Apgar scores are taken when on the new born?

A. immediately and 3 mins

B. 1 & 5 mins

C. 1 & 3 mins

D. 3 & 10 mins

How many points are given on the Apgar scale for a HR of 107?

A. 0

B. 1

C. 2

D. 3

C. 2

-Pertaining to HR 0 points are given for an absent HR, 1 point is given for anything less than 100, 2 points are given for a HR above 100

At one minute the neonate has slow RR and a weak cry.  How many points would you give on the Apgar score?

A. 0

B. 1

C. 2

D. 3

B. 1

-0 is given for no respirations, 1 point is given for slow RR and weak cry, 2 points are given for spontaneous RR and a strong cry

At one minute the neonate demonstrates limp posture.  What score would you give on the Apgar scale?

A. 0

B. 1

C. 2

D. 3

A. 0

-0 points are given for a limp posture, 1 point is given for minimal flexion and sluggish movement, 2 points are given flexed posture and vigorous movement

The neonate grimaces in response to suction at one minute.  What score would you give on the Apgar scale?

A. 0

B. 1

C. 2

D. 3

B. 1

-0 points are given for no response, 1 point is given for a weak response (grimace) to suction or gentle slap on the sole, 2 points are given for prompt response with active movement or cry

The neonate is pink with slight acrocyanosis at one minute.  What score would you give on the Apgar scale?

A. 0

B. 1

C. 2

D. 3

B. 1

-0 points are given for pale or cyanosis, 1 point is given for bluish hands or feet (acrocyanosis) only, 2 points are given pink or absence of cyanosis

What interventions are appropriate for a new born with a one minute Apgar score of 5? Select all that apply

A. rubbing the back

B. administer oxygen

C. perform resuscitation

D. administer Vitamin K

A,B

-rubbing the back promotes circulation and may elicit reflex responses

-administering oxygen obviously improves oxygenation

-this new born doesn't require resuscitation

-Vitamin K is not a priority at this moment

The neonate can't regulate his body temperature and is at an increased risk of heat loss to the cooler air around him.  This process of heat loss is called:

A. conduction

B. perspiratoin

C. evaporation

D. convection

D. convection

-conduction is loss of heat by contact will cooler objects (stethescope, crip, etc)

What, that develops around 36 weeks gestation, keeps the new borns lungs inflated?

A. residual volume

B. partial pressure of oxygen

C. surfactant

D. ductus arteriosus

C. surfactant

-a good residual volume develops after 10 mins of life

-the ductus arteriosus is a short broad vessel in the fetus that connects the pulmonary artery with the aorta and conducts most of the blood directly from the right ventricle to the aorta bypassing the lungs

You are assessing a new born's VS and his RR is 37 with periods of apnea.  What is the appropriate intervention?

A. chart and continue to monitor

B. rub the baby's back

C. administer O₂ via hood

D. get the mom to breast feed

A. chart and continue to monitor

-a normal new born respiration rate is 30-60 per minute with brief (by the time you notice they breath again) periods of apnea

The expected new born HR is?

A. 60-100 BPM

B. 90-120 BPM

C. 110-160 BPM

D. 120-150 BPM

C. 110-160 BPM

-you may also auscultate a soft systolic murmur due to the fetal openings of the heart that may not have closed yet

(ductus arteriosus and foramen ovale)

-the foramen ovale is an opening in the septum between the two atria of the heart that is normally present only in the fetus

Why would a baby born at 35 weeks be at a greater risk for hypothermia than a term baby?

A. immature circulatory system

B. immature lung development

C. less brown fat development

D. lower birth weight

C. less brown fat development

-brown fat develops at about 37 weeks gestation

The RN is observing a student nurse perform an assessment on a new born.  What action by the student would require the RN to interveine?

A. warming the stethescope prior to use

B. completely uncovering the baby for assessment

C. obtaining an axillary temperature

D. measuring abdomnial and head circumferences

B. completely uncovering the baby for assessment

-new borns have large surface areas which causes rapid heat loss

-they also have a thin layer of sub q tissue

Main sources of brown fat are located at:

Select all that apply

A. buttocks

B. abdomen

C. anterior sternum

D. neck

E. posterior sternum

C,D,E

You are caring for a new born following assessments and have placed him in a warmer.  What should his temp be before giving him a bath?

A. 98.0^F

B. 98.6^F

C. 99.0^F

D. 99.6^F

B. 98.6^F

-Following the bath he should be placed back under the warmer until his temp reads 98.6^F again

A nurse assessing a new born with a persistent low body temp should assess the new born for what?

A. infection

B. thyroid disorder

C. ocular hemorrhage

D. developmental delay

A. infection

-a change in temp may be the first sign of infection, however; unlike adults, a new born's temp doesn't always increase with an infection

When assessing the new born's temp what may be a reason to perform a rectal temp?

A. Moro reflex

B. imperforate anus

C. stimulate peristalsis

D. ease of assessment

B. imperforate anus

-rectal temp may be performed early to ensure a patent anus

A new mother questions why her baby urinates so often.  What would be the RN's response?

A. the baby is excreting retained fluid

B. it is a possible sign of infection

C. the baby is eliminating volume normally removed by the umbilical cord

D. the baby's kidneys can't concentrate urine

D. the baby's kidneys can't concentrate urine

-the baby will void frequently because the renal system doesn't reach maturity until around one year of life

What is the expected UOP of the new born for a 24 hr period?

A. 200-300 mL

B. 300-500 mL

C. 500-650 mL

D. 800-1000 mL

The fetal GI system matures around what gestational time?

A. 12-16 wks

B. 20-24 wks

C. 30-32 wks

D. 36-38 wk

D. 36-38 wks

-saliva is not produced in the first few weeks of life

-when feeding place the nipple on the back of the tongue

-sucking pads in the checks aid with sucking

-distention may cause reverse peristalisis

What should the feeding schedule be for a formula fed new born?

A. 1-2 oz q 4 hrs

B. 0.5-1 oz q 3 hrs

C. 2-3 oz q 3 hrs

D. 1-2 oz q 4 hrs

1. rooting
2. sucking
3. grasp
4. moro (startle)
5. tonic neck (fencing)
6. stepping
7. plantar
8. babinski

Vitamin K is given to all newborns because:

A. inadequate immune response

B. immature circulation

C. sterile GI tract

D. immature renal function

C. sterile GI tract

-the absence of normal flora in the GI tract leads to decreased coagulation factors  and increased bleeding times for new borns

Erythromycin ointment is applied to the new born prophylactically to prevent blindness caused by?

A. herpes

B. chylamidia

C. gonorrhea

D. HIV

Which part of PERRLA is absent in the new born?

A. equal

B. round

C. reactive

D. accommodation

D. accommodation

-new borns can't hold a gaze very long and have no accommodation

-blink reflex is present and the pupils are equal, round, and reactive

The new born's stages of reactivity are characterized by: Select all that apply

A. sleep phase for 15-30 mins

B. active phase for 15-30mins

C. sleep phase for 2-4 hrs

D. active phase for 4-6 hrs

E. active phase for 2-4 hrs

F. sleep phase for 4-6 hrs

B,C,D

-new borns are active the first 15-30 mins, they have a sleep phase for 2-4 hrs, followed by an active phase for 4-6 hrs

As part of the new born assessment the RN needs to get measurements of baby's what?  Select all that apply

A. head circumference

B. chest circumference

C. abd circumference

D. length

Behaviors that are part of the new born assessment include:  Select all that apply

A. awaken easily

B. comforted

C. sleep/activity

D. reactive to stimuli

E. satisfied with feeding

: a pasty covering chiefly of dead cells and sebaceous secretions that protects the skin of the fetus

-excessive vernix is an indication of early gestation

-by 40 weeks gestation vernix is only in crevices

the soft downy hair that covers the fetus

-excessive lanugo indicates early gestational age

distended sebacious glands, appear as small white papules on the nose, cheeks, chin

-normal variation that disappears within a week

bluish tone of the hands and feet of the new born due to immature circulation

-usually disappears within a few hours of delivery

-normal variation

one side of the new born has a deep pink color and the other side appears pale, this is caused by blood pooling on the lower side due to immature circulation

-normal variation

occur more frequently in darker skin toned babies, look like bruises usually on the sacrum

-present at birth

-must be documented due to bruising appearence

-may be visable up to 4 years

red skin tone in an area, usually present on the forehead or back of the skull base

-normal variation

-goes away within 2 years

-becomes vibrant red with crying

permanent change of skin color, idiopathic

-injury to this area could cause a bleeding problem

-caused by vascular beds near the skins surface

-possibility of tumor growth

-normal variation

rough rash, red base possibly puss

-develops with a day or 2 postpartum

-resolves on its own

-normal variation

An RN can determine the difference between ecchymosis and mongolian spots by:

A. blanching

B. molding

C. fontanel assessment

D. appearence

A. blanching

-ecchymosis (bruising) goes away momentarily when pressure is applied (blanching) mongolian spots do not

The process by which a baby's head conforms to the birth canal:

A. blanching

B. lightening

C. molding

D. fontanels

C. molding

-there may be bone displacement at birth, this will go away on its on

There are several subtle differences between caput succedaneum and cephalhematoma, but the most obvious of these is:

A. involvement of a suture

B. associated fever

C. Hct levels

D. associated jaundice

A. involvement of a suture

-caput will cross a suture line, cephalhematoma will not cross a suture

Characteristics of caput succedaneum are:

Select all that apply

A. will cross a suture line

B. onset within 24 hrs postpartum

C. outline is well defined

D. soft mass, pressure causes pitting edema

A,B,D

-the outline of caput is not well defined

-it is a normal variation that will go away

Characteristics of cephalhematoma are:

Select all that apply

A. will cross a suture line

B. onset within 24 hrs

C. outline is well defined

D. softer than caput

E. unilateral

C,E

-will not cross a suture line

-onset is 24-48 hrs

-it is harder than caput

The circumference of the head should be approximately ___ _______ than the circumference of the chest.

A. 2cm, smaller

B. 3cm, smaller

C. 2cm, larger

D. 3 cm, larger

The anterior fontanel has a(n) _______ shape and the posterior fontanel has a(n) _______ shape.

A. diamond, triangular

B. triangular, diamond

C. irregular, diamond

D. diamond, irregular

A. diamond, triangular

-just remember the anterior stays open longer and "Diamonds are forever"

As part of discharge teaching the RN tells the parents that the baby's posterior fontanel should be closed around _____ months and the anterior fontanel should be closed around ________ months.

A. 12-18, 2

B. 6-8, 10-12

C. 2, 12-18

D. 6, 14-18

C. posterior closed by 2 months

anterior closed by 12-18 months

-chest taken at the nipple line

-abd taken at the umbilicus

Which of these is NOT part of care for the umbilical cord?

A. alcohol to the base

B. clamp comes off before discharge

C. should fall off in 10-14 days

D. do not tub bathe until cord falls off

Which of these are part of circumsion and post circumsion care?  Select all that apply

A. must void before discharge

B. consent by both parents

C. post op wrapped in saline gauze

D. A&D ointment applied with diaper changes

E. any blood on diaper should be reported

F. yellow granular tissue is a sign of healing

A, D, F

-consent of the mom alone is needed

-post op it is wrapped in a vasoline gauze for 24 hours

-oinment is applied to keep it from sticking to diapers

-a little blood is expected

-during the procedure the limbs are strapped down in an extended posture and local anesthetic is used.

wedding of fingers or toes

-typically a family trait

extra digits on hands or feet

-if there is a bone it must be surgially removed

-if not it can be sutured to cut off blood supply

club foot is a change in bone structure that will require serial casting to correct

-positional deformity can be manipulated back in place

Clamping the umbilical cord causes:

A. increased systemic vascular resistance

B. decreased left atrial pressure

C. increased right atrial pressure

D. opening of the foramen ovale

E. weak flow of the umbilical arteries and vein

A. increased systemic vascular resistance

-this causes the ductus venosus to close

-left atrial pressure increases and right atrial pressure decreases closing the foramen ovale

-clamping immediately closes the umbilical vessels

ductus venosus : a vein passing through the liver and connecting the left umbilical vein with the inferior vena cava of the fetus, losing its circulatory function after birth, and persisting as the ligamentum venosum of the liver

foramen ovale : an opening in the septum between the two atria of the heart that is normally present only in the fetus

Increasing _______ causes the ductus arteriosus to close.

A. PCO₂

B. circulation

C. HCO₃

D. PO₂

D. PO₂

the ductus arteriosus is a short broad vessel in the fetus that connects the pulmonary artery with the aorta and conducts most of the blood directly from the right ventricle to the aorta bypassing the lungs

The stools of a breast fed new born compared to a formula fed new born would be:

A. soft, seedy

B. less frequent

C. dry

D. light yellow in color

A. soft, seedy

-breast fed babys have more frequent stool as breast milk is easier to digest

-the color is typically mustard yellow

Which of these is NOT a possible cause of not passing meconium within the first 24-48 hours?

A. meconium ileus

B. imperforate anus

C. bowel obstruction

D. necrotizing colitis

D. necrotizing colitis

-meconium is sterile, greenish-black, and viscous and usually passed within 24 hours

-it is contained in the lower intestine at birth

-bowel sounds can be heard about 1 hour after birth

False;

-this makes hypothermia a little harder to assess visually since new borns maintain temp through nonshivering thermogenesis

-primary sources of thermogenesis are the heart, liver, and brain

Which of these is not one of the three immunoglobulins that the new born immune system depends on?

A. IgB

B. IgA

C. IgG

D. IgM

A. Igb

-IgG is placentally transferred and provides antibodies to viral and bacterial agents.  It can be detected in the third month of gestation.  The infant synthesizes its own IgG by 3 months of life.

-IgM is synthesized by 20 wks gestation.  IgM does not cross the placenta. High levels of IgM in the neonate indicate a nonspecific intrauterine infection

-IgA is not dectable at birth and doesn't cross the placenta.  IgA is found in colostrum and breast milk.  It limits bacterial growth in the GI tract

The neurological status of the new born can best be assessed by:

A. sleep/activity patterns

B. feeding habits

C. primary reflexes

D. respiratory activity

C. primary reflexes

-diminished or absent reflexes is a good indication to the possibility of neurological impairment and will require further testing and monitoring

Jaundice is caused by:

A. conjugated bilirubin

B. unconjugated bilirubin

B. unconjugated bilirubin

-the yellowish color begins to appear when bilirubin levels reach 4-6 mg/dL

-factors also leading to jaundice include increased RBC lysis, altered bilirubin conjugation, or increased bilirubin reabsorbtion in the GI tract

_________ jaundice appears after 24 hrs of life, _________ jaundice appears before 24 hrs and is more dangerous.

A. Pathologic, physiologic

B. Physiologic, pathologic

Elements in the treatment of jaundice include all of the following except:

A. eye protection

B. hydration

C. serum bilirubin levels

D. bilirubin lights/blankets

E. UAC/UVC access

Is 97.6^F considered a normal axillary temp for a new born?

A. yes

B. no

A. yes

-normal axillary temps for new borns range from 97.5^F - 99^F

True

-if the new born is sleeping a rate of 110 is acceptable

The postpartum mom is worried because her baby has lost a little weight.  The RN should respond:

A. some new borns lose a little weight

B. this is a sign of inadequate feeding and we should try bottle feeding

C. new born weight loss is normal and will come back

D. this is a sign your colostrum is inadequate

C. new born weight loss is normal and will come back

-The Rule of 10, newborns lose 10% of their birth weight but gain it back by 10 days of life

False, most newborns double their weight by 6 months and triple their birthweight by 1 year

-infants typically gain 1 oz per day for the first 6 months and 1/2 oz per day for the second 6 months

The RN is giving discharge instruction for the postpartum parents.  She is covering nutritional needs and states correctly that the newborn will need how many calories per kg per day.

A. 50-100

B. 100-200

C. 200-300

D. 300-350

The newborn will need how much fluid intake per day?

A. 75-100 ml/kg

B. 100-125 ml/kg

C. 125-150 ml/kg

D. 150-180 ml/kg

D. 150-180 ml/kg

-they require alot of fluid intake due to their high metabolic rate

How does new born cold stress increase the risk for jaundice?

A. through increased distruction of RBCs

B. brown fat metabolism

C. vasoconstriction of vessels to the liver

D. as a byproduct of hypoglycemia

B. brown fat metabolism

-brown fat metabolism causes an increase release of fatty acids which not only causes metabolic acidosis but the elevated fatty acids in the blood can interfere with transport of bilirubin to the liver, increasing the risk for jaundice

Why is critical to maintain a stable temperature in a new born with respiratory distress?

A. the increase in metabolic rate

B. complications of vasodilation

C. they have depleted brown fat reserves

D. S&S of hypothermia aren't as obvious

A. the increase in metabolic rate

-this increases the use of oxygen for thermogenesis which by itself worsens respiratory distress

-cold stress also decreases the production of surfactant which impedes lung expansion

-with a drop of oxygen in the blood the pulmonary vessels will constrict also exacerbating respiratory distress

What effect does cold stress have on the serum glucose level of a new born?

A. causes hypoglycemia

B. causes hyperglycemia

C. no effect

A. causes hypoglycemia

-more glucose is used for thermogenesis due to an increased metabolic rate resulting in a low glucose level in the blood

Which of these is NOT a risk factor for new born respiratory distress syndrome?

A. prematurity

B. maternal diabetes

C. new born acidosis

D. L/S ratio of 2:1

D. L/S ratio of 2:1

-this is the ideal ratio and indicates good lung maturity

-RDS is almost exclusively seen in premature births

-new born acidosis caused by stress during delivery is a risk factor for RDS

RDS is characterized by poor gas exchange and ventilatory failure due to a lack of:

A. mature alveoli

B. lung surface area

C. surfactant

D. patent brochioles

C. surfactant

-surfactant coats the alveoli keeping them open so gas exchange can occur

-since premies lack surfactant they may have trouble maintaining alveolar stability

Which of these is NOT a direct result of insufficiant surfactant?

A. atelectasis

B. respiratory alkalosis

C. labored breathing

D. hypoxemia

C. respiratory alkalosis

-RDS will actually result in respiratory acidosis

-also with worsening atelectasis pulmonary vascular resistance increases, which decreases blood flow to the lungs

-the foramen ovale and ductus arteriosus remain patent

-the alveoli become necrotic and capillaries are damaged

False

-it can be apparent at birth or it may appear within 2-3 hours, after regualr breathing has been established

What drug is typically given to the pregant mother presenting with preterm labor directed at increasing maturity of fetal lungs?

A. Magnesium Sulfate

B. Betamethasone

C. Spironalactone

D. Tetracyclines

B. Betamethasone

-Magnesium Sulfate will probably be given to but it is directed at slowing labor giving the Betamethasone time to improve fetal lung maturity

Signs and symptoms of respiratory distress syndrome include:  Select all that apply

A. grunting

B. nasal flaring

C. retractions

D. wheezing

E. respirations over 50

F. cyanosis on room air

A,B,C,F

-fine crackles, not wheezing, are a sign of pregressing RDS

-respirations over 60 are a sign of RDS (30-60) is normal

-chest X-ray will help rule out other causes

-lab studies may include: blood, urine, CSF cultures, serum glucose/calcium, and ABGs

-also an extended nonflexed posture

New borns in the acute phase of RDS need to be NPO.

True or False?

True

-oral feedings increase respiratory rate and oxygen consumption both exacerbate the condition

Which are appropriate interventions for the new born with RDS?  Select all that apply

A. continuous pulse ox

B. suction

C. radiant warmer

D. perform only 1 intervention at a time

E. NPO status

F. admin oxygen as ordered

A,B,C,E,F

-interventions need to be clustered allowing the new born as much time to rest as possible (while at rest the new born uses less oxygen which is very important)

-parenteral feedings are used because oral feeding increases RR and oxygen use

Variable Decels               Cord Compression

Early Decels                    Head Compression

Accelerations                  OK

Late Decels                     Placental Insufficiency

-thanks Amelia

Newborns weighing less than _____ are put in reverse isolation.

A. 1000 g

B. 1250 g

C. 1500 g

D. 2000 g

Which mechanical ventilation temporarily substitutes for the heart and lungs?

A. CPAP

B. conventional mechanical ventilation

C. jet

D. ECMO

D. ECMO

-CPAP is continuous positive airway pressure, the newborn is doing most of the work

-Jet delivers small volumes of oxygen at high frequency

What is not an initial sign of cold stress in the newborn?

A. tachypnea

B. apnea

C. shivering

D. cyanosis

Why is transient tachypnea of the neonate more prevalent in C/S delivered newborns?

A. no thoracic compression of birth canal

B. more sudden exposure to extrauterine environment

C. average larger size of newborns

D. increased risk of immature lungs

A. no thoracic compression of the birth canal

-TTN is caused by the fluid in the lungs not being fully expelled upon delivery, during a normal vaginal delivery the thoracic compression of the birth canal expels most of this fluid and the rest is expelled when the lungs fill with air

-S&S are similar to RDS but xray imagery shows streaking

-interventions mimic those for RDS and the problem tends to resolve by 48 hrs as the fluid is absorbed

A green or gold color of the amniotic fluid upon rupture indicates:

A. maternal sepsis

B. uteroplacental insufficiency

C. meconium passage

D. maternal hemolytic disease

C. meconium passage

-green indicates recent passage of meconium, gold indicates some time has passed

Meconium aspiration causes a trapping of air in the ________ and prevents adequate gas exchange.

A. bronchi

B. bronchioles

C. plueral space

D. alveolus

D. alveolus

-aspyxia in utero leads to increased fetal peristalsis, relaxation of the anal sphincter, and passage of the meconium

Aside from the greenish color of amniotic fluid, other signs of meconium aspiration syndrome are: Select all

A. xray image of streaks or patches

B. expiratory wheezing bilaterally

C. Apgar scores below 6

D. hyperreflexia

A,C

-the xray image will reveal meconium streaks or patches, air trapping, or hyperinflation

-coarse crackles are heard

-newborns exhibit reduced activity

Treatment of meconium aspiration syndrome may include which of the following: Select all that apply

A. mechanical ventilation

B. thermoregulation

C. admin surfactant

D. admin antibiotics

You are an L&D nurse assisting a 27 yr old primapara who is delivering vaginally.  FHR baseline of 135 with early decels.  Upon ROM you observe a greenish color.  What interventions do you anticipate performing? Select all

A. endotracheal suctioning

B. auscultation of lung sounds

C. administer antibiotics

D. administer oxygen

ALL

-meconium aspiration should be your immediate concern

-you will also need to provide thermoregulation, possible surfactant, and do FREQUENT VS checks and listen to the lungs

What are possible signs of sepsis in the newborn?

Select all that apply

A. hypothermia

B. abd distention

C. positive Babinski sign

D. apnea

E. change in feeding patterns

A,B,D,E

-newborns can have an increase or decrease in temp associated with an infection or sepsis

-other signs are lethargy, hyperbilirubinemia, mottling, pallor, cyanosis

-definitive diagnosis is a positive blood culture

obtain your cultures

-the point of this question is just to remind us to obtain cultures prior to starting antibiotics

-you may need to administer oxygen or IV fluids as ordered

-monitor F&E balance, respiratory status, and whether supplemental nutrition is needed

-lumbar puncture may be needed to rule out meningitis

Hyperbilirubinemia is also called:

A. patholic jaundice

B. physiologic jaundice

Hyperbilirubinemia is characterized by a bilirubin level that exceeds ___ mg/dL within the first ____ hrs.

A. 8, 24

B. 4, 24

C. 4, 36

D. 6, 24

D. 6mg/dL within 24 hrs

-also characterized by a bilirubin level that rises more than 5 mg/day or a level greater than 12 mg/dL

Which of these is NOT a possible cause of pathologic jaundice?

A. macrosomia

B. hemolytic disease of the newborn

C. sepsis

D. polycythemia

E. hypothermia

F. hypoglycemia

A. macrosomia

-other possible causes are: impaired liver function, enclosed hemorrhage, and asphyxia neonatorum

______ is what unconjugated bilirubin binds to for transport to the liver, where it conjugates with glucuronide forming direct bilirubin.

A. iron

B. heme

C. magnesium

D. albumin

D. albumin

-this is important as this can be included in treatment (albumin administration) to provide additional albumin for binding of unconjugated bilirubin

-heme (iron) fragments that are left after RBC breakdown form unconjugated bilirubin

The treatment of choice for hyperbilirubinemia is:

A. exchange transfusion

B. therapuetic hypothermia

C. admin of albumin

D. phototherapy

D. phototherapy

-infant is placed under one or two fluorrescent lights (black lights) to decompose bilirubin in the skin by oxidation

-EYE PROTECTION MUST BE WORN AT ALL TIMES and the infant should be in a warmer so that as much skin as possible can be exposed

-exchange transfusion can be used to replace neonates blood with fresh blood, albumin is administered 1-2 hrs prior to transfusion to provide additional binding albumin for unconjugated bilirubin

Prevention of hyperbilirubinemia consists of all of the following except:

A. RhoGAM

B. encourage breastfeeding 8-12 times daily

C. don't supplement breastfed babies with water

D. phototherapy

D. phototherapy

-phototherapy is treatment, not preventative

-RhoGAM prevents hemolytic disease of the newborn a cause of hyperbilirubinemia

-fasting and water supplementation for breastfed babies stimulates the conversion of heme to bilirubin

Hemolytic disease of the newborn involves a breakdown of:

A. RBCs

B. liver enzymes

C. macrophages

D. fibrin and fibrinogen

A. RBCs

-usually caused by ABO incompatibility, but can also be caused by Rh incompatibility

-the most common incompatibility is a mother with a blood type of O (which has antibodies for A & B type blood) carrying a child with type A or B blood.  Her antibodies travel transplacentally to the fetus causing hemolysis

Assessment findings of the patient with hemolytic disease of the newborn would be expected to be:  Select all

A. hemolytic anemia

B. hyperbilirubinemia within 24 hrs

C. increased bleeding times

D. retinopathy

E. hepatosplenomegaly

The RN in the NICU is caring for a baby diagnosed with hemolytic disease of the newborn.  What drug should the RN anticipate having to administer?

A. erythromycin

B. penicillan

C. erythropoietin

D. betamethasone

C. erythropoietin

-is used to stimulate RBC formation

-other treatments mimic treatments for jaundice: phototherapy, exchange transfusion, monitoring bilirubin levels

False

-fetal alcohol syndrome has been detected in newborns of mothers who reported this intake of alcohol daily

-there is no safe amount of alcohol to drink, if the mother consumes alcohol it crosses the placenta and enters the fetus's circulation

Which is NOT an expected assessment finding in a newborn with fetal alcohol syndrome?

A. difficulty establishing respirations

B. irritability

C. lethargy

D. hyperbilirubinemia

E. seizures

F. poor sucking reflex

D. hyperbilirubinemia

-other signs of FAS are: prenatal/postnatal growth retardation, abd distention, strabismus, ptosis, myopia, facial anomalies of the nose or mouth, developmental delays

-most commonly caused by gonorrhea

-prophylactic eye ointment given at birth

-S&S: fiery red conjunctivae, thick purulent discharge from eyes, eyelid edema

-treat with IV antibiotics, contact precautions, sterile saline for eye irrigation

Kernicterus occurs when serum bilirubin levels get above ___dg/mL and moves into brain tissue.

A. 12

B. 15

C. 20

D. 22

C. 20

-causes permanent neurological problems

-S&S changes in LOC and shrill cry

-Opisthotonic position: "rainbowing" of the back

Retinopathy of preterm newborn is typically caused by:

A. gonorrhea

B. toxoplasmosis

C. birth trauma

D. oxygen

D. oxygen

-specifically prolonged exposure to high concentration O₂

-retinal detachment causes by rupture of retinal blood vessels

-gonorrhea causes opthamalia neonatorum

Which route of temperature assessment should be avoided with newborns experiencing apnea?

A. rectal

B. axillary

C. otic

D. temporal artery

A. rectal

-taking a temp rectally causes vagal stimulation and subsequently bradycardia and apnea

-assess all body systems, extent of problems directly related to how premature the infant is

-expect suppressed reflexes

-possible resusitation, oxygen administration, mechanical ventilation

-maintain neutral thermal environment

-possible TPN or gavage feedings

-Monitor F&E status, daily weight, strict I&Os

False

-HIV is acquired transplacentally through contact with maternal blood and secretions and it is transmitted through breast milk

When assessing a newborn and the RN notes polycythemia, what could be a possible cause?

A. early stage leukemia

B. hyperglycemia

C. fetal chronic hypoxia

D. newborn is LGA

C. fetal chronic hypoxia

-being chronically hypoxic the fetus will speed up RBC production to compensate

The RN suspects a broken clavicle in the newborn.  What would be an indication for this?

A. denting at the site

B. bruising at the site

C. asymmetrical moro response

D. redness at the site

The RN is caring for a newborn of a diabetic mother.  The newborn's serum glucose is 60 mg/dL.  What other test can the RN anticipate will be ordered?

A. serum chloride

B. CBC

C. serum magnesium

D. serum calcium

D. serum calcium

-the newborn with a diabetic mother may also have an immature parathyroid gland and subsequent calcium imbalance.