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WorksheetsOB Ch 13, 14, & 15
Total questions: 76
Worksheet time: 6hrs 20mins
The failure of the uterus to follow the pattern of normal involution; the organ remains the same instead of returning to its pre-pregnancy size.
involution
subinvolution
postpartum hemorrhage
retained placenta
What is the nursing care for a hematoma? (select all that apply)
assessing pain and administering pain medication and applying an ice pack
explaining treatment
assess frequently to determine if it is changing size
monitoring vitals for signs of shock
What are the signs of endometritis? (select all that apply)
temperature above 38 C or 100.4 F
foul smelling lochia
lower abdominal tenderness
a feeling of needing to defecate
What are the signs and symptoms of a UTI? (select all that apply)
urgency of urination or increased frequency of urination
dysuria and fever
urination of small amounts
hematuria and flank pain
An infection of the breast tissue is referred to as what?
mastitis
thrombus
breast engorgement
endometritis
What is the most common organism to cause mastitis?
Staph aureus
E. coli
pseudomonas aeruginosa
bacilli
Who is at high risk of developing postpartum depression? (select all that apply)
those with a personal history of depression
PPD with a previous birth
those with a history of bipolar disorder
adolescents
What are other risk factors for postpartum depression? (select all that apply)
recent stressful life events
lack of social support
unintended pregnancy
financial factors
Medical management of postpartum depression usually includes what?
(a)
The woman at the highest risk for postpartum psychiatric disorder is who? (select all that apply)
adolescent
a woman over 35
a woman with a history of bipolar disorder
the woman with a previous episode of postpartum psychiatric disorder
What is the onset of postpartum psychiatric disorder?
12-24 hours
24-48 hours
48-72 hours
72-96 hours
For most women when will the signs and symptoms of postpartum psychiatric disorder appear?
1 week
3 weeks
2 weeks
1 month
The consequences of an increased metabolic rate in the cold newborn are which of the following? (select all that apply)
increased need for oxygen
decrease in surfactant production
increase in the us of stored glycogen, which can lead to hypoglycemia
rapid metabolism of brown fat, leading to metabolic acidosis
What can happen if the newborn cries for too long? (select all that apply)
the infant will tire
the infant will use up stored glycogen
it will increase the depth of respirations
it will aid in the opening of the alveoli
What happens to the cardiovascular system after the newborn starts breathing and the umbilical cord is cut? (select all that apply)
blood flow, pressure, and volume change
fetal circulation is no longer effective
blood flows in a new route
RBCs brerakdown
The newborn has a normal elevated WBC of what?
20,000-60,000
15,000-30,000
10,000-20,000
12,000-25,000
As the RBCs start to break down what happens to the bilirubin?
bilirubin rises
bilirubin decreases
bilirubin stays the same
What do we give the newborn to help with clotting?
vitamin A
vitamin B
Vitamin C
Vitamin K
Which of the following are nursing interventions for the renal system? (select all that apply)
monitoring the first void
weighing the diapers if concerned about urinary output
encouraging frequent breast feeding to increase fluid intake
monitoring meconium stool
How long after birth should the newborn produce meconium stool?
12-24 huors
24-48 hours
48-72 hours
72-96 hours
What are the nursing interventions for the newborns GI system? (select all that apply)
monitoring the meconium stool and reporting if it is not expelled within 24 hours
teaching parents not to over feed the newborn
teaching parents about the immature cardiac sphincter and regurgitation
monitoring for constipation
Which of the following is a common cause of postpartum hemorrhage?
involution
trauma
subinvolution
thrombosis
Normal Newborn Vital Signs-Temperature
97.7 F-99.3 F
90.0 F-95.5F
95.3 F-97.1 F
99.0 F-101.0 F
Normal Newborn Vital Signs-Heart Rate
Asleep: 98 bpm; Awake: 110-120 bpm; Crying: 150 bpm
Asleep: 100 bpm; Awake: 120–160 bpm; Crying: 180 bpm
Asleep: 110 bpm; Awake: 130-180 bpm; Crying: 190 bpm
Asleep: 80 bpm; Awake: 100-118 bpm; Crying: 120 bpm
Normal Newborn Vital Signs-Respiratory Rate
40-80 breaths per minute
30-80 breaths per minute
22-55 breaths per minute
30–60 breaths per minute
Normal Newborn Vital Signs-Blood Pressure
Systolic 45-70 mm Hg
Diastolic 25-40 mm Hg
Systolic 60-80 mm Hg
Diastolic 40-55 mm Hg
Systolic 50–75 mm Hg
Diastolic 30–45 mm Hg
Systolic 80-100 mm Hg
Diastolic 60-80 mm Hg
What is a bluish color of the hands and feet because of immature peripheral circulation called?
apnea
Acrocyanosis
acne neonatorum
Argyria
It is also common for newborns to have ______ on the scalp, forehead, and cheeks. These are tiny pinpoint bruises that occurred from pushing during delivery or from a rapid delivery.
variations
mucous membranes
petechiae
creases
To assess for skin turgor in the newborn what would you do?
gently pinch the skin on the thigh or chest
gently pinch the forehead
gently pinch the top of the foot
gently pinch the back of the neck
In skin turgor of newborn, If the skin remains “pinched,” the newborn has what?
has poor turgor and may be dehydrated.
has a skin disorder
has good turgor and is hydrated.
has skin cancer
The palms of the hands and the soles of the feet of the newborn should have what?
thermoregulation
good skin turgor
a bluish tent
creases
The creases in the sole develop from toe to heel. An absence of creases could indicate what?
a motor defect
a neurological disorder
nothing
a serious brain impairment
It is thought that sole creases develop in the uterus because of what?
god
fetal movement of the lower extremities
peripheral circulation
mucous membranes
What is Lanugo?
pushing during delivery or a rapid delivery
lower extremities
a white protective coating on the skin of the newborn
fine, downy hair that covers the forehead, ears, and body of the newborn
What is Vernix caseosa?
fine, downy hair that covers the forehead, ears, and body of the newborn
a white protective coating on the skin of the newborn
amniotic fluid that surrounds the fetus
nevus vascularis
A strawberry hemangioma, also known as a nevus vascularis, consists of?
sharp demarcation
Congenital melanocytic nevi
newly formed capillaries in the dermal and subdermal layers of the skin
further investigation by the health-care provider
No medical intervention is required unless the hemangioma is larger than?
12 cm
5 cm
10 cm
3 cm
Nevus simplex, is also known as?
a stork bite, angel kiss, or salmon patch
port wine stain
strawberry hemangioma
nervous system
It may be found on the forehead or nape of the neck. It is pink in color and does blanch when pressure is applied. It may be more prominent when the newborn cries. No treatment is required, and it usually fades by 18 months of age.
moles
Nevus flammeus
Nevus simplex
Erythema toxicum
Congenital melanocytic nevi, also known as?
hotspot
moles
red spots
birthmark
are uncommon in the newborn but have a potential for malignancy
Nevus simplex, also known as stork bites
Congenital melanocytic nevi, also known as moles
Erythema toxicum neonatorum, also known as newborn rash
Nevus flammeus, also known as port wine stain
A hairy nevus noted along the base of the spine could indicate what?
a skin disorder
Acne neonatorum
malignancy
a spina bifida congenital spine abnormality
Dermal melanosis, also known as?
Dermal spot
Mongolian spot
Red spot
Gray spot
Dermal melanosis, also known as Mongolian spot, is a common finding in?
any infant
infants of an addict mother, particularly cocaine or heroin addicts
infants of darker skin, particularly infants of Asian, East Indian, or African descent
infants of lighter skin, particularly infants of Scottish, and English descent
The spots are caused by melanocytes trapped deep in the skin. They appear flat and bluish-gray or brown, and are located on the back or buttocks
Dermal melanosis, also known as Mongolian spot
melanocytic
Erythema toxicum neonatorum also known as newborn rash
melanocytic nevi, also known as moles
a swelling on the head that does not cross the suture line
melanosis
cephalohematoma
hypothermia
dermal melanosis
a swelling of the scalp of the newborn
acne neonatorum
an underlying red tone
cephalohematoma
caput succedaneum
It is caused by pressure from the uterus or vaginal wall during delivery. The scalp will be soft and spongelike with possible bruising.
caput succedaneum
fontanel
fibrous membranes
occipital-frontal circumference
Respiratory Assessment: Document and report the following:
• A respiratory rate of less than 18 or more than 32 breaths/minute
• Cessation of breathing (apnea) of more than 30 seconds
• Any abnormal sound other than crackles in the first 24 hours
• Any increased work of breathing noted, especially seesaw chest movements and retraction of the skin around the ribs and sternum
• A respiratory rate of less than 30 or more than 60 breaths/minute
• Cessation of breathing (apnea) of more than 20 seconds
• Any abnormal sound other than crackles in the first 24 hours
• Any increased work of breathing noted, especially seesaw chest movements and retraction of the skin around the ribs and sternum
• A respiratory rate of less than 20 or more than 40 breaths/minute
• Cessation of breathing (apnea) of more than 10 seconds
• Any abnormal sound other than crackles in the first 24 hours
• Any increased work of breathing noted, especially seesaw chest movements and retraction of the skin around the ribs and sternum
• A respiratory rate of less than 50 or more than 80 breaths/minute
• Cessation of breathing (apnea) of more than 40 seconds
• Any abnormal sound other than crackles in the first 24 hours
• Any increased work of breathing noted, especially seesaw chest movements and retraction of the skin around the ribs and sternum
In the female what should the genitalia look like?
In a healthy newborn, the labia will cover the urethral opening
In a healthy newborn, the labia will cover the clitoris
In a healthy newborn, the labia will not cover the clitoris
In a healthy newborn, the labia will cover the midline
In the male what does normal genitalia look like?
the infant’s penis should be midline and straight with the urethral opening midline at the tip of the penis. The length of the nonerect penis is 3 to 5 cm at birth
the infant’s penis should be midline and straight with the urethral opening midline at the tip of the penis. The length of the nonerect penis is 2 to 3 cm at birth
The male infant’s penis should not be midline and straight with the urethral opening to the left at the tip of the penis. The length of the nonerect penis is 2 to 3 cm at birth
The male infant’s penis should be midline and straight with the urethral opening tothe left at the tip of the penis. The length of the nonerect penis is 3 to 5 cm at birth
When the sole of the foot is stroked, the newborn’s big toe moves upward toward the top surface of the foot and the other toes fan out.
Babinski Reflex
Plantar Grasp
Rooting Reflex
Moro’s (Startle) Reflex
The newborn’s toes curl downward in response to pressure applied to the sole of the foot at the base of the toes.
Babinski Reflex
Plantar Grasp
Rooting Reflex
Moro’s (Startle) Reflex
The newborn turns the mouth to the same side of the cheek that is stroked
Rooting Reflex
Babinski Reflex
Moro’s (Startle) Reflex
Trust Reflex
The newborn coughs in response to stimulation of the posterior oral cavity.
Gag Reflex
Moro’s (Startle) Reflex
Rooting Reflex
Tonic Neck Reflex
In response to a slight drop, sudden movement of the crib, or a loud noise, the newborn quickly makes a symmetrical abduction of the extremities and places the index fingers and thumbs into a “C” shape.
Babinski Reflex
Moro’s (Startle) Reflex
Moro’s (Startle) Reflex
Rooting Reflex
The newborn wraps the fingers around the examiner’s finger when it is placed in the newborn’s palm.
Palmar Grasp
Plantar Grasp
Rooting Reflex
Babinski Reflex
The newborn simulates walking when held in an upright position and the sole of the foot touches a flat surface.
Stepping Reflex
Moro’s (Startle) Reflex
Rooting Reflex
Extrusion Reflex
In a supine position, if the newborn’s head is turned to one side with the jaw over the shoulder, the arm and leg on the same side extend while the opposite arm and leg flex.
Tonic Neck Reflex
Extrusion Reflex
Stepping Reflex
Rooting Reflex
The newborn uses the tongue to push foreign objects out of the mouth.
Tonic Neck Reflex
Extrusion Reflex
Rooting Reflex
Stepping Reflex
Safety Stat!
Warning signs observed during the physical assessment that must be reported immediately include the following:
• Heart rate less than 110 bpm or greater than 160 bpm (180 bpm if crying)
• Respiratory rate of less than 30 or greater than 60 breaths/minute
• Hypotonic or hypertonic muscle tone
• Lack of movement of arms and legs
• Jaundice
• Periods of apnea longer than 20 seconds
• Axillary temperature of less than 36.1°C (96.9°F) or greater than 37.2°C (99°F)
• Cyanosis of the body, lips, nailbeds (not normal acrocyanosis of the newborn’s feet and hands)
reduces the risk of bleeding because babies don’t get enough vitamin K during the pregnancy or while breastfeeding.
Vitamin K injection
Antibiotic
hepatitis B vaccine
erythromycin ointment
reduces the risk of the baby getting an eye infection from passing through the birth canal.
hepatitis B vaccine
Vitamin K injection
Antibiotic ointment for the eyes
gestational age
starts the immunization process to prevent the baby from acquiring hepatitis B
consent from mother
erythromycin ointment
Vitamin K injection
Hepatitis B injection
tests for the metabolic disorder phenylketonuria and up to 40 other disorders. The blood is obtained from a heel stick.
Newborn screening EKG test
Newborn screening blood test
Newborn screening x-ray
Newborn screening glucose test
a noninvasive test with a pulse oximeter measuring the baby’s oxygen levels on his or her limbs. This test is for early detection of a heart problem.
Critical oxygen screening
Critical chest screening
Critical congenital heart defect screening
Critical brain screening
a noninvasive test for early detection of a hearing problem.
Hearing screening
Blood screening
Face screening
Lack of movement screening
Labs & Diagnostics: The following is the correct technique for obtaining blood specimens for newborn screening:
*Warm the newborn’s heel to increase circulation.
*Cleanse the newborn’s heel with alcohol and allow to dry.
*Collect the blood directly on the collection paper or pipette.
*Apply gentle pressure to the heel with gauze and cover with an adhesive bandage.
*Provide comfort to the newborn.
*Use a spring-activated lancet to puncture the skin no deeper than 2.4 mm on the outer aspect of the heel.
can be used to remove excess mucus, breast milk, or formula if the infant chokes
circular syringe
bulb syringe
syringe without catheter
blue syringe
A baby should ride how?
in a front-facing seat that is compliant with current safety standards for car seats until he or she reaches the highest weight or height allowed by state law
in a rear-facing seat that is compliant with current safety standards for car seats until he or she reaches the highest weight or height allowed by state law
in a rear-facing seat that is compliant with current safety standards for car seats until he or she reaches the highest weight or height allowed by the car seat manufacturer
in a front-facing seat that is compliant with current safety standards for car seats until he or she reaches the highest weight or height allowed by the car seat manufacturer
The car seat’s harness cradles and protects the child’s ____ and ____ in the event of a crash.
brain and spinal cord
neck and shoulders
brain and neck
neck and spinal cord
If the baby develops diaper rash, the recommended treatment is as follows:
• Keep the diaper area open to air as long as possible before applying a clean diaper
• Clean the skin with warm water and avoid commercial premoistened cleaning cloths.
• Apply a barrier of zinc oxide cream to the skin.
• Change diapers often.
Caring for the Umbilical Stump:
• Keep the stump dry by folding the diaper below the stump so that it is exposed to air.
• Allow the dried cord to fall off on its own. Avoid pulling on the cord to dislodge it.
• Sponge bathe the baby until the cord falls off.
• Apply no antimicrobial cream to the stump.
• Be aware that when the cord falls off, a small amount of bleeding may occur.
• Report any signs of infection such as pus or redness around the umbilical stump.
• Keep the cord clean. If the cord becomes soiled, clean with warm water and pat dry.
Instruct the parents of a circumcised newborn to do the following:
• For a few days, wrap the penis in a small amount of gauze with a dab of petroleum jelly to keep it from sticking to the diaper.
• Do not remove or try to wash off the yellow crust that forms. It is not a sign of infection.
• Give sponge baths until healing is complete and the “ring” falls off, if a Plastibell® appliance was used.
• Keep the penis clean and dry.
Instruct the parents of a circumcised newborn to Call the doctor if any of the following are noted:
• Discoloration of the penis
• Lack of urination
• Discharge from the penis or surgical site that includes pus
• A spot of blood in the diaper larger than 2 inches
• A fever greater than 37.8°C (100°F) axillary occurs
• The baby cannot be calmed or soothed
The procedure for sponge bathing is as follows:
1. Gather all supplies before beginning the bath: a mild or hypoallergenic baby soap, washcloths, towel, clean diaper, and clean clothes.
2. Place a towel on a firm surface next to the sink or basin of water filled with lukewarm water. Always test the temperature of the water on a forearm.
3. Undress the baby and cover with a towel. To avoid chilling the baby, only the parts of the body being washed should be exposed.
4. Always keep one hand on the baby.
5. Start with the eyes. Using a clean cloth and no soap, wipe gently from the bridge of the nose outward.
6. Move next to the ears and the rest of the face. No soap is needed for the face.
7. Uncover the chest and, using gentle soap, clean the neck, chest, arms, and hands. Pay attention to creases in the skin. Rinse carefully, keeping the umbilical stump dry. Pat the skin dry.
8. Cover the chest and uncover the lower body. Wash, rinse, and pat dry the toes, feet, and legs.
9. Turn the baby over and wash and rinse the back.
10. Wash the genitals and buttocks last. For a girl, wash from front to back. If the boy is circumcised, do not wash the penis until it is healed.
11. After drying the baby, place a clean diaper on him or her and wrap the baby in a towel before washing the hair.
12. To wash the hair, hold the baby in the football hold, supporting the neck and head; use the other hand to wash and rinse the hair. Tilt the head slightly back to keep water and shampoo from running into the eyes.
