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RNC - Low Risk Neonatal Nursing Questions and Answers
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RNC - Low Risk Neonatal Nursing Questions and Answers
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RNC - Low Risk Neonatal NursingQuestions and Answers
A 2-day-old, former 37-week-gestation infant is diagnosed with congenital pneumonia.
When administering the prescribed antibiotic therapy, the nurse knows that this
condition is: - ANSWER-Most likely caused by Staphylococcus epidermidis
Feedback
Most cases of bacterial neonatal/congenital pneumonia are caused by Staphylococcus
epidermidis, Group B Streptococcus, E. coli, and Ureaplasma urealyticum. Congenital
pneumonia may also be caused by viruses, the most common of which are herpes
simplex (HSV) and human immunodeficiency virus (HIV).
A 29-week-gestation infant weighs 1340 gm (3 lbs.) and has a respiratory rate of 60
immediately after delivery. This infant is most likely to lose body heat by: - ANSWER-
Convection and evaporation
Feedback
Radiation, conduction, convection, and evaporation are the four basic heat transfer
mechanisms. Preterm, low birth weight infants lose heat primarily by convection (cooler
air) and evaporation (water loss) immediately following delivery. Measures should be
taken to reduce all mechanisms of heat loss. Place a hat on the infant's head
(radiation), preheat the radiant warmer and all linens (radiation/conduction), wrap ELBW
infants in plastic or dry the infant and swaddle as soon as possible
(evaporation/convection), and warm the delivery room (convection).
A 3-day-old, former 35-week-gestation female infant born to a mother with a history of
methadone use is beginning to show signs of neonatal abstinence syndrome (NAS).
Nursing support measures for this infant should include all of the following EXCEPT: -
ANSWER-Encouraging bottle feeding
Feedback
Breastfeeding is encouraged for bonding, and may also help alleviate some of the
infant's symptoms of methadone withdrawal. Bottle feeding should only be encouraged
if the infant is not demonstrating adequate weight gain with breastfeeding alone, or if the
infant is showing other adverse reactions to breastfeeding. Breastfeeding should not be
encouraged when the mother has a history of illicit drug use.
A 3.1 kg (6.8 lbs) neonate was delivered vaginally at 38 weeks gestation. At one minute
of life, the neonate has a heart rate (HR) of 115, respiratory rate (RR) of 65 with
intermittent grunting, flaccid tone, no response to stimulus, and acrocyanosis. The
infant's one minute Apgar score should be: - ANSWER-5
Feedback
A perfect Apgar score is 10, with 2 points for each of 5 categories (HR, respirations,
muscle tone, response to stimulus, and color). This infant gets 2 points for a HR over
100, 2 points for respirations, 0 points each for muscle tone, stimulus response, and 1
point for color. Therefore, the total Apgar would be 5.
,A 30-year veteran neonatal nurse is a member of the ethics committee that meets
monthly at the local hospital facility. In reviewing recent court documents, which of the
following medicolegal terms most closely sums up the phrase, "First, do no harm"? -
ANSWER-Nonmaleficence
Feedback
Nonmaleficence indicates, in general, that the actions and treatments provided by
medical personnel were meant to provide benefit, not harm, to the recipient(s).
A 33-week-gestation neonate has not responded to routine resuscitation efforts. The
nurse notes decreased breath sounds on the left side and a scaphoid abdomen. The
nurse should prepare for: - ANSWER-Immediate intubation and insertion of an
orogastric tube
Feedback
A scaphoid abdomen with decreased left-sided breath sounds is highly indicative of a
diaphragmatic hernia. Immediate intubation and insertion of an orogastric tube will
provide optimal ventilation while decompressing the stomach to maximize left-sided
lung inflation.
A 34-week-gestation male patient is diagnosed with respiratory distress syndrome
(RDS) related to prematurity. Which of the following arterial blood gas readings most
closely correlates with this patient's condition? - ANSWER-pH 7. 22, pCO2 70 , pO2 52,
HCO3 28
Feedback
An infant in acute respiratory distress would be expected to be in uncompensated
respiratory acidosis, best represented by low pH, low oxygen, elevated carbon dioxide,
and normal bicarbonate levels on an arterial blood gas.
A 36-week pregnant woman was involved in a head-on automobile collision and is
determined to need an emergency cesarean section for fetal distress. The infant
exhibits hypotension, decreased respiratory effort, and pallor. The nurse suspects: -
ANSWER-Hypovolemic shock
Feedback
Trauma to the uterus may trigger a placental abruption. Blood loss from the abruption
leads to fetal hypovolemic shock, which manifests as delayed capillary refill, tachycardia
(early sign), abnormal respiratory effort, hypotension, and pallor.
A 38-week-gestation infant weighing 4.5 kg (9.9 lbs) is born to a mother with history of
gestational diabetes. Approximately two hours after birth, the infant exhibits tremors and
seizure-like movements of the upper and lower extremities. The nurse should FIRST: -
ANSWER-Obtain a heelstick glucose level
Feedback
Signs of infant hypoglycemia include extremity tremors, irritability or lethargy, respiratory
distress, poor feeding, and hypothermia. The nurse should first obtain a heelstick
glucose, and report the level and patient presentation to the practitioner. Depending on
how low the level, breastfeeding or formula may be sufficient to correct the level.
,A 38-week-gestation newborn is vigorous at birth. The infant is dried, wrapped in warm
blankets and placed on the mother's chest. At 6 minutes of life, the infant still appears
cyanotic. According to recommended practice guidelines, which of the following should
the nurse perform FIRST? - ANSWER-Check the infant's pulse oximeter reading
Feedback
Recommended practice guidelines for neonatal resuscitation utilize pulse oximeter
readings to determine if an infant is within acceptable saturation range for minutes of
life. Use of 100% oxygen is discouraged.
A 39-week gestation newborn, weighing 4.8 kg (10.6 lbs.) with Apgar scores of 8 at 1
minute and 9 at 5 minutes following cesarean delivery, is exhibiting tremors of the
hands and feet and an increased respiratory rate. This infant is likely demonstrating: -
ANSWER-Symptoms of hypoglycemia
Feedback
Large infants require higher caloric intake to maintain their glycogen stores. Symptoms
of hypoglycemia can include limb tremors and tachypnea.
A 39-week-gestation male infant was delivered by cesarean section due to breech
position. Upon delivery, the nurse notes that the infant's face is asymmetrical and the
head is positioned so that the infant appears to be looking over his left shoulder. This
infant most likely has: - ANSWER-Congenital torticollis
Feedback
Malposition in the uterus or other congenital complications may cause congenital
torticollis, a shortening of the sternocleidomastoid muscle that causes abnormal rotation
of the head. Facial asymmetry is the primary sign of congenital causes for this defect.
A 39-week-gestation newborn male weighing 3.3 kg (7.3 lbs.) is admitted to the
newborn nursery following a cesarean section. How many kilocalories (kcal) should this
infant consume to meet the average daily requirement? - ANSWER-330 kcal/day
Feedback
Term newborns require approximately 100 kcal/kg/day. Premature infants require
approximately 120-150 kcal/kg/day.
A cephalhematoma is located where? - ANSWER--below the periosteum and confined
by the cranial sutures.
The periosteum of the cranial bone limits the potential space available for blood to
expand. Cephalhematoma may contribute to jaundice, but is rarely of clinical
significance from a neurological standpoint.
A chromosomal disorder that affects sexual development in males? - ANSWER-
Klinefelter syndrome is a genetic chromosomal condition that affects male physical and
cognitive development. Klinefelter syndrome can cause problems with learning and
sexual development in males. It happens randomly from an error in cell division when a
parent's reproductive cells are being formed.
, A client has arrived at the labor and delivery unit in active labor. The nursing
assessment reveals a history of genital herpes with active lesions in the genital tract at
present. The nurse plans to: - ANSWER-Prepare the client for a cesarean delivery
Feedback
A cesarean delivery can reduce the risk of neonatal infection with a mother in labor who
has herpetic genital tract lesions. Standard precautions should be maintained.
A clinical nurse educator for a labor and delivery unit is reviewing her notes on
congenital heart defects. When teaching about medical closure of a PDA, which of the
following medications should be included? - ANSWER-Indomethacin (Indocin)
Feedback
Indomethacin is a nonsteroidal anti-inflammatory drug (NSAID) used to close PDAs
when other medical treatment for PDA fails after 48 hours. Indomethacin is also known
as a COX inhibitor, a group of medications that reduce the action of prostaglandins on
the vascular system.
A fourth heart sound (S4) should rarely be heard in neonates. If present, it is heard at: -
ANSWER-the apex of the heart and is a low-pitched sound of late diastole
-A fourth heart sound (S4) should rarely be heard in neonates. If present, it is heard at
the apex of the heart and is a low-pitched sound of late diastole. S4 is always pathologic
and is heard in conditions characterized by decreased compliance or congestive heart
failure.
A galactocele is best defined as which of the following? - ANSWER-milk-retention cyst
A galactocele is a milk-retention cyst. It is caused by blockage of a milk duct. It usually
will resolve with warm compresses and continuation of breastfeeding.
A large anterior fontanelle may be a sign of: - ANSWER-The fontanelles vary in
diameter from a fingertip breadth to several centimeters. A large anterior fontanelle may
be a sign of hypothyroidism.
A large-for-gestational-age (LGA) neonate is one whose weight falls according to what
percentile? - ANSWER-A large-for-gestational-age (LGA) neonate is one whose weight
falls above the 90th percentile. LGA neonates weigh more than 4000 g (8 pounds, 13
ounces) due to accelerated growth for length of gestation.
A multigravida mother with history of oligohydramnios during pregnancy delivers a 39-
week-old male infant. The infant manifests significant respiratory distress. Which of the
following diagnoses is the MOST LIKELY cause of this infant's presentation? -
ANSWER-Pulmonary hypoplasia
Feedback
Oligohydramnios can result in pulmonary hypoplasia, along with several other GI, renal,
and growth complications.
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