Chapter 23: Nursing Care of the Newborn with Special Needs
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."
When preparing to resuscitate a preterm newborn, the nurse would perform which action first?
Place the newborn's head in a neutral position.
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 (2.5 mmol/L). Which nursing action would be the priority?
Initiate early oral feedings.
A nurse is assessing the fluid status of a preterm newborn. Which parameter would be most appropriate for the nurse to assess?
fontanels (fontanelles)
What is a consequence of hypothermia in a newborn?
holds breath 25 seconds
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 offer early feedings initiate phototherapy
The nurse in a newborn nursery is observing for developmentally appropriate care. Which is an example of self-regulation?
infant has hand in mouth
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?
meconium aspiration in utero or at birth
Which symptom would most accurately indicate that a newborn has experienced meconium aspiration during the birth process?
meconium stained fluids followed by tachypnea
The nurse assesses a post-term newborn. What finding corresponds with this gestational age diagnosis?
meconium-stained skin and fingernails
After a gavage feeding of a preterm neonate, the nurse aspirates 4 ml of undigested formula. This finding may indicate the development of which complication?
necrotizing enterocolitis
How does the nurse position the infant experiencing respiratory difficulty?
on the back with the head elevated 15 degrees
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)?
sternal retraction
Which sign would indicate dehydration in a newborn?
sunken fontanels (fontanelles)
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 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,:
the ductus arteriosus remains open.
The nurse is assessing a post-term newborn. Which finding would the nurse be least likely to assess?
thick umbilical cord
The nurse determines a newborn is small-for-gestational-age based on which characteristics?
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?
"Come on over and I will explain your infant's exam and findings."
A premature newborn has repeated blood work drawn by heel prick. The mother asks the nurse, "Does my baby feel the pain from all these procedures?" What is the nurse's best response?
"Your baby is more sensitive to the pain than adults are."
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 cannot sustain respirations yet due to the lack of assistance from surfactant."
Hypoglycemia in a mature infant is defined as a blood glucose level below which amount?
45 mg/100 ml whole blood
Which safety precautions should a nurse take to prevent infection in a newborn? Select all that apply.
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?
Begin early feedings either by the breast or bottle.
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?
Closely monitor temperature.
A newborn is receiving bag and mask ventilation and cardiac compression. The resuscitation is paused, and the nurse reassesses the infant. The infant's heart rate is 70 bpm with irregular gasping respirations. What is the appropriate action in this situation?
Continue bag and mask ventilation only.
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?
Ensure that the infant is kept warm.
A preterm newborn has just received synthetic surfactant through an endotracheal tube by a syringe. Which intervention should the nurse implement at this point?
Place the infant in an elevated position.
An 18-year-old client has given birth at 28 weeks' gestation and her newborn is showing signs of respiratory distress syndrome (RDS). Which statement is true for a newborn with RDS?
RDS is caused by a lack of alveolar surfactant.
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 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 nurse observes a neonate born at 28 weeks' gestation. Which finding would the nurse expect to see?
The pinna of the ear is soft and flat and stays folded.
A woman who has given birth to a postterm newborn asks the nurse why her baby looks so thin with so little muscle. The nurse integrates understanding about which concept when responding to the mother?
With postterm birth, the fetus uses stored nutrients to stay alive, and wasting occurs.
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 90th percentile
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
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?
breast milk
What is a classic sign of neonatal respiratory distress syndrome? Select all that apply.
expiratory grunting nasal flaring retractions tachypnea
A nurse is providing care to a 3-day-old newborn who is receiving phototherapy to treat hyperbilirubinemia. The nurse determines that the treatment is effective based on assessment of the newborn's stools appearing as which color?
green
After an extended resuscitation, the infant's body temp is 96.4°F (35.8°C). What assessment finding would the nurse anticipate as a consequence of this temperature? Select all that apply.
heart murmur hypoglycemia decreasing oxygen saturation
The infant is born with copious secretions in the mouth and nose. When using a bulb syringe to remove secretions, the nurse might observe what response from the infant?
heart rate of 88 beats per minute
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
A woman with diabetes has just given birth. While caring for this neonate, the nurse is aware that the child is at risk for which complication?
hypoglycemia
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?
hypoglycemia
A nurse completes the initial assessment of a newborn. According to the due date on the antenatal record, the baby is 12 days' postmature. Which physical finding does not confirm that this newborn is 12 days' postmature?
increased amounts of vernix
Which finding would the nurse expect to assess in an infant with hypoglycemia?
limpness or jitteriness
The nurse is assessing a small-for-gestational age (SGA) newborn, 12 hours of age, and notes the newborn is lethargic with cyanosis of the extremities, jittery with handling, and a jaundiced, ruddy skin color. The nurse expects which diagnosis as a result of the findings?
polycythemia
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
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?
pulse rate of 110 beats per minute
A preterm newborn receives oxygen therapy to treat respiratory distress syndrome (RDS). Which complication should the nurse consider a result of oxygen administration at a high concentration?
retinopathy of prematurity