Question 1

A 25-year-old female has just given birth to an eight-pound baby boy. Suctioning of the neonate is required. The first action of the nurse midwife when suctioning a neonate immediately after birth is to:

Accepted Answer

After birth, neonates require assistance in clearing their airways of the mucus and amniotic fluids from their lungs. The first action of the nurse is to suction the neonate's mouth immediately after birth. The nose is suctioned after the mouth. Suctioning the neonate's nose first may stimulate the receptors in the nose, resulting in aspiration of secretions from the mouth.

Question 2

Which of the following actions by a nurse midwife is the least appropriate when giving respiratory care to a healthy, full-term newborn?

Accepted Answer

A newborn should be placed on one side with the head down, not up, to facilitate drainage of secretions from the respiratory tract. A newborn's respiratory rate should be assessed every 15 minutes during the first hour of life, taking note of alterations in respiratory effort and rate. The mouth should be suctioned before the nose to prevent aspiration. The newborn should be re-positioned frequently to further encourage the drainage of secretions.

Question 3

A 38-week newborn is born to a 30-year-old through vaginal birth. A minute after birth, a nurse midwife obtains the newborn's APGAR score with the following assessment findings: flexed arms and legs with some active movement, a pulse rate of 110 beats per minute, grimace after inserting a tube through a nostril, pink skin tone except for the hands and feet and regular breathing pattern with a good cry. What is the newborn's APGAR score?

Accepted Answer

The newborn's APGAR score is 7. APGAR scoring is performed 1 minute and 5 minutes after birth. This scoring system assesses five components:
§Activity, or muscle tone
§Pulse
§Grimace, or reflex irritability
§Appearance, or skin color
§Respiration
The newborn's APGAR score is calculated as follows: flexed arms and legs with some movement = 1; pulse rate above 100 = 2; grimacing = 1; pink skin tone except for the hands and feet = 1; a good cry and regular breathing pattern = 2. 1+2+1+1+2 = 7.

Question 4

A 37-week female newborn is born to a 28-year-old female through cesarean birth. A nurse midwife assesses the newborn a minute after birth for APGAR scoring. The following assessment findings are obtained: flexed arms and legs with limited active movement; a pulse rate of 90 beats per minute; grimacing observed after inserting a tube through one of the nostrils; bluish skin tone, including the extremities; and slow, irregular breaths. Which of the following is the next action of the nurse midwife?

Accepted Answer

The next action of the nurse is to initiate clearing of the airways and oxygen therapy. The newborn has an APGAR of 4, calculated as follows: flexed arms and legs with limited active movement = 1; pulse rate below 100 beats per minute = 1; grimacing after inserting a tube through one of the nostrils = 1; bluish skin tone, including the extremities = 0; slow, irregular breaths = 1. An APGAR score of 4 to 6 indicates that the newborn requires oxygen therapy. An APGAR score of less than 4 indicates that the newborn needs immediate resuscitation. An APGAR score greater than 6 indicates well-being of the newborn. Options B and D are most appropriate for a newborn who has an APGAR score between 7 and 10.

Question 5

A female client at 32 weeks' gestation gives birth to a baby girl. The newborn weighs 1400 grams. When managing the newborn's nutritional needs, which of the following actions by the nurse midwife is the most appropriate?

Accepted Answer

The most appropriate action is to prepare the newborn for parenteral hyperalimentation. Premature babies born sooner than 34 weeks' gestation find it hard to feed from a breast or bottle because they have difficulty coordinating sucking, breathing and swallowing. Newborns weighing less than 1500 grams are considered very low-birth weight infants. These newborns are nourished intravenously. As they get older and stronger, gavage feeding may be initiated. If the newborn is born at 35 weeks' gestation and is able to tolerate oral feedings, breast milk may be given through a bottle using a preemie nipple. To prevent dehydration, it is recommended that mothers of premature babies, unlike mothers of full-term babies, not wait four hours between feedings.

Question 6

A nurse 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 7

After birth, the nurse midwife immediately dries a male neonate's face and hair with a clean, pre-warmed towel. After drying, the nurse midwife covers the neonate's hair with a cap. The purpose of these actions is to prevent heat loss through:

Accepted Answer

The actions of the nurse midwife help prevent heat loss through the process of evaporation. Evaporation is the loss of heat when a liquid is converted to vapor. Drying the neonate with a clean, pre-warmed towel and covering the neonate's hair with a cap are some of the interventions that prevent evaporation. Convection is the flow of heat from the surface of the body to cooler surrounding air. Conduction is the transfer of body heat to a cooler object that is in contact with the baby. Radiation is the transfer of body heat to a cooler solid object not in contact with the body.

Question 8

A nurse 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 9

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 10

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 nurse midwife can maintain the sucking reflex by offering the newborn non-nutritive sucking objects after the surgery.

Question 11

When a substance is placed on the anterior portion of the newborn's tongue, the newborn extrudes the substance. The nurse 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 12

On assessment, the nurse midwife notes that a female newborn has pink patches at the nape of the neck. The nurse 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 13

A nurse 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 14

A nurse 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 15

A newborn with physiological jaundice is placed on phototherapy. Which of the following actions of the nurse 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 nurse 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 16

A nurse 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 nurse 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 17

A mother who gave birth a week ago comes to the facility complaining of a cracked and fissured nipple on her right breast. The mother is diagnosed with mastitis. Which of the following teachings is the most effective when managing a client with mastitis?

Accepted Answer

If a client has one good and one cracked nipple, instruct her to begin breastfeeding on the unaffected nipple. Antibiotic therapy is prescribed for clients with mastitis, but the mother should be advised to continue breastfeeding. If the breasts are too painful, the mother may manually extract the milk until the mastitis is resolved. The client must be instructed to wear a good supportive bra to relieve pain.

Quiz 4: Newborn