Question 1

Which refers to a newborn whose rate of intrauterine growth was slowed and whose birth weight falls below the 10th percentile on intrauterine growth charts?
A) Postterm
B) Postmature
C) Low birth weight
D) Small for gestational age

Accepted Answer

A small-for-gestational-age (or small-for-date) newborn is any child whose rate of intrauterine growth was slowed and whose birth weight falls below the 10th percentile on intrauterine growth curves. A postterm or postmature newborn is any child born after 42 weeks of gestational age, regardless of birth weight. A low birth weight newborn is a child whose birth weight is less than 2500 g, regardless of gestational age.

Question 2

Which finding on a newborn assessment should the nurse recognize as suggestive of a clavicle fracture?
A) Negative scarf sign
B) Asymmetric Moro reflex
C) Swelling of fingers on affected side
D) Paralysis of affected extremity and muscles

Accepted Answer

A newborn with a broken clavicle may have no symptoms. The Moro reflex, which results in sudden extension and abduction of the extremities followed by flexion and adduction of the extremities, will most likely be asymmetric. The scarf sign that is used to determine gestational age should not be performed if a broken clavicle is suspected. Swelling of fingers on affected side and paralysis of affected extremity and muscles are not indicative of a fractured clavicle.

Question 3

Which is a bright red, rubbery nodule with a rough surface and a well-defined margin that may be present at birth?
A) Port-wine stain
B) Juvenile melanoma
C) Cavernous hemangioma
D) Strawberry hemangioma

Accepted Answer

Strawberry hemangiomas or capillary hemangiomas are benign cutaneous tumors that involve capillaries only. They are bright red, rubbery nodules with rough surfaces and well-defined margin. They may or may not be apparent at birth but enlarge during the first year of life and tend to resolve spontaneously by age 2 to 3 years. Port-wine stain is a vascular stain that is a permanent lesion and is present at birth. Initially it is a pink, red, or, rarely, purple stain of the skin that is flat at birth and thickens, darkens, and proportionately enlarges as the child grows. Melanoma is not differentiated into juvenile and adult forms. A cavernous hemangioma involves deeper vessels in the dermis and has a bluish red color and poorly defined margins.

Question 4

What does nursing care of the newborn with oral candidiasis (thrush) include?
A) Avoiding use of pacifier
B) Removing characteristic white patches with a soft cloth
C) Continuing medication for a prescribed number of days
D) Applying medication to oral mucosa, being careful that none is ingested

Accepted Answer

The medication must be continued for the prescribed number of days. To prevent relapse, therapy should continue for at least 2 days after the lesions disappear. Pacifiers can be used. The pacifier should be replaced with a new one or boiled for 20 minutes once daily. One of the characteristics of thrush is that the white patches cannot be removed. The medication is applied to the oral mucosa and then swallowed to treat Candida organisms in the gastrointestinal tract.

Question 5

A healthy, stable, preterm newborn will soon be discharged. The nurse should recommend which position for sleep?
A) Prone
B) Supine
C) Side lying
D) Position of comfort

Accepted Answer

The American Academy of Pediatrics recommends that healthy newborns be placed to sleep in a supine position. Other positions are associated with sudden infant death syndrome. The prone position can be used for supervised play.

Question 6

Which intervention should the nurse implement to maintain the skin integrity of the preterm newborn?
A) Cleanse skin with a gentle alkaline-based soap and water.
B) Cleanse skin with a neutral pH solution only when necessary.
C) Thoroughly rinse skin with plain water after bathing in a mild hexachlorophene solution.
D) Avoid cleaning skin.

Accepted Answer

The preterm newborn should be given baths no more than two or three times per week with a neutral pH solution. The eyes, oral and diaper areas, and pressure points should be cleansed daily. Alkaline-based soaps might destroy the acid mantle of the skin. They should not be used. The increased permeability of the skin facilitates absorption of the chemical ingredients. The newborn's skin must be cleaned to remove stool and urine, which are irritating to the skin.

Question 7

What is oral candidiasis (thrush) in the newborn?
A) Bacterial infection that is life threatening in the neonatal period
B) Bacterial infection of mucous membranes that responds readily to treatment
C) Yeastlike fungal infection of mucous membranes that is relatively common
D) Benign disorder that is transmitted from mother to newborn during the birth process only

Accepted Answer

Oral candidiasis, characterized by white adherent patches on the tongue, palate, and inner aspects of the cheeks, is not uncommon in newborns. Candida albicans is the usual causative organism. Oral candidiasis is usually a benign disorder in the newborn, often confined to the oral and diaper regions. It is caused by a yeastlike organism and is treated with good hygiene, application of a fungicide, and correction of any underlying disorder. Thrush can be transmitted in several ways, including by maternal transmission during delivery; person-to-person transmission; and contaminated bottles, hands, or other objects.

Question 8

Which is defined as a vaguely outlined area of edematous tissue situated over the portion of the scalp that presents in a vertex delivery?
A) Caput succedaneum
B) Hydrocephalus
C) Cephalhematoma
D) Subdural hematoma

Accepted Answer

A vaguely outlined area of edematous tissue situated over the portion of the scalp that presents in a vertex delivery is the definition of a caput succedaneum. The swelling consists of serum and/or blood accumulated in the tissues above the bone, and it may extend beyond the bone margin. Hydrocephalus is caused by an imbalance in production and absorption of cerebrospinal fluid. When production exceeds absorption, fluid accumulates within the ventricular system, causing dilation of the ventricles. A cephalhematoma has sharply demarcated boundaries that do not extend beyond the limits of the (bone) suture line. A subdural hematoma is located between the dura and the cerebrum. It would not be visible on the scalp.

Question 9

The mother of a preterm newborn asks the nurse when she can start breastfeeding. The nurse should explain that breastfeeding can be initiated when her newborn:
A) achieves a weight of at least 3 pounds.
B) indicates an interest in breastfeeding.
C) does not require supplemental oxygen.
D) has adequate sucking and swallowing reflexes.

Accepted Answer

Research supports that human milk is the best source of nutrition for term and preterm newborns. Preterm newborns should be breastfed as soon as they have adequate sucking and swallowing reflexes and no other complications such as respiratory complications or concurrent illnesses. Weight is not an issue. Interest in breastfeeding can be evaluated by having nonnutritive sucking at the breast during skin-to-skin kangaroo care so the mother and child may become accustomed to each other. Supplemental oxygen can be provided during breastfeeding by using a nasal cannula.

Question 10

Which is an important nursing action related to the use of tape and/or adhesives on preterm newborns?
A) Avoid using tape and adhesives until skin is more mature.
B) Use solvents to remove tape and adhesives instead of pulling on skin.
C) Remove adhesives with warm water or mineral oil.
D) Use scissors carefully to remove tape instead of pulling tape off.

Accepted Answer

Warm water, mineral oil, or petrolatum can be used to facilitate the removal of adhesive. In the preterm newborn, often it is impossible to avoid using adhesives and tape. The smallest amount of adhesive necessary should be used. Solvents should be avoided because they tend to dry and burn the delicate skin. Scissors should not be used to remove dressings or tape from the extremities of very small and immature newborns because it is easy to snip off tiny extremities or nick loosely attached skin.

Question 11

The nurse is caring for a 3-week-old preterm newborn born at 29 weeks of gestation. While taking vital signs and changing the newborn's diaper, the nurse observes the newborn's color is pink but slightly mottled, arms and legs are limp and extended, hiccups are present, and heart rate is regular and rapid. The nurse should recognize these behaviors as manifestations of:
A) stress.
B) subtle seizures.
C) preterm behavior.
D) onset of respiratory distress.

Accepted Answer

Color pink but slightly mottled, arms and legs limp and extended, hiccups, respiratory pauses and gasping, and an irregular, rapid heart rate are signs of stress or fatigue in a newborn. Neonatal seizures usually have some type of repetitive movement from twitching to rhythmic jerking movements. The behavior of a preterm newborn may be inactive and listless. Respiratory distress is exhibited by retractions and nasal flaring.

Question 12

A mother is upset because her newborn has erythema toxicum neonatorum. What information should the nurse base the response to the mother?
A) Easily treated
B) Benign and transient
C) Usually not contagious
D) Usually not disfiguring

Accepted Answer

Erythema toxicum neonatorum, or newborn rash, is a benign, self-limiting eruption of unknown cause that usually appears within the first 2 days of life. The rash usually lasts about 5 to 7 days. No treatment is indicated. Erythema toxicum neonatorum is not contagious. Successive crops of lesions heal without pigmentation.

Question 13

The parents of a newborn with a strawberry hemangioma ask the nurse what the treatment will be. What information does the nurse need to include in the response?
A) Excision of the lesion will be necessary.
B) Injections of prednisone into the lesion will reduce it.
C) No treatment is usually necessary because of the high rate of spontaneous involution.
D) Pulsed dye laser treatments will be necessary immediately to prevent permanent disability.

Accepted Answer

There is a high rate of spontaneous resolution, so treatment is usually not indicated for hemangiomas. Surgical removal would not be indicated. If steroids are indicated, then systemic prednisone is administered for 2 to 3 weeks. The pulse dye laser is used in the uncommon situation of potential visual or respiratory impairment.

Question 14

A preterm newborn, after spending 8 weeks in the NICU, is being discharged. The parents of the newborn express apprehension and worry that the newborn may still be in danger. How should the nurse interpret these statements?
A) Normal
B) A reason to postpone discharge
C) Suggestive of maladaptation
D) Suggestive of inadequate bonding

Accepted Answer

Parents become apprehensive and excited as the time for discharge approaches. They have many concerns and insecurities regarding the care of their newborn. A major concern is that they may be unable to recognize signs of illness or distress in their newborn. Preparation for discharge should begin early and include helping the parent acquire the skills necessary for care. Apprehension and worry are normal adaptive responses. The NICU nurses should facilitate discharge by involving parents in care as soon as possible.

Question 15

The parents of a newborn ask the nurse what caused the baby's facial nerve paralysis. What knowledge should the nurse's response be based on?
A) Genetic defect
B) Birth injury
C) Spinal cord injury
D) Inborn error of metabolism

Accepted Answer

Pressure on the facial nerve during delivery may result in injury to cranial nerve VII, which can occur with birth injury. A genetic defect, spinal cord injury, or inborn error of metabolism would not cause facial paralysis.

Question 16

The nurse is caring for a very low birth weight (VLBW) newborn with a peripheral intravenous infusion. Which statement describes nursing considerations regarding infiltration?
A) Infiltration occurs infrequently because VLBW newborns are inactive.
B) Continuous infusion pumps stop automatically when infiltration occurs.
C) Hypertonic solutions can cause severe tissue damage if infiltration occurs.
D) Infusion site should be checked for infiltration at least once per 8-hour shift.

Accepted Answer

Hypertonic fluids can damage cells if the fluid leaks from the vein. Careful monitoring is required to prevent severe tissue damage. Infiltrations occur for many reasons, not only activity. The vein, catheter, and fluid used all contribute to the possibility of infiltration. The continuous infusion pump may alarm when the pressure increases, but this does not alert the nurse to all infiltrations. Infusion rates and sites should be checked hourly to prevent tissue damage from extravasations, fluid overload, and dehydration.

Question 17

The nurse is caring for a high-risk newborn with an umbilical catheter in a radiant warmer. The nurse notes blanching of the feet. Which is the most appropriate nursing action?
A) Elevate feet 15 degrees.
B) Place socks on newborn.
C) Wrap feet loosely in prewarmed blanket.
D) Report findings immediately to the practitioner.

Accepted Answer

Blanching of the feet, in a newborn with an umbilical catheter, is an indication of vasospasm. Vasoconstriction of the peripheral vessels, triggered by the vasospasm, can seriously impair circulation. It is an emergency situation and must be reported immediately.

Question 18

When is the best time for the neonatal intensive care unit (NICU) nurse to initiate an individualized stimulation program for the preterm newborn?
A) As soon as possible after newborn is born
B) As soon as parent is available to provide stimulation
C) When newborn is over 38 weeks of gestation
D) When developmental organization and stability are sufficient

Accepted Answer

Newborn stimulation is essential for growth and development. The appropriate time for the introduction of an individualized program is when developmental organization and stability are achieved at approximately 34 and 36 weeks of gestation. The newborn needs to be developmentally ready for a stimulation program. The newborn must be assessed to determine the readiness and appropriateness of the stimulation program. The program should be designed and implemented by the nursing staff. The family can be involved, as the nurses help teach the parents to be responsive to the child's cues, but the stimulation should not depend on the family's availability. An individualized stimulation program should be started when the child is developmentally ready.

Question 19

Which term refers to a newborn born before completion of week 37 of gestation, regardless of birth weight?
A) Postterm
B) Preterm
C) Low birth weight
D) Small for gestational age

Accepted Answer

A preterm newborn is any child born before 37 weeks of gestation, regardless of birth weight. A postterm or postmature newborn is any child born after 42 weeks of gestational age, regardless of birth weight. A low birth weight newborn is a child whose birth weight is less than 2500 g, regardless of gestational age. A small-for-gestational-age (or small-for-date) newborn is any child whose rate of intrauterine growth was slowed and whose birth weight falls below the 10th percentile on intrauterine growth curves.

Question 20

Which is the most appropriate nursing action when intermittently gavage-feeding a preterm newborn?
A) Allow formula to flow by gravity.
B) Insert tube through nares rather than mouth.
C) Avoid letting newborn suck on tube.
D) Apply steady pressure to syringe to deliver formula to stomach in a timely manner.

Accepted Answer

The formula is allowed to flow by gravity. The length of time to complete the feeding will vary. Preferably, the tube is inserted through the mouth. Newborns are obligatory nose breathers, and the presence of the tube in the nose irritates the nasal mucosa. Passage of the tube through the mouth allows the nurse to observe and evaluate the sucking response. The feeding should not be done under pressure. This procedure is not used as a timesaver for the nurse.

Quiz 8: Health Problems of Newborns

Which refers to a newborn whose rate of intrauterine growth was slowed and whose birth weight falls below the 10th percentile on intrauterine growth charts?

Which finding on a newborn assessment should the nurse recognize as suggestive of a clavicle fracture?

Which is a bright red, rubbery nodule with a rough surface and a well-defined margin that may be present at birth?

What does nursing care of the newborn with oral candidiasis (thrush) include?

A healthy, stable, preterm newborn will soon be discharged. The nurse should recommend which position for sleep?

Which intervention should the nurse implement to maintain the skin integrity of the preterm newborn?

What is oral candidiasis (thrush) in the newborn?

Which is defined as a vaguely outlined area of edematous tissue situated over the portion of the scalp that presents in a vertex delivery?

The mother of a preterm newborn asks the nurse when she can start breastfeeding. The nurse should explain that breastfeeding can be initiated when her newborn:

Which is an important nursing action related to the use of tape and/or adhesives on preterm newborns?

A mother is upset because her newborn has erythema toxicum neonatorum. What information should the nurse base the response to the mother?

The parents of a newborn with a strawberry hemangioma ask the nurse what the treatment will be. What information does the nurse need to include in the response?

A preterm newborn, after spending 8 weeks in the NICU, is being discharged. The parents of the newborn express apprehension and worry that the newborn may still be in danger. How should the nurse interpret these statements?

The parents of a newborn ask the nurse what caused the baby's facial nerve paralysis. What knowledge should the nurse's response be based on?

The nurse is caring for a very low birth weight (VLBW) newborn with a peripheral intravenous infusion. Which statement describes nursing considerations regarding infiltration?

The nurse is caring for a high-risk newborn with an umbilical catheter in a radiant warmer. The nurse notes blanching of the feet. Which is the most appropriate nursing action?

When is the best time for the neonatal intensive care unit (NICU) nurse to initiate an individualized stimulation program for the preterm newborn?

Which term refers to a newborn born before completion of week 37 of gestation, regardless of birth weight?

Which is the most appropriate nursing action when intermittently gavage-feeding a preterm newborn?