chapter 21
The nurse is providing education to the parents of an infant who was just diagnosed with transposition of the great arteries. The parents ask, "Which vessels were involved?" The nurse is correct to educate about:
the aorta and pulmonary artery.
The nursing student is describing a protrusion of the spinal cord and the meninges. The nursing instructor realizes that the student is correctly describing which neural tube defect?
myelomeningocele
A nurse is providing preoperative care to a female newborn client with the congenital abnormality myelomeningocele. Which intervention is the priority?
preventing infection
A nurse is performing a newborn assessment and notices a small dimple on the sacral area. The infant has a normal neurological assessment and moves all extremities well. What does the nurse suspect that the dimple indicates?
spina bifida occulta
The nursing instructor is discussing congenital heart disease with a group of students. Which statement indicates that students need further teaching?
"The ductus arteriosus carries deoxygenated blood from the aorta to the pulmonary artery during fetal life."
The nurse is caring for a newborn client newly diagnosed with developmental dysplasia of the hip (DDH). Which response by the nurse educates the parents on the correct plan of treatment for this diagnosis?
"Treatment will begin immediately."
A newborn boy is diagnosed with esophageal atresia and tracheoesophageal fistula. After the nurse provides preoperative teaching, which statement indicates that the parents need additional teaching?
"We can probably start feeding him with the bottle about a day after the surgery."
An older infant is scheduled to have a cleft palate repair. The mother asks if she will still be able to breastfeed the baby during the postoperative phase. What is the best response by the nurse?
"You will not be able to breastfeed immediately after, but you can pump and feed the child with a cup."
A pediatric nurse who cares for newborns with congenital heart defects informs the precepting student nurse that cyanotic heart disease implies an oxygen saturation of the peripheral arterial blood of:
85% or less
A new mother is concerned because she fears that her infant's head is larger than normal. What would be the nurse's best response?
A large head at birth in itself is not indicative of hydrocephalus, but we will keep a check on it.
A newborn was diagnosed as having hypothyroidism at birth. The parent asks the nurse how the disease could be discovered this early. Which is the nurse's best answer?
A simple blood test to diagnose hypothyroidism is required in most states.
Which clinical manifestation is seen in the child with hydrocephalus?
An extremely large and rapidly growing head
Immediately after birth, the nurse is caring for a newborn with a myelomeningocele. What intervention should the nurse provide to prevent drying out of the sac to avoid damage?
Apply a sterile dressing moistened in a warm, sterile saline solution.
While assessing a newborn, a nurse notes that it appears as if the newborn is blowing copious amounts of bubbles. The nurse suspects esophageal atresia/tracheoesophageal fistula. Which action will the nurse expect to do next?
Assist with passing a firm catheter to the newborn's stomach to aspirate contents.
The nurse is caring for a neonate in the newborn nursery with clubfoot (congenital talipes equinovarus). If nonsurgical treatment is chosen, which nursing action is anticipated?
Holding feet/ankles in position for casting
Which health care provider assessment technique does the nurse anticipate being used to determine developmental dysplasia of the hip (DDH) on a newborn?
Barlow sign and Ortolani click
A baby is born with spina bifida with meningocele. The parents are visibly upset. The father states, "What did we do wrong? How will I ever love this child?" What is the priority action by the nurse?
Encourage the parents to express their feelings and emotions openly.
A cardiac catheterization is done prior to heart surgery as a diagnostic tool to obtain information about the child's heart condition. Which of the following is accurate related to a cardiac catheterization?
Following the procedure, the extremities are monitored for edema.
From which pair of metabolic disorders must the nurse instruct the parents to eliminate breast and cow's milk from the diet?
Galactosemia and phenylketonuria
The nurse is caring for an infant after repair of a cleft lip. The nurse expects which of the following to be included in the plan of care? Select all that apply.
Give parenteral fluids to maintain hydration in the immediate postoperative period. Use a special feeder to prevent tension on the suture line. Use elbow restraints to prevent fingers in the mouth. Clean the suture line with tepid water after feedings.
A nurse is conducting an assessment of a 13-month-old infant. The parent notes that the infant cannot pull oneself into a standing position. To help determine a cause, which assessment will the nurse conduct?
Observe symmetry of gluteal skin folds.
The nurse is caring for a neonate with epispadias. In which location will the nurse assess the anomaly?
On the dorsal end of the penis
At which time does the nurse obtain the Guthrie inhibition assay test to rule out phenylketonuria (PKU)?
On the second day of life
A nurse is caring for a newborn client who is diagnosed with myelomeningocele. Which nursing intervention would protect the newborn from injury?
Place the newborn in a prone or lateral position.
A nurse is caring for a newborn with a repaired cleft lip. What intervention can the nurse provide to facilitate drainage of mucus and secretions to prevent aspiration?
Position the child on the side.
The infant has a myelomeningocele. What specific assessment is performed by the nurse to evaluate the impact of the myelomeningocele? Select all that apply.
Record movement of lower extremities. Monitor for continual leaking of fecal output
The nurse is assessing the neonate shown. From the assessment, the nurse notes that there is paralysis of the lower extremities. For which condition does the nurse anticipate performing care?
Spina bifida with myelomeningocele
An infant is born with an omphalocele. Which explanation by the nurse is the best description of the feeding plan for the infant?
The infant will be fed by TPN to supply nutrients and keep the bowel from filling with air or stool.
The nurse is mentoring a new graduate in the newborn nursery. Which statement regarding a neonate with hypospadias would require the mentoring nurse to clarify?
The neonate will be circumcised before discharge.
The nurse is caring for a neonate with an exstrophy of the bladder. When the nurse is planning care, which client goal is the priority?
The neonate will be free from infection.
The nurse is reinforcing discharge teaching with the mother of an infant who is being discharged prior to having a required blood test done. The nurse explains to this mother that she needs to bring the newborn back to check the infant's phenylalanine level. Which statement is mostaccurately related to this blood test?
The test is done after the newborn has ingested protein.
The nurse is educating the parents of a neonate with Down syndrome regarding nutrition. Which provides the biggest challenge in feeding the neonate?
Thick, fissured tongue
Which congenital condition is an immediate emergency requiring notification of the health care provider?
Tracheoesophageal fistula
The nurse is caring for an infant diagnosed with a ventricular septal defect. Which assessment findings does the nurse anticipate?
a harsh murmur
In the infant diagnosed with spina bifida with myelomeningocele, the infant will likely have:
a partial to complete paralysis in the lower extremities.
The nurse is reviewing the medical record of the antepartum client with an abnormal maternal serum alpha-fetoprotein test. The mother is distraught and states, "How bad can it be?" The nurse is correct to describe which?
a type of spina bifida
When examining a newborn for developmental dysplasia of the hip (DDH), which motion would the newborn's hip be unable to accomplish?
abduction
The practical nurse is assisting the registered nurse with a neonate following ventriculoperitoneal shunting (VP shunt) related to hydrocephalus. Which assessment findings are communicated with the registered nurse immediately? Select all that apply.
anterior fontanels (fontanelles) noted as raised temperature of 100.7ºF (38.2ºC)
Which diagnostic procedure is anticipated prior to heart surgery in an infant with a congenital heart defect?
cardiac catheterization
In the child diagnosed with hydrocephalus, an obstruction occurs that blocks the normal process of:
cerebrospinal fluid.
What assessment should the nurse perform daily on an infant suspected of having hydrocephalus?
daily head circumference
A pregnant client asks the nurse at what point in pregnancy the fetal heart is most susceptible to damage during development. The nurse correctly explains the period as:
during the first 8 weeks of pregnancy when it is forming.
Which assessment findings are most prominent in the infant with tetralogy of Fallot and significant pulmonary stenosis?
dyspnea on limited exertion, fatigue, cyanosis
A nurse in the newborn nursery has noticed that an infant is frothing and appears to have excessive drooling. Further assessment reveals that the baby has episodes of respiratory distress with choking and cyanosis. What disorder should the nurse suspect based on these findings?
esophageal atresia
The nurse is providing care for a newborn who was born with myelomeningocele and Chiari II malformation. For which potential additional condition should the nurse be diligent to monitor this newborn?
hydrocephalus
During cardiac surgery, the surgeon reduces the child's body temperature to decrease the effects of the surgery on the brain and other body organs. This process is referred to as inducing which of the following?
hypothermia
The parent reports that the health care provider said that the infant had a hernia but cannot remember which type. When recalling what the health care provider said, the parent said that a surgeon will repair it soon and there is no problem with the testes. Which hernia type is anticipated?
inguinal hernia
The nurse is caring for an infant with a myelomeningocele prior to surgical repair. Which nursing consideration is the highest priority?
maintaining a clean environment
In the infant born with a cleft lip and a cleft palate, the highest priority of the nurse is related to which intervention?
maintaining the nutritional needs of the infant
When planning preoperative care for a newborn with a cleft lip and palate, the nurse would plan interventions for which major need?
nutrition
It would be best to place an infant with a meningomyelocele in which position prior to surgery?
on the stomach (prone)
A 5-month-old is having a cleft lip/palate repair. What games could the nurse play with the child to provide comfort and diversion postoperatively while the baby is in elbow restraints?
peek-a-boo
What treatment can the nurse anticipate assisting with for a newborn with clubfoot (congenital talipes equinovarus)?
serial casting
While caring for a newborn with cleft lip, the nurse would assess which activity that may be compromised due to the cleft lip?
sucking ability
The nurse is caring for a newborn with hydrocephalus. To protect the newborn from injury in the postoperative period, the nurse should position the head:
turned away from the operative site.
A student nurse is learning about congenital heart defects in newborns and correctly identifies which of the following to be the most common intracardiac defect?
ventricular septal defect
The nurse is performing a cardiac assessment on a newborn and hears a loud, harsh murmur associated with a systolic thrill. What congenital heart defect does the nurse suspect?
ventricular septal defect
The nurse is caring for neonates in the neonatal intensive care unit (NICU). In reviewing the records of the neonates, the nurse notes that one of the infants has a common congenital heart defect. She recognizes that the most common of the congenital heart defects is:
ventricular septal defect.