Chapter 24: Nursing Care of the Newborn and Family My Nursing Test Banks

Lowdermilk: Maternity & Womens Health Care, 10th Edition

Chapter 24: Nursing Care of the Newborn and Family

Test Bank

MULTIPLE CHOICE

1. An infant boy was born a few minutes ago. The nurse is conducting the initial assessment. Part of the assessment includes the Apgar score. The Apgar assessment is performed:

a.

Only if the newborn is in obvious distress

b.

Once by the obstetrician, just after the birth

c.

At least twice, 1 minute and 5 minutes after birth

d.

Every 15 minutes during the newborns first hour after birth

ANS: C

Apgar scoring is performed at 1 minute and at 5 minutes after birth. Scoring may continue at 5-minute intervals if the infant is in distress and requires resuscitation efforts.

The Apgar score is performed on all newborns.

Apgar score can be completed by the nurse or the birth attendant.

The Apgar score permits a rapid assessment of the newborns transition to extrauterine life.

An interval of every 15 minutes is too long to wait to complete this assessment.

DIF: Cognitive Level: Comprehension REF: 555

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

2. A new father wants to know what medication was put into his infants eyes and why it is needed. The nurse explains to the father that the purpose of the erythromycin (Ilotycin) ophthalmic ointment is to:

a.

Destroy an infectious exudate caused by Staphylococcus that could make the infant blind

b.

Prevent gonorrheal and chlamydial infection of the infants eyes potentially acquired from the birth canal

c.

Prevent potentially harmful exudate from invading the tear ducts of the infants eyes, leading to dry eyes

d.

Prevent the infants eyelids from sticking together and help the infant see

ANS: B

The nurse should explain that erythromycin ophthalmic ointment prevents gonorrheal and chlamydial infection of the infants eyes potentially acquired from the birth canal

Prophylactic ophthalmic ointment is instilled in the eyes of all neonates to prevent gonorrheal or chlamydial infection.

Prophylactic ophthalmic ointment is not instilled to prevent dry eyes. It is instilled to prevent gonorrheal or chlamydial infection.

Prophylactic ophthalmic ointment has no bearing on vision other than to protect against infection that may lead to vision problems.

DIF: Cognitive Level: Comprehension REF: 572

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

3. A nurse is assessing a newborn girl who is 2 hours old. What finding warrants a call to the physician?

a.

Blood glucose of 45 mg/dl using a Dextrostix

b.

Heart rate of 160 beats/min after crying vigorously

c.

A crepitant-like feeling when assessing the clavicles

d.

Passage of a dark black-green substance from the rectum

ANS: C

A crepitant-like feeling when assessing the clavicles may indicate a fracture. If a fracture is suspected, the physician should be notified.

A blood glucose level of 45 mg/dl is a normal finding and does not warrant a call to the physician.

A heart rate of 160 beats/min after crying is a normal finding that does not warrant a call to the physician.

The passage of meconium from the rectum is an expected finding in the newborn.

DIF: Cognitive Level: Comprehension REF: 564

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Assessment

4. The nurse administers vitamin K to the newborn for what reason?

a.

Most mothers have a diet deficient in vitamin K, which results in the infant being deficient.

b.

Vitamin K prevents the synthesis of prothrombin in the liver and must be given by injection.

c.

Bacteria that synthesize vitamin K are not present in the newborns intestinal tract.

d.

The supply of vitamin K is inadequate for at least 3 to 4 months, and the newborn must be supplemented.

ANS: C

Vitamin K is provided because the newborn does not have the intestinal flora to produce this vitamin for the first week.

The maternal diet has no bearing on the amount of vitamin K found in the newborn.

Vitamin K promotes the formation of clotting factors in the liver and is used for the prevention and treatment of hemorrhagic disease in the newborn.

Vitamin K is not produced in the intestinal tract of the newborn until after microorganisms are introduced. By day 8, normal newborns are able to produce their own vitamin K.

DIF: Cognitive Level: Comprehension REF: 573

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Implementation

5. The nurse is using the New Ballard Scale to determine the gestational age of a newborn. Which assessment finding is consistent with a gestational age of 40 weeks?

a.

Flexed posture

b.

Abundant lanugo

c.

Smooth, pink skin with visible veins

d.

Faint red marks on the soles of the feet

ANS: A

Term infants typically have a flexed posture.

Abundant lanugo usually is seen on preterm infants.

Smooth, pink skin with visible veins is seen on preterm infants.

Faint red marks usually are seen on a preterm infant.

DIF: Cognitive Level: Comprehension REF: 568

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Diagnosis

6. A newborn is jaundiced and is receiving phototherapy via ultraviolet bank lights. An appropriate nursing intervention when caring for an infant with hyperbilirubinemia and receiving phototherapy by this method is to:

a.

Apply an oil-based lotion to the newborns skin to prevent dying and cracking

b.

Limit the newborns intake of milk to prevent nausea, vomiting, and diarrhea

c.

Place eye shields over the newborns closed eyes

d.

Change the newborns position every 4 hours

ANS: C

The infants eyes must be protected by an opaque mask to prevent overexposure to the light. Eye shields should cover the eyes completely but not occlude the nares.

Lotions and ointments should not be applied to the infant because they absorb heat, and this can cause burns.

The lights increase insensible water loss, placing the infant at risk for fluid loss and dehydration. Therefore, it is important that the infant be adequately hydrated.

The infant should be turned every 2 hours to expose all body surfaces to the light.

DIF: Cognitive Level: Application REF: 585

OBJ: Client Needs: Safe and Effective Care Environment

TOP: Nursing Process: Planning

7. Early this morning an infant boy was circumcised using the PlastiBell method. The nurse tells the mother that she and the infant can be discharged after:

a.

The bleeding stops completely

b.

Yellow exudate forms over the glans

c.

The PlastiBell rim falls off

d.

The infant voids

ANS: D

The infant should be observed for urination after the circumcision.

Bleeding is a common complication after circumcision. The nurse will check the penis for 12 hours after a circumcision to assess and provide appropriate interventions for prevention and treatment of bleeding.

Yellow exudate covers the glans penis in 24 hours after the circumcision. This is part of normal healing and not an infective process.

The PlastiBell remains in place for about a week and falls off when healing has taken place.

DIF: Cognitive Level: Comprehension REF: 588

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

8. When preparing to administer a hepatitis B vaccine to a newborn, the nurse should:

a.

Obtain a syringe with a 25-gauge, 5/8-inch needle

b.

Confirm that the newborns mother has been infected with the hepatitis B virus

c.

Assess the dorsogluteal muscle as the preferred site for injection

d.

Confirm that the newborn is at least 24 hours old

ANS: A

Administration of the hepatitis B vaccine should be given with a 25-gauge, 5/8-inch needle.

Hepatitis B vaccination is recommended for all infants. If the infant is born to an infected mother who is a chronic carrier, hepatitis vaccine and hepatitis B immune globulin should be administered within 12 hours of birth.

Hepatitis B vaccine should be given in the vastus lateralis muscle.

Hepatitis B vaccine can be given at birth. If the mother is a hepatitis B carrier, the vaccine should be given to the infant within 12 hours of birth.

DIF: Cognitive Level: Application REF: 583

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Implementation

9. The nurse is performing a gestational age and physical assessment on the newborn. The infant appears to have an excessive amount of saliva. The nurse recognizes that this finding:

a.

Is normal

b.

Indicates that the infant is hungry

c.

May indicate that the infant has a tracheoesophageal fistula or esophageal atresia

d.

May indicate that the infant has a diaphragmatic hernia

ANS: C

The presence of excessive saliva in a neonate should alert the nurse to the possibility of tracheoesophageal fistula or esophageal atresia.

Excessive salivation may not be a normal finding and should be further assessed for the possibility that the infant has an esophageal abnormality.

The hungry infant reacts by making sucking motions, rooting, or making hand to mouth movements.

The infant with a diaphragmatic hernia presents with severe respiratory distress.

DIF: Cognitive Level: Analysis REF: 562

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Assessment

10. A mother is changing the diaper of her newborn son. She notices that his scrotum appears large and swollen. She asks the nurse, What is that? The best response from the nurse is:

a.

That is a hydrocele, which is a common finding in newborn males. The swelling usually decreases without intervention.

b.

I dont know, but Im sure it is nothing.

c.

Your baby might have testicular cancer.

d.

Your babys urine is backing up into his scrotum.

ANS: A

Explaining what a hydrocele is and its characteristics is the most appropriate response by the nurse.

Telling the mother that the condition is nothing important is inappropriate and does not address the mothers concern. Furthermore, if the nurse is unaware of any abnormal-appearing conditions, she should seek assistance from additional resources.

Telling the mother that her newborn might have testicular cancer is inaccurate, inappropriate, and could cause the new mother undue worry.

Urine will not back up into the scrotum if the infant has a hydrocele. Any nurse caring for the normal newborn should understand basic anatomy.

DIF: Cognitive Level: Application REF: 564

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Diagnosis

11. As part of Standard Precautions, nurses wear gloves when handling the newborn. The chief reason is:

a.

To protect the baby from infection

b.

It is part of the Apgar protocol

c.

To protect the nurse from contamination by the newborn

d.

Because the nurse has primary responsibility for the baby during the first 2 hours

ANS: C

With the possibility of transmission of viruses such as hepatitis B virus (HBV) and human immunodeficiency virus (HIV) through maternal blood and amniotic fluid, the newborn must be considered a potential contamination source until proved otherwise. As part of Standard Precautions, nurses should wear gloves when handling the newborn until blood and amniotic fluid are removed by bathing.

Proper hand hygiene is all that is necessary to protect the infant from infection.

Wearing gloves is not necessary in order to complete the Apgar score assessment.

The nurse assigned to the mother-baby couplet has primary responsibility regardless of whether or not she wears gloves.

DIF: Cognitive Level: Comprehension REF: 553

OBJ: Client Needs: Safe and Effective Care Environment

TOP: Nursing Process: Implementation

12. At 1 minute after birth a nurse assesses an infant and notes a heart rate of 80 beats/min, some flexion of extremities, a weak cry, grimacing, and a pink body but blue extremities. The nurse calculates an Apgar score of:

a.

4

b.

5

c.

6

d.

7

ANS: B

Each of the five signs the nurse notes scores a 1 on the Apgar scale, for a total of 5.

A score of 4 is too low for this infant.

A score of 6 is too high for this infant.

A score of 7 is too high for an infant with this presentation.

DIF: Cognitive Level: Application REF: 554

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Assessment

13. In the classification of newborns by gestational age and birth weight, the appropriate-for-gestational age (AGA) weight:

a.

Falls between the 25th and 75th percentiles for the infants age

b.

Depends on the infants length and the size of the head

c.

Falls between the 10th and 90th percentiles for the infants age

d.

Is modified to consider intrauterine growth restriction (IUGR)

ANS: C

AGA weight falls between the 10th and 90th percentiles for the infants age.

The AGA range is larger than the 25th and 75th percentiles.

The infants length and head size are measured but these do not affect the normal weight designation.

IUGR applies to the fetus, not the newborns weight.

DIF: Cognitive Level: Comprehension REF: 568

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Diagnosis

14. During the complete physical examination 24 hours after birth:

a.

The parents are excused to reduce their normal anxiety

b.

The nurse can gauge the neonates maturity level by assessing his or her general appearance

c.

Once often neglected, blood pressure is now routinely checked

d.

When the nurse listens to the heart, the S1 and S2 sounds can be heard; the first sound is somewhat higher in pitch and sharper than the second

ANS: B

The nurse is looking at skin color, alertness, cry, head size, and other features.

The parents presence actively involves them in child care and gives the nurse a chance to observe interactions.

Blood pressure is not usually taken unless cardiac problems are suspected.

The second sound is higher and sharper than the first.

DIF: Cognitive Level: Comprehension REF: 566

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

15. With regard to lab tests and diagnostic tests in the hospital after birth, nurses should be aware that:

a.

All states test for phenylketonuria (PKU), hypothyroidism, cystic fibrosis, and sickle cell diseases

b.

Federal law prohibits newborn genetic testing without parental consent

c.

If genetic screening is done before the infant is 24 hours old, it should be repeated at age 1 to 2 weeks

d.

Hearing screening is now mandated by federal law

ANS: C

If testing is done prior to 24 hours of age, genetic screening should be repeated when the infant is 1 to 2 weeks old.

All states test for PKU and hypothyroidism, but not for other genetic defects.

Federal law mandates newborn genetic screening; however, parents can decline testing. A waiver should be signed and a notation made in the infants medical record.

Federal law does not mandate screening for hearing problems; however, the majority of states have enacted legislation mandating newborn hearing screening. In the United States the majority (95%) of infants are screened for hearing loss prior to discharge from the hospital.

DIF: Cognitive Level: Knowledge REF: 578

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Planning

16. Nurses can help parents deal with the issue and fact of circumcision if they explain:

a.

The pros and cons of the procedure during the prenatal period

b.

That the American Academy of Pediatrics (AAP) recommends that all newborn males be routinely circumcised

c.

That circumcision is rarely painful and that any discomfort can be managed without medication

d.

That the infant will likely be alert and hungry shortly after the procedure

ANS: A

Parents need to make an informed choice regarding newborn circumcision based on the most current evidence and recommendations. Health care providers and nurses who care for childbearing families should provide factual, unbiased information regarding circumcision and give parents opportunities to discuss the risks and benefits of the procedure.

The AAP and other professional organizations note the benefits but stop short of recommending routine circumcision.

Circumcision is painful and must be managed with environmental, nonpharmacologic, and pharmacologic measures.

After the procedure the infant may be fussy for several hours, or he may be sleepy and difficult to awaken for feeding.

DIF: Cognitive Level: Comprehension REF: 586

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

17. An assessment tool for pain in newborns uses the acronym CRIES to identify behavioral indicators of pain. In the acronym:

a.

R stands for requiring more medication

b.

I stands for increased vital signs

c.

E stands for elimination

d.

S stands for sleepiness

ANS: B

In the acronym, C stands for crying; R is for requiring increased oxygen; I is for increased vital signs; E is for expression; and S is for sleeplessness.

R is for requiring increased oxygen.

E is for expression.

S is for sleeplessness.

DIF: Cognitive Level: Knowledge REF: 590

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Assessment

18. Although most blood specimens are drawn by laboratory technicians, nurses may be required to perform heelsticks to obtain blood for glucose monitoring or newborn screening. The most serious complication of an infant heelstick is necrotizing osteochondritis resulting from lancet penetration of the bone. To prevent this problem the stick should be made:

a.

At the outer aspect of the heel

b.

On the walking surface of the heel

c.

In the ball of the foot

d.

In the area just below the fifth toe

ANS: A

The stick should be made at the outer aspect of the heel and should penetrate no deeper than 2.4 mm.

Repeated trauma to the walking surface of the heel can cause fibrosis and scarring that can lead to problems with walking later in life.

The ball of the foot is not an appropriate site for a heelstick.

The area below the fifth toe is not the correct site for a heelstick.

DIF: Cognitive Level: Application REF: 579

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Implementation

19. The normal term infant has little difficulty clearing its airway after birth. Most secretions are brought up to the oropharynx by the cough reflex. However, if the infant has excess secretions, the mouth and nasal passages can easily be cleared with a bulb syringe. When instructing parents on the correct use of this piece of equipment, it is important that the nurse teach them to:

a.

Avoid suctioning the nares

b.

Insert the compressed bulb into the center of the mouth

c.

Suction the mouth first

d.

Remove the bulb syringe from the crib when finished

ANS: C

The mouth should be suctioned first to prevent the infant from inhaling pharyngeal secretions by gasping as the nares are suctioned.

The nasal passages should be suctioned one nostril at a time. The mouth should always be suctioned first.

After compression of the bulb it should be inserted into one side of the mouth. If it is inserted into the center of the mouth, the gag reflex is likely to be initiated.

When the infants cry no longer sounds as though it is through mucus or a bubble, suctioning can be stopped. The bulb syringe should remain in the crib so that it is easily accessible if needed again.

DIF: Cognitive Level: Application REF: 570

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Implementation

20. As part of the infant discharge teaching, the nurse is reviewing the use of the infant car safety seat. The nurse is teaching that:

a.

Infant carriers are fine until an infant car safety seat can be purchased

b.

For traveling on airplanes, buses, and trains, infant carriers are satisfactory

c.

Infant car safety seats are used for infants only from birth to 15 pounds

d.

Infant car seats should be rear facing and placed in the back seat of the car

ANS: D

An infant placed in the front seat could be severely injured by an air bag that has deployed during an accident.

Infants should travel only in federally approved rear-facing safety seats secured in the rear seat.

Infants should travel only in federally approved rear-facing safety seats even if traveling on a commercial vehicle.

Infants should use a rear-facing car seat from birth to 20 pounds and to age 1 year.

DIF: Cognitive Level: Application REF: 594

OBJ: Client Needs: Safe and Effective Care Environment

TOP: Nursing Process: Planning

21. Parents lost their first child to sudden infant death syndrome (SIDS). Therefore, you are teaching them infant cardiopulmonary resuscitation (CPR). You know they are knowledgeable when they demonstrate infant CPR compressions of _____ per minute.

a.

50

b.

75

c.

100

d.

125

ANS: C

100 is the correct number of chest compressions that should be given in 1 minute.

50 compressions per minute do not provide adequate circulation.

75 compressions per minute do not provide adequate circulation.

125 compressions are too many.

DIF: Cognitive Level: Comprehension REF: 600

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Evaluation

22. A nurse is responsible for teaching new parents about the hygienic care of their newborn. The nurse should tell the parents to:

a.

Avoid washing the head for at least 1 week to prevent heat loss

b.

Sponge bathe only until the cord has fallen off

c.

Cleanse the ears and nose with cotton-tipped swabs, such as Q-tips

d.

Create a draft-free environment of at least 75 F (24 C) when bathing the infant

ANS: D

The temperature of the room should be 75 F (24 C), and the bathing area should be free of drafts.

To prevent heat loss, the infants head should be bathed before unwrapping and undressing.

Tub baths may be initiated from birth. Ensure that the infant is fully immersed.

Q-tips should not be used because they may cause injury. A corner of a moistened washcloth should be twisted into shape so that it can be used to cleanse the ears and nose.

DIF: Cognitive Level: Application REF: 596

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

23. Nurses can help the family develop useful day-night routines (i.e., help the infant tell the difference between day and night) by suggesting all of these interventions except:

a.

Save the crib or bassinet for nighttime sleep

b.

Feed the baby for the last evening time around 11 PM

c.

Keep a small night-light on to avoid turning on bright lights

d.

Play with the baby during nighttime feedings to tire out the infant, for more and longer sleep

ANS: D

Playing with the baby during nighttime feeding not only sends the wrong message but also may keep everyone in the household awake.

In the afternoon, bring the baby out to be the center of family activity. If the baby falls asleep, let the baby do so in the infant seat or someones arms. Save the crib or bassinet for nighttime sleep.

Feed the baby for the last evening time around 11 PM and then put him or her to bed in the crib or bassinet.

For nighttime feedings keep a small night-light on to avoid turning on the bright lights.

DIF: Cognitive Level: Comprehension REF: 599

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

MULTIPLE RESPONSE

1. Pain should be assessed regularly in all newborn infants. If the infant is displaying physiologic or behavioral cures indicating pain, measures should be taken to manage the pain. Examples of nonpharmacologic pain management techniques include (choose all that apply):

a.

Swaddling

b.

Nonnutritive sucking

c.

Skin-to-skin contact with the mother

d.

Sucrose

e.

Acetaminophen

ANS: A, B, C, D

Swaddling, nonnutritive sucking, skin-to-skin contact with the mother, and sucrose are all appropriate nonpharmacologic techniques used to manage pain in neonates.

Acetaminophen is a pharmacologic method of treating pain.

DIF: Cognitive Level: Comprehension REF: 589

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Implementation

2. When teaching new parents about infant quieting techniques, the nurse should include what activities as suggestions? Choose all that apply.

a.

Carry your infant in a front pack or backpack.

b.

Swaddle your infant snugly in a receiving blanket.

c.

Place a heating pad in your infants crib while he or she sleeps.

d.

Rhythmic, monotonous flashing lights may soothe the infant.

e.

Movement such as rocking often helps quiet an infant.

ANS: A, B, E

Carrying the infant in a front pack or backpack, swaddling the infant snugly in a receiving blanket, and rocking the infant are all appropriate infant quieting techniques.

Preheating a crib with a water bottle or heating pad may help quiet the infant. However, the infant should not sleep with a hot water bottle or heating pad in the crib, because this may pose a risk of burns on the infant. Rhythmic, monotonous noise that simulates the intrauterine sounds of a heartbeat may be soothing to the infant. Infants do not like bright lights, particularly flashing lights.

DIF: Cognitive Level: Application REF: 601

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Implementation

3. As recently as 2005, the American Academy of Pediatrics (AAP) revised safe sleep practices to assist in the prevention of sudden infant death syndrome. The nurse should model these practices in the hospital and incorporate this information into the teaching for new parents. They include (choose all that apply):

a.

Fully supine position for all sleep

b.

Side-sleeping position as an acceptable alternative

c.

Tummy time for play

d.

Infant sleep sacks or buntings

e.

A soft mattress

ANS: A, C

The back to sleep position is now recommended as the only position for every sleep period. To prevent positional plagiocephaly (flattening of the head) the infant should spend time on his or her abdomen while awake and for play. Loose sheets and blankets may be dangerous because they could easily cover the babys head. The parents should be instructed to tuck any bedding securely around the mattress or use sleep sacks or bunting bags instead.

The side-sleeping position is no longer an acceptable alternative according to the AAP. Infants should always sleep on a firm surface, ideally a firm crib mattress covered by a sheet only. Quilts, sheepskins, and so on should not be placed under the infant.

DIF: Cognitive Level: Application REF: 593

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Implementation

COMPLETION

1. Sucking is an infants chief pleasure. Sucking that is not satisfied by either breastfeeding or a bottle is referred to as ____________________ sucking.

ANS:

Nonnutritive

Several benefits of nonnutritive sucking have been documented, including weight gain in premature infants, less crying, and an ability to maintain an organized state. Infants may suck on their thumb, fingers, or a pacifier. Some newborns are born with sucking pads on their fingers from sucking while in utero. Infants with cleft lips will often suck on their tongue. Parents should be educated on correct pacifier use if this is an acceptable option for their infant.

DIF: Cognitive Level: Comprehension REF: 595

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Diagnosis

2. A nurse is discussing infant care as part of a mother-infants couplet discharge planning. The mother asks the nurse, When will my babys cord fall off? The nurse responds, Your babys cord should fall off by ____________________ (weeks/days) after birth.

ANS:

2 weeks

Cord separation is influenced by several factors, including type of cord care, type of birth, and other perinatal events. The average cord separation time is 10 to 14 days. Some dried blood may be seen at the umbilicus after separation.

DIF: Cognitive Level: Application REF: 596

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

Mosby items and derived items 2012, 2007, 2006 by Mosby, Inc., an affiliate of Elsevier Inc.

Leave a Reply