dl. ANS: 43. In the classification of newborns by gestational age and birth weight, the appropriate for gestational age (AGA) weight would: a. Fall between the 25th and 75th percentiles for the infant’s age. b. Depend on the infant’s length and the size of the head. c. Fall between the 10th and 90th percentiles for the infant’s age. d. Be modified to consider intrauterine growth restriction (IUGR). ANS: 44. Nurses can help parents deal with the issue and fact of circumcision if they explain: a. The pros and cons of the procedure during the prenatal period. b. That the American Academy of Pediatrics (AAP) recommends that all newborn males be routinely circumcised. c. That circumcision is rarely painful and any discomfort can be managed without medication. d. That the infant will likely be alert and hungry shortly after the procedure. ANS: 45. A 3.8-kg infant was delivered vaginally at 39 weeks after a 30-minute second stage. There was a nuchal cord. After birth the infant is noted to have petechial over the face and upper back. Information given to the infant’s parents should be based on the knowledge that petechiae: a. Are benign if they disappear within 48 hours of birth. b. Result from increased blood volume. c. Should always be further investigated. d. Usually occur with forceps delivery. ANS: 46. An Apgar score of 10 at 1 minute after birth would indicate a (n): a. Infant having no difficulty adjusting to extra uterine life and needing no further testing. b. Infant in severe distress that needs resuscitation. c. Prediction of a future free of neurologic problems. d. Infant having no difficulty adjusting to extra uterine life but who should be assessed again at 5 minutes after birth. ANS: 47. A newborn is jaundiced and receiving phototherapy via ultraviolet bank lights. An appropriate nursing intervention when caring for an infant with hyperbilirubinemia and receiving phototherapy by this method would be to: a. Apply an oil-based lotion to the newborn’s skin to prevent dying and cracking. b. Limit the newborn’s intake of milk to prevent nausea, vomiting, and diarrhea. c. Place eye shields over the newborn’s closed eyes. d. Change the newborn’s position every 4 hours. ANS: 48. When preparing to administer a hepatitis B vaccine to a newborn, the nurse should: a. Obtain a syringe with a 25-gauge, 5/8-inch needle. b. Confirm that the newborn’s mother has been infected with the hepatitis B virus. c. Assess the dorsolateral muscle as the preferred site for injection. d. Confirm that the newborn is at least 24 hours old. ANS: 49. At 1 minute after birth the nurse assesses the infant and notes: a heart rate of 80 beats/min, some flexion of extremities, a weak cry, grimacing, and a pink body but blue extremities. The nurse would calculate an Apgar score of: a. 4. b. 5. c. 6. d. 7. ANS: 50. 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: 51. 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. Because the nurse has primary responsibility for the baby during the first 2 hours. ANS: 52. 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: 53. 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: