Question 1

A midwife is assessing a mature female neonate born to a 21-year-old G3P2 client. Which of the following findings suggests that further evaluation and notification of the physician are necessary?

Accepted Answer

A birth weight of 11 pounds is unusual, which requires further evaluation and notification of the physician. Mature female newborns usually weigh 7.5 pounds, whereas mature male newborns weigh 7.7 pounds on the average. The average birth length for female newborns is 53 cm. In mature newborns, the head circumference is usually 34 to 35 cm. Chest circumference is usually 2 cm less than the head circumference.

Question 2

A 3-day-old newborn is placed under the phototherapy lights for the treatment of jaundice. The midwife expects the newborn to pass:

Accepted Answer

A newborn placed under phototherapy lights passes bright green stools because of increased bilirubin excretion. Blackish-green stools are usually passed within 24 hours after birth. Light yellow stools are passed by breastfed newborns by the fourth day of life. Bright yellow stools are passed by formula-fed newborns.

Question 3

A midwife is assessing the gastrointestinal system of a 3-day-old newborn. Which of the following findings indicates that further tests are required?

Accepted Answer

A newborn presenting with blood-flecked stools indicates that further tests and notification of the physician are necessary. It is usually a sign of anal fissure. In certain cases, the newborn swallows the maternal blood during birth, so a dipstick Apt test is usually performed. The other options are expected findings in newborns. Newborns usually pass meconium stools 24 to 48 hours after birth. If this does not occur, the newborn may have meconium ileus, an imperforated anus or a bowel obstruction. Newborns regurgitate easily because of immature cardiac sphincters. Loose, green stools on the third day of life are transitional stools.

Question 4

Which of the following statements about the tonic-clonic reflex is not accurate?

Accepted Answer

The tonic-clonic reflex disappears between the second and third month of life. It appears that tonic-clonic reflex does not have function. The movement is observed in the arms and lower extremities, but it is more evident in the arms. A newborn is demonstrating tonic-clonic reflex when the arm and leg on the side to which the head turns extend and the opposite arm and leg contract.

Question 5

A newborn has difficulty breathing and experiences severe coughing spells during breastfeeding. The newborn is diagnosed with a tracheoesophageal fistula. Without proper management, the newborn is most likely to lose which reflex?

Accepted Answer

Without proper management, a newborn with a tracheoesophageal fistula is most likely to lose the sucking reflex. The sucking reflex is characterized by sucking motion of the lips when the lips are touched. It can disappear immediately if it is never stimulated. Because newborns with TEF are not allowed to take anything by mouth until the abnormality is corrected, their sucking reflex may be insufficiently stimulated. The midwife can maintain the sucking reflex by offering the newborn non-nutritive sucking objects after the surgery.

Question 6

When a substance is placed on the anterior portion of the newborn's tongue, the newborn extrudes the substance. The midwife knows that this reflex disappears at about:

Accepted Answer

The extrusion reflex is demonstrated when a newborn extrudes any substance that is placed on the anterior portion of the tongue. This reflex prevents the swallowing of inedible substances, and it normally disappears when an infant is about four months old.

Question 7

On assessment, the midwife notes that a female newborn has pink patches at the nape of the neck. The midwife informs the mother that these patches:

Accepted Answer

Nevus flammeus lesions, also known as stork's beak marks or stork bites, do not fade, but they are usually covered by the hair line. They are more common in females than in males. These lesions are classified as vascular tumors of the skin. They are not caused by an injury during labor. Mongolian spots may disappear by school age without treatment.

Question 8

A midwife is monitoring the newborns for jaundice. Which of the following newborns has the least risk of developing jaundice caused by extensive bruising?

Accepted Answer

A newborn with a birth weight of 8 pounds has the least risk of developing jaundice. About 50% of newborns develop physiological jaundice, which involves the breakdown of fetal red blood cells. Large infants, infants born through vaginal breech delivery and immature infants are at risk for jaundice caused by extensive bruising.

Question 9

A midwife observes that a full-term newborn has yellowish skin and sclera of the eyes on the second day of life. Total serum bilirubin level is determined at 15 mg/dL. Which of the following interventions are appropriate for the newborn?
I.Early feeding
II.Exchange transfusion
III.Phototherapy
IV.Supplemental feedings with additional formula

Accepted Answer

A newborn with physiological jaundice should be initiated with early feeding, placed under the phototherapy lights and offered supplemental feedings with additional formula. These interventions aim to reduce the levels of indirect bilirubin levels. Bowel elimination removes bilirubin as bilirubin is incorporated into feces. Early feeding stimulates bowel peristalsis. Phototherapy changes the bilirubin into a compound that can be broken down and excreted through urine and feces. Supplemental feedings may be given to newborns on phototherapy to prevent dehydration. Exchange transfusion is administered to newborns with jaundice caused by ABO or Rh incompatibility.

Question 10

A newborn with physiological jaundice is placed on phototherapy. Which of the following actions of the midwife are appropriate for the newborn on phototherapy?
I.Maintain eye dressings during breastfeeding.
II.Place the lights 30 inches above the newborn.
III.Monitor axillary temperature of the newborn.
IV.Undress the infant, except for the diaper, when exposed to the light.

Accepted Answer

The midwife places the light 30 inches above the newborn, monitors axillary temperature of the newborn and undresses the infant except for the diaper when exposed to light. Eye dressings or cotton balls are firmly secured in place when the newborn is exposed to bright lights. When feeding, the eye dressings should be removed in order to stimulate vision and strengthen the bond between mother and child.

Question 11

A midwife is assessing a client and her infant one week after delivery. The infant's birth weight was 7.5 pounds. Which of the following findings indicate that the infant is getting enough milk?
I.The mother reports that the infant is wetting 6 to 8 diapers a day.
II.The mother informs the midwife that the infant appears content between feedings.
III.The infant's weight is 6.8 pounds.
IV.The mother reports that the infant quietly swallows during breastfeeds.

Accepted Answer

The signs indicating that an infant is getting enough breast milk include wetting of 6 to 8 diapers a day, appearing content between feedings and losing no more than 10% of birth weight during the first week of life. The mother is effectively breastfeeding the infant if the mother hears a suck-suck-swallow pattern when feeding the infant.

Question 12

A full-term and healthy newborn baby requires immediate attention following delivery. Which of the following is the incorrect measure in attending to the newborn baby?

Accepted Answer

Delaying clamping and ligature of the cord for hours
Supportive care following the birth of a newborn includes the following:
1) Suction of mucous from air passage
2) APGAR scoring
3) Clamping and ligature of the umbilical cord
4) Checking to detect abnormalities
5) Wrapping baby in a receiving blanket
6) Prevention of hypothermia
7) Allowing breastfeeding
8) Monitoring sleeping pattern
9) Measuring weight

Question 13

A newborn has developed some abnormalities on the second day following delivery. In a healthy, full-term baby, which of the following is most likely to be accurate?

Accepted Answer

Pulse rate of 100-160 beats/minute
Rhythmic respiration is expected in a full-term, healthy newborn. A birthweight of less than 5 pounds, 8 ounces is considered low birthweight. A birthweight of less than 3 pounds, 5 ounces is considered a dangerously low birthweight. Characteristics of a healthy newborn baby include: 1) rhythmic respiration; 2) birth weight within normal range; and 3) respiratory rate of 30-60/ minute.

Question 14

There are some common fetal congenital anomalies. Which of the following is a fetal congenital anomaly?

Accepted Answer

All of the above
Fetal congenital defects can be divided into three categories: 1) multi-factorial, 2) chromosomal, and 3) single gene-mediated. Commoncongential anomalies include cleft lip and palate, heart defects, neural tube defects, dislocated hip, clubfoot, and hypospadias.

Question 15

Perinatal asphyxia is a state of decreased oxygen delivery to the fetus (or neonate) resulting in inadequate tissue perfusion-as manifested by low APGAR score and metabolic acidosis. Which of the following is a cause of birth asphyxia?

Accepted Answer

All of the above
Possible causes of newborn asphyxia at birth include:
1) Premature separation of placenta
2) Severe case of maternal anemia
3) Umbilical ord compression
4) Circumvallate placenta
5) Eclampsia
6) Cyanotic heart diseases
7) Dehydration
8) Breech presentation

Question 16

Perinatal asphyxia is a state of decreased oxygen delivery to the fetus (or neonate) resulting in inadequate tissue perfusion-as manifested by low APGAR score and metabolic acidosis. Of the following, which provides an example of management of birth hypoxia?

Accepted Answer

All of the above
Management of birth asphyxia includes:
1) Cleaning of the airway
2) Providing artificial oxygen supply
3) Compressing the chest
4) Providing more ventilation
5) Stimulation and repositioning of the neonate

Question 17

A newborn has developed a "yellow" tinge to skin and mucous membrane. Which of the following is a probable cause?

Accepted Answer

Jaundice
Neonatal jaundice is a yellowing of the skin and other tissues of a newborn. A bilirubin level of more than 5mg/dl is associated with clinical jaundice in neonates. Jaundice in newborns may be detected by applying slight pressure with a digit to the skin so that it reveals underlying skin and subcutaneous tissue color. About 30-35% of full-term newborns (and a higher percentage of preterm newborns) develop clinical jaundice.

Question 18

Neonatal jaundice is a yellowing of the skin and other tissues of a newborn. A bilirubin level of more than 5mg/dl is associated with clinical jaundice in neonates. Which of the following is a cause of jaundice? (Choose all that apply)

Accepted Answer

Hemolytic disease and D - Sepsis
Neonatal jaundice is a yellowing of the skin and other tissues of a newborn. A bilirubin level of more than 5mg/dl is associated with clinical jaundice in neonates. It is a common condition in newborns. Besides a high level of bilirubin in the blood, some other possible causes of neonatal jaundice are:
1) Physiological jaundice
2) Sepsis
3) Rh incompatibility
4) Acidosis
5) Drugs
6) Galactosemia
7) Hypoglycemia
8) Glucose 6 phosphate dehydrogenase deficiency
9) Hemolytic disease

Question 19

A newborn has developed jaundice on the third day after birth. Neonatal jaundice is a yellowing of the skin and other tissues of a newborn. Of the following, which provides an example of management of neonatal jaundice?

Accepted Answer

All of the above
Neonatal jaundice is a yellowing of the skin and other tissues of a newborn. A bilirubin level of more than 5mg/dl is associated with clinical jaundice in neonates. Management of physiological jaundice includes: 1) phototherapy, 2) medication, and 3) transfusion. The management depends on the cause and severity of the neonatal jaundice.

Quiz 7: Well Baby Care