Neonatal Care

The nurse is using the Finnegan scoring system to assess a neonate for opioid withdrawal. The first score is 9 and the second score is 14. Which statement is accurate?

A new mother calls the nurse hotline concerned that her 4-day-old infant is sleeping too much. The nurse bases the response on which understanding of the newborn and postpartum period?

The nurse is preparing to discharge a newborn and her mother. The nurse checks that the mother is able to state which principle of safe sleeping?

The nurse provides which education to parents of a 1-day-old infant to prevent Sudden Infant Death Syndrome? Select all that apply.

Which hormone is produced in the mother as a result of breastfeeding?

The fetus is delivered in which stage of labor?

Which reflex is demonstrated by allowing the infant to fall a few inches to a padded surface?

Which term describes the white biofilm that covers neonatal skin at birth?

The postpartum nurse is supervising new parents placing their newborn into the car seat to drive home during a snowstorm. Which observation is most concerning?

Which information does the nurse include when preparing an informational session for expectant first-time parents about car seat safety? Select all that apply

A baby is born precipitously to a mother who did not have prenatal care. The neonate requires only the initial steps of resuscitation but is found to have a bilateral cleft lip and palate. Review the patient’s assessment here: Position at rest: Complete flexion Square window: 0° Arm recoil: 75° Popliteal angle: 80° Scarf sign: Elbow does not cross midline Heel to ear: Foot does not reach the umbilicus Skin: No veins visible, cracking of skin at joints, dry Lanugo: Mostly bald skin Plantar surface: Creases over entire sole Breast: 4 mm bud with raised areola Ear: Formed pinna with instant recoil Genitals: Descended testes bilaterally, rugae over entire scrotum For which referrals does the nurse advocate for the baby prior to discharge? Select all that apply.

The 2-day-old full term child has been rooming in with the mother who reports successful breastfeeding. Which information is most important to report to the provider?

The baby born at 23-weeks-gestation is 6 hours old when a pneumothorax develops and the patient decompensates rapidly. Despite stabilization of the airway and evacuation of the pneumothorax, the baby is not responding to chest compressions and intravenous epinephrine and is deemed unlikely to survive. The parents request the baby to be baptized before life-saving interventions are ceased. The chaplain is called but is unable to make it to the hospital immediately. Which action by the nurse is most appropriate?

The nurse is supervising a nursing student in the emergency department. Which actions by the nursing student indicate effective learning? Select all that apply.  

Which intervention is most important for the 38-week-gestation neonate who was antenatally diagnosed with hypoplastic left heart syndrome and born 2 hours ago?  

The nurse in a tertiary medical center with attached pediatric hospital is caring for the 28-year-old gravida 3 para 2 woman who is 40-weeks pregnant and presents to the labor and delivery unit 1 hour after spontaneous rupture of membranes. Patient had good prenatal care, an amniotic fluid index of 12, and pregnancy is complicated only by the antenatal diagnosis of fetal single ventricle anatomy.  Labor is progressing well and the fetus is tolerating contractions well with moderate variability in fetal heart tones. The nurse is most concerned with having which item in the delivery room? 

The nurse is providing discharge education to the parents of the 7-day-old neonate who required a blood transfusion due to blood loss following circumcision. Which instruction is most important?  

The 3-week-old neonate of the mother who desires to formula feed is noted to have musty urine and excessive vomiting. Which initial intervention is most appropriate?  

The 18-day-old neonate has musty-smelling urine and vomits with almost every feeding. The patient, who was born after an uncomplicated pregnancy and delivery, had a normal newborn screening that was drawn in the hospital after birth. Which action by the nurse is most appropriate?   

The nurse is preparing to care for a baby antenatally diagnosed with type C esophageal atresia with tracheoesophageal fistula. Which interventions are the priority in the first day after birth?  

The 36-hour-old neonate who was born at 37 weeks gestation to a G3P2 mother has yet to pass meconium. The baby was born by cesarean section due to refractory preeclampsia with severe features. The mother reports the baby has been breastfeeding well after a slow first 12 hours. Upon assessment, the baby appears well with good tone and responsiveness. The baby’s anus is patent and the abdomen is soft and rounded; bowel sounds present. The mother denies emesis in the baby. An abdominal x-ray is obtained, which is normal. The nurse informs the mother that which test will be performed next? 

During the 1-hour assessment of the healthy, full-term neonate born to the 25-year-old G1P1 mother, the nurse notes the urethral meatus is on the ventral part of the penile shaft just proximal to the glans. The assessment is also notable for widely-spaced, downward-slanting eyes that resemble the baby’s father. The nurse provides which information to the parents?  

During the shift assessment of the healthy, full-term neonate born 24 hours ago to the 25-year-old G1P1 mother who had an uncomplicated pregnancy and delivery, the nurse notes the urethral meatus is on the ventral part of the penile shaft. The assessment is also notable for wide-spaced, downward-slanting eyes that resemble the baby’s father. The baby is pink, well-perfused, and breathing comfortably with normal heart and lung sounds. The mother reports the child is breastfeeding every 2 hours and has voided and stooled several times. Which additional assessment is most important? 

The 20-year-old mother brings her 6-day-old infant to the clinic because the child has had yellow drainage from both eyes since yesterday that returns despite wiping it away. Upon assessment, bilateral eyes are closed due to a sticky, mucopurulent discharge. The mother reports a normal spontaneous vaginal delivery after an uncomplicated history. The baby went to breast immediately and the pair were discharged from the hospital 48 hours after birth. The nurse performs a swab of the drainage and anticipates which gram stain result? 

The 5-day-old 38-week-gestation neonate was born to a 25-year-old primigravida woman after a pregnancy and vacuum-assisted delivery complicated by gestational diabetes, large for gestational age fetus, and shoulder dystocia. The neonate required vigorous stimulation and positive pressure ventilation. Apgar scores were 3 and 8 at 1 and 5 minutes of life. At the pediatrician’s appointment after discharge, the neonate is found to have a large bruise at the back of the head that was sustained during birth and eyes glued shut with yellow, mucopurulent discharge. A gram stain of the drainage reveals gram-negative cocci in pairs. The mother states, “No matter what I do, it keeps coming back. I’ve used warm compresses and washed it away.” Additionally, the mother reports the infant is breastfeeding well with 4 wet diapers and 1 stool per day. The nurse informs the provider of the assessment and requests which order first?  

The 4-week-old neonate in the neonatal intensive care unit was born at 29 weeks gestation. The patient is stable on room air and has been tolerating nasogastric feedings of expressed breast milk. Generally an active and responsive patient, the nurse notes the patient is lethargic and does not react to his diaper change. Additionally, the patient’s heart rate is 194 bpm, respiratory rate is 82 breaths per minute, and the blood pressure is 54/21 mm Hg. The patient’s abdomen is distended and discolored; dark green emesis is noted as well. An abdominal x-ray is ordered and performed. Which x-ray findings are consistent with the patient’s clinical picture? Select all that apply.  

During the provider’s exam of the 6-hour-old neonate, the provider reports observing a red reflex in the neonate’s right eye, but not the left. The provider observes whiteness at the back of the eye. The nurse compiles information for the new parents about which procedure?  

During the provider’s exam of the 6-hour-old neonate, the provider reports observing a red reflex in the neonate’s right eye, but not the left. The provider observes whiteness at the back of the eye. Enucleation is performed and the diagnosis of retinoblastoma with clear tumor margins is confirmed. No chemotherapy or radiation is required. The infant is ready to be discharged home as a healthy baby. Which health screening information is most relevant to this family? 

The 28-year-old G2P1 patient presents after rupture of membranes 2 hours ago at 39 weeks gestation. She has a history of prior cesarean section for failure to progress but is otherwise healthy; this pregnancy is uncomplicated. Contractions are painful and labor is progressing. Abruptly, the patient complains of extreme abdominal pain; the nurse observes a significant amount of blood coming from her vagina. Which action is most important? 

The 28-year-old G2P1 patient presents after rupture of membranes 2 hours ago at 39 weeks gestation. She has a history of prior cesarean section for failure to progress but is otherwise healthy; this pregnancy is uncomplicated. Contractions are painful and labor is progressing. Abruptly, the patient complains of extreme abdominal pain; the nurse observes a small amount of blood coming from her vagina. Which assessment prompts the nurse to prepare the patient for an emergency cesarean section? 

The nurse notes the 4-day-old infant develops circumoral cyanosis while breastfeeding. Once the seal is broken and the neonate begins to cry, the cyanosis resolves and the child becomes pink. There are no nasal secretions and the neonate’s vitals are normal. Which action by the nurse is most helpful?  

The 12-hour-old neonate was born at 39 weeks to a G2P2 mother after an uncomplicated pregnancy and delivery. Slight oligohydramnios was noted during the pregnancy. The neonate has not urinated. Upon assessment, the nurse notes stable vital signs and suprapubic distention. The nurse contacts the provider to advocate for which initial intervention?  

The mother of the 7-week-old infant reports the baby has had fewer and fewer wet diapers and hasn’t stooled in 3 days despite having a ravenous appetite. The mother reports that the child has been vomiting with increasing force and volume over the past two weeks. The emesis just appears to be partially digested breastmilk and fluid. The infant appears well and vitals are normal. Upon palpation of the abdomen, a small, olive-shaped mass is appreciated. The nurse alerts the provider and prepares education for which procedure?  

The mother of the 7-week-old infant reports the baby has had fewer and fewer wet diapers and hasn’t stooled in 3 days despite having a ravenous appetite. The mother reports that the child has been vomiting with increasing force and volume over the past two weeks. The emesis just appears to be partially digested breastmilk and fluid. The infant appears well, but mucous membranes are dry, the child has a low-grade fever, and is tachycardic. Upon palpation of the abdomen, a small, olive-shaped mass is appreciated. A serum electrolyte panel reveals a sodium of 132, potassium of 2.7, chloride of 89, and a glucose of 92. The nurse performs which nursing action first? 

The baby born at 40 weeks gestation requires substantial resuscitation at birth and remains a critically ill neonate. Initial testing reveals a diagnosis of E. coli sepsis. Until further testing is completed, the nurse avoids administering which substance?

The neonate is found to have a hemoglobin of 26 g/dL on the first day of life. Which additional findings does the nurse anticipate in this patient? Select all that apply.