ADVENTIST MEDICAL CENTER COLLEGE

BRGY. SAN MIGUEL, ILIGAN CITY

SCHOOL OF NURSING

CARE OF MOTHER, CHILD, AND ADOLSECENT – SECTION A

Related Learning Experience (Clinical: DR)
First Semester, AY 2021– 2022

Name of Students: _____________________________________ Date: _______ Score: 40 pts

Case Scenario #9: Nursing Care of a Family with A Newborn

A FAMILY WITH AN INFANT BORN BREECH

Jeremy is a 1-day-old male who was born from a frank breech position.

CHIEF CONCERN:
“He looks funny. Could he have brain damage?”

HISTORY OF CHIEF CONCERN:

Labor began with ruptured membranes; amniotic fluid was stained “dark green.” When Mrs.
Farmer arrived at the hospital, an ultrasound revealed her baby was presenting breech;
because dilatation was already at 8 cm, she was allowed to give birth vaginally. The infant
was born with aid of Piper forceps and was intubated immediately to assess for meconium.
None visualized beyond vocal cords; Apgar scores of 9 and 9. The infant retains in
intrauterine position (legs extended at knee; sharply bent at hip).

FAMILY PROFILE:
The family lives in a two-bedroom condominium next to national park. The father works as a
park ranger; the mother works part time as a paralegal in lawyer’s office. They have one
other child: 1-year-old Margo. Finances are “adequate.” The mother is concerned something
is wrong with baby because he was born breech; points to stiffness of legs as indication some
neurological problem must be present.

PREGNANCY HISTORY:
The mother is G2P2. Pregnancy was unintended because older child is only 1 year old
(mother had not begun on a contraceptive as yet following first birth). The mother’s
hemoglobin was low at beginning of pregnancy (10 g/dl) so she was prescribed an iron
supplement. There are no other complications with pregnancy other than breech
presentation. The mother states as long as children are so close together, she would have
preferred a second female, not a boy.

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PHYSICAL EXAMINATION:
Weight: 8.1 lb (3.6 kg); height: 20 in. (51 cm); head circumference: 35 cm
Temperature: 98.6°F (37°C)
General appearance: Well-proportioned, alert, male newborn who assumes a frank breech
position
Head: Normocephalic; no molding; ant. fontanelle: 3 cm × 3 cm; posterior fontanelle: 1 cm
Eyes: Red reflex present; follows to midline without difficulty
Ears: Normal alignment; canal patent
Nose: Midline septum; no drainage
Mouth: No teeth; palate intact; midline uvula
Neck: No lymph nodes palpable; midline trachea
Chest: Occasional rhonchi present; no rales; respiratory rate: 20 breaths/min
Heart: No murmurs; heart rate: 145 beats/min
Abdomen: Soft; no masses; liver palpable 1 cm
Genitalia: Normal male; testes palpable in scrotum bilaterally; midline meatus
Extremities: Full range of motion in upper extremities; lower extremities are positioned
sharply bent at the hip with extended knees; knees flex but with difficulty; no fractures
in long bones palpable; unable to flex and abduct hips to assess for subluxated hip;
buttocks have large ecchymotic areas
Neuro: Moro, sucking, and rooting reflexes present; step-in-place, crossed extension, tonic
neck poorly demonstrated because of stiffness of legs

LABORATORY FINDINGS:
Hemoglobin: 18.0 g/dl
Hematocrit: 56%

Jeremy was administered AquaMEPHYTON (vitamin K) and erythromycin eye ointment in the
birthing room. He was scored as a term 39-week infant by a Ballard scale.

STUDY QUESTIONS:
1. Jeremy’s temperature at 1 hour after birth was 98.6°F (37°C). The temperature of the
average newborn immediately after birth is: (2 pts)
A. 96°F (35.6°C)
B. 99°F (37.2°C)
C. 101°F (38.4°C)
D. 105°F (40.6°C)

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Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________
2. A major way that Jeremy can lose heat is by radiation. This type of heat loss involves
which of the following? (2 pts)
A. Loss of heat from a draft in the room
B. Shift of body heat from trunk to extremities
C. Loss of heat to a cold surface that Jeremy is laying upon
D. Heat lost to a distant cold surface like a window
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________

3. Jeremy’s hemoglobin is 18 g/100 mL. You should recognize that the usual hemoglobin
value of newborns is: (2 pts)
A. 7 to 11 g/100 mL
B. 11 to 12 g/100 mL
C. 17 to 18 g/100 mL
D. 19 to 21 g/100 mL
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________
4. Jeremy weighed 8.1 lb at birth. Suppose on the third day of life, he weighs 7.5 lb. You
would assess this as which of the following? (2 pts)
A. Excessive newborn weight loss
B. An average weight loss for a newborn
C. A loss still normal but becoming dangerous
D. A loss not consistent with breastfeeding
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________
5. You have taught Jeremy’s mother to provide skin-to-skin care. This type of care will
primarily involve what practice? (2 pts)
A. Frequently walking with the infant to decrease conduction
B. Keeping the newborn covered with baby oil to seal in heat
C. Holding the infant against her chest or abdomen for warmth
D. Covering the infant with clothes so completely no skin shows
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________

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6. Jeremy was administered vitamin K in the birthing room. What rationale for this
intervention should you explain to Mrs. Farmer? (2 pts)
A. Breast milk does not contain vitamin K.
B. His mother’s hemoglobin was 10.5 g/dl.
C. He was scored as only a 39-week infant.
D. Newborns cannot produce vitamin K.
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________
7. Jeremy’s first stool was black and sticky. Knowing the importance of the QSEN competency
of safety, you would evaluate this as: (2 pts)
A. A normal newborn meconium stool.
B. He must have swallowed blood at birth.
C. He may have some internal bleeding.
D. He may be allergic to breast milk.
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________
8. At 20 hours after birth, Jeremy still has not voided. How would you appraise this
assessment finding? (2 pts)
A. He needs a referral for both kidney and bladder structure.
B. This is within normal parameters for a breastfed newborn.
C. This is an emergency situation requiring catheterization.
D. Jeremy likely needs his breast milk intake supplemented.
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________
9. Jeremy was assessed for a tonic neck reflex. In a typical tonic neck reflex: (2 pts)
A. One arm extends on the side to which he turns his head when he is supine.
B. The infant throws out his hands and legs and then “curls back” again.
C. The infant takes a few pacing steps forward when he is held upright.
D. On his stomach, the newborn lifts up his head and nods expectantly.
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________
10. You notice Jeremy’s mother sings to him. How soon after birth can newborns hear? (2
pts)
A. At 3 to 4 weeks of age
B. As soon as vernix is wiped from the ear pinna
C. As soon as eustachian tube fluid is absorbed
D. When the infant yawns and opens the ear canal
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Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________
11. Jeremy’s skin is described as having slight physiologic jaundice. What factor is involved in
the etiology of this problem? (2 pts)
A. Shunting of blood from the extremities to the body core
B. A reaction from the vitamin K administered at birth
C. An allergy to the protein in either formula or in breast milk
D. The breakdown of hemoglobin which occurs in newborns
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________
12. Which finding in Jeremy’s history puts him at higher risk for an increased serum bilirubin
level than other infants?
A. He has bruising on his buttocks from birth.
B. His mother had a low hemoglobin during pregnancy.
C. He was born within 1 year of a sibling.
D. He was a full-term infant.
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________
13. Jeremy’s Apgar score at 5 minutes was 9. How should you evaluate this assessment
finding?
A. He was having trouble breathing at 5 minutes of age.
B. He must have been hyperventilating at this time period.
C. His heart must have been beating too fast to be accurately assessed.
D. He is adjusting well to intrauterine life.
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________
14. A heel stick blood sample from Jeremy at 12 hours of age revealed a glucose level of 50
mg/100 ml. You would interpret this as: (2 pts)
A. Severe hypoglycemia.
B. Mild hypoglycemia.
C. Normal for a newborn.
D. Hyperglycemia.
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________

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15. Jeremy was scored as a term newborn on a Ballard scale. In a term newborn, you would
expect which of the following assessment findings? (2 pts)
A. No creases on the sole of the foot
B. Creases covering the entire sole
C. Rounded or “rocker-bottom” feet
D. Toes held in a splayed position
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________
16. You inspect Jeremy’s head, mouth, and ears closely. What finding would you consider to
be normal if discovered at birth? (2 pts)
A. Craniotabes
B. Protruding eye globes
C. Swollen tongue
D. Yellow-tinged sclera
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________
17. Mrs. Farmer asks you how to care for Jeremy’s umbilical cord. What advice should you
provide? (2 pts)
A. Keep it covered with a clean, tight Band-Aid.
B. Wash it daily with soap and water or alcohol.
C. Keep it dry by folding diapers underneath it.
D. Apply lotion so it remains soft to the touch.
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________

18. While Jeremy’s mother takes a shower, you place Jeremy in his bassinette. Which would
be the best position in which to place him? (2 pts)
A. On his back
B. On his abdomen
C. On his right side
D. On his left side
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________

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19. Jeremy’s parents have chosen to have him circumcised. What would you teach his
parents? (2 pts)
A. Do not feed him for 12 hours postprocedure.
B. Using local anesthesia will help control pain.
C. He will need to receive IV heparin afterward.
D. Bleeding of about 100 ml can be expected.
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________
20. Mr. Farmer is preparing to take Jeremy and Mrs. Farmer home. In the interests of safety,
what would you teach him? (2 pts)
A. His mother should hold him securely on her lap during the trip home.
B. Newborns do not necessarily need car seats until they are 2 weeks old.
C. Newborn seats should be placed in the back seat facing forward.
D. In the back seat, facing backward, is the safest position for newborn car seats.
Answer (letter only), Rationale of answer, & Reference (page from textbook):
______________________________________________________________________________

Assessed by:

________________________
Name of Clinical Instructor