Neonatal Care

The nurse has been called to help with a 24-year-old G1P0 female with a viable intrauterine pregnancy at 42-weeks’ estimated gestational age. Patient is not in active labor, following an arrest of descent at the end of the first stage of labor. There was meconium detected in the amniotic fluid after PROM, and the fetus has had multiple episodes of bradycardia and late decelerations. Patient has a history of cocaine abuse. Which of the following statements is most correct regarding the management of this neonate when it is delivered?

Which of the following may benefit from inhaled surfactant therapy? Select all that apply.

The nurse is called to assist a 32-year-old G1P0 female who is in active labor with a viable intrauterine pregnancy at 30-weeks estimated gestational age. The patient delivers a neonate who requires intubation due to secondary apnea. The nurse auscultates to assess for endotracheal tube placement and notes breath sounds are louder on the right than the left. Which of the following is the next best step in management?

A 15 mL/kg transfusion of packed red blood cells has been ordered for a premature neonate with a hemoglobin of 6.4 g/dL. The neonate is 4 days old and weighs 14 ounces. How many milliliters of blood does the nurse administer? Enter your response as a whole number.

The nurse is assessing a neonate’s fit in the car seat for safety. The nurse notes the parent has placed the clip snugly against the infant’s chest at the level of the armpits; the nurse cannot pinch any slack at the shoulder straps. Which response by the nurse is appropriate?

The nurse is called to assist a 29-year-old G1P0 female with a viable intrauterine pregnancy at 42-weeks estimated gestational age who is in active labor. During spontaneous vaginal delivery of the neonate, shoulder dystocia occurs. The nurse should carefully assess the neonate for which of the following common complication of shoulder dystocia?

An infant has undergone surgery for plagiocephaly. No hydrocephalus is present. The nurse anticipates providing education to the parents about which post-surgical intervention?

The neonate experiences respiratory distress immediately after birth and is intubated after receiving bag-mask ventilation. The nurse notes copious oral secretions and is unable to pass a nasogastric tube or an orogastric tube. Upon assessment, the nurse notes the child has small eyes, malformed ears, and a micropenis. Which of the following genetic disorders does this neonate most likely have?

The nurse is called to assist with a 25-year-old G1P0 female with a viable intrauterine pregnancy at 40-weeks gestational age. Patient is already in the second stage of labor and quickly delivers a vigorous, healthy infant without complications. The neonate is placed skin-to-skin with mom and latches well to breastfeed but becomes acutely cyanotic after two minutes of eating. Once separated from the breast, the baby begins to cry, and the cyanosis resolves. Which of the following interventions by the nurse is most appropriate?

The nurse is assigned to care for an infant diagnosed with Down syndrome. The nurse understands that this chromosomal abnormality was most likely caused by which of the following events?

A neonate is born at full term to a mother who did not receive prenatal care. The neonate required moderate resuscitation at birth. Upon assessment, the nurse notes poor muscle tone, a protruding tongue, low nasal bridge, and low-set ears. A loud continuous “machine-like” heart murmur is heard. The patient requires 85% FiO2 to maintain an oxygen saturation above 90%. Which of the following tests is the next best diagnostic step in the management of this patient?

A female neonate is born at full term to a mother with late prenatal care. Upon assessment, the nurse notes swelling of the neonate’s feet, a webbed neck, and widely-spaced nipples. Upper extremity pulses are bounding, but lower extremity pulses are barely felt. The nurse anticipates which karyotype result for this neonate?

The nurse is assigned to care for a neonate who is born with a chromosomal abnormality. The nurse is reviewing the cytogenetic location of the chromosomal defect for this patient. The results state the patient has a deletion at 14q21. Which of the following is the correct interpretation of this result?

The nurse is educating the parents of a child diagnosed with maple syrup urine disease. The nurse asks the parent, “Which nutrient should you avoid giving your child?” Which of the following responses by the parents indicates a need for further teaching?

A 3-day-old premature neonate was born at 24-weeks estimated gestational age. The patient is mechanically ventilated with a fraction of inspired oxygen (FiO2) of 30%, rate of 40 breaths per minute, positive end expiratory pressure of 5, and peak inspiratory pressure of 20. The arterial blood gas results are as follows: pH = 7.34, PaCO2 = 48 mmHg, PaO2 = 70 mmHg, and HCO3 = 25 mEq/L. The nurse anticipates which changes will be made to the patient’s ventilator settings?

An infant is brought to the emergency department with abdominal distention, currant-jelly stools, dark-green emesis, and lethargy. Upon assessment, the nurse notes a palpable sausage-shaped mass in the right upper quadrant. The nurse suspects which condition?

A fetus is diagnosed in utero with autosomal recessive polycystic kidney disease. The mother is noted to have severe oligohydramnios. Which statement is most accurate for the prognosis of the fetus?

The nurse is attending the delivery of a full-term neonate whose mother received poor prenatal care. The neonate has cyanosis, increased work of breathing, a barrel chest, and a scaphoid abdomen. The nurse auscultates the patient’s lung fields and notes bowel sounds over the left side of the chest. The nurse suspects which condition in this neonate?

The nurse notes a mother attempting to remove the vernix from her newborn baby during a bath. Which response by the nurse is most appropriate?

The nurse is counseling the pregnant woman on care the baby will receive after birth. Which statement by the nurse is correct?

Which type of heat loss has the greatest effect on a neonate immediately after delivery?

The 4-hours-old neonate is brought to the special care nursery from the mother’s room for an assessment. The temperature is 35.4° Celsius. Which initial action does the nurse take?

The nurse is providing discharge teaching to a new mother. Which of the following statements about the neonate’s sleep patterns is correct?

Which patients may benefit from exogenous surfactant administration? Select all that apply.

A 6-day-old neonate in the newborn intensive care unit has been prescribed oxacillin for a suspected central line-associated bloodstream infection. The nurse receives the following order: oxacillin IV 50 mg/kg/day, divided q12h. The neonate weighs 2 lb. 11 oz and the pharmacy dispenses the medication in a concentration of 20 mg/mL. How many milliliters will the nurse administer for each dose? Round your answer to the nearest tenth decimal place.

At delivery, the neonate is noted to have diffuse purple lesions over the entire body and is taken to the neonatal intensive care unit for further assessment and management. The nurse notes the toes have turned black; pedal pulses are palpable. The nurse anticipates testing will reveal a deficiency in which substance?

The neonate is diagnosed with purpura fulminans. Which order does the nurse anticipate first?

The neonate born at 34-weeks estimated gestational age had Apgar scores of 3 and 7 at 1 and 5 minutes, respectively and is taken to the nursery for observation due to a need for continuous positive airway pressure (CPAP). Significant oral secretions are noted and an orogastric tube is unable to be placed because it meets resistance and comes back out the mouth. The nurse suspects which condition?

The premature neonate with severe intrauterine growth restriction is being evaluated for possible in utero TORCH organism exposure. The nurse obtains lab specimens to test for which organisms? Select all that apply.

An infant of 32 weeks gestation is born precipitously and is noted to be pale and limp. Resuscitative actions are initiated. At one minute of life, the infant has a pinkish central body, bluish hands and feet, a heart rate of 135 bpm, grimaces with painful stimuli, remains limp, and exhibits gasping respiration. Assign an Apgar score to this neonate using a whole number.

The nurse in the neonatal intensive care unit receives report from the Labor and Delivery nurse about a full-term neonate and learns the patient’s Apgar scores were 0-0-1-5 at 1, 5, 10, and 15 minutes of life, respectively. How does the nurse interpret this information?

The full-term neonate is born via normal spontaneous vaginal delivery (NSVD). The neonate cries at the perineum and maintained flexion against gravity but is noted to be bluish gray. Which intervention is appropriate?

The 3-week-old neonate has failed to return to birth weight due to projectile vomiting partially-digested breast milk after most feedings. Upon assessment, an olive-shaped mass is palpated in the upper right abdominal quadrant. The nurse anticipates which diagnosis?

The neonate of 36 weeks estimated gestational age is born via emergency cesarean section, appears limp, blue, and apneic, and is brought to the warming table. He is warmed, dried, and stimulated, and a pulse oximeter is placed on his right wrist. At 30 seconds of life, his heart rate is 66 bpm and his oxygen saturation is 54%. Positive pressure ventilation is initiated via CPAP bag and mask. At one minute of life, the heart rate is 118 bpm, the extremities are still blue but the trunk is pink, and he begins to move and cry with stimulation. The nurse documents which number for the Apgar score? Enter your answer using a whole number.

The neonate born at 41 weeks gestation is diagnosed with persistent pulmonary hypertension of the newborn (PPHN). Which information does the nurse give the mother about this condition?

The grandparents of a baby in the newborn intensive care unit (NICU) ask the nurse about the age of another baby. Which response by the nurse is most appropriate?

A newborn was delivered one minute ago. He is not breathing, has a heart rate of 128 bpm, has a moderate amount of lanugo, has some muscle tone without active movement, does not grimace with stimuli, and has a pink body with blue extremities. Which APGAR score is correct?

A cesarean section is the only safe method of delivery for the fetus when the pregnant woman has which condition? 

The G2P1 patient who is 33 weeks pregnant is brought via ambulance to the emergency department due to significant vaginal bleeding and abdominal pain. Which action does the nurse take first?

The 5-day-old infant presents to the pediatrician's office for a well-baby visit. The parents report being happy that their child is a "good baby" who sleeps a lot and rarely cries. They also report the baby eats 4 times per day, sleeping for 8 hours at night. The nurse notes the baby is at the 70th percentile for weight. Upon assessment, the baby is minimally responsive. The nurse is most concerned about which condition? 

The 34-year-old G1P1 patient who just delivered a healthy baby via cesarean section four hours ago. The patient sits on the bed watching her newborn lying in the bed but does not touch or hold the baby. Which response by the nurse is most appropriate? 

Maternal infection with which organism(s) during pregnancy may lead to neonatal seizures? Select all that apply.

A new mother is discussing alcohol consumption while breastfeeding her baby. Which statement indicates a need for further teaching? 

The 4-hour-old neonate in the nursery begins making rhythmic movements with the hands and smacking of the lips. An electroencephalogram is performed, and seizures are observed. The nurse prepares to administer which medication?

The nurse knows which immunoglobulins are passed to the neonate through breastfeeding? Select all that apply.

A palliative plan of care is created for a newborn with Trisomy 18. Which is the underlying principle for this healthcare decision?

The new mother reports the baby makes snoring noises while trying to breastfeed. The nurse anticipates an examination will reveal narrowing at which level of the airway?

A 23-year-old pregnant woman presents to the clinic stating, “I am a teacher and have heard there is a measles outbreak in my community. I want to get the measles vaccine to protect my baby and myself. Which response by the nurse is most appropriate?

The 3-day-old full-term neonate has yet to pass meconium and is experiencing significant abdominal distention. The child is otherwise healthy and is not requiring respiratory support. The nurse learns that Hirschsprung disease is suspected and prepares the patient for which test that will definitively diagnose the condition?

The neonate with suspected Hirschsprung disease is scheduled to undergo testing to definitively diagnose the disorder. Which assessment finding prompts the nurse to request the procedure be postponed?