prematurity/preterm
A pregnant patient at 31 weeks gestation arrives at the hospital reporting contactions and pelvic pressure. The provider orders a fetal fibronectin test. Which statement best explains the purpose of this test?
a. determine fetal lung maturity
b. predicts risk of delivery within the next 14 days
c. diagnose placenta previa
d. determine fetal genetic abnormalities
b. predict the risk of delivery within the next 14 days
Rational
The fetal fibronectin (fFN) test detects the presence of fetal fibronectin in cervical or vaginal secretions. This protein normally acts as a “glue” between the fetal membranes and the uterine lining.
Between 22 and 34 weeks, fetal fibronectin is usually absent. If it is present during this time in a patient with symptoms such as contractions or pelvic pressure, it suggests disruption of the membranes and increased risk of preterm labor.
A negative result is especially useful because it strongly predicts that delivery is unlikely within the next 7–14 days.
True or False
If the 5-min Apgar score is below 7, the nurse should repeat the score at 10 minutes.
TRUE
If the 5-minute Apgar score is less than 7, the newborn may still be having difficulty adapting. In this situation, the score should be repeated every 5 minutes until the infant improves, typically at 10, 15, and 20 minutes if needed.
This helps the healthcare team monitor the newborn’s response to resuscitation or supportive interventions.
What is the normal tempature axillary range for a newborn?
a. 96-97 F
b. 97.9- 99.5 F
c. 100-101 F
d. 95-96 F
b. 97.7-99.5 (The normal axillary temperature range for a newborn is approximately 97.7°F–99.5°F (36.5°C–37.5°C). This range indicates the newborn is maintaining normal thermoregulation.)
Which finding is a hallmark of Down Syndrome (Trisomy 21)?
A. Overlapping fingers
B. Single palmar crease
C. Webbed neck
D. Cleft lip
B. Single palmar crease
A single palmar crease (Simian crease) is a classic physical finding associated with Down syndrome (Trisomy 21). Normally, the palm has two creases, but in Down syndrome there is often one single crease across the palm.
Down syndrome occurs due to an extra copy of chromosome 21, leading to characteristic physical and developmental features.
Common Findings in Down Syndrome
Single palmar creaseOne crease across the palmFlat facial profile Flattened midface and nasal bridge Upward slanting eyes Epicanthal folds present Small ears Low-set or small Hypotonia Poor muscle tone ("floppy baby") Protruding tongueLarge tongue relative to mouthShort neckOften with excess skin
A newborn delivered via Cesarean section is grunting and has a respiratory rate of 72 breaths/minute. The nurse explains to the parents that C-section babies are at higher risk for Transient Tachypnea of the Newborn (TTN) because:
A. They have insufficient surfactant
B. The chest was not compressed in the birth canal to squeeze out fluid
C. They have an altered gut microbiome
D. They are always born prematurely
B. The chest was not compressed in the birth canal to squeeze out fluid
Transient Tachypnea of the Newborn (TTN) occurs when excess fetal lung fluid remains in the lungs after birth.
During a vaginal delivery, the baby’s chest is compressed while passing through the birth canal, which helps push fluid out of the lungs.
In a Cesarean section, this compression does not occur, so more fluid may remain in the lungs. This leads to temporary rapid breathing (tachypnea).
SATA
A nurse is assesing a 32-week premature newborn. Which findings are expected?
a. thin transparent skin
b. abudant lanugo
c. poor muscle tone
d. deep plantar creases
e. thick leathery skin
f. minimal subcutaneous fat
a. thin transparent skin (Preterm infants have very thin, translucent skin because the skin layers and fat stores are not fully developed. Blood vessels may be visible through the skin)
b. abundant lanugo (fine, soft hair covering the body) is more abundant in premature infants. It normally disappears closer to term gestation.
c. poor muscle tone (Premature infants often have hypotonia (poor muscle tone) due to immature neuromuscular development. Their posture tends to be extended rather than flexed, unlike term infants)
f. minimal subcutaneous fat (Premature infants have little body fat, which makes them more susceptible to heat loss and hypothermia)
A newborn's axillary temperature is 97.2. What is the nurse's priority action?
a. initiate warming interventions
b. administer antibiotics
c. start oxygent therapy
d. notify health care provider
a. initiate warming interventions
A newborn’s normal axillary temperature is 97.7°F–99.5°F (36.5°C–37.5°C).
A temperature of 97.2°F indicates mild hypothermia (cold stress).
Newborns are very vulnerable to heat loss because they:
Have little subcutaneous fat
Have a large body surface area
Cannot shiver effectively
The priority nursing action is to warm the infant immediately to prevent complications.
Examples of warming interventions:
Skin-to-skin contact (kangaroo care)
Place under radiant warmer
Wrap in warm blankets
Put on a hat
A newborn loses heat when placed on a cold scale. What type of heat loss occurred?
A. Conduction
B. Radiation
C. Convection
D. Evaporation
A. Conduction is the loss of heat when a newborn’s body comes into direct contact with a colder surface.
In this scenario:
The newborn is placed on a cold scale
The baby’s skin touches the cold surface
Heat transfers from the baby → to the cold scale
➡️ This is direct contact heat loss, which defines conduction.
Which substance is the leading cause of preventable intellectual disability in newborns?
A. Marijuana
B. Alcohol
C. Cocaine
D. Tobacco
B. Alcohol
Alcohol is the leading preventable cause of intellectual disability in newborns. Exposure to alcohol during pregnancy can lead to Fetal Alcohol Spectrum Disorders, a group of conditions that affect the brain, growth, and physical development of the fetus.
Which interventions are appropriate for uterine atony?
A. Fundal massage
B. Administer oxytocin
C. Empty bladder
D. Start IV fluids
E. Encourage ambulation
A. Fundal massage
B. Administer oxytocin
C. Empty bladder
D. Start IV fluids
Uterine Atony occurs when the uterus fails to contract after delivery, leading to postpartum hemorrhage. The priority is to stimulate uterine contraction and maintain circulation.
Appropriate nursing interventions include:
Fundal massage Stimulates the uterus to contract and reduces bleeding Administer oxytocin Promotes uterine contractions Empty bladder A full bladder can displace the uterus and prevent contraction Start IV fluids Helps maintain circulatory volume during blood loss
True or False
Preterm labor is defines as uterine contactions with cervical changes occuring betwwen 20 and 37 weeks gestation
TRUE
Gestational age:
Occurs after 20 weeks but before 37 weeks of pregnancy.
Uterine contractions:
Regular contractions (often ≥4 contractions in 20 minutes or ≥8 in 60 minutes).
Cervical change:
Cervical dilation (opening of the cervix)
Cervical effacement (thinning of the cervix)
SATA
Which are normal newborn reflexes?
a. moro
b. babinski
c. grasp
d. gag
e. cough
a. moro (The Moro reflex (startle reflex) occurs when the infant experiences a sudden movement or loud noise. The baby extends the arms, then brings them back toward the body. This reflex is normal in newborns and usually disappears around 4–6 months.)
b. babinski (The Babinski reflex occurs when the sole of the foot is stroked. The newborn’s toes fan outward and the big toe dorsiflexes. This is normal in infants because their nervous system is still immature.)
c. grasp (The palmar grasp reflex occurs when something touches the baby’s palm, causing the infant to grip tightly. It is present at birth and usually disappears around 3–4 months.)
d. gag (The gag reflex is a protective airway reflex that helps prevent aspiration. It is present at birth and is important for safe feeding and airway protection.)
Which mechanism produces heat in newborns during cold stress?
A. Shivering
B. Brown fat metabolism
C. Increased sweating
D. Muscle contraction
B. Brown fat metabolism
Newborns do not shiver effectively to generate heat like adults. Instead, they produce heat through non-shivering thermogenesis, which occurs when brown adipose tissue (brown fat) is metabolized.
Which is an X-linked recessive disorder?
A. Cystic fibrosis
B. Hemophilia A
C. Huntington disease
D. Sickle cell anemia
B. Hemophilia A
Hemophilia A is an X-linked recessive genetic disorder caused by a deficiency of clotting factor VIII. Because the gene is located on the X chromosome, the condition primarily affects males, while females are usually carriers.
When a male inherits the defective X chromosome, he will express the disease because males only have one X chromosome.
Common signs of Hemophilia A:
Excessive bleeding
Easy bruising
Prolonged bleeding after injury
Joint bleeding (hemarthrosis)
Which findings indicate Magnesium Sulfate toxicity?
Select all that apply.
A. Hyperreflexia
B. Absent patellar reflexes
C. Respiratory rate of 10/min
D. Increased urine output
E. Decreased level of consciousness
B. Absent patellar reflexes
C. Respiratory rate of 10/min
E. Decreased level of consciousness
Magnesium Sulfate is commonly used to prevent seizures in patients with Preeclampsia. However, high magnesium levels can lead to toxicity, which depresses the central nervous system and respiratory system.
Key signs of magnesium toxicity include:
Absent patellar reflexes (DTRs) First major warning sign of toxicity Respiratory depression (<12/min) Magnesium depresses respiratory center Decreased level of consciousness CNS depressionLow urine output (<30 mL/hr) Magnesium is excreted by the kidneys
A premature newborn develops RDS. The primary cause is:
a. lack of surfactant
b. increase pulmonary blood flow
c. excess fluid intake
d. overproduction of mucus
a. lack of surfactant
Respiratory Distress Syndrome (RDS) in premature infants occurs primarily because of insufficient surfactant production in the lungs.
Surfactant is produced by type II alveolar cells.
It reduces surface tension in the alveoli, allowing them to remain open during exhalation.
Premature infants (especially <34 weeks gestation) often have immature lungs that do not produce enough surfactant.
Without surfactant, the alveoli collapse (atelectasis), leading to:
Difficulty breathing
Decreased oxygen exchange
Increased work of breathing
SATA
Which are potential bleeding sites in vitamin K deficiency?
a. brain
b. umbilical cord
c. GI tract
d. skin
e. eye
a. brain (Vitamin K deficiency can cause intracranial hemorrhage, which is one of the most serious complications in newborns. This occurs because newborns have low levels of clotting factors (II, VII, IX, X) that require vitamin K.)
b. umbilical cord (Bleeding may occur at the umbilical stump, especially after cord clamping, because the infant cannot properly clot blood.)
c. GI tract (Newborns with vitamin K deficiency may develop gastrointestinal bleeding, which can appear as blood in stool or vomit)
d. skin (Bleeding under the skin can appear as bruising, petechiae, or purpura)
Which are signs of hyperthermia in a newborn?
Select all that apply.
A. Bradycardia
B. Tachycardia
C. Tachypnea
D. Irritability
E. Increased muscle tone
B. Tachycardia
C. Tachypnea
D. Irritability
E. Increased muscle tone
When a newborn develops hyperthermia (elevated body temperature), the body increases metabolic activity and oxygen consumption. This leads to cardiorespiratory stimulation and neurologic irritability.
Typical signs of hyperthermia in a newborn include:
Sign Why it Happens
Tachycardia Increased metabolic rate raises heart rate Tachypnea Body tries to increase oxygen delivery and heat dissipation IrritabilityCNS stimulation due to overheating Increased muscle tone Neuromuscular stimulation from elevated temperature
An infant exposed to heroin in utero may show which Neonatal Abstinence Syndrome (NAS) symptoms?
Select all that apply.
A. Lethargy and hypotonia
B. High-pitched cry
C. Tremors
D. Projectile vomiting
E. Sneezing and yawning
B. High-pitched cry
C. Tremors
D. Projectile vomiting
E. Sneezing and yawning
Infants exposed to opioids (such as heroin) during pregnancy may develop Neonatal Abstinence Syndrome after birth. This occurs because the baby was exposed to the drug in utero and then experiences withdrawal once the drug supply stops after delivery.
Symptoms usually appear within 24–72 hours after birth.
A patient at 36 weeks gestation presents with painless bright red bleeding. Which actions should the nurse take?
Select all that apply.
A. Perform sterile vaginal exam
B. Monitor fetal heart rate
C. Prepare for possible C-section
D. Avoid vaginal exams
E. Encourage walking
B. Monitor fetal heart rate
C. Prepare for possible C-section
D. Avoid vaginal exams
Painless, bright red bleeding at 36 weeks is a classic sign of Placenta Previa, where the placenta partially or completely covers the cervical opening (os).
Because the placenta is covering the cervix, any vaginal exam can tear the placenta and cause severe hemorrhage.
Appropriate Nursing Actions
Monitor fetal heart rate Assess fetal oxygenation and detect distress Prepare for possible C-sectionDelivery is usually by cesarean section to prevent hemorrhage Avoid vaginal exams Prevents disruption of the placenta and massive bleeding
SATA
Whic conditions increase a patient risk for preterm birth?
a. maternal HTN
b. smoking
c. lack of prenatal care
d. low maternal BMI
e. adequate prenatal nutrition
a. Maternal HTN (Hypertensive disorders (such as chronic hypertension or preeclampsia) increase the risk of placental insufficiency, fetal distress, and early delivery, which can result in preterm birth)
b. smoking (Smoking during pregnancy causes vasoconstriction and decreased oxygen delivery to the fetus. It is strongly associated with preterm birth, low birth weight, and placental complications.)
c. lack of prenatal care (Without prenatal care, maternal conditions, infections, or pregnancy complications may go untreated. This significantly increases the risk of preterm labor and delivery.)
d. Low maternal BMI (Women with low BMI or poor maternal nutrition may have inadequate fetal growth and increased risk for preterm birth)
SATA
Which instructions should be given to parents regarding umbilical cord care?
a. fold diaper below cord
b. sponge baths
c. keep cord dry
d. apply powder
e. do not cover cord
a. fold diaper below cord (The diaper should be folded below the umbilical stump to prevent moisture and irritation, which helps the cord dry and fall off faster.)
b. sponge baths (Newborns should receive sponge baths until the umbilical cord falls off (usually 7–14 days). Submerging the cord in water may delay drying and increase infection risk.)
c. keep cord dry (The umbilical stump should be kept clean and dry to promote natural drying and separation.)
e. do not cover cord (The cord should be left exposed to air as much as possible. Covering it traps moisture, which can delay cord separation and increase infection risk.)
Which factors increase the risk of heat loss in newborns?
A. Thin skin
B. Lack of subcutaneous fat
C. Large body surface area
D. Ability to shiver
E. Immature thermoregulation
A. Thin skin
B. Lack of subcutaneous fat
C. Large body surface area
E. Immature thermoregulation
Newborns are very susceptible to heat loss because of several physiologic characteristics.
Factor Why It Increases Heat
LossThin skin Allows heat to escape more easily from the body. Lack of subcutaneous fat Fat normally acts as insulation. Newborns have very little. Large body surface area More skin exposed relative to body weight → more heat loss. Immature thermoregulation he newborn's hypothalamus and temperature regulation system are not fully developed.
Which facial features are characteristic of Fetal Alcohol Spectrum Disorder (FASD)?
Select all that apply.
A. Thin upper lip
B. Prominent cheekbones
C. Small eyes
D. Flattened midface
E. Large low-set ears
A. Thin upper lip
C. Small eyes (short palpebral fissures)
D. Flattened midface (smooth/flat midface and smooth philtrum)
Fetal Alcohol Spectrum Disorder (FASD) occurs when a fetus is exposed to alcohol during pregnancy, which interferes with normal development. It commonly causes distinct facial abnormalities, growth restriction, and neurologic problems.
Classic facial features of FASD include:
Thin upper lip One of the hallmark facial findings Small eye openings (short palpebral fissures) Eyes appear smaller than normal Flattened midface / smooth philtrum The groove between nose and lip is smooth or absent
Symptoms of iron deficiency anemia include:
A. Pica
B. Glossitis
C. Cheilosis
D. Fatigue
E. Hypertension
A. Pica
B. Glossitis
C. Cheilosis
D. Fatigue
Iron Deficiency Anemia occurs when the body does not have enough iron to produce hemoglobin, leading to decreased oxygen delivery to tissues.
Common symptoms include:
Pica Craving non-food substances such as ice, clay, or dirt Glossitis Inflammation of the tongue, often smooth and sore Cheilosis Cracks at the corners of the mouth (angular stomatitis) FatigueReduced oxygen delivery causes weakness and tiredness