NGN MATERNAL NEWBORN PROCTORED
s s s
EXAM 5 2024
s s s
Exhibit s1: sMedical shx
Newborn sdelivered sby srepeat scesarean sbirth sat s40 sweeks sof sgestation. sBirth sweight
s3,515 sg s(7 slb s12 soz) sApgar sscores s8 sat s1 smin sand s9 sat s5 smin. sMaternal shistory sof
smethadone suse sduring spregnancy.
Exhibit s2: sVS
@0700: sHeart srate s156/min. sRespiratory srate s58/min. sTemperature s37.2° sC s(98.9° sF)
Oxygen ssaturation s98% son sroom sair
@1100: sHeart srate s160/min. sRespiratory srate s60/min. sTemperature s37.3° sC s(99.2° sF)
Oxygen ssaturation s96% son sroom sair
Exhibit s3: sPhys sExam
Newborn sis sinconsolable swith sa shigh-pitched scry. sNewborn ssucks svigorously son
spacifier sbut sbreastfeeds spoorly. sRespirations sunlabored. sLungs ssound sclear son
sauscultation. sIncreased smuscle stone swith smoderate sto ssevere stremors swhen
sdisturbed. sHyperactive sMoro sreflex snoted. sSeveral sloose sstools stoday.
Exhibit s4: sDiagnostic sResults
Maternal surine stoxicology sscreen spositive sfor sopiates s(-). sNewborn surine stoxicology
sscreen spositive sfor sopiates s(- s- sRespiratory sfindings sis sincorrect. sThe snewborn's
srespiratory srate sis swithin sthe sexpected sreference srange sof s30 sto s60/min. sThere sis sno
sindication sthe snewborn shas san salteration sin srespiratory sstatus; stherefore, sthis sfinding
sdoes snot sneed sto sbe sreported sto sthe sprovider.
Temperature sis sincorrect. sThe snewborn's stemperature sis swithin sthe sexpected
sreference srange sof s36.5° sto s37.5° sC s(97.7° sto s99.5° sF). sTherefore, sthis sfinding sdoes
snot sneed sto sbe sreported sto sthe sprovider.
Oxygen ssaturation sis sincorrect. sThe snewborn's soxygen ssaturation sis swithin sthe
sexpected sreference srange sof sgreater sthan s94%; stherefore, sthis sfinding sdoes snot
sneed sto sbe sreported sto sthe sprovider.
Central snervous ssystem sfindings sis scorrect. sThe snewborn sis sdisplaying
sinconsolability, shigh-pitched scry, sincreased smuscle stone, stremors, shyperactive sMoro
sreflex, sand sexcessive ssucking. sThese sfindings sare smanifestations sof sNAS sand
sshould sbe sreported sto sthe sprovider.
Gastrointestinal sfindings sis scorrect. sThe snewborn sis sdisplaying spoor sfeeding sand
sloose sstools. sThese sfindings sare smanifestations sof sNAS sand sshould sbe sreported sto
sthe sprovider.
,Exhibit s1: sRN snote
@ s0900: sClient sreports sa ssmall samount sof sbright sred sblood sin stheir sunderwear supon
sawakening. sClient sdenies scontractions sor sabdominal spain. sExternal sfetal smonitor
sapplied. s@0930: sClient spassed slarge samount sof sbright sred sblood sfrom svagina.
sDenies spain.
Uterine stone ssoft sand snontender sto spalpation. sContraction spattern: sno scontractions
snoted. sFetal sheart srate spattern: sFetal sheart srate sbaseline s135/min. sModerate
svariability. sNo sdecelerations snoted.
Exhibit s2: sVS
@0900: sTemperature s36.2°C s(97.2° sF)Pulse srate s78/min. sRespiratory srate s20/min.
sBlood spressure s112/64 smmHg. sFetal sheart srate s132/min
@0930: sPulse srate s82/min. sBlood spressure s116/60 smmHg. sFetal sheart srate s160/min
Exhibit s3: sMedical shx
G4P3. s30 sweeks sgestation. sPrevious spregnancies sdelivered svia scesarean ssection
sWhen sgenerating ssolutions, sinserting sa slarge sbore sintravenous scatheter sis sindicated.
sClients swho shave sthird strimester svaginal sbleeding smay sexperience sa ssudden
shemorrhage sand srequire sfluid sresuscitation sor sthe sadministration sof sblood sproducts.
sThe snurse sshould sweigh sperineal spads. sWeighing sperineal spads safter suse swill
sprovide sa smore saccurate sassessment sof sthe svolume sof sblood sloss sthat sthe sclient sis
sexperiencing.
When sgenerating ssolutions, sthe snurse sshould snot sadminister smethotrexate sor sassess
sfor scervical sdilation sbecause sit sis scontraindicated sfor sthis sclient. sMethotrexate sis san
santimetabolite sand sfolic sacid santagonist swhich sdestroys srapidly sdividing scells. sIt scan
sbe sadministered sduring spregnancy sto smedically sresolve san sectopic spregnancy sduring
sthe sfirst strimester. sAssessing scervical sdilation sis scontraindicated sfor sany spregnant
sclient swho sis sexperiencing svaginal sbleeding. sManipulation sof sthe scervix sduring sthe
sexamination smay sresult sin sfurther sdamage sto sthe splacenta sand scompromise sthe
swell-being sof sthe sclient sand sfetus.
A snurse sis sassessing sthe snewborn sof sa sclient swho stook sselective sserotonin
sreuptake sinhibitor s(SSRI) sduring spregnancy. sWhich sof sthe sfollowing
smanifestations sshould sthe snurse sidentify sas san sindication sof swithdrawal sfrom san
sSSRI? sa. sLarge sfor sgestational sage
b. Hyperglycemia
c. Bradypnea
d. Vomiting s- sd. sVomiting
, Expected smanifestations sassociated swith sfetal sexposure sto sSSRIs sinclude sirritability,
sagitation, stremors, sdiarrhea, sand svomiting. sThese smanifestations stypically slast s2
sdays.
A snurse sin sa sfamily splanning sclinic sis scaring sfor sa sclient swho srequests san soral
scontraceptive. sWhich sof sthe sfollowing sfindings sin sthe sclient's shistory sshould sthe
snurse srecognize sas sa scontraindication sto soral scontraceptives? s(Select sall sthat
sapply) sa. sCholecystitis
b. Hypertension
c. Human spapillomavirus
d. Migraine sheadaches
e. Anxiety sdisorder s- sCholecystitis, shypertension, sand smigraine sheadaches sis scorrect.
sA shistory sof sgallbladder sdisease sis sa scontraindication sfor sthe suse sof soral
scontraceptives. sHypertension sis sa scontraindication sfor sthe suse sof soral
scontraceptives. sA shistory sof smigraine sheadaches sis sa scontraindication sfor sthe suse
sof soral scontraceptives.
HPV sand sanxiety sdisorder sis sincorrect. sThe spresence sof shuman spapillomavirus sis snot
sa scontraindication sfor sthe suse sof soral scontraceptives. sThe spresence sof san sanxiety
sdisorder sis snot sa scontraindication sfor sthe suse sof soral scontraceptives.
A snurse sis scaring sfor sa snewborn.
Exhibit s1: sMedical shx
@1600: sApgar sscore s9 sat s1 smin sand s9 sat s5 smin. sBirth sweight s4,706g s(10lb s6oz).
sGestational sage s40 sweeks. sDifficult svaginal sbirth swith sshoulder sdystocia.
Exhibit s2: sRN snote
@1700: sNewborn sis sactive sand smoves sall sextremities sexcept sfor sright sarm. sNo
sspontaneous smovement sof sthe sright sarm snoted. sRight sarm sremains sat sside sduring
sMoro sreflex.
Exhibit s3: sPhysical sExam
Absent sMoro sreflex snoted sin sright sarm.
Right sshoulder sand sarm sare sinternally srotated sand sadducted. sElbow sextended.
sForearm spronated swith swrist sand sfingers sflexed. sDiagnosis: sBrachial splexus sinjury
sresulting sin sErb-Duchenne s(Erb's spalsy) sparalysis. s- sEducate sthe sparents sto sbegin
srange sof smotion sexercises son sthe saffected sarm safter s1 sweek sis sindicated. sPassive
sROM sexercises sof sthe sarm sare sindicated sto srestore sfunction sof sthe sextremity. sThe
s s s
EXAM 5 2024
s s s
Exhibit s1: sMedical shx
Newborn sdelivered sby srepeat scesarean sbirth sat s40 sweeks sof sgestation. sBirth sweight
s3,515 sg s(7 slb s12 soz) sApgar sscores s8 sat s1 smin sand s9 sat s5 smin. sMaternal shistory sof
smethadone suse sduring spregnancy.
Exhibit s2: sVS
@0700: sHeart srate s156/min. sRespiratory srate s58/min. sTemperature s37.2° sC s(98.9° sF)
Oxygen ssaturation s98% son sroom sair
@1100: sHeart srate s160/min. sRespiratory srate s60/min. sTemperature s37.3° sC s(99.2° sF)
Oxygen ssaturation s96% son sroom sair
Exhibit s3: sPhys sExam
Newborn sis sinconsolable swith sa shigh-pitched scry. sNewborn ssucks svigorously son
spacifier sbut sbreastfeeds spoorly. sRespirations sunlabored. sLungs ssound sclear son
sauscultation. sIncreased smuscle stone swith smoderate sto ssevere stremors swhen
sdisturbed. sHyperactive sMoro sreflex snoted. sSeveral sloose sstools stoday.
Exhibit s4: sDiagnostic sResults
Maternal surine stoxicology sscreen spositive sfor sopiates s(-). sNewborn surine stoxicology
sscreen spositive sfor sopiates s(- s- sRespiratory sfindings sis sincorrect. sThe snewborn's
srespiratory srate sis swithin sthe sexpected sreference srange sof s30 sto s60/min. sThere sis sno
sindication sthe snewborn shas san salteration sin srespiratory sstatus; stherefore, sthis sfinding
sdoes snot sneed sto sbe sreported sto sthe sprovider.
Temperature sis sincorrect. sThe snewborn's stemperature sis swithin sthe sexpected
sreference srange sof s36.5° sto s37.5° sC s(97.7° sto s99.5° sF). sTherefore, sthis sfinding sdoes
snot sneed sto sbe sreported sto sthe sprovider.
Oxygen ssaturation sis sincorrect. sThe snewborn's soxygen ssaturation sis swithin sthe
sexpected sreference srange sof sgreater sthan s94%; stherefore, sthis sfinding sdoes snot
sneed sto sbe sreported sto sthe sprovider.
Central snervous ssystem sfindings sis scorrect. sThe snewborn sis sdisplaying
sinconsolability, shigh-pitched scry, sincreased smuscle stone, stremors, shyperactive sMoro
sreflex, sand sexcessive ssucking. sThese sfindings sare smanifestations sof sNAS sand
sshould sbe sreported sto sthe sprovider.
Gastrointestinal sfindings sis scorrect. sThe snewborn sis sdisplaying spoor sfeeding sand
sloose sstools. sThese sfindings sare smanifestations sof sNAS sand sshould sbe sreported sto
sthe sprovider.
,Exhibit s1: sRN snote
@ s0900: sClient sreports sa ssmall samount sof sbright sred sblood sin stheir sunderwear supon
sawakening. sClient sdenies scontractions sor sabdominal spain. sExternal sfetal smonitor
sapplied. s@0930: sClient spassed slarge samount sof sbright sred sblood sfrom svagina.
sDenies spain.
Uterine stone ssoft sand snontender sto spalpation. sContraction spattern: sno scontractions
snoted. sFetal sheart srate spattern: sFetal sheart srate sbaseline s135/min. sModerate
svariability. sNo sdecelerations snoted.
Exhibit s2: sVS
@0900: sTemperature s36.2°C s(97.2° sF)Pulse srate s78/min. sRespiratory srate s20/min.
sBlood spressure s112/64 smmHg. sFetal sheart srate s132/min
@0930: sPulse srate s82/min. sBlood spressure s116/60 smmHg. sFetal sheart srate s160/min
Exhibit s3: sMedical shx
G4P3. s30 sweeks sgestation. sPrevious spregnancies sdelivered svia scesarean ssection
sWhen sgenerating ssolutions, sinserting sa slarge sbore sintravenous scatheter sis sindicated.
sClients swho shave sthird strimester svaginal sbleeding smay sexperience sa ssudden
shemorrhage sand srequire sfluid sresuscitation sor sthe sadministration sof sblood sproducts.
sThe snurse sshould sweigh sperineal spads. sWeighing sperineal spads safter suse swill
sprovide sa smore saccurate sassessment sof sthe svolume sof sblood sloss sthat sthe sclient sis
sexperiencing.
When sgenerating ssolutions, sthe snurse sshould snot sadminister smethotrexate sor sassess
sfor scervical sdilation sbecause sit sis scontraindicated sfor sthis sclient. sMethotrexate sis san
santimetabolite sand sfolic sacid santagonist swhich sdestroys srapidly sdividing scells. sIt scan
sbe sadministered sduring spregnancy sto smedically sresolve san sectopic spregnancy sduring
sthe sfirst strimester. sAssessing scervical sdilation sis scontraindicated sfor sany spregnant
sclient swho sis sexperiencing svaginal sbleeding. sManipulation sof sthe scervix sduring sthe
sexamination smay sresult sin sfurther sdamage sto sthe splacenta sand scompromise sthe
swell-being sof sthe sclient sand sfetus.
A snurse sis sassessing sthe snewborn sof sa sclient swho stook sselective sserotonin
sreuptake sinhibitor s(SSRI) sduring spregnancy. sWhich sof sthe sfollowing
smanifestations sshould sthe snurse sidentify sas san sindication sof swithdrawal sfrom san
sSSRI? sa. sLarge sfor sgestational sage
b. Hyperglycemia
c. Bradypnea
d. Vomiting s- sd. sVomiting
, Expected smanifestations sassociated swith sfetal sexposure sto sSSRIs sinclude sirritability,
sagitation, stremors, sdiarrhea, sand svomiting. sThese smanifestations stypically slast s2
sdays.
A snurse sin sa sfamily splanning sclinic sis scaring sfor sa sclient swho srequests san soral
scontraceptive. sWhich sof sthe sfollowing sfindings sin sthe sclient's shistory sshould sthe
snurse srecognize sas sa scontraindication sto soral scontraceptives? s(Select sall sthat
sapply) sa. sCholecystitis
b. Hypertension
c. Human spapillomavirus
d. Migraine sheadaches
e. Anxiety sdisorder s- sCholecystitis, shypertension, sand smigraine sheadaches sis scorrect.
sA shistory sof sgallbladder sdisease sis sa scontraindication sfor sthe suse sof soral
scontraceptives. sHypertension sis sa scontraindication sfor sthe suse sof soral
scontraceptives. sA shistory sof smigraine sheadaches sis sa scontraindication sfor sthe suse
sof soral scontraceptives.
HPV sand sanxiety sdisorder sis sincorrect. sThe spresence sof shuman spapillomavirus sis snot
sa scontraindication sfor sthe suse sof soral scontraceptives. sThe spresence sof san sanxiety
sdisorder sis snot sa scontraindication sfor sthe suse sof soral scontraceptives.
A snurse sis scaring sfor sa snewborn.
Exhibit s1: sMedical shx
@1600: sApgar sscore s9 sat s1 smin sand s9 sat s5 smin. sBirth sweight s4,706g s(10lb s6oz).
sGestational sage s40 sweeks. sDifficult svaginal sbirth swith sshoulder sdystocia.
Exhibit s2: sRN snote
@1700: sNewborn sis sactive sand smoves sall sextremities sexcept sfor sright sarm. sNo
sspontaneous smovement sof sthe sright sarm snoted. sRight sarm sremains sat sside sduring
sMoro sreflex.
Exhibit s3: sPhysical sExam
Absent sMoro sreflex snoted sin sright sarm.
Right sshoulder sand sarm sare sinternally srotated sand sadducted. sElbow sextended.
sForearm spronated swith swrist sand sfingers sflexed. sDiagnosis: sBrachial splexus sinjury
sresulting sin sErb-Duchenne s(Erb's spalsy) sparalysis. s- sEducate sthe sparents sto sbegin
srange sof smotion sexercises son sthe saffected sarm safter s1 sweek sis sindicated. sPassive
sROM sexercises sof sthe sarm sare sindicated sto srestore sfunction sof sthe sextremity. sThe
