Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn; O'Meara: Maternity, Newborn, and Women's Health; PREPU Level 5

A woman at 15 weeks' gestation who works at a daycare center thinks she may have just been exposed to rubella at work. The client asks how this may affect her fetus. What is the best response the nurse can give? a. "By the end of the eighth week all of the organ systems and major structures are present, so exposure to any teratogen can lead to birth defects. More assessments are needed." b. "Your health care provider will let you know if there are any problems with your baby." c. "We will have to see what gestational age your baby was at exposure." d. "We will need to perform some additional tests."

a. "By the end of the eighth week all of the organ systems and major structures are present, so exposure to any teratogen can lead to birth defects. More assessments are needed." All organ systems are complete at 8 weeks gestation. During this time of organogenesis the growing structure is most vulnerable to invasion by teratogens.

The nurse is assessing a toddler at a well-child visit and notes the following: small in stature, appears mildly developmentally delayed; short eyelid folds; and the nose is flat. Which advice should the nurse prioritize to the mother in response to her questions about having another baby? a. "It's a good idea to stop drinking alcohol 3 months before trying to get pregnant." b. "It's important to add iron and vitamin B supplements to your diet." c. "It would be good to stop smoking before getting pregnant." d. "It's important to keep insulin levels controlled during pregnancy."

a. "It's a good idea to stop drinking alcohol 3 months before trying to get pregnant." Alcohol is one of the many teratogenic substances that cross the placenta to the fetus. Fetal alcohol spectrum disorder is often apparent in newborns of mothers with chronic alcoholism and sometimes appears in newborns whose mothers consume low-to-moderate amounts of alcohol. No amount of alcohol is believed to be safe, and women should stop drinking at least 3 months before they plan to become pregnant. The ability of the mother's liver to detoxify the alcohol is apparently of greater importance than the actual amount consumed. Fetal alcohol spectrum disorder is characterized by low birth weight, smaller height and head circumference, short palpebral fissures (eyelid folds), reduced ocular growth, and a flattened nasal bridge. These newborns are prone to respiratory difficulties, hypoglycemia, hypocalcemia, and hyperbilirubinemia. Their growth continues to be slow, and their mental development is delayed despite expert care and nutrition. Smoking is related to respiratory issues. Proper nutrition and glucose control are also important but do not result in fetal alcohol spectrum disorder.

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? a. Closely monitor temperature. b. Assess for hyperglycemia. c. Monitor intake and output. d. Observe feeding tolerance.

a. Closely monitor temperature. Difficulty with thermoregulation in SGA newborns is common due to less muscle mass, less brown fat, less heat-preserving subcutaneous fat, and limited ability to control skin capillaries. The priority would be to closely monitor the newborn's temperature. It is also associated with depleted glycogen stores; therefore, this is hypoglycemia not hyperglycemia. Immaturity of CNS (temperature-regulating center) interferes with the ability to regulate body temperature. Intake and output monitoring and observing feeding are not the priority.

A client in labor with chronic back pain tells the nurse about taking a dose of hydrocodone/acetaminophen for labor pain prior to coming to the hospital. What should the nurse prepare to do once the fetus is born? Select all that apply. a. Evaluate the neonate for withdrawal symptoms. b. Inform the health care provider so that liver effects can be monitored. c. Suggest that no additional opioid pain medication be provided during labor. d. Coach the client in breathing techniques because other pain medication is contraindicated. e. Request that the health care prescribe the same medication to be used for pain during labor.

a. Evaluate the neonate for withdrawal symptoms. b. Inform the health care provider so that liver effects can be monitored. A typical prescription drug abused by women is hydrocodone/acetaminophen, because this is frequently prescribed for chronic back pain. The half-life of this drug is about 2 hours in addicted women. Even though it appears to have little effect on neonates, the neonate needs to be observed for both withdrawal and liver effects. The client can receive other opioid pain medication during labor. Other pain medication is not contraindicated for this client. There are other, safer pain medications that can be prescribed for the client and fetus during labor.

Newborns receive an antibiotic in their eyes within the first hour after birth to prevent neonatorum ophthalmia. Which type of bacteria is most likely to cause this condition? a. Neisseria gonorrhoeae b. Escherichia coli c. Trichomonas vaginalis d. group B streptococcus (GBS)

a. Neisseria gonorrhoeae N. gonorrhoeae and Chlamydia trachomatis are the organisms that cause neonatorum ophthalmia.

Which intervention is helpful for the neonate experiencing drug withdrawal? a. Place the isolette in a quiet area of the nursery. b. Withhold all medication to help the liver metabolize drugs. c. Dress the neonate in loose clothing so the infant will not feel restricted. d. Place the isolette near the nurses' station for frequent contact with health care workers.

a. Place the isolette in a quiet area of the nursery. Neonates experiencing drug withdrawal commonly have sleep disturbance. The neonate should be moved to a quiet area of the nursery to minimize environmental stimuli. Medications such as phenobarbital and paregoric should be given as needed. The neonate should be swaddled to prevent him from flailing and stimulating himself.

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? a. Provide supplemental oxygen and monitor respiratory status b. Administer oxygen via a bag and mask c. Gently shake the neonate d. Flick the sole of the neonate's foot

a. Provide supplemental oxygen and monitor respiratory status When the amniotic fluid is stained greenish black, the neonate is at risk for meconium aspiration syndrome (MAS). Treatment for MAS depends on severity, but standard guidelines include supplemental oxygen and close monitoring of respiratory status. Additional treatment depends on the severity of respiratory compromise. The health care provider would determine if additional treatment is needed. The nurse should not administer oxygen under pressure (bag and mask) until the neonate has been intubated and suctioned, so the pressure of the oxygen does not drive small plugs of meconium farther down into the lungs, worsening the irritation and obstruction. Gently shaking the neonate and flicking the sole of the foot are methods of stimulating breathing in a neonate experiencing apnea.

A nurse is planning care for a newborn with a bilirubin level of 18 mg/dl who is undergoing phototherapy. Which is the best intervention for the nurse to implement to promote growth and development in the newborn? a. Provide time for intermittent feedings with parents. b. Place the infant in a supine position in an incubator. c. Maximize the body surface covered by the therapy lights. d. Monitor newborn intake and output.

a. Provide time for intermittent feedings with parents. Newborns with bilirubin levels below 20 mg/dl can have phototherapy temporarily discontinued for feeding and bonding activities, which promotes growth and development. The newborn should be placed in a supine position but in a bassinet or warmer, not in an incubator. The nurse should maximize the body surface covered by the therapy lights and monitor the newborn's intake and output, but neither are measures that promote growth and development.

The nurse is conducting a class for pregnant women on problems associated with infections seen in women during gestation. One mother tells the nurse that she has never had chickenpox (varicella) and is worried she will contract it before she delivers. What would the nurse explain to this mother to ease her anxiety? a. She can receive her varicella vaccine immediately after delivery, followed by a second dose at her 6-week postpartum visit. b. The likelihood of her catching varicella is very slim, so tell her not to worry. c. She needs to let her physician know that she has not had varicella so she can get immunized at her next visit. d. Even if she does get varicella, her baby will be fine since varicella is not passed on to the fetus.

a. She can receive her varicella vaccine immediately after delivery, followed by a second dose at her 6-week postpartum visit. Varicella zoster is spread by respiratory droplets and is easily contracted if the mother is exposed. If the mother does contract varicella, especially from weeks 12 to 20 of gestation, it can be devastating to the fetus. Birth defects, central nervous system damage, low birth weight, cognitive delays and deafness can all occur. However, a mother cannot receive a varicella immunization during pregnancy since the immunization can cross the placenta and act like the actual disease, causing the same effects. The mother is immunized prior to discharge after delivery and at her 6-week postpartum visit.

The nurse is caring for a preterm neonate and has chosen the following goal: improvement of the neonate's respiratory function. Which expected outcome is most appropriate for the first week? a. The neonate will not use accessory muscles when breathing. b. The neonate will have 99% oxygen saturation. c. The neonate will sleep without apnea periods. d. The neonate will maintain a temperature under 99.5°F (37.5°C).

a. The neonate will not use accessory muscles when breathing. The goal most appropriate for the first week of life is to not use accessory muscles or grunting when breathing. This signifies an improvement in the respiratory status. A 99% oxygen saturation rate is too high for the neonate. Maintaining the temperature and sleeping without apnea are acceptable goals but not most reflective of improvement in the respiratory status.

A newborn delivered of a diabetic mother by cesarean section 90 minutes ago is exhibiting nasal flaring, expiratory grunting, and tachypnea. Lungs are clear on auscultation and oxygen saturation is 95% on room air. What inference can the nurse make about the newborn's condition? a. The newborn will be monitored with an expectation of improvement within 24-48 hours. b. Oxygen supplementation will be needed to maintain current oxygen saturation levels. c. The newborn will likely need treatment for pneumonia. d. Administration of diuretics will be part of the treatment regimen.

a. The newborn will be monitored with an expectation of improvement within 24-48 hours.

In the child diagnosed with hydrocephalus, an obstruction occurs that blocks the normal process of: a. cerebrospinal fluid. b. genitourinary tract. c. circulatory blood flow. d. lymphatic system.

a. cerebrospinal fluid. In congenital hydrocephalus, an obstruction occurs and cerebrospinal fluid is not able to pass between the ventricles and the spinal cord.

A preterm newborn has developed necrotizing enterocolitis (NEC). Which of the following gastrointestinal (GI) characteristics would the nurse explain as predisposing a preterm newborn to NEC? a. diminished gastric enzymes b. enhanced gut motility c. faster gastric emptying d. strong esophageal sphincter tone

a. diminished gastric enzymes Diminished gastric enzymes in the preterm newborn predispose the newborn to NEC. In NEC, there is acute inflammation of the bowel associated with ischemia. This can lead to bowel necrosis and perforation. Preterm infants are at higher risk of developing NEC due to gastric immaturity and increased risk of infections. The other GI characteristics predisposing preterm infants to NEC include decreased gut motility, delayed gastric emptying, and weak esophageal sphincter tone.

A newborn admitted to the neonatal intensive care unit is diagnosed with persistent pulmonary hypertension of the newborn (PPHN). What findings in the mother's prenatal history would best correlate with this diagnosis? a. fluoxetine use during last trimester of pregnancy b. maternal diagnosis of alcoholism during pregnancy c. poorly controlled myasthenia gravis d. maternal diagnosis of anorexia nervosa

a. fluoxetine use during last trimester of pregnancy Current research links increased risk of developing PPHN to exposure to selective serotonin reuptake inhibitors (SSRIs) (antidepressants) such as fluoxetine in late pregnancy. Treatment of depression with antidepressants is complicated by the mother's needs. Careful consideration must be given to the risks, benefits, and alternatives of utero medication exposure. PPHN can also occur as a complication of maternal smoking, maternal obesity, and maternal asthma. Alcohol use during pregnancy causes other birth defects not PPHN. Myasthenia gravis and anorexia are not associated with PPHN.

The newborn nursery nurse suspects a newborn of having neonatal abstinence syndrome. What assessment findings would most correlate with the diagnosis? a. frequent yawning and sneezing b. vigorous rooting and feeding c. positive Babinski and Moro reflexes d. cyanotic discoloration of the hands and feet

a. frequent yawning and sneezing Manifestations of neonatal abstinence syndrome include: CNS dysfunction such as hyperactive reflexes resulting in exaggerated Babinski and Moro reflexes; hypertonic muscle tone and constant movement; metabolic, vasomotor, and respiratory disturbances with frequent yawning and sneezing; gastrointestinal dysfunction, including poor feeding; and frantic sucking or rooting. Acrocyanosis is a normal newborn finding which is cyanotic discoloration of the extremities.

Which of the following would lead you to suspect that a newborn has developmental hip dysplasia? a. inability of the right hip to abduct b. crying on straightening of the right leg c. continual drawing of his legs under him while prone d. inward rotation of his right foot

a. inability of the right hip to abduct Newborns whose acetabulums are shallow cannot abduct their hip joint.

What would the nurse suspect in a premature newborn who has difficulty feeding and maintaining a stable temperature and is vomiting bile? a. necrotizing enterocolitis b. meconium aspiration syndrome c. intraventricular hemorrhage d. respiratory distress syndrome

a. necrotizing enterocolitis Necrotizing enterocolitis is a disease that is characterized by inflammation in the bowels. It is generally idiopathic and results in difficulty feeding and maintaining thermoregulation, as well as vomiting of bile.

The nurse is providing care to a newborn with severe meconium aspiration syndrome (MAS). The nurse is reviewing the newborn's diagnostic test results. Which finding would the nurse expect? a. patchy, fluffy infiltrates on chest X-ray b. vocal cords negative for meconium c. elevated blood pH d. increased PaO2

a. patchy, fluffy infiltrates on chest X-ray Chest X-rays show patchy, fluffy infiltrates unevenly distributed throughout the lungs and marked hyperaeration mixed with areas of atelectasis. Arterial blood gases analysis will indicate metabolic acidosis with a low blood pH, decreased PaO2, and increased PaCO2. Direct visualization of the vocal cords for meconium staining using an appropriate size laryngoscope is needed.

The nurse reviews the prenatal record in anticipation of a birth. Which finding would alert the nurse to the possibility of an intestinal obstruction in the infant? Select all that apply. a. polyhydramnios b. sibling with cystic fibrosis c. placenta previa d. meconium-stained amniotic fluid e. hyperemesis gravidarum

a. polyhydramnios b. sibling with cystic fibrosis Intestinal obstruction may be anticipated if the mother had polyhydramnios during pregnancy. Cystic fibrosis is also associated with intestinal obstructions. Since cystic fibrosis is genetic, a sibling with the disease is a significant finding. Placenta previa, meconium stained fluid, and hyperemesis gravidarium are not associated with a higher incidence of intestinal obstruction.

A nurse is providing preoperative care to a female newborn client with the congenital abnormality myelomeningocele. Which intervention is the priority? a. preventing infection b. promoting newborn nutrition c. preserving newborn GI function d. maximizing newborn motor function

a. preventing infection A congenital condition of the newborn with a spinal deformity puts the newborn at risk for infection. A myelomeningocele is a fluid-filled sac on the spine that includes part of the spinal cord defect and the meninges. This cyst on the outside of the newborn requires surgical intervention. Although nutrition, GI function, and motor function are all important to the health of the newborn, the spinal and meninges defect puts the newborn at high risk for infection.

A nurse is conducting a review class for a group of perinatal nurses working at the local clinic. The clinic sees a high population of women who are HIV positive. After discussing the recommendations for antiretroviral therapy with the group, the nurse determines that the teaching was successful when the group identifies which rationale as the underlying principle for the therapy? a. reduction in viral loads in the blood b. treatment of opportunistic infections c. adjunct therapy to radiation and chemotherapy d. can cure acute HIV/AIDS infections

a. reduction in viral loads in the blood Drug therapy is the mainstay of treatment and is important in reducing the viral load as much as possible. Antiretroviral agents do not treat opportunistic infections and are not adjunctive therapy. There is no cure for HIV/AIDS.

A nurse is caring for a newborn with fetal alcohol spectrum disorder. What characteristic of the fetal alcohol spectrum disorder should the nurse assess for in the newborn? a. small head circumference b. decreased blood glucose level c. poor breathing pattern d. wide eyes

a. small head circumference The nurse should assess for small head circumference in a newborn being assessed for fetal alcohol spectrum disorder. Fetal alcohol spectrum disorder does not cause decreased blood glucose level, a poor breathing pattern, or wide eyes.

The nurse is caring for a client in the early stages of labor. What maternal history factors will alert the nurse to plan for the possibility of a small-for-gestational-age (SGA) newborn? Select all that apply. a. smoking during pregnancy b. hypotension upon admission c. asthma exacerbations during pregnancy d. drug use e. pregnancy weight gain of 25 lb (11 kg)

a. smoking during pregnancy c. asthma exacerbations during pregnancy d. drug use The nurse should be alert to the possibility of an SGA newborn if the history of the mother reveals smoking, chronic medical conditions (such as asthma), and a substance use disorder. Additional maternal factors that increase the risk for an SGA newborn include hypertension, genetic disorders, and multiple gestations.

A nurse is conducting a presentation at a community health center about congenital malformations. The nurse describes that some common congenital malformations can occur and are recognized to be caused by multiple genetic and environmental factors. Which example would the nurse most likely cite? a. spina bifida b. cystic fibrosis c. color blindness d. hemophilia

a. spina bifida Spina bifida is a multifactorial inherited disorder thought to be due to multiple genetic and environmental factors. Cystic fibrosis is considered an autosomal recessive inherited disorder, while color blindness and hemophilia are considered X-linked inheritance disorders.

A 36-week neonate born weighing 1,800 g has microcephaly and microphthalmia. Based on these findings, which risk factor might be expected in the maternal history? a. use of alcohol b. use of marijuana c. gestational diabetes d. positive group B streptococci

a. use of alcohol The most common sign of the effects of alcohol on fetal development is restricted growth in weight, length, and head circumference. Intrauterine growth restriction is not characteristic of marijuana use. Gestational diabetes usually produces large-for-gestational-age neonates. Positive group B streptococcus is not a relevant risk factor.

A woman's baby is HIV positive at birth. She asks the nurse if this means the baby will develop AIDS. Which statement would be the nurse's best answer? a. "She already has AIDS. That's what being HIV positive means." b. "The antibodies may be those transferred across the placenta; the baby may not develop AIDS." c. "HIV is transmitted at birth; having a cesarean birth prevented transmission." d. "HIV antibodies do not cross the placenta; this means the baby will develop AIDS."

b. "The antibodies may be those transferred across the placenta; the baby may not develop AIDS." Infants born of HIV-positive women test positive for HIV antibodies at birth because these have crossed the placenta. An accurate disease status cannot be determined until the antibodies fade at about 18 months. Testing positive for HIV antibodies does not mean the infant has AIDS. Having a cesarean birth does decrease the risk of transmitting the virus to the infant at birth; it does not prevent the transmission of the disease. HIV antibodies do cross the placenta, which is why babies born of HIV positive mothers are HIV positive.

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? a. "Treatment will start once your child can bear weight." b. "Treatment will begin immediately." c. "Treatment will consist of surgery when your child weighs about 10 pounds." d. "Treatment will include bilateral casts at 1 month of age."

b. "Treatment will begin immediately." Developmental dysplasia of the hip (DDH) is a congenital newborn condition that requires immediate intervention. The development of the acetabulum of the hip is defective, and it may or may not be dislocated. Treatment of the defect and dislocated hips involves positioning the hip into a flexed, abducted (externally rotated) position to attempt to press the femur into the acetabulum. This involves splints and halters as the first line of treatment. Treatment should not be delayed. Surgery and casts are typically not used as the first line of treatment.

A pregnant client has been diagnosed with gonorrhea. Which nursing interventions should be performed to prevent gonococcal ophthalmia neonatorum in the baby? a. Administer cephalosporins to mother during pregnancy. b. Instill a prophylactic agent in the eyes of the newborn. c. Perform cesarean birth to prevent infection. d. Administer an antiretroviral syrup to the newborn.

b. Instill a prophylactic agent in the eyes of the newborn. To prevent gonococcal ophthalmia neonatorum in the baby, the nurse should instill a prophylactic agent in the eyes of the newborn. Cephalosporins are administered to the mother during pregnancy to treat gonorrhea but not to prevent infection in the newborn. Performing a cesarean birth will not prevent gonococcal ophthalmia neonatorum in the newborn. An antiretroviral syrup is administered to the newborn only if the mother is HIV positive and will not help prevent gonococcal ophthalmia neonatorum in the baby.

A nurse is assigned to care for a newborn with hyperbilirubinemia. The newborn is relatively large in size and shows signs of listlessness. What most likely occurred? a. The infant's mother must have had a long labor. b. The infant's mother probably had diabetes. c. The infant may have experienced birth trauma. d. The infant may have been exposed to alcohol during pregnancy.

b. The infant's mother probably had diabetes. The nurse should know that the infant's mother more than likely had/has diabetes. The large size of the infant born to a mother with diabetes is secondary to exposure to high levels of maternal glucose crossing the placenta into the fetal circulation. Common problems among infants of mothers with diabetes include macrosomia, respiratory distress syndrome, birth trauma, hypoglycemia, hypocalcemia and hypomagnesemia, polycythemia, hyperbilirubinemia, and congenital anomalies. Listlessness is also a common symptom noted in these infants. Infants born to clients who use alcohol during pregnancy, infants who have experienced birth traumas, or infants whose mothers have had long labors are not known to exhibit these particular characteristics, although these conditions do not produce very positive pregnancy outcomes. Infants with fetal alcohol spectrum disorder or alcohol exposure during pregnancy do not usually have hypoglycemia problems.

A nurse is conducting a presentation for a group of pregnant women about measures to prevent toxoplasmosis. The nurse determines that additional teaching is needed when the group identifies which measure as preventive? a. washing raw fruits and vegetables before eating them b. cooking all meat to an internal temperature of 125° F (52° C) c. wearing gardening gloves when working in the soil d. avoiding contact with a cat's litter box

b. cooking all meat to an internal temperature of 125° F (52° C) Meats should be cooked to an internal temperature of 160° F (71° C). Other measures to prevent toxoplasmosis include peeling or thoroughly washing all raw fruits and vegetables before eating them, wearing gardening gloves when in contact with outdoor soil, and avoiding the emptying or cleaning of a cat's litter box.

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? a. cleft palate b. esophageal atresia c. cleft lip d. coarctation of the aorta

b. esophageal atresia Any swallowed mucus or fluid enters the blind pouch of the esophagus when a newborn suffers from esophageal atresia. The newborn with this disorder will have frothing, excessive drooling, and periods of respiratory distress with choking and cyanosis. If this happens, no feedings should be given until the newborn has been examined.

A nurse is conducting an in-service presentation to a group of perinatal nurses about sexually transmitted infections and their effect on pregnancy. The nurse determines that the teaching was successful when the group identifies which infection as being responsible for ophthalmia neonatorum? a. syphilis b. gonorrhea c. chlamydia d. HPV

b. gonorrhea Infection with gonorrhea during pregnancy can cause ophthalmia neonatorum in the newborn from birth through an infected birth canal. Infection with syphilis can cause congenital syphilis in the neonate. Infection with chlamydia can lead to conjunctivitis or pneumonia in the newborn. Exposure to HPV during birth is associated with laryngeal papillomas.

The nurse is providing care to a neonate whose mother has heroin use disorder. The nurse suspects that the neonate is experiencing neonatal abstinence syndrome based on which finding? a. hypotonicity b. sneezing c. easy consolability d. vigorous sucking

b. sneezing Newborns of mothers with heroin or other opioid use disorder display irritability, hypertonicity, a high-pitched cry, vomiting, diarrhea, respiratory distress, disturbed sleeping, sneezing, diaphoresis, fever, poor sucking, tremors, and seizures.

The nurse is assessing a newborn of a woman who is suspected of abusing alcohol. Which newborn finding would provide additional evidence to support this suspicion? a. wide, large eyes b. thin upper lip c. protruding jaw d. elongated nose

b. thin upper lip Newborn characteristics suggesting fetal alcohol spectrum disorder include thin upper lip, small head circumference, small eyes, receding jaw, and short nose. Other features include a low nasal bridge, short palpebral fissures, flat midface, epicanthal folds, and minor ear abnormalities.

A nurse is providing care to a 34-week newborn diagnosed with neonatal abstinence syndrome (NAS). What is most important for the nurse to consider for successful management of the newborn with NAS? a. Parents should be encouraged to participate in care. b. Pharmacologic therapy is preferred for newborns with NAS. c. Nursing care should be supportive and client specific. d. Collaboration with social services is important.

c. Nursing care should be supportive and client specific. The most important thing for the nurse to consider is that it is essential for care to be supportive and specific to the newborn. Parents should be encouraged to participate in care when possible and the nurse should collaborate with social services but it is most important that the nurse provide care that is specific to the newborn. Most newborns diagnosed with NAS do not require pharmacologic therapy and are treated with supportive measures until they finish withdrawal.

A newborn with esophageal atresia has just returned from surgery to place a gastrostomy tube. Which client outcome will the nurse use when planning postoperative nursing care? a. The client will have balanced nutrition within 4 weeks. b. The client will reverse fluid volume excess within 2 days. c. The client will remain free from infection at the gastrostomy tube site. d. The client will cough and deep breathe following surgical procedure.

c. The client will remain free from infection at the gastrostomy tube site. An outcome of nursing care is important to identify early. For this newborn, the priority is skin integrity and the outcome is that the client will remain free from infection. Acidic gastric secretions can leak onto the skin from the gastrostomy site, leading to skin irritation. The nurse should plan interventions to protect the skin by using a cream or commercial skin protection system or consult with a wound, ostomy, and continence therapy nurse to reduce the possibility of skin irritation and infection. With the placement of the gastrostomy tube, the newborn is at less risk for imbalanced nutrition and excess fluid volume. The gastrostomy tube will not affect the newborn's gas exchange; however, a newborn is unable to complete coughing and deep breathing exercises.

A nurse is preparing a presentation for a group of neonatal nurses on clubfoot (congenital talipes equinovarus). The nurse determines that the presentation was successful when the group makes which statement? a. Clubfoot is a common genetic disorder. b. The condition affects girls more often than boys. c. The exact cause of clubfoot is not known. d. The intrinsic form can be manually reduced.

c. The exact cause of clubfoot is not known. Clubfoot (congenital talipes equinovarus) is a complex, multifactorial deformity with genetic and intrauterine factors. Heredity and race seem to factor into the incidence, but the means of transmission and the etiology are unknown. Most newborns with clubfoot have no identifiable genetic, syndromal, or extrinsic cause. Clubfoot affects boys twice as often as girls. With the intrinsic type, manual reduction is not possible.

What would the nurse expect to prioritize in the assessment of a newborn who has a positive Coombs test? a. tremor activity b. hyperglycemia c. jaundice development d. phenylketonuria

c. jaundice development A direct Coombs test is done to identify hemolytic disease of the newborn; positive results indicate that the newborn's red blood cells have been coated with antibodies and thus are sensitized. The Coombs test is frequently used in the evaluation of a jaundiced infant. Phenylketonuria (PKU) is a genetic disorder in which the body cannot process part of a protein called phenylalanine.

A newborn is suspected to have fetal alcohol syndrome as a result of maternal use of alcohol during pregnancy. Which of the following would the nurse expect to assess? a. thick upper lip b. large bulging eyes c. low nasal bridge d. long nose

c. low nasal bridge A low nasal bridge is seen in fetal alcohol syndrome (FAS). The other features of FAS include thin, flat upper lip, small eyes with short palpebral fissure, flattened midface with a short nose. The facial features result from damage to the embryonic cells in early pregnancy.

The nurse should carefully monitor which neonate for hyperbilirubinemia? a. neonate of African descent b. neonate of an Rh-positive mother c. neonate with ABO incompatibility d. neonate with Apgar scores 9 and 10 at 1 and 5 minutes

c. neonate with ABO incompatibility The mother's blood type, which is different from the neonate's, has an impact on the neonate's bilirubin level due to the antigen antibody reaction. Neonates of African descent tend to have lower mean levels of bilirubin. Chinese, Japanese, Korean, and Greek neonates tend to have higher incidences of hyperbilirubinemia. Neonates of Rh-negative, not Rh-positive, mothers tend to have hyperbilirubinemia. Low Apgar scores may indicate a risk for hyperbilirubinemia; 9 and 10 associate with normal adjustment to extrauterine life.

A pregnant woman in her second trimester comes to the prenatal clinic for a routine visit. She reports that she has a new kitten. The nurse would have the woman evaluated for which infection? a. cytomegalovirus b. parvovirus B19 c. toxoplasmosis d. herpes simplex virus

c. toxoplasmosis Toxoplasmosis is transferred by hand to mouth after touching cat feces while changing the litter box or through gardening in contaminated soil. Cytomegalovirus is transmitted via sexual contract, blood transfusions, kissing, and contact with children in daycare centers. Parvovirus B19 is a common self-limiting benign childhood virus that causes fifth disease. A pregnant woman may transmit the virus transplacentally to her fetus if she is exposed to an infected child. Herpesvirus infection occurs by direct contact of the skin or mucous membranes with an active lesion through kissing, sexual contact, or routine skin-to-skin contact.

Which respiratory disorder in a neonate is usually mild and runs a self-limited course? a. pneumonia b. meconium aspiration syndrome c. transient tachypnea of the newborn d. Persistent pulmonary hypertension

c. transient tachypnea of the newborn Transient tachypnea of the newborn (TTN) has an invariably favorable outcome after several hours to several days. The outcome of pneumonia depends on the causative agent involved and may have complications. Meconium aspiration, depending on severity, may have long-term adverse effects. In persistent pulmonary hypertension, mortality is more than 50%.

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? a. "They will be placing a tube in the stomach during surgery." b. "The baby will have tubes in the chest to drain chest fluids." c. "Intravenous fluids are going to be needed so that the baby won't get dehydrated." d. "After this surgery is done tomorrow, my baby will be able to eat and drink."

d. "After this surgery is done tomorrow, my baby will be able to eat and drink." The newborn will need IV fluids to maintain optimal hydration. The first stage of surgery may involve a gastrostomy and a method of draining the proximal esophageal pouch. A chest tube is inserted to drain chest fluids. If the repair is complex, surgery may need to be done in stages.

A pregnant single mom living alone tells the nurse she is considering getting a cat for her 2-year-old daughter. Which is the best response by the nurse? a. "The exposure to the cat litter may cause you to need a C-section." b. "This will cut down on the jealousy for your two-year-old when the baby comes." c. "If you don't think caring for a cat is too much work, that would be great." d. "You should wait until after you give birth to obtain the cat for your daughter."

d. "You should wait until after you give birth to obtain the cat for your daughter." Toxoplasma gondii is a protozoan that can be transmitted via undercooked meat and through cat litter. Having a cat is not an issue, but cleaning the litter box may expose the mother to the infection and result in fetal anomalies. Exposure to the cat litter will not necessitate a cesarean section, and having a cat will not cut down on any jealousy the 2-year-old might feel when the new baby is born. The nurse would discourage the mother from getting cat until after the baby is born.

A nurse is caring for an infant with an elevated bilirubin level who is under phototherapy. What evaluation data would best indicate that the newborn's jaundice is improving? a. Reticulocyte count is 6%. b. Hematocrit is 38. c. Skin looks less jaundiced. d. Bilirubin level went from 15 to 11.

d. Bilirubin level went from 15 to 11. The newborn has physiologic jaundice, which is related to decreased bilirubin conjugation. Newborns have relatively immature livers and cannot conjugate (break down) bilirubin as fast as needed. Bilirubin overproduction is responsible for causing jaundice. A serum bilirubin is the best way to determine whether the jaundice is improving. The other listed methods will not address the needed information.

A client at 34 weeks' gestation has recently been diagnosed with human immunodeficiency virus (HIV). The client asks how HIV would be transmitted to the newborn. Which statement would be the nurse's best response? a. "It is not transmitted to your newborn as it is protected in the uterus." b. "The risk of your newborn being infected with HIV infection is about 1%." c. "It is only transmitted through the birth canal so a cesarean birth will be scheduled." d. "It is recommended to formula-feed your newborn as it is transmitted through your breast milk."

d. It is recommended to formula-feed your newborn as it is transmitted through your breast milk." An infected mother can transmit HIV infection to her newborn before or during birth and through breastfeeding. The risk of perinatal transmission of HIV from an infected mother to her newborn is about 25%. This risk falls to less than 1% if the mother receives antiretroviral therapy during pregnancy. HIV can be spread to the infant through breastfeeding. HIV-infected mothers should be counseled to avoid breastfeeding and use formula instead.

The nursery nurse notes that one of the newborn infants has white patches on his tongue that look like milk curds. What action would be appropriate for the nurse to take? a. Wipe the tongue off vigorously to remove the white patches. b. Rinse the tongue off with sterile water and a cotton swab. c. Since it looks like a milk curd, no action is needed. d. Report the finding to the pediatrician.

d. Report the finding to the pediatrician. Although the finding looks like a milk curd, if the white patch remains after feeding, the pediatrician needs to be notified. The likely cause of the white patch on the tongue is a fungal infection called Candida albicans, which the newborn probably contracted while passing through the birth canal. The nurse should not try to remove the patches.

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

d. meconium stained fluids followed by tachypnea Meconium stained cord and skin indicates a potential of meconium aspiration, and the nurse should inform the primary care provider. But if the infant actually experiences respiratory distress following a birth with meconium stained fluids, the likelihood of meconium aspiration is greatly increased. Listlessness or lethargy by themselves does not indicate meconium aspiration. Bluish skin discoloration is normal in infants shortly after birth until the infant's respiratory system clears out all the amniotic fluid.

The small-for-gestational-age neonate is at increased risk for which complication during the transitional period? a. anemia probably due to chronic fetal hypoxia b. hyperthermia due to decreased glycogen stores c. hyperglycemia due to decreased glycogen stores d. polycythemia, probably due to chronic fetal hypoxia

d. polycythemia, probably due to chronic fetal hypoxia The small-for-gestational-age neonate is at risk for developing polycythemia during the transitional period in an attempt to decrease hypoxia. This neonate is also at increased risk for developing hypoglycemia and hypothermia due to decreased glycogen stores.

When caring for a neonate receiving phototherapy, the nurse should remember to: a. decrease the amount of formula. b. dress the neonate warmly. c. massage the neonate's skin with lotion. d. reposition the neonate frequently.

d. reposition the neonate frequently. Phototherapy works by the chemical interaction between a light source and the bilirubin in the neonate's skin. Therefore, the larger the skin area exposed to light, the more effective the treatment. Changing the neonate's position frequently ensures maximum exposure. Because the neonate will lose water through the skin as a result of evaporation, the amount of formula or water may need to be increased. The neonate is typically undressed to ensure maximum skin exposure. The eyes are covered to protect them from light, and an abbreviated diaper is used to prevent soiling. The skin should be clean and patted dry. Use of lotions would interfere with phototherapy.

Assessment of a pregnant client reveals that she has tested positive for a sexually transmitted infection (STI). The nurse understands that the client's newborn is at risk for which of the following? a. diabetes b. hypertension c. neurologic damage d. low birth weight

neurologic damage Explanation: The nurse should inform the client that children born of mothers with STIs are often born with neurologic damage, congenital abnormalities, and meningitis. Children born of STI mothers are not known to be born with diabetes or hypertension. Low birth weight is associated with smoking during pregnancy.