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WorksheetsExam 4 (OB): Preterm/Newborns at Risk
Total questions: 110
Worksheet time: 3570secs
The Apgar scores indicate the condition of the neonate shortly after delivery. What does Apgar stand for?
Appearance, Pulse, Grimace, Activity, and Respiration
Appearance, Pressure, Girth, Activity, and Respiration
Activity, Pulse, Grimace, Agitation, and Restlessness
Activity, Power, Girth, Affect, and Respiration
When are the Apgar scores typically completed by the RN?
1 minute after birth and 5 minutes after birth.
Immediately after birth and 10 minutes after birth.
2 minutes after birth and 10 minutes after birth.
Only at 1 minute after birth.
The GREATEST risk to the newborn during delivery if there is meconium in the amniotic fluid is:
Meconium aspiration syndrome
Neonatal hypoglycemia
Patent arteriosus ductus
Neonatal pathological jaundice
Meconium encopresis
Can Meconium Aspiration Syndrome (MAS) be prevented with any interventions?
Yes, certain interventions such as bulb suction can help prevent MAS.
No, there are no real interventions that can prevent MAS. Early detection is key.
MAS is always preventable with antibiotics.
MAS prevention is only possible after birth.
What does the acronym WETFROG stand for in the context of newborn respiratory distress?
Wheezing, Effort, Tachypnea, Flaring, Retractions, Oxygenation, Grunting
Wheezing, Edema, Tachycardia, Flaring, Retractions, Oxygenation, Grunting
Wheezing, Effort, Tachypnea, Fever, Retractions, Oxygenation, Grunting
Wheezing, Effort, Tachypnea, Flaring, Rashes, Oxygenation, Grunting
Which of the following is a sign of newborn respiratory distress?
Wheezing
Sneezing
Vomiting
Coughing
What are the respiratory rate parameters for neonatal tachypnea?
RR must be greater than or equal to 60 for neonate to be considered tachypnea.
RR must be greater than or equal to 40 for neonate to be considered tachypnea.
RR must be greater than or equal to 30 for neonate to considered tachypnea.
RR must be greater than or equal to 100 for neonate to be considered tachypnea.
The neonatal patient in respiratory distress should be immediately placed in a humidified warmer while the RNs and HCPs perform other interventions.
True
False
What is the recommended oxygen saturation (SpO2%) for newborns with respiratory distress?
Ideal O2 sat between 88-93%
Ideal O2 sat above 98%
Ideal O2 sat between 93-97%
Ideal O2 sat between 95-100%
Ideal O2 sat between 82-90%
What complication can result from too much oxygen in premature infants?
Retinopathy of prematurity/ROP
Chronic obstructive pulmonary disorder/COPD
Pulmonary embolism/PE
Deep vein thrombosis/DVT
Lower extremity neuropathy/LEN
Retinopathy of prematurity can cause permanent and irreversible eye damage.
True
False
A neonate in respiratory distress is not responding to incubator and nasal cannula O2 administration, and is continuing to decline. What is the next step to provide this neonate adequate oxygenation?
CPAP
Mechanical ventilation
Cricothyroidotomy
ECMO
What medication can be administered through an endotracheal tube to treat acute neonatal respiratory distress?
Synthetic Surfactant
Synthetic Epinephrine
Synthetic Albuterol
Synthetic Methylprednisone
What does ECMO stand for?
Extracorporeal Membrane Oxygenation
Endotracheal Mechanical Oxygenation
External Membrane Oxygenation
Extracorporeal Mechanical Oxygenation
How does ECMO help to oxygenate neonates?
provides positive airway pressure at all times
delivers individualized amounts of O2 and initiates ventilation
bypasses the cardiopulmonary system to oxygenate neonate's blood as an artificial lung
warms neonate and provides 100% FiO2, similar to a non-rebreather
ECMO requires anticoagulation therapy so blood does not clot in the tubing.
True
False
Prior to 32-34 weeks gestational age, newborns lack endogenous ________.
surfactant
insulin
bilirubin
thyroxine
How should neonates be weaned from O2 therapy?
Slowly, in a stepwise format
Quickly, ideally less than 24 hrs
No weaning, cut off O2 immediately
Very slowly, after multiple years of therapy ideally
What is a major risk factor for a fetus of a mom who has gestational diabetes?
uncontrolled maternal blood glucose levels
uncontrolled maternal weight/obesity
uncontrolled neural tube defects due to folate insufficiency
uncontrolled anemia due to iron insufficiency
SATA: What are some neonatal complications of maternal hyperglycemia?
cardiomyopathies
perinatal asphyxia
neonatal hypoglycemia
polyhydramnios
hyperbilirubinemia
Congenital anomalies related to uncontrolled maternal blood glucose levels have the highest incidence in ____ babies.
SGA
AGA
LGA
Choose the BEST answer: Will mom or the newborn develop problems from GBS if mom tests positive for GBS?
Yes, both mom and newborn can develop problems if mom tests positive for GBS. Both mom and baby can develop serious complications from GBS.
No, neither mom nor newborn will develop problems if mom tests positive for GBS. They should be completely unaffected.
Only the newborn can develop problems if mom tests positive for GBS. The mom should be completely unaffected.
Only the mom can develop problems if mom tests positive for GBS. The newborn should be completely unaffected.
While GBS can cause issues in adults, it will be next to harmless for mom. GBS can be life threatening to newborns.
When should pregnant mothers get tested for GBS?
At 35-37 weeks of gestation
At 22-24 weeks of gestation
At 17-21 weeks of gestation
At 26-28 weeks of gestation
What treatment should be done if mom is GBS positive?
Administer intrapartum antibiotics
Perform emergency cesarean section
Delay delivery until GBS is negative
No treatment is necessary
The route penicillin is given for GBS positive mothers is:
Oral
Intravenous
Intramuscular
Subcutaneous
Which of the following are respiratory signs and symptoms that may indicate a newborn has an infection?
Rapid breathing, grunting, nasal flaring, chest retractions
Excessive crying, frequent hiccups, weak sucking reflex
High-pitched wheezing, frequent yawning, strong grip
Constant sneezing, chest retractions, irregular sleeping patterns
Fill in the blank: The integumentary symptoms of neonatal infection include jaundice, pallor, mottling, and ________.
petechiae
cyanosis
edema
hypotonia
Fill in the blank: Maternal fever during ________ is a precursor to neonatal infection.
labor
first trimester
postpartum
third trimester
second trimester
Fill in the blank: Foul-smelling ________ fluid is a precursor to neonatal infection.
amniotic
peritoneal
pleural
synovial
SATA: Which of the following are CNS manifestations of neonatal infection?
temperature instability
lethargy and hypotonia
irritability and inconsolability
seizures
metabolic acidosis
Which of the following is NOT a TORCH infection agent?
Toxoplasmosis
Syphilis
Rubella
GBS
Cytomegalovirus
Fill in the blank: HIV/AIDS transmission can occur prenatally, during birth, and through ________.
lactation
digestion
perspiration
respiration
Transmission of HIV from mother to child can be reduced from 12-40% to less than 1% by:
Treating HIV pregnant mom with zidovudine during pregnancy and intrapartum
Treating infant for first 6 weeks of life with zidovudine
Schedule an elective C/S
All of the above
Fill in the blank: GBS Early Onset Illness symptoms usually occur within ________ after birth.
24hrs
48hrs
72hrs
1 week
Fill in the blank: GBS Early Onset Illness results in SEVERE ____________.
respiratory distress
meningitis
ascites buildup
cold stress
hyperbilirubinemia
In GBS Late Onset Illness, which is more common?
Meningitis
Respiratory distress
Fill in the blank: GBS Late Onset Illness symptoms start about ________ to ________ after birth.
1 week to 3 months
3 months to 6 months
6 months to 12 months
12 months to 18 months
What percentage of babies with GBS Late Onset Illness will develop long term neurological complications?
25%
50%
75%
100%
What typically happens INITIALLY with a neonate's temperature if they have an infection?
Their temperature DROPS due to an immature immune system
Their temperature RISES due to a strong immune response
Their temperature REMAINS CONSTANT regardless of infection
Their temperature FLUCTUATES unpredictably
SATA: Which of the following are treatment options for a neonatal infection?
IV antibiotics, antivirals, or antifungals
Oxygen or other respiratory aids
Breast feeding for protective antibodies
Frequent phototherapy
Complex carbohydrate administration
What specific meds would you expect for treating infection?
Penicillin, Gentamycin, Ampicillin, Azithromycin, Erythromycin, etc.
Ibuprofen, Paracetamol, Aspirin, Diclofenac, Naproxen, etc.
Metformin, Insulin, Glipizide, Sitagliptin, Pioglitazone, etc.
Omeprazole, Ranitidine, Pantoprazole, Esomeprazole, Lansoprazole, etc.
What is hyperbilirubinemia?
Increased level of bilirubin in the blood, characterized by jaundice of the skin and sclera
Decreased level of bilirubin in the blood, leading to pale skin and sclera
Increased level of hemoglobin in the blood, causing jaundice of the skin and sclera
Deficiency of urobilinogen, resulting in anemia and jaundice of the skin and sclera
What are the two subtypes of hyperbilirubinemia/jaundice?
Infectious and Non-infectious
Psychological and Physical
Physiological and Pathological
Hepatic and Renal
What is physiologic jaundice?
Type of jaundice due to liver immaturity
Type of jaundice due to bile duct obstruction
Type of jaundice caused by hemolytic disease
Type of jaundice due to viral hepatitis
What are the criteria for physiologic jaundice?
Jaundice appears 24 hours after birth; Disappears by the end of 7th day of life; Bilirubin level does NOT exceed 12 mg/100 ml; If the above criteria does NOT FIT, jaundice may be due to a more serious 'pathologic' problem
Jaundice appears within 12 hours of birth; Disappears by the end of 3rd day of life; Bilirubin level exceeds 15 mg/100 ml; Always indicates a pathologic problem
Jaundice appears immediately after birth; Persists beyond 14 days; Bilirubin level does NOT exceed 8 mg/100 ml; Never indicates a pathologic problem
Jaundice appears 48 hours after birth; Disappears by the end of 10th day of life; Bilirubin level exceeds 20 mg/100 ml; Always associated with infection
What is pathologic jaundice?
Pathologic jaundice is a more serious problem that does not fit the criteria for physiologic jaundice.
Pathologic jaundice is a mild condition that resolves without treatment.
Pathologic jaundice is caused by excessive intake of vitamin C.
Pathologic jaundice is a type of skin rash seen in newborns.
SATA: Which of the following are interventions used to treat neonatal hyperbilirubinemia?
Phototherapy
Antibiotics
Surgical removal of the liver
Reduction in total daily feedings
Early and frequent feedings
Phototherapy in the treatment of jaundice is:
the use of artificial light to reduce bilirubin levels in the blood
the use of artificial light to increase bilirubin levels in the blood
the use of laser therapy to remove lesions on the liver
the use of sunlight exposure to improve liver function
the use of photography to take cool pictures of the newborn's liver
What safety interventions must be performed during phototherapy for infants?
Cover the infant's eyes and monitor temperature regularly
Feed the infant only water during phototherapy
Keep the infant in complete darkness during phototherapy
Apply lotion to the infant's skin before phototherapy
Fill in the blank: Breastfed infants have an ______ risk of jaundice when compared to formula-fed infants.
increased
decreased
A breastfeeding mother just gave birth to a boy with pathologic jaundice 2 days ago. How many times per day should she breastfeed him in order to facilitate stool removal of excess bilirubin?
3-4
5-6
7-9
10-12
18-24
If left untreated, what life-threatening condition could occur in infants with high bilirubin levels?
Kernicterus
Guillan-Barre
Patent arteriosus ductus
Immune thrombocytopenia purpura
Sickle-cell anemia
Necrotizing enterocolitis is an acute inflammatory disease of the _____ system mucosa.
Cardiovascular
Respiratory
Hepatic
Gastrointestinal
Renal
SATA: Which of the following is a symptom of kernicterus?
CNS depression or excitation
Seizures
Hypotonia
Hemorrhage
Blood glucose instability
Indirect bilirubin is highly fat soluble and WILL pass the blood brain barrier in neonates if given the opportunity.
True
False
SATA: Which of the following are possible causes of neonatal necrotizing enterocolitis (NEC)?
Intestinal ischemia from hypoxia at birth
Malnutrition due to underfeeding
Underdeveloped protective intestinal mucin layer
Infection due to an immature immune response
Decreased amount of gastric acid
What is the approximate mortality rate for neonatal necrotizing enterocolitis (NEC)?
5%
10%
40%
80%
NEC (Necrotizing Enterocolitis) can lead to ulcerations and ________ in newborns.
Strictures
Hernias
Perforation
Encopresis
SATA: Which of the following are clinical manifestations of NEC?
abdominal tenderness and distension
bile and/or blood in the vomitus
erythema of the abdominal wall
hypotonia
blood in the stools
What type of nutrition is REQUIRED for newborns with necrotizing enterocolitis/NEC?
enteral
parenteral
breastmilk
formula
clear liquid
SATA: What treatments are indicated for a newborn with NEC?
OG tube for GI decompression
Strict infection control measures
Surgical resection if necessary
Antibiotics as ordered
Placement of a foley catheter
SATA: How can NEC be prevented in newborns?
Breastfeeding
Non-nutritive sucking
Reversal of perinatal asphyxia
Immediate surgery after birth
Enteral nutrition only for first week of life
What is neonatal abstinence syndrome?
A disorder is characterized by in-utero exposure to chemical substances.
A genetic disorder affecting the immune system of newborns.
A condition where newborns are born with congenital heart defects.
A syndrome characterized by premature aging in infants.
SATA: Maternal use of which chemical substances can lead to the development of neonatal abstinence syndrome in her infant?
Amphetamines, Cocaine
Benzodiazepines, Barbituates
Alcohol
Opiates, Narcotics
Methadone
Clinical manifestations of neonatal substance exposure occur during the first ____ hours of life.
24-48
72-96
12-18
48-72
Which of the following is a CNS sign/symptom of neonatal substance exposure?
High pitched cry
Diaphoresis
Excessive sucking
Loose stools
Which of the following is a metabolic symptom of neonatal substance exposure?
Projectile vomiting
Diaphoresis
Hyperactive moro reflex
Excoriation
Which of the following is a GI sign/symptom of neonatal substance exposure?
Increased respiratory rate
Excessive sucking
High pitched cry
Diaphoresis
What is one intervention used to treat neonatal substance exposure?
Reduce stimuli
Increase noise levels
Limit feeding
Encourage bright lights
Which of the following is a pharmacologic treatment for neonatal substance exposure?
Diazepam
Ibuprofen
Acetaminophen
Penicillin
Promoting positive maternal-infant bonding is an intervention used to treat neonatal substance exposure.
True
False
Newborns with neonatal abstinence syndrome require constant and intense stimuli.
True
False
A preterm infant is born BEFORE completion of the ___ week of gestation, REGARDLESS of birth weight.
37th
40th
35th
30th
SATA: A high pitched and shrill cry is one of the hallmarks of neonatal abstinence syndrome. What are some other CNS manifestations of this disorder?
hyperactive moro reflex
mild to severe tremors
decreased muscle tone
myoclonic jerks
generalized convulsions
Babies that are born preterm make up ____ of ALL infant deaths.
2/3rds
1/3rd
1/2
1/4
Preterm infants often have a head that is disproportionately ______ compared to their chest.
Small
Large
SATA: Which reflexes are MOST COMMONLY absent in preterm infants?
Suck reflex
Grasping reflex
Babinski reflex
Startle reflex
Swallow reflex
The skin of preterm infants is often ruddy-looking. These newborns will usually present with ______ vernix and ______ lanugo.
abundant, abundant
abundant, minimal
minimal, abundant
minimal, minimal
no, minimal
What does PDA stand for in regards to possible cardiovascular complications of preterm infants?
Patent ductus arteriosus
Pulmonary distress anomaly
Peripheral ductal abnormality
Primary diastolic arrhythmia
SATA: Which of the following are factors that influence the nutritional difficulties of preterm newborns?
congenital anomalies that cause an inability to suck
respiratory distress that necessitates the use of a ventilator
increased tendency for necrotizing enterocolitis
lack of adequate O2 reserves
decreased caloric requirement when compared to term infants
A baby boy has just been born 1 minute ago. His torso is pink, but his hands and feet are blue. He has a HR of 97 bpm. He is able to sneeze when stimulated. He has minimal flexion in his limbs. He has a strong cry. What should his first total Apgar score be?
10
9
7
6
4
A baby girl has just been born 5 minutes ago. Her entire body is pink. She has a HR of 132 bpm. She slightly grimaces when stimulated. She is very actively moving her limbs. Her cry is weak. What should her second total Apgar score be?
10
9
6
5
8
If a neonate's 1 minute and 5 minute Apgar scores are poor, the Apgar scoring can be repeated every 5 minutes until a satisfactory score is achieved.
True
False
SATA: What are some potential complications of Meconium Aspiration Syndrome/MAS?
altered gas exchange
inflammation of the airways
infection of the airways (i.e. pneumonia)
obstruction of the airways
life threatening hypoxia
How can the RN or HCP detect Meconium Aspiration Syndrome early during labor?
FHT strip monitoring, assess amniotic fluid for traces of meconium
Bedside U/S, assess amniotic fluid for traces of meconium
FHT strip monitoring, frequent SVEs
Bedside U/S, bladder scan, IUPC monitoring
A newborn is suspected to have MAS. The baby is crying, but the cry is very weak. The RN will perform _____ suction on the baby and place a _______ on the baby as their INITIAL interventions.
bulb, simple oxymask
wall, venturi mask
bulb, non-rebreather
bulb, BVM
wall, nasal cannula
How does retinopathy of prematurity/ROP cause blindness and eye damage?
extreme vasodilation of immature retinal vessels
extreme vasoconstriction of immature retinal vessels
extreme intraocular pressure due to fluid leakage behind eyes
extreme loss of blood to the retinal vasculature
A neonatal patient receiving CPAP therapy should have a ______ placed for decompression of the stomach.
foley catheter
nasogastric tube
orogastric tube
endotracheal tube
PICC line
SATA: Which of the following are cultures used to identify maternal GBS infection as part of routine prenatal care?
blood cultures
vaginal cultures
rectal cultures
sputum cultures
urine cultures
SATA: Which of the following are cardiovascular manifestations of neonatal infection?
tachycardia
bradycardia
hypotension
hypertension
decreased perfusion
Some GI manifestations of neonates with an active infection include _______ suck strength and ______ abdominal distention.
increased, increased
increased, decreased
decreased, increased
decreased, decreased
Physiologic jaundice occurs in 50-60% of full term newborns and 80% of preterm newborns. This type of jaundice is USUALLY a ______ condition.
malignant
congenital
autoimmune
benign
life threatening
Physiologic jaundice is more severe and life threatening than pathologic jaundice.
True
False
SATA: Phototherapy works by breaking down bilirubin in the skin into substances than can be excreted by the body. Via which routes is the neonate EXPECTED to excrete these substances?
feces
urine
emesis
sputum
hemorrhage
An infant undergoing phototherapy should have their eyes protected by an opaque mask AT ALL TIMES.
True
False
An infant's phototherapy mask should occlude the nares when placed correctly.
True
False
Besides the opaque protective mask, an infant undergoing phototherapy should be fully unclothed prior to the start of therapy.
True
False
Kernicterus is also known as bilirubin encephalopathy. This condition is characterized by deposits of bilirubin in the _______.
heart
lungs
brain
liver
GI tract
Kernicterus can cause _______ of brain neurons.
infection
regeneration
separation
necrosis
Why does perinatal asphyxia have to be reversed within 30 minutes to prevent necrotizing enterocolitis/NEC?
after 30 minutes of hypoxia, newborn's body will redistribute blood from GI tract to essential organs
after 30 minutes of cord compression, newborn will start to pass more meconium than normal
after 30 minutes of placental insufficiency, newborn's heart rate will begin to decelerate
after 30 minutes of hypoxemia, newborn will compensate with respiratory alkalosis, which impacts the GI tract
Preterm newborns have an accelerated metabolic rate due to stress on, growth of, and repair of internal systems.
True
False
What is the weight based daily caloric requirement for both term and preterm infants?
Preterm: 160-200 kcal/kg
Term: 120-140 kcal/kg
Preterm: 135-180 kcal/kg
Term: 115-125 kcal/kg
Preterm: 100-125 kcal/kg
Term: 150-165 kcal/kg
Preterm: 115-140 kcal/kg
Term: 100-110 kcal/kg
Why are orogastric tubes preferred over nasogastric tubes in the context of providing enteral nutrition to preterm newborns?
OG tubes are more comfortable than NG tubes.
OG tubes can run larger amounts of tube feed/formula than NG tubes.
Infants breathe through their nose, which an NG tube can impede.
Infants need to smell their formula, which an NG tube can impede.
Pacifiers can ______ oxygenation and _______ energy expenditure in preterm newborns.
increase, increase
decrease, decreased
decrease, increase
increase, decrease
Periventricular-intraventricular hemorrhage is a type of intracranial hemorrhage that preterm infants are at risk for. This type of hemorrhage results when neonatal cranial capillaries _______ whenever there is a change in cerebral blood pressure.
vasoconstrict
vasodilate
dry up
rupture
SATA: Which of the following are events that commonly precipitate periventricular-intraventricular hemorrhages?
rapid birth
prolonged hypoxia
use of mechanical ventilation
rapid IV infusions
pneumothorax
Choose the BEST answer: To prevent the development of a periventricular-intraventricular hemorrhage in a preterm patient, the RN should monitor _____ closely and AVOID ___________.
HR, analgesics
RR, slow IV infusions
BP, rapid IV infusions
Temperature, OG/NG tubes
Neonatal apnea is defined as a pause in respirations lasting at least ___ seconds that accompanies _________.
20+, tachycardia
20+, bradycardia
60+, tachycardia
60+, bradycardia
A newborn's full stomach may put pressure on their ______, which can impact incidence of apnea.
heart
lungs
diaphragm
esophagus
larynx
Neonatal apnea is a rare occurrence for preterm infants.
True
False
