Nokea
Whose baby is at highest risk of developing jaundice based on risk factors?
- A. A 16-year-old mother who labored with Pitocin and had an uncomplicated delivery.
- B. A 23-year-old mother who made it to the hospital after a delivery at home, umbilical cord cut at the hospital.
- C. A 28-year-old mother with type A blood and a father with O+ blood type delivered a newborn with nuchal cord x2; forceps used
- D. A 30-year-old mother who delivered twins via cesarean section; newborn A was breech; father unknown
Correct Answer: C
Rationale: The correct answer is C because the newborn has both type A blood (from the mother) and O+ blood (from the father), leading to a higher risk of jaundice due to ABO incompatibility. The presence of nuchal cord x2 and the use of forceps during delivery also increase the risk of newborn jaundice.
Choice A is incorrect because the mother's age and use of Pitocin do not inherently increase the risk of jaundice. Choice B is incorrect because the baby being born at home and the timing of the umbilical cord cutting are not directly related to jaundice risk. Choice D is incorrect because the method of delivery and the father's unknown blood type do not specifically indicate a high risk of jaundice compared to the scenario in Choice C.
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An infant weight is documented as being in the 90th percentile. What does the RN understand about this measurement?
- A. The infant’s weight is appropriate or average.
- B. The 90th percentile indicates LGA.
- C. Infants in the 90th percentile will be overweight as adults.
- D. The infant’s weight is less than 90% of all other infants’ weights.
Correct Answer: C
Rationale: The correct answer is C because being in the 90th percentile for weight as an infant does not necessarily mean the weight is appropriate or average (choice A) or that the infant is LGA (choice B). Choice D is incorrect because being in the 90th percentile means the infant's weight is greater than 90% of other infants, not less. Choice C is correct because research shows that infants in the 90th percentile for weight are more likely to be overweight as adults due to potential genetic factors and lifestyle habits developed early in life.
Which factor does not influence bilirubin levels in the infant?
- A. Prematurity
- B. Maternal diabetes
- C. Exclusively breastfeeding
- D. Birth trauma
Correct Answer: D
Rationale: The correct answer is D: Birth trauma. Birth trauma does not directly influence bilirubin levels in infants. Prematurity can lead to immature liver function affecting bilirubin metabolism. Maternal diabetes can lead to increased risk of neonatal jaundice. Exclusively breastfeeding can lead to breastfeeding jaundice due to inadequate milk intake. Therefore, birth trauma is the only option that does not directly impact bilirubin levels in infants.
Which clinical sign is most concerning immediately following the delivery of a high-risk neonate?
- A. Axillary temperature of 97.8°F
- B. Blood glucose of 35 g/dL
- C. Oxygen saturation of 90%
- D. Blue-tinged hands and feet
Correct Answer: B
Rationale: The correct answer is B: Blood glucose of 35 g/dL. This is the most concerning sign as hypoglycemia in neonates can lead to serious neurological complications. Low blood glucose levels can result in seizures, brain damage, and even death if not promptly addressed. It is crucial to maintain appropriate blood glucose levels in neonates to support their brain development and overall health.
Explanation of other choices:
A: Axillary temperature of 97.8°F - Slightly below normal but not immediately concerning.
C: Oxygen saturation of 90% - Suboptimal but not as critical as severe hypoglycemia.
D: Blue-tinged hands and feet - Could indicate poor circulation, but hypoglycemia is more urgent to address.
Which diagnosis is most common in a newborn born at 35 + 3 gestational age?
- A. Hyperglycemia
- B. Respiratory distress syndrome
- C. Infection
- D. Altered nutrition, more than body requirements
Correct Answer: B
Rationale: The correct answer is B: Respiratory distress syndrome. At 35 + 3 weeks gestational age, the newborn's lungs may not be fully developed, leading to respiratory distress. This condition is common in premature babies due to surfactant deficiency, resulting in difficulty breathing. Hyperglycemia, infection, and altered nutrition are less likely in this scenario as they are not typically associated with prematurity at this gestational age. Respiratory distress is the most common concern in premature infants and requires prompt medical intervention to support breathing and lung function.
If the neonatal nurse is suspicious of necrotizing enterocolitis in the infant, which intervention should take place first?
- A. Stop feeds
- B. Obtain a blood gas
- C. Call the practitioner
- D. Check electrolytes
Correct Answer: A
Rationale: The correct answer is A: Stop feeds. This is the first intervention because neonatal necrotizing enterocolitis is a serious condition that requires immediate action to prevent further complications. Stopping feeds helps reduce intestinal inflammation and allows the bowel to rest. This step is crucial in managing NEC and preventing perforation. Obtaining a blood gas or checking electrolytes can provide valuable information but are not as urgent as stopping feeds. Calling the practitioner is important but should come after initiating the immediate intervention of stopping feeds.