Ob Test 3

Front 1

A preterm infant is one that is born with less than ____ completed weeks gestation.

Page 929

Back 1

37

Front 2

A term infant is one that is born between ___ and ___ weeks gestation.

Page 929

Back 2

38 and 41

Front 3

A postterm infant is one that is born at greater than ___ weeks gestation.

Page 929

Back 3

42

Front 4

Neonatal mortality risk is the chance of death within the neonatal period, that is within the first ___ days of life.

Page 929

Back 4

28

Front 5

____ % of all neonatal deaths occur within the first week of life, with the highest rate ocurring the first day of life.

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Back 5

75

Front 6

The previously high mortality rates for LGA infants have _____ because of improved management of diabetes in pregnancy and the recognition of potential complications of LGA newborns.

Page 929

Back 6

decreased

Front 7

Infants are considered SGA when they are more than ___ standard deviations below the population norm or at less than the 3rd percentile.

Page 930

Back 7

two

Front 8

Higher altitudes typically result in _____ birth weights.

Page 930

Back 8

lower

Front 9

In the normal pregnancy, intrauterine growth is linear from approximately ___ to ___ weeks' gestation.

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Back 9

28 to 38

Front 10

One maternal factor that leads to growth restriction is age extreme. This is defined as under ___ or over ___.

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Back 10

under 16 or over 40

Front 11

Only in the ___ trimester is maternal malnutrition a limiting factor in fetal growth.

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Back 11

third

(before the third trimester, the nutritional supply to the fetus far exceeds his or her needs.)

Front 12

Complications associated with the following can diminish blood flow to the uterus, thereby decreasing oxygen delivery to the fetus. (select all that apply)

a) preeclampsia
b) alcohol abuse
c) chronic hypertensive vascular dz
d) advanced diabetes mellitus


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Back 12

a) preeclampsia
c) chronic hypertensive vascular dz
d) advanced diabetes mellitus

Front 13

Gender can affect the fetal growth. _____ tend to be smaller.

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Back 13

female

Front 14

At about 36 weeks gestation you can identify asymmetric (disproportional) IUGR because what occurs?

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Back 14

The abdominal circumference of a normal fetus becomes larger than the head circumference.

In asymmetric IUGR, the head circumference remains larger than the abdominal circumference.

Thus, measuring only biparietal diameter on ultrasound will not reveal asymmetric (disproportional) IUGR.

Front 15

Congenital malformations occur in ____% of SGA infants.

Page 933

Back 15

8%

The more severe the IUGR, the greater the chance for malformation as a result of impaired mitotic activity and cellular hypoplasia.

Front 16

(asymmetric)/(symmetric) IUGR infants can be expected to catch up in weight and approach their inherited growth potential when given an optimal environment.

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Back 16

Asymmetric


Asymmetric IUGR infants *CAN* be expected to catch up.

Front 17

If assessing a growth-restricted infant resulting from unexplained maternal etiology, what is likely the answer?

Clinical Tip, Page 933

Back 17

an in utero viral infection may be the answer.

Front 18

Which of the following clients are at risk of having a newborn with hypoglycemia? (Select all that apply)

A) An adolescent mother of a 32-week SGA infant

B) A diabetic mother of a 36-week LGA infant

C) A mother of a 40-week infant with IUGR

D) term twins of average weight for gestational age

Back 18

A) An adolescent mother of a 32-week SGA infant

B) A diabetic mother of a 36-week LGA infant

C) A mother of a 40-week infant with IUGR


NCLEX Review question - Chapter 32

Front 19

Assessment data of a newborn includes: a long, thin, emaciated appearance; loose skin folds; head large in appearance. The nurse recognizes these characteristics are associated with which of the following?

1) symmetric IUGR
2) asymmetric IUGR
3) preterm AGA infant
4) term SGA infant

Back 19

Answer 2 is correct; these findings are characteristic of asymmetric intrauterine growth retardation.

NCLEX Review question - Chapter 32

Front 20

A nurse is caring for a two-hour-old infant of a diabetic mother. How frequently should the nurse monitor the infant’s blood glucose level?

1) Every hour
2) Every 4 hours
3) Every 8 hours
4) Every 12 hours

Back 20

Answer 1 is correct; the blood glucose level should be checked hourly until stable; signs of hypoglycemia frequently present within the first one to three hours after birth.

NCLEX Review question - Chapter 32

Front 21

A nurse is caring for a postterm infant who had a reassuring fetal heart rate pattern during labor. The nurse should assess for which of the following complications?

1) respiratory distress
2) meconium aspiration
3) fractured clavicle
4) polycythemia

Back 21

Answer 3 is correct; CPD (cephalopelvic disproportion) and shoulder dystocia are frequent intrapartum complications of postterm infants who are otherwise healthy; the infant should be assessed for a fractured clavicle. Answer 1 is incorrect; respiratory distress is a complication usually seen in preterm infants. Answer 2 is incorrect; meconium aspiration is associated with postmaturity syndrome. Answer 4 is incorrect; polycythemia is usually seen in preterm infants and infants with postmaturity syndrome.

NCLEX Review question - Chapter 32

Front 22

A nurse is caring for a 27-week newborn. Which of the following physical characteristics will affect this infant’s ability to maintain thermoregulation? (Select all that apply)

1) High ratio of body surface area to body weight
2) Flexed posture
3) Thinner, permeable skin
4) Little subcutaneous fat

Back 22

1) High ratio of body surface area to body weight
3) Thinner, permeable skin
4) Little subcutaneous fat

Answers 1, 3, and 4 are correct. Preterm infants are at greater risk of heat loss related to their high ratio of body surface area to weight, thinner skin that increases insensible water loss and heat loss, and poorly developed subcutaneous fat that reduces their ability to generate body heat. Answer 2 is incorrect; a 27-week gestation newborn will have a hypotonic, extended posture, thus increasing the body surface area and heat loss to the environment.

NCLEX Review question - Chapter 32

Front 23

A nurse admits a 30-week newborn to the NICU. Assessment data includes: respirations 82, color dusky, expiratory grunting, nasal flaring, and substernal retractions. Which nursing diagnosis does this data best support?

1) Altered nutrition
2) Ineffective breathing patterns
3) Impaired gas exchange
4) Ineffective thermoregulation

Back 23

Rationale: Answer 3 is correct; these symptoms are associated with respiratory distress and are characteristic of impaired gas exchange. Answer 1 is incorrect; these symptoms do not reflect altered nutrition. Answer 2 is incorrect; ineffective breathing patterns in preterm infants relate to CNS immaturity and are characterized by episodes of apnea. Answer 4 is incorrect, although ineffective thermoregulation may result in cold stress and contribute to respiratory distress.

NCLEX Review question - Chapter 32

Front 24

A nurse is caring for a 39-week infant who frequently sneezes, hiccups and yawns, has mild tremors when stimulated, is a poor feeder, and has respirations of 70 when quiet. What condition does this data indicate?

1) Meconium aspiration
2) Neonatal abstinence syndrome
3) Postmaturity syndrome
4) Respiratory distress

Back 24

Rationale: Answer 2 is correct; these behaviors are typical of neonatal abstinence or withdrawal from maternal drug or alcohol use during pregnancy. Answer 1 is incorrect; these symptoms are not associated with meconium aspiration. Answer 3 is incorrect; these symptoms are not associated with postmaturity syndrome, which is characterized by decreased placental function and places the infant at risk for hypoglycemia and hypoxemia and other problems. Answer 4 is incorrect; these behaviors are not associated with respiratory distress, which is indicated by expiratory grunting, flaring, and retractions.

NCLEX Review question - Chapter 32

Front 25

A nurse is counseling an HIV+ mother on the required neonatal testing and followup. Which of the following statements indicates the need for further teaching?

1) “At three months, we will know for sure if my baby has HIV.”
2) “My baby will be given AZT following birth.”
3) “I should not breastfeed my baby.”
4) “I should bring my baby in for regular immunizations.”

Back 25

Rationale: Answer 1 is correct; no HIV testing offers definite results at 3 months. DNA-PCR testing is ideally completed at 48 hours, 1 month, and 4 months followed by an ELISA at 18 months to confirm negative results. Answer 2 is incorrect; infants born to HIV+ mothers should receive AZT between 8 and 12 hours of life. Answer 3 is incorrect; in developed countries, breastfeeding is not recommended. Answer 4 is incorrect; infants born to HIV+ mothers should receive all immunizations as scheduled. HIV+ infants should not receive live attenuated vaccines and should receive prompt attention if exposed to varicella.

NCLEX Review question - Chapter 32

Front 26

A nurse is caring for a term infant at 20 hours of life. Assessment data includes the following: respirations 42 and regular, heart rate 137, temperature 98.6, circumoral cyanosis, and a dusky color that does not improve with the administration of oxygen. The nurse recognizes this infant could have which of the following conditions?

1) Meconium aspiration
2) Formula aspiration
3) Congenital heart defect
4) Respiratory distress

Back 26

Rationale: Answer 3 is correct; infants between 12 and 24 hours of life with no signs of respiratory distress and cyanosis which is unresolved with oxygen frequently have a congenital heart defect. Answer 1 is incorrect; meconium aspiration would be associated with respiratory distress symptoms and decreased lung sounds. Answer 2 is incorrect; formula aspiration would be associated with respiratory distress symptoms or decreased lung sounds. Answer 4 is incorrect; symptoms associated with respiratory distress include altered respirations, grunting, flaring, and retractions.

NCLEX Review question - Chapter 32

Front 27

A nurse is caring for the infant of a heroin-addicted mother. Which of the following interventions will assist the infant in achieving a more organized behavior state?

1) Providing a pacifier
2) Performing neonatal abstinence scoring
3) Swaddling the infant with hands near the mouth
4) Gentle horizontal rocking

Back 27

Rationale: Answer 3 is correct; swaddling the infant with hands near the mouth assists the infant in achieving more organized behavior. Answer 1 is incorrect; pacifiers assist with non-nutritive excessive sucking. Answer 2 is incorrect; abstinence scoring is an assessment tool. Answer 4 is incorrect; gentle vertical rocking will help calm an out of control infant.

NCLEX Review question - Chapter 32

Front 28

What are some of the more common expected outcomes of nurses caring for an SGA infant?

Back 28

The SGA newborn will:
1) remain free from respiratory compromise
2) maintain a stable temperature
3) remain free from hypoglycemic episodes and maintain glucose homeostasis
4) gain weight and take feedings without physiologic stress or fatigue

The parents will:
1) verbalize concerns about the baby's health problems
2) understand the rationale behind management of their newborn's care

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Front 29

A newborn whose birth weight is at or above the ___ percentile at any week of gestation is considered LGA.

Back 29

90th

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Front 30

Some AGA newborns have been incorrectly categorized as LGA because...

Back 30

The date of conception was miscalculated. This is often due to postconceptional bleeding that is assumed to be a period.

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Front 31

The condition most often associated with excessive fetal growth is _______.

Back 31

Maternal diabetes (but, only a small portion of LGA babies are actually born to diabetic mothers. The cause of most cases of LGA is unclear.)

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Front 32

Who is likely to deliver an LGA infant? Select all that apply:

1) A multiparous Native American woman of average weight carrying a male

2) A primigravidas mother of average weight carrying a female

3) A woman who weights 265 pounds and is 5' 11" carrying a male

4) A woman of average weight carrying a male with transposition of the great vessels.

Back 32

1, 3, and 4

Rationale: Multiparous women are more likely to deliver LGA babies. Male infants are more likely to be LGA than females.
Large parents have large babies. Transposition of the great vessels can result in LGA. There is a higher incidence of macrosomic infants born to Native American, Mexican American, African American, and Pacific Islaner mothers.

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Front 33

LGA babies born to a diabetic mother are typically heavy, and have:

1) lenght and head circumference in the normal range

2) lenght and head circumference above normal

3) lenght and head circumference below normal

Back 33

1) lenght and head circumference in the normal range

Most LGA babies are proportional, but those born to a diabetic mother frequently have a high body weight, but head circumference and length in the normal range.

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Front 34

An IDM (infant of diabetic mother) has all of the following features except which two?

1) larger visceral organs
2) increased total body water
3) cardiomegaly (hypertrophy)
4) increased body fat
5) larger brain

Back 34

2) increased total body water
5) larger brain

IDMs have *decreased* total body water, particularly in the extracellular spaces, and are therefore not edematous. The only organ *not* increased in size is the brain.

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Front 35

_____ is an important regulator of fetal metabolism and has a "growth hormone" effect that results in increased linear growth.

Back 35

Insulin

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Front 36

The excessive fetal growth of the IDM is caused by exposure to high levels of maternal _____.

1) insulin
2) glucose
3) lipids
4) protein

Back 36

glucose.

The fetus responds to these high glucose levels with increased insulin production.

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Front 37

If normal glucose levels cannot be maintained with oral feeding, D10W at a rate of _____ to _____ usually maintains nomoglycemia in the IDM.

Back 37

6 mg/kg/min to 8 mg/kg/min

Note that is MINUTE

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Front 38

In monozygomatic twins, division during the first 72 hours after ferilization will cause:

1) monochorionic and diamniotic
2) diamniotic and dichorionic
3) monochorionic and monoamniotic

Back 38

2) diamniotic and dichorionic

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Front 39

In monozygomatic twins, division during the blastocyst phase (4 to 8 days after ferilization) will cause:

1) monochorionic and diamniotic
2) diamniotic and dichorionic
3) monochorionic and monoamniotic

Back 39

1) monochorionic and diamniotic

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Front 40

In monozygomatic twins, division of the primitive germ disk (9 to 13 days after ferilization) will cause:

1) monochorionic and diamniotic
2) diamniotic and dichorionic
3) monochorionic and monoamniotic

Back 40

3) monochorionic and monoamniotic

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Front 41

Approximately ___% of all twin pregnancies are lost before the end of the first trimester.

Back 41

25%

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Front 42

Although the loss of one twin can occur at any point in the pregnancy, it most often occurs in the _____ trimester.

Back 42

First

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Front 43

Postmaturity syndrome is caused by all of the following EXCEPT:

1) Prolonged pregnancy
2) Placental Aging
3) Continued Exposure to amniotic fluid

Back 43

1) Prolonged pregnancy

Rationale: Prolonged pregnancy itself is not responsible for the postmaturity syndrome. The characteristics are caused primariliy by a combination of placental aging and subsequent insufficiency and continued exposure to amniotic fluid.

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