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A patient who is G3P2 at 32 weeks' gestation arrives at the triage unit complaining of regular uterine contractions. Her pregnancy history includes a preterm delivery at 34 weeks. Before examining her, the nurse performs electronic fetal monitoring and obtains a complete history. The patient reports no bleeding and no rupture of membranes. She has no vaginal examinations or sexual activity for more than 24 hours. The biochemical marker useful in this situation for predicting preterm birth is: - Correct Answer Fetal Fibronectin- Fibronectins are a family of proteins found in extracellular matrix. Fetal fibronectins are found in fetal membranes and decidua throughout the pregnancy. As the gestational sac implants and attaches to the interior of the uterus in the first half of pregnancy, fFns are normally found in cervicovaginal fluid. After 22 wks, the presence of fFns normally is no longer detected in vaginal secretions until approximately 2 weeks before the onset of delivery, term or preterm. When electronic fetal monitoring is used, the best indicator of fetal oxygenation status during labor is - Correct Answer Moderate fetal heart rate variability- variability is the most important fetal HR characteristic. It is the most important indicator of normal fetal pH or acidosis. Moderate FHR variability reliably predicts the absence of fetal metabolic academia The biophysical profile (BPP) is currently the primary method for evaluating fetal well- being through the assessment of various activities that are controlled by the central nervous system and are sensitive to oxygenation. The five variables included in the BPP are: - Correct Answer Feral tone, fetal breathing, fetal movement, nonstress test, and amniotic fluid An appropriate gestational age for glucose screening in women who are at low risk for developing gestational diabetes is - Correct Answer 24 - 28 weeks' gestation. Patients with risk factors (>35 years, body mass index >30, history of gestational diabetes, delivery of a LGA infant, polycystic ovarian syndrome, strong family hx) should receive a plasma glucose screening at their first prenatal visit followed by one at 24 - 28 weeks When women give birth sitting upright, which of the following indicators show lower values in cord blood? - Correct Answer PCO
What is the physiologic cause of late decelerations? - Correct Answer Transient interruption in fetal oxygenation An intrauterine pressure catheter, placed for the monitoring of uterine pressure, amnioinfusion, and fluid sampling, is useful in the treatment of - Correct Answer Variable decelerations- amnioinfusion is used to attempt to resolve variable fetal heart rate decelerations by correcting umbilical cord compression as a result of oligohydramnios. Must be careful to not cause polyhydramnios A patient who is at 42+5 has been pushing for 90 minutes and is near delivery. Her membranes spontaneously ruptured 3 hours ago and meconium was observed. The electronic fetal monitor demonstrates minimal fetal heart rate baseline variability. The most likely potential cause is: - Correct Answer Fetal metabolic acidosis- moderate variability reliably predicts the abscence of fetal metabolic acidemia at the time it is observed. Absent variability --> severe hypoxia. Marked variability--> methamphetamine use and scalp stimulation When performing a BPP, which of these fetal variables should the nurse recognize as placing the fetus at high risk and in need of either delivery or repeat BPPs no fewer than two times/week? - Correct Answer An amniotic fluid pocket measuring 1.5cm in two planes perpendicular to each other. Oligohydramnios is defined as a single deepest pocket of <2cm, or an amniotic fluid index of <5cm Elevated maternal serum a-fetoprotein is associated with: - Correct Answer neural tube defects- MSAFP is a protein made by the fetal liver. High levels may indicate neural tube defects or ventral abdominal wall defects, esophageal and duodenal atresia, and some renal or urinary tract anomalies. Low levels occur in some case of down syndrome What is triple marker screening? - Correct Answer Combines the chemical markers of MSAFP, hCG, and unconjugated estriol with the mother's age. A low value is associated with trisomy 18 After a vacuum-assisted delivery, the nurse should assess the infant for: - Correct Answer Subgaleal hemorrhage- the hemorrhage causes the veins above the skull and periosteum to rupture and bleeding occurs in the subaponeurotic space, which extends from the orbital ridges to the nape of the neck laterally to the ears. Potentially, the entire neonatal blood volume can hemorrhage into this space. Crosses the suture lines. Nurse should monitor serial head circumferences ad HCT levels and observe for signs of shock
responsible for glucose homeostasis, thermoregulation, increasing the BP, and stimulating surfactant production
- preterm infant secrets higher levels of catecholamines than the term infant
- administration of antenatal steroids actually causes a decrease of production of cats Which statement about cord blood gases is correct? - Correct Answer The cord arterial blood is the best indicator of the fetal metabolic condition before delivery; strongly correlates with perinatal asphyxia Which of the following statements correctly describes the role of surfactant? - Correct Answer Surfactant decreases surface tension to maintain a functional residual capacity A term infant delivered vaginally had APGAR scores of 9 at 1 min and 9 at 5 mins. The maternal hx identifies that mom is hep B surface antigen +. The plan of care for this infant should include which one of the following options? - Correct Answer Administer hep B immune globulin and hep B vaccine within 12 hours after birth. Term infant with negative mother should be given hep b vaxx at time of discharge A 36 week infant was delivered precipitously to a 35 y/o mother. Previous maternal hx reveals rapid deliveries. Pregnancy was uneventful with the exception of late preterm delivery. APGAR scores were 8 at 1 min and 9 at 5 mins. The infant was placed skin to skin at the time of brith and has remained on the moms chest attempting to breast feed. Initial VS: T: 97.6, HR: 156, RR: 50 - 60 occasional 70s. Breath sounds are slightly coarse w/ an occasional expiratory grunt. Color is pink with mild peripheral cyanosis. Based on these initial findings. follow up care should include which of the following interventions? - Correct Answer Keep the infant with mom and continue attempt to breast feed. Monitor VS and assess glucose status A term infant if now 24 hours old and rooming in w/ mom. The infant was a c-sec due to maternal arrest of labor. Apgars of 7 and 8. Membranes ruptured 12 hours before delivery and were mec stained. Prenatal group B step screen at 36 weeks (-). Maternal T before delivery was 100.2. Assessment reveals color slightly pale, decreased peripheral pulses and perfusion in lower extremities, difficulty getting baby to latch, slight lethargy, and RR 80 w/ no grunting, flaring, or retractions. Interventions? - Correct Answer Notify the pediatric provider and transfer infant to the special care nursery for obs under a radiant warmer with the poss dx of coarction of the aorta
- COA has the classic findings of decreased perfusion and pulses in the lower extremities. Can develop temp instabilities and poor feeding. VHD should be suspected when infants present with an increase in RR in the absence of any other resp distress and cyanosis
A term infant was just delivered with gastroschisis. Before transfer to a special care nursery, delivery room mgt would include which of the following options? - Correct Answer Place the infant under a radiant warmer, in a sterile bowel bag tied at the axilla, and in a supported side-lying position. The neonatal nurse is called over to the labor and delivery dep to assess a term infant in resp distress after an uneventful vaginal delivery. Upon arrival, the l&d nurse is providing bag mask ventilation. Infant appears dusky. Abdomen has scaphoid appearance Breath sounds are not audible on the L side of the chest, Heart sounds more prominent on the R side. Based on this info, infant most likely has? - Correct Answer Diaphragmatic hernia Which of the following descriptions defines a cephalohematoma? - Correct Answer Collection of blood between the periosteum and the skull that does not cross the suture line. May enlarge during the 24 hours after birth and may take several months to resolve. After the birth of an infant through pea soup meconium who has poor muscle tone and inadequate breathing, the appropriate first step is to: - Correct Answer Place the infant on the radiant warmer, dry, stimulate, and clear the airway A newborn is cyanotic, is grunting, and has a barrel chest and scaphoid abdomen, Upon auscultation the nurse hears bowel sounds in the L side of its chest. Breath sounds are diminished. Most likely cause? - Correct Answer Congenital diaphragmatic hernia The most effective intervention to treat respiratory distress in the infant with intestines herniated in the chest cavity is: - Correct Answer Intubation and ET tube ventilation After resuscitation of a term infant delivered after a motor vehicle accident, the infant is noted to be pale with sats of 95%. The BP is 34/22 (28). Tone is diminished and blood glu is 30. First action at this time would be? - Correct Answer Give a 30mL NS When preparing for the delivery of a hydropic infant, the team should be prepared to immediately: - Correct Answer Perform a thoracentesis- remove the fluid so it does not inhibit chest expansion -- ABCs A term infant is born via normal spontaneous vaginal deliver. The infant is noted to be cyanotic when quiet but pinks up when crying. The most likely dx? - Correct Answer Choanal atresia
asymmetric growth restriction, resulting in a larger HC in comparison to length and weight. Maternal HTN can cause asymmetric IUGR A 3.2 kg, 37 week infant is admitted to the NICU because of resp distress. The infant was a c-sec for maternal HTN, APGARS were 6 and 8. On admission, the RR is 80 - 90 w/ moderate indrawing and occasional grunting. A chest radiograph shows increased vascular markings with expansion of the chest to the tenth rib. This infant most likely has: - Correct Answer TTN- more common in late preterm and term infants born by c-sec. CXRs w/ over-expansion, haziness, increased vascular markings, and fluid in the fissure X-ray findings for MAS & RDS - Correct Answer 1. Hyperinflation, patchy infiltrates
- Atelectasis, air bronchograms, and diffuse granular infiltrates that often progress to severe b//l opacity A term, SGA infant is noted to have several anomalies, including low set ears, a low posterior hairline with webbed neck, a broad chest with widely spaced nipples, and edema of the hands and feet. These findings are most likely r/t: - Correct Answer Turner Syndrome- occurs in phenotypic females These findings including a prominent occiput, low-set malformed ears, small eyes and jaws, clenched hands with overlapping fingers, and rocker bottom feet are signs of: - Correct Answer Trisomy 18 These findings including Brushfield spots, small eats, simian creases, excess skin at the nape of the neck, upslanting palpebral fissures, hypotonia, large protruding tongue, and cardiac anomalies - Correct Answer Trisomy 21 Occurs in males, presents with long limbs, elbow dysplasia, clindodactyly of the 5th finger, hypospadias, hypogonadism, and cryptorchidism - Correct Answer Klinefelter Syndrome A term infant presents with tachypnea and increased WOB. The infant's O2 sat is 78%- 80% despite being given 100% O2. Congenital heart disease is suspected. Which of the following defects is most likely to cause these symptoms? - Correct Answer Transposition of the great vessels occurs when the aorta arises from the RV and the pulmonary artery rises from the LV. Marked cyanosis is a presenting feature because the aorta carries deoxygenated blood from the RV to the systemic circulation
Aortic stenosis - Correct Answer Usually asymptomatic at birth. When PDA closes, pallor, mottling, and poor perfusion mat develop A term infant is born to a mother with a history of cocaine use in pregnancy. The mother is concerned about the effects of cocaine on her baby. The nurse's response should be based on the knowledge that intrauterine cocaine exposure increases the risk of: - Correct Answer perinatal infection and respiratory distress syndrome Cardiac arhythmias and cleft lip can be seen in infants exposed to which substance in utero? - Correct Answer Amphetamines An infant is admitted to the NICU for mgt of neonatal abstinence syndrome secondary to maternal methadone use. Assessment of this infant is based on the knowledge that symptoms of methadone withdrawal typically present at how many days of life? - Correct Answer 2 - 3 days withdrawal of methadone presents later than other opioids b/c the half life is longer. Maintenance is usually given daily, therefore 1 day is too soon for symptoms to appear. Between 24 - 28 hours after delivery, methadone is still present in the infant's bloodstream In assessing a 3 day old infant with a hx of chronic intrauterine narcotic exposure, the nurse would expect to find - Correct Answer skin excoriation, diarrhea, tachypnea, hyperthermia, jitteriness, tremors, sleeplessness, hypertonia A term infant is noted to have low-set ears, a short neck with excessive skin, brushfield spots, a large tongue, and simian creases. This infant is at increased risk of - Correct Answer Duodenal atresia Heart defects seen in Tri21 inckude cardial cushion defects, VSD, PDA, ASD, and TOF. Infants at increased risk of renal anomalies An otherwise healthy infant is found to have eight cafe au lait spots scattered over his trunk and extremities. This infant should be investigated for the presence of what condition? - Correct Answer Neurofibromatosis After a vaginal delivery, a newborn infant is noted to have an enlarged fluctuant nontender scrotal sac. The left scrotum is larger than the right. There is no tenderness, but the scrotum appears bruised. The most likely explanation? - Correct Answer hydrocele - can be transilluminated
Microphthalmia, cataracts, glaucoma, chorioretinitis, and congenital heart disease are characteristic of which infection? - Correct Answer Congenital Rubella A 10 - day old infant born at 34 wks by spontaneous vaginal delivery after 12 hours of ruptured membranes develops a vesicular rash over the occiput. In addition to culturing the lesion, the nurse should anticipate that this infant will require which of the following tests on an urgent basis? - Correct Answer LP- performed in all suspected cases of neonatal herpes simplex virus Which of the following (BP, fundoscopy, percussion, red reflex) is done as part of the routine assessment of the well newborn? - Correct Answer Red reflex exam As part of a developmental assessment, the nurse is assessing the infant's ability to fixate on a picture of a human face. The technique she uses is based on the knowledge that a term newborn can be expected to briefly fixate on objects at a distance of _____ in? - Correct Answer 10 - 12 Which of these is the most common early sign of neonatal sepsis - Correct Answer Tachypnea-the lungs are the most frequent infection entry portal An infant is born vaginally complicated by mod shoulder dystocia. The infant is noted to have an asymmetric Moro reflex, and his arm is adducted and internally rotated. The wrist is flexed. Most likely cause? - Correct Answer Erb palsy- injury to brachial plexus A 1 month old infant born at 27 weeks gestation has developed two soft, raised, bright red tumors, one on the chest and one on the arm. These lesions have grown in size over the past 10 days when they were first noted. The mom asks the nurse if these lesions will continue to grow. The nurse's response is based off the knowledge that this type of lesion will: - Correct Answer Grow for 6 - 12 months and then involute- can treat with oral or topical propanolol, however, not necessary for it to go away A 2 day old full term male w/ a hx of low apgar scores, poor urine output, and hypertonicity was noted to have 2 episodes of apnea accompanied by lip smacking and eye deviations. Episodes are most likely: - Correct Answer Subtle seizures- most common type of seizures in premature infants Benign familiar seizures present similarly but w/o hx of low apgar scores Neonatal myoclonus manifests as episodes of repetitive jerking or jitteriness that does not stop with passive restraint
Tonic-clonic include stiffening and repetitive jerking An infant was born at 31 weeks and tx with CPAP for 10 days. At 2 weeks the infant was noted to have difficulty feeding and high-pitched inspiratory stridor. Most likely cause? - Correct Answer Laryngomalacia- most common cause of stridor in infants and typically presents in the first month of life. Risk factors include prematurity and respiratory support Laryngeal atresia is present at birth A newborn presents with FTT, liver failure, coppery brown skin rash, and purulent nasal discharge. The mother should be tested for? - Correct Answer Syphilis Skin lesions or scars, microphthalmia, and microcephaly or hydranencephaly are symptoms of which infection - Correct Answer Congenitally acquired herpes A 2 day old is noted to have significant jaundice. His blood work shows decreased hgb, hyperbili, and a positive direct antigen test. These findings are most likely a result of? - Correct Answer Immune-mediated hemolysis The nurse caring for a 2 day old African American infant notices a scattered rash on the infant's face and trunk. The rash consists of a mix of vesicles, pustules, and brown macules. The infant is afebrile and feeding well. The rash most likely represents: - Correct Answer Transient neonatal pustular melanosis- pustular melanosis is more common in infants with pigmented skin. The benign rash consists of a mixture of vesicles and pustules and pigmented macules. The vesicles and pustules resolve quickly, however the macules may remain for several months. Milia - Correct Answer small white cysts appearing most often over the nose and chin of the newborn Erythema toxicum - Correct Answer A pustular rash on an erythematous base. Tends to fade in one location and reappear in another Cutaneous candida - Correct Answer beefy red rash with satellite lesions. Found in the groin, diaper area, and occasionally in other skin folds such as the axilla A term newborn presents with a large port-wine stain over the forehead and eyelid. this infant is at risk for - Correct Answer Underlying hemangiomas- port wine stains over the
After a pregnancy complicated by polydramnios, the newborn should be assessed for the presence of - Correct Answer TEF- the presence of an esophageal atresia in an infant with TEF prevents the fetus from swallowing amniotic fluid resulting in polyhdramnios A 3 day old infant born after induction at 41 weeks has a birthweight of 4.2kg. The infant has course facial features, a large anterior fontanel with a normal HC, an umbilical hernia, and a hx of poor feeding. The infant should be assessed for? - Correct Answer Congenital hypothyroidism- signs are not always obvious at birth, often diagnosed during routine newborn screening. Other signs include thick skin, delayed bone age, poor perfusion, and hypothermia. After a vaginal delivery complicated by a prolonged second stage, a term infant is noted to have bruising over the occiput with a small firm mass on the right side of the sagittal suture. The mass does not cross the suture line. This is likely a: - Correct Answer Cephalohematoma- collection of blood under the periosteum most likely found over the parietal or occipital bones A 2 week old premie neonate has vesiculopapular lesions with an erythematous baise in her groin. Small white pustules can be seen on the lower abdomen. The most likely cause of this rash is - Correct Answer Candida albicans- common in groin with satellite lesions extending beyond the groin At 6 days of life a 24 week neonate is noted to have edema of the eyes with reddened conjunctiva and yellow discharge The most likely cause is: - Correct Answer Chalmydia trachomatis infection- onset of symptoms is between 5 - 7 days Herpes infection of the eye presents with keratoconjunctivitis, inflammation of the cornea, and conjunctiva, some edema may be present but no purulent discharge During a routine assessment after a spontaneous vaginal birth at term gestation, the neonate is pink when crying but demonstrates central cyanosis when quiet. Breath sounds are equal w/ no tachypnea. Most likely cause? - Correct Answer Bilateral choanal atresia *neonates are obligate nose breathers The mother of a healthy full teem newborn asks about the hymenal tag that she saw when changing her daughter's diaper. The nurse's response is based on the knowledge that: - Correct Answer Tags are benign and resolve spontaneously- usually disappear within a few weeks of delivery
After therapeutic cooling for HIE, the nurse notes a 1.5 cm area of induration on the infant's right arm and a second small, firm nodule over the sacrum. Which of the following should be monitored in this infant? - Correct Answer Calcium- these nodules are the result of subcutaneous fat necrosis, a complication of cooling. In the presence of multiple nodules, the risk of hypercalcemia is increased; Mg, Na, & K are not affected by the presence of these nodules In the immediate newborn period, the nurse should assess the PMI by placing the stethoscope over which intercostal space? - Correct Answer 5th- because of the dominance of the RV, the PMI best heard over 5th in the immediate newborn period Pulmonic valve- second intercostal Mitral valve- third intercostal Apex- 4th intercostal An infant born at 33 weeks gestation is now 2 weeks old and is noted to have an umbilical mass and persistent fluid drainage in the umbilical area. The infant is otherwise well and there is no erythema or edema around the umbilicus. The most likely explanation for this finding is? - Correct Answer Umbilical granuloma- most common umbilical mass and most frequently identified after cord separation due to persistent drainage from the umbilicus The strength of the lower extremities can be evaluated by eliciting which reflex? - Correct Answer Stepping Low birth weight is classified as birth weight less than: - Correct Answer 2500g very low birthweight <1500g extremely low birthweight <1000g Length measurement entails measuring the infant: - Correct Answer crown to heel LGA is birth weight - Correct Answer greater than the 90th percentile SGA is birth weight - Correct Answer less than the 10th percentile Head circumference indicates brain - Correct Answer growth- normal 10th-90th%
The correct way to assess the scarf sign in an infant is to: - Correct Answer Position the infant supine, take the infant's hand and pull it across the infant's chest and around the neck as far posterior as possible toward the opposite shoulder, and observe the elbow position in relation to the midline of the infant's body The correct way to perform the square window test is to: - Correct Answer Flexing the infant's hand on the forearm between the examiner's thumb and index ginger, using enough pressure to get full flexion, and visually measuring the angle between the hypothenar eminence and the ventral aspect of the forearm A newborn's mother asks why the nurse is performing a gestational age assessment when she had ultrasonography to determine her due date. The best explanation is: - Correct Answer The newborn's care is based on the gestational age and size-date plotting. *early (second trimester) ultrasonograms provide an accurate estimation of gestational age The mother of an infant born at 28 weeks gestation tells the nurse that she is very worried because her baby's ears do not look normal. Which of the following is the best explanation to give her? - Correct Answer As a baby matures, the pinnae of the ears will mature and the cartilage will eventually firm up
- genitilia will mature, skin will thicken, and subcutaneous fat will beceome deposited The nurse is performing a gestational age assessment on a premature infant. Observations will likely include which of the following? - Correct Answer Preterm infants have smooth plantar surfaces, which develop creases as the mature, and large amounts of lanugo over the shoulders and back, which will eventually slough off into the amniotic fluid as they get closer to term. Vernix covers preterm fetuses, but sloughs off into the amniotic fluid as the fetus develops, so that by term it is only left in the skin folds like the groin and axilla. Which of the following statements is true of growth curves? - Correct Answer Growth curves should be gestational age and gender specific Which of the following is a true statement about the neurologic portion of the gestational age exam? - Correct Answer Neurologic exam findings can be altered by neurologic disorders or asphyxic injury, which can affect tone and responsiveness, and therefore may not be reliable
SGA infants are at risk for which of the following: Anemia, Hyperthermia, Hypoglycemia, Brachial plexus palsy - Correct Answer Hypoglycemia- SGA infants may have hypoglycemia due to inadequate glycogen stores. Also at risk for polycythemia and hypothermia A 40 - week, 2000g infant is admitted to the NICU. The nurse should assess for? - Correct Answer Polycythemia Which of the following problems is a full-term LGA infant at highest risk for developing? Hypothermia, Hyponatremia, Hypokalemia, Hypoglycemia - Correct Answer Full term, LGA infants are at risk for birth trauma, polycythemia, and hypoglycemia Which statement best describes normal intrauterine growth and development? - Correct Answer Female genitilia develop with advancing age, and, by term, the labia majora and minora completely cover the clitoris An extremely low-birth-weight infant born at less than 25 weeks can be scored using the New Ballard Score gestational age examination. Which of the following findings is expected in an infant born at less than 25 weeks? - Correct Answer Plantar creases are absent- in the absence of foot creases, foot length (heel to toe) is the characteristic scored What maternal factor is a risk for an infant being born LGA? - Correct Answer Poorly controlled maternal glucose levels General considerations for accurate use of gestational age assessment tool, such as the Dubowitz score or New Ballard Score, include which of the following? - Correct Answer Perform the exam within 48 hours of life for the best accuracy A 4.5kg infant born at 38 weeks is most at risk for which of the following? - Correct Answer Fractured clavicle A systematic approach to the physical exam of a newborn should be performed: - Correct Answer between 12 - 18 hours of life (after successfully transitioning-- at birth may be too soon) The recommendation for when to use neonatal assessment tools for gestational age assessment is: - Correct Answer birth to 5 days before physical characteristics change
