OB - Ch 24: Nursing Management of the Newborn at Risk: Acquired and Congenital Newborn Conditions (PrepU Questions)
A nurse is explaining to the parents the preoperative care for their infant born with bladder exstrophy. The parents ask, "What will happen to the bladder while waiting for the surgery?" What is the nurse's best response?
"The bladder will be covered in a sterile plastic bag to keep it moist." Explanation: In the preoperative period, infant care is focused on protecting the exstrophied bladder and preventing infection. The infant is kept in a supine position, and the bladder is kept moist and covered with a sterile plastic bag. Change soiled diapers immediately to prevent contamination of the bladder with feces. Sponge-bathe the infant only (rather than immersing him or her in water) to prevent pathogens in the bath water from entering the bladder. Consult the ostomy nurse if necessary.
The nurse is caring for a client who is at her due date. The client asks. "How long is the health care provider going to let me go?" The nurse is correct to state that typical a mother should not pass how many weeks' gestation?
42 weeks Explanation: The nurse is most correct to state that mothers do not progress longer than 42 weeks gestation. At that point, either a cesarean section or an induction would be completed. Actual dates do vary depending on the status of the fetus.
A nursing instructor is teaching about newborn congenital disorders and realizes that the student needs further instruction after making which statement?
All congenital disorders can be diagnosed at birth." Explanation: All congenital disorders are not diagnosed at birth. Hydrocephalus is one such disorder that may be diagnosed at birth but also may not be diagnosed until after a few weeks or months. It is also true that congenital defects may be caused by both genetics and environmental factors.
After assessing the status of a newborn, the nurse is concerned that this newborn has persistent pulmonary hypertension. When explaining it to the parents, the nurse would integrate knowledge about which event as having most likely occurred?
Foramen ovale has not closed. Explanation: With persistent pulmonary hypertension, pulmonary vascular resistance is elevated to where the venous blood is diverted to some degree through fetal structures, preventing the foramen ovale or ductus arteriosus from closing as they should. This leads to a right-to-left shunting of blood into the systemic circulation. Hypoxia will result in acidosis, and there may also be a tricuspid insufficiency murmur noted on auscultation.
In completing the newborn assessment checklist, the nurse documents a meconium stool. This documentation rules out which condition?
Imperforate anus Explanation: Clinical manifestations of an imperforate anus include not having a meconium stool within the first 24 hours of birth. A hiatal hernia can cause esophageal reflux. Spina bifida occulta is caused by a neural tube defect and is typically asymptomatic, causing no problems. Epispadias is when the opening of the urethra is on the dorsal aspect of the penis.
A nurse is caring for a preterm newborn born at 29 weeks' gestation. Which nursing diagnosis would have the highest priority?
Ineffective thermoregulation related to decreased amount of subcutaneous fat Explanation: In the condition of hypothermia, newborns typically metabolize brown fat. This requires the newborn to use glucose and oxygen. A premature infant is at risk for respiratory distress and hypoglycemia. The hypoglycemia can increase the infant's need for glucose and oxygen, which, in turn, could cause more severe disease or further complications. The other diagnoses are appropriate but not the highest priority.
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?
It's a good idea to stop drinking alcohol 3 months before trying to get pregnant." Explanation: 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.
When providing care to the newborn withdrawing from a drug such as cocaine or heroin, which drug is given to ease the symptoms and prevent complications?
Morphine Explanation: Care of the newborn experiencing substance withdrawal focuses on providing physical and emotional support and also medication administration to ease withdrawal symptoms. Morphine, an opioid, is given to the client to ease the withdrawal symptoms and also gradually remove opioids from the system. The other options do not ease withdrawal symptoms.
Which intervention is helpful for the neonate experiencing drug withdrawal?
Place the isolette in a quiet area of the nursery. Explanation: 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.
The nurse is caring for a neonate. Which is the most important step the nurse can take to prevent and control infection?
Practice meticulous handwashing. Explanation: To prevent and control infection, the nurse should practice meticulous handwashing, scrubbing for 3 minutes before entering the nursery, washing frequently during caregiving activities, and scrubbing for 1 minute after providing care. Checking for signs of infection can detect, not prevent, infection. The nurse should use sterile technique for invasive procedures, not all caregiving. The nurse should wear gloves whenever contact with blood or body fluids is possible.
Which condition of delivery would predispose a neonate to respiratory distress syndrome (RDS)?
Premature birth Explanation: Prematurity is the single most important risk factor for developing RDS. The second born of twins and neonates born by cesarean delivery are also at increased risk for RDS. Surfactant deficiency, which commonly results in RDS, isn't a problem for postdate neonates.
A nurse is assigned to care for a newborn with esophageal atresia. What preoperative nursing care is the priority for this newborn?
Prevent aspiration by elevating the head of the bed, and inserting an NG tube to low suction. Explanation: The preoperative nursing care focuses on preventing aspiration by elevating the head of the bed and inserting an NG tube to low suction to prevent aspiration. Documenting the amount and color of drainage is not needed with the NG tube in place. An infant with esophageal atresia is NPO and fed nothing until after the defect is repaired. Administering antibiotics and total parenteral nutrition is a postoperative nursing intervention when caring for a newborn with esophageal atresia.
An infant is suspected of having persistent pulmonary hypertension of the newborn (PPHN). What intervention implemented by the nurse would be appropriate for treating this client?
Provide oxygen by oxygen hood or ventilator. Explanation: The nurse should administer oxygen to the infant in whatever manner needed to help maintain the infant's oxygen levels. Anticonvulsants are not necessary in treating this disorder. The infant's physical environment should be warm, not cool, and stimulation should be limited for these clients
An infant is suspected of having persistent pulmonary hypertension of the newborn (PPHN). What intervention implemented by the nurse would be appropriate for treating this client?
Provide oxygen by oxygen hood or ventilator. Explanation: The nurse should administer oxygen to the infant in whatever manner needed to help maintain the infant's oxygen levels. Anticonvulsants are not necessary in treating this disorder. The infant's physical environment should be warm, not cool, and stimulation should be limited for these clients.
Upon shift handoff the nurse reports meconium staining of the amniotic fluid. Which neonatal system requires close monitoring by the incoming nurse?
Respiratory system Explanation: If the incoming nurse is told that the neonate had meconium staining of the amniotic fluid, the nurse realizes that the respiratory system can be affected. Meconium is the thick, pasty, greenish-black substance that is present in the fetal bowel. When the fetus releases the meconium in utero, the fetus can inhale the meconium into the lungs causing respiratory distress. This is called meconium aspiration syndrome.
Which nursing action is required when caring for the post-term infant?
Serial blood glucose levels Explanation: Of the options provided, the one that is required is serial blood glucose levels. The newborn may require IV glucose infusion to stabilize glucose level. The rest of the options are on an as-needed basis.
A nurse is concerned that a 1-day-old newborn is becoming ill and may be septic. What sign of distress would validate the nurse's concerns?
Temperature instability Explanation: Temperature instability is one of several signs of possible sepsis in a newborn. Other signs include poor feeding, lethargy, irritability, and hypoglycemia. Late signs of sepsis include apnea and jaundice. A heart rate of 152 beats/min, a respiratory rate of 40 breaths/min, and erythema toxicum are all normal findings.
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?
The infant's mother probably had diabetes. Explanation: 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.
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?
The neonate will not use accessory muscles when breathing. Explanation: 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.
The nurse is examining a newborn and notes that there is bruising and swelling on the newborn's head, limited to the right side of the scalp and does not cross the suture lines. How will the nurse interpret this finding?
This is a cephalohematoma that typically spontaneously resolves without interventions. Explanation: The newborn is exhibiting signs of a cephalohematoma, a collection of blood under the periosteum of the skull. It is caused by birth trauma and should resolve spontaneously. If the swelling crosses the suture line, caput succedaneum is suspected. A subarachnoid hemorrhage in a newborn usually results in symptoms such as seizures, apnea, and bradycardia.
The nursing instructor is teaching a session on techniques that the nursing students can use to properly address concerns of parents with children who are born with a cleft lip and palate. The instructor determines the session is successful when the students correctly choose which nursing intervention as being the most effective in these situations?
Use reflective listening with nonjudgmental support. Explanation: Families are naturally apprehensive and find it difficult not to overprotect a child who is ill. They often increase the child's anxiety and cause fear in the child about participating in normal activities. Children are rather sensible about finding their own limitations and usually limit their activities to their capacity if they are not made unduly apprehensive. Some families can adjust well and provide guidance and security for the sick child. Others may become confused and frightened and show hostility, disinterest, or neglect; these families need guidance and counseling. The nurse has a great responsibility to support the family. The nurse's primary goal is to reduce anxiety in the child and family. This goal may be accomplished through open communication and ongoing contact.
As the nurse examines the birth records, which newborn would the nurse expect to monitor closely for respiratory distress syndrome (RDS)?
a term male newborn, born by a repeat cesarean birth, whose mother has diabetes mellitus Explanation: It is necessary to review the maternal history for risk factors associated with RDS. Risk factors in the term infant placing the infant at most risk include a cesarean birth in the absence of preceding labor, male gender, and maternal diabetes, which produces high levels of insulin that inhibit surfactant production. The other infant situations would not be the priority.
When providing care to a newborn with necrotizing enterocolitis (NEC), the nurse would need to report which finding immediately?
abdomen appearing red and shiny Explanation: An abdomen that appears red and shiny in a newborn with NEC indicates peritonitis and must be reported immediately. A decrease in abdominal girth, stools negative for blood, and active bowel sounds suggest that the condition is resolving.
A nurse is reading a journal article about birth defects and finds that some birth defects are preventable. Which risk factor would the nurse expect to find as being cited as the current leading preventable cause of birth defects?
alcohol Explanation: Alcohol is now recognized as the leading preventable cause of birth defects and developmental disorders in the United States. Smoking, recreational drugs, and obesity are also contributing
A nurse is reading a journal article about birth defects and finds that some birth defects are preventable. Which risk factor would the nurse expect to find as being cited as the current leading preventable cause of birth defects?
alcohol Explanation: Alcohol is now recognized as the leading preventable cause of birth defects and developmental disorders in the United States. Smoking, recreational drugs, and obesity are also contributing factors.
A preterm newborn is noted to be cyanotic. Which laboratory test will the nurse prepare the infant for to determine if the cyanosis is due to respiratory or circulatory problems?
arterial blood gases Explanation: Arterial blood gases are obtained to determine the oxygenation levels and to help differentiate lung disease from heart disease. Chest x-rays will help identify cardiac size, shape, and position. An echocardiogram will evaluate the heart anatomy and flow defects. An angiography will be conducted to prepare the client for cardiac surgery, if needed.
The priority for the nurse caring for a newborn with esophageal atresia is to observe for which finding?
aspiration Explanation: In the newborn with esophageal atresia, any mucus or fluid that the newborn swallows enters the blind pouch of the esophagus. This pouch soon fills and overflows, usually resulting in aspiration into the trachea.
The nurse suspects a preterm newborn receiving enteral feedings of having necrotizing enterocolitis (NEC). What assessment finding best correlates with this diagnosis?
bloody stools Explanation: NEC assessment includes assessing the newborn's health history and physical examination as well as laboratory and diagnostic testing. The onset of NEC is demonstrated by the development of feeding intolerance, abdominal distention, and bloody stools in a preterm infant receiving enteral feedings. As the disease worsens, the infant develops signs and symptoms of septic shock with RDS, temperature instability, lethargy, hypotension, and oliguria.
A nurse is caring for a newborn who was diagnosed with an imperforate anus. Assessment reveals drooling, copious bubbles of mucus in mouth, rattling respirations, and abdominal distention. During feeding, the newborn coughs and becomes cyanotic. Which action by the nurse would be appropriate?
clear the airway Explanation: The newborn is showing signs of esophageal atresia based on the assessment. The nurse would clear the airway and notify the health care provider. Newborns with imperforate anus often have other anomalies including esophageal atresia. With this condition, a gastric tube cannot be inserted beyond a certain point because the esophagus ends in a blind pouch. Therefore gavage feedings would be inappropriate. Although the newborn has copious mucus, suctioning the throat and endotracheal intubation are not warranted. Excess secretions should be removed with a bulb syringe.
The nurse is caring for an infant born to a mother with cocaine use disorder during her pregnancy. The nurse would likely notice that this infant:
cries when touched. Explanation: Developmental delays occur in young children of mothers with a substance use disorder. Infants of mothers with cocaine use disorder do not like to be touched or held and avoid the caregiver's gaze, which contributes to bonding delays. Infants of mothers with cocaine use disorder are often restless and below average weight when born.
When providing postpartum teaching to a couple, the nurse correctly identifies what time as when pathologic jaundice may be found in the newborn?
during the first 24 hours of life Explanation: Pathologic jaundice occurs within the first 24 hours of life and is often related to blood incompatibility. Conversely, physiologic jaundice occurs 48 hours or more after birth, peaks at the 5th to 7th day, and disappears between the 7th and 10th day postpartum. Physiologic jaundice is caused by the normal reduction of red blood cells and occurs in both breastfed and bottle-fed babies
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?
esophageal atresia Explanation: 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.
The newborn nursery nurse suspects a newborn of having neonatal abstinence syndrome. What assessment findings would most correlate with the diagnosis?
frequent yawning and sneezing Explanation: 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.
Following anastomosis repair of a tracheoesophageal fistula, the nurse assesses the infant for which potential complication?
gastroesophageal reflux Explanation: Gastroesophageal reflux may also occur after a repair, especially if the esophagus is left shorter than usual; this can lead to recurrent fistula formation and irritation from the presence of stomach acid in the esophagus. Aspiration is a risk prior to the surgical repair. Esophageal rupture and pyloric stenosis are not complications related to the surgical repair.
The nurse is caring for a pregnant woman who is struggling with controlling gestational diabetes mellitus. What effect does the nurse predict this situation may have on the fetus?
grow to an unusually large size Explanation: Maternal diabetes is the most widely known contributing factor to large-for-gestational-age newborns. LGA babies are frequently born to mothers with diabetes and poor glucose control. Continued high blood glucose levels in the mother lead to an increase in insulin production in the fetus. Increased insulin levels act as a fetal growth hormone causing macrosomia, an unusually large newborn with a birth weight of greater than 4,500 grams (9 pounds, 14 ounces). The incidence of birth defects in newborns born of a mother with gestational diabetes is not greatly increased. IUGR is not a typical outcome of uncontrolled gestational diabetes. It is more likely that the newborn will be large-for-gestational-age.
A newborn requires resuscitation secondary to asphyxia. The resuscitation team frequently assesses the newborn's response and continues resuscitation efforts based on which assessment finding?
heart rate of 70 beats/min Explanation: Resuscitation is continued until the newborn has a heart rate higher than 100 beats/min, a good healthy cry, or good breathing efforts and a pink tongue. This last sign indicates a good oxygen supply to the brain.
A preterm newborn is noted to have hypotonia, apnea, bradycardia, a bulging fontanel (fontanelle), cyanosis, and increased head circumference. These signs indicate the newborn has which complication?
intraventricular hemorrhage (IVH) Explanation: Signs that may accompany IVH include hypotonia, apnea, bradycardia, a full or bulging fontanel (fontanelle), cyanosis, and increased head circumference.
What would the nurse expect to prioritize in the assessment of a newborn who has a positive Coombs test?
jaundice development Explanation: 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.
The use of breast milk for premature neonates helps prevent which condition?
necrotizing enterocolitis Explanation: Components specific to breast milk have been shown to lower the incidence of necrotizing enterocolitis in premature neonates. Infantile respiratory distress syndrome isn't directly influenced by breast milk or breastfeeding. Down syndrome and Turner syndrome are genetic defects and aren't influenced by breast milk.
A premature infant in the neonatal intensive care unit exhibits worsening respiratory distress and is noted to have abdominal distention, absent bowel sounds, and frequent diarrhea stools that are positive for hemoccult. What diagnosis would be most likely to correlate with the symptoms?
necrotizing enterocolitis Explanation: Observations for the development of NEC in the premature newborn may include feeding intolerance with abdominal distention, abdominal tenderness, and bloody or hemoccult-positive stools. Diarrhea is present with NEC and worsening of respiratory distress. Decreased or absent bowel sounds are noted. Rotavirus causes inflammation of a child's stomach and digestive tract, usually triggering vomiting, diarrhea, and fever and not seen in a preterm infant. Garamycin-resistant bacteria is usually seen in older adults.
The nurse should carefully monitor which neonate for hyperbilirubinemia?
neonate with ABO incompatibility Explanation: 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 32 weeks' gestation newborn is admitted to the neonatal intensive care unit. The assessment reveals a pale dyspneic newborn with marked tremors, a bulging anterior fontanel (fontanelle), and a high-pitched cry. What diagnosis best correlates with the assessment findings?
periventricular-intraventricular hemorrhage Explanation: If periventricular-intraventricular hemorrhage is suspected, evaluate the newborn for a drop in hematocrit, pallor, and poor perfusion as evidenced by respiratory distress and oxygen desaturation. Note seizures, lethargy, or other changes in level of consciousness, bulging fontanel, weak sucking, metabolic acidosis, high-pitched cry, or hypotonia. Palpate the anterior fontanel (fontanelle) for tenseness. PPHN, MAS, and RDS would not present with a bulging anterior fontanel (fontanelle) and high-pitched cry and therefore do not correlate.
In the preterm newborn, the most critical complications are related to which system?
respiratory Explanation: The preterm newborn's physiologic immaturity causes many difficulties involving virtually all body systems, the most critical of which is the respiratory system.
When assessing a newborn, the nurse determines that the newborn is most likely experiencing respiratory distress syndrome (RDS) based on which finding?
see-saw respirations Explanation: Typically the newborn with RDS demonstrates signs and symptoms of severe respiratory distress at birth or within a few hours of birth. Fine, inspiratory crackles are noted on auscultation of a newborn with RDS. See-saw respirations are characteristic of RDS. A newborn with RDS typically demonstrates generalized cyanosis.
Which sign appears early in a neonate with respiratory distress syndrome?
tachypnea more than 60 breaths/minute Explanation: Tachypnea and expiratory grunting occur early in respiratory distress syndrome to help improve oxygenation. Poor capillary filling time, a later manifestation, occurs if signs and symptoms aren't treated. Crackles occur as the respiratory distress progressively worsens. A pale gray skin color obscures earlier cyanosis as respiratory distress symptoms persist and worsen.
Which newborn would the nurse suspect to be most at risk for intellectual disability due to the mother's actions during pregnancy?
the child of a client who admits to drinking a liter of alcohol daily during the pregnancy Explanation: Fetal alcohol spectrum disorder is one of the most common known causes of intellectual disability. The newborn is also at risk for fetal alcohol spectrum disorder and other alcohol-related birth defects. The other illicit drugs are not linked to intellectual disability but have many other teratogenic effects on the fetus/newborn. Marijuana has not shown to have teratogenic effects on the fetus.
Which respiratory disorder in a neonate is usually mild and runs a self-limited course?
transient tachypnea of the newborn Explanation: 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%
Four weeks before the birth of a client's already large child, the health care provider has told the client that if the baby gets bigger and the baby's lungs are ready, a cesarean birth is preferred. The woman asks the nurse what the downside is to having a cesarean rather than a vaginal birth. What is an appropriate response by the nurse?
"As the baby passes through the birth canal some of the excess fluid is expelled from the lungs; if that doesn't happen there's a higher risk of respiratory distress." Explanation: Transient tachypnea of the newborn (TTN) involves the development of mild respiratory distress in a newborn. TTN results from a delay in absorption of fetal lung fluid after birth. As the fetus passes through the birth canal during birth, some of the fluid is expelled as the thoracic area is compressed. TTN is commonly seen in newborns born by cesarean birth. It typically occurs after birth with the greatest degree of distress occurring approximately 36 hours after birth. TTN commonly disappears spontaneously around the third day.