Repro

1. Which is most helpful in preventing premature birth? a. High socioeconomic status b. Adequate prenatal care c. Aid to Families with Dependent Children d. Women, Infants, and Children (WIC) nutritional program

ANS: B Prenatal care is vital for identifying possible problems. People with higher socioeconomic status are more likely to seek adequate prenatal care, which is the most helpful for prevention. Lower socioeconomic groups do not seek out health care, and that puts them at risk for preterm labor. Aid to Families with Dependent Children and WIC aid in the nutritional status of the pregnant woman, but the most helpful aid for the prevention of premature births is adequate prenatal care.

Cardiovascular changes that cause the foramen ovale to close at birth are a direct result of a. increased pressure in the right atrium. b. increased pressure in the left atrium. c. decreased blood flow to the left ventricle. d. changes in the hepatic blood flow.

ANS: B With the increase in the blood flow to the left atrium from the lungs, the pressure is increased, and the foramen ovale is functionally closed. The pressure in the right atrium decreases at birth. It is higher during fetal life. Blood flow increases to the left ventricle after birth. The hepatic blood flow changes, but that is not the reason for the closure of the foramen ovale.

A pregnant woman at 37 weeks of gestation has had ruptured membranes for 26 hours. A cesarean section is performed for failure to progress. The fetal heart rate before birth is 180 beats/min with limited variability. At birth, the newborn has Apgar scores of 6 and 7 at 1 and 5 minutes and is noted to be pale and tachypneic. Based on the maternal history, the cause of this newborn's distress is most likely a. Hypoglycemia b. Phrenic nerve injury c. Respiratory distress syndrome d. Sepsis

ANS: D

Which nursing action is especially important for an SGA newborn? a. Promote bonding. b. Observe for and prevent dehydration. c. Observe for respiratory distress syndrome. d. Prevent hypoglycemia with early and frequent feedings.

ANS: D The SGA infant has poor glycogen stores and is subject to hypoglycemia. Promoting bonding is a concern for all infants and is not specific for SGA infants. Dehydration is a concern for all infants and is not specific for SGA infants. Respiratory distress syndrome is seen in preterm infants.

A nurse is developing a plan of care for a newborn with omphalocele. Which of the following would the nurse include? A) Placing the newborn into a sterile drawstring bowel bag B) Using clean technique for dressing changes C) Preparing the newborn for incision and drainage D) Instituting gavage feedings

Ans: A Feedback: An infant with an omphalocele is placed in a sterile drawstring bowel bag that maintains a sterile environment for the exposed contents, allows visualization, reduces heat and moisture loss, and allows heat from radiant warmers to reach the newborn. The newborn is placed feet-first into the bag and the drawstring is secured around the torso. Strict sterile technique is necessary to prevent contamination of the exposed abdominal contents. An orogastric tube attached to low suction is used to prevent intestinal distention. IV therapy is administered to maintain fluid and electrolyte balance and provide a route for antibiotic therapy. Surgery is done to repair the defect, not incise and drain it.

While reviewing a newborn's medical record, the nurse notes that the chest x-ray shows a ground glass pattern. The nurse interprets this as indicative of: A) Respiratory distress syndrome B) Transient tachypnea of the newborn C) Asphyxia D) Persistent pulmonary hypertension

Ans: A Feedback: The chest x-ray of a newborn with RDS reveals a reticular (ground glass) pattern. For TTN, the chest x-ray shows lung over aeration and prominent perihilar interstitial markings and streaking. A chest x-ray for asphyxia would reveal possible structural abnormalities that might interfere with respiration, but the results are highly variable. An echocardiogram would be done to evaluate persistent pulmonary hypertension.

Which action would be most appropriate for the nurse to take when a newborn has an unexpected anomaly at birth? A) Show the newborn to the parents as soon as possible while explaining the defect. B) Remove the newborn from the birthing area immediately. C) Inform the parents that there is nothing wrong at the moment. D) Tell the parents that the newborn must go to the nursery immediately.

Ans: A Feedback: When an anomaly is identified at or after birth, parents need to be informed promptly and given a realistic appraisal of the severity of the condition, the prognosis, and treatment options so that they can participate in all decisions concerning their child. Removing the newborn from the area or telling them that the newborn needs to go to the nursery immediately is inappropriate and would only add to the parents' anxieties and fears. Telling them that nothing is wrong is inappropriate because it violates their right to know.

A newborn was diagnosed with a congenital heart defect and will undergo surgery at a later time. The nurse is teaching the parents about signs and symptoms that need to be reported. The nurse determines that the parents have understood the instructions when they state that they will report which of the following? (Select all that apply.) A) Weight loss B) Pale skin C) Fever D) Absence of edema E) Increased respiratory rate

Ans: A, C, E Feedback: Signs and symptoms that need to be reported include weight loss, poor feeding, cyanosis, breathing difficulties, irritability, increased respiratory rate, and fever.

Which of the following would the nurse include in the plan of care for a newborn receiving phototherapy? A) Keeping the newborn in the supine position B) Covering the newborn's eyes while under the bililights C) Ensuring that the newborn is covered or clothed D) Reducing the amount of fluid intake to 8 ounces daily

Ans: B Feedback: During phototherapy, the newborn's eyes are covered to protect them from the lights. The newborn is turned every 2 hours to expose all areas of the body to the lights and is kept undressed, except for the diaper area, to provide maximum body exposure to the lights. Fluid intake is increased to allow for added fluid, protein, and calories.

Which of the following would alert the nurse to suspect that a newborn has developed NEC? A) Irritability B) Sunken abdomen C) Clay-colored stools D) Bilious vomiting

Ans: D Feedback: The newborn with NEC may exhibit bilious vomiting with lethargy, abdominal distention and tenderness, and bloody stools.

Respiratory distress syndrome (RDS) develops in a neonate born at 33 weeks' gestation 6 hours after birth. What would the nurse's assessment of the newborn at this time reveal? 1 High-pitched cry 2 Intercostal retractions 3 Respirations of 30 breaths/min 4 Heart rate of 140 beats/min

2 Intercostal retractions

A nurse is caring for a neonate who is undergoing phototherapy. What specific care should the nurse plan for this infant? 1 Applying mineral oil to the skin to prevent excoriation 2 Covering the infant's head with a cap to minimize heat loss 3 Regulating radiant heat to maintain optimum skin temperature 4 Discontinuing therapy during feeding to meet the infant's emotional needs

4 Discontinuing therapy during feeding to meet the infant's emotional needs Discontinuing therapy during feedings is necessary to ensure psychosocial contact. Mineral oil may block light rays from acting on bilirubin deposits; cleansing after each voiding and defecation will prevent skin excoriation. All parts of the body may contain bilirubin deposits and should be exposed to the light. Radiant heaters are not used; a fluorescent light source is used.

A newborn's Apgar score at 5 minutes is 5. With what condition that requires intensive monitoring of this neonate does a low Apgar score 5 minutes after birth correlate? 1 Cerebral palsy 2 Genetic defects 3 Mental retardation 4 Neonatal morbidity

4 Neonatal morbidity Neonatal morbidity is related to neonatal morbidity and mortality; by 5 minutes the healthy neonate is relatively stable, with an Apgar score of 8 to 10, and requires routine care. The presence of cerebral palsy is not related to the Apgar score. It is rarely diagnosed in the newborn. Genetic defects may or may not be apparent at this time and are not related to the Apgar score. Mental retardation has not been proved to be correlated with Apgar score, although research continues in this area.

A newborn is experiencing cold stress. Which of the following would the nurse expect to assess? (Select all that apply.) A) Respiratory distress B) Decreased oxygen needs C) Hypoglycemia D) Metabolic alkalosis E) Jaundice

A, C, E

Which preterm infant should receive gavage feedings instead of bottle feedings? a. Sucks on a pacifier during gavage feedings b. Sometimes gags when a feeding tube is inserted c. Has a sustained respiratory rate of 70 breaths/min d. Has an axillary temperature of 98.4° F, an apical pulse of 149 beats/min, and respirations of 54 breaths/min

ANS: C Infants less than 34 weeks of gestation or those who weigh less than 1500 g generally have difficulty with bottle feeding. Gavage feedings should be initiated if the respiratory rate is above 60 breaths/min. Providing a pacifier during gavage feedings gives positive oral stimulation and helps the infant associate the comfortable feeling of fullness with sucking. The presence of the gag reflex is important before initiating bottle feeding. Axillary temperature of 98.4° F, an apical pulse of 149 beats/min, and respirations of 54 breaths/min are within expected limits and an indication that the infant is not having respiratory problems at that time.

After an emergency cesarean birth, a neonate born at 35 weeks' gestation is admitted to the neonatal intensive care unit. The neonate has a Silverman-Anderson score of 6. What nursing intervention is needed? 1. Monitoring of cardiac status 2. Assessment of neurological reflexes 3. Ensuring increased caloric intake and fluids 4. Administration of respiratory support and observations

ANSWER: 4 Administration of respiratory support and observation The Silverman-Anderson score is an index of neonatal respiratory distress. A Silverman-Anderson score of 6 does not reflect cardiac function, neurological status, or caloric need.

A newborn has an Apgar score of 6 at 5 minutes. Which of the following is the priority? A) Initiating IV fluid therapy B) Beginning resuscitative measures C) Promoting kangaroo care D) Obtaining a blood culture

Ans: B Feedback: An Apgar score below 7 at 1 or 5 minutes indicates the need for resuscitation. Intravenous fluid therapy and blood cultures may be done once resuscitation is started. Kangaroo care would be appropriate once the newborn is stable.

The nurse is assessing the newborn of a mother who had gestational diabetes. Which of the following would the nurse expect to find? (Select all that apply.) A) Pale skin color B) Buffalo hump C) Distended upper abdomen D) Excessive subcutaneous fat E) Long slender neck

Ans: B, C, D Feedback: Infants of diabetic mothers exhibit full rosy cheeks with a ruddy skin color, short neck, buffalo hump over the nape of the neck, massive shoulders, distended upper abdomen, and excessive subcutaneous fat tissue.

preterm newborn is admitted to the neonatal intensive care unit (NICU). Which concern is most commonly expressed by NICU parents? 1 Fear of handling the infant 2 Delayed ability to bond with the infant 3 Prolonged hospital stay needed by the infant 4 Inability to provide breast milk for the infant preterm newborn is admitted to the neonatal intensive care unit (NICU).

1 Fear of handling the infant

A nurse determines that a newborn is in respiratory distress. Which signs confirm this assessment? Select all that apply. 1 Crackles 2 Cyanosis 3 Wheezing 4 Tachypnea 5 Retractions

2. Cyanosis, 4.Tachypnea, 5. Retractions Cyanosis occurs because of inadequate oxygenation. Tachypnea is a compensatory mechanism to increase oxygenation. Retractions occur in an effort to increase lung capacity. Crackles occur in the healthy newborn. Wheezing in the newborn is benign.

After hyperbilirubinemia develops in a neonate, phototherapy is prescribed. What should the plan of care for an infant undergoing phototherapy include? 1 Taking vital signs every hour 2 Keeping the eye shields on continuously 3 Administering additional fluids every 2 hours 4 Covering the neonate with a lightweight blanket

3 Administering additional fluids every 2 hours insensible and intestinal fluid losses are increased during phototherapy; extra fluid prevents dehydration. Taking the vital signs every hour is unnecessary unless a change from the baseline occurs. The eye shields should be removed for feeding and when the infant is being held. The total body needs to be exposed to the light.

In evaluating the respiratory effort of a one-hour-old infant using the Silverman-Anderson Index, the nurse determines the infant has synchronized chest and abdominal movement, just visible lower chest retractions, just visible xiphoid retractions, minimal and transient nasal flaring, and an expiratory grunt heard only on auscultation. What Silverman-Anderson score should the nurse assign to this infant? (Enter numeral value only.)

4

After an emergency cesarean birth, a neonate born at 35 weeks' gestation is admitted to the neonatal intensive care unit. The neonate has a Silverman-Anderson score of 6. What nursing intervention is needed? 1 Monitoring of cardiac status 2 Assessment of neurological reflexes 3 Ensuring increased caloric intake and fluids 4 Administration of respiratory support and observation

4 Administration of respiratory support and observation.

Under which circumstance should the nurse immediately alert the pediatric provider? a. Infant is dusky and turns cyanotic when crying. b. Acrocyanosis is present 1 hour after childbirth. c. The infant's blood glucose level is 45 mg/dl. d. The infant goes into a deep sleep 1 hour after childbirth.

A

Which major neonatal complication is carefully monitored after the birth of the infant of a diabetic mother? A. Hypoglycemia B. Hypercalcemia C. Hypobilirubinemia D. Hypoinsulinemia

A. Hypoglycemia

Which actions does the nurse take while counseling anxious parents who visit their preterm infant in an neonatal intensive care unit? Select all that apply. A. Informs the parents of visiting hours. B. Avoids telling the parents any unpleasant facts. C. Encourages the parents to express their sadness. D. Persuades the parents to touch and hold the infant. E. Explains the function of each piece of equipment used.

A. Informs the parents of visiting hours. C. Encourages the parents to express their sadness. E. Explains the function of each piece of equipment used.

A newborn assessment finding that would support the nursing diagnosis of post maturity would be: a. loose skin. b. ruddy skin color. c. presence of vernix. d. absence of lanugo.

ANS: A Decreased placental function because of a prolonged pregnancy results in loss of subcutaneous tissue in the neonate, which is evidenced by loose skin. Ruddy skin color, presence of vernix, and absence of lanugo do not indicate a postmature infant.

A first-time dad is concerned that his 3-day-old daughter's skin looks "yellow." In the nurse's explanation of physiologic jaundice, what fact should be included? a. Physiologic jaundice occurs during the first 24 hours of life. b. Physiologic jaundice is caused by blood incompatibilities between the mother and infant blood types. c. The bilirubin levels of physiologic jaundice peak between the second and fourth days of life. d. This condition is also known as "breast milk jaundice."

ANS: C Physiologic jaundice becomes visible when the serum bilirubin reaches a level of 5 mg/dL or greater, which occurs when the baby is approximately 3 days old. This finding is within normal limits for the newborn. Pathologic jaundice occurs during the first 24 hours of life. Pathologic jaundice is caused by blood incompatibilities, causing excessive destruction of erythrocytes, and must be investigated. Breast milk jaundice occurs in one third of breastfed infants at 2 weeks and is caused by an insufficient intake of fluids.

Which is true about newborns classified as small for gestational age (SGA)? a. They weigh less than 2500 g. b. They are born before 38 weeks of gestation. c. They are below the tenth percentile on gestational growth charts. d. Placental malfunction is the only recognized cause of this condition.

ANS: C SGA infants are defined as below the tenth percentile in growth when compared with other infants of the same gestational age. SGA is not defined by weight. Infants born before 38 weeks are defined as preterm. There are many causes of SGA infants.

A nurse is planning care for a newborn who is receiving phototherapy for an elevated bilirubin level. What action should the nurse take? a. apply barrier ointment to the newborn's perianal region b. offer the newborn glucose water between feedings c. use photometer to monitor the lamp's energy d. keep the newborn's eye patches on during feedings

ANSWER: C

Infants born before surfactant production are at risk for _________.

Answer: Respiratory distress syndrome

A nurse is teaching postpartum client and her partner about caring for their newborns umbilical cord site. Which statement by the parents indicates a need for additional teaching? A) We can put him in the tub to bathe him once the cord falls off and is healed. B) The cord stump should change from brown to yellow. C) Exposing the stump to the air helps it to dry. D) We need to call the doctor if we notice a funny odor.

B

The nurse's initial action when caring for an infant with a slightly decreased temperature is to a. notify the physician immediately. b. place a cap on the infant's head. c. Keep the infant in the nursery for the next 4 hours. d. Assess for other signs of inaccurate gestational age.

B

Heat loss in a preterm infant is more significant than a full-term infant. The nurse should assess for heat loss continually in a preterm infant. The first sign that the infant's temperature is low may be: a. hyperglycemia. b. hypoglycemia. c. respiratory stability. d. increased flexion.

B Hypoglycemia and respiratory distress may be the first signs that the infant's temperature is low. Other signs are poor feeding, lethargy, irritability, poor muscle tone, cool skin temperature, and mottled skin.

A neonate weighing 5 lb 6 oz (2438 g) is born in a cesarean birth and admitted to the newborn nursery. What range of resting respiratory rate should the nurse anticipate? a. 20 to 40 breaths/min b. 30 to 60 breaths/min c. 60 to 80 breaths/min d. 70 to 90 breaths/min

B 30 to 60 breaths/min After respiration is established, the normal neonate respiratory rate ranges from 30 to 60 breaths/min with short periods of apnea. Twenty breaths per minute is bradypnea. A respiratory rate faster than 60 breaths/min is tachypnea.

The nurse completes the initial assessment of a newborn. Which finding would lead the nurse to suspect that the newborn is experiencing difficulty with oxygenation? A)Respiratory rate of 54 breaths/minute B) Abdominal breathing C) Nasal flaring D) Acrocyanosis

C

When explaining how a newborn adapts to extrauterine life, the nurse would describe which body systems as undergoing the most rapid changes? A)Gastrointestinal and hepatic B)Urinary and hematologic C)Respiratory and cardiovascular D)Neurological and integumentary

C Respiratory and cardiovascular

The most important factor that determines the extent of respiratory problems in a preterm infant is the: a. age of the infant. b. size of the infant. c. presence of surfactant in adequate amounts. d. Silverman-Anderson index grade.

C. Problems of the respiratory system are a major concern in a preterm infant. The presence of surfactant in adequate amounts is of primary importance. Infants born before surfactant production is adequate develop respiratory distress syndrome.

A nurse is caring for a preterm neonate with physiological jaundice who requires phototherapy. What is the action of this therapy? 1 Stimulates the liver to dispose of the bilirubin 2 Breaks down the bilirubin into a conjugated form 3 Facilitates the excretion of bilirubin by activating vitamin K 4 Dissolves the bilirubin, allowing it to be excreted by the skin

Correct 2 Breaks down the bilirubin into a conjugated form Phototherapy changes unconjugated bilirubin in the skin to conjugated bilirubin bound to protein, permitting excretion in the urine and feces. Phototherapy does not affect liver function; the liver does not dispose of bilirubin. Vitamin K is necessary for prothrombin formation, not bilirubin excretion. The bilirubin is not excreted by way of the skin.

The nurse institutes measure to maintain thermoregulation based on the understanding that newborns have limited ability to regulate body temperature because they: A)Have a smaller body surface compared to body mass B) Lose more body heat when they sweat than adults C) Have an abundant amount of subcutaneous fat all over D)Are unable to shiver effectively to increase heat production

D

A nurse completes the initial assessment of a newborn. According to the due date on the antenatal record, the baby is 12 days postmature. Which of the following physical findings does not confirm that this newborn is 12 days postmature? a) Increased amounts of vernix. b) Absence of lanugo. c) Meconium aspiration. d) Hypoglycemia. Increased amounts of vernix.

Explanation: Vernix caseosa is a whitish substance that serves as a protective covering over the fetal body throughout the pregnancy. Vernix usually disappears by term gestation. It is highly unusual for a 12-day postmature baby to have increased amounts of vernix. A discrepancy between EDC and gestational age by physical examination must have occurred. Meconium aspiration is a sign of fetal distress but does not coincide with gestation. The presence of lanugo is greatest at 28 to 30 weeks and begins to disappear as term gestation approaches. Therefore, an absence of lanugo on assessment would be expected with a postmature infant. Hypoglycemia can occur at any gestation.

Pulmonary surfactant: a. Prevents alveolar collapse b. Reduces alveolar surface tension c. Increases lung compliance d. Is secreted by type II alveolar cells e. All of the above

e. All of the above

A nurse weighs a neonate who is born at 29 weeks' gestation. The weight is 1619 g (3 lb 9 oz). In light of this weight and gestational age, how should this infant be classified? 1 Preterm 2 Immature 3 Small for gestational age 4 Appropriate for gestational age

1 Preterm Preterm describes a neonate born at 37 weeks' gestation or sooner, regardless of weight. There is no classification called immature. Small for gestational age means that the weight is below the 10th percentile at any week of gestation. Although this infant's weight is appropriate for gestational age, the term implies a healthy full-term infant.

A nurse determines that a newborn is in respiratory distress. Which signs confirm this assessment? Select all that apply. 1 Crackles 2 Cyanosis 3 Wheezing 4 Tachypnea 5 Retractions

2 Cyanosis 4 Tachypnea 5Retractions Cyanosis occurs because of inadequate oxygenation. Tachypnea is a compensatory mechanism to increase oxygenation. Retractions occur in an effort to increase lung capacity. Crackles occur in the healthy newborn. Wheezing in the newborn is benign.

The nurse is assessing a female preterm neonate after delivery. Which assessment findings does the nurse document in the hospital reports of the infant? Select all that apply. A. The infant has a prominent clitoris. B The sole of the infant is deeply creased. C The hair of the infant is fine and feathery. D. The infant rests in a more flexed attitude. E The infant shows no resistance to the heel-to-ear maneuver.

A The infant has a prominent clitoris. B The sole of the infant is deeply creased. C The hair of the infant is fine and feathery. E The infant shows no resistance to the heel-to-ear maneuver. A female preterm neonate lacks proper growth of the labia majora; therefore, the neonate will have a prominent clitoris. A preterm neonate lacks proper nourishment to the hair, resulting in fine and feathery hair. The knee of a preterm infant does not offer resistance to the heel-to-ear maneuver. The soles of a preterm infant's feet appear more turgid and may have only fine wrinkles. The preterm infant has less subcutaneous tissue, and therefore rests in a relaxed attitude.

The nurse should alert the provider when a. the infant is dusky and turns cyanotic when crying. b. acrocyanosis is present at age 1 hour. c. the infant's blood glucose is 45 mg/dL. d. the infant goes into a deep sleep at age 1 hour.

ANS: A An infant who is dusky and becomes cyanotic when crying is showing poor adaptation to extrauterine life. The nurse needs to notify the provider. Acrocyanosis is an expected finding during the early neonatal life. A blood glucose of 45 mg/dL is within normal range for a newborn. Infants enter the period of deep sleep when they are about 1 hour old.

Decreased surfactant production in the preterm lung is a problem because: a. Surfactant keeps the alveoli open during expiration. b. Surfactant causes increased permeability of the alveoli. c. Surfactant dilates the bronchioles, decreasing airway resistance. d. Surfactant provides transportation for oxygen to enter the blood supply.

ANS: A Surfactant prevents the alveoli from collapsing each time the infant exhales, thus reducing the work of breathing. It does not affect the bronchioles. By keeping the alveoli open, it permits better oxygen exchange, but that is not its main purpose.

A woman in preterm labor at 30 weeks of gestation receives two 12-mg doses of betamethasone intramuscularly. The purpose of this pharmacologic treatment is to a. stimulate fetal surfactant production. b. reduce maternal and fetal tachycardia associated with ritodrine administration. c. suppress uterine contractions. d. maintain adequate maternal respiratory effort and ventilation during magnesium sulfate therapy.

ANS: A Antenatal glucocorticoids given as intramuscular injections to the mother accelerate fetal lung maturity. Inderal would be given to reduce the effects of ritodrine administration. Betamethasone has no effect on uterine contractions. Calcium gluconate would be given to reverse the respiratory depressive effects of magnesium sulfate therapy.

Which newborn would the nurse recognize as being most at risk for developing respiratory distress syndrome? a. A 35-week-gestation female baby born vaginally 72 hours after the rupture of membranes b. A 36-week-gestation male baby born by cesarean delivery to a mother with insulin-dependent diabetes c. A 35-week-gestation male baby born vaginally to a mother addicted to heroin d. A 35-week-gestation female baby born vaginally to a mother who has pregnancy-induced hypertension

ANS: B

In caring for the preterm infant, which complication is thought to be a result of high arterial blood oxygen level? a. Necrotizing enterocolitis (NEC) b. Retinopathy of prematurity (ROP) c. Intraventricular hemorrhage (IVH) d. Bronchopulmonary dysplasia (BPD)

ANS: B ROP is thought to occur as a result of high levels of oxygen in the blood. NEC is due to the interference of blood supply to the intestinal mucosa. Necrotic lesions occur at that site. IVH is caused by rupture of the fragile blood vessels in the ventricles of the brain. It is most often associated with hypoxic injury, increased blood pressure, and fluctuating cerebral blood flow. BPD is caused by the use of positive-pressure ventilation against the immature lung tissue.

A newborn was admitted to the neonatal intensive care unit (NICU) after being delivered at 29 weeks of gestation to a 28-year-old multiparous, married, Caucasian woman whose pregnancy was uncomplicated until the premature rupture of membranes and preterm birth. The newborn's parents arrive for their first visit after the birth. The parents walk toward the bedside but remain approximately 5 feet away from the bed. What is the nurse's most appropriate action? a. Wait quietly at the newborn's bedside until the parents come closer. b Go to the parents, introduce him or herself, and gently encourage them to meet their infant. Explain the equipment first, and then focus on the newborn. c. Leave the parents at the bedside while they are visiting so that they have some privacy. d. Tell the parents only about the newborn's physical condition and caution them to avoid touching their baby.

ANS: B The nurse is instrumental in the initial interactions with the infant. The nurse can help the parents see the infant rather than focus on the equipment. The importance and purpose of the apparatus that surrounds their infant also should be explained to them. Parents often need encouragement and recognition from the nurse to acknowledge the reality of the infant's condition. Parents need to see and touch their infant as soon as possible to acknowledge the reality of the birth and the infant's appearance and condition. Encouragement from the nurse is instrumental in this process. Telling the parents to avoid touching their baby is inappropriate and unhelpful.

Of all of the signs seen in infants with respiratory distress syndrome, which one is especially indicative of the syndrome? a. Pulse greater than 160 beats/minute b. Circumoral cyanosis c. Grunting d. Substernal retractions

ANS: C

Which statement is most true about large-for-gestational age (LGA) infants? a. They weigh more than 3500 g. b. They are above the 80th percentile on gestational growth charts. c. They are prone to hypoglycemia, polycythemia, and birth injuries. d. Postmaturity syndrome and fractured clavicles are the most common complications.

ANS: C Hypoglycemia, polycythemia, and birth injuries are all common in LGA infants. LGA infants are determined by their weight compared to their age. They are above the 90th percentile on gestational growth charts. Birth injuries are a problem, but postmaturity syndrome is not an expected complication with LGA infants.

A characteristic of a post-term infant who weighs 7 lb, 12 oz, and who lost weight in utero, is: a. Soft and supple skin. b. A hematocrit level of 55%. c. Lack of subcutaneous fat. d. An abundance of vernix caseosa.

ANS: C This post-term infant actually lost weight in utero, which is seen as loss of subcutaneous fat. The skin is normally wrinkled, cracked, and peeling. A hematocrit of 55% is within the expected range of all newborns. There is no vernix caseosa in a post-term infant.

A nurse is observing a 38-week gestation newborn in the nursery. Data reveals periods of apnea lasting approximately 10 seconds followed by a period of rapid respirations. The infant's color and heart rate remain unchanged. The nurse suspects that the infant: a. Is exhibiting signs of RDS. b. Requires tactile stimulation around the clock to ensure that apneic periods do not progress further. c. Is experiencing periodic breathing episodes and will require continuous monitoring while in the nursery unit. d. Requires the use of CPAP to promote airway expansion.

ANS: C Periodic breathing can occur in term or preterm infants; it consists of periods of breathing cessation (5 to 10 seconds) followed by a period of increased respirations (10 to 15 breaths/min). It is not associated with any color or heart rate changes. Infants who exhibit this pattern should continue to be observed. There is no clinical evidence that the infant is exhibiting signs of respiratory distress syndrome (RDS). There is no indication that a pattern of tactile stimulation should be initiated. Continuous positive airway pressure (CPAP) and tactile stimulation would be indicated if the infant were to have apneic spells.

In caring for the post-term infant, thermoregulation can be a concern, especially in an infant who also has a(n): a. Hematocrit level of 58%. b. RBC count of 5 million/L. c. WBC count of 15,000 cells/mm3. d. Blood glucose level of 25 mg/dL.

ANS: D Because glucose is necessary to produce heat, the infant who is also hypoglycemic will not be able to produce enough body heat. A hematocrit level of 58% is within the expected range for newborns. WBC count may be as high as 30,000 cells/mm3. RBC count ranges from 3.9 to 5.5 million/L.

After teaching the parents of a newborn with retinopathy of prematurity (ROP) about the disorder and treatment, which statement by the parents indicates that the teaching was successful? A) "Can we schedule follow-up eye examinations with the pediatric ophthalmologist now?" B) "We can fix the problem with surgery." C) "We'll make sure to administer eye drops each day for the next few weeks." D) "I'm sure the baby will grow out of it."

Ans: A Feedback: Parents of a newborn with suspected retinopathy of prematurity (ROP) should schedule follow-up vision screenings with a pediatric ophthalmologist every 2 to 3 weeks, depending on the severity of the findings at the initial examination.

The nurse prepares to administer a gavage feeding for a newborn with transient tachypnea based on the understanding that this type of feeding is necessary for which reason? A) Lactase enzymatic activity is not adequate. B) Oxygen demands need to be reduced. C) Renal solute lead must be considered. D) Hyperbilirubinemia is likely to develop.

Ans: B Feedback: For the newborn with transient tachypnea, the newborn's respiratory rate is high, increasing his oxygen demand. Thus, measures are initiated to reduce this demand. Gavage feedings are one way to do so. With transient tachypnea, enzyme activity and kidney function are not affected. This condition typically resolves within 72 hours. The risk for hyperbilirubinemia is not increased.

Which of the following would the nurse include when teaching a new mother about the difference between pathologic and physiologic jaundice? A) Physiologic jaundice results in kernicterus. B) Pathologic jaundice appears within 24 hours after birth. C) Both are treated with exchange transfusions of maternal O- blood. D) Physiologic jaundice requires transfer to the NICU.

Ans: B Feedback: Pathologic jaundice appears within 24 hours after birth, whereas physiologic jaundice commonly appears around the third to fourth days of life. Kernicterus is more commonly associated with pathologic jaundice. An exchange transfusion is used only if the total serum bilirubin level remains elevated after intensive phototherapy. With this procedure, the newborn's blood is removed and replaced with nonhemolyzed red blood cells from a donor. Physiologic jaundice often is treated at home.

A group of nursing students are reviewing the different types of congenital heart disease in infants. The students demonstrate a need for additional review when they identify which of the following as an example of increased pulmonary blood flow (left-to-right shunting)?A) Atrial septal defect B) Tetralogy of Fallot C) Ventricular septal defect D) Patent ductus arteriosus

Ans: B Feedback: Tetralogy of Fallot is a congenital heart condition that results from decreased, not increased, pulmonary blood flow. Atrial septal defect, ventricular septal defect, and patent ductus arteriosus are heart conditions that involve increased blood flow from higher pressure (left side of heart) to lower pressure (right side of heart), resulting in left-to-right shunting.

The nurse is assessing a newborn who is large for gestational age. The newborn was born breech. The nurse suspects that the newborn may have experienced trauma to the upper brachial plexus based on which assessment findings? A) Absent grasp reflex B) Hand weakness C) Absent Moro reflex D) Facial asymmetry

Ans: C Feedback: An injury to the upper brachial plexus, or Erb's palsy, is manifested by adduction, pronation, and internal rotation of the affected extremity, absent shoulder movement, absent Moro reflex and positive grasp reflex. An absent grasp reflex and hand weakness is noted with a lower brachial plexus injury. Facial asymmetry is associated with a cranial nerve injury.

A newborn has been diagnosed with a Group B streptococcal infection shortly after birth. The nurse understands that the newborn most likely acquired this infection from which of the following? A) Improper handwashing B) Contaminated formula C) Nonsterile catheter insertion D) Mother's birth canal

Ans: D Feedback: Most often, a newborn develops a Group B streptococcus infection during the birthing process when the newborn comes into contact with an infected birth canal. Improper handwashing, contaminated formula, and nonsterile catheter insertion would most likely lead to a late-onset infection, which typically occurs in the nursery due to horizontal transmission.

1) The nurse is caring for the newborn of a diabetic mother whose blood glucose level is 39 mg/dL. What should the nurse include in the plan of care for this newborn? 1. Offer early feedings with formula or breast milk. 2. Provide glucose water exclusively. 3. Evaluate blood glucose levels at 12 hours after birth. 4. Assess for hypothermia.

Answer: 1 Explanation: 1. IDMs whose serum glucose falls below 40 mg/dL should have early feedings with formula or breast milk (colostrum).

Marked changes occur in the cardiopulmonary system at birth include which of the following? Select all that apply. 1. Closure of the foramen ovale 2. Closure of the ductus venosus 3. Mean blood pressure of 31 to 61 mmHg in full-term resting newborns 4. Increased systemic vascular resistance and decreased pulmonary vascular resistance 5. Opening of the ductus arteriosus

Answer: 1, 2, 4 Explanation: 1. Closure of the foramen ovale is a function of changing arterial pressures. 2. Closure of the ductus venosus is related to mechanical pressure changes that result from severing the cord, redistribution of blood, and cardiac output. 4. Increased systemic vascular resistance and decreased pulmonary vascular resistance; with the loss of the low-resistance placenta, systemic vascular resistance increases, resulting in greater systemic pressure. The combination of vasodilation and increased pulmonary blood flow decreases pulmonary vascular resistance.

The nurse is using the New Ballard Score to assess the gestational age of a newborn delivered 4 hours ago. The infant is 33 weeks by early ultrasound and last menstrual period. The nurse expects the infant to exhibit: 1. Full sole creases, nails extending beyond the fingertips, scarf sign shows the elbow beyond the midline. 2. Testes located deep in the scrotum, rugae cover the scrotum, vernix covering the entire body. 3. Ear cartilage remains folded over, lanugo present over much of the body, and some flexion of arms and legs at rest. 4. 1 cm breast bud, peeling skin and veins not visible, rapid recoil of legs and arms to extension.

Answer: 3. All of these characteristics are indications of a preterm infant.

The nurse is assessing a newborn at 1 hour of age. Which finding requires an immediate intervention? 1. Respiratory rate 60 and irregular in depth and rhythm 2. Pulse rate 145, cardiac murmur heard 3. Mean blood pressure 55 mm Hg 4. Pauses in respiration lasting 30 seconds

Answer: 4 Pauses in respirations greater than 20 seconds are considered episodes of apnea, and require further intervention.

The nurse has assessed four newborns' respiratory rates immediately following birth. Which respiratory rate would require further assessment by the nurse? 1. 60 breaths per minute 2. 70 breaths per minute 3. 64 breaths per minute 4. 20 breaths per minute

Answer: 4. If respirations drop below 20 when the baby is at rest the primary care provider should be notified.

he nurse places a newborn with jaundice under the phototherapy lights in the nursery to achieve which goal? A)Prevent cold stress B)Increase surfactant levels in the lungs C)Promote respiratory stability D)Decrease the serum bilirubin level

Answer: D

The major pathologic and structural changes associated with TTN include: 1. open foramen ovale 2. increased pulmonary vascular tone 3. excessive bronchial secretions 4. interstitial edema A. 1, 2 B. 3, 4 C. 1, 4 D. 2, 3, 4

B. 3, 4

The preterm infant who should receive gavage feedings instead of a bottle is the one who a. Sometimes gags when a feeding tube is inserted b. Is unable to coordinate sucking and swallowing c. Sucks on a pacifier during gavage feedings d. Has an axillary temperature of 98.4 F, an apical pulse of 149 beats/min, and respirations of 54 breaths/m

B. Infants less than 34 weeks of gestation or who weigh less than 1500 g generally have difficulty with bottle-feeding.

The main problem in an infant with TTN (transient tachypnea of the newborn) is: A. decreased surfactant B. delayed absorption of pulmonary fluid C. increased bronchial secretions D. cardiogenic pulmonary edema

B. delayed absorption of pulmonary fluid

The nurse is taking care of a 30-week gestational preterm infant that is 3 days old. The infant is stable enough for a bath to remove the old blood and vernix, but has areas of cracking on the skin. During the bath it is best for the nurse to use: a. plain warm water. b. a soap especially formulated for an infant's skin. c. sterile water. d. distilled water.

C Bathing preterm infants is not necessary on a daily basis and should be performed as necessary. Bathing can disrupt the chemistry of the skin and may be stressful. Soap should be avoided during the first week for infants less than 32 weeks' gestational age. If there are areas of skin breakdown, sterile water is safest for cleansing.

A nurse is assessing a newborn for signs of hyperbilirubinemia (pathologic jaundice). What clinical finding confirms this complication? 1 Muscle irritability within 1 hour of birth 2 Neurologic signs during the first 24 hours 3 Jaundice that develops in the first 12 to 24 hours 4 Jaundice that develops between 48 and 72 hours after birth

Correct 3 Jaundice that develops in the first 12 to 24 hours The development of jaundice in the first 24 hours indicates hemolytic disease of the newborn. Neurologic signs may or may not be present during the first 24 hours; they are dependent on the bilirubin level. Muscle irritability may or may not be present during the first 24 hours; usually it develops later. Serum bilirubin is expected to accumulate in the neonatal period because of the short life span of fetal erythrocytes, reaching a level of 7 mg/100 mL the second to third day when jaundice appears (physiologic jaundice).

Which sign indicates to the nurse that a neonate is preterm? 1 Flexion of extremities 2 Absent femoral pulses 3 Presence of Babinski reflex 4 Numerous superficial veins

Correct 4 Numerous superficial veins Numerous superficial veins are observed in the preterm infant because of the lack of subcutaneous fat deposits. Flexion of the extremities is the posturing of a healthy term infant; a preterm infant usually postures with extremities extended and flaccid. An absence of femoral pulses is indicative of coarctation of the aorta, a congenital heart defect that is not related to gestational age. Presence of the Babinski reflex is expected in the full-term, not preterm, newborn.

While making rounds in the nursery, the nurse sees a 6-hour-old baby girl gagging and turning bluish. Which of the following would the nurse do first? A) Alert the physician stat and turn the newborn to her right side. B) Administer oxygen via facial mask by positive pressure. C) Lower the newborns head to stimulate crying. D) Aspirate the oral and nasal pharynx with a bulb syringe.

D

A student nurse is asked to administer vitamin K to a newborn. The student is aware that vitamin K must be administered within 1 hour of birth but is not sure about which route is appropriate. Vitamin K should be given by which route to this newborn? a. Oral b. Subcutaneous c. Intravascular d. Intramuscular

D Oral vitamin K has been used for newborn prophylaxis. It is not recommended at this time because it has not been shown to be as effective as parenteral vitamin K. The appropriate route is intramuscular. (Vastus Lateralis)

An insulin-dependent diabetic delivered a 10-pound male. When the baby is brought to the nursery, the priority of care is to... A) Clean the umbilical cord with Betadine to prevent infection B) Give the baby a bath C) Call the laboratory to collect a PKU screening test D) Check the baby's serum glucose level and administer glucose if < 40 mg/dL

D) Check the baby's serum glucose level and administer glucose if < 40 mg/dL

The primary risk factor for necrotizing enterocolitis (NEC) is: 1. Early oral feedings with formula 2. Passage of meconium during labor 3. Prematurity 4. Low birth weight

3. Prematurity