Chapter 23 Nursing Care of Newborn With Special Needs PrepU

The nurse is teaching nursing students about the risks that late preterm infants may experience. The nurse feels confident learning has taken place when the students make which statement? "Late preterm infants have fewer clinical problems leading to shorter hospital stays." "Late preterm infant complications are considered minor compared to those of preterm infants." "Late preterm infants may have more clinical problems compared with full-term infants." "Late preterm infants are more mature and able to cope as well as full-term infants."

"Late preterm infants may have more clinical problems compared with full-term infants."

At a prenatal class the nurse describes the various birth weight terms that may be used to describe a newborn at birth. The nurse feels confident learning has occurred when a participant makes which statement? Appropriate-for-gestational-age describes a newborn with a weight over the 90th percentile at birth." "Newborns who are appropriate-for-gestational-age at birth have lower chance of complications than others." "Infants who are larger-for-gestational-age at birth have fewer complications than the other groups." "Appropriate-for-gestational-age means a newborn is born with a weight that falls in the 10th percentile."

"Newborns who are appropriate-for-gestational-age at birth have lower chance of complications than others."

A nursing student, observing care of a 30-week-gestation infant in the neonatal intensive care unit, asks the nurse, "Are premature infants more susceptible to infection as I have to wash my hands so often in this department?" What is the nurse's best response? "That is correct; a 30-week-gestation infant lacks the protective antibody called IgG." "Feeding premature infants breast milk establishes the best protective mechanisms." "Yes, as they lack the antibody called IdD that acts as protection from infections." "Not really, as premature infants are cared for in an isolate, protecting them from infection."

"That is correct; a 30-week-gestation infant lacks the protective antibody called IgG."

A client expresses concerns that her grandmothers had complicated pregnancies. What principle(s) should the nurse discuss to allay the fears of the client? Select all that apply. "We work to ensure that birth of high-risk infants happens in settings where we are able to care for them." "We work to ensure care for mothers and infants to reduce infant illnesses, disabilities, and death." "We allow families to grieve the loss of a newborn, should it occur." "We will work with you to identify prenatal risk factors early and take actions to reduce their impact." "We support those at risk of having a preterm births with the goal of delaying early births."

"We work to ensure that birth of high-risk infants happens in settings where we are able to care for them." "We will work with you to identify prenatal risk factors early and take actions to reduce their impact." "We support those at risk of having a preterm births with the goal of delaying early births." "We work to ensure care for mothers and infants to reduce infant illnesses, disabilities, and death."

A premature infant is admitted to the neonatal intensive care unit with respiratory distress syndrome and requires assisted ventilation. The parents asks the nurse, "Why won't our baby breath on its own?" What is the nurse's best response? "Your infant's cardiovascular system is not developed yet in order to sustain respiration." "Most preterm infants require additional oxygen through ventilation to sustain respiration." "Premature infants have a respiratory system that takes time to adjust to extrauterine life." "Your infant cannot sustain respirations yet due to the lack of assistance from surfactant."

"Your infant cannot sustain respirations yet due to the lack of assistance from surfactant."

The nurse is weighing a newborn and documents AGA (appropriate for gestational age) on the newborn record. Which weight percentile is anticipated? 20th 9th 95th 5th

20th

The nurse is concerned that a newborn is hypoglycemic. Which blood glucose level would support the nurse's intervention? 30 mg/dl (1.67 mmol/l) 50 mg/dl (2.77 mmol/l) 40 mg/dl (2.25 mmol/l) 60 mg/dl (3.33 mmol/l)

30 mg/dl (1.67 mmol/l)

Hypoglycemia in a mature infant is defined as a blood glucose level below which amount? 100 mg/100 ml whole blood 45 mg/100 ml whole blood 80 mg/100 ml whole blood 30 mg/100 ml whole blood

45 mg/100 ml whole blood

A nurse is caring for a preterm infant. Which intervention will prepare the newborn's gastrointestinal tract to better tolerate feedings when initiated? Administer vitamin D supplements. Administer dextrose intravenously. Administer 0.5 ml/kg/hr of breast milk enterally. Administer iron supplements.

Administer 0.5 ml/kg/hr of breast milk enterally.

A newborn with high serum bilirubin is receiving phototherapy. Which is the most appropriate nursing intervention for this client? Application of eye dressings to the infant Delay of feeding until bilirubin levels are normal Placing light 6 inches above the newborn's bassinet Gentle shaking of the baby

Application of eye dressings to the infant

Which assessment by the nurse will best monitor the nutrition and fluid balance in the postterm newborn? Monitor for fall in temperature, indicative of dehydration. Assess for increased muscle tone. Assess for decrease in urinary output. Measure weight once every 2 to 3 days.

Assess for decrease in urinary output.

Which safety precautions should a nurse take to prevent infection in a newborn? Select all that apply. Avoid coming to work when ill. Cover jewelry while washing hands. Initiate universal precautions when caring for the infant. Use sterile gloves for an invasive procedure. Avoid using disposable equipment.

Avoid coming to work when ill. Use sterile gloves for an invasive procedure. Initiate universal precautions when caring for the infant.

A nurse is caring for an infant. A serum blood sugar of 40 was noted at birth. What care should the nurse provide to this newborn? Place infant on radiant warmer immediately. Begin early feedings either by the breast or bottle. Focus on decreasing blood viscosity by introducing feedings. Give dextrose intravenously before oral feedings.

Begin early feedings either by the breast or bottle.

The obstetrics nurse has admitted a large-for-gestational-age infant, 1-hour old, for observation. The initial blood glucose level is 44 mg/dl (2.44 mmol). What is the nurse's priority action? Begin supervised feedings for the newborn. Recheck the newborn's blood glucose in 4 hours. Return the newborn to its parents for bonding. Transfer the newborn to the neonatal intensive care unit.

Begin supervised feedings for the newborn.

The nurse has admitted a small-for-gestational-age infant (SGA) to the observation nursery from the birth room. Which action would the nurse prioritize in the newborn's care plan? Observe feeding tolerance. Monitor intake and output. Closely monitor temperature. Assess for hyperglycemia.

Closely monitor temperature.

A 33-week-gestation infant has just been born. The child's heartbeat is not audible. What is the priority nursing intervention? Depression of the sternum with both thumbs 1 to 2 cm at a rate of 100 times per minute Administration of IV epinephrine, as prescribed Palpation for a femoral pulse Transfer to a transitional or high-risk nursery for continuous cardiac surveillance

Depression of the sternum with both thumbs 1 to 2 cm at a rate of 100 times per minute

The nurse in the NICU is caring for preterm newborns. Which guidelines are recommended for care of these newborns? Select all that apply. Take the newborn's temperature often. Supply oxygen for the newborn, if necessary. Handle the newborn as much as possible. Dress the newborn in ways to preserve warmth. Give the newborn a warm bath immediately. Discourage contact with parents to maintain asepsis.

Dress the newborn in ways to preserve warmth. Take the newborn's temperature often. Supply oxygen for the newborn, if necessary.

At birth, a term infant has irregular respirations and a weak cry. What is the sequence of events initiated by the nurse when caring for this infant? Open the airway, initiate respirations, and dry the infant. Dry the infant, administer blow-by oxygen, and keep the infant warm. Dry the infant, stimulate the infant, and keep the infant warm. Open the airway, suction the trachea, and administer oxygen.

Dry the infant, stimulate the infant, and keep the infant warm.

A preterm infant has an umbilical vessel catheter inserted so that blood can be drawn readily. Which would be most important to implement during this procedure? Prevent the infant from crying. Evaluate the infant's urinary output. Ensure that the infant is kept warm. Assess the infant's cranial vascular tension

Ensure that the infant is kept warm.

A nurse is caring for an infant born with polycythemia. Which intervention is most appropriate when caring for this infant? Check blood glucose within 2 hours of birth by reagent test strip. Focus on decreasing blood viscosity by increasing fluid volume. Repeat screening every 2 to 3 hours or before feeds. Focus on monitoring and maintaining blood glucose levels.

Focus on decreasing blood viscosity by increasing fluid volume.

A full-term infant with spontaneous respiration at birth begins exhibiting signs of respiratory distress syndrome (RDS) at 22 hours of age. Which condition would the nurse assess for in this infant? persistent pulmonary circulation meconium aspiration syndrome transient tachypnea of the newborn Group B streptococcus (GBS) infection

Group B streptococcus (GBS) infection

In an infant who has hypothermia, what would be an appropriate nursing diagnosis? Impaired skin integrity Ineffective parental attachment Alteration in nutrition Impaired tissue perfusion

Impaired tissue perfusion

A nurse is caring for an infant born with an elevated bilirubin level. When planning the infant's care, what interventions will assist in reducing the bilirubin level? Select all that apply. Increase the infant's hydration. Initiate phototherapy. Administer vitamin supplements. Offer early feedings. Stop breastfeeding until jaundice resolves.

Increase the infant's hydration. Initiate phototherapy. Offer early feedings.

The nurse in a newborn nursery is observing for developmentally appropriate care. Which is an example of self-regulation? Infant is quiet. Infant is kicking feet. Infant is crying. Infant has hand in mouth.

Infant has hand in mouth.

The nurse is caring for a small-for-gestational-age infant at 1 hour old, after a difficult birth, with a glucose level of 40 mg/dl (2.22 mmol/L). Which nursing action is the priority? Initiate early oral feedings. Monitor the infant at feedings. Ensure feedings are on demand. Initiate daily infant weights.

Initiate early oral feedings.

Which intervention should a nurse implement to promote thermal regulation in a preterm newborn? Observe for clinical signs of cold stress such as weak cry. Set the temperature of the radiant warmer at a fixed level. Assess the newborn's temperature every 8 hours until stable. Check the blood pressure of the infant every 2 hours.

Observe for clinical signs of cold stress such as weak cry.

The nurse is caring for a preterm neonate on an apnea monitor. When the monitor alarms, what action does the nurse take? Select all that apply. Counts the respiratory rate for a full minute Silences the alarm Begins bag and mask ventilation Performs a focused assessment of the neonate Administers a dose of caffeine

Performs a focused assessment of the neonate Silences the alarm Counts the respiratory rate for a full minute

A preterm newborn has just received synthetic surfactant through an endotracheal tube by a syringe. Which intervention should the nurse implement at this point? Immediately suction the infant's airway. Place the infant in an elevated position. Take a blood sample. Place the infant supine in a radiant heat warmer.

Place the infant in an elevated position.

A preterm infant will be hospitalized for an extended time. Assuming the infant's condition is improving, which environment would the nurse feel is most suitable for the child? Bring the child's open bassinet near the desk area so the infant sees people. Provide a mobile the child can see no matter how he or she is turned. Place the infant's Isolette near the window so the child can see outside. Keep the environment free of color to reduce eye straining.

Provide a mobile the child can see no matter how he or she is turned.

A nurse assisting in a birth notices that the amniotic fluid is stained greenish black as the neonate is being born. Which intervention should the nurse implement as a result of this finding? Flick the sole of the neonate's foot Administer oxygen via a bag and mask Provide supplemental oxygen and monitor respiratory status Gently shake the neonate

Provide supplemental oxygen and monitor respiratory status

A nurse is caring for a preterm newborn who has developed rapid, irregular respirations with periods of apnea. Which additional assessment finding should the nurse identify as an indication of respiratory distress syndrome (RDS)? Deep inspiration Sternal retraction Inspiratory grunt Expiratory lag

Sternal retraction

At birth, the newborn was at the 8th percentile with a weight of 2350 g and born at 36 weeks' gestation. Which documentation is most accurate? The infant was born at term but at a very low birth weight and small-for-gestational-age The infant was born at term but at a low birth weight and small-for-gestational age The infant was a preterm, very-low-birthweight and small-for-gestational-age The infant was a preterm, low-birth-weight and small-for-gestational-age

The infant was a preterm, low-birth-weight and small-for-gestational-age

A 20-year-old client gave birth to a baby boy at 43 weeks' gestation. What might the nurse observe in the newborn during routine assessment? The newborn may look wrinkled and old at birth. The testes in the child may be undescended. The infant may have excess of lanugo and vernix caseosa. The newborn may have short nails and hair.

The newborn may look wrinkled and old at birth.

A one-day-old neonate born at 32 weeks' gestation is in the neonatal intensive care unit under a radiant overhead warmer. The nurse assesses the morning axilla temperature as 95°F (35°C). What could explain the assessment finding? Axillary temperatures are not accurate. The supply of brown adipose tissue is not developed. This is a normal temperature. Conduction heat loss is a problem in the baby.

The supply of brown adipose tissue is not developed.

Which result of a biophysical profile would indicate to the nurse that the fetus might tolerate labor poorly? Select all that apply. a positive stress test poor fundal growth low amniotic fluid volume placental grade III a nonreactive nonstress test (NST)

a nonreactive nonstress test (NST) low amniotic fluid volume placental grade III

When documenting the newborn's weight on a growth chart, the nurse recognizes the newborn is large-for-gestational-size based on which percentile on growth charts? above 85th percentile above 90th percentile above 80th percentile above 95th percentile

above 90th percentile

All infants need to be observed for hypoglycemia during the newborn period. Based on the facts obtained from pregnancy histories, which infant would be most likely to develop hypoglycemia? an infant whose labor began with ruptured membranes an infant whose mother craved chocolate during pregnancy an infant who had difficulty establishing respirations at birth an infant who has marked acrocyanosis of his hands and feet

an infant who had difficulty establishing respirations at birth

The nurse examines a 26-week-old premature neonate. The skin temperature is lowered. What could be a consequence of the infant being cold? crying apnea tachycardia sleepiness

apnea

The nurse examines a 26-week-old premature neonate. The skin temperature is lowered. What could be a consequence of the infant being cold? tachycardia crying apnea sleepiness

apnea

What action by the nurse provides the neonate with sensory stimulation of a human face? having mothers look at the infant through the isolette's porthole assisting the mother to position the infant in an en face position encouraging the mother to view the baby through the isolette dome teaching parents to maintain a distance of 18 inches (7 cm) from the baby's face

assisting the mother to position the infant in an en face position

During the newborn's assessment, which finding would lead the nurse to suspect that a large-for-gestational-age newborn has experienced birth trauma? asymmetrical movement feeble sucking seizures temperature instability

asymmetrical movement

A nurse is administering prescribed enteral feedings to assist in preparing the gut of a preterm newborn. Which type of solution would the nurse most likely administer for the feeding? formula breast milk sterile water normal saline

breast milk

A newborn does not breathe spontaneously at birth. The nurse administers oxygen by bag and mask. If oxygen is entering the lungs, the nurse should notice that the: chest rises with each bag compression. infant's neck veins become prominent and palpable. abdomen rises while the chest falls with bag compressions. infant's pupils dilate after 3 minutes.

chest rises with each bag compression.

Which condition may cause intrauterine asphyxia? Select all that apply. gestational diabetes intrauterine growth restriction (IUGR) placental abruption (abruptio placentae) group B streptococcus (GBS) infection cord compression

cord compression placental abruption (abruptio placentae) intrauterine growth restriction (IUGR)

Which maternal factors should the nurse consider contributory to a newborn being large for gestational age? Select all that apply. postdates gestation diabetes prepregnancy obesity renal infection alcohol use

diabetes postdates gestation prepregnancy obesity

A nurse is assessing the fluid status of a preterm newborn. Which parameter would be most appropriate for the nurse to assess? fontanels (fontanelles) urinary output skin turgor fluid intake

fontanels (fontanelles)

A nurse is conducting an in-service presentation for a group of neonatal nurses. After teaching the group about the effects of prematurity on various body systems, the nurse determines that the class was successful when the group identifies which condition as an effect of prematurity? enhanced ability to digest proteins enlarged respiratory passages fragile cerebral blood vessels rapid glomerular filtration rate

fragile cerebral blood vessels

A client has given birth to a small-for-gestational-age (SGA) newborn. Which finding would the nurse expect to assess? head larger than body protuberant abdomen brown lanugo body hair round flushed face

head larger than body

A client asks the nurse what surfactant is. Which explanation would the nurse give as the main role of surfactant in the neonate? helps the lungs remain expanded after the initiation of breathing assists with ciliary body maturation in the upper airways promotes clearing of mucus from the respiratory tract helps maintain a rhythmic breathing pattern

helps the lungs remain expanded after the initiation of breathing

An obese woman with diabetes has just given birth to a term, large-for-gestational-age (LGA) newborn. Which condition should the nurse most expect to find in this infant? hyperglycemia hypotension hypertension hypoglycemia

hypoglycemia

The nurse begins frequent oral feedings for a small-for-gestational-age newborn to prevent which occurrence? polycythemia asphyxia hypoglycemia meconium aspiration

hypoglycemia

A nurse is assessing a preterm newborn. The nurse determines that the newborn is comfortable and without pain based on which finding? lack of body posturing increased muscle tone sudden high-pitched cry fussiness

lack of body posturing

A newborn is designated as very-low-birth-weight. When weighing this newborn, the nurse would expect to find which weight? approximately 2,500 g less than 1,500 g more than 4,000 g less than 1,000 g

less than 1,500 g

A 35-year-old client has just given birth to a healthy newborn during her 43rd week of gestation. What should the nurse expect when assessing the condition of the newborn? seizures, respiratory distress, cyanosis, and shrill cry tremors, irritability, and high-pitched cry meconium aspiration in utero or at birth yellow appearance of the newborn's skin

meconium aspiration in utero or at birth

Which symptom would most accurately indicate that a newborn has experienced meconium aspiration during the birth process? listlessness or lethargy meconium stained fluids followed by tachypnea bluish skin discoloration stained umbilical cord and skin

meconium stained fluids followed by tachypnea

The nurse assesses a post-term newborn. What finding corresponds with this gestational age diagnosis? Wharton's jelly abundant vernix caseosa and lanugo meconium-stained skin and fingernails few creases on soles

meconium-stained skin and fingernails

The nurse assesses a post-term newborn. What finding corresponds with this gestational age diagnosis? abundant vernix caseosa and lanugo few creases on soles Wharton's jelly meconium-stained skin and fingernails

meconium-stained skin and fingernails

A neonate is being admitted to the observational nursery with the diagnosis of postmaturity. What would the nurse expect to find with this gestational age variation? Select all that apply. abundant lanugo few sole creases decreased breast tissue peeling, wrinkled skin thin umbilical cord abundant vernix caseosa meconium-stained skin and fingernails

meconium-stained skin and fingernails thin umbilical cord peeling, wrinkled skin

Which finding is indicative of hypothermia of the preterm neonate? pink skin nasal flaring regular respirations oxygen saturation of 95%

nasal flaring

How does the nurse position the infant experiencing respiratory difficulty? on the left side with the head elevated 45 degrees on the right side with the head lower than the body on the back with the head elevated 15 degrees on the stomach with the head lowered 30 degrees and head turned to the side

on the back with the head elevated 15 degrees

A client has just given birth at 42 weeks' gestation. What would the nurse expect to find during her assessment of the neonate? a sleepy, lethargic neonate peeling and wrinkling of the neonate's epidermis vernix caseosa covering the neonate's body lanugo covering the neonate's body

peeling and wrinkling of the neonate's epidermis

The newborn nursery nurse is admitting a small-for-gestational-age (SGA) infant and is reviewing the maternal history. What factor in the maternal history would the nurse correlate as a risk factor for an SGA infant? grand multiparity blood group incompatibility age of 30 years placental factors

placental factors

A preterm infant receives surfactant by lung lavage. Which interventions should the nurse perform immediately? Select all that apply. placing the infant in a prone position not suctioning the airway frequent suctioning of secretions placing the infant in a supine position placing the infant in an upright position

placing the infant in an upright position not suctioning the airway

At birth, the infant has dry, cracked skin, absence of vernix, lack of subcutaneous fat, fingernail extending beyond the fingertips, and poor skin turgor. Based on these findings, how would the nurse would classify this neonate? postterm SGA LGA preterm

postterm

A nurse is assisting with the resuscitation of a preterm newborn. Which assessment would help assist the team in determining that the resuscitation efforts have been successful? weak cry effort pulse rate of 110 beats per minute respiratory rate of 10 breaths per minute pink conjunctiva

pulse rate of 110 beats per minute

A newborn is being monitored for retinopathy of prematurity. Which condition predisposes an infant to this condition? Down syndrome esophageal atresia respiratory distress syndrome hydrocephalus

respiratory distress syndrome

Which assessment finding would best validate a problem in a small-for-gestational age newborn secondary to meconium in the amniotic fluid? heart rate of 162 beats/min hematocrit of 44% (0.44) total bilirubin level of 15 mg/dl (256.56 µmol/l) respiratory rate of 60 to 70 breaths/min

respiratory rate of 60 to 70 breaths/min

A nurse is caring for a baby girl born at 34 weeks' gestation. Which feature should the nurse identify as those of a preterm newborn? paper-thin eyelids closely approximated labia shiny heels and palms scant coating of vernix

shiny heels and palms

Meconium is the first stool passed in a newborn. What would be the correct documentation of the meconium? soft brown seedy yellow formed green sticky forest green

sticky forest green

The nurse needs to conduct a procedure on a preterm newborn. Which measure(s) will the nurse use to help reduce pain? Select all that apply. increasing the volume on device alarms offering a pacifier prior to a procedure swaddling the newborn closely encouraging skin-to-skin (kangaroo) care during procedures removing tape quickly from the skin

swaddling the newborn closely offering a pacifier prior to a procedure encouraging skin-to-skin (kangaroo) care during procedures

Which finding would lead the nurse to suspect that a large-for-gestational-age newborn is developing hyperbilirubinemia? feeble sucking tea-colored urine seizures temperature instability

tea-colored urine

A newborn girl who was born at 38 weeks' gestation weighs 2000 g and is below the 10th percentile in weight. The nurse recognizes that this girl will be placed in which classification? term, small-for-gestational-age, and very-low-birth-weight infant late preterm, large-for-gestational-age, and low-birth-weight infant late preterm and appropriate for gestational age term, small-for-gestational-age, and low-birth-weight infant

term, small-for-gestational-age, and low-birth-weight infant

A premature infant develops respiratory distress syndrome. With this condition, circulatory impairment is likely to occur because, with increased lung tension,: there are aortic valve strictures. the ductus arteriosus remains open. the pulmonary artery closes. the foramen ovale closes prematurely.

the ductus arteriosus remains open.

A nurse initiates bag and mask ventilation with an anesthesia bag on a newborn with no spontaneous respiratory effort. What controls the pressure of breaths delivered by an anesthesia bag? the blow-off valve, which limits the pressure in the apparatus the pressure the nurse uses when the hand squeezes against the bag the pressure setting on the dial at the point where the mask connects to the bag the flow rate of air into the inflatable bag on the apparatus

the pressure the nurse uses when the hand squeezes against the bag

The nurse determines a newborn is small-for-gestational-age based on which characteristics? wasted appearance of extremities, gelatinous umbilical cord, and abundant subcutaneous fat stores normal subcutaneous fat stores, cord-like umbilical cord, and increased development to extremities reduced subcutaneous fat stores to buttocks, thicker umbilical cord, and smaller head compared to body wasted appearance of extremities, thin umbilical cord, and reduced subcutaneous fat stores

wasted appearance of extremities, thin umbilical cord, and reduced subcutaneous fat stores

An infant born 10 minutes prior was brought into the nursery for an examination. The nurse notices the infant's lip and palate are malformed. The parent comes up to door and asks if the infant seems okay. What is the appropriate response by the nurse? "Oh yeah, the infant seems fine, you can see your infant soon." "Come on over and I will explain your infant's exam and findings." "Wait outside and we will call you later." "The infant is okay, just wait until your health care provider speaks to you."

"Come on over and I will explain your infant's exam and findings."