Deck 40: Perinatal Conditions

Question 1

The primary care pediatric nurse practitioner performs a well baby exam on a
2­day­old infant and notes clusters of firm, yellow­white papules with a surrounding erythematous flare. What will the nurse practitioner do?
A. Encourage frequent cleansing with mild soap.
B. Obtain a Wright­stained smear of the lesions.
C. Prescribe a topical antibiotic medication.
D. Reassure the parents that no treatment is necessary.

Answer 1

Reassure the parents that no treatment is necessary.

Question 2

The parent of a 4­day­old infant tells the primary care pediatric nurse
practitioner that the infant was diagnosed with hydronephrosis while in utero and asks what will be done. What will the nurse practitioner tell this parent?
A. Renal function will be abnormal and will require lifetime treatment.
B. Spontaneous resolution often occurs within 6 months to a year of age.
C. The affected kidney will be non­functional but the other kidney will compensate.
D. The infant will eventually require renal transplantation for that kidney.

Answer 2

Spontaneous resolution often occurs within 6 months to a year of age.

Question 3

The primary care pediatric nurse practitioner is performing a well­baby
examination on a 7­day­old infant born to a Chlamydia­positive mother. The infant's eyes are clear without exudate. The infant is free from cough and lungs are clear. What will the primary care pediatric nurse practitioner do to prevent illness in this infant?
A. Administer a single dose of intramuscular ceftriaxone.
B. Obtain bacterial cultures of both conjunctivae.
C. Prescribe prophylactic erythromycin suspension.
D. Schedule a follow­up appointment in 1 week.

Answer 3

Schedule a follow­up appointment in 1 week.

Question 4

A 3­day­old infant has a total serum bilirubin (TSB) level of 15.7 mg/dL after
having a TSB of 10.8 mg/dL 24 hours prior. The infant nursed 8 times, had 7 wet diapers, and passed 4 stools in the past 24 hours. What is the indicated treatment for this infant?
A. Admit to an inpatient setting for phototherapy and every­12­hour bilirubin monitoring.
B. Have the mother supplement with extra fluids and return to the clinic in 24 hours for a repeat TSB.
C. Recommend nursing every 2 hours, order a biliblanket, and recheck TSB in 24 hours.
D. Suspend breastfeeding for 24 to 72 hours and have the mother save pumped breast milk.

Question 5

The primary care pediatric nurse practitioner is discussing newborn care with
parents prior to the delivery of their first child. What will the nurse practitioner tell them about circumcision?
A. Circumcision is a relatively painless procedure.
B. The benefits of the procedure outweigh the risks of the procedure.
C. There is a slight increase in penile cancer in circumcised males.
D. There is no good evidence to support the practice.

Question 6

The parent of a 4­week­old infant reports that the infant began having
forceful vomiting 1 week prior, which has worsened over time. The infant continues to nurse
well but is losing weight. A physical examination reveals a 90­g weight loss over the past 2 weeks, dry mucous membranes, and a sunken fontanel. What will the primary care pediatric nurse practitioner do?
A. Encourage the mother to nurse the infant more frequently for shorter duration.
B. Obtain serum electrolytes and hospitalize for surgical intervention.
C. Recommend oral rehydration fluids for 24 to 48 hours to correct dehydration.
D. Suggest trying a soy­based or hydrolyzed protein formula until vomiting resolves.

Question 7

The parent of a 2­week­old infant reports that the infant was diagnosed with
transient tachypnea of the newborn shortly after birth. The primary care pediatric nurse practitioner understands that, in this condition,
A. antibiotic therapy is generally necessary to prevent severe infection.
B. home oxygen therapy is needed until the infant grows out of the condition.
C. recovery is usually complete with minimal intervention and treatments.
D. treatment with exogenous surfactant and mechanical ventilation is needed.

Question 8

A well­baby examination of a 3­day­old infant born to a primigravida mother
reveals swelling on the right parietal area of the scalp that stops at the suture line. What action will the primary care pediatric nurse practitioner take based on this finding?
A. Assess the infant for sacral dimpling.
B. Observe the infant for hyperbilirubinemia.
C. Obtain a computerized tomography scan.
D. Perform serum coagulation studies.

Question 9

A 2­month­old infant has increased head circumference from the 10th
percentile at the 2­week exam to the 30th percentile today. What will the primary care pediatric nurse practitioner do?
A. Order a magnetic resonance imaging exam of the infant's head.
B. Refer the infant immediately to a pediatric neurosurgeon.
C. Schedule frequent clinic visits to monitor head growth.
D. Watch the infant closely over time if the rest of the exam is normal.

Question 10

A 5­day­old infant who was delivered at home has abdominal distension and
poor feeding. The mother is worried that the infant is constipated because he didn't have a first stool until yesterday and has only passed a small amount of meconium. What will the primary care pediatric nurse practitioner do?
A. Obtain a sweat chloride skin test to evaluate for possible cystic fibrosis.
B. Order an abdominal radiograph and refer the infant to a pediatric surgeon.
C. Prescribe glycerin suppositories to use as needed until bowel function is normal.
D. Suggest that the mother increase her fluid intake to help with constipation.