CRITICAL THINKING EXERCISES

1. In the immediate care of the newborn, which nursing action is implemented

first to ensure newborn safety?
a. Identify the newborn using a foot tag identical with that of the mother
b. Clear the mouth and the nose of mucus
c. Inject vitamin K to prevent bleeding
d. Administer Credes prophylaxis right after birth to prevent gonorrheal
conjunctivitis
2. While performing a complete assessment of a term neonate, which of the
following findings would alert the nurse to notify the pediatrician?
a. Red reflex in the eyes
b. Respiratory rate of 45 breaths/minute
c. Expiratory grunt
d. Prominent xyphoid process
3. Which of the following physical signs would support a diagnosis of Downs
syndrome?
a. Constipation, subnormal temperature, apnea, bradycardia
b. Hypotonia, simian crease, epicanthal fold, flat occiput
c. Blue eyes, blond hair, fair skin
d. Mental retardation, lethargy, irritability
4. The newborns breathing is characterized by short period of apnea. Which of
the following manifestations in a 24-hour-old infant who born at 37 weeks
would lead a nurse to suspect that the infant may have apnea?
a. Transient mottling with environmental temperature changes
b. Intermittent episodes of acrocyanosis for periods of 10 minutes
c. Respiratory rate of 24/min
d. A lapse of spontaneous breathing for 20 or more seconds
5. The nursing student is evaluating the newborn for danger signals. Which of
the following assessment findings should be reported as abnormal in a 12hour-old newborn?
a. Icteric (yellow) sclera
b. Acrocyanosis
c. Epsteins pearls
d. Caput succedaneum
6. Baby Carlos, a 72 hour-old newborn infant, appears slightly jaundiced and has
a bilirubin level of 10mg/dl. A nurse would give the parent which of the
following instructions?
a. Give the baby formula instead of breastfeeding 48 hours.
b. Check the babys temperature every four hours.
c. Feed the baby at least every three hours.
d. Expose the babys skin to direct sunlight daily for one hour.
7. When evaluating an infants laboratory results for effectiveness of
phototherapy, the NICU nurse should expect which of the following
outcomes?
a. Serum bilirubin 5mg/dl
b. Increase urine specific gravity
c. Red blood cell count: 5 million/cumm

d. Decreased Rh positive antibodies

8. Nurse Fe witnesses a two-hour-old infant experiencing a generalized seizure
while being evaluated in the nursery. Which of the following actions should
nurse Fe take first?
a. Refer to the pediatrician
b. Check for febrile condition; take the infants temperature per axilla
c. Protect the child from physical injury
d. Reassure the parents that this is a common occurrence
9. A one-day-old newborn infant is in respiratory distress. The nurse should
observe the infant for which of the following signs?
a. Nasal flaring and chest retractions
b. Clubbing of fingers and toes
c. Sweating, cool, clammy skin
d. Bradycardia
10.Head nursing student My Dy is discussing with junior students the care of a
neonate delivered by cesarean section. Which of the following conditions
would Ms Dy emphasize as possible complication in infants delivered by CS?
a. Rh incompatibility
b. Respiratory distress
c. Small-for-gestational age
d. Erb-Duchenne palsy
11.In caring for a preterm NBs skin, the nurse must understand the special
characteristics that exist. These include:
a. A thin gelatinous skin, plenty of lanugo and open exposure
b. A thin and wrinkled greenish skin with flexed posture
c. A think and pinkish, plenty of vernix, and increased amounts of brown fat
d. Plenty of lanugo, flexed posture and increased amounts of brown fat
12.A 11lb 6 oz baby girl was delivered by CS section to a diabetic mother. The
priority assessment of the infant of a diabetic mother would be for:
a. Hypoglycemia
b. Sepsis
c. Hypobilirubinemia
d. Hypercalcemia
13.As you walk into the NB nursery, you see a baby in respiratory distress from
apparent mucus. Your first nursing action is to:
a. Call the code team
b. Carefully slap the infants back
c. Thump the chest and start CPR
d. Pick the baby up by the feet
14.If RhoGAM is given to a mother after delivering a healthy baby, the condition
that must be present for the globulin to be effective is that the:
a. Baby is Rh negative
b. Mother has no antibody titer in her blood
c. Mother is Rh positive
d. Mother has some antibody titer in her blood
15.During a typical initial NB assessment, a nurse would expect to identify the
presence of:
a. Hands and feet that have a bluish color
b. An eye discharge that is yellow and watery

c. An apical heart rate of 94 beats per minute

d. An umbilical stump that has no veins and one artery
16.A newly delivered NB is assessed thoroughly for danger signs and symptoms.
Which of the following assessment findings would alert the nurse to
anticipate the development of jaundice in a full-term NB?
a. A negative direct Coombs test result
b. Presence of a caput succedaneum
c. NB blood type O negative
d. Presence of cephalhematoma
17.Pink, 2 days old has congenital heart disease of the acyanotic type. The nurse
would expect to observe:
a. Edema in the extremities
b. An elevated hematocrit
c. Absence of pedal pulses
d. Dyspnea during feeding and crying
18.A NB is diagnosed to have hemophilia. Which of the following sign would
support the diagnosis at this time?
1. Prolonged bleeding from the cord
2. Abnormal bleeding from circumcision wound
3. Prolonged caput succedaneum
4. Bleeding in the joints
a. 3&4
b. 1&2
c. 2&3
d. 2&4
19.Before surgical closure of the infants spina bifida, the defect should be:
a. Covered with wet, sterile dressing
b. Left open and exposed to the air
c. Covered with gauze impregnated with petroleum jelly
d. Covered with sterile tissue wipes
20.On physical assessment of the newborn, the following findings are identified.
Which will require reporting to the physician for further evaluation and
possibly treatment?
a. Cephalhematoma
b. Palpable kidneys, liver and spleen
c. Palpable thyroid gland
d. Easy-to-palpate femoral pulse and difficult-to-palpate radial pulse
21.When determining the difference between cephalhematoma and caput
succedaneum, the nurse understands that with caput succedaneum the:
a. Affected area will be tender
b. Swelling does not cross the suture line
c. Swelling not limited by cranial bones
d. Scalp over the swelling becomes ecchymotic
22.A 5 day old infant diagnosed with neonatal sepsis is receiving parenteral
antibiotic. Which of the following findings would best indicate are
improvement in the babys condition?
a. 6 wet diapers in 24 hours
b. 18 hours of daily sleep
c. Increase the length of the sucking reflex

d. Moist mucus membranes

23.The NB is having choking, coughing and excessive drooling in spite of
frequent suctioning, a thorough work-up revealed tracheoesophageal fistula.
Which of the following nursing orders will the nurse implement?
1. Observe NPO; give a pacifier
2. Place on slight Trendelenburg position to continuously drains secretions
3. Gently suction frequently
4. Feed carefully with a preemie nipple
a. 1,2&3
b. 2,3&4
c. 1&3
d. 2&3
24.The nurse caring for a neonate born to a mother addicted to drugs would
assess the neonate for which of the following signs and symptoms?
a. Lethargy, sleeping most of the time, and infrequent cries
b. Disturbed sleep, poor sucking reflex, and constipation
c. Convulsions, sleeping most of the time, and weak cry
d. Respiratory distress, sleeping for short intervals, diarrhea, high-pitched
cry, and poor sucking reflex
25.When assessing a neonate 1 hour after birth, the nurse observes that the
neonate exhibits slight cyanosis when quiet but becomes pink when crying.
The nurse is unable to pass a catheter through the left nostril. The nurse
notifies the pediatrician because the neonate most likely is exhibiting
symptoms of which of the following?
a. Esophageal reflux disorder
b. Respiratory distress syndrome
c. Unilateral choanal atresia
d. Tracheosophageal fistula
26.After teaching the parents of a neonate NB with cleft lip and cleft palate
about appropriate feeding techniques, the nurse determines that the mother
needs further instruction when the mother says which of the following?
a. I should clean her mouth with soapy water after feeding.
b. I should feed her in an upright position.
c. I need to remember to burp her often.
d. I may need to use a special nipple for feeding.
27.