OB-Newborn-NCLEX UPDATED
ACTUAL Exam Questions and CORRECT
ANSWERS
A nurse is assessing a newborn infant following circumcision and notes that the circumcised
area is red with a small amount of bloody drainage. Which of the following nursing actions
would be most appropriate?
1. Document the findings
2. Contact the physician
3. Circle the amount of bloody drainage on the dressing and reassess in 30 minutes
4. Reinforce the dressing - CORRECT ANSWER- ✔✔1. Document the findings - The penis
is normally red during the healing process. A yellow exudate may be noted in 24 hours, and
this is a part of normal healing. The nurse would expect that the area would be red with a
small amount of bloody drainage. If the bleeding is excessive, the nurse would apply gentle
pressure with sterile gauze. If bleeding is not controlled, then the blood vessel may need to be
ligated, and the nurse would contact the physician. Because the findings identified in the
question are normal, the nurse would document the assessment.
A nurse in a delivery room is assisting with the delivery of a newborn infant. After the
delivery, the nurse prepares to prevent heat loss in the newborn resulting from evaporation
by:
1. Warming the crib pad
2. Turning on the overhead radiant warmer
3. Closing the doors to the room
4. Drying the infant in a warm blanket - CORRECT ANSWER- ✔✔4. Drying the infant in a
warm blanket - Evaporation of moisture from a wet body dissipates heat along with the
moisture. Keeping the newborn dry by drying the wet newborn infant will prevent
hypothermia via evaporation.
A nurse in the newborn nursery is monitoring a preterm newborn infant for respiratory
distress syndrome. Which assessment signs if noted in the newborn infant would alert the
nurse to the possibility of this syndrome?
1. Hypotension and Bradycardia
2. Tachypnea and retractions
3. Acrocyanosis and grunting
, 4. The presence of a barrel chest with grunting - CORRECT ANSWER- ✔✔2. Tachypnea
and retractions - The infant with respiratory distress syndrome may present with signs of
cyanosis, tachypnea or apnea, nasal flaring, chest wall retractions, or audible grunts.
A nurse in a newborn nursery is performing an assessment of a newborn infant. The nurse is
preparing to measure the head circumference of the infant. The nurse would most
appropriately:
1. Wrap the tape measure around the infant's head and measure just above the eyebrows.
2. Place the tape measure under the infants head at the base of the skull and wrap around to
the front just above the eyes
3. Place the tape measure under the infants head, wrap around the occiput, and measure just
above the eyes
4. Place the tape measure at the back of the infant's head, wrap around across the ears, and
measure across the infant's mouth. - CORRECT ANSWER- ✔✔3. To measure the head
circumference, the nurse should place the tape measure under the infant's head, wrap the tape
around the occiput, and measure just above the eyebrows so that the largest area of the
occiput is included.
A postpartum nurse is providing instructions to the mother of a newborn infant with
hyperbilirubinemia who is being breastfed. The nurse provides which most appropriate
instructions to the mother?
1. Switch to bottle feeding the baby for 2 weeks
2. Stop the breast feedings and switch to bottle-feeding permanently
3. Feed the newborn infant less frequently
4. Continue to breast-feed every 2-4 hours - CORRECT ANSWER- ✔✔4. Continue to breast-
feed every 2-4 hours - Breast feeding should be initiated within 2 hours after birth and every
2-4 hours thereafter. The other options are not necessary.
A nurse on the newborn nursery floor is caring for a neonate. On assessment the infant is
exhibiting signs of cyanosis, tachypnea, nasal flaring, and grunting. Respiratory distress
syndrome is diagnosed, and the physician prescribes surfactant replacement therapy. The
nurse would prepare to administer this therapy by:
1. Subcutaneous injection
2. Intravenous injection
3. Instillation of the preparation into the lungs through an endotracheal tube
ACTUAL Exam Questions and CORRECT
ANSWERS
A nurse is assessing a newborn infant following circumcision and notes that the circumcised
area is red with a small amount of bloody drainage. Which of the following nursing actions
would be most appropriate?
1. Document the findings
2. Contact the physician
3. Circle the amount of bloody drainage on the dressing and reassess in 30 minutes
4. Reinforce the dressing - CORRECT ANSWER- ✔✔1. Document the findings - The penis
is normally red during the healing process. A yellow exudate may be noted in 24 hours, and
this is a part of normal healing. The nurse would expect that the area would be red with a
small amount of bloody drainage. If the bleeding is excessive, the nurse would apply gentle
pressure with sterile gauze. If bleeding is not controlled, then the blood vessel may need to be
ligated, and the nurse would contact the physician. Because the findings identified in the
question are normal, the nurse would document the assessment.
A nurse in a delivery room is assisting with the delivery of a newborn infant. After the
delivery, the nurse prepares to prevent heat loss in the newborn resulting from evaporation
by:
1. Warming the crib pad
2. Turning on the overhead radiant warmer
3. Closing the doors to the room
4. Drying the infant in a warm blanket - CORRECT ANSWER- ✔✔4. Drying the infant in a
warm blanket - Evaporation of moisture from a wet body dissipates heat along with the
moisture. Keeping the newborn dry by drying the wet newborn infant will prevent
hypothermia via evaporation.
A nurse in the newborn nursery is monitoring a preterm newborn infant for respiratory
distress syndrome. Which assessment signs if noted in the newborn infant would alert the
nurse to the possibility of this syndrome?
1. Hypotension and Bradycardia
2. Tachypnea and retractions
3. Acrocyanosis and grunting
, 4. The presence of a barrel chest with grunting - CORRECT ANSWER- ✔✔2. Tachypnea
and retractions - The infant with respiratory distress syndrome may present with signs of
cyanosis, tachypnea or apnea, nasal flaring, chest wall retractions, or audible grunts.
A nurse in a newborn nursery is performing an assessment of a newborn infant. The nurse is
preparing to measure the head circumference of the infant. The nurse would most
appropriately:
1. Wrap the tape measure around the infant's head and measure just above the eyebrows.
2. Place the tape measure under the infants head at the base of the skull and wrap around to
the front just above the eyes
3. Place the tape measure under the infants head, wrap around the occiput, and measure just
above the eyes
4. Place the tape measure at the back of the infant's head, wrap around across the ears, and
measure across the infant's mouth. - CORRECT ANSWER- ✔✔3. To measure the head
circumference, the nurse should place the tape measure under the infant's head, wrap the tape
around the occiput, and measure just above the eyebrows so that the largest area of the
occiput is included.
A postpartum nurse is providing instructions to the mother of a newborn infant with
hyperbilirubinemia who is being breastfed. The nurse provides which most appropriate
instructions to the mother?
1. Switch to bottle feeding the baby for 2 weeks
2. Stop the breast feedings and switch to bottle-feeding permanently
3. Feed the newborn infant less frequently
4. Continue to breast-feed every 2-4 hours - CORRECT ANSWER- ✔✔4. Continue to breast-
feed every 2-4 hours - Breast feeding should be initiated within 2 hours after birth and every
2-4 hours thereafter. The other options are not necessary.
A nurse on the newborn nursery floor is caring for a neonate. On assessment the infant is
exhibiting signs of cyanosis, tachypnea, nasal flaring, and grunting. Respiratory distress
syndrome is diagnosed, and the physician prescribes surfactant replacement therapy. The
nurse would prepare to administer this therapy by:
1. Subcutaneous injection
2. Intravenous injection
3. Instillation of the preparation into the lungs through an endotracheal tube
