Chapter 23: Nursing Care of the Newborn with Special Needs

A nurse is assisting the anxious parents of a preterm newborn to cope with the situation. Which statement by the nurse would be least appropriate?

"Forget about what's happened in the past, and focus on the now."

A late preterm newborn is being prepared for discharge to home after being in the neonatal intensive care unit for 4 days. The nurse instructs the parents about the care of their newborn and emphasizes warning signs that should be reported to the pediatrician immediately. The nurse determines that additional teaching is needed based on which parental statement?

"If our newborn's skin turns yellow, it is from the treatments and our newborn is okay."

A woman gives birth to a newborn at 36 weeks' gestation. She tells the nurse, "I'm so glad that my baby isn't premature." Which response by the nurse would be most appropriate?

"We still need to monitor him closely for problems."

A nurse is providing care to a large for gestational age newborn. The newborn's blood glucose level was 32 mg/dL one hour ago. Breast-feeding was initiated. The nurse checks the newborn's blood glucose level and finds it to be 23 mg/dL. Which action would the nurse do next?

Administer intravenous glucose.

A nurse is developing a plan of care for a preterm infant experiencing respiratory distress. Which measure will the nurse include in this plan?

Administer oxygen using an oxygen hood

Rapid assessment of a newborn indicates the need for resuscitation. The newborn has copious secretiohs. The newborn is dried and placed under a radiant warmer. Which action would the nurse do next?

Clear the airway with a bulb syringe.

After a rapid assessment determines that a newborn is in need of resuscitation, the nurse would perform which action first?

Dry the newborn thoroughly

An LGA newborn has a blood glucose level of 30 mg/dL and is exhibiting symptoms of hypoglycemia. Which action would the nurse do next?

Encourage frequent feedings

The parents of a preterm newborn being cared for in the neonatal intensive care unit (NICU) are coming to visit for the first time. The newborn is receiving mechanical ventilation, intravenous fluids and medications and is being monitored electronically by various devices. Which action by the nurse would be most appropriate?

Encourage the parents to touch their preterm newborn.

A 20-hour-old neonate is suspected of having polycythemia. Which nursing intervention(s) will the nurse utilize to provide care for this neonate? Select all that apply.

Obtain hemoglobin and hematocrit laboratory tests, Provide early feedings to prevent hypoglycemia, Maintain oxygen saturation parameters, Monitor urinary output

A nurse is reviewing a journal article about newborn pain prevention and management. Which information would the nurse most likely find discussed in the article?

Pain is frequently mistaken for irritability or agitation

A nurse is developing the plan of care for a small-for-gestational-age newborn. Which action would the nurse determine as a priority?

Preventing hypoglycemia with early feedings

Which intervention would be most appropriate for the nurse to do when assisting parents who have experienced the loss of their preterm newborn?

Provide opportunities for them to hold the newborn

A group of pregnant women are discussing high-risk newborn conditions as part of a prenatal class. When describing the complications that can occur in these newborns to the group, which would the nurse include as being at lowest risk?

appropriate-for-gestational-age (AGA) newborns

The nurse is assessing a preterm newborn's fluid and hydration status. Which finding would alert the nurse to possible overhydration?

bulging fontanels

A nurse is developing a plan of care for a preterm newborn to address the nursing diagnosis of risk for delayed development. Which measures would the nurse include? Select all that apply.

clustering care to promote rest, using kangaroo care, providing nonnutritive sucking

The nurse frequently assesses the respiratory status of a preterm newborn based on the understanding that the newborn is at increased risk for respiratory distress syndrome because of which factor?

deficiency of surfactant

A nurse is reviewing the maternal history of a large-for-gestational-age (LGA) newborn. Which factor, if noted in the maternal history, would the nurse identify as possibly contributing to the birth of this newborn?

diabetes

The nurse prepares to assess a newborn who is considered to be large-for-gestational-age (LGA). Which characteristic would the nurse correlate with this gestational age variation?

difficulty in arousing to a quiet alert state

The nurse is assessing a preterm newborn who is in the neonatal intensive care unit (NICU) for signs and symptoms of overstimulation. Which assessment finding would the nurse correlate with this situation?

flaying hands

The nurse is teaching a group of parents who have preterm newborns about the differences between a full-term newborn and a preterm newborn. Which characteristic would the nurse describe as associated with a preterm newborn but not a term newborn?

greater body surface area in proportion to weight

The nurse is providing care to a newborn who was born at 36 weeks' gestation. Based on the nurse's understanding of gestational age, the nurse identifies this newborn as:

late preterm

A nurse is conducting a class for expectant parents about newborns. As part of the class, the nurse describes newborns with birth weight variations. The nurse determines that the teaching was successful when the class identifies which variation if a newborn weighs 5.2 lb (2,358 g) at any gestational age?

low birth weight

A preterm newborn has received large concentrations of oxygen therapy during a 3-month stay in the NICU. As the newborn is prepared to be discharged home, the nurse anticipates a referral for which specialist?

ophthalmologist

While caring for a preterm newborn receiving oxygen therapy, the nurse monitors the oxygen therapy duration closely based on the understanding that the newborn is at risk for which condition?

retinopathy of prematurity

A nurse suspects that a preterm newborn is having problems with thermal regulation. Which findings would support the nurse's suspicion? Select all that apply.

shallow, slow respirations, cyanotic hands and feet, feeble cry

A nurse is assessing a preterm newborn. Which finding would alert the nurse to suspect that a preterm newborn is in pain?

sudden high-pitched cry

A nurse is preparing a presentation for a group of perinatal nurses about common problems associated with preterm birth. When describing the preterm newborn's risk for perinatal asphyxia, the nurse includes which factor as contributing to the newborn's risk? Select all that apply.

surfactant deficiency, immaturity of the respiratory control centers

A nurse is assessing a post-term newborn. Which finding would the nurse correlate with this gestational age variation?

thin umbilical cord

A nurse is assessing a newborn who has been classified as small for gestational age. Which characteristics would the nurse expect to find? Select all that apply.

wasted extremity appearance, sunken abdomen, narrow skull sutures