OB: Chapter 23 and 24

The nurse is monitoring a new parent changing their newborn's diaper and notices a musty smell to the infant's urine. Which condition should the nurse prioritize in further assessments to rule out?

A. Maple syrup urine disease

B. Congenital hypothyroidism

C. Phenylketonuria

D. Galactosemia

C. Phenylketonuria

Rationale:

A musty or "mousy" odor in urine is a classic hallmark of phenylketonuria (PKU) due to phenylalanine buildup. Early detection and treatment prevent neurological damage.

A nurse is caring for a child born with a tracheoesophageal fistula. Which finding during pregnancy would have caused the nurse to suspect this might be present?

A. Hydramnios

B. Placental insufficiency

C. Intrauterine growth restriction

D. Oligohydramnios

A. Hydramnios

Rationale:

A fetus with TEF cannot swallow amniotic fluid normally → leads to excess amniotic fluid (polyhydramnios/hydramnios).

A nurse is caring for an infant. A serum blood sugar of 40 was noted at birth. What care should the nurse provide to this newborn?

A. Initiate IV dextrose immediately

B. Begin early feedings either by the breast or bottle

C. Delay feedings

D. Recheck glucose in 2 hours

B. Begin early feedings either by the breast or bottle

Rationale:

40 mg/dL is low in a newborn. First-line treatment is feeding to stabilize glucose. IV dextrose is needed only if feeds fail or the baby is symptomatic.

The parents of an infant diagnosed with phenylketonuria are not sure they agree with the diagnosis and proposed treatment. The nurse should point out that this condition can result in which additional condition if left untreated?

A. Failure to thrive

B. Seizure disorder

C. Microcephaly

D. Intellectual disability

D. Intellectual disability

Rationale:

Accumulated phenylalanine causes permanent brain damage → severe cognitive impairment. Early dietary management prevents this.

A nurse is assigned to care for a newborn with hyperbilirubinemia. The newborn is relatively large in size and shows signs of listlessness. What most likely occurred?

A. Maternal hypertension

B. ABO incompatibility

C. The infant's mother probably had diabetes

D. Rh isoimmunization

C. The infant's mother probably had diabetes

Rationale:

Infants of diabetic mothers are often LGA (large for gestational age) and have metabolic issues like hypoglycemia → fatigue and poor feeding that worsen jaundice.

When teaching a class for pregnant clients about the effects of substance use during pregnancy, the nurse will include which effect?

A. Neural tube defects

B. Macrosomia

C. Low-birth-weight infants

D. Hyperthermia

C. Low-birth-weight infants

Rationale:

Most substances—especially nicotine, alcohol, cocaine—cause vasoconstriction and poor placental perfusion, leading to low birth weight.

When caring preoperatively for a neonate with a diagnosed tracheoesophageal fistula, which symptoms are anticipated? Select all that apply:

A. Excessive drooling

B. Cyanosis

C. Elevated heart rate

D. Frothing

E. Abdominal distention

A. Excessive drooling (saliva can't be swallowed)

B. Cyanosis (aspiration risk)

C. Elevated heart rate (from respiratory distress)

D. Frothing (hallmark TEF sign)

Rationale:

TEF prevents normal swallowing → secretions collect → choking, frothing, drooling, distress.

Which nursing measure is most effective in reducing newborn infections?

A. Limiting visitors

B. Maintain medical asepsis while providing care

C. Isolating newborns

D. Administering antibiotics

B. Maintain medical asepsis while providing care

Rationale:

Newborns have immature immune systems → basic medical aseptic technique (hand hygiene, clean procedures) is the #1 infection prevention method.

A newborn is returned to the observational nursery demonstrating signs of cold stress after a prolonged bath. Which action would be a priority for the nurse?

A. Assess blood sugar level

B. Apply a radiant warmer

C. Notify the provider

D. Warm the newborn slowly

A. Assess blood sugar level

Rationale:

Cold stress increases metabolic demand → newborns rapidly burn glucose → hypoglycemia, which is the most dangerous complication.

What will nurses include in their discharge teaching regarding medications and feedings to the parents of a premie leaving the NICU?

A. Give extra iron

B. Keep baby NPO for 24 hours

C. Provide high-calorie formula only

D. If you are breastfeeding your baby you must include a daily vitamin D supplement for the baby

D. If you are breastfeeding your baby you must include a daily vitamin D supplement for the baby

Rationale:

Breast milk alone doesn't provide adequate vitamin D; all breastfed infants require 400 IU/day to prevent rickets.

The nurse is caring for a newborn that was born 20 minutes ago at 37 weeks' gestation. The newborn's birth weight is in the 99th percentile. Vital signs: RR 48, HR 128, Temp 99.1°F (37.3°C). The nurse leaves the room to gather supplies. Which should the nurse gather?

A. Thermometer

B. Glucometer and a lancet

C. Oxygen saturation probe

D. Bulb syringe

B. Glucometer and a lancet

Rationale:

LGA infants are at high risk for hypoglycemia due to excess insulin. Early glucose checks are essential.

A nursing instructor is teaching about newborn congenital disorders and realizes that the student needs further instruction after making which statement?

A. Some conditions require surgery

B. All congenital disorders can be diagnosed at birth

C. Some may not present until later in childhood

D. Many conditions are diagnosed prenatally

B. All congenital disorders can be diagnosed at birth

Rationale:

Many congenital conditions appear later in infancy or childhood, not necessarily at birth.

An infant with a tracheoesophageal fistula is carefully examined to identify other teratogenic effects at the same week in gestation. Which systems need to be examined? Select all that apply:

A. Anal

B. Vertebral

C. Legs

D. Respiratory

E. Cardiovascular

A. Anal → imperforate anus

B. Vertebral → spinal anomalies

C. Legs → limb abnormalities

E. Cardiovascular

Rationale:

These defects are associated with VACTERL anomalies seen with TEF.

A nurse is caring for a 25-year-old G1P0 at 37 weeks' gestation. The client has alcohol abuse disorder throughout pregnancy. What signs and symptoms does the nurse expect the newborn to exhibit?

A. Flat midface, jitteriness, thin upper lip, and high-pitched, shrill cry

B. Low-set ears, tremors, large fontanel

C. Bradycardia, lethargy, wide nasal bridge

D. Hypotonia, macrocephaly, weak cry

A. Flat midface, jitteriness, thin upper lip, and high-pitched, shrill cry

Rationale:

Classic FAS features include facial abnormalities, CNS irritability, and neurobehavioral signs due to alcohol teratogenicity.

A nurse is working in the newborn observational unit and is assigned four newborns. In which newborn will the nurse suspect difficulties with thermal regulation?

A. Term newborn

B. LGA newborn

C. Post-term newborn

D. Newly born preterm newborn

D. Newly born preterm newborn

Rationale:

Preterm infants have:

thin skin

less brown fat

poor muscle tone

immature temperature regulation

→ high risk of hypothermia.

A newborn's oxygen was tested three times with two different oximeters. Each time, the right hand and right foot showed a 4% difference. What does the nurse suspect?

A. Respiratory infection

B. Congenital heart defect

C. Persistent pulmonary hypertension

D. TTN

B. Congenital heart defect

Rationale:

Screening for critical congenital heart disease uses pre- and post-ductal O2 sats. A difference ≥3% is suspicious.

A 39-year-old multigravida with diabetes at 32 weeks presents with absent fetal movement. Fetal death is confirmed. The nurse asks if the client wants photos after birth; the client angrily says no and cries. What is the best response?

A. Apologize and leave the room

B. Offer more counseling

C. Tell the client that the hospital will keep the photos for the client in case they change their mind

D. Say they must decide now

C. Tell the client that the hospital will keep the photos for the client in case they change their mind

Rationale:

Parents often regret declining memories in grief. Keeping them supports future healing without pressuring the patient.

A newborn born at 35 weeks' gestation. How would the nurse classify this newborn?

A. Late preterm

B. Moderate preterm

C. Term

D. Very preterm

A. Late preterm

Rationale:

Late preterm = 34-36 weeks, 6 days.

Why is caffeine given to a 29-week premature baby?

A. Helps digestion

B. It helps babies with apnea issues

C. Reduces jaundice

D. Promotes weight gain

B. It helps babies with apnea issues

Rationale:

Caffeine stimulates respiratory drive and reduces apnea of prematurity.

A nurse is presenting a review class for neonatal nurses. Which statement indicates effective learning?

A. All congenital conditions are fatal

B. "Congenital conditions typically affect a specific body system."

C. They rarely affect body systems

D. Congenital conditions always require surgery

B. "Congenital conditions typically affect a specific body system."

Rationale:

Most congenital anomalies involve one organ/system (cardiac, renal, GI, etc.).

A preterm newborn with omphalocele is admitted. Which actions would the nurse perform? Select all that apply:

A. The abdominal contents are protected

B. Provide oral feeding immediately

C. Perfusion to the exposed abdominal contents will be maintained

D. Fluid loss of the neonate will be minimized

E. Place infant prone

A. The abdominal contents are protected

C. Perfusion to the exposed abdominal contents will be maintained

D. Fluid loss of the neonate will be minimized

Protect abdominal contents

Maintain perfusion to exposed area

Minimize fluid loss (because exposed organs lose heat + moisture)

Rationale:

Omphalocele = abdominal organs outside the body covered by a sac → thermal/fluid loss and injury risks.

A newborn female born at 38 weeks weighs 2000 g (<10th percentile). How is this infant classified?

A. Term, small-for-gestational-age, and low-birth-weight infant

B. Preterm SGA

C. Post-term LGA

D. Term appropriate-for-gestational-age

A. Term, small-for-gestational-age, and low-birth-weight infant

Rationale:

38 weeks = term

<10th percentile = SGA

<2500 g = low birth weight

While caring for a neonate born of a diabetic parent, the nurse should monitor for:

A. Hypothermia

B. Polycythemia

C. Macrosomia

D. Hypocalcemia

C. Macrosomia

Rationale:

Maternal hyperglycemia → fetal hyperinsulinemia → excessive growth (LGA/macrosomia).

A 2-day-old infant suddenly chokes during feeding, becomes cyanotic, and has frothy sputum from the mouth. What congenital malformation is indicated?

A. Esophageal atresia

B. Cleft palate

C. Laryngomalacia

D. Diaphragmatic hernia

A. Esophageal atresia

Rationale:

Classic symptoms:

frothy saliva

choking during feeds

respiratory distress

These occur because the esophagus ends blindly.