Obstetric Nurse Test Obstetric Nurse Newborn Assessment and Care 4 — Questions and Answers
Question 1: A mother asks why her 2-day-old infant's eyes look yellowish. The nurse explains that neonatal jaundice at this age is most likely caused by:
- Normal breakdown of fetal hemoglobin exceeding the immature liver's conjugation capacity (Correct answer)
- ABO incompatibility causing hemolysis
- Biliary atresia obstructing bile flow
- Infection causing hepatocellular injury
Correct answer: Normal breakdown of fetal hemoglobin exceeding the immature liver's conjugation capacity
Physiologic jaundice results from the accelerated breakdown of fetal RBCs and relative hepatic immaturity that limits bilirubin conjugation and excretion.
Question 2: A newborn's initial Apgar score is 5 at 1 minute. The nurse's priority action is to:
- Provide tactile stimulation, position the airway, and administer supplemental oxygen if needed (Correct answer)
- Begin chest compressions immediately
- Intubate the newborn and call the neonatal team
- Administer epinephrine via the umbilical vein
Correct answer: Provide tactile stimulation, position the airway, and administer supplemental oxygen if needed
An Apgar score of 4–6 indicates moderate depression; the nurse should initiate basic resuscitative steps (stimulation, airway positioning, supplemental oxygen) and reassess at 5 minutes.
Question 3: During circumcision aftercare teaching, the nurse instructs parents to apply petroleum jelly to the site with each diaper change primarily to:
- Prevent the healing tissue from adhering to the diaper (Correct answer)
- Provide analgesia to the circumcision site
- Promote faster skin regeneration
- Reduce the risk of infection with antimicrobial properties
Correct answer: Prevent the healing tissue from adhering to the diaper
Petroleum jelly prevents the raw tissue of the circumcision site from sticking to the diaper, reducing trauma and discomfort during healing.
Question 4: The nurse notes a newborn has positional (postural) talipes equinovarus (clubfoot). Which intervention is appropriate for the nurse to initiate?
- Perform passive range-of-motion exercises and refer to orthopedics (Correct answer)
- Apply a rigid fiberglass cast immediately
- Document as normal positional variant and reassure parents no follow-up needed
- Order an urgent MRI of the lower extremities
Correct answer: Perform passive range-of-motion exercises and refer to orthopedics
Positional clubfoot responds to passive stretching and orthopedic referral; early intervention with the Ponseti method is the standard of care.
Question 5: When preparing a newborn for a heel stick glucose test, which technique reduces pain most effectively?
- Administer 24% sucrose solution orally 2 minutes before the procedure while the infant sucks on a pacifier (Correct answer)
- Apply EMLA cream 60 minutes prior to the heel stick
- Perform the procedure during active sleep
- Cool the heel with an ice pack before lancing
Correct answer: Administer 24% sucrose solution orally 2 minutes before the procedure while the infant sucks on a pacifier
Sweet oral solutions (24% sucrose) combined with non-nutritive sucking activate endogenous opioid pathways and are the most evidence-based non-pharmacologic neonatal analgesic for minor procedures.
Question 6: A newborn born at 36 weeks gestation is classified as:
- Late preterm (Correct answer)
- Early preterm
- Term
- Near-term with no special observation required
Correct answer: Late preterm
Late preterm is defined as 34 0/7 through 36 6/7 weeks gestation; these infants have higher risks of feeding difficulties, hypoglycemia, jaundice, and respiratory problems than term newborns.
Question 7: The nurse is assessing a newborn's fontanels. Which finding requires immediate notification of the provider?
- Bulging anterior fontanel with a high-pitched cry and lethargy (Correct answer)
- Anterior fontanel measuring 2 cm × 2 cm and pulsating gently
- Posterior fontanel that is fingertip-sized and flat
- Anterior fontanel slightly sunken when the infant is upright
Correct answer: Bulging anterior fontanel with a high-pitched cry and lethargy
A bulging fontanel accompanied by high-pitched cry and lethargy suggests increased intracranial pressure (e.g., meningitis, hydrocephalus, hemorrhage) requiring urgent evaluation.
Obstetric Nurse Test Obstetric Nurse Newborn Assessment and Care 4
A mother asks why her 2-day-old infant's eyes look yellowish.
The nurse explains that neonatal jaundice at this age is most likely caused by: