Maternity Chapter 23

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

B A birth injury is typically characterized by asymmetrical movement. Temperature instability, seizures, and feeble sucking suggest hypoglycemia.

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

B Hyperbilirubinemia is associated with jaundice and tea-colored urine. Temperature instability, seizures, and feeble sucking suggest hypoglycemia.

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? malabsorption syndrome dumping syndrome necrotizing enterocolitis acute gastroenteritis

C An inability to digest enteral feeding is a sign that necrotizing enterocolitis (NEC), a destructive intestinal disorder that often occurs in preterm babies, may be developing. Dumping syndrome and malabsorption may be consequences of NEC. Neonates rarely develop acute gastroenteritis.

What is a consequence of hypothermia in a newborn? skin pink and warm heart rate of 126 respirations of 46 holds breath 25 seconds

D Apnea is the cessation of breathing for a specific amount of time, and in newborns it usually occurs when the breath is held for 15 seconds. Apnea, cyanosis, respiratory distress, and increased oxygen demand are all consequences of hypothermia.

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

B The newborn may be in pain if the following are exhibited: sudden high-pitched cry; facial grimace with furrowing of brown and quivering chin; increased muscle tone; oxygen desaturation; body posturing, such as squirming, kicking, and arching; limb withdrawal and thrashing movements; increase in heart rate, blood pressure, pulse, and respirations; fussiness and irritability.

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? "The late preterm infant is more mature and able to cope as well as a full-term infant." "Late preterm newborns have fewer clinical problems leading to shorter hospital stays." "A late preterm newborn may have more clinical problems compared with full-term newborns." "Late preterm infant complications are considered minor compared to the preterm newborn."

C The most common complications for late preterm infants are cold stress, respiratory distress, hypoglycemia, sepsis, cognitive delays, hyperbilirubinemia, and feeding difficulties. These are similar to those facing the preterm newborn and require similar management. Late preterm newborns have more clinical problems, longer lengths of stay, higher costs when compared with full-term newborns, and increased mortalities.

When discussing heat loss in newborns, placing a newborn on a cold scale would be an example of what type of heat loss? conduction convection radiation evaporation

A A conduction heat loss results from direct contact with an object that is cooler.

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 brown lanugo body hair round flushed face protuberant abdomen

A A small-for-gestational-age (SGA) newborn will typically have a head that is larger than the rest of his or her body. SGA newborns weigh below the 10th percentile on the intrauterine growth chart for gestational age. They have an angular and pinched face and not a rounded and flushed face. Round flushed face and protuberant abdomen are the characteristic features of large-for-gestational-age (LGA) newborns. Preterm newborns, and not SGA newborns, are covered with brown lanugo hair all over the body.

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? "Newborns who are appropriate-for-gestational-age at birth have lower chance of complications than others." "Appropriate-for-gestational-age describes a newborn with a weight over the 90th percentile at birth." "Appropriate-for-gestational-age means a newborn is born with a weight that falls in the 10th percentile." "Infants who are larger-for-gestational-age at birth have fewer complications than the other groups."

A Birth weight variations include appropriate-for-gestational-age (AGA), which describes a newborn with a weight that falls within the 10th to 90th percentile for that particular gestational age. This describes approximately 80% of all newborns. Infants who are appropriate-for-gestational-age have lower morbidity and mortality than other groups.

The nurse is caring for a neonate in the neonatal intensive care unit (NICU). Which nursing action exemplifies developmental care? clustering care and activities holding the infant administering medications giving a bath

A Clustering care and activities in the NICU decreases stress and helps developmentally support premature and sick infants. Developmental care can decrease assistance needed and length of hospital stay. The other choices are part of basic infant care.

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. Observe feeding tolerance. Monitor intake and output. Assess for hyperglycemia.

A 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 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." "Not really, as premature infants are cared for in an isolate, protecting them from infection." "Yes, as they lack the antibody called IdD that acts as protection from infections.

A Explanation: The preterm newborn's immune system is very immature, increasing his or her susceptibility to infections. A deficiency of IgG may occur because transplacental transfer does not occur until after 34 weeks' gestation. This protection is lacking if the baby was born before this time. Preterm newborns have an impaired ability to manufacture antibodies to fight infection if they were exposed to pathogens during the birth process. The preterm newborn's thin skin and fragile blood vessels provide a limited protective barrier, adding to the increased risk for infection. Anticipating and preventing infections is the goal with frequent handwashing. Breastfeeding will eventually establish some protective mechanisms.

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)

A Hypoglycemia in a neonate is defined as blood glucose value typically below 35 to 45 mg/dl (1.94 to 2.50 mmol/l). The American Academy of Pediatrics recommends intervening for a blood glucose less than 40 mg/dl (2.25 mmol/l) in the first 4 hours of life, and less than 45 mg/dl (mmol/l) at ages 4 hours to 24 hours.

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

A Intermittent oral feedings are initiated to prevent hypoglycemia as the newborn now must assume control of glucose homeostasis. Hydration and frequent monitoring of hematocrit are important to prevent polycythemia. Resuscitation and suctioning are used to manage meconium aspiration. Immediate resuscitation is used to manage asphyxia.

A small-for-gestational-age neonate is admitted to the observational nursery for blood work. Which result would require further assessment? hematocrit: 80% (0.80) total bilirubin: 0.3 to 1.9 mg/dl (5.13 µmol/L to 32.50 µmol/L) serum glucose: 40 mg/dl (2.5 mmol/L) hemoglobin: 15.6 grams/dl (156 g/L)

A Polycythemia is not uncommon and is a potentially serious disorder of newborns. It is defined as a venous hematocrit above 65% and hemoglobin of more than 20 grams. Polycythemia occurs in up to 12% of neonates, very commonly in SGA newborns 6 to 12 hours after birth. The other test results are normal for a newborn.

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? Provide a mobile the child can see no matter how he or she is turned. Bring the child's open bassinet near the desk area so the infant sees people. Place the infant's Isolette near the window so the child can see outside. Keep the environment free of color to reduce eye straining.

A Preterm infants are able to focus at short distances before they can see well at long distances. A mobile offers short-distance stimulation.

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." "Most preterm infants require additional oxygen through ventilation to sustain respiration." "Your infant's cardiovascular system is not developed yet in order to sustain respiration." "Premature infants have a respiratory system that takes time to adjust to extrauterine life."

A Preterm infants lacks surfactant to lower the surface tension in the alveoli and stabilize them to prevent their collapse. Even if preterm newborns can initiate respirations, they have a limited ability to retain air due to insufficient surfactant. Preterm newborns develop atelectasis quickly without alveoli stabilization. Fetal circulation patterns persist.

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. The skin is pale, and no vessels show through it. Creases appear on the interior two-thirds of the sole. The neonate has 7 to 10 mm of breast tissue.

A The ear has a soft pinna that is flat and stays folded. Pale skin with no vessels showing through and 7 to 10 mm of breast tissue are characteristic of a neonate at 40 weeks' gestation. Creases on the anterior two-thirds of the sole are characteristic of a neonate at 36 weeks' gestation.

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

A The nurse should administer 0.5 to 1 ml/kg/hr of breast milk enterally to induce surges in gut hormones that enhance maturation of the intestine. Administering vitamin D supplements, iron supplements, or intravenous dextrose will not significantly help the preterm newborn's gut overcome feeding difficulties.

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 Expiratory lag Inspiratory grunt Deep inspiration

A The nurse should identify sternal retraction as a sign of respiratory distress syndrome in the preterm newborn. Deep inspiration is not seen during respiratory distress; rather, a shallow and rapid respiration is seen. There is an inspiratory lag, instead of an expiratory lag, during respiratory distress. There is a grunting heard when the air is breathed out, which is during expiration and not during inspiration.

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. infant's pupils dilate after 3 minutes. abdomen rises while the chest falls with bag compressions.

A air is entering the lungs of a newborn, his or her chest muscles are so elastic that the chest can be seen rising and falling with bag compression.

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

ABC To minimize the risk of infections, the nurse should avoid coming to work when ill, use sterile gloves for an invasive procedure, and initiate universal precautions. The nurse should remove all jewelry before washing hands, not cover the jewelry. The nurse should use disposable equipment rather than avoid it.

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

ABE Controlling the temperature of preterm newborns is often difficult; therefore, special care should be taken to keep these babies warm. Nurses should dress them in a stockinette cap, take their temperature often, and supply oxygen, if necessary. To conserve the energy of small newborns, the nurse should handle them as little as possible. Usually, they will not give them a bath immediately. Parents should be encouraged to bond with their infants.

The nurse needs to conduct a procedure on a preterm newborn. Which measures would be most effective in reducing pain? Select all that apply. offering a pacifier prior to a procedure swaddling the newborn closely removing tape quickly from the skin increasing the volume on device alarms encouraging skin-to-skin (kangaroo) care during procedures

ABE Interventions to reduce pain in the preterm newborn include swaddling the newborn closely to establish physical boundaries; using gentle handling, rocking, caressing, and cuddling; encouraging skin-to-skin (kangaroo) care during procedures; and offering a pacifier for nonnutritive sucking prior to a procedure. Tape should be used minimally and should be removed gently to prevent skin tearing. Environmental stimuli need to be reduced, such as by turning down the volumes on alarms. Warm rather than cool blankets facilitate relaxation.

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? The newborn aspirated meconium, causing the wasted appearance. With postterm birth, the fetus uses stored nutrients to stay alive, and wasting occurs. A postterm newborn has begun to break down red blood cells more quickly. The newborn was exposed to an infection while in utero

B After 42 weeks' gestation, the placenta loses its ability to provide adequate oxygen and nutrients to the fetus, causing the fetus to use stored nutrients to stay alive. This leads to wasting. Meconium aspiration can occur with postterm newborns, but this is not the reason for the baby's wasted appearance. Hyperbilirubinemia occurs with the increased breakdown of red blood cells, but this too would not account for the wasted appearance. Exposure to an intrauterine infection is unrelated to the wasted appearance.

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? Monitor the infant at feedings. Initiate early oral feedings. Initiate daily newborn weights. Ensure feedings are on demand.

B Metabolic needs are increased for catch-up growth in the SGA newborn. Initiate early and frequent oral feedings. Neonatal hypoglycemia is a major cause of brain injury since the brain needs glucose continuously as a primary source of energy. A newborn stressed at birth uses up available glucose stores quickly with resulting hypoglycemia. A plasma glucose concentration at or below 40 mg/dL (2.5 mmol/L) necessitates and frequent oral feedings. With the loss of the placenta at birth, the newborn now must assume control of glucose homeostasis through oral feedings. The others at this time are not a priority.

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

B Nasal flaring is a sign of respiratory distress. Neonates with hypothermia show signs of respiratory distress (cyanosis, increased respirations, low oxygen saturation, nasal flaring, and grunting). The other choices are normal findings.

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? "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." "Oh yeah, the infant seems fine, you can see your infant soon." "Wait outside and we will call you later."

B The nurse should include the parents and notify them of any visible anomalies right away. An in-depth discussion can take place later when the diagnosis is more definitive. Although the family may be in shock or denial, the nurse should give a realistic appraisal of the condition of their infant. Keeping communication lines open will lessen the family's feelings of helplessness and support their parental role.

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

B The nurse should perform a thorough physical examination of the newborn and closely observe the newborn for typical SGA characteristics, which include the following: a newborn head that is disproportionately large compared with rest of body; a wasted appearance of extremities with reduced subcutaneous fat stores; a reduced amount of breast tissue; poor muscle tone over buttocks and cheeks; and a thin umbilical cord.

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? Give dextrose intravenously before oral feedings. Begin early feedings either by the breast or bottle. Focus on decreasing blood viscosity by introducing feedings. Place infant on radiant warmer immediately.

B The nurse should provide some nutrition to any infant born with hypoglycemia. Dextrose should be given intravenously only if the infant refuses oral feedings, not before offering the infant oral feedings. Placing the infant on a radiant warmer will not help maintain blood glucose levels. The nurse should focus on decreasing blood viscosity in an infant who is at risk for polycythemia, not hypoglycemia.

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 Provide supplemental oxygen and monitor respiratory status Administer oxygen via a bag and mask Gently shake the neonate

B 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.

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 80th percentile above 90th percentile above 95th percentile

C A newborn whose weight is above the 90th percentile on growth charts is defined as large-for-gestational-age.

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

C Because newborns do not manifest symptoms of a reduced glucose level until it decreases well below adult levels, a finding below 45 mg/100 ml whole blood is considered hypoglycemia

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

C Excess pressure in the alveoli stimulates the ductus arteriosus to remain open, compromising efficient cardiovascular function.

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

C Postdate neonates lose the vernix caseosa, and the epidermis may become peeled and wrinkled. A neonate at 42 weeks' gestation is usually very alert and missing lanugo.

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

C Postterm newborns typically exhibit the following characteristics: dry, cracked, peeling, wrinkled skin; vernix caseosa and lanugo are absent; long, thin extremities; creases that cover the entire soles of the feet; abundant hair on scalp; thin umbilical cord; long fingernails; limited vernix and lanugo; and meconium-stained skin and fingernails.

The nurse notices while holding a 1-day-old infant upright that the baby has a significantly indented anterior fontanel (fontanelle). She immediately brings it to the attention of the health care provider. What does this finding indicate? cyanosis vernix caseosa dehydration increased intracranial pressure

C The anterior fontanel (fontanelle) can be felt as a soft spot. It should not appear indented (a sign of dehydration) or bulging (a sign of increased intracranial pressure) when the infant is held upright. Vernix caseosa is the white, cream cheese-like substance that serves as a skin lubricant in utero. Some of it is invariably noticeable on a term newborn's skin, at least in the skin folds, at birth. Cyanosis is a condition of decreased oxygenation that results in the skin having a blue hue.

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 monitoring and maintaining blood glucose levels. Focus on decreasing blood viscosity by increasing fluid volume. Repeat screening every 2 to 3 hours or before feeds.

C The nurse should focus on decreasing blood viscosity by increasing fluid volume in the newborn with polycythemia. Checking blood glucose within 2 hours of birth by a reagent test strip and screening every 2 to 3 hours or before feeds are not interventions that will alleviate the condition of an infant with polycythemia. The nurse should monitor and maintain blood glucose levels when caring for a newborn with hypoglycemia, not polycythemia.

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

C The nurse should identify respiratory complications such as tachypnea as a symptom of meconium aspiration in the newborn that results from the presence of meconium in the amniotic fluid. Tachycardia, elevated bilirubin levels, and polycythemia are some of the common problems faced by an SGA newborn, but these are not related to meconium in the amniotic fluid.

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? "Feeding premature infants breast milk establishes the best protective mechanisms." "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." "Yes, as they lack the antibody called IdD that acts as protection from infections."

C The preterm newborn's immune system is very immature, increasing his or her susceptibility to infections. A deficiency of IgG may occur because transplacental transfer does not occur until after 34 weeks' gestation. This protection is lacking if the baby was born before this time. Preterm newborns have an impaired ability to manufacture antibodies to fight infection if they were exposed to pathogens during the birth process. The preterm newborn's thin skin and fragile blood vessels provide a limited protective barrier, adding to the increased risk for infection. Anticipating and preventing infections is the goal with frequent handwashing. Breastfeeding will eventually establish some protective mechanisms.

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

C To allow the infant to see a human face, assist the mother to assume an en face position with the infant. Mother and child need to be in the same plane and about 6 to 10 inches (15 to 25 cm) apart. Looking through the isolette dome or porthole distorts the image. Infants need to see objects within 12 inches (30 cm) to focus clearly.

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 low birth weight and small-for-gestational age The infant was born at term but at a very 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

D Born at 36 weeks' gestation is a preterm age (under 37 weeks). The infant was a low birthweight (under 2500 g) and small-for-gestational-age at the 8th percentile (under the 10th percentile). The other documentation is not accurate.

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? yellow appearance of the newborn's skin tremors, irritability, and high-pitched cry seizures, respiratory distress, cyanosis, and shrill cry meconium aspiration in utero or at birth

D Infants born after 42 weeks of pregnancy are postterm. These infants are at a higher risk of swallowing or aspirating meconium in utero or after birth. As soon as the infant is born, the nurse usually suctions out the secretions and fluids in the newborn's mouth and throat before the first breath to avoid aspiration of meconium and amniotic fluid into the lungs. Seizures, respiratory distress, cyanosis, and shrill cry are signs and symptoms of infants with intracranial hemorrhage. Intracranial hemorrhage can be a dangerous birth injury that is primarily a problem for preterm newborns, not postterm neonates. Yellow appearance of the newborn's skin is usually seen in infants with jaundice. Tremors, irritability, high-pitched or weak cry, and eye rolling are seen in infants with hypoglycemia.

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? late preterm and appropriate for gestational age late preterm, large-for-gestational-age, and low-birth-weight infant term, small-for-gestational-age, and very-low-birth-weight infant term, small-for-gestational-age, and low-birth-weight infant

D Infants born before term (before the beginning of the 38th week of pregnancy) are classified as preterm infants, regardless of their birth weight. Term infants are those born after the beginning of week 38 and before week 42 of pregnancy. Infants who fall between the 10th and 90th percentiles of weight for their gestational age, whether they are preterm, term, or postterm, are considered appropriate for gestational age (AGA). Infants who fall below the 10th percentile of weight for their age are considered small-for-gestational-age (SGA). Those who fall above the 90th percentile in weight are considered large-for-gestational-age (LGA). Still another term used is low-birth-weight (LBW; one weighing under 2500 g at birth). Those weighing 1000 to 1500 g are very-low-birth-weight (VLBW). Those born weighing 500 to 1000 g are considered extremely-low-birth-weight infants (ELBW).

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? "We will let the pediatrician know if our newborn's temperature goes above 100.4°F (38°C)." "We will call 911 if we start to see that our newborn's lips or skin are looking bluish." "If our newborn does not have a wet diaper in 12 hours, we will call our pediatrician." "If our newborn's skin turns yellow, it is from the treatments and our newborn is okay."

D The parents of a preterm newborn need teaching about when to notify their pediatrician or nurse practitioner. These include: displaying a yellow color to the skin (jaundice); having difficulty breathing or turning blue (call for emergency services in this case); having a temperature below 97°F (36.1°C) or above 100.4°F (38°C); and failing to void for 12 hours.

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 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

D The pressure exerted by the nurse's hand squeezing the bag controls the pressure delivered by an anesthesia bag. An ambu or resusci bag has a blow-off value that limits the pressure administered.