Evolve: McKinney: Maternal-Child Nursing 6TH Edition - Chapter 26 P.263; Chapter 29,46 (Prematurity/VSD) Evolve: McKinney: Maternal-Child Nursing 6TH Edition

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Sample questions from Evolve: McKinney: Maternal-Child Nursing 6TH Edition - Chapter 26 P.263; Chapter 29,46 (Prematurity/VSD) Evolve: McKinney: Maternal-Child Nursing 6TH Edition

This material has 90 questions with answers and rationales. Here are the first 5.

1. 1.In the neonatal intensive care unit, a 30-week preterm newborn receiving CPAP develops increasing retractions, grunting, and an oxygen saturation of 84% despite an FiO2 increase. Which action should the nurse take first?

   • A.Assess airway patency and immediately notify the neonatal provider of the acute deterioration
   • B.Begin oral feeding to provide energy
   • C.Place the newborn prone and reassess in 30 minutes
   • D.Decrease the CPAP pressure to reduce air trapping

   Rationale: The worsening work of breathing and hypoxemia require immediate assessment and escalation because respiratory distress can progress rapidly in a preterm newborn. Repositioning may help but does not replace urgent assessment; oral feeding is unsafe during significant respiratory distress, and reducing CPAP could worsen oxygenation. The exam takeaway is to address airway and breathing deterioration before routine supportive care.

2. 2.At change of shift in a neonatal unit, which client should the nurse assess first?

   • A.A 35-week newborn whose parent is waiting for discharge teaching
   • B.A 29-week newborn whose apnea episode required stimulation and whose saturation remains 88%
   • C.A 34-week newborn with a temperature of 36.6 C in an open crib
   • D.A 32-week newborn due for a scheduled gavage feeding

   Rationale: Persistent low oxygen saturation after an apnea episode signals an immediate respiratory problem. The other newborns need care, but a stable temperature, scheduled feeding, and discharge teaching are not as urgent. Prioritize acute airway and breathing changes over routine tasks.

3. 3.A clinical nurse educator is assigning care for a stable 32-week preterm newborn who receives scheduled gavage feedings. Which task is appropriate to delegate to an experienced unlicensed assistive personnel (UAP)?

   • A.Determine whether the feeding volume should be increased
   • B.Teach the parent how to check the feeding tube
   • C.Assess the newborn's tolerance of the feeding
   • D.Measure and record the newborn's daily weight using the unit's procedure

   Rationale: A UAP may collect and document routine measurements for a stable client when the nurse provides clear instructions. Feeding assessment, decisions about volume, and parent teaching require nursing judgment and cannot be delegated. The RN remains responsible for interpreting the weight trend and acting on it.

4. 4.A parent asks the neonatal nurse why a preterm newborn with a ventricular septal defect (VSD) is breathing faster during feeds. Which response is best?

   • A.The fast breathing means the VSD has already closed
   • B.The defect prevents blood from reaching the lungs, so feeding causes low oxygen
   • C.The heart defect can increase blood flow to the lungs, making feeding more tiring
   • D.Feeding-related fast breathing is expected and does not need to be reported

   Answer and rationale are in the full material.

5. 5.A 31-week newborn is on day 4 in the neonatal intensive care unit. The chart shows increasing oxygen need, recurrent apnea, and a new systolic murmur. Refer to the client's chart. Which actions should the nurse take? Select all that apply.

   • A.Notify the neonatal provider promptly about the change in respiratory status and murmur
   • B.Offer a full oral feeding to assess endurance
   • C.Document the change and the newborn's response to interventions
   • D.Wait until the next scheduled round because the newborn is already monitored
   • E.Continue cardiorespiratory and oxygen-saturation monitoring

   Answer and rationale are in the full material.