Chapter 21: The Newborn at Risk: Congenital Disorders

A nursing student is learning about congenital disorders in newborns and correctly associates the causes for central nervous system defects to be which factors? Select all that apply.

imbalanced cerebrospinal fluid malformation of the neural tube during embryonic development

A newborn is diagnosed with congenital hypothyroidism prior to discharge from the hospital. What medication does the nurse anticipate administering to the newborn?

levothyroxine

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

The nurse notes a diminished level of consciousness in an infant with hydrocephalus. What is a priority action at this time?

palpating the anterior fontanel (fontanelle)

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

A nurse is caring for a child with complex esophageal atresia who will be undergoing surgery for repair. What comment by the parents indicates further teaching is required?

"After this surgery is done tomorrow, my baby will be able to eat and drink."

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.

Following surgery for cleft lip, the infant will have a Logan bar. Which explanation of the Logan bar is most accurate?

A Logan bar is an apparatus that may be used to protect the surgical incision following a cleft lip repair.

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.

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

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.

The nurse is assessing a 6-week-old at a pediatrician's appointment. What objective data gathered by the nurse indicates a diagnosis of possible developmental dysplasia of the hip? Select all that apply.

Asymmetry of the gluteal skin folds Limited abduction of the affected hip Apparent shortening of the femur

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

The parent has brought a 2-year-old to the public clinic for immunizations. The nurse documents the following characteristics: A duck waddle gait Shortened extremity Asymmetry of the gluteal folds Protruding abdomen The nurse then refers the toddler to the health care provider for potential diagnosis of which?

Developmental dysplasia of the hip (DDH)

The nurse is assessing a neonate brought into the newborn nursery. The nurse notes a dimple on the lower back with a tuft of hair over the site. Which nursing intervention is most appropriate?

Document the assessment finding and report in shift handoff.

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.

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.

In completing the newborn assessment checklist, the nurse documents a meconium stool. This documentation rules out which condition?

Imperforate anus

Which maternal screening during pregnancy indicates the possibility of Down syndrome?

Maternal serum alpha-fetoprotein test

The nurse is reviewing a chart for a male client with Klinefelter syndrome. Which physical characteristics does the nurse anticipate?

No development of secondary sex characteristics

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

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 nurse is completing a medication history for a client with Turner syndrome. Which medication is anticipated?

Somatropin

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.

When caring for parents whose neonate is newly diagnosed with a congenital disorder, which parents would be referred to pediatric hospice services?

The parent with a neonate diagnosed with maple syrup urine disease

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 most accurately 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 observes a newborn experiencing coughing, choking, and unexplained cyanosis during feeding. These are classic signs of what condition?

esophageal atresia

During the newborn examination, the nurse would suspect spina bifida occulta if what finding is present? Select all that apply.

a dimpling at the base of spine abnormal tufts of hair at the base of spine discolored skin at the base of spine

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

A newborn is scheduled for casting to correct clubfoot (congenital talipes equinovarus). The nurse would advise her parents that the cast will extend:

above the knee.

The priority for the nurse caring for a newborn with esophageal atresia is to observe for which finding?

aspiration

A newborn infant has been diagnosed with Down syndrome. What assessment finding(s) of the hand and feet does the nurse expect to document on this infant's medical record? Select all that apply.

broad, short hands transverse palmar crease wide space between first and second toes

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

Following surgery for an imperforated anus, care of the infant should include which nursing intervention? Select all that apply.

daily stool softener to prevent straining clean suture line with saline after each bowel movement side-lying position

The nurse is feeding a 2-day-old in the nursery when the infant begins choking and becomes cyanotic. Frothy sputum is observed coming from the mouth. What congenital malformation does the nurse understand these symptoms indicate?

esophageal atresia

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

A nursing student has read that cleft lip is diagnosed at birth based on inspection of physical appearance and that cleft palate is diagnosed by which method?

feeling the palate with a gloved finger or using a tongue blade

Following anastomosis repair of a tracheoesophageal fistula, the nurse assesses the infant for which potential complication?

gastroesophageal reflux

An infant will have surgery within the first days of life when which condition is present at birth? Select all that apply.

gastroschisis myelomeningocele imperforate anus

The parent of a newborn diagnosed with Turner syndrome asks the nurse about the treatment that will be required for their newborn. Complete the following sentence(s) by choosing from the lists of options. The nurse should educate the parents on the primary treatments used in the treatment of Turner syndrome, which includes

growth hormone estrogen therapy

A nursing student is caring for a newborn with a defect in the neural arch where the posterior laminae of the vertebrae have failed to close. The nurse knows that this infant is suffering from which disorder?

hydrocephalus

A nursing student is learning about newborn congenital defects. The defect with symptoms that include a shiny scalp, dilated scalp veins, a bulging anterior fontanel (fontanelle), and eyes pushed downward with the sclera visible above the irises is which defect?

hydrocephalus

Congenital myelomeningocele is commonly associated with which condition?

hydrocephalus

For which condition would the nurse commonly assess in an infant following surgery for a meningomyelocele?

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

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

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 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.

The nurse is working in the emergency department when a 2-week-old is brought in for restlessness, a cry that has become high-pitched and projectile vomiting. The infant's head circumference has grown by 4 cm from birth measurements. What nursing action is most appropriate?

witnessing a consent for surgery