OB: Chapter 17 and 18 Study Guide Practice Questions

A nurse is assessing a newborn who was delivered via cesarean section and observes a respiratory rate of 70 breaths/min. The infant is pink, with mild nasal flaring but no retractions. Which condition should the nurse suspect?

A. Respiratory distress syndrome (RDS)

B. Transient tachypnea of the newborn (TTN)

C. Persistent pulmonary hypertension

D. Meconium aspiration syndrome

B. Transient tachypnea of the newborn (TTN)

Rationale:

TTN occurs when fluid in the newborn's lungs isn't absorbed quickly after birth, leading to tachypnea (>60 breaths/min) and mild respiratory distress. It's common after cesarean births where thoracic squeezing doesn't occur. Symptoms resolve within 24-72 hours.

A. RDS: Caused by surfactant deficiency, typically in preterm infants (<35 weeks).

C. Persistent pulmonary hypertension: Causes severe hypoxemia and cyanosis, not mild distress.

D. Meconium aspiration: Causes coarse crackles, barrel chest, and significant respiratory distress, not mild tachypnea.

Which statement best describes the function of the ductus arteriosus in fetal circulation?

A. It connects the umbilical vein to the inferior vena cava.

B. It connects the right and left atria.

C. It connects the pulmonary artery to the aorta.

D. It directs blood from the aorta to the pulmonary artery.

C. It connects the pulmonary artery to the aorta.

Rationale:

The ductus arteriosus allows blood to bypass the lungs by shunting from the pulmonary artery → aorta in fetal life.

A. Describes the ductus venosus.

B. Describes the foramen ovale.

D. Reverse direction — incorrect anatomy.

A nurse is preparing to administer erythromycin ophthalmic ointment to a newborn. The nurse understands the primary purpose of this medication is to:

A. Prevent hemorrhagic disease of the newborn.

B. Prevent conjunctivitis caused by gonorrhea or chlamydia.

C. Provide immunity against hepatitis B.

D. Promote synthesis of clotting factors II, VII, IX, and X.

B. Prevent conjunctivitis caused by gonorrhea or chlamydia.

Rationale:

Erythromycin ophthalmic ointment prevents ophthalmia neonatorum, an infection transmitted during delivery from infected mothers.

A. Vitamin K prevents hemorrhagic disease, not infection.

C. Hepatitis B vaccine prevents Hepatitis B virus, not eye infections.

D. Vitamin K (AquaMEPHYTON) promotes clotting factor synthesis, not infection prevention.

A newborn's bilirubin level at 12 hours of age is 6.1 mg/dL. Which nursing action is the priority?

A. Increase oral feedings to promote bilirubin excretion.

B. Prepare for immediate exchange transfusion.

C. Reassess bilirubin levels in 24 hours per provider order.

D. Apply a warm blanket to improve perfusion.

C. Reassess bilirubin levels in 24 hours per provider order

Rationale:

A bilirubin level of 6.1 mg/dL at 12 hours places the newborn in the high-intermediate risk zone, warranting close monitoring.

A. Helpful but not the priority—must first monitor and report before interventions.

B. Exchange transfusion is reserved for severe cases (>25 mg/dL).

D. Warming does not affect bilirubin metabolism.

During a newborn assessment, the nurse notes a localized swelling on the scalp that crosses suture lines. Which finding should be documented?

A. Cephalhematoma

B. Caput succedaneum

C. Molding

D. Subgaleal hemorrhage

B. Caput succedaneum

Rationale:

Caput succedaneum is edema that crosses suture lines and resolves in a few days.

A. Cephalhematoma does not cross suture lines.

C. Molding is normal skull shaping, not swelling.

D. Subgaleal hemorrhage is deeper, extensive, and may cause shock.

A nurse is educating a postpartum client on breastfeeding. Which statement by the client indicates further teaching is needed?

A. "I'll feed my baby every 2-3 hours."

B. "Breast milk provides antibodies that protect my baby."

C. "I don't need to give my baby vitamin D drops."

D. "Breastfeeding helps my uterus contract after birth."

C. "I don't need to give my baby vitamin D drops."

Rationale:

Breast milk lacks sufficient vitamin D, so supplementation is required to prevent rickets.

A. Correct: newborns feed every 2-3 hours.

B. Correct: breast milk provides antibodies (IgA).

D. Correct: oxytocin release during breastfeeding helps uterine contraction.

A newborn is noted to be below the 10th percentile for weight. How should this infant be classified?

A. Preterm

B. AGA

C. SGA

D. LGA

C. SGA

Rationale:

An infant below the 10th percentile for weight is classified as SGA.

A. Refers to gestational age (<37 weeks).

B. AGA = 10th-90th percentile.

D. LGA = above the 90th percentile.

The nurse prepares to give Vitamin K (AquaMEPHYTON) to a newborn. Which statement best explains the purpose of this medication?

A. To promote intestinal absorption of calcium

B. To prevent vitamin K deficiency bleeding

C. To enhance liver conjugation of bilirubin

D. To prevent bacterial infections

B. To prevent vitamin K deficiency bleeding

Rationale:

Newborns lack intestinal bacteria to produce vitamin K, so they're at risk for bleeding. Vitamin K (AquaMEPHYTON) promotes synthesis of clotting factors II, VII, IX, and X.

A. Not related to calcium absorption.

C. Bilirubin conjugation occurs in the liver, not affected by vitamin K.

D. It's not an antimicrobial.

Which of the following is a normal finding in the immediate newborn period?

A. Central cyanosis

B. Acrocyanosis

C. Sunken fontanels

D. Persistent nasal flaring

B. Acrocyanosis

Rationale:

Acrocyanosis (bluish hands and feet) is normal due to immature circulation and peripheral vasoconstriction.

A. Central cyanosis = abnormal → indicates hypoxia.

C. Sunken fontanels → dehydration.

D. Persistent nasal flaring → respiratory distress.

When performing a heel stick for PKU screening, which nursing action is essential?

A. Collect the specimen before the infant's first feeding.

B. Perform the test within the first 12 hours of life.

C. Ensure the newborn has ingested protein before the test.

D. Warm the heel to increase blood flow, then cleanse with alcohol.

C. Ensure the newborn has ingested protein before the test.

Rationale:

PKU testing requires that the infant has ingested milk or formula (contains phenylalanine) for accurate results.

A. Testing before feeding gives false negatives.

B. Testing before 24 hours is too early.

D. Warming the heel is correct for collection, but not the key to accuracy.

Which finding indicates possible dehydration in a neonate?

A. Moist mucous membranes

B. Tented skin on the abdomen

C. Flat anterior fontanel

D. Urine output of 6-8 wet diapers per day

B. Tented skin on the abdomen

Rationale:

Skin that remains "tented" after pinching indicates dehydration.

A. Moist membranes = normal hydration.

C. Flat fontanel = normal; sunken indicates dehydration.

D. 6-8 wet diapers/day = adequate hydration.

The nurse teaches parents about circumcision care. Which statement indicates correct understanding?

A. "We'll pull off the Plastibell in 3 days."

B. "We should apply petroleum jelly to the penis at each diaper change."

C. "We should clean the site with alcohol wipes twice daily."

D. "If swelling occurs, we'll apply a tight diaper to prevent bleeding."

B. "We should apply petroleum jelly to the penis at each diaper change."

Rationale:

Petroleum jelly prevents the healing tissue from sticking to the diaper.

A. Plastibell falls off on its own (~1 week); do not pull it off.

C. Alcohol irritates tissue and delays healing.

D. A tight diaper increases pressure and swelling.

Which of the following newborns is considered postmature?

A. Delivered at 36 weeks

B. Delivered at 39 weeks

C. Delivered at 42 weeks with placental aging

D. Delivered at 41 weeks

C. Delivered at 42 weeks with placental aging

Rationale:

Postmature infants are born after 42 weeks and may show signs of placental insufficiency (wrinkled skin, meconium staining).

A. 36 weeks = preterm.

B. 39 weeks = term.

D. 41 weeks = post-term but not postmature (placenta still functioning).

The nurse observes bluish spots over a newborn's lower back and buttocks. Which documentation is most appropriate?

A. Congenital dermal melanocytosis

B. Stork bites

C. Acrocyanosis

D. Milia

A. Congenital dermal melanocytosis

Rationale:

Commonly known as Mongolian spots, these are bluish marks on the buttocks or back, benign and usually fade over time.

B. Stork bites are flat pink patches on the face or neck.

C. Acrocyanosis involves extremities, not buttocks.

D. Milia are white sebaceous cysts on the nose.

A nurse identifies a well-demarcated, fluctuant swelling on one side of a newborn's scalp that does not cross suture lines. Which term describes this finding?

A. Caput succedaneum

B. Cephalhematoma

C. Subgaleal hemorrhage

D. Molding

B. Cephalhematoma

Rationale:

A cephalhematoma is a collection of blood between the skull bone and periosteum — it does not cross suture lines.

A. Caput crosses sutures (edema, not blood).

C. Subgaleal hemorrhage crosses sutures and may be life-threatening.

D. Molding is a normal head shape change from birth pressure.

A preterm newborn receiving caffeine therapy is being monitored in the NICU. The nurse recognizes the purpose of caffeine is to:

A. Promote closure of the ductus arteriosus

B. Stimulate respiratory effort and prevent apnea

C. Improve gastrointestinal motility

D. Decrease metabolic rate

B. Stimulate respiratory effort and prevent apnea

Rationale:

Caffeine citrate stimulates the central nervous system and respiratory center, reducing apnea episodes in preterm infants.

A. Ductus arteriosus closure occurs due to increased O₂, not caffeine.

C. Not indicated for GI motility.

D. Caffeine increases, not decreases, metabolic rate.

Which nursing responsibility is most important when caring for a newborn receiving phototherapy for hyperbilirubinemia?

A. Keep the infant uncovered at all times to maximize light exposure

B. Monitor temperature and hydration status closely

C. Keep the infant's eyes uncovered during treatment

D. Apply lotion to protect skin from drying

B. Monitor temperature and hydration status closely

Rationale:

Phototherapy increases insensible water loss, so temperature and hydration must be closely monitored.

A. Infant should be diapered and eyes protected.

C. Eyes must be covered to prevent retinal damage.

D. Lotions are avoided—they can absorb light and cause burns.

Which of the following vaccines is routinely administered to newborns within 24 hours of birth?

A. MMR vaccine

B. Hepatitis B vaccine

C. Tdap vaccine

D. Varicella vaccine

B. Hepatitis B vaccine

Rationale:

The Hepatitis B vaccine is given within 24 hours of birth, followed by 2 more doses.

A. MMR: given at 12-15 months.

C. Tdap: starts at 2 months (mother receives during pregnancy).

D. Varicella: given at 12-15 months.

Which physiologic event prompts closure of the foramen ovale after birth?

A. Increased pulmonary resistance

B. Decrease in left atrial pressure

C. Increase in left atrial pressure and decrease in right atrial pressure

D. Opening of the ductus venosus

C. Increase in left atrial pressure and decrease in right atrial pressure

Rationale:

When the newborn breathes, pulmonary circulation increases → raises left atrial pressure and decreases right atrial pressure → closes the foramen ovale.

A. Pulmonary resistance decreases, not increases.

B. Left atrial pressure rises, not falls.

D. Ductus venosus closure is unrelated to atrial pressure changes.

The nurse is assessing a newborn who was delivered at 35 weeks' gestation. Which condition is this infant at highest risk for?

A. Respiratory distress syndrome

B. Hyperbilirubinemia

C. Hypoglycemia

D. All of the above

D. All of the above

Rationale:

Preterm infants (<37 weeks) are at risk for respiratory distress syndrome (due to surfactant deficiency), hyperbilirubinemia (immature liver), and hypoglycemia (limited glycogen stores).