PHARMACOLOGY PRACTICE QUESTIONS (FINAL)
serum levels of cephalosporins?
Penicillins and Cephalosphorins
1. A 28-year-old female patient presents to the clinic
with complaints of severe vaginal itching and discharge.
She tells the nurse that she is usually very healthy but
has been taking antibiotics for an ear infection. What
does the nurse recognize as a possible cause of her
vaginal itching and discharge?
a. Anaphylaxis
b. Hypersensitivity
c. Nephrotoxicity
d. Superinfection
2. A patient is scheduled to receive ceftriaxone
(Rocephin) for Klebsiella pneumoniae. What will
the nurse teach the patient about this medication?
a. It is given IM or IV only.
b. There is no cross-reaction to penicillins.
c. Ceftriaxone is safe to take with anticoagulants.
d. There is no effect on lab values.
3. The nurse knows that aztreonam (Azactam) is ef
fective against which bacteria?
a. Escherichia coli
b. Haemophilus influenzae
c. Proteus mirabilis
d. Pseudomonas aeruginosa
4. A 40-year-old patient with renal dysfunction is suf
fering from a Staphylococcus aureus infection. He
is prescribed cefprozil monohydrate (Cefzil). What
is the maximum dose the nurse would anticipate?
a. 250 mg/d
b. 500 mg/d
c. 750 mg/d
d. 1 g/d
5. Which class of medication would increase risk of
nephrotoxicity in a patient taking ceftriaxone?
a. Angiotensin-converting enzyme (ACE) inhibitors
b. Antiarrhythmics
c. Loop diuretics
d. Nonsteroidal antiinflammatorydrugs (NSAIDs)
6. The patient has been started on ceftriaxone
(Rocephin). Her family is concerned regarding her
recent weight loss. What can the nurse tell the family
regarding side effects of ceftriaxone?
a. Loss of appetite is a common side effect.
b. Gastrointestinal bleeding may occur frequently.
c. Ceftriaxone causes nutrient absorption
problems.
d. She will eat more when the infection is cured.
7. What statement by a parent indicates more discharge
teaching is necessary for care of 5-year old child who
has been prescribed dicloxacillin (Dynapen) for otitis
media?
a. “Abdominal pain can be a side effect.”
b. “She needs to drink plenty of orange juice with
this medication.”
c. “My child must take all of the medication until
it is gone.”
d. “If my child develops a rash, I should bring her
back to the doctor.”
What category of drugs is known to increase the
a. Antacids
b. Laxatives
c. Opioids
d. Uricosurics
How does penicillin V potassium work?
a. Alteration in membrane permeability
b. Inhibition of cell wall synthesis
c. Inhibition of protein synthesis
d. Interference with cellular metabolism
Which patient should not be taking amoxicillin?
a. 10-year-old patient with a staphylococcal infec
tion of the skin
b. 21-year-old pregnant patient
c. 38-year-old patient with asthma
d. 62-year-old diabetic patient
Macrolides, Tetracyclines, Aminoglycosides, and
Fluoroquinolones
1. Which laboratory test is influenced by tetracycline?
a. White blood count
b. Serum calcium level
c. Blood urea nitrogen
d. Serum potassium levels
2. The patient has been prescribed doxycycline. What
statement(s) by the patient indicate(s) that the nurse
needs to provide more discharge teaching? (Select
all that apply.)
a. “It is best if I take this with meals.”
b. “I should drink extra milk.”
c. “I have to take this medicine on an empty
stomach.”
d. “I should wait a half-hour after meals to take the
medication.”
e. “I cannot eat eggs when I take this medication.”
3. What will the nurse include in the teaching for a
patient taking tetracycline for a respiratory tract
infection? (Select all that apply.)
a. Outdated tetracycline breaks down into toxic by
products and must be discarded.
b. Observe for superinfection like vaginitis or gastritis.
c. Avoid tetracycline during ¿rst and third trimesters of
pregnancy.
d. Anticipate urinary urgency.
e. Wear sunscreen and limit outdoor exposure during
peak daylight hours.
4. The nurse assesses a patient who is taking
gentamicin (Garamycin). What assessment finding(s)
should be cause for serious concern? (Select all that
apply.)
a. Nausea
b. Ototoxicity
c. Headache
d. Photosensitivity
e. Thrombocytopenia
5. The trough level that the nurse drew for a patient
taking gentamicin (Garamycin) is 3.5 mcg/mL.
What is the best action by the nurse?
a. Administer the medication at the correct time.
b. Hold the medication and contact the health care
provider.
c. Repeat the trough level after the next dose of
medication.
d. Give the patient Benadryl to decrease the risk of
a reaction.
6. The patient tells the nurse that she has developed
vaginal discharge since she began taking gentamicin
(Garamycin). What does the nurse suspect may
be occurring?
a. The patient has been exposed to other infectious
agents.
b. The patient is experiencing an allergic reaction.
c. A superinfection has developed.
d. A drug-drug interaction is taking place.
7. The nurse is doing a morning assessment on a
65-year-old patient who is receiving vancomycin.
The patient states that her ears have been ringing
all night. What does the nurse know about vancomycin
and ringing in the ears?
a. Only low-pitched sounds are affected by vancomycin.
b. Tinnitus is a sign of vancomycin allergy.
c. Ototoxicity is caused by damage to cranial nerve
VIII.
d. Only female patients have ringing in their ears.
8. The nurse is noting the intake and output for a
70-year-old patient receiving vancomycin and sees
that the patient’s urine output has decreased to 500
mL/day. What is the best action by the nurse?
a. Increase the patient’s oral fluid intake.
b. Increase the patient’s IV rate.
c. Contact the health care provider.
d. Document this in the patient’s chart.
9. What will the nurse routinely monitor in a 65-year old
patient taking amikacin (Amikin)? (Select all that apply.)
a. Color of sclera
b. Color and clarity of urine
c. AST/ALT
d. Blood glucose
e. Visual acuity
10. The patient has been prescribed azithromycin
(Zithromax) for an upper respiratory infection. What
statement by the patient indicates understanding of side
effects of the medication?
a. “I need to stay out of the sun or wear
sunscreen.”
b. “I have to take it on an empty stomach to prevent
nausea.”
c. “If my eyes get red and itchy, I shouldn’t wear
my contacts.”
d. “I cannot take anything for pain if I get a
headache.”
Sulfonamides
1. Sulfacetamide solution may be prescribed to treat
conjunctivitis caused by which organism?
a. Escherichia coli
b. Serratia marcescens
c. Pseudomonas aeruginosa
d. Neisseria meningitidis
2. The patient has her first postnatal visit with her
obstetrician. She is complaining of frequency and
burning on urination. She has been diagnosed with
a urinary tract infection (UTI) and is started on
TMP-SMZ. What important question(s) should the
nurse ask when teaching the patient? (Select all
that apply.)
a. “What kind of juice do you like to drink?”
b. “Are you breastfeeding?”
c. “Are you allergic to any medications?”
d. “Do you have a history of kidney stones?”
e. “What medications do you take regularly?”
3. What intervention(s) should the nurse implement in
a 50-year-old patient with bronchitis who is receiving
TMP-SMZ and lisinopril (Zestril)? (Select all that apply.)
a. Encourage Àuids.
b. Monitor urinary output.
c. Observe for undesired side effects.
d. Assess lung sounds.
e. Administer laxatives.
4. Why aren’t sulfonamides classi¿ ed as antibiotics?
a. They do not inhibit cell wall growth.
b. They are only bacteriostatic, not bactericidal.
c. They were not obtained from biological sources.
d. They are only effective against viruses and
fungi.
5. The patient has been started on TMP-SMZ for otitis.
What side effect will the nurse advise the patient about?
a. Confusion
b. Constipation
c. Fever
d. Insomnia
6. The 28-year-old patient is taking sulfasalazine
(Azulfadine) for Crohn’s disease. What is the main
tenance dose?
a. 500 mg q6h
b. 1000 mg q6h
c. 1250 mg per day
d. 1500 mg per day
Antivirals
1. The 48-year-old patient is scheduled to receive
a dose of acyclovir. Which medication on the
medication administration record will concern the
nurse?
a. Amantadine
b. Flucytosine
c. Gentamicin
d. Primaquine
2. The patient works as a paramedic and has a “cold d. “Drink prune juice four times per day to make
sore” caused by HSV-1. What health teaching urine alkaline.”
does the nurse provide to the patient regarding his
treatment? 3. The patient has been prescribed an antibiotic and
a. “Wear sunscreen when you are outside due to a common urinary analgesic for a UTI. She calls
photosensitivity.” the clinic and is very concerned that her urine has
b. “You will not be able to work as a paramedic turned bright orange. After reviewing the patient’s
again since you have HSV-1.” chart and her medications, what will the nurse tell
c. “You will need to take the famciclovir 125 mg the patient?
twice per day for 5 days.” a. “If you do not take the antibiotic with food in
d. “Your medication must be taken on an empty your stomach, your urine will turn orange.”
stomach.” b. “Inadequate liquid intake will cause your urine
to turn bright orange.”
3. The 61-year-old patient is taking ganciclovir c. “This is an indication of an allergic reaction.
(Cytovene) for an active cytomegalovirus (CMV) You need to come back to the clinic.”
infection. What baseline laboratory test(s) does the d. “Bright reddish-orange urine is to be expected
nurse anticipate will be ordered? (Select all that apply.) when taking phenazopyridine.”
a. Bilirubin
b. Blood glucose 4. The patient has a UTI and has been prescribed a
c. BUN and creatinine À uoroquinolone. Which pair of symptoms would
d. Electrolytes cause concern for the nurse?
e. INR a. Chest pain and dif¿ culty breathing
b. Headache and dizziness
4. What is the causative agent for malaria? c. Nausea and diarrhea
a. Bacterium d. Photosensitivity and sunburn
b. Fungus
c. Protozoan HIV-AIDS RELATED DRUGS
d. Virus
1. What including is a leading AIDS indicator?
5. The patient has recently returned from an archeology a. Pneumocystis jirovecii pneumonia
dig in Belize. She presents to the emergency b. CD4 counts of fewer than 200 cells/mm3
department with complaints of fever, chills, and body c. Kaposi’s sarcoma
aches. She has been diagnosed with malaria. What d. Mycobacterium avium complex
medication does the nurse anticipate she may be
prescribed? 2. What is/are the potential benefits of early initiation of
a. Acyclovir (Zovirax) antiretroviral therapy in the asymptomatic
b. Chloroquine HCl (Aralen) HIV-infected patient? (Select all that apply.)
c. Delavirdine (Rescriptor) a. Control of viral replication
d. Tobramycin b. Cure the disease
c. Decreased risk of drug toxicity
6. The patient, who is 80 years old, has been diag d. Earlier development of drug resistance
nosed with shingles. What illness in the patient’s e. Prevention of progressive immunodeficiency
medical history will support this diagnosis?
a. AIDS 3. What is/are potential risk(s) of early initiation
b. Chicken pox antiretroviral therapy in patients with asymptomatic HIV
c. Measles infection? (Select all that apply.)
d. Mumps a. Lower risk of drug-drug interaction
e. Strep throat b. Earlier development of drug resistance
c. Reduction in quality of life from adverse effects
URINARY TRACT INFECTION d. Severe anaphylactic reaction
e. Unknown long-term toxicity
1. What may occur when methenamine (Hiprex) is
given with sulfonamide? 4. What is the goal of combination therapy highly
a. Bleeding active antiretroviral therapy (HAART)]?
b. Chest pain a. To offer a cure to AIDS-diagnosed patients
c. Crystalluria b. To offer a cure to pediatric patients
d. Intestinal distention c. To provide prophylaxis/treatment of major secondary
infections
2. The patient has a urinary tract infection and has d. To target enzymes throughout the HIV life cycle
been advised to increase her fluid intake and decrease
her urine pH. What information would the nurse include
in discharge teaching to help the patient meet this goal?
a. “Drinking whole milk will help.”
b. “Cranberry juice will help acidify the urine.”
c. “Be sure to drink 12-14 8-oz glasses of water
per day.”
5. During the time that a patient is taking zidovudine
(Retrovir), frequent monitoring of which laboratory
value(s) is required? (Select all that apply.)
a. ALT/AST
b. Complete blood count (CBC) with differential
c. Creatinine
d. Serum sodium
e. Urine sedimentation rate
6. The nurse is assessing a patient taking zidovudine
(Retrovir). What should the nurse expect to see if
the patient is experiencing side effects? (Select all that
apply.)
a. Difficulty swallowing
b. Headache
c. Numbness and pain in lower extremities
d. Rash
ANTINEOPLASTIC DRUGS
1. The nurse is caring for a patient receiving
combination chemotherapy. The patient asks why she
has to take more than one agent. What is the nurse’s
best response?
a. “It has better response rates than single-agent
chemotherapy.”
b. “It has fewer side effects than when given alone.”
c. “It is always more effective than surgery or radiation.”
d. “Survival rates are always better.”
2. The nurse is teaching a community group about
factors that influence the development of cancer in
humans. Which information will the nurse include
in this teaching?
a. Aflatoxin is associated with cancer of the lung.
b. Benzene is associated with cancer of the tongue.
c. Epstein-Barr virus is associated with cancer of
the stomach.
d. Human papillomavirus is associated with cancer
of the cervix.
3. A patient is receiving chemotherapy and asks the
nurse about side effects. What should the nurse
know concerning the side effects of chemotherapy?
a. Side effects are minimal because chemotherapy
drugs are highly selective.
b. Side effects usually only occur during the first cycle of
treatment.
c. Side effects are caused by toxicities to normal cells.
d. Side effects of chemotherapy are usually permanent.
4. The 65-year-old patient has metastatic cancer. He is
scheduled to receive to palliative chemotherapy. He
states that he does not understand why he should
receive palliative chemotherapy if it won’t kill the
cancer cells. What is the best response?
a. “It is done to help improve your quality of life.”
b. “It is given to limit further growth of the
cancer.”
c. “It is given to slow the growth of the cancer.”
d. “It will shrink the tumors throughout your
body.”
4. The patient will be receiving chemotherapy that
will lower her white blood cell count. Monitoring
for which finding will be a nursing priority?
a. Change in temperature
b. Evidence of petechiae
c. Increase in diarrhea
d. Taste changes
5. The patient has a low platelet count secondary to
chemotherapy. Which nursing actions would be the
most appropriate?
a. Apply pressure to injection site and assess for
occult bleeding.
b. Help the patient conserve energy by scheduling
care.
c. Monitor breath sounds and vital signs.
d. Provide small frequent meals and monitor loss
of fluids from diarrhea.
6. The patient has diarrhea secondary to chemo
therapy. What important information should be
included in patient teaching about chemotherapy
related diarrhea?
a. Eat only very hot or very cold foods.
b. Increase intake of fresh fruits and vegetables.
c. Increase intake of high-fiber foods.
d. Limit caffeine intake.
7. The 70-year-old patient is to receive
cyclophosphamide (Cytoxan) for treatment of his
lymphoma. His medical history is also positive for atrial
fibrillation, arthritis, and cataracts. He takes digoxin
0.125 mg daily and naproxen 500 mg at bedtime. What
should the nurse be aware of when giving these
medications?
a. Cyclophosphamide increases digoxin levels.
b. Cyclophosphamide decreases digoxin levels.
c. Digoxin increases cyclophosphamide levels.
d. These drugs cannot be given together.
8. The patient, 61 years old, is to receive doxorubicin
(Adriamycin) as part of his chemotherapy protocol.
Which assessment is the most important before ad
ministering the medication?
a. Cardiac status
b. Liver function
c. Lung sounds
d. Neurologic status
9. The patient, 69 years old, is receiving
cyclophosphamide (Cytoxan), doxorubicin (Adriamycin),
and methotrexate (Trexall) (CAM) for the treatment of
prostate cancer. During morning rounds, the patient
complains of feeling short of breath. Physical
assessment reveals crackles in both lungs. What is the
most likely cause of this clinical manifestation?
a. Anxiety
b. Cyclophosphamide
c. Doxorubicin
d. Methotrexate
10. A patient is being discharged after receiving IV
chemotherapy. Which statement made by the patient
indicates a need for additional teaching?
a. “Chemotherapy is excreted in my bodily fluids.”
b. “I will not need to know how to check my
temperature.”
c. “My spouse should wear gloves when emptying
my urinal.”
d. “The chemotherapy will remain in my body for
2-3 days.”
11. A patient has reached the nadir of his blood counts
secondary to chemotherapy. Which nursing diagnosis is
the most appropriate?
a. Risk for cardiac failure
b. Risk for dehydration
c. Risk for infection
d. Risk for malnutrition
12. The nurse is preparing to administer chemotherapy,
which can cause severe nausea and vomiting, to a
patient in the outpatient clinic. Which nursing action
would be most appropriate?
a. Give an antiemetic before administering the
chemotherapy.
b. Withhold any antiemetic drugs until the patient
complains of nausea.
c. Give an antiemetic only after the patient has
vomited.
d. Offer the patient a glass of ginger ale to prevent
nausea.
13. A patient is scheduled to receive vincristine
(Oncovin) as part of treatment for cancer. The
medication record for the patient indicates that he is
receiving phenytoin (Dilantin) to control a seizure
disorder. What should the nurse monitor for in this
patient?
a. Headaches
b. Increased blood pressure
c. Renal failure
d. Seizures
14. A patient in the outpatient oncology clinic has
developed mucositis secondary to cancer therapy.
Which statement made by the patient would indicate that
she needs additional teaching about mucositis?
a. “I will rinse my mouth out frequently with normal
saline.”
b. “I will try using ice pops or ice chips to help relieve
mouth pain.”
c. “I will use a mouthwash that has an alcohol base.”
d. “I will use a soft toothbrush.”
15. A patient presents with neutropenia secondary to
cancer therapy. Which nursing diagnosis would be the
most appropriate?
a. Risk for cardiac failure
b. Risk for dehydration
c. Risk for infection
d. Risk for malnutrition
16. The nurse is preparing IV vinblastine (Velban),
bleomycin (Blenoxane), and cisplatin (Platinol) (VBP) for
administration to a patient on the nursing unit. Which
precaution should the nurse take when hanging IV
chemotherapy?
a. Wear a clean cotton gown.
b. Wear shoe covers.
c. Wear a hair net.
d. Wear powder-free gloves.
17. The nurse is administering doxorubicin (Adriamycin)
to a patient diagnosed with cancer. What should the
nurse keep in mind with regard to tissue necrosis
associated with this drug?
a. Tissue necrosis may occur 3-4 weeks after
administration.
b. Tissue necrosis occurs immediately after
administration.
c. Tissue necrosis occurs 2-4 days after
administration.
d. Tissue necrosis rarely occurs with this drug.
18. The nurse is administering doxorubicin (Adriamycin)
to a patient in the outpatient oncology clinic. What is
priority information to include in the patient teaching?
a. Blood counts will most likely remain normal.
b. Complete alopecia rarely occurs with this drug.
c. Report any shortness of breath, palpitations, or
edema to your health care provider.
d. Tissue necrosis usually occurs 2-3 days after
administration.
19. The nurse is teaching a patient about doxorubicin
(Adriamycin), which she will receive as part of her
treatment for breast cancer. Which statement made
by the patient indicates that she needs additional
teaching?
a. “Adriamycin is a severe vesicant.”
b. “My blood counts will be checked.”
c. “My cardiac status will be closely monitored.”
d. “This drug may make my urine turn blue.”
20. One week ago in the outpatient oncology clinic, a
patient received his first cycle of chemotherapy
consisting of cyclophosphamide (Cytoxan), doxorubicin
(Adriamycin), and Àuorouracil (5-FU; Adrucil) (CAF). He
returns to the clinic today for follow-up. Which nursing
intervention would be
most appropriate at this time?
a. Culture the IV site and send a specimen to the
laboratory for analysis.
b. Monitor blood counts and laboratory values.
c. Offer analgesics for pain and evaluate
effectiveness.
d. Teach the patient about good skin care.
21. A patient is scheduled to receive vincristine as part
of her treatment for non-Hodgkin’s lymphoma. She
reports that she likes to “rely on nature” for
complementary therapy. Which herbal/supplement(s)
should be avoided by this patient? (Select all that apply.)
a. Bromelain
b. Daily multivitamin
c. Periwinkle
d. Sheng-Mai-San
e. Valerian
 b. to suppress resistant strains of bacteria.
c. to reduce the number of invading bacteria so
that the immune system can deal with the
Chapter 9 – Antibiotics infection.
d. to stop the drug as soon as the patient feels
1. A bacteriostatic substance is one that better.
a. directly kills any bacteria it comes in contact
with. 10. The penicillins
b. directly kills any bacteria that are sensitive to a. are bacteriostatic.
the substance. b. are bactericidal, interfering with bacteria cell
c. prevents the growth of any bacteria. walls.
d. prevents the growth of specific bacteria that are c. are effective only if given intravenously.
sensitive to the substance. d. do not produce cross-sensitivity within their
class.
2. Gram-negative bacteria
a. are mostly found in the respiratory tract. Chapter 10 – Antiviral
b. are mostly associated with soft tissue 1. In assessing a patient, a viral cause might be
infections. suspected if the patient was diagnosed with
c. are mostly found in the GI and GU tracts. a. tuberculosis.
d. accept a positive stain when tested. b. leprosy.
c. the common cold.
3. Antibiotics that are used together to increase their d. gonorrhea.
effectiveness and limit the associated adverse
effects are said to be 2. Virus infections have proved difficult to treat
a. broad spectrum. because they
b. synergistic. a. have a protein coat.
c. bactericidal. b. inject themselves into human cells to survive
d. anaerobic. and to reproduce.
c. are bits of RNA or DNA.
4. An aminoglycoside antibiotic might be the drug of d. easily resist drug therapy.
choice in treating
a. serious infections caused by susceptible strains 3. Naturally occurring substances that are released in
of Gram-negative bacteria. the body in response to viral invasion are called
b. otitis media in an infant. a. antibodies.
c. cystitis in a woman who is 4 months pregnant. b. immunoglobulins.
d. suspected pneumonia before the culture results c. interferons.
are available. d. interleukins.
4. Herpes viruses cause a broad range of conditions
5. Which of the following is not a caution for the use of but have not been identified as the causative agent
cephalosporins? in
a. Allergy to penicillin a. cold sores.
b. Renal failure b. shingles.
c. Allergy to aspirin c. genital infections.
d. Concurrent treatment with aminoglycosides d. leprosy.
6. The fluoroquinolones 5. Which of the following would be an important
a. are found freely in nature. teaching point for the patient receiving an agent to
b. are associated with severe adverse reactions. treat herpes virus or CMV?
c. are widely used to treat Gram-positive a. Stop taking the drug as soon as the lesions
infections. have disappeared.
d. are broad-spectrum antibiotics with few b. Sexual intercourse is fine—as long as you are
associated adverse effects. taking the drug, you are not contagious.
c. Drink plenty of fluids to decrease the drug’s toxic
7. Cipro, a widely used antibiotic, is an example of effects on the kidneys.
a. a penicillin. d. There are few if any associated GI adverse
b. a fluoroquinolone. effects.
c. an aminoglycoside.
d. a macrolide antibiotic. 6. HIV selectively enters which of the following cells?
8. A patient receiving a fluoroquinolone should be a. B clones
cautioned to anticipate b. Helper T cells
a. increased salivation. c. Suppressor T cells
b. constipation. d. Cytotoxic T cells
c. photosensitivity.
d. cough. 7. Nursing interventions for the patient receiving
antiviral drugs for the treatment of HIV probably
9. The goal of antibiotic therapy is would include
a. to eradicate all bacteria from the system.
 a. monitoring renal and hepatic function
periodically during therapy.
b. administering the drugs just once a day to
increase drug effectiveness.
c. encouraging the patient to avoid eating if GI
upset is severe.
d. stopping the drugs and notifying the prescriber if
severe rash occurs.
8. Locally active antiviral agents can be used to treat
a. HIV infection.
b. warts.
c. RSV.
d. CMV systemic infections.
Chapter 39 – introduction to reproductive system
1. In a nonpregnant woman, the levels of the sex
hormones fluctuate in a cyclical fashion until
a. all of the ova are depleted.
b. the FSH and LH are depleted.
c. the hypothalamus no longer senses FSH
and LH.
d. the hypothalamus becomes more sensitive
to androgens.
2. A woman develops ova, or eggs,
a. continually until menopause.
b. during fetal life.
c. until menopause.
d. starting with puberty.
3. Control of the female sex hormones starts with
the release of GnRH from the hypothalamus.
Because of this, the cycling of these hormones
may be influenced by
a. body temperature.
b. stress or emotional problems.
c. age.
d. androgen release.
4. The rhythm method of birth control depends on
the effects of progesterone
a. to increase uterine motility.
b. to decrease and thicken cervical secretions.
c. to elevate body temperature.
d. to depress appetite.
5. The menstrual cycle
a. always repeats itself every 28 days.
b. is associated with changing hormone levels.
c. is necessary for a human sexual response.
d. cannot occur if ovulation does not occur.
6. In the male reproductive system,
a. the seminiferous tubules produce sperm
and testosterone.
b. the interstitial cells produce sperm.
c. the seminiferous tubules produce sperm
and the interstitial cells produce
testosterone.
d. the interstitial cells produce sperm and
testosterone.
7. Spring fever occurs as a result of increased
light. In males, this increase in light causes an
increase in the production of
a. inhibin.
b. adrenal androgens.
c. estrogen.
d. testosterone.
8. The human sexual response depends on
stimulation of
a. the sympathetic nervous system.
b. the parasympathetic nervous system.
c. the hypothalamic sex drive center.
d. adrenal androgens.
Chapter 40 – drug affecting female reproductive
system
1. A postmenopausal woman is to receive short-
term HRT to control her menopausal symptoms.
Which adverse effect would the nurse include in
the patient teaching about this therapy?
a. Constipation
b. Breakthrough bleeding
c. Weight loss
d. Persistently elevated body temperature
2. An estrogen receptor modulator might be the
drug of choice in the treatment of
postmenopausal osteoporosis in a patient with a
family history of breast or uterine cancer. The
nurse would instruct the patient that she might
experience which side effects?
a. Constipation and dry, itchy skin
b. Flushing and dry vaginal mucosa
c. Hot flashes and vaginal bleeding
d. Diarrhea and weight loss
3. Combination estrogens and progestins are
commonly used as OCs. It is thought that this
combination has its effect by
a. acting to block the release of FSH and LH,
preventing follicle development.
b. directly suppressing the ovaries and
preventing ovulation.
c. keeping the endometrium constantly thick
and blood filled.
d. preventing menstruation, which prevents
pregnancy.
4. Any patient who is taking estrogens, progestins,
or combination products should be cautioned to
avoid smoking because
a. nicotine increases the metabolism of the
hormones, making them less effective.
b. the risk for potentially dangerous
thromboembolic episodes increases.
c. nicotine amplifies the adverse effects of the
hormones.
d. nicotine blocks hormone receptor sites, and
they may no longer be effective.
5. Oxytocin, a synthetic form of the hypothalamic
hormone, is used to
a. induce abortion via uterine expulsion.
b. stimulate milk letdown in the lactating
woman.
c. increase fertility and the chance of
conception.
 d. relax the gravid uterus to prevent preterm
labor.
6. The use of an abortifacient drug is
contraindicated in a woman
a. who is 15 weeks pregnant.
b. who is older than 50 years of age.
c. who has a history of four previous cesarean
births.
d. who is 10 weeks pregnant.
7. A young woman chooses OCs because she
feels that it is not the right time for her to get
pregnant. You would evaluate her teaching
about the drug to be effective if she makes
which statement?
a. “I shouldn’t smoke for the first month to
make sure I don’t react severely to the pills.”
b. “If I forget to take a pill, I’ll just start over the
next day with a new series of pills.”
c. “I may not be able to wear my contact
lenses while taking these pills, or I might
have to be fitted for a new pair.”
d. “If I have to take an antibiotic while I am
using these pills, I should take double pills
on those days that I am using the antibiotic.”
CHAPTER 41 Drugs Affecting the Male Reproductive
System
1. Testosterone is approved for use in
a. the treatment of breast cancers.
b. increasing muscle strength in athletes.
c. oral contraceptives.
d. increasing hair distribution in male pattern
baldness.
2. Illegal use of large quantities of unprescribed
anabolic steroids to enhance athletic
performance has been associated with
a. increased sexual prowess.
b. muscle rupture from overexpansion.
c. development of chronic obstructive
pulmonary disease.
d. cardiomyopathy and liver cancers.
3. Anabolic steroids would be indicated for the
treatment of
a. hair loss.
b. angioedema.
c. debilitation and severe weight loss.
d. breast cancers in males.
4. What cause of erectile penile dysfunction is
treated with PDE5 inhibitors?
a. Problems with childhood authority figures
prevent a male erection.
b. The corpus cavernosum does not fill with
blood to allow for penile erection.
c. The sympathetic nervous system fails to
function.
d. Past exposure to sexually transmitted
disease causes physical damage within the
penis.
5. A potentially deadly drug–drug interaction can
occur if a PDE5 inhibitor (sildenafil, avanafil,
tadalafil, or vardenafil) is combined with
a. corticosteroids.
b. oral contraceptives.
c. organic nitrates.
d. halothane anesthetics.
6. A female may be prescribed an androgen for
which diagnosis?
a. Breast cancer
b. Infertility
c. Pain during intercourse
d. Females are never prescribed androgens
7. Men taking alprostadil for treatment of erectile
dysfunction must
a. take the drug orally about 1 hour before
anticipated intercourse.
b. arrange for sexual stimulation to promote
erection.
c. learn to inject the drug directly into the
penis.
d. avoid the use of nitrates for cardiovascular
disorders.
8. Viagra is known to
a. cause unexpected and enlarged erections.
b. make a person young and agile.
c. promote interpersonal relationships between
partners.
d. increase nitrous oxide levels in the corpus
cavernosum, causing vascular relaxation
and promoting blood flow into the corpus
cavernosum.
CHAPTER 42 Introduction to the Cardiovascular
System
1. When describing heart valves to a group of
students, would the instructor include?
a. The closing of the AV valves is what is
solely responsible for heart sounds.
b. Small muscles attached to the AV valves are
responsible for opening and closing the
valves.
c. The aortic valve opens when the pressure in
the left ventricle becomes greater than the
aortic pressure.
d. The valves leading to the great vessels are
called the cuspid valves.
2. In the heart,
a. the ventricles will not contract unless they
are stimulated by action potentials arising
from the SA node.
b. fibrillation of the atria will cause blood
pressure to fall to zero.
c. spontaneous depolarization of the muscle
membrane can occur in the absence of
nerve stimulation.
d. the muscle can continue to contract for a
long period of time in the absence of
oxygen.

3. The activity of the heart depends on both the
inherent properties of the cardiac muscle cells
and the activity of the autonomic nerves to the
heart. Therefore,
a. cutting all of the autonomic nerves to the
heart produces a decrease in resting heart
rate.
b. blocking the parasympathetic nerves to the
heart decreases the heart rate.
c. stimulating the sympathetic nerves to the
heart increases the time available to fill the
ventricles during diastole.
d. the heart rate will increase in cases of
dehydration, which will lead to less filling
time.
4. A heart transplantation patient has no nerve
connections to the transplanted heart. In such
an individual, one would expect to find
a. a slower-than-normal resting heart rate.
b. atria that contract at a different rate than
ventricles.
c. an increase in heart rate during emotional
stress.
d. inability to exercise because there is no way
to increase heart rate.
5. Which is correct regarding the cardiac cycle?
a. Blood that has a high amount of oxygen
enters the left atrium.
b. Blood that has a high amount of oxygen
enters the right ventricle.
c. The highest pressure is found in the right
ventricle of the heart.
d. The mitral valve allows for bidirectional
blood flow.
6. Cardiac cells differ from skeletal muscle cells in
that
a. they contain actin and myosin.
b. they possess automaticity and conductivity.
c. calcium must be present for muscle
contraction to occur.
d. they do not require oxygen to survive.
7. Clinically, dysrhythmias, or arrhythmias, may
cause
a. altered cardiac output that could affect all
cells.
b. changes in capillary filling pressures.
c. alterations in osmotic pressure.
d. valvular dysfunction.
8. A client is brought to the emergency room with a
suspected myocardial infarction. The client is
upset because he had just had an ECG in his
doctor’s office and it was fine. The explanation
of this common phenomenon would include the
fact that
a. the ECG only reflects changes in cardiac
output.
b. the ECG is not a very accurate test.
c. the ECG only measures the flow of electrical
current through the heart.
d. the ECG is not related to the heart
problems.
9. Blood flow to the myocardium differs from blood
flow to the rest of the cells of the body in that
a. blood perfuses the myocardium during
systole.
b. blood flow is determined by many local
factors, including buildup of acid.
c. blood perfuses the myocardium during
diastole.
d. oxygenated blood flows to the myocardium
via veins.
CHAPTER 43 Drugs Affecting Blood Pressure
1. Baroreceptors are the most important factor in
controlling fast changes in BP. Baroreceptors
a. are evenly distributed throughout the body
to maintain pressure in the system.
b. sense pressure and immediately send that
information to the medulla in the brain.
c. are directly connected to the sympathetic
nervous system.
d. are as sensitive to oxygen levels as to
pressure changes.
2. Essential hypertension is the most commonly
diagnosed form of high BP. Essential
hypertension is
a. caused by a tumor in the adrenal gland.
b. associated with no known cause.
c. related to renal disease.
d. caused by liver dysfunction.
3. Hypertension is associated with
a. loss of vision.
b. strokes.
c. atherosclerosis.
d. all of the above.
4. The stepped-care approach to the treatment of
hypertension includes
a. lifestyle modification, including exercise,
diet, and decreased smoking and alcohol
intake.
b. use of a diuretic, beta-blocker, or ACE
inhibitor to supplement lifestyle changes.
c. a combination of antihypertensive drug
classes to achieve desired control.
d. all of the above.
5. ACE inhibitors work on the renin–angiotensin
system to prevent the conversion of angiotensin
I to angiotensin II. Because this blocking occurs
in the cells in the lung, which is usually the site
of this conversion, the use of ACE inhibitors
often results in
a. spontaneous pneumothorax.
b. pneumonia.
c. unrelenting cough.
d. respiratory depression.

6. A client taking an ACE inhibitor is scheduled for
surgery. Because this medication may be
dangerous in the setting of general anesthesia,
the nurse should
a. stop the drug without discussing with the
providers.
b. alert the provider caring for the patient, and
mark the client’s chart prominently.
c. cancel the surgery and consult with the
prescriber.
d. monitor fluid levels and make sure the fluids
are restricted before surgery.
7. A patient who is hypertensive becomes
pregnant. Which is the safest medication for this
patient?
a. An angiotensin II receptor blocker
b. An ACE inhibitor
c. A beta-blocker
d. A calcium-channel blocker
8. Droxidopa, an antihypotensive drug, should be
used
a. only with patients who are confined to bed.
b. in the treatment of acute shock.
c. in patients with known pheochromocytoma.
d. to treat orthostatic hypotension in patients
whose lives are impaired by the disorder
CHAPTER 44 Agents for Treating Heart Failure
1. A nurse assessing a patient with HF would
expect to find
a. cardiac arrest.
b. congestion of blood vessels.
c. an MI.
d. a pulmonary embolism.
2. Calcium is needed in the cardiac muscle
a. to break apart actin–myosin bridges.
b. to activate troponin.
c. to promote contraction via sliding.
d. to maintain the electrical rhythm.
3. When assessing a patient with right-sided HF,
the nurse would expect to find edema
a. in gravity-dependent areas.
b. in the hands and fingers.
c. around the eyes.
d. when the patient is lying down.
4. ACE inhibitors and other vasodilators are used
in the early treatment of HF. They act to
a. decrease workload on the heart by lowering
preload and afterload.
b. increase arterial pressure and perfusion.
c. cause pooling of the blood and decreased
venous return to the heart.
d. increase the release of aldosterone and
improve fluid balance.
5. A nurse is preparing to administer a prescribed
cardiac glycoside to a patient based on the
understanding that this group of drugs acts in
which way?
a. They block the sympathetic nervous system.
b. They block the renin–angiotensin system.
c. They block the parasympathetic influence
on the heart muscle.
d. They affect intracellular calcium levels in the
heart muscle.
6. A nurse would instruct a patient taking Lanoxin
(digoxin) for the treatment of HF to take which
action?
a. Make up any missed doses the next day.
b. Report changes in heart rate.
c. Avoid exposure to the sun.
d. Switch to generic tablets if less expensive.
7. A nurse is about to administer Lanoxin to a
patient whose apical pulse is 48 beats/min. He
or she should
a. administer the drug and notify the prescriber
that the heart rate is low.
b. retake the pulse in 15 minutes and give the
drug if the pulse has not changed.
c. retake the pulse in 1 hour and withhold the
drug if the pulse is still less than 60
beats/min.
d. withhold the drug and notify the prescriber
that the heart rate is below 60 beats/min.
8. How does ivabradine (Corlanor) work in the
body?
a. Blocks beta-receptors to slow the heart rate
b. Slows influx of calcium to decrease force of
contraction
c. Slows influx of calcium and relaxes blood
vessels
d. Reduces heart rate by inhibiting action
potentials at the SA node
CHAPTER 45 Antiarrhythmic Agents
1. Cardiac contraction and relaxation are
controlled by
a. a specific area in the brain.
b. the sympathetic nervous system.
c. the autonomic nervous system.
d. action potential and electrical conduction
arising within the heart.
2. Antiarrhythmic drugs alter the action potential of
the cardiac cells. Because they alter the action
potential, antiarrhythmic drugs often
a. cause HF.
b. alter blood flow to the kidney.
c. cause new arrhythmias.
d. cause electrolyte disturbances.
3. Lidocaine is a class Ib antiarrhythmic. Which is
correct regarding its mechanism of action?
a. It primarily blocks potassium influx.
b. It primarily blocks beta receptors.
c. It primarily blocks calcium influx.
d. It primarily blocks sodium influx.
4. Ibutilide (Corvert) is a class III antiarrhythmic
drug that is used for
a. sedation during electrocardioversion.
 b. conversion of recent-onset AF and flutter.
c. treatment of life-threatening ventricular
arrhythmias.
d. treatment of arrhythmias complicated by HF.
5. The drug of choice for the treatment of a
supraventricular tachycardia associated with
Wolff-Parkinson-White syndrome is
a. digoxin.
b. verapamil.
c. lidocaine.
d. adenosine.
6. A patient who is receiving an antiarrhythmic
drug needs
a. constant cardiac monitoring until stabilized.
b. frequent blood tests, including drug levels.
c. an antidepressant to deal with psychological
depression.
d. dietary changes to prevent irritation of the
heart muscle.
a. prevent any CV exercise, preventing strain
on the heart.
b. block strong muscle contractions, causing
vasodilation.
c. alter the electrolyte balance of the heart,
preventing arrhythmias.
d. increase the heart rate, making it more
efficient.
5. A nurse would question an order for which drug
if the patient was also receiving verapamil?
a. Oral contraceptives
b. Cyclosporine
c. Digoxin
d. Barbiturate anesthetics
6. Prinzmetal angina occurs as a result of
a. electrolyte imbalance.
b. a spasm of a coronary vessel.
c. decreased venous return to the heart.
d. a ventricular arrhythmia.

7. A patient is brought into the emergency room

with a potentially life-threatening ventricular
arrhythmia. Immediate treatment might include
a. a loading dose of digoxin.
b. injection of quinidine.
c. bolus and titrated doses of lidocaine.
d. loading dose of propafenone.

8. A client stabilized on quinidine for the regulation

of AF would be cautioned to avoid which foods?
a. Potassium-rich foods
b. Foods containing tyrosine
c. High-sodium–containing foods
d. Foods that alkalinize the urine

CHAPTER 46 Antianginal Agents

1. Coronary artery disease results in

a. an imbalance in cardiac muscle oxygen
supply and demand.
b. delivery of blood to the heart muscle during
systole.
c. increased pulse pressure.
d. a decreased workload on the heart.

2. Angina
a. causes death of heart muscle cells.
b. is pain due to lack of oxygen to myocardial
cells.
c. cannot occur at rest.
d. is not treatable.

3. Nitrates are commonly used antianginal drugs

that act to
a. increase the preload on the heart.
b. increase the afterload on the heart.
c. dilate coronary vessels to increase the
delivery of oxygen through those vessels.
d. decrease venous return to the heart,
decreasing the myocardial workload.

4. Calcium channel blockers are effective in

treating angina because they

POST PARTUM CARE
Definitions
- Postpartum period
o The period following the delivery of the
placenta
 The first hour immediately after the
delivery of the placenta was designated in
the previous module as the 4th stage of
labor
 The time after the 4th stage of labor is
designated in this module as the
postpartum period
- Puerperium
o The period six weeks after delivery
Components of Postpartum Care Visit
- Early detection and management of complications
- Complication readiness
- Promoting health and preventing disease
- Woman-centered education and counselling
Continue care after 1 hour postpartum
- Keep mother at close watch for at least 2 hours
o Check the temperature, blood pressure and
pulse every 30 minutes
o Check at 2,3, and 4 hours, then every 4 hours
for firmness (hardness) of the uterus and
emergency signs
Check for bladder distension if unable to void
- Advise clean cloth/napkin to collect vaginal blood
- Advice mother to eat and drink high-energy foods
that are easily digestible
- Request the companion: to watch her and to call you
for bleeding or pain, dizziness or for any other
problem
Caring for the baby
- Keep the baby in the room with the mother, in her
bed or within easy reach
- Support exclusive breastfeeding on demand, day
and night, as often and as long as the baby wants
- Immunize according to the EPI schedule
o BCG and Hepatitis B vaccines are given after
the first full breastfeed
- Instruct the mother and the companion to watch the
baby closely and report immediately any untoward
happening like:
o Breastfeeding difficulty (poor suck, vomiting)
o Difficulty of breathing (fast breathing or
cyanosis)
o Cold feet or hands
o Bleeding from the cord or discharge from the
umbilical stump
- Instruct the mother and the companion to watch the
baby closely and report immediately any untoward
happening like:
o Fever
o Jaundice
o Diarrhea or loose watery stools with or without
blood
- Check baby at around 4 and 8 hours and then daily
Educate and counsel on family planning
- Provide the family planning method if available. If
not available, refer
o Ask what are the couple’s plans regarding
having more children
o Stress the importance of proper birth spacing
o Give relevant information and advice
o Advice that exclusive breastfeeding is the best
contraceptives in the 1st six months
- Help mother to choose the most appropriate method
for her and her partner
Inform, teach and counsel the women on important MCH
messages
- Talk to the woman when she is rested and
comfortable
- Also give important information and advice to her
companion
- Take time to explain, use visual aids, and
demonstrate important lessons
- Encourage them to participate actively in
discussions and to ask questions
Discharge the women and her baby
- The woman and her baby may be discharged 24
hours after delivery
- Ensure that the woman is able to breastfeed
successfully before discharge
- Repeat important health information
- Check understanding of all discharge instructions
and advice and arrange follow-up
Schedule follow-up visits
- Advice mother to bring along the newborn during
these visits
o 2 – 3 days postpartum
o 7 days postpartum
o 4 – 6 weeks postpartum
- Mothers who cannot come to the clinic must be
visited at the home
Assess for emergency signs
o Vaginal bleeding
o Pallor
o Fever
o Looks very ill
- DO NOT make a very sick woman wait, attend to
her immediately
- Make the woman comfortable
Inquire about the circumstances of her delivery
- Check her records and her present state of health
- Ask and assess:
o When, where delivered?
o How are you feeling?
o Pain, fever, bleeding since delivery?
o Hard to avoid urine?
o Breastfeeding problems or breast discomfort?
o Family planning?
 o Other concerns?
o Check records: complications, treatment during Abnormalities in Postpartum Period
delivery? - Elevated BP
o HIV status? - Pallor
- Vaginal bleeding
Examination - Foul smelling lochia
- Look for pallor - Dribbling urine
- Check BP, temp, pulse rate - Pus or perineal pain
- Check breast - Feeling unhappy
- Feel uterus: is it hard, round and well-contracted? - Vaginal discharge
- Look at vulva and perineum for: tear/s, swelling, pus - Breast problem
- Look at pad for bleeding and lochia: does it smell? Is o Infection/ breast abscess
it profuse? o Sore or cracked nipple
o Engorgement
Assess breastfeeding o Insufficient milk
- Is there any difficulty breastfeeding? - Cough or breathing difficulty
- Observe how mother breastfeeds for atleast 4
minutes: Complete work-up and give any treatment or prophylaxis
o Is baby positioned well? due
o Is baby able to attach to the nipples well? - Prevent anemia with iron/ folate supplementation by
o Is baby sucking effectively? giving 2 tablets of iron/ folate daily for 3 months (or
more if mother is pale)
Assess neonatal health and development - Give one capsule Vitamin A (200,000 IU) if none
- Danger signs of newborn for immediate referral was given postpartum- to protect the baby from
o Fever nutritional blindness and infections
o Jaundice - Complete tetanus immunizations if not yet done
o Fast breathing or cyanosis - Do RPR (Rapid Plasma Reagin) if not yet done
o Breastfeeding difficulty – vomiting or poor suck
o Diarrhea or loose watery stools with or without Advice and counsel (health education)
blood - Postpartum care and hygiene
o Foul-smelling umbilical discharge or infected o Wash hands before and after handling the baby
cord stump o Wash the perineum daily
o Poor weight gain or rapid weight loss o Have enough rest and sleep
o Non-response no startle reflex to loud noise - Avoid sex until perineal wound heals
(possible congenital hearing abnormality) - Advise proper maternal nutrition
o Eat a greater amount and variety of healthy
Identify any abnormalities foods especially green leafy vegetables and
- Refer accordingly: fruits
o Breast problem o increase oral fluids intake: water, soup-based
 Infection/ breast abscess diet, fruit juices
 Sore or cracked nipple o Spend more time in nutrition counselling with
 Engorgement thin women and adolescents
 Insufficient milk - Encourage breastfeeding
o Cough or breathing difficulty o Stress the importance, advantages and benefits
o Feeling unhappy of breastfeeding and the superiority of
breastmilk for infant nutrition
Postpartum Bleeding o Teach correct positioning and attachment for
- Women who develop vaginal bleeding breastfeeding
o 24 hours postpartum have LATE postpartum o Support exclusive breastfeeding for the first 6
bleeding months of life
- May be due to retained placental fragments o Encourage breastfeeding on demand avoid
- Uterus is soft and larger than expected supplementary feeds
- REFER! - Counsel regarding birth spacing and family planning
- If excessive bleeding: insert IVF, give 10 units o Counsel on importance of birth spacing and
oxytocin IM family planning
o Inform about all contraceptive choices in
Elevated BP postpartum period
- Blood pressure: >140/90 o Discuss the family planning methods -for the
- Look for signs that could indicate severe pre- breastfeeding and non- breastfeeding woman
eclampsia - Method options for breastfeeding woman
o Severe headache o Immediately postpartum: lactation amenorrhea
o Blurring of vision method (LAM), condom, BTL, IUD
o Epigastric pain
o Severe breathing difficulty
 o Delay 6 weeks: progestin-only oral
contraceptive pills (OCP) and injectables
(DMPA)
o Delay 6 months: combined OCP, natural family
planning
- Method options for non-breastfeeding woman
o Immediately postpartum: condoms, IUD, BTL,
Progestin-only OCP and injectables
o Delayed 6 weeks: combined OCP/ injectables,
natural family planning
Lactation Amenorrhea Method (LAM)
- 1st line family planning method for postpartum
women
- 3 conditions should be present:
o Exclusive breastfeeding
o Menstruation has not returned (amenorrhea)
o Within 1st 6 months of delivery
Family planning methods
- Stress that a woman who is not exclusively
breastfeeding can become pregnant as soon as 4
weeks after delivery if she has sex
- Reinforce that non-hormonal methods (LAM, barrier
methods, IUD and sterilization) are best options for
lactating mothers
- Facilitate free informed choice for all women
Schedule return visits
- All postpartum women should have atleast 2 routine
postpartum visits
o 1st visit: 1st week postpartum, preferably within
24-72 hours
o 2nd visit 6 weeks postpartum
Routine Postpartum Care
Monitoring and management after discharge
- Women who do not return for postpartum visits or
those who do not bring along their newborns during
their postnatal visits should be visited at home.
NEWBORN
Profile of the Newborn – Physiologic function and
appearance
Newborn
- A newborn infant or neonate, is a child under 28
days of age
- During these first 28 days of life, the child is at the
highest risk of dying
- The vast majority of newborn deaths take place in
developing countries where access to health care is
low
o PRETERM INFANT
o FULLTERM INFANT
o POST-TERM INFANT
SKIN
- At birth, the skin of a normal infant is purplish-red in
color, then within minutes, the skin pinks up.
Blueness of the hands and feet is frequently seen
during the early hours of life.
- JAUNDICE, more than half of newborns have some
degree of jaundice in the first week of life. In most
cases, this condition us due to the immaturity of the
liver and is not a threat to the baby.
- VERNIX CASEOSA
HEAD
- Molding refers to the long, narrow, cone-shaped
head that results from passage through a tight birth
canal. If a vacuum is used to deliver your baby, you
may notice more molding and bruising. The head
returns to a normal shape in a few days.
- “Soft spot” is found in the top front part of the head
- Closes with bone when the baby is between 12 and
18 months of age.
Cacut Succedaneum and cephalhematoma
- Cephalhematoma does not cross suture line
- Caput succedaneum is scalp swelling
EYES
- Puffy because of pressure on the face during
delivery
- Producing “crossed-eyes” and jerky uneven
movements, are normal. The muscle control of eye
movement is still developing
NOSE
- Misshapen during the birth process. It may be
flattened or pushed to one side. It will look normal by
1 week of age
ENDOCRINE SYSTEM
Ordinarily the endocrine system of newborn is
adequately developed, but its functions are immature
- The effect of maternal sex hormones is particularly
evident in newborns
- The labia are hypertrophied and the breast of both
genders may be engorged and secrete milk from the
first few days of life to as long as 2 months of age
- Female newborns may have pseudo menstruation
(more often seen as a milky secretion than actual
blood) from a sudden drop in progesterone and
estrogen levels.
Reproductive organs
- Swollen breasts are present during the first week of
life in many female and male babies
- Swollen genitals
- Erections occur commonly in a newborn boy; mean
bladder is full and nerves are normal
FEET
- Feet may be turned in any direction inside the
cramped quarters of the womb
HAIR
- Lanugo is the fine downy hair that is sometimes
present on the back and shoulders it is more
common in premature infants
APGAR SCALE
- A score is given for each sign at one minute and five
minutes after the birth. If there are problems with the
baby an additional score is given at 10 minutes
- Caesarean section the baby is additionally assessed
at 15 minutes after delivery
APGAR SCORE
- What does the score mean? - Nasal breathers, gentle, quiet, rapid but shallow;
o A score of 7-10 is considered normal may have short periods of apnea (<15 secs) and
o 4-7 might require some resuscitative measures irregular without cyanosis – periodic
o A baby with an APGAR score of 3 and below - Rate: 30 – 60 cycle per minute (CPM)
requires immediate resuscitation - Duration: 1 full minute
o 0 means stillbirth
NURSING CONSIDERATIONS
VITAL SIGNS - Position on side
- Suction secretion PRN
TEMPERATURE - Observe for respiratory distress
- Site: axillary NOT rectal - Administer oxygen via hood PRN and as prescribed
- Duration: 3 mins
- Normal range: 36.5 – 37.6 C Silverman – Anderson index
- Stabilizes within 8-12 hrs - Perform to observe for signs for respiratory distress
- Monitor q30 mins until stable for 2 hrs then q8 hrs o Chest lag
o Retractions
Heat loss mechanisms o Nasal flaring
Convection – the flow of heat from the body surface to o Expiratory grunting
cooler surrounding air
- Eliminating drafts such as windows or aircon
reduces convection BLOOD PRESSURE
Conduction – the transfer of body heat to a cooler solid - Not routinely measured unless in distress or CHD is
object in contact with the baby suspected
- Covering surfaces with a warmed blanket or loved - At birth: 80/46 mmHg
helps minimize conduction heat loss - After birth: 65/41 mmHg
Radiation – the transfer of heat to a cooler object not in Using doppler UTZ
contact with the baby
- Cold window surface or aircon, moving as far from BODY MEASUREMENTS
the cold surface reduces heat loss Weight:
Evaporation – loss of heat through conversion of a liquid - 5.5 to 9.6 lbs (2500 – 4300 gms)
to a vapor o Caucasian: 7lbs
- From amniotic fluid, newborn baby should be dried o Filipinos: 6.6 lbs
immediately - 70 – 75% TBW is water
- LBW = below 2500 gms; regardless of AOG
NURSING CONSIDERATION
- Keep dry and well-wrapped Length:
- Keep away from cold objects or outside walls - 45 to 55 cm (18 – 22 inches)
- Perform procedures in warm, padded surfaces o Average: 50 cm
- Keep room temperature warm o Techniques: using tape measure
- Supine with legs extended
PULSE o Crown to rump
- Awake: 120 – 160 bmp 120 – 140 bpm
o Head to heel
- Asleep: 90 – 110 bpm
Head circumference (HC):
- Crying: 180 bpm
- 33 to 35.5 cm (13-14 inches)
- Rhythm: irregular, immaturity of cardiac regulatory
- Technique: using tape measure
center in the medulla
o From the most prominent part of the occiput to
- Duration: 1 full minute, not crying
just above the eyebrows
- Site: apical
- 1/3 the size of an adult’s head
- Disproportionately LARGE for its body
NURSING CONSIDERATION
- HC should be = or 2cm> CC
- Keep warm
- Take heart rate (HR) for 1 minute
Chest Circumference (CC):
- Listen for murmurs
o 30 to 33 cm (12 – 13 inches)
- Palpate peripheral pulses
o Technique: using tape measure
- Assess for cyanosis
- From the lower edge of the SCAPULAS to directly
- Observe for Cerebral Palsy (CP) distress
over the NIPPLE LINE anteriorly
o CC should be = or <2cm than HC
Special concerns
- CH is measured by placing the tap at level, around
- (+) prominent radial pulses = Coronary Heart
the nipple, in between inspiration and expiration
Disease (CHD)
- (-) Femoral pulse = coarctation of aorta
NURSING CONSIDERATIONS
- Under natural light
RESPIRATION
- Assess for:
Characteristics:
o Hair distribution (lanugo)
 o Turgor/ texture - due to passage of meconium in utero related to fetal
o Pigmentation/ birthmarks hypoxia
o Other skin marks Clinical features
- an infant who has released meconium in utero for
Skin color some reason before birth are stained from green
- Velvety smooth and puffy esp. at the legs, dorsal meconium
aspects of hands and feet and in the scrotum or
labia - if the meconium is thin and light in color and the
- Pinkish red (light skinned) to pinkish brown to yellow infant is vigorous
(dark skinned) o most meconium can be cleared away with a
- “Ruddy” or reddish due to increased RBC bulb syringe
concentration and decreased subQ tissues o always suction mouth first, then nose, in that
order
Types of color o suctioning the nose stimulates breathing in the
- Cyanosis/ Acrocyanosis newborn
- Pallor o want to clear the mouth first so first breath is as
- Jaundice clean as possible
- Meconium staining o limit suction (2 second per region)

Acrocyanosis Meconium aspiration syndrome

- Bluish discoloration of palms of hands and soles of
feet
- Due to immature peripheral circulation
- Exacerbated by cold temperatures
- Normal within 1st 24 hrs
- "Respiratory distress in newborn infants from
inhalation of meconium-stained amniotic fluid into
the tracheobronchial tree with compatible
radiological findings which cannot be otherwise
explained."

Pallor/ Cyanosis Meconium severity grading

- May indicate hypothermia, infection, anemia,
hypoglycemia, cardiac, respiratory, or neurological Grade 1
problems - thin, slightly yellow or green meconium. no
indication of fetal distress
Jaundice Grade 2
- Under natural light - moderately thick meconium that is light green or
- Blanch skin over the chest or tip of the nose brownish in color. could be an indication of some
fetal distress
Physiologic Grade 3
- FT: after the 1st 24 hrs (2-7 days) - thick, pea-soup like meconium that appears brown
- PT: after the 1st 48 hrs or black in color. there is an increased risk of fetal
- Peaks at 5 – 7 days and disappears by the 2nd week distress
- Due to immaturity of liver
LANUGO
- Usually found over the face, upper body and
- found after 20 weeks of gestation on the entire body
conjunctiva of eyes
except for the palms and soles
Pathologic
- fine downy hair that covers the shoulders. back and
- Within 1st 24 hrs
upper arms
- May indicate early hemolysis of RBC or underlying
- some newborns are covered by fine downy hair at
disease process
birth. known as lanugo, it is found most often on the
- Duration:
baby's back, shoulder, forehead, and temples.
o FT: 1 week
- tiny hairs may also appear on your newborn ears or
o PT: 2 weeks in other spots
- it is most common in premature babies
MANAGEMENT OF JAUNDICE - it typically wears off from normal friction within
- Monitoring serum bilirubin levels several weeks
o Physiologic: not more than 5mg/dl per day
o Pathologic: more than 15 – 20 mg/dl (critical NURSING CONSIDERATIONS:
levels) - more mature, less lanugo
- Maintain hydration - may disappear within 2 weeks
- Place in bilirubin lights as needed - preterm: woolly patches of lanugo on skin and head
- Provide emotional support to parents - post-term: parchment-like skin w/o lanugo
- PHOTOTHERAPY UNIT VERNIX CASEOSA
o Nursing responsibilities: - protective cheesy-like, gray-white fatty substance
 cover eyes and sex organ - FT: skin folds under the arms and in the groin under
the scrotum or in the labia
MECONIUM STAINING - NURSING CONSIDERATION:
- over the skin, fingernails and umbilical cord o Just spread over the body
 o DO NOT attempt to remove vigorously
DESQUANMATION
- Dryness/ peeling of the skin
- Usually occurs after 24-36 hours
- Marked scaliness and desquamation
o Signs of post maturity
MILIA
- Multiple, yellow, or pearly white papules approx.
1mm wide
- Due to enlarged or clogged sebaceous glands
- Usually found on the nose, chin, cheeks, eyebrows,
and forehead
- The white spots on the baby’s chin and cheeks
- Milia are keratin filed epithelial cysts which occur in
up to 40% of newborn
- Newborn acne even though caused by maternal
hormones does not generally appear until after 2
weeks
NEWBORN BIRTHMARKS
MONGOLIAN SPOTS
- Blue-green or gray pigmentation
- Lower back, sacrum and buttocks
- Disappear by 4 years of age
SALMON PATCHES
- Seen commonly in newborn
- More in Caucasian
- AKA: naevus simplex, “angel kisses” (when on the
forehead or eyelids), and “stork bites” (over the nape
of the neck)
- Midline malformations consisting of ectatic
capillaries with normal overlying skin
ERYTHEMA TOXICUM
- Neonatorum is the most common pustular eruption
in newborns
- Estimated of incidence vary between 40 and 70
percent. 4 it is most common in infants born at term
and weighing more than 2,500 g (5.5lb)
STORK BITES
- Telangiectatic nevi
- Flat red or purple lesions
- Back of neck, lower occiput, upper eyelid and bridge
of the nose
- After 2 years of age
STRAWBERRY MARKS
- Nevus vascullosis or capillary hemangioma
- Dark red, raised lobulated tumor
- Head, neck, trunk and extremities
- After 7 to 9 years of age
PORT-WINE STAIN
- Nevus Flammeus or Capillary Angioma
- Capillary malformation
- Flat Red to Purple sharply demarcated dense areas
beneath the capillaries
- Face
- Does not fade with time
- Associated with Sturge-Weber syndrome
- Are a discoloration of skin to pink, red, or purple
color.
- These marks are present from birth or occur shortly
after birth
- Are explained as vascular birthmarks which cannot
be left unattended always, as sometimes they may
indicate some severe disorder
Sturge-Weber syndrome
- PWS involving the forehead (V1 area of the
trigeminal nerve), eye abnormalities (choroidal
vascular abnormalities, glaucoma) and
leptomeningeal and brain abnormalities (vascular
malformations, calcification, or cerebral atrophy)
MOTTLING
- Cutis marmorata
- Reticulated pattern of constricted capillaries and
venules due to vasomotor instability in immature
infants
- Bluish mottling or marbling of skin in response to
chilling, stress, or overstimulation
- Typically seen in newborn infants
- During the time of delivery, skin mottling can
develop as a result of broken blood vessels present
on the upper layer of the skin
- It produces a typical marbled appearance of the skin
- Appears when the infants passes stools
ERYTHEMA TOXICUM
- Newborn rash
- Small, white, yellow or pink to red popular rash
- Trunk, face and extremities
- Within 48 hours
PETECHIAE
- Pinpoint hemorrhages on skin
- Due to increased vascular pressure, infection or
thrombocytopenia
- Within 48 hrs
ECCHYMOSIS
- Bruises
- As a result of rupture of blood vessels
- May appear over the presenting part as a result of
trauma during delivery
- May also indicate infection bleeding problems
HARLEQUIN SIGN
- When on side dependent side turns red and upper
side/ half turns pale
- Due to gravity and vasomotor instability or immature
circulation
- Skin resembles a CLOWN’s SUIT
CAFÉ- AU-LAIT SPOTS
- Tan or light brown macules or patches
- NO pathologic significance, if <3cm in length and <6
in number
- If >3 or 6 = cutaneous neurofibromatosis
HEAD – WHAT TO ASSESS - Premature closure of the fontanelles
- For symmetry, shape, movement
- Soft, pliable, moves easily
- With some molding (if VSD); round and well-shaped WHAT TO ASSESS
(if CS) - Facial movement and symmetry
- Measure HC; HC = or > CC - Symmetry, size, shape, and spacing of eyes, nose
and ears
FONTANELLES – “soft spot”
- BAD (12-18 months) EYES
- LPT (2-3 months or 8-12 weeks) - Color:
- Bulging or sunken o White sclera
o Slate gray, brown or dark blue
HEAD LAG o Final eye color: after 6-12 months
- Common when pulling newborn to a sitting position - Symmetrical
- When prone, newborn should be able to lift the head - Pupils equal, round, reactive to light
slightly and turn head from side to side - (+) blink reflex
- (+) transient strabismus due to weak EOM
SUTURES - Able to move and fixate momentarily
- Overriding or separated - (+) red reflex – if (-), cataract
- (+) edema on eyelids related to pressure during
POSTERIOR FONTANEL delivery or effects of medication
- Triangular - (-) tear formation (begins at 2-3 months)
- Located between occipital and 2 parietal bones
- Closes by the end of the 1st month of age NURSING CONSIDERATIONS
- Administer eye medication within 1 hr after birth to
ANTERIRO FONTANEL prevent ophthalmia neonatorum
- Diamond In shape
- The junction of the sagittal, corneal and frontal
sutures forms it - DOC:
- Between 2 frontal and 2 parietal bones o erythromycin 0.5%
- 3-4 cm in length and 2-3 cm width o tetracycline 1%
- It closes at 12-18 months of age o silver nitrate 1%
- from inner canthus to outer canthus of the eye
CAPUT SUCCEEDANEUM (conjunctival sac)
- Swelling of soft tissues of the scalp
- Due to pressure NOSE
- Crosses the suture lines - small and narrow
- Presenting part - flattened, midline
- 3 days after birth - nasal breathers
- (+) Periodic sneezing
CEPHALHEMATOMA - Reactive to strong odors
- Subperiosteal hemorrhage with collection blood - (+) flaring = respiratory distress
- Due to rupture of capillaries as a result of trauma - (+) low nasal bridge = down’s syndrome
- Does not crossed suture lines
- Several weeks EARS
- Soft and pliable; with firm cartilage pinna should be
MOLDING at the level of outer canthus of the eye
- Overlapping of skull bones - (+) low set ears = renal or chromosomal
- Due to compression during labor and delivery abnormalities
- Disappears in few days - May be congested and hear well after few days

FORCEP MARKS MOUTH

- U-shaped bruising usually on the cheeks after - Pink, moist gums
forcep delivery - Intact soft and hard palates
o (+) Epstein’s pearls
CRANIOTABES - Uvula midline
- Localized softening of the cranial bones - Tongue moves freely, symmetrical with short
- Can be identified by pressure of fingers frenulum
- MOST common among 1st born babies, pathological - (+) extrusion and gag reflexes
in older child – metabolic disorder - Small mouth or large tongue = chromosomal
- Caused by pressure of the fetal skull against the problems
mother’s pelvic bone in utero - (+) white patches on tongue or side of the cheek =
oral thrush
Craniosynostosis
NECK - Breastfeeding can usually begin immediately after
- Short, thick, in midline birth
- Able to flex and extend but cannot support the full - Bottle-feeding may be started with sterile water to 4
weight of the head hrs after birth prior to formula feeding
- Creased with skin folds - Burp during and after feeding
- Trachea midline - Position properly during and after feeding
- Thyroid gland not palpable
- Intact clavicle GENITALS
- Female
CHEST o Labia: edematous
- CC = or <2cm that HC o Clitoris: enlarged
- Cylindrical; equal AP: T diameters o (+) smegma
- Symmetrical o Pseudo menstruation possible
- Abdominal breathers o Visible “hymen tag”
- (+) bronchial sounds o First voiding within 24 hrs
- (+) breast engorgement; subside after 2 weeks - Male
- (+) prominent/ edematous nipple o Prepuce covers glans penis
- (+) accessory nipples  (+) adherent foreskin = phimosis
- (+) “WITCH MILK” o Scrotum: edematous
 (+) enlarged = hernia
ABDOMEN o Meatus: central
- Umbilical cord  (+) ventral/ dorsal = hypo/ epispadias
o 2 arteries; 1 vein o Testes: descended
o White and gelatinous immediately after birth  (+) undescended = cryptorchidism
o Begins to dry between 1-2 hrs following birth
o Blackened or shrivelled between 2-3 days BACK
o Dried and gradually falls off by 7 days - Spine
o Straight, posture flexed
o Supports head momentarily
o Arms and legs flexed
DAILY CORD CARE o Chin flexed on upper chest
- Keep cord dry and clean and clamp secured o Check for protrusion, excessive or poor muscle
- Apply 70% isopropyl alcohol to the cord with each contraction = CNS damage
diaper change and atleast 2-3x a day. EXTREMETIES
- DO NOT cover with diaper - Flexed, full ROM, symmetrical
- Note for any signs of bleeding or drainage from the - Clenched fists; flat soles
cord and other abnormalities - With 10 fingers and toes in each hand
- Sponge bath until cord falls off - Legs bowed
- Even gluteal folds
GASTROINTESTINAL TRACT - (+) creases on soles of feet
- Capacity: 90ml with rapid intestinal peristalsis (2 ½
o (-) creases = prematurity
to 3 hrs)
- Check for hip fractures or dysplasia
- Bowel sound; (+) within 1-2 hrs after birth
o (+) Ortolani’s click and uneven gluteal folds =
- Prescence of mass, distention depression or
Hip dysplasia
protrusion
- (+) inward turning of the foot = club foot or talipes
- (+) scaphoid = diaphragmatic hernia
equinovarus
- (+) distended = LGIT obstruction/ mass
- (+) extra digits = polydactyly
- (+) web fingers = syndactyly
ANUS
NEUROLOGIC SYSTEM – REFLEX
- Check patency
- First stool (MECONIUM) – within 1st 24 hrs
SUCKING/ ROOTING
o Sticky, tarlike, blackish- green, odorless
- Touch the lip, cheek or corner of the mouth
material
- Turns head toward the nipple, opens mouth, takes
hold of the nipple and sucks
TRANSITIONAL STOOL
- Disappears after 3-4 months up to 1 year
- Within 2-10 days after birth
- Breastfed:
EXTRUSION
o Golden yellow, mushy, more frequent 3-4x and
- Anything place on the anterior portion of the tongue
sweet smelling will be “spit out”
- Bottle-fed - To prevent swallowing of inedible substance
o Pale yellow, firm, less frequent 2-3x with more - Disappears after 4 months
noticeable odor - Disappearance indicate readiness for semi-solid to
solid foods
NURSING CONSIDERATION
SWALLOWING BALLARD’s SCORING
- Occurs spontaneously after sucking and obtaining - Completed in 3-4 hrs
fluids - 2 portions: physical maturity and neuromuscular
- NEVER disappear maturity
- Newborn swallows in coordination with sucking
without gagging, coughing, or vomiting OTHER NURSING RESPONSIBILITIES
TONIC NECK/ FENCING - Identification band
- While the baby is falling asleep or sleeping, gently - Birth registration
and quickly turn the head to one side - Birth record and documentation
- As the baby faces the left side, the left arm and leg
extend outward while the right arm or leg flex and NEWBORN SCREENING
vice-versa - The newborn screening reference center (NSRC) is
- Disappears within 3-4 months an office under the national institutes of health
(NIH), University of the Philippines Manila created
PALMAR (GRASPING)/ PLANTAR under RA 9288 – the newborn screening act of 2004
- Place a finger in the palm of the baby’s hand, then - Performed after 24 hours of life up to 3 days except
place a finger at the base of the toes for patient in intensive care, must be tested by 7
- Fingers will curl or grasp the examiner’s finger and days
the toes will curl downward
- Palmar: fades within 3-4 months o Congenital hypothyroidism (CH)
- Plantar: fades within 8 months o Congenital adrenal hyperplasia (CAH)
o Galactosemia (GAL)
MORO o Phenylketonuria (PKU)
- Hold baby in semi sitting position then allow the o Glucose-6-phospate-dyhydrogenase deficiency
head and trunk to fall backward to atleast a 30- (G6PD def)
degree angle
- Symmetrically abducts and extend the arms; fans INFANT CARE SKILLS
the fingers out and forms a C with the thumb and the - holding the baby
forefinger; and adducts the arms to an embracing o Football hold
position and returns to a relaxed state o Cradle hold
- Present at birth; complete response at 8 weeks o Shoulder hold
- MOST significant singular reflex indicate of CNS
problem (>6 months)
- Disappear after 4-5 months

STARTLE
- Best elicited if baby is 24 hrs old FOOT BALL HOLD
- Make a loud noise or claps hand Purpose:
- Baby’s arms adduct while elbows flex with fists o to carry on one hand free
clenched o a holding technique in bathing a baby
- Disappears within 4 months o use for small babies
Procedure
BABINSKI 1. slide forearm under his back
- Gently stroke upward along the lateral aspect of the 2. support neck and head with your hand
sole, starting at the heel of the foot to the ball of the 3. press his arm firmly against your side
foot 4. his head faces you
- Dorsiflexion of big toe and fanning of little toes 5. infant’s feet tucked under your elbow
- Disappears starts at 3 months to 1 year
- Disappearance indicates maturity of CNS CRADLE HOLD
Purpose
STEPPING/ WALKING/ DANCING o use for feeding and cuddling a baby
- Hold baby in a standing position allowing one foot to Procedure
touch a surface 1. support head in the crook of your arm
- Stimulates walking by alternately flexing and 2. encircle the body with your arm
extending feet 3. press baby firmly against your side
- Disappear after 3-4 months 4. use other hand to support bottom and thigh

ASSESSMENT OF GESTATIONAL AGE SHOULDER HOLD

- Dubowitz Maturity Scale Purpose
o Gestational rating scale o use for burping
o Newborn are observed and tested according to Procedure
the criteria 1. draw baby towards your chest with one forearm
o Helps determine whether the newborn needs 2. bracing his back and your hand cradling his
immediate high-risk nursery intervention head
3. support your baby’s bottom and thighs with your
older arm
4. gently press his head against shoulder