Chapter 25: PrepU - Acquired Conditions and Congenital Abnormalities in the Newborn

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? 1- syphilis 2- gonorrhea 3- chlamydia 4- HPV

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The nurse is assisting a client who has just undergone an amniocentesis. Blood results indicate the mother has type O blood and the fetus has type AB blood. The nurse should point out the mother and fetus are at an increased risk for which situation related to this procedure? 1- Placental abruption 2- Preterm birth 3- Baby developing hemolytic anemia 4- Baby developing postbirth jaundice

4

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? 1- small head circumference 2- decreased blood glucose level 3- poor breathing pattern 4- wide eyes

1

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? 1- spina bifida 2- cystic fibrosis 3- color blindness 4- hemophilia

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A nurse is providing preoperative care to a female newborn client with the congenital abnormality myelomeningocele. Which intervention is the priority? 1- preventing infection 2- promoting newborn nutrition 3- preserving newborn GI function 4- maximizing newborn motor function

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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? 1- Neisseria gonorrhoeae 2- Escherichia coli 3- Trichomonas vaginalis 4- Group B streptococci

1

The priority for the nurse caring of a newborn with esophageal atresia is to observe for which finding? 1- Aspiration 2- Bleeding 3- Constipation 4- Vomiting

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What would the nurse suspect in a premature newborn who has difficulty feeding and maintaining a stable temperature and is vomiting bile? 1- Necrotizing enterocolitis 2- Meconium aspiration syndrome 3- Intraventricular hemorrhage 4- Respiratory distress syndrome

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Which newborn would the nurse suspect to be most at risk for intellectual disability due to the mother's actions during pregnancy? 1- the child of a client who admits to drinking a liter of alcohol daily during the pregnancy 2- the child of a teenage client who used marijuana through her pregnancy to cope with stress 3- the newborn of a client addicted to heroin and in the methadone maintenance program 4- the newborn of a client who used cocaine occasionally during her pregnancy

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A neonate undergoing phototherapy treatment must be monitored for which adverse effect? 1- Hyperglycemia 2- Increased insensible water loss 3- Severe decrease in platelet count 4- Increased GI transit time

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A newborn is admitted to the nursery. Maternal history reveals the use of opioids. When assessing this newborn for symptoms of opioid withdrawal, which of the following the nurse expect the newborn to exhibit first? 1- Poor feeding 2- Tremors 3- Diarrhea 4- Weight loss

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A pregnant woman diagnosed with syphilis comes to the clinic for a visit. The nurse discusses the risk of transmitting the infection to her newborn, explaining that this infection is transmitted to the newborn through the: 1- amniotic fluid. 2- placenta. 3- birth canal. 4- breast milk.

2

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? 1- "She already has AIDS. That's what being HIV positive means." 2- "The antibodies may be those transferred across the placenta; the baby may not develop AIDS." 3- "HIV is transmitted at birth; having a cesarean birth prevented transmission." 4- "HIV antibodies do not cross the placenta; this means the baby will develop AIDS."

2

Which assessment finding would best validate a problem in a small-for-gestational age newborn secondary to meconium in the amniotic fluid? 1- total bilirubin level of 15 2- respiratory rate of 60 to 70 bpm 3- heart rate of 162 bpm 4- hematocrit of 44%

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Which finding would lead the nurse to suspect that a large-for-gestational-age newborn is developing hyperbilirubinemia? 1- temperature instability 2- tea-colored urine 3- seizures 4- feeble sucking

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A newborn has ambiguous genitalia. The parents are quite emotional and do not know what to do, or if they should raise the child as a boy or girl. What is the best advice for the nurse to offer at this time? 1- "It is important to make the decision based on your desire to have either a girl or boy." 2- "It is not that important right now. You have lots of time to make that decision." 3- "Research shows that it is best for anatomical structure to determine the sex of rearing." 4- "Surgery can be done to correct anomalies, so that's the important thing to consider."

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A newborn is diagnosed with ophthalmia neonatorum. The nurse understands that this newborn was exposed to which infection? 1- syphilis 2- Candida albicans 3- gonorrhea 4- human immunodeficiency virus

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A nurse is preparing a presentation for a group of neonatal nurses on congenital clubfoot. The nurse determines that the presentation was successful when the group makes which statement? 1- Clubfoot is a common genetic disorder. 2- The condition affects girls more often than boys. 3- The exact cause of clubfoot is not known. 4- The intrinsic form can be manually reduced.

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A nurse is preparing a presentation for a group of young adult pregnant women about common infections and their effect on pregnancy. When describing the infections, which infection would the nurse include as the most common congenital and perinatal viral infection in the world? 1- rubella 2- hepatitis B 3- cytomegalovirus 4- parvovirus B19

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A nurse is teaching a group of pregnant women about the adverse effects of substances on the fetus. The nurse determines that additional teaching is needed when the the group identifies which substance as being teratogenic? 1- alcohol 2- nicotine 3- marijuana 4- cocaine

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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? 1- Diabetes 2- Hypertension 3- Neurologic damage 4- Low birth weight

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Which respiratory disorder in a neonate is usually mild and runs a self-limited course? 1- Pneumonia 2- Meconium aspiration syndrome 3- Transient tachypnea 4- Persistent pulmonary hypertension

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Which assessment findings are most prominent in the infant with Tetralogy of Fallot and significant pulmonary stenosis? 1- Irregular heart rate, fatigue, pink tinged skin 2- Dry mucous membranes, poor urine output 3- Poor weight gain, nausea, decreased muscle tone 4- Dyspnea on limited exertion, fatigue, cyanosis

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A baby is born with congenital rubella. Which of the following would be an important assessment to be made before hospital discharge? 1- Hearing assessment 2- Assessment for cerebral palsy 3- Skin assessment for hemangiomas 4- Intravenous pyelogram for kidney function

1

A nurse identifies the urethral opening of a male newborn to be on the dorsum of the shaft of the penis. The nurse documents this finding as which of the following? 1- Hypospadias 2- Talipes equinovarus 3- Hydrocephalus 4- Omphalocele

1

A nurse is caring for a newborn client who is diagnosed with myelomeningocele. Which nursing intervention would protect the newborn from injury? 1- Place the newborn in a prone or lateral position. 2- Delay the parents from holding the newborn. 3- Place petroleum jelly gauze on the spinal sac to keep it moist. 4- Place a urine collection bag on newborn for the continuous leakage.

1

A nurse is conducting a presentation about prenatal care and preexisting maternal conditions. When discussing the various risks to the mother and infant, the nurse would include information about which condition as the leading cause of intellectual disability in the United States? 1- fetal alcohol spectrum disorder 2- genetic anomalies 3- maternal drug addiction 4- pregnancy category X medications

1

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? 1- reduction in viral loads in the blood 2- treatment of opportunistic infections 3- adjunct therapy to radiation and chemotherapy 4- can cure acute HIV/AIDS infections

1

Cytomegalovirus infection can result in different congenital anomalies. It can also be transmitted via different routes. When discussing this infection with a pregnant woman, the nurse integrates understanding that permanent fetal disability can occur with which type of transmission of CMV? 1- in utero transmission 2- during birth transmission 3- after birth transmission 4- with any transmission

1

Newborns born to a mother with diabetes are at risk for which of the following? 1- Hypoglycemia, delayed fetal lung maturity, respiratory distress, and shoulder dystocia 2- Hyperglycemia, meconium aspiration syndrome, cerebral ischemia, and polycythemia 3- Hypoglycemia, polycythemia, respiratory distress, and hyperviscosity of the blood 4- Hyperglycemia, intrauterine hypoxia, hemolytic disease of the newborn, and hyperviscosity of the blood

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The client brings her infant daughter to the pediatrician's office for her first visit since hospital discharge. At birth, the newborn was at the 8th percentile with a weight of 2,350 g. She was born at 36 weeks' gestation. Which documentation is most accurate? 1- The infant was a preterm, low birth weight and small for gestational age neonate. 2- The infant was born at term but at a low birth weight and small for gestational age. 3- The infant was born at term but a very low birth weight and small for gestational age. 4- The infant was a preterm, very low birth weight and small for gestational age.

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The newborn nursery nurse suspects a newborn of having neonatal abstinence syndrome. What assessment findings would most correlate with the diagnosis? 1- frequent yawning and sneezing 2- vigorous rooting and feeding 3- positive Babinski and Moro refelxes 4- cyanotic discoloration of the hands and feet

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The nurse is caring for a newborn client newly diagnosed with developmental dysplasia of the hip. Which response by the nurse educates the parents on the correct plan of treatment for this diagnosis? 1- "Treatment will start once your child can bear weight." 2- "Treatment will begin immediately." 3- "Treatment will consist of surgery when your child weighs about 10 pounds." 4- "Treatment will include bilateral casts at 1 month of age."

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The nurse is providing care to a neonate whose mother has heroin use disorder. Which finding would the nurse expect to assess? 1- hypotonicity 2- sneezing 3- easy consolability 4- vigorous sucking

2

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? 1- "It's a good idea to stop drinking alcohol 3 months before trying to get pregnant." 2- "It's important to add iron and vitamin B supplements to your diet." 3- "It would be good to stop smoking before getting pregnant." 4- "It's important to keep insulin levels controlled during pregnancy."

1

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? 1- She can receive her varicella vaccine immediately after delivery, followed by a second dose at her 6-week postpartum visit. 2- The likelihood of her catching varicella is very slim, so tell her not to worry. 3- She needs to let her physician know that she has not had varicella so she can get immunized at her next visit. 4- Even if she does get varicella, her baby will be fine since varicella is not passed on to the fetus.

1

The nurse suspects a preterm newborn receiving enteral feedings of having necrotizing enterocolitis (NEC). What assessment finding best correlates with this diagnosis? 1- bloody stools 2- poor suck reflex 3- high-pitched cry 4- meconium stools

1

The nurse is assessing a newborn diagnosed with meconium aspiration. Which of the following would the nurse expect to assess? Select all that apply. 1- Intercostal and substernal retractions 2- Increased anteroposterior chest diameter 3- Pink skin 4- Respirations of 45 5- Tachycardia

1,2,

A nurse is assessing a newborn. The nurse suspects that the newborn was exposed to drugs while in utero based on which findings? Select all that apply. 1- tremors 2- frequent yawning 3- coordinated sucking 4- respirations of 43 breaths per minute 5- nasal flaring

1,2,5

A premature, 38-week-gestation neonate is admitted to the observational nursery and placed under bili-lights with evidence of hyperbilirubinemia. Which assessment findings would the neonate demonstrate? Select all that apply. 1- clay-colored stools 2- tea-colored urine 3- cyanosis 4- Mongolian spots 5- increased serum bilirubin levels

1,2,5

After teaching a group of nursing students about fetal alcohol syndrome, the instructor determines that the teaching was successful when the students identify which of the following as an appropriate nursing intervention? Select all that apply. 1- Clustering of nursing care activities 2- Maintaining a well-stimulated environment 3- Limiting how often the newborn is handled 4- Administering clonidine as ordered 5- Providing meticulous perianal skin care

1,3

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. 1- Increase the infant's hydration. 2- Stop breastfeeding until jaundice resolves. 3- Offer early feedings. 4- Administer vitamin supplements. 5- Initiate phototherapy.

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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? 1- The infant's mother must have had a long labor. 2- The infant's mother probably had diabetes. 3- The infant may have experienced birth trauma. 4- The infant may have been exposed to alcohol during pregnancy.

2

A nurse is caring for a preterm newborn born at 29 weeks' gestation. Which nursing diagnosis would have the highest priority? 1- Grieving related to the loss of "a healthy full-term newborn" 2- Ineffective thermoregulation related to decreased amount of subcutaneous fat 3- Risk for injury related to the very thin epidermis layer of skin 4- Imbalanced nutrition: Less than body requirements related to the premature digestive system

2

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? 1- washing raw fruits and vegetables before eating them 2- cooking all meat to an internal temperature of 125° F (52° C) 3- wearing gardening gloves when working in the soil 4- avoiding contact with a cat's litter box

2

A nurse is teaching the mother of a newborn experiencing cocaine withdrawal about caring for the neonate at home. The mother stopped using cocaine near the end of her pregnancy. The nurse determines that additional teaching is needed when the mother identifies which action as appropriate for her newborn? 1- wrapping the newborn snugly in a blanket 2- waking the newborn every hour 3- checking the newborn's fontanels 4- offering a pacifier

2

A pregnant client has been diagnosed with gonorrhea. Which nursing interventions should be performed to prevent gonococcal ophthalmia neonatorum in the baby? 1- Administer cephalosporins to mother during pregnancy. 2- Instill a prophylactic agent in the eyes of the newborn. 3- Perform cesarean birth to prevent infection. 4- Administer an antiretroviral syrup to the newborn.

2

An infant is suffering from neonatal abstinence syndrome. The nurse provides appropriate care and support for the infant during the infant's time on the unit. Besides nursing and medical care, what other step would the nurse take to support the infant? 1- Contact the chaplain. 2- Link the family with community sources for aid. 3- Make sure the infant was in a bright, loud room. 4- Make sure a volunteer feeds the baby.

2

The nursing instructor is discussing congenital heart disease with a group of students. Which statement indicates that students need further teaching? 1- "The foramen ovale allows blood to pass from the right atrium to the left atrium during fetal life." 2- "The ductus arteriosus carries deoxygenated blood from the aorta to the pulmonary artery during fetal life." 3- "Oxygenated blood goes out to the body through the aorta." 4- "Blood returns to the heart from the inferior vena cava."

2

A male newborn is born with hypospadias. The nurse doing the newborn physical assessment notes that the penis is also curved downward. What information would the nurse provide the parents for this infant? 1- The circumcision may have to be revised when he is older. 2- The infant's penis will not require surgery but may never be completely straight. 3- His ability to void and have an erection in adulthood may be impaired and surgery is needed. 4- The parents will be taught maneuvers to perform on the penis to help straighten it out prior to repairing the urethral opening.

3

A newborn is discharged from a healthcare center following treatment for bronchopulmonary dysplasia. Which of the following interventions would be most important for the home care nurse to do when caring for this newborn? 1- Administering surfactant on a weekly basis 2- Monitoring the arterial blood gas level 3- Monitoring oxygen saturation levels weekly 4- Administering intravenous antibiotics

3

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. 1- Thick upper lip 2- Large bulging eyes 3- Low nasal bridge 4- Long nose

3

A nurse is caring for a newborn whose chest X-ray reveals marked hyperaeration mixed with areas of atelectasis. The infant's arterial blood gas analysis indicates metabolic acidosis. For which dangerous condition should the nurse prepare when providing care to this newborn? 1- choanal atresia 2- diaphragmatic hernia 3- meconium aspiration syndrome 4- pneumonia

3

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? 1- a normal spinal closure 2- spina bifida with menigocele 3- spina bifida occulta 4- spina bifida with myelomeningocele

3

The nurse is teaching new parents about their newborn who was born with respiratory distress syndrome (RDS). The nurse determines the teaching session is successful when the parents correctly choose which explanation as being the cause of their newborn's condition? 1- The lungs are hyperextended due to increased load of work. 2- The infant has inherited allergies from the mother. 3- The lungs are immature and deficient in surfactant. 4- The mother has a history of asthma which interfered in lung development.

3

The nurse teaches the parents of a newborn with hyperbilirubinemia about home phototherapy using bilirubin lights. Which statement indicates that the teaching was successful? 1- "We'll place the lights so that they are about 5 inches above our baby at all times." 2- "We will turn him every ½ hour to make sure that his whole body is exposed." 3- "We'll take off the patches on his eyes when we're feeding him so he can look at us." 4- "We should see reddened areas on his skin, which means the treatment is working."

3

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? 1- Reticulocyte count is 6%. 2- Hematocrit is 38. 3- Skin looks less jaundiced. 4- Bilirubin level went from 15 to 11.

4

A nurse is providing postoperative care to an infant who had a ventriculoatrial shunt placed. Approximately 8 hours after surgery, the nurse notes on assessment shrill crying and projective vomiting. Which response should the nurse prioritize at this time? 1- Assess surgical site for signs of infection. 2- Increase the flow of IV fluids and maintain NPO status. 3- Assess and administer pain medication. 4- Notify the primary care provider immediately.

4

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? 1- "The exposure to the cat litter may cause you to need a C-section." 2- "This will cut down on the jealousy for your two-year-old when the baby comes." 3- "If you don't think caring for a cat is too much work, that would be great." 4- "You should wait until after you give birth to obtain the cat for your daughter."

4

A pregnant woman asks the nurse, "I'm a big coffee drinker. Will the caffeine in my coffee hurt my baby?" Which response by the nurse would be most appropriate? 1- "The caffeine in coffee has been linked to birth defects." 2- "Caffeine has been shown to cause growth restriction in the fetus." 3- "Caffeine is a stimulant and needs to be avoided completely." 4- "If you keep your intake to less than 300 mg/day, you should be okay."

4

Assessment of a pregnant woman and her fetus reveals tachycardia and hypertension. There is also evidence suggesting vasoconstriction. The nurse would question the woman about use of which substance? 1- marijuana 2- alcohol 3- heroin 4- cocaine

4

The nurse is assessing a newborn suspected of having meconium aspiration syndrome. What sign or symptom would be most suggestive of this condition? 1- high-pitched, shrill cry 2- bile-stained emesis 3- intermittent tachypnea 4- expiratory grunting

4

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? 1- Wipe the tongue off vigorously to remove the white patches. 2- Rinse the tongue off with sterile water and a cotton swab. 3- Since it looks like a milk curd, no action is needed. 4- Report the finding to the pediatrician.

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