CH 9-2

Which statement is true concerning the nutritional needs of preterm infants? a. The secretion of lactase is low. b. Carbohydrates and fats are better tolerated than protein. c. The demand for nutrients is less than in full-term infants. d. Breast milk lacks the proper concentration of nutrients.

A

1- The nurse is monitoring an infant's temperature to avoid cold stress. The nurse understands that cold stress in the infant can cause which complications? (Select all that apply.) a.Hypoxia b.Hypoglycemia c.Metabolic acidosis d.Respiratory alkalosis e.Increased shivering response

A B C

7- The nurse is admitting a drug-exposed newborn to the neonatal intensive care unit. The nurse should assess the newborn for which signs of withdrawal? (Select all that apply.) a.Tremors b.Nasal stuffiness c.Loose, watery stools d.Hypoactive Moro reflex e.Decrease in respiratory rate

A B C

4- The nurse is caring for a neonate on positive-pressure ventilation. The nurse monitors for which complications of positive-pressure ventilation? (Select all that apply.) a.Pneumothorax b.Pneumomediastinum c.Respiratory distress syndrome d.Meconium aspiration syndrome e.Pulmonary interstitial emphysema

A B E

5- The home care nurse is visiting a 6-month-old infant with bronchopulmonary dysplasia (BPD). The nurse assesses the child for which signs of overhydration? (Select all that apply.) a.Edema b.Serum sodium of 140 mEq/L c.Urine specific gravity of 1.008 d.Weight gain of 1 lb in 1 week

A D

6- The nurse is caring for a neonate with an intraventricular hemorrhage. What interventions should the nurse avoid to prevent any increase in intracranial pressure? (Select all that apply.) a.Keeping the head of the bed flat b.Keeping the environment quiet c.Handling the neonate minimally d.Suctioning the endotracheal tube frequently e.Maintaining the neonate's head in a midline position

A D

A preterm infant of 33 weeks of gestation is admitted to the neonatal intensive care unit. Approximately 2 hours after birth, the neonate begins having difficulty breathing, with grunting, tachypnea, and nasal flaring. What should the nurse recognize? a. This is a normal finding. b. Further evaluation is needed. c. Improvement should occur within 24 hours. d. This is not significant unless cyanosis is present.

B

In about 1 week, a stable preterm infant will be discharged. The nurse should teach the parents to place the infant in which position for sleep? a. Prone b. Supine c. Position of comfort d. Abdomen with head elevated

B

The nurse is caring for a newborn who was born at 35 weeks of gestation and is considered a late preterm infant. What intervention should be included in the infant's care plan? a. Feed the infant dextrose water as the first feeding after 12 hours. b. Promote skin-to-skin care in the immediate postpartum period. c. Avoid administration of the hepatitis B vaccine until after discharge. d. Delay the newborn screening and hearing test until the infant is at 40 weeks' corrected age.

B

Which is an important nursing action related to the use of tape or adhesives on premature neonates? a. Avoid using tape and adhesives until skin is more mature. b. Remove adhesives with water, mineral oil, or petrolatum. c. Use scissors carefully to remove tape instead of pulling off the tape. d. Use solvents to remove tape and adhesives instead of pulling on the skin.

B

A mother planned to breastfeed her infant before giving birth at 33 weeks of gestation. The infant is stable and receiving oxygen. What is the most appropriate nursing action related to this? a. Assist the mother in expressing breast milk. b. Assess the infant's readiness to breastfeed. c. Explain to the mother that the infant is too small to receive breast milk. d. Reassure the mother that infant formula is a good alternative to breastfeeding.

B

The nurse is attending a delivery of a full-term infant with meconium noted in the amniotic fluid. The nurse should understand that what action should be performed in the delivery room? a. The infant will be suctioned with a DeLee trap suctioning device after delivery of the head while the chest is still compressed in the birth canal. b. The infant's nose will be suctioned at the delivery of the head; subsequent suctioning of the mouth will occur after completion of the delivery. c. The infant will need to take the first breath after delivery of the head and shoulders and will require tracheal suctioning. d. The infant's mouth, nose, and posterior pharynx will be suctioned just after the head is delivered while the chest is still compressed in the birth canal.

D

The nurse is caring for a high-risk neonate who has an umbilical catheter and is in a radiant warmer. The nurse notes blanching of the feet. Which is the most appropriate nursing action? a. Place socks on the infant's feet. b. Elevate the infant's feet 15 degrees. c. Wrap the infant's feet loosely in a prewarmed blanket. d. Report the findings immediately to the practitioner.

D

The nurse is caring for an infant born at 37 weeks of gestation of a nondiabetic mother just admitted to the neonatal intensive care unit for observation. The nurse notes that which lecithin/sphingomyelin (L/S) ratio obtained before delivery indicates no risk of respiratory distress syndrome (RDS)? a. 1.4:1 b. 1.6:1 c. 1.8:1 d. 2:1

D

The nurse is planning care for a family expecting their newborn infant to die because of an incurable birth defect. What should the nurse's interventions be based on? a. Tangible remembrances of the infant (e.g., lock of hair, picture) prolong grief. b. Photographs of infants should not be taken after death. c. Funerals are not recommended because the mother is still recovering from childbirth. d. The parents should be given the opportunity to "parent" the infant, including seeing, holding, touching, or talking to the infant in private.

D

The nurse is preparing to administer a gavage feeding to an infant. The nurse should place the infant in which position for the feeding? a. Supine with the head flat b. Sitting upright in a car seat c. Left side-lying with the head flat d. Prone with the head slightly elevated

D

The nurse is providing care to a preterm infant. Which characteristic of daily care should be considered supportive? a. Coordinated with parental visiting times b. Given on a fixed schedule to ensure needs are met c. Provided when infant's heart rate is at its lowest level d. Directed toward development of sleep organization

D

The parents of an infant who has just died decide they want to hold the infant after their infant has gone to the morgue. What is the most appropriate nursing intervention at this time? a. Explain gently that this is no longer possible. b. Encourage the parents to accept the loss of their infant. c. Offer to take a photograph of their infant because they cannot hold the infant. d. Have the infant brought back to the unit, wrapped in a blanket, and rewarmed in a radiant warmer.

D

What can stroking infants who are physiologically unstable result in? a. Fewer sleep periods b. Increased weight gain c. Shortened hospital stay d. Decreased oxygen saturation

D

What is a characteristic of most neonatal seizures? a. Clonic b. Generalized c. Well organized d. Subtle and barely discernible

D

What is most descriptive of the signs observed in neonatal sepsis? a. Seizures b. Sudden hyperthermia c. Decreased urinary output d. Subtle, vague, and nonspecific physical signs

D

What should the nurse anticipate in an infant who was exposed to cocaine during pregnancy? a. Seizures b. Hyperglycemia c. Large for gestational age d. Hypertonia and jitteriness

D

What signs should the nurse expect when a pneumothorax occurs in an infant on mechanical ventilation? a. Tachycardia b. Clear, distinct heart tones c. Widened pulse pressure d. Abrupt duskiness or cyanosis

D

Which is a characteristic of postmature infants? a. Abundant lanugo b. Lack of scalp hair c. Plump appearance d. Parchment-like skin

D

Women who smoke during pregnancy are most likely to have infants who are what? a. Large for gestational age b. Preterm but size appropriate for gestational age c. Growth restricted in weight only d. Growth restricted in weight, length, and chest and head circumference

D

The nurse knows that during deep sleep the neonate should not be disturbed if possible. Characteristics of deep sleep include what? a. Regular breathing b. Occasional smiling c. Rapid eye movements d. Apneic pauses of less than 20 seconds

A

What are possible premature infant complications from oxygen therapy and mechanical ventilation? a. Bronchopulmonary dysplasia and retinopathy of prematurity b. Anemia and necrotizing enterocolitis c. Cerebral palsy and persistent patent ductus arteriosus d. Congestive heart failure and cerebral edema

A

What does the nursing care for infants with fetal alcohol syndrome (FAS) include? a. Nutritional guidance b. An intensive stimulation program c. Facilitation of improvement in cardiovascular status d. An individualized program based on maternal alcohol consumption

A

A preterm infant who is being fed commercial formula by gavage has had an increase in gastric residuals, abdominal distention, and apneic episodes. Which is the most appropriate nursing action? a. Notify the practitioner. b. Reduce the amount fed by gavage. c. Feed human milk by gavage. d. Feed only a glucose solution until the infant stabilizes.

A

The neonatal intensive care nurse is planning care for an infant in an incubator. Which interventions should the nurse plan to assure therapeutic visual stimulation for the neonate? a. Use an incubator cover. b. Keep lights bright in the unit. c. Place a cloth over the infant's face. d. Leave a visual stimulus at the head of the infant's bed.

A

The nurse is caring for a 3-week-old boy born at 29 weeks of gestation. While taking vital signs and changing his diaper after stooling, the nurse observes his color is pink but slightly mottled, his arms and legs are limp and extended, he has the hiccups, his respirations are deep and rapid, and his heart rate is regular and rapid. The nurse should recognize these behaviors as signs of what? a. Stress b. Subtle seizures c. Preterm behaviors d. Onset of respiratory distress

A

The nurse is caring for a neonate with respiratory distress syndrome. The infant has an endotracheal tube. What should nursing considerations related to suctioning include? a. Suctioning should not be carried out routinely. b. The infant should be in the Trendelenburg position for suctioning. c. Routine suctioning, usually every 15 minutes, is necessary. d. Frequent suctioning is necessary to maintain the patency of the bronchi.

A

The nurse is caring for a preterm neonate who requires mechanical ventilation for treatment of respiratory distress syndrome. Because of the mechanical ventilation, the nurse should recognize an increased risk of what? a. Pneumothorax b. Transient tachypnea c. Meconium aspiration d. Retractions and nasal flaring

A

What is the most common cause of iatrogenic anemia in preterm infants? a. Frequent blood sampling b. Respiratory distress syndrome c. Meconium aspiration syndrome d. Persistent pulmonary hypertension

A

8- The nurse is teaching parents of a bottle-fed preterm infant techniques to facilitate feeding. Which techniques should the nurse include? (Select all that apply.) a.Choose a soft nipple. b.Avoid arousing the infant. c.Recognize the infant's limits. d.Prepare a calm, quiet area for the feeding. e.Ensure a restful environment between feedings.

C D E

2- The neonatal intensive care nurse is caring for a neonate born at 36 weeks of gestation in an incubator. Which actions should the nurse plan to assure adequate skin care for the neonate? (Select all that apply.) a.Changing any adhesives every 12 hours b.Removing adhesives or skin barriers slowly c.Using an adhesive remover when removing tape d.Applying emollient as needed for dry, flaking skin e.Using cleanser or soaps no more than two or three times a week

B D E

A newborn is diagnosed with retinopathy of prematurity. What should the nurse know about this condition? a. Blindness cannot be prevented. b. No treatment is currently available. c. Cryotherapy and laser therapy are effective treatments. d. Long-term administration of oxygen will be necessary.

C

A preterm infant is being fed by gavage. What is an important consideration for this infant? a. Warm the feeding to body temperature before feeding. b. Feed the infant in an isolette to minimize handling. c. Provide a pacifier for nonnutritive sucking during bolus feeding. d. Do not allow the infant to have increased stress by becoming hungry.

C

An infant of a mother with herpes simplex infection has just been born. What should nursing considerations include? a. The infant should be isolated in a nursery. b. No special precautions are necessary. c. The mother and infant should be together in a private room. d. Immediate discharge is indicated to prevent spread of infection.

C

The health care provider has prescribed surfactant, beractant (Survanta), to be administered to an infant with respiratory distress syndrome (RDS). The nurse understands that the beractant will be administered by which route? a. Orally b. Intravenously c. Via the ET tube d. Intramuscularly

C

The nurse is caring for a preterm infant who is receiving caffeine citrate for treatment of apnea of prematurity. What signs should indicate caffeine toxicity? a. Bradycardia and hypotension b. Oliguria and sleepiness c. Vomiting and irritability d. Constipation and weight loss

C

The nurse is placing an infant in a servocontrol radiant warmer. The nurse should attach the temperature probe to which area of the infant's body? a. Scapula b. Sternum c. Abdomen d. Front of the lower leg

C

What explains why a neutral thermal environment is essential for a high-risk neonate? a. The neonate produces heat by increasing activity and shivering. b. Metabolism slows dramatically in the neonate experiencing cold stress. c. It permits the neonate to maintain a normal core temperature with minimum oxygen consumption. d. It permits the neonate to maintain a normal core temperature with increased caloric consumption.

C

What is a priority of care for an infant with an intraventricular hemorrhage? a. Avoid use of analgesia. b. Keep the infant's head to the right side. c. Minimize interventions that cause crying. d. Encourage the staff and parents to hold the infant.

C

What is an essential component in caring for the very low- or extremely low-birth-weight infant? a. Holding the infant to help develop trust b. Using electronic monitoring devices exclusively c. Coordinating care to reduce environmental stress d. Incorporating infant stimulation elements during assessment

C

When caring for a neonate in a radiant warmer, what should the nurse be alert to? a. Exposure to prolonged cold stress b. Need for Plexiglas shields to protect the infant c. Transepidermal water loss leading to dehydration d. Increased risk of infection from the open environment

C

Which statement best describes the characteristics of preterm infants? a. Thermoregulation is well established. b. Extremities remain in attitude of flexion. c. Sucking reflex is absent, weak, or ineffectual. d. The head is proportionately small in relation to the body.

C

While a mother is feeding her high-risk neonate, the nurse observes the neonate having occasional apnea, pallor, and bradycardia. What is the most appropriate nursing action? a. Let the neonate rest before breastfeeding again. b. Resume gavage feedings until the neonate is asymptomatic. c. Recognize that this may indicate an underlying illness. d. Use a high-flow, pliable nipple because it requires less energy to use.

C

3- The nurse is positioning a preterm neonate. What are therapeutic positions the nurse should implement? (Select all that apply.) a.Elbows extended b.Hands at the side c.Neutral or slightly flexed neck d.Trunk slightly rounded with pelvic tilt e.Hips partially flexed and adducted to near midline

C D E

. Which is a central factor responsible for respiratory distress syndrome in a newborn? a. Absence of alveoli b. Immature bronchioles c. Overdeveloped alveoli d. Deficient surfactant production

D

1. Which refers to an infant whose rate of intrauterine growth has slowed and whose birth weight falls below the 10th percentile on intrauterine growth charts? a. Postterm b. Postmature c. Low birth weight d. Small for gestational age

D

2. A woman in premature labor delivers an extremely low-birth-weight (ELBW) infant. Transport to a neonatal intensive care unit is indicated. The nurse explains that which level of service is needed? a. Level I b. Level IA c. Level II d. Level IIIB

D

A preterm infant with respiratory distress syndrome is receiving inhaled nitric oxide (NO). What is the reason for administering the inhaled nitric oxide? a. To mature the lungs b. To deliver a level of oxygen that is safe c. To increase the removal of pulmonary debris such as meconium d. To reduce pulmonary vasoconstriction and pulmonary hypertension

D

A preterm neonate has begun breastfeeding, but the infant tires easily and has weak sucking and swallowing reflexes. What is the most appropriate nursing intervention? a. Encourage the mother to breastfeed. b. Resume orogastric feedings of formula. c. Try nipple feeding the preterm infant formula. d. Feed the remainder of breast milk by the orogastric route.

D

Parents of an infant born at 36 weeks' gestation ask the nurse, "Will our infant need a car seat trial before being discharged?" What is the nurse's best response? a. "Yes, to see if the car seat is the appropriate size." b. "Yes, to determine if blanket rolls will be needed." c. "No, your infant was old enough at birth to not need a trial." d. "Yes, to monitor for possible apnea and bradycardia while in the seat."

D

The nurse has been caring for an infant who has just died. The parents are present but appear to be "afraid" to hold the dead infant. What is the most appropriate nursing intervention? a. Tell them there is nothing to fear. b. Insist that they hold the infant "one last time." c. Respect their wishes and release the body to the morgue. d. Keep the infant's body available for a few hours in case they change their minds.

D