Test Bank For Davis Advantage for Maternal-Newborn
Nursing: Critical Components of Nursing Care, 4th Edition By
Roberta Durham; Linda Chapman; Connie Miller ( ) /
9781719645737 / Chapter 1-19/ All Chapters with Answers
and Rationals
The nurse is discussing the neonatal blood screening test with a new mother. The nurse knows that
the teaching was successful when the mother states that the test screens for the presence in the
newborn of which of the following diseases? *Select all that apply.*
1. Hypothyroidism.
2. Sickle cell disease.
3. Galactosemia.
4. Cerebral palsy.
5. Cystic fibrosis. - ANSWER: 1. Hypothyroidism.
2. Sickle cell disease.
3. Galactosemia.
5. Cystic fibrosis.
The nursery nurse is careful to wear gloves when admitting neonates into the nursery. Which of the
following is the scientific rationale for this action?
1. Meconium is filled with enteric bacteria.
2. Amniotic fluid may contain harmful viruses.
3. The high alkalinity of fetal urine is caustic to the skin.
4. The baby is at high risk for infection and must be protected. - ANSWER: 2. Amniotic fluid may
contain harmful viruses.
A full-term newborn was just born. Which nursing intervention is important for the nurse to perform
*first*?
1. Remove wet blankets.
2. Assess Apgar score.
3. Insert eye prophylaxis.
4. Elicit the Moro reflex. - ANSWER: 1. Remove wet blankets.
To reduce the risk of hypoglycemia in a full-term newborn weighing 2,900 grams, what should the
nurse do?
1. Maintain the infant's temperature above 97.7°F/36.5°C.
2. Feed the infant glucose water every 3 hours until breastfeeding well.
3. Assess blood glucose levels every 3 hours for the first twelve hours.
4. Encourage the mother to breastfeed every 4 hours. - ANSWER: 1. Maintain the infant's temperature
above 97.7°F/36.5°C.
A mother asks the nurse to tell her about the responsiveness of neonates at birth. Which of the
following answers is appropriate? *Select all that apply.*
1. "Babies have a poorly developed sense of smell until they are 2 months old."
2. "Babies respond to all forms of taste well, but they prefer to eat sweet things
like breast milk."
3. "Babies are especially sensitive to being touched and cuddled."
4. "Babies are nearsighted with blurry vision until they are about 3 months of
age."
5. "Babies respond to many sounds, especially to the high-pitched tone of the
female voice." - ANSWER: 2. "Babies respond to all forms of taste well, but they prefer to eat sweet
things
,like breast milk."
3. "Babies are especially sensitive to being touched and cuddled."
5. "Babies respond to many sounds, especially to the high-pitched tone of the
female voice."
A mother, 1 day postpartum from a 3-hour labor and a spontaneous vaginal delivery, questions the
nurse because her baby's face is "purple." Upon examination, the nurse notes petechiae over the
scalp, forehead, and cheeks of the baby. The nurse's response should be based on which of the
following?
1. Petechiae are indicative of severe bacterial infections.
2. Rapid deliveries can injure the neonatal presenting part.
3. Petechiae are characteristic of the normal newborn rash.
4. The injuries are a sign that the child has been abused. - ANSWER: 2. Rapid deliveries can injure the
neonatal presenting part.
A 2-day-old breastfeeding baby born via normal spontaneous vaginal delivery has just been weighed
in the newborn nursery. The nurse determines that the baby has lost 3.5% of the birth weight. Which
of the following nursing actions is appropriate?
1. Do nothing because this is a normal weight loss.
2. Notify the neonatologist of the significant weight loss.
3. Advise the mother to bottle feed the baby at the next feed.
4. Assess the baby for hypoglycemia with a glucose monitor. - ANSWER: 1. Do nothing because this is
a normal weight loss.
Four newborns are in the neonatal nursery, none of whom is crying or in distress. Which of the babies
should the nurse report to the neonatologist?
1. 16-hour-old baby who has yet to pass meconium.
2. 16-hour-old baby whose blood glucose is 50 mg/dL.
3. 2-day-old baby who is breathing irregularly at 70 breaths per minute.
4. 2-day-old baby who is excreting a milky discharge from both nipples. - ANSWER: 3. 2-day-old baby
who is breathing irregularly at 70 breaths per minute.
The pediatrician has ordered vitamin K 0.5 mg IM for a newborn. The medication is available as 2
mg/mL. How many milliliters (mL) should the nurse administer to the baby? *Calculate to the nearest
hundredth.*
______ mL - ANSWER: 0.25 mL
A nurse is doing a newborn assessment on a new admission to the nursery. Which of the following
actions should the nurse make when evaluating the baby for developmental dysplasia of the hip
(DDH)? *Select all that apply.*
1. Grasp the baby's legs with the thumbs on the inner thighs and forefingers on
the outer thighs.
2. Gently adduct and abduct the baby's thighs.
3. Palpate the trochanter during hip rotation.
4. Place the baby in a fetal position.
5. Compare the lengths of the baby's legs. - ANSWER: 1. Grasp the baby's legs with the thumbs on the
inner thighs and forefingers on
the outer thighs.
2. Gently adduct and abduct the baby's thighs.
3. Palpate the trochanter during hip rotation.
5. Compare the lengths of the baby's legs.
A nurse notes that a 6-hour-old neonate has cyanotic hands and feet. Which of the following actions
by the nurse is appropriate?
1. Place the child in an isolette.
2. Administer oxygen.
, 3. Swaddle the baby in a blanket. 4. Apply pulse oximeter. - ANSWER: 3. Swaddle the baby in a
blanket.
A couple is asking the nurse whether or not their son should be circumcised. On which fact should the
nurse's response be based?
1. Boys should be circumcised for them to establish a positive self-image.
2. Boys should not be circumcised because there is no medical rationale for the
procedure.
3. Experts from the Centers for Disease Control and Prevention (CDC) argue that
circumcision is desirable.
4. A statement from the American Academy of Pediatrics (AAP) asserts that
circumcision is optional. - ANSWER: 4. A statement from the American Academy of Pediatrics (AAP)
asserts that
circumcision is optional.
A baby boy is to be circumcised by the mother's obstetrician. Which of the following actions shows
that the nurse is being a patient advocate?
1. Before the procedure, the nurse prepares the sterile field for the physician.
2. The nurse refuses to unclothe the baby until the doctor orders something for
pain.
3. The nurse holds the feeding immediately before the circumcision.
4. After the procedure, the nurse monitors the site for signs of bleeding. - ANSWER: 2. The nurse
refuses to unclothe the baby until the doctor orders something for
pain.
Using the Neonatal Infant Pain Scale (NIPS), a nurse is assessing the pain response of a newborn who
has just had a circumcision. The nurse is assessing a change in which of the following
signs/symptoms? Select all that apply.
1. Heart rate.
2. Blood pressure.
3. Temperature.
4. Facial expression.
5. Breathing pattern. - ANSWER: 4. Facial expression.
5. Breathing pattern.
A nurse is teaching a mother how to care for her 3-day-old son's circumcised penis. Which of the
following actions demonstrates that the mother has learned the information?
1. The mother cleanses the glans with a cotton swab dipped in hydrogen peroxide.
2. The mother covers the glans with antifungal ointment after rinsing off any
discharge.
3. The mother squeezes soapy water from the wash cloth over the glans.
4. The mother replaces the dry sterile dressing before putting on the diaper. - ANSWER: 3. The mother
squeezes soapy water from the wash cloth over the glans.
Please put an "X" on the site where the nurse should administer vitamin K 0.5 mg IM to the neonate. -
ANSWER: The "X" should be placed on the baby in the *supine position* on the *vastus lateralis* on
either the left or right *thigh*—that is, the anterior-lateral portion of the middle third of the thigh
from the trochanter to the patella. This is the only safe site for intra*muscular* injections in infants.
The nurse is teaching a mother regarding the baby's sutures and fontanelles. Please put an "X" on the
fontanelle that will close at 6 to 8 weeks of age. - ANSWER: The "X" should be placed on the
*posterior fontanelle* or the triangle-shaped area on the *occiput* of the baby's head.
A neonate is being admitted to the well-baby nursery. Which of the following findings should be
reported to the neonatologist?
1. Umbilical cord with three vessels.
2. Diamond-shaped anterior fontanelle.
Nursing: Critical Components of Nursing Care, 4th Edition By
Roberta Durham; Linda Chapman; Connie Miller ( ) /
9781719645737 / Chapter 1-19/ All Chapters with Answers
and Rationals
The nurse is discussing the neonatal blood screening test with a new mother. The nurse knows that
the teaching was successful when the mother states that the test screens for the presence in the
newborn of which of the following diseases? *Select all that apply.*
1. Hypothyroidism.
2. Sickle cell disease.
3. Galactosemia.
4. Cerebral palsy.
5. Cystic fibrosis. - ANSWER: 1. Hypothyroidism.
2. Sickle cell disease.
3. Galactosemia.
5. Cystic fibrosis.
The nursery nurse is careful to wear gloves when admitting neonates into the nursery. Which of the
following is the scientific rationale for this action?
1. Meconium is filled with enteric bacteria.
2. Amniotic fluid may contain harmful viruses.
3. The high alkalinity of fetal urine is caustic to the skin.
4. The baby is at high risk for infection and must be protected. - ANSWER: 2. Amniotic fluid may
contain harmful viruses.
A full-term newborn was just born. Which nursing intervention is important for the nurse to perform
*first*?
1. Remove wet blankets.
2. Assess Apgar score.
3. Insert eye prophylaxis.
4. Elicit the Moro reflex. - ANSWER: 1. Remove wet blankets.
To reduce the risk of hypoglycemia in a full-term newborn weighing 2,900 grams, what should the
nurse do?
1. Maintain the infant's temperature above 97.7°F/36.5°C.
2. Feed the infant glucose water every 3 hours until breastfeeding well.
3. Assess blood glucose levels every 3 hours for the first twelve hours.
4. Encourage the mother to breastfeed every 4 hours. - ANSWER: 1. Maintain the infant's temperature
above 97.7°F/36.5°C.
A mother asks the nurse to tell her about the responsiveness of neonates at birth. Which of the
following answers is appropriate? *Select all that apply.*
1. "Babies have a poorly developed sense of smell until they are 2 months old."
2. "Babies respond to all forms of taste well, but they prefer to eat sweet things
like breast milk."
3. "Babies are especially sensitive to being touched and cuddled."
4. "Babies are nearsighted with blurry vision until they are about 3 months of
age."
5. "Babies respond to many sounds, especially to the high-pitched tone of the
female voice." - ANSWER: 2. "Babies respond to all forms of taste well, but they prefer to eat sweet
things
,like breast milk."
3. "Babies are especially sensitive to being touched and cuddled."
5. "Babies respond to many sounds, especially to the high-pitched tone of the
female voice."
A mother, 1 day postpartum from a 3-hour labor and a spontaneous vaginal delivery, questions the
nurse because her baby's face is "purple." Upon examination, the nurse notes petechiae over the
scalp, forehead, and cheeks of the baby. The nurse's response should be based on which of the
following?
1. Petechiae are indicative of severe bacterial infections.
2. Rapid deliveries can injure the neonatal presenting part.
3. Petechiae are characteristic of the normal newborn rash.
4. The injuries are a sign that the child has been abused. - ANSWER: 2. Rapid deliveries can injure the
neonatal presenting part.
A 2-day-old breastfeeding baby born via normal spontaneous vaginal delivery has just been weighed
in the newborn nursery. The nurse determines that the baby has lost 3.5% of the birth weight. Which
of the following nursing actions is appropriate?
1. Do nothing because this is a normal weight loss.
2. Notify the neonatologist of the significant weight loss.
3. Advise the mother to bottle feed the baby at the next feed.
4. Assess the baby for hypoglycemia with a glucose monitor. - ANSWER: 1. Do nothing because this is
a normal weight loss.
Four newborns are in the neonatal nursery, none of whom is crying or in distress. Which of the babies
should the nurse report to the neonatologist?
1. 16-hour-old baby who has yet to pass meconium.
2. 16-hour-old baby whose blood glucose is 50 mg/dL.
3. 2-day-old baby who is breathing irregularly at 70 breaths per minute.
4. 2-day-old baby who is excreting a milky discharge from both nipples. - ANSWER: 3. 2-day-old baby
who is breathing irregularly at 70 breaths per minute.
The pediatrician has ordered vitamin K 0.5 mg IM for a newborn. The medication is available as 2
mg/mL. How many milliliters (mL) should the nurse administer to the baby? *Calculate to the nearest
hundredth.*
______ mL - ANSWER: 0.25 mL
A nurse is doing a newborn assessment on a new admission to the nursery. Which of the following
actions should the nurse make when evaluating the baby for developmental dysplasia of the hip
(DDH)? *Select all that apply.*
1. Grasp the baby's legs with the thumbs on the inner thighs and forefingers on
the outer thighs.
2. Gently adduct and abduct the baby's thighs.
3. Palpate the trochanter during hip rotation.
4. Place the baby in a fetal position.
5. Compare the lengths of the baby's legs. - ANSWER: 1. Grasp the baby's legs with the thumbs on the
inner thighs and forefingers on
the outer thighs.
2. Gently adduct and abduct the baby's thighs.
3. Palpate the trochanter during hip rotation.
5. Compare the lengths of the baby's legs.
A nurse notes that a 6-hour-old neonate has cyanotic hands and feet. Which of the following actions
by the nurse is appropriate?
1. Place the child in an isolette.
2. Administer oxygen.
, 3. Swaddle the baby in a blanket. 4. Apply pulse oximeter. - ANSWER: 3. Swaddle the baby in a
blanket.
A couple is asking the nurse whether or not their son should be circumcised. On which fact should the
nurse's response be based?
1. Boys should be circumcised for them to establish a positive self-image.
2. Boys should not be circumcised because there is no medical rationale for the
procedure.
3. Experts from the Centers for Disease Control and Prevention (CDC) argue that
circumcision is desirable.
4. A statement from the American Academy of Pediatrics (AAP) asserts that
circumcision is optional. - ANSWER: 4. A statement from the American Academy of Pediatrics (AAP)
asserts that
circumcision is optional.
A baby boy is to be circumcised by the mother's obstetrician. Which of the following actions shows
that the nurse is being a patient advocate?
1. Before the procedure, the nurse prepares the sterile field for the physician.
2. The nurse refuses to unclothe the baby until the doctor orders something for
pain.
3. The nurse holds the feeding immediately before the circumcision.
4. After the procedure, the nurse monitors the site for signs of bleeding. - ANSWER: 2. The nurse
refuses to unclothe the baby until the doctor orders something for
pain.
Using the Neonatal Infant Pain Scale (NIPS), a nurse is assessing the pain response of a newborn who
has just had a circumcision. The nurse is assessing a change in which of the following
signs/symptoms? Select all that apply.
1. Heart rate.
2. Blood pressure.
3. Temperature.
4. Facial expression.
5. Breathing pattern. - ANSWER: 4. Facial expression.
5. Breathing pattern.
A nurse is teaching a mother how to care for her 3-day-old son's circumcised penis. Which of the
following actions demonstrates that the mother has learned the information?
1. The mother cleanses the glans with a cotton swab dipped in hydrogen peroxide.
2. The mother covers the glans with antifungal ointment after rinsing off any
discharge.
3. The mother squeezes soapy water from the wash cloth over the glans.
4. The mother replaces the dry sterile dressing before putting on the diaper. - ANSWER: 3. The mother
squeezes soapy water from the wash cloth over the glans.
Please put an "X" on the site where the nurse should administer vitamin K 0.5 mg IM to the neonate. -
ANSWER: The "X" should be placed on the baby in the *supine position* on the *vastus lateralis* on
either the left or right *thigh*—that is, the anterior-lateral portion of the middle third of the thigh
from the trochanter to the patella. This is the only safe site for intra*muscular* injections in infants.
The nurse is teaching a mother regarding the baby's sutures and fontanelles. Please put an "X" on the
fontanelle that will close at 6 to 8 weeks of age. - ANSWER: The "X" should be placed on the
*posterior fontanelle* or the triangle-shaped area on the *occiput* of the baby's head.
A neonate is being admitted to the well-baby nursery. Which of the following findings should be
reported to the neonatologist?
1. Umbilical cord with three vessels.
2. Diamond-shaped anterior fontanelle.
