23.6.1: Review Questions
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Review Questions
1 .
A new parent asks the nurse why the 36-hour-old newborn has a yellow skin tint. What should the nurse explain to the parent?
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The newborn’s liver is not functioning as well as it should.
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The yellow color indicates possible brain damage.
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The infant’s bowels are not excreting bilirubin.
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The color is a sign of physiologic jaundice, a normal finding.
2 .
At birth, a newborn weighed 6 pounds, 12 ounces. Three days later, the newborn weighs 5 pounds, 10 ounces. What conclusion should the nurse draw regarding this newborn’s weight?
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This weight loss is within normal limits.
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This weight gain is within normal limits.
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This weight loss is excessive.
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This weight gain is excessive.
3 .
The nurse is completing an initial assessment of the newborn. The newborn’s ears appear to be parallel to the outer and inner canthus of the eye. How does the nurse document the ear placement?
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low set
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high set
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a normal position
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facial paralysis
4 .
A new parent is concerned about a mass on the newborn’s head. The nurse assesses this to be a cephalohematoma based on what characteristics?
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The mass just appeared.
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The mass is on one side of the head and does not cross suture lines.
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The head is boggy and the crosses suture lines.
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The mass increases when the infant cries.
5 .
What condition can result from a long, difficult labor and is characterized by a localized, soft area on the newborn’s head?
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caput succedaneum
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molding
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depressed fontanelles
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cephalohematoma
6 .
During an assessment of a 12-hour-old newborn, the nurse notices pale pink spots on the nape of the neck. How does the nurse document this finding?
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nevus vasculosus
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Mongolian spots
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nevus flammeus
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telangiectatic nevi
7 .
How would the nurse elicit a rooting reflex in a newborn?
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Gently rub a finger on the side of the newborn’s cheek.
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Put a finger into the palm of the newborn’s hand and wait for them to grab on.
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Put a gloved finger into the newborn’s mouth and stimulate the roof.
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Grab both arms, pulling upward, and let them go, watching for a startle response bilaterally.
8 .
The nurse notices that a 6-hour-old newborn patient’s urethral opening is on the dorsal side of the penis. The nurse knows that this is called what?
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hypospadias
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epispadias
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phimosis
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unispadias
9 .
The nurse is completing a gestational assessment on a newborn whose parent was treated for preeclampsia during labor. The neonate is demonstrating “frog-like” posturing. The nurse knows this is likely due to what medication during labor?
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fentanyl in the epidural
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penicillin for treatment of group B strep infection
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magnesium sulfate for treatment of preeclampsia
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prenatal vitamins
10 .
The nurse knows that a full-term newborn presents with ears that include what assessment characteristics?
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slightly curved pinna; soft; slow recoil
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well-curved pinna; soft; ready recoil
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thick cartilage, ear stiff
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pinna flat, stay folded
11 .
The nurse is assessing a newborn girl born at 40 weeks of gestation based on the parent’s LMP. What assessment finding of the genitalia confirms this gestational age?
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labia majora covering clitoris and labia minora
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clitoris prominent, labia minora enlarged
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small labia minora, clitoris enlarged
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labia majora enlarged, labia minora small
12 .
What are the characteristics of a 40-week preterm newborn male’s genitalia?
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scrotum empty, faint rugae
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testes in upper canal, rare rugae
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testes down, appropriate rugae
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testes pendulous, deep rugae
13 .
When assessing the newborn for the presence of lanugo, where should the nurse look for it?
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on the newborn’s face
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on the newborn’s extremities
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on the newborn’s back near their buttocks
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on the newborn’s back between the scapulae
14 .
The nurse is assigned to the postpartum room of a 12-hour-old neonate, and the EHR has a task reminder prompting the nurse to complete a Brazelton assessment on the newborn. Why is this not appropriate?
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This newborn has been born to a person who is placing the infant up for adoption.
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This newborn has been born to a person who birthed by cesarean section.
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This newborn is only 12 hours old.
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This newborn is experiencing pathologic jaundice.
15 .
The nurse is assigned to the room of a 15-year-old person who gave birth to a newborn 72 hours ago. Why is this newborn a perfect candidate for the Brazelton assessment?
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This parent-newborn couplet is at risk for delayed attachment.
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The newborn is likely going home soon.
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The EHR is prompting her to do so.
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The infant is likely withdrawing from a substance.
16 .
What categories are in the Brazelton assessment? Select all that apply.
- interactive process
- organizational process
- behavioral process
- motoric process
17 .
The nurse knows that during the interactive process of the Brazelton assessment, the newborn will receive an exceptionally good rating by reacting to what? Select all that apply.
- turns their head toward a familiar voice
- stays awake
- focuses on an object
- cries inconsolably
18 .
The nurse knows that during the motoric process, the newborn will be rated poorly if they do what?
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They have good reflexes.
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They have hyper- or hypotonic movements.
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They have good head control.
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They have moderate activity levels.
19 .
The nurse knows that during the organizational process, the newborn will be rated as exceptionally good if they do what? Select all that apply.
- They will remain alert.
- They will be highly irritable and demonstrate mood swings.
- They will demonstrate self-soothing and quieting techniques.
- The newborn will shut down body responses to stimuli when drowsy.
20 .
The nurse knows that newborns that are high-risk for delayed attachment with their parents/caregivers are at risk for what? Select all that apply.
- poor breast-feeding initiation
- not bonding with their parents
- hard to wake to feed
- not feeling happy
21 .
When the nurse determines they have a high-risk newborn and birthing person in their care, what can they do to mitigate the situation?
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Document in the chart.
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Reassure the parent that everything will be fine.
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Refer the couplet to social work for early intervention.
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Refer to a pediatric health-care provider for well-baby checkup.