Maternal Chapter 26: Nursing Care of the
Newborn and Family: QUESTIONS AND
100% VERIFIED ANSWERS 2025/2026
An infant boy was born just a few minutes ago and the nurse is assessing the Apgar score. When is the
Apgar score performed?
a. It is performed only if the newborn is in obvious distress.
b. It is performed once by the obstetrician, just after the birth.
c. It is performed at least twice, 1 minute and 5 minutes after birth.
d. It is performed every 15 minutes during the newborn's first hour after birth. - Answer ANS: C
Apgar scoring is performed at 1 minute and 5 minutes after birth. Scoring may continue at 5-minute
intervals if the infant is in distress and requires resuscitation efforts.
A new father wants to know what medication was put into his infant's eyes and why it is needed. What
does the nurse explain to the father about the purpose of the erythromycin ophthalmic ointment?
a. It destroys an infectious exudate caused by Staphylococcus that could make the infant blind.
b. It prevents gonorrheal and chlamydial infection of the infant's eyes that is potentially acquired from
the birth canal.
c. It prevents potentially harmful exudate from invading the tear ducts of the infant's eyes, leading to
dry eyes.
d. It prevents the infant's eyelids from sticking together and helps the infant see. - Answer ANS: B
The purpose of the erythromycin ophthalmic ointment is to prevent gonorrheal and chlamydial infection
of the infant's eyes that is potentially acquired from the birth canal. Prophylactic ophthalmic ointment is
instilled in the eyes of all neonates to prevent gonorrheal or chlamydial infection. Prophylactic
ophthalmic ointment is not instilled to prevent dry eyes. Prophylactic ophthalmic ointment has no
bearing on vision other than to protect against infection that may lead to vision problems.
The nurse is using the Ballard scale to determine the gestational age of a newborn. Which 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 - Answer ANS: A
, Term infants typically have a flexed posture. Abundant lanugo usually is seen on preterm infants.
Smooth, pink skin with visible veins is seen on preterm infants. Faint red marks usually are seen on
preterm infants.
A 3800 g infant was delivered vaginally at 39 weeks after a 30-minute second stage. There was a nuchal
cord. After birth, the infant had petechiae over the face and upper back. Which information would be
accurate to be given to the infant's parents about petechiae?
a. They are benign if they disappear within 48 hours of birth.
b. They result from increased blood volume.
c. They should always be further investigated.
d. They usually occur with forceps delivery. - Answer ANS: A
Petechiae, or pinpoint hemorrhagic areas, acquired during birth may extend over the upper portion of
the trunk and face. These lesions are benign if they disappear within 2 days of birth and no new lesions
appear. Petechiae may result from decreased platelet formation. In this situation, the presence of
petechiae is most likely a soft-tissue injury resulting from the nuchal cord at birth. Unless they do not
dissipate in 2 days, there is no reason for the family to be alarmed. Petechiae usually occur with a
breech presentation vaginal birth.
A newborn is jaundiced and receiving phototherapy via ultraviolet bank lights. Which is an appropriate
nursing intervention when caring for an infant with hyperbilirubinemia and receiving phototherapy?
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. - Answer ANS: C
The infant's eyes must be protected by an opaque mask to prevent overexposure to the light. Eye
shields should cover the eyes completely but not occlude the nares. Lotions and ointments should not
be applied to the infant because they absorb heat, and this can cause burns. The lights increase
insensible water loss, placing the infant at risk for fluid loss and dehydration. Therefore, it is important
that the infant be adequately hydrated. The infant should be turned every 2 hours to expose all body
surfaces to the light.
Early this morning, an infant boy was circumcised using the PlastiBell method. When should the nurse
tell the mother that she and her infant can be discharged?
a. The bleeding stops completely.
Newborn and Family: QUESTIONS AND
100% VERIFIED ANSWERS 2025/2026
An infant boy was born just a few minutes ago and the nurse is assessing the Apgar score. When is the
Apgar score performed?
a. It is performed only if the newborn is in obvious distress.
b. It is performed once by the obstetrician, just after the birth.
c. It is performed at least twice, 1 minute and 5 minutes after birth.
d. It is performed every 15 minutes during the newborn's first hour after birth. - Answer ANS: C
Apgar scoring is performed at 1 minute and 5 minutes after birth. Scoring may continue at 5-minute
intervals if the infant is in distress and requires resuscitation efforts.
A new father wants to know what medication was put into his infant's eyes and why it is needed. What
does the nurse explain to the father about the purpose of the erythromycin ophthalmic ointment?
a. It destroys an infectious exudate caused by Staphylococcus that could make the infant blind.
b. It prevents gonorrheal and chlamydial infection of the infant's eyes that is potentially acquired from
the birth canal.
c. It prevents potentially harmful exudate from invading the tear ducts of the infant's eyes, leading to
dry eyes.
d. It prevents the infant's eyelids from sticking together and helps the infant see. - Answer ANS: B
The purpose of the erythromycin ophthalmic ointment is to prevent gonorrheal and chlamydial infection
of the infant's eyes that is potentially acquired from the birth canal. Prophylactic ophthalmic ointment is
instilled in the eyes of all neonates to prevent gonorrheal or chlamydial infection. Prophylactic
ophthalmic ointment is not instilled to prevent dry eyes. Prophylactic ophthalmic ointment has no
bearing on vision other than to protect against infection that may lead to vision problems.
The nurse is using the Ballard scale to determine the gestational age of a newborn. Which 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 - Answer ANS: A
, Term infants typically have a flexed posture. Abundant lanugo usually is seen on preterm infants.
Smooth, pink skin with visible veins is seen on preterm infants. Faint red marks usually are seen on
preterm infants.
A 3800 g infant was delivered vaginally at 39 weeks after a 30-minute second stage. There was a nuchal
cord. After birth, the infant had petechiae over the face and upper back. Which information would be
accurate to be given to the infant's parents about petechiae?
a. They are benign if they disappear within 48 hours of birth.
b. They result from increased blood volume.
c. They should always be further investigated.
d. They usually occur with forceps delivery. - Answer ANS: A
Petechiae, or pinpoint hemorrhagic areas, acquired during birth may extend over the upper portion of
the trunk and face. These lesions are benign if they disappear within 2 days of birth and no new lesions
appear. Petechiae may result from decreased platelet formation. In this situation, the presence of
petechiae is most likely a soft-tissue injury resulting from the nuchal cord at birth. Unless they do not
dissipate in 2 days, there is no reason for the family to be alarmed. Petechiae usually occur with a
breech presentation vaginal birth.
A newborn is jaundiced and receiving phototherapy via ultraviolet bank lights. Which is an appropriate
nursing intervention when caring for an infant with hyperbilirubinemia and receiving phototherapy?
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. - Answer ANS: C
The infant's eyes must be protected by an opaque mask to prevent overexposure to the light. Eye
shields should cover the eyes completely but not occlude the nares. Lotions and ointments should not
be applied to the infant because they absorb heat, and this can cause burns. The lights increase
insensible water loss, placing the infant at risk for fluid loss and dehydration. Therefore, it is important
that the infant be adequately hydrated. The infant should be turned every 2 hours to expose all body
surfaces to the light.
Early this morning, an infant boy was circumcised using the PlastiBell method. When should the nurse
tell the mother that she and her infant can be discharged?
a. The bleeding stops completely.
