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1. A yellow crust has formed over the circumcision site. The mother calls the hotline at the local hospital, 5 days after her son was circumcised. She is very concerned. On which rationale should the nurse base her reply?
a. After circumcision, the diaper should be changed frequently and fastened snugly.
b. This yellow crust is an early sign of infection.
c. The yellow crust should not be removed.
d. Discontinue the use of petroleum jelly to the tip of the penis.
Crust is a normal part of healing and should not be removed. The diaper should be fastened loosely to prevent rubbing or pressure on the incision site. The normal yellowish exudate that forms over the site should be differentiated from the purulent drainage of infection. The only contraindication for petroleum jelly is the use of a PlastiBell.
2. A new father wants to know what medication was put into his infant's eyes and why it is needed. The nurse explains to the father that the purpose of the ophthalmic ointment is to
a. destroy an infectious exudate caused by Staphylococcus that could make the infant blind.
b. prevent gonorrheal and chlamydial infection of the infant's eyes potentially acquired from the birth canal.
c. prevent potentially harmful exudate from invading the tear ducts of the infant's eyes, leading to dry eyes.
d. prevent the infant's eyelids from sticking together and help the infant see.
The ointment is used to prevent potential gonorrheal and chlamydial infection of the infant's eyes.
3. When instructing parents on the correct use of a bulb syringe it is important include what information?
a. Avoid suctioning the nares.
b. Insert the compressed bulb into the center of the mouth.
c. Suction the mouth first.
d. Remove the bulb syringe from the crib when finished.
The mouth should be suctioned first to prevent the infant from inhaling pharyngeal secretions by gasping as the nares are suctioned. The nasal passages should be suctioned one nostril at a time. The mouth should always be suctioned first. After compression of the bulb it should be inserted into one side of the mouth. If it is inserted into the center of the mouth, the gag reflex is likely to be initiated. The bulb syringe should remain in the crib so that it is easily accessible if needed again.
4. In providing and teaching cord care, what is an important principle?
a. Cord care is done only to control bleeding.
b. Alcohol is the only agent used for cord care.
c. It takes a minimum of 24 days for the cord to separate.
d. The process of keeping the cord dry will decrease bacterial growth.
Bacterial growth increases in a moist environment, so keeping the umbilical cord dry impedes bacterial growth. Cord care is to prevent infection and add in the drying of the cord. No agents are necessary to facilitate drying of the cord. The cord will fall off within 10 to 14 days.
5. The nurse's initial action when caring for an infant with a slightly decreased temperature is to
a. notify the physician immediately.
b. place a cap on the infant's head.
c. Keep the infant in the nursery for the next 4 hours.
d. Assess for other signs of inaccurate gestational age.
A cap will prevent further heat loss from the head, and having the mother place the infant skin-to-skin should increase the infant's temperature. Nursing actions are needed first to correct the problem. If the problem persists after interventions, notification may then be necessary. A slightly decreased temperature can be treated in the mother's room. This would be an excellent time for parent teaching on prevention of cold stress. There is no need for another gestational age assessment.
6. When teaching parents about mandatory newborn screening, it is important for the nurse to explain that the main purpose is to
a. keep the state records updated.
b. allow accurate statistical information.
c. document the number of births.
d. recognize and treat newborn disorders early.
Early treatment of disorders will prevent morbidity associated with inborn errors of metabolism or other genetic conditions. Keeping and updating records are not the reasons for the testing.
7. What action by the nurse is most important to prevent the kidnapping of newborns from the hospital?
a. Instruct the mother not to give her infant to anyone except the one nurse assigned to her that day.
b. Question anyone who is seen walking in the hallways carrying an infant.
c. Allow no visitors in the maternity area except those who have identification bracelets.
d. Restrict the amount of time infants are out of the nursery.
Infants should be transported in the hallways only in their cribs. It is impossible for one nurse to be on call for one mother and baby for the entire shift, so the parents need to be able to identify the nurses who are working on the unit. Limiting visitors may cut the new family off from vital support. Infants should be with their parents the majority of the time
8. The nurse administers vitamin K to the newborn for what reason?
a. Most mothers have a diet deficient in vitamin K, which results in the infant's being deficient.
b. Vitamin K prevents the synthesis of prothrombin in the liver and must be given by injection.
c. Bacteria that synthesize vitamin K are not present in the newborn's intestinal tract.
d. The supply of vitamin K is inadequate for at least 3 to 4 months, and the newborn must be supplemented.
In order to promote clotting, vitamin K is necessary. However, the bacteria that synthesize vitamin K are not present in the newborn's intestinal tract, so the nurse administers it via injection. The maternal diet has no bearing on the amount of vitamin K found in the newborn. It is not involved in the synthesis of prothrombin. By day 8, normal newborns are able to produce their own vitamin K.
9. The student nurse asks why gloves are needed when handling a newborn because the newborn "hasn't been exposed to anything." What response by the nurse is best?
a. It is part of standard precautions.
b. It is hospital policy.
c. Amniotic fluid and maternal blood pose risks to us.
d. We are protecting the infant from our bacteria.
With the possibility of transmission of viruses such as HBV and HIV through maternal blood and amniotic fluid, the newborn must be considered a potential contamination source until proved otherwise. As part of standard precautions, nurses should wear gloves when handling the newborn until blood and amniotic fluid are removed by bathing. While this may be policy and is part of standard precautions, simply stating these facts does not convey any detailed information. The nurses are not protecting the infant from themselves.
10. With regard to lab tests and diagnostic tests in the hospital after birth, nurses should be aware that
a. all states test for phenylketonuria (PKU), hypothyroidism, cystic fibrosis, and sickle cell diseases.
b. federal law prohibits newborn genetic testing without parental consent.
c. if genetic screening is done before the infant is 24 hours old, it should be repeated at age 1 to 2 weeks.
d. hearing screening is now mandated by federal law.
If testing is done prior to 24 hours of age, genetic screening should be repeated when the infant is 1 to 2 weeks old. States all test for PKU and hypothyroidism, but other genetic defects are not universally covered. Federal law mandates newborn genetic screening; however, parents can decline testing. A waiver should be signed and a notation made in the infant's medical record. Federal law does not mandate screening for hearing problems; however, the majority of states have enacted legislation mandating newborn hearing screening. In the United States the majority (95%) of infants is screened for hearing loss prior to discharge from the hospital.
11. Nurses can help parents deal with the issue and fact of circumcision if they explain
a. the pros and cons of the procedure during the prenatal period.
b. that the American Academy of Pediatrics (AAP) recommends that all newborn males be routinely circumcised.
c. that circumcision is rarely painful and that any discomfort can be managed without medication.
d. that the infant will likely be alert and hungry shortly after the procedure.
Parents need to make an informed choice regarding newborn circumcision based on the most current evidence and recommendations. Health care providers and nurses who care for childbearing families should provide factual, unbiased information regarding circumcision and give parents opportunities to discuss the risks and benefits of the procedure. The AAP and other professional organizations note the benefits but stop short of recommendation for routine circumcision. Circumcision is painful and must be managed with environmental, nonpharmacologic, and pharmacologic measures. Infants may or may not be alert and hungry after the procedure.
12. A nurse is responsible for teaching new parents about the hygienic care of their newborn. What information does the nurse include?
a. Avoid washing the head for at least 1 week to prevent heat loss.
b. Sponge bathe only until the cord has fallen off.
c. Cleanse the ears and nose with cotton-tipped swabs, such as Q-tips.
d. Water temperature should be at least 38° C.
The ideal temperature of the bath water should be at least 38° C, or 100.4° F. The head can be washed. Tub baths may be initiated from birth. Ensure that the infant is fully immersed. Q-tips should not be used, because they may cause injury. A corner of a moistened washcloth should be twisted into shape so that it can be used to cleanse the ears and nose
13. An unfortunate but essential role of the nurse is protecting the infant from abduction. Which statement regarding the profile of a potential abductor is the most accurate?
a. Male gender
b. A young woman who has had a previous pregnancy loss
c. A middle-aged woman past childbearing age
d. A female with a number of children of her own
The woman is usually of childbearing age and may have had a previous pregnancy loss or has been unable to have a child of her own. She may want an infant to solidify the relationship with her husband or boyfriend and may have pretended to be pregnant. The women are usually familiar with the facility and its routines.
14. When the nurse is in the process of health teaching it is very important that he or she consider the family's cultural beliefs regarding child care. One of these beliefs includes that
a. Arab women are anxious to breastfeed while still in the hospital.
b. it is important to complement Asian parents about their new baby.
c. women from India tie a black thread around the infant's waist.
d. in the Korean culture the patient's mother is the primary caregiver of the infant.
Women from India may tie a black thread around the infant's wrist, ankle, or waist to ward off evil spirits. This thread should not be removed by the nurse. Arab women are hesitant to breastfeed in the birth facility and wish to wait until they are home and their milk comes in. Asian parents may be uneasy when caregivers are too complementary about the baby or casually touch the infant's head. In the Korean culture, the husband's mother is the primary caregiver for the infant and the mother during the early weeks.
15. Nursing follow-up care often includes home visits for the new mother and her infant. Which information related to home visits is correct?
a. Ideally the visit is scheduled between 24 and 72 hours after discharge.
b. Home visits are available in all areas.
c. Visits are completed within a 30-minute time frame.
d. Blood draws are not a part of the home visit.
The home visit is ideally scheduled during the first 24 to 72 hours after discharge. This timing allows early assessment and intervention for problems with feedings, jaundice, newborn adaptation, and maternal-infant interaction. Because home visits are expensive, they are not available in all geographic areas. Visits are usually 60 to 90 minutes in length to allow enough time for assessment and teaching. When jaundice is found, the nurse can discuss the implications and check the transcutaneous bilirubin level or draw blood for testing.
16. A nurse is observing a student nurse apply erythromycin ophthalmic ointment. What action by the student requires the nurse to intervene?
a. Applies ointment in thin ribbon
b. Applies ointment from outer canthus to inner canthus.
c. Holds the tube horizontally while applying ointment
d. Wipes excess ointment away after 1 minute.
The ointment should be applied from inner to outer canthus. When the student does this incorrectly, the nurse should intervene. The other actions are appropriate.
17. A student nurse is preparing an injection of vitamin K (aquaMEPHYTON). What action by the student shows good understanding of this procedure?
a. Draws up 1.5 mg of solution
b. Protects solution from light
c. Finds landmark for subQ injection
d. Administers directly after circumcision
The solution of vitamin K is light-sensitive, so it should be protected from light. The dose is 0.5 to 1 mg. It is given IM and should be administered prior to a circumcision.
1. Nurses use many different nonpharmacologic methods of pain management. Examples of nonpharmacologic pain management techniques include which of the following? (Select all that apply.)
b. Nonnutritive sucking (pacifier)
c. Skin-to-skin contact with the mother
ANS: A, B, C, D
These interventions are all appropriate nonpharmacologic techniques used to manage pain in neonates. Other interventions include soothing music, dim lighting and speaking to the infant in a quiet voice. Acetaminophen is a pharmacologic method of treating pain.
2. The nurse should model and teach practices used to prevent sudden infant death syndrome. Which of the following do these include? (Select all that apply.)
a. Fully supine position for all sleep
b. Side-sleeping position as an acceptable alternative
c. "Tummy time" for play
d. Placing the infant's crib in the parents' room
e. A soft mattress
ANS: A, D
The back to sleep position is now recommended as the only position for every sleep period. Ideally the infant's crib should be placed in the parents' room. Side sleeping is not an acceptable alternative because of the possibility the infant will roll to the prone position. Tummy time helps develop muscles and reduces plagiocephaly. Mattresses in cribs should be firm.
3. Auditory screening of all newborns within the first month of life is recommended by the American Academy of Pediatrics. Reasons for having this testing performed include (Select all that apply.)
a. To prevent or reduce developmental delay
b. Reassurance for concerned new parents
c. Early identification and treatment
d. To help the child communicate better
e. To achieve one of the Healthy People 2020 goals
ANS: A, C, D, E
These are all appropriate reasons for auditory screening of the newborn. Infants who do not pass should be rescreened. If they still do not pass the test, they should have a full audiologic and medical evaluation by 3 months of age. If necessary, the infant should be enrolled in early intervention by 6 months of age. New parents are often anxious about this test and the impending results; however, it is not the reason for the screening to be performed. Auditory screening is usually done before hospital discharge. It is important for the nurse to ensure that the infant receive the appropriate testing and that the test is fully explained to the parents. For infants who are referred for further testing and follow-up, it is important for the nurse to provide further explanation and emotional support
4. The parents of a newborn are considering circumcision. What possible complications does the nurse teach them about? (Select all that apply.)
a. Urinary retention
c. Necrosis of the site
d. Kidney infection
e. Unsatisfactory cosmetic result
ANS: A, B, C, E
Urinary retention, adhesions, necrosis, and unsatisfactory cosmetic results are possible complications of this procedure. Kidney infection is not.
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