NCLEX-RN NEONATAL AND HIGH-RISK NEONATAL MANAGEMENT PRACTICAL QUESTIONS AND ANSWERS EXAM

NCLEX-RN NEONATAL AND HIGH-RISK NEONATAL MANAGEMENT PRACTICAL QUESTIONS AND ANSWERS EXAM 1. The nurse meets the frantic father at an ED door. He says he just delivered his wife’s full—term newborn in the car when the temperature outside is only 10°F (—12.2°C). In response to the cold environment, the nurse knows that the infant’s body will immediately begin to produce heat by which mechanism? A. Shivering B. Metabolizing body fat C. Dilating surface blood vessels D. Decreasing flexion of the extremities ANSWER: B A. Shivering is rarely seen in newborns, and it does little to produce heat. B. When skin receptors of full-term newborns perceive a drop in environmental temperature, the sympathetic nervous system is stimulated. This in turn stimulates metabolism of brown fat, thus producing heat that is transferred to the peripheral circulation. C. Newborns are able to conserve body heat by constricting, not dilating, blood vessels. D. Decreasing flexion promotes heat loss by exposing more skin surface to the environment. Fullterm newborns normally maintain a flexed posture. 2. At a prenatal class, the nurse utilizes a picture of the fetal heart to explain that functional closure of the ductus arteriosus occurs within 15 hours after birth. Place an X at the location on the fetal heart illustrated where the nurse should be pointing to identify the ductus arteriosus. The ductus arteriosus connects the pulmonary artery to the descending aorta (X) and acts as a shunt to carry blood directly from the right ventricle into the aorta. This should close within 15 hours after birth. 3. The nurse finds documentation in the 4-hour-old newbom’s medical record that states, “Clamping of the umbilical cord was delayed until cord pulsations ceased.” When assessing and collecting additional information about the newborn, what effect should the nurse find as a result of the delayed cord clamping? A. More rapid expulsion of meconium by the newborn B. Increased level of newborn alertness after birth C. An increase in the newbom’s initial temperature D. An increase in the newbom’s hemoglobin and hematocrit ANSWER: D A. Full-term newborns normally pass meconium naturally within 8 to 24 hours after birth. Delayed clamping of the umbilical cord will not affect this process. B. The healthy newborn is born awake and active. This alertness typically lasts for 30 minutes after birth and is known as the first period of reactivity. This will not be affected by delayed cord clamping. C. At birth, the newborn’s temperature may fall due to evaporative heat loss. Delayed cord clamping will not afiect this evaporation process. D. Newborn Hgb and Hct values will be higher when placental transfusion, accomplished through delayed cord clamping, occurs at birth. Blood volume increases by up to 50% with delayed cord clamping. 4. The nurse is completing the l-minute Apgar assessment on the full-term newborn. The newbom’s HR is 80 bpm. What should the nurse do next? A. Assign a 2 for the Apgar score that pertains to the heart rate. B. Suction the excess secretions from the newborn’s oral cavity. C. Wrap in warm blankets and place on the mother’s abdomen. D. Begin immediate positive pressure ventilation on the newborn. ANSWER: D A. To score a 2 on the HR criterion of the Apgar scoring, the newbom’s HR must be above 100 bpm. B. During birth, as soon as the head emerges, the newborn’s mouth is suctioned first (because the newborn is an obligate nose breather) and then the nares with a bulb syringe to prevent aspiration of mucus, amniotic fluid, or meconium. Suctioning should be completed during the newborn’s care, but there is no indication that this is needed. C. The newborn would not be wrapped and placed on the mother’s abdomen until the assessment is complete; the HR is only the first parameter to be scored on the Apgar scoring system.