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1. A newborn girl who was born at 38 weeks of gestation weighs 2000 g and is below the 10th percentile in weight. The nurse recognizes that this girl will most likely be classified as which of the following?
- Term, small for gestational age, and very-low-birth-weight infant
- Term, small for gestational age, and low-birth-weight infant
- Late preterm and appropriate for gestational age
- Late preterm, large for gestational age, and low-birth-weight infant
2. An obese woman with diabetes has just given birth to a term, large for gestational age (LGA) newborn. Which of the following conditions should the nurse most expect to find in this infant?
3. The nurse is caring for a large-for-gestational-age newborn (also known as macrosomia). What maternal condition is the usual cause of this condition?
- Celiac disease
- Alcohol use
4. Infants of drug-dependent women tend to be large for gestational age.
5. When reviewing the medical record of a newborn who is large for gestational age (LGA), which of the following factors would the nurse identify as having increased the newborn’s risk for being LGA?
- Fetal exposure to low estrogen levels
- Low weight gain during pregnancy
- Maternal pregravid obesity
- Low maternal birth weight
6. A nurse is caring for a large for gestational age newborn. Which of the following signs would lead the nurse to suspect that the newborn is experiencing hypoglycemia? Select all that apply.
- Bulging fontanels
- Lethargy and stupor
- Appearance of central cyanosis
- Respiratory difficulty
- High-pitched shrill cry
7. The nurse weighs the new infant and calculates his measurements. The new mom asks, “Did my baby grow well? The doctor said he was LGA: What does that mean?” What is the best explanation?
- “That means your baby is over the 90th percentile for weight.”
- “That means your baby is in the 5th percentile for weight.”
- “That means that your baby is lazy sometimes.”
- “That means your baby is average for gestational age.”
8. A client with diabetes delivers a full-term neonate who weights 10 lb, 1 oz (4.6 kg). While caring for this large-for-gestational age (LGA) neonate, the nurse palpates the clavicles for which reason?
- Clavicles are commonly absent in neonates of mothers with diabetes.
- Neonates of mothers with diabetes have brittle bones.
- LGA neonates have glucose deposits on their clavicles.
- One of the neonate’s clavicles may have been broken during delivery.
9. Which of the following is the most likely effect on the fetus if the woman is severely anemic during pregnancy?
- Large for gestational age (LGA) fetus
- Small for gestational age (SGA) baby
- Erythroblastosis fetalis
10. The nurse is caring for a neonate whose mother is diabetic. The nurse will expect the neonate to be:
- Hypoglycemic, small for gestational age
- Hyperglycemic, large for gestational age
- Hypoglycemic, large for gestational age
- Hyperglycemic, small for gestational age
Answers & Rationale
- B. Term, small for gestational age, and low-birth-weight infant. Infants born before term (before the beginning of the 38th week of pregnancy) are classified as preterm infants, regardless of their birth weight. Term infants are those born after the beginning of week 38 and before week 42 of pregnancy. Infants who fall between the 10th and 90th percentiles of weight for their gestational age, whether they are preterm, term, or postterm, are considered appropriate for gestational age (AGA). Infants who fall below the 10th percentile of weight for their age are considered small for gestational age (SGA). Those who fall above the 90th percentile in weight are considered large for gestational age (LGA). Still another term used is low-birth-weight (LBW; one weighing under 2500 g at birth). Those weighing 1000 to 1500 g are very-low-birth-weight (VLB). Those born weighing 500 to 1000 g are considered extremely very-low-birth-weight infants (EVLB).
- A. Hypoglycemia. LGA infants also need to be carefully assessed for hypoglycemia in the early hours of life because large infants require large amounts of nutritional stores to sustain their weight. If the mother had diabetes which was poorly controlled (the cause of the large size), the infant would have had an increased blood glucose level in utero to match the mother’s; this caused the infant to produce elevated levels of insulin. After birth, these increased insulin levels will continue for up to 24 hours of life, possibly causing rebound hypoglycemia.
- A. Diabetes. In the condition known as macrosomia, a newborn is born large for gestational age (LGA). These newborns are those with birth weights that exceed the 90th percentile of newborns of the same gestational age. They are born most often to mothers with diabetes.
- B. False. Infants of drug-dependent women tend to be small for gestational age.
- C. Maternal pregravid obesity. The nurse should identify maternal pregravid obesity as a risk factor for the development of LGA newborns. The other risk factors for the development of LGA newborns include fetal exposure to high estrogen, excess weight gain during pregnancy, gestational diabetes and high maternal birth weight.
- B,C,D. The features indicating hypoglycemia in LGA infants include lethargy, stupor and fretfulness, respiratory difficulty and central cyanosis. The other features include poor feeding in a previously well feeding infant and weak whimpering cry. High-pitched shrill cry and bulging fontanels are seen in increased intracranial pressure following head trauma in LGA infants.
- A. “That means your baby is over the 90th percentile for weight.” LGA stands for large for gestational age. These infants are over the 90th percentile for weight. The other choices are not over the 90th percentile for weight or describe a different characteristic.
- D. One of the neonate’s clavicles may have been broken during delivery. Because of the neonate’s large size, clavicular fractures are common during delivery. The nurse should assess all LGA neonates for this occurrence. None of the other options are true.
- C. Small for gestational age (SGA) baby. Anemia is a condition where there is a reduced amount of hemoglobin. Hemoglobin is needed to supply the fetus with adequate oxygen. Oxygen is needed for normal growth and development of the fetus.
- C. Hypoglycemic, large for gestational age. The infant of a diabetic mother is usually large for gestational age. After birth, glucose levels fall rapidly due to the absence of glucose from the mother. Answer A is incorrect because the infant will not be small for gestational age. Answer B is incorrect because the infant will not be hyperglycemic. Answer D is incorrect because the infant will be large, not small, and will be hypoglycemic, not hyperglycemic.