High-Risk Neonatal Nursing Care, Exam
3 Practice
. Women with hyperemesis gravidarum:
a.
Are a majority, because 80% of all pregnant women suffer from it at some time.
b.
Have vomiting severe and persistent enough to cause weight loss, dehydration, and
electrolyte imbalance.
c.
Need intravenous (IV) fluid and nutrition for most of their pregnancy.
d.
Often inspire similar, milder symptoms in their male partners and mothers. - ANSWER-
ANS: B
Women with hyperemesis gravidarum have severe vomiting; however, treatment for
several days sets things right in most cases. Although 80% of pregnant women
experience nausea and vomiting, fewer than 1% (0.5%) proceed to this severe level. IV
administration may be used at first to restore fluid levels, but it is seldom needed for
very long. Women suffering from this condition want sympathy because some
authorities believe that difficult relationships with mothers and/or partners may be the
cause.
10. A 42-week gestation neonate is admitted to the NICU (neonatal intensive care unit).
This neonate is at risk for which complication?
a. Meconium aspiration syndrome
b. Failure to thrive
c. Necrotizing enterocolitis
d. Intraventricular hemorrhage - ANSWER-ANS: a
a. Although there is nothing in the scenario that states that the amniotic fluid is green
tinged, post-term babies are high risk for meconium aspiration syndrome.
b. Post-term babies often gain weight very quickly.
c. Preterm, not post-term, babies are high risk for necrotizing enterocolitis.
d. Preterm, not post-term, babies are high risk for intraventricular hemorrhages.
10. A woman with severe preeclampsia has been receiving magnesium sulfate by
intravenous infusion for 8 hours. The nurse assesses the woman and documents the
following findings: temperature of 37.1° C, pulse rate of 96 beats/min, respiratory rate of
24 breaths/min, blood pressure (BP) of 155/112 mm Hg, 3+ deep tendon reflexes, and
no ankle clonus. The nurse calls the physician, anticipating an order for:
a.
Hydralazine.
c.
Diazepam.
,b.
Magnesium sulfate bolus.
d.
Calcium gluconate. - ANSWER-ANS: A
Hydralazine is an antihypertensive commonly used to treat hypertension in severe
preeclampsia. Typically it is administered for a systolic BP greater than 160 mm Hg or a
diastolic BP greater than 110 mm Hg. An additional bolus of magnesium sulfate may be
ordered for increasing signs of central nervous system irritability related to severe
preeclampsia (e.g., clonus) or if eclampsia develops. Diazepam sometimes is used to
stop or shorten eclamptic seizures. Calcium gluconate is used as the antidote for
magnesium sulfate toxicity. The client is not currently displaying any signs or symptoms
of magnesium toxicity.
11. A 1-day-old neonate in the well-baby nursery is suspected of suffering from drug
withdrawal because he is markedly hyperreflexic and is exhibiting which of the following
additional sign or symptom?
a. Prolonged periods of sleep
b. Hypovolemic anemia
c. Repeated bouts of diarrhea
d. Pronounced pustular rash - ANSWER-ANS: c
a. Babies who are withdrawing from drugs have disorganized behavioral states and
sleep very poorly.
b. There is nothing in the scenario that indicates that this child is hypovolemic or
anemic.
c. Babies who are experiencing withdrawal often experience bouts of diarrhea.
d. A pustular rash is characteristic of an infectious problem, not of neonatal abstinence
syndrome.
11. A woman at 39 weeks of gestation with a history of preeclampsia is admitted to the
labor and birth unit. She suddenly experiences increased contraction frequency of every
1 to 2 minutes; dark red vaginal bleeding; and a tense, painful abdomen. The nurse
suspects the onset of:
a.
Eclamptic seizure.
c.
Placenta previa.
b.
Rupture of the uterus.
d.
Placental abruption. - ANSWER-ANS: D
Uterine tenderness in the presence of increasing tone may be the earliest finding of
premature separation of the placenta (abruptio placentae or placental abruption).
Women with hypertension are at increased risk for an abruption. Eclamptic seizures are
evidenced by the presence of generalized tonic-clonic convulsions. Uterine rupture
, manifests as hypotonic uterine activity, signs of hypovolemia, and in many cases the
absence of pain. Placenta previa manifests with bright red, painless vaginal bleeding.
12. A baby boy was just born to a mother who had positive vaginal cultures for group B
streptococci. The mother was admitted to the labor room 30 minutes before the birth.
For which of the following should the nursery nurse closely observe this baby?
a. Grunting
b. Acrocyanosis
c. Pseudostrabismus
d. Hydrocele - ANSWER-ANS: a
a. This infant is high risk for respiratory distress. The nurse should observe this baby
carefully for grunting.
b. Acrocyanosis is a normal finding.
c. Pseudostrabismus is a normal finding.
d. Hydrocele should be reported to the neonatologist. It is not, however, an emergent
problem, and it is not related to group B streptococci colonization in the mother.
12. The patient that you are caring for has severe preeclampsia and is receiving a
magnesium sulfate infusion. You become concerned after assessment when the woman
exhibits:
a.
A sleepy, sedated affect.
c.
Deep tendon reflexes of 2.
b.
A respiratory rate of 10 breaths/min.
d.
Absent ankle clonus. - ANSWER-ANS: B
A respiratory rate of 10 breaths/min indicates that the client is experiencing respiratory
depression from magnesium toxicity. Because magnesium sulfate is a central nervous
system depressant, the client will most likely become sedated when the infusion is
initiated. Deep tendon reflexes of 2 and absent ankle clonus are normal findings.
13. The laboratory reported that the L/S ratio (lecithin/sphingomyelin) results from an
amniocentesis of a gravid client with preeclampsia are 2:1. The nurse interprets the
result as which of the following?
a. The baby's lung fields are mature.
b. The mother is high risk for hemorrhage.
c. The baby's kidneys are functioning poorly.
d. The mother is high risk for eclampsia - ANSWER-ANS: a
a. An L/S ratio of 2:1 usually indicates that the fetal lungs are mature.
b. L/S ratios are unrelated to maternal blood loss.
c. L/S ratios are unrelated to fetal renal function.
d. L/S ratios are unrelated to maternal risk for becoming eclamptic.
3 Practice
. Women with hyperemesis gravidarum:
a.
Are a majority, because 80% of all pregnant women suffer from it at some time.
b.
Have vomiting severe and persistent enough to cause weight loss, dehydration, and
electrolyte imbalance.
c.
Need intravenous (IV) fluid and nutrition for most of their pregnancy.
d.
Often inspire similar, milder symptoms in their male partners and mothers. - ANSWER-
ANS: B
Women with hyperemesis gravidarum have severe vomiting; however, treatment for
several days sets things right in most cases. Although 80% of pregnant women
experience nausea and vomiting, fewer than 1% (0.5%) proceed to this severe level. IV
administration may be used at first to restore fluid levels, but it is seldom needed for
very long. Women suffering from this condition want sympathy because some
authorities believe that difficult relationships with mothers and/or partners may be the
cause.
10. A 42-week gestation neonate is admitted to the NICU (neonatal intensive care unit).
This neonate is at risk for which complication?
a. Meconium aspiration syndrome
b. Failure to thrive
c. Necrotizing enterocolitis
d. Intraventricular hemorrhage - ANSWER-ANS: a
a. Although there is nothing in the scenario that states that the amniotic fluid is green
tinged, post-term babies are high risk for meconium aspiration syndrome.
b. Post-term babies often gain weight very quickly.
c. Preterm, not post-term, babies are high risk for necrotizing enterocolitis.
d. Preterm, not post-term, babies are high risk for intraventricular hemorrhages.
10. A woman with severe preeclampsia has been receiving magnesium sulfate by
intravenous infusion for 8 hours. The nurse assesses the woman and documents the
following findings: temperature of 37.1° C, pulse rate of 96 beats/min, respiratory rate of
24 breaths/min, blood pressure (BP) of 155/112 mm Hg, 3+ deep tendon reflexes, and
no ankle clonus. The nurse calls the physician, anticipating an order for:
a.
Hydralazine.
c.
Diazepam.
,b.
Magnesium sulfate bolus.
d.
Calcium gluconate. - ANSWER-ANS: A
Hydralazine is an antihypertensive commonly used to treat hypertension in severe
preeclampsia. Typically it is administered for a systolic BP greater than 160 mm Hg or a
diastolic BP greater than 110 mm Hg. An additional bolus of magnesium sulfate may be
ordered for increasing signs of central nervous system irritability related to severe
preeclampsia (e.g., clonus) or if eclampsia develops. Diazepam sometimes is used to
stop or shorten eclamptic seizures. Calcium gluconate is used as the antidote for
magnesium sulfate toxicity. The client is not currently displaying any signs or symptoms
of magnesium toxicity.
11. A 1-day-old neonate in the well-baby nursery is suspected of suffering from drug
withdrawal because he is markedly hyperreflexic and is exhibiting which of the following
additional sign or symptom?
a. Prolonged periods of sleep
b. Hypovolemic anemia
c. Repeated bouts of diarrhea
d. Pronounced pustular rash - ANSWER-ANS: c
a. Babies who are withdrawing from drugs have disorganized behavioral states and
sleep very poorly.
b. There is nothing in the scenario that indicates that this child is hypovolemic or
anemic.
c. Babies who are experiencing withdrawal often experience bouts of diarrhea.
d. A pustular rash is characteristic of an infectious problem, not of neonatal abstinence
syndrome.
11. A woman at 39 weeks of gestation with a history of preeclampsia is admitted to the
labor and birth unit. She suddenly experiences increased contraction frequency of every
1 to 2 minutes; dark red vaginal bleeding; and a tense, painful abdomen. The nurse
suspects the onset of:
a.
Eclamptic seizure.
c.
Placenta previa.
b.
Rupture of the uterus.
d.
Placental abruption. - ANSWER-ANS: D
Uterine tenderness in the presence of increasing tone may be the earliest finding of
premature separation of the placenta (abruptio placentae or placental abruption).
Women with hypertension are at increased risk for an abruption. Eclamptic seizures are
evidenced by the presence of generalized tonic-clonic convulsions. Uterine rupture
, manifests as hypotonic uterine activity, signs of hypovolemia, and in many cases the
absence of pain. Placenta previa manifests with bright red, painless vaginal bleeding.
12. A baby boy was just born to a mother who had positive vaginal cultures for group B
streptococci. The mother was admitted to the labor room 30 minutes before the birth.
For which of the following should the nursery nurse closely observe this baby?
a. Grunting
b. Acrocyanosis
c. Pseudostrabismus
d. Hydrocele - ANSWER-ANS: a
a. This infant is high risk for respiratory distress. The nurse should observe this baby
carefully for grunting.
b. Acrocyanosis is a normal finding.
c. Pseudostrabismus is a normal finding.
d. Hydrocele should be reported to the neonatologist. It is not, however, an emergent
problem, and it is not related to group B streptococci colonization in the mother.
12. The patient that you are caring for has severe preeclampsia and is receiving a
magnesium sulfate infusion. You become concerned after assessment when the woman
exhibits:
a.
A sleepy, sedated affect.
c.
Deep tendon reflexes of 2.
b.
A respiratory rate of 10 breaths/min.
d.
Absent ankle clonus. - ANSWER-ANS: B
A respiratory rate of 10 breaths/min indicates that the client is experiencing respiratory
depression from magnesium toxicity. Because magnesium sulfate is a central nervous
system depressant, the client will most likely become sedated when the infusion is
initiated. Deep tendon reflexes of 2 and absent ankle clonus are normal findings.
13. The laboratory reported that the L/S ratio (lecithin/sphingomyelin) results from an
amniocentesis of a gravid client with preeclampsia are 2:1. The nurse interprets the
result as which of the following?
a. The baby's lung fields are mature.
b. The mother is high risk for hemorrhage.
c. The baby's kidneys are functioning poorly.
d. The mother is high risk for eclampsia - ANSWER-ANS: a
a. An L/S ratio of 2:1 usually indicates that the fetal lungs are mature.
b. L/S ratios are unrelated to maternal blood loss.
c. L/S ratios are unrelated to fetal renal function.
d. L/S ratios are unrelated to maternal risk for becoming eclamptic.
