Ch 27: Nursing Care of the child Born with a Physical or Developmental Challenge

d) Place the newborn in a prone or lateral position Pg. 747 The nurse should place the newborn in a prone or lateral position to keep pressure off the spinal sac and avoid newborn injury. Parents should be allowed to hold the stable infant with assistance. The spinal sac should be kept covered and moist until surgery to avoid rupture. Collecting urine decreases the risk of urine stasis, which is sometimes common in spinal defects.

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

d) A type of spina bifida Pg. 744 The maternal serum alpha-fetoprotein test is an indicator of a neural tube defect indicating a form of spina bifida. Spina bifida is a bony defect that occurs in various forms and can produce a varied level of disability (ranging from no disability to paralysis). This test is not an indicator of a cardiac deficit, a cleft lip/cleft palate, or a kidney disorder.

13. The nurse is reviewing the medical record of the antepartum client with an abnormal maternal serum alpha-fetoprotein test. The mother is distraught and states, "How bad can it be?" The nurse is correct to describe which? a) The absence of a kidney b) A cleft lip and palate c) A cardiac deficit d) A type of spina bifida

d) Moro Pg. 695 When a neonate has a brachial plexus palsy, there will be asymmetry of the Moro reflex. The stepping reflex assesses movement of the legs. The rooting reflex is used to stimulate sucking and feeding. A positive Babinski sign indicates neurologic immaturity.

25. At birth, a neonate is diagnosed with brachial plexus palsy. The parent asks how the nurse knows the neonate's positioning of the arm is a result of the palsy and not just a preferred position. The nurse would show the parent that the neonate has asymmetry of which neonatal reflex? a) Babinski b) Stepping c) Rooting d) Moro

c) Eyes appear to be pushed downward Pg. 739 In hydrocephalus, the eyes appear to be pushed downward slightly with the sclera visible above the iris, the so-called setting sun sign. The fontanels (fontanelles) are bulging and tense, with the suture lines separating and the spaces palpable through the scalp. The scalp also becomes shiny and its veins dilate. In Down syndrome the hands are short with an incurved finger. In congenital hypothyroidism, the neck is short and thick.

10. The nurse is monitoring a newborn who exhibited a large head at birth and is exhibiting an increasing head growth on continued assessment. Which additional findings on assessment should lead the nurse to suspect hydrocephalus in this infant? a) The scalp is dull and becoming dark red b) Neck area is thickened and strong c) Eyes appear to be pushed downward d) Hands short with curved fingers

b) Cerebrospinal fluid Pg. 738 In congenital hydrocephalus, an obstruction occurs and cerebrospinal fluid is not able to pass between the ventricles and the spinal cord.

11. In the child diagnosed with hydrocephalus, an obstruction occurs that blocks the normal process of: a) Circulatory blood flow b) Cerebrospinal fluid c) Genitourinary tract d) Lymphatic system

b) Hydrocephalus Pg. 746 A myelomeningocele is commonly associated with hydrocephalus or excessive cerebrospinal fluid (CSF) within the cranial cavity. Microcephaly is associated with maternal exposure to cytomegalovirus (CMV) or rubella. Anencephaly is a different type of neural tube defect. Cranial suture overlap may occur with vaginal birth, but it is not associated with myelomeningocele.

40. Congenital myelomeningocele is commonly associated with which condition? a) Microcephaly b) Hydrocephalus c) Cranial suture overlap d) Absence of the cranial vault

a) Caffeine has a superior safety profile with fewer side effects than theophylline b) Caffeine improves the rate of recovery when used in conjunction with CPAP therapy d) The neonate can be discharged home while taking caffeine, as it can be given orally e) Caffeine stimulates the breathing center of the preterm infant's brain Pg. Caffeine citrate has a superior safety profile with fewer side effects than theophylline, and it improves the rate of recovery when used in conjunction with CPAP therapy. Because it is available in an oral preparation, the parents can administer this at home after discharge. Caffeine sodium benzoate is contraindicated in neonatal treatment of apnea.

12. The administration of caffeine has become common in NICU infants with apnea of prematurity. The NICU nurse explains the advantages of this medication to the parents and knows the parents understood when they make which statements? Select all that apply. a) Caffeine has a superior safety profile with fewer side effects than theophylline b) Caffeine improves the rate of recovery when used in conjunction with CPAP therapy c) Caffeine can be given to neonates as either caffeine citrate or caffeine sodium benzoate d) The neonate can be discharged home while taking caffeine, as it can be given orally e) Caffeine stimulates the breathing center of the preterm infant's brain

a) Apply a sterile dressing moistened in a warm, sterile saline solution Pg. 747 Until surgery is performed, the sac must be covered with a sterile dressing moistened in a warm, sterile solution (often saline). The nurse should change this dressing every 2 hours and not allow it to dry to avoid damage to the covering of the sac.

14. Immediately after birth, the nurse is caring for a newborn with a myelomeningocele. What intervention should the nurse provide to prevent drying out of the sac to avoid damage? a) Apply a sterile dressing moistened in a warm, sterile saline solution c) Cover the sac with petroleum jelly and a dry sterile dressing d) Allow the sac to dry out to "toughen" it d) Cover the sac with a water-soluble lubricant and a dry sterile dressing

a) "The swelling in your newborn's head is due to the head pressing against your cervix during labor and birth. It will go away on its own in a few days" Pg. 332 Assessment indicates that the newborn has caput succedaneum. This is soft tissue swelling caused by edema of the head against the dilating cervix during the birth process. In caput succedaneum, swelling is not limited by suture lines; it extends across the midline and is associated with head molding. It does not usually cause complications other than a misshapen head and usually resolves over the first few days without treatment. Cephalohematoma is the subperiosteal collection of blood secondary to the rupture of blood vessels between the skull and periosteum. Suture lines delineate its extent and it is usually located on one side, over the parietal bone. Cephalohematoma resolves gradually over 2 to 3 weeks without treatment. Subarachnoid hemorrhage (one of the most common types of intracranial trauma) may be due to hypoxia/ischemia, variations in blood pressure, and the pressure exerted on the head during labor. Bleeding is of venous origin, and underlying contusions also may occur. Subarachnoid hemorrhage requires minimal handling to reduce stress. Subdural hemorrhage (hematomas) involves tears of the major veins or venous sinuses overlying the cerebral hemispheres or cerebellum. Increased pressure on the blood vessels inside the skull leads to tears. Subdural hematoma requires aspiration; can be life-threatening if it is in an inaccessible location and cannot be aspirated.

15. A woman gave birth to a healthy term newborn about 2 hours ago. She asks the nurse about the appearance of her newborn's head. Assessment reveals swelling of the head that extends across the midline. Which response by the nurse would be appropriate? a) "The swelling in your newborn's head is due to the head pressing against your cervix during labor and birth. It will go away on its own in a few days" b) "Your newborn has a collection of blood that was caused by tearing of the veins and is pushing on the brain. This collection of blood will need to be drained" c) "You must have had some problems during labor with keeping your blood pressure under control. Your newborn will need to be handled gently" d) "The tiny blood vessels under your newborn's skull broke during labor and caused the swelling. It will get better in about 2 to 3 weeks"

d) Congenital hypothyroidism Pg. 735 Two common features seen in the infant with congenital hypothyroidism are chronic constipation and abdomen enlargement caused by poor muscle tone. Infants with galactosemia will present with vomiting and diarrhea resulting in dehydration, weight loss, and jaundice. Infants with phenylketonuria show progressive mental deficiency, frequent vomiting, aggressive and hyperactive traits, as well as a musty urine smell. Infants with Turner syndrome present with short stature, low set ears, broad-based neck, broad chest, increased angle of the arms, and edema of the hands and feet.

16. The nurse is assessing a group of infants and notes one of the infants has chronic constipation and an enlarged abdomen. The nurse would determine this infant is showing indications of which condition? a) Phenylketonuria b) Galactosemia c) Turner syndrome d) Congenital hypothyroidism

a) Morphine Pg. 710 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.

17. 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? a) Morphine b) Aspirin c) Acetaminophen d) Ibuprofen

a) Limited abduction of the affected hip Pg. 720 The infant with DDH usually has limited abduction of the affected hip. The infant has asymmetry of the gluteal skin folds and shortening of the femur. Adduction is not a concern.

18. The nurse is assessing a newborn and suspects developmental dysplasia of the hip (DDH). For which sign is the nurse prioritizing in this potential diagnosis? a) Limited abduction of the affected hip b) Symmetry of the gluteal skin folds c) Bilateral adduction of the legs d) Lengthening of the femur

c) During the postpartum period Pg. 704 The treatment for Rh incompatibility is Rho(D) immune globulin. It is given to prevent complications during the second pregnancy and is administered in the postpartum period. This prevents antibodies from entering fetal circulation and hemolyzing or destroying the fetus's RBC.

19. At which point is the treatment Rho(D) immune globulin for hemolytic disease of the newborn finished? a) It is no longer needed after the first pregnancy b) Immediately before delivery c) During the postpartum period d) During the prenatal period

b) The skin is jaundiced Pg. 704 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. This neonate exhibits pathologic jaundice, which needs to be reported immediately. Milia is common on the newborn. It is appropriate for the newborn to sleep for most of the day and eat a couple ounces of formula.

2. Which assessment finding within the first 24 hours of birth requires immediate health care provider notification? a) The neonate ate 1 to 2 oz of formula b) The skin is jaundiced c) The neonate slept for 18 hours d) Milia is noted on the nose

d) The aorta and pulmonary artery Pg. 1143 The nurse is correct to educate that in the congenital condition known as transposition of the great arteries, it is the aorta and the pulmonary artery that are reversed. In this condition, the aorta rises from the right ventricle and the pulmonary artery arises from the left.

20. The nurse is providing education to the parents of an infant who was just diagnosed with transposition of the great arteries. The parents ask, "Which vessels were involved?" The nurse is correct to educate about: a) The inferior vena cava and pulmonary vein b) The pulmonary vein and pulmonary artery c) The superior and inferior vena cava d) The aorta and pulmonary artery

a) Apparent shortening of the femur c) Limited abduction of the affected hip e) Asymmetry of the gluteal skin folds Pg. 720 Signs that are useful after age 1 month are asymmetry of the gluteal skin folds, limited abduction of the affected hip, and apparent shortening of the femur.

21. The nurse is assessing a 6-week-old at a pediatrician's appointment. What objective data gathered by the nurse indicates a diagnosis of possible developmental dysplasia of the hip? Select all that apply. a) Apparent shortening of the femur b) Adduction of the hips c) Limited abduction of the affected hip d) Hip clicking e) Asymmetry of the gluteal skin folds

d) Cuddle the baby in a chest-to-chest position Pg. 748 The family of a newborn with such a major anomaly is in a state of shock on first learning of the problems. Be especially sensitive to their needs and emotions. Encourage family members to express their feelings and emotions as openly as possible. If possible, encourage the family members to cuddle or touch the newborn using proper precautions for the safety of the defect. With the permission of the physician, the newborn may be held in a chest-to-chest position to provide closer contact. The preoperative goals for care of the newborn with myelomeningocele include preventing infection, maintaining skin integrity, preventing trauma related to disuse, increasing family coping skills, education about the condition, and support. Diapering is not advisable with a low defect.

22. The parents of a newborn are struggling with the news that their infant has spina bifida. Which technique should the nurse prioritize teaching to the parents that will help increase the infant's comfort and development? a) Diaper the baby safely b) Clean and moisturize the myelomeningocele sac c) Hold the baby during feeding d) Cuddle the baby in a chest-to-chest position

a) Turned away from the operative site Pg. 739-740 In the early postoperative period, the infant's head should be placed turned away from the operative site to promote comfort until the physician instructs otherwise. Trendelenberg would facilitate additional fluid accumulation. Infants should not be placed on pillows. If turned toward the operative site, additional pain and fluid accumulation would result.

23. The nurse is caring for a newborn with hydrocephalus. To protect the newborn from injury in the postoperative period, the nurse should position the head: a) Turned away from the operative site b) Turned toward the operative site c) In Trendelenburg position d) Supported on a pillow

b) Spina bifida with myelomeningocele Pg 746 The neonate shown was born with spina bifida myelomeningocele, which is a sac containing the spinal cord and meninges with nerves roots embedded in the wall. Spina bifida occulta is a bony defect that occurs without soft tissue involvement. These neonates are asymptomatic and present no problems. A neonate with spina bifida with a meningocele would have spinal meninges protrude through a bony defect forming a sac. There is no condition as spina bifida major.

24. The nurse is assessing the neonate shown. From the assessment, the nurse notes that there is paralysis of the lower extremities. For which condition does the nurse anticipate performing care? a) Spina bifida occulta b) Spina bifida with myelomeningocele c) Spina bifida major d) Spina bifida with meningocele

d) Notify the primary care provider immediately Pg. 743 The projectile vomiting should raise suspicions of increasing intracranial pressure and requires emergent intervention, so the nurse should notify the primary care provider immediately. Symptoms of increased intracranial pressure (ICP) may also include irritability, restlessness, personality change, high-pitched cry, ataxia, failure to thrive, seizures, severe headache, changes in level of consciousness, and papilledema. At least every 2 to 4 hours, the nurse should monitor the newborn's level of consciousness, check the pupils for equality and reaction, monitor the neurologic status, and observe for a shrill cry, lethargy, or irritability. Edema and localized redness at the surgical site are potential indications of an infection. Assessing for pain and administering pain medication in this situation can result in the symptoms being masked and the infant could die. Increasing the fluid rate could contribute to the increased volume of fluids in the brain and would exacerbate the situation.

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

c) Attempt to straighten the feet to the midline position Pg. 719 The type/extent of deformity in the lower extremities depends on the muscles that are active or inactive. Passive positioning in utero may result in deformities of the feet, such as pseudo talipes or congenital talipes equinovarus (clubfoot). Upon newborn assessment, it is standard of care to straighten the feet of all newborns to the midline to detect this disorder. The nurse would not wait for the health care provider to complete the nursing assessment of the newborn. Documentation of the assessment findings is standard of care. An ultrasound is not needed to appropriately document the assessment findings. Soft splints may be approved by the health care provider following the medical assessment.

27. The nurse is completing the newborn assessment in the nursery. The nurse notes that the newborn's feet have an unusual foot position. How will the nurse assess the significance of this position? a) Suggest an ultrasound to assess bone structure b) Swaddle the newborn and wait for the health care provider c) Attempt to straighten the feet to the midline position d) Obtain a soft splint to place on the feet

d) "We will pin the right sleeve of the shirt to the front of the shirt to keep it secure" Pg. 1461-1462 Midclavicular fractures typically heal rapidly and uneventfully; arm motion may be limited by pinning the newborn's sleeve to the front of the shirt. Femoral and humeral shaft fractures are treated with splinting. Healing and complete recovery are expected within 2 to 4 weeks without incident.

28. The nurse is teaching the parents of a newborn diagnosed with a right midclavicular fracture about care of the newborn at home. The nurse determines that the teaching was successful based on which statement by the parents? a) "It will probably take about 6 weeks before this fracture heals" b) "Our baby will likely need surgery to have a pin placed to fix the fracture" c) "The splint will need to stay on for 23 out of the 24 hours each day" d) "We will pin the right sleeve of the shirt to the front of the shirt to keep it secure"

a) The spinal meninges protrude through the bony defect and form a cystic sac Pg. 746 When part of the spinal meninges protrudes through the bony defect and forms a cystic sac, the condition is termed spina bifida with meningocele. In spina bifida with myelomeningocele, there is a protrusion of the spinal cord and the meninges, with nerve roots embedded in the wall of the cyst. A bony defect that occurs without soft-tissue involvement is called spina bifida occulta.

29. The community health nurse is preparing a presentation which will illustrate the various forms of spina bifida for a health fair. Which explanation should the nurse use to explain spina bifida with meningocele? a) The spinal meninges protrude through the bony defect and form a cystic sac b) There is a bony defect that occurs without soft-tissue involvement c) There is protrusion of the spinal cord and meninges, with nerve roots embedded d) There is no protrusion of the spinal cord, only soft-tissue inflammation occurs

b) Let the infant become accustomed to being in elbow restraints Pg. 727 The thumb, although comforting, may quickly undo the repair or cause undesirable scarring along the suture line. The infant's ultimate happiness and well-being must take precedence over immediate satisfaction. Acclimating the infant to elbow restraints gradually before admission is helpful. For an infant who has had a palate repair, no nipples, spoons, or straws are permitted; only a drinking glass or a cup is recommended.

3. The nurse is preparing pre- and postoperative instructions for a family whose 6-month-old infant is scheduled for an initial surgical repair of a cleft lip and palate. Which activity should the nurse prioritize in the instructions to the caregivers of this infant? a) Train the infant to drink from a glass or cup b) Let the infant become accustomed to being in elbow restraints c) Feed the infant with a drinking straw d) Feed the infant with a rubber covered spoon

d) Significant level of maternal serum alpha-fetoprotein present in amniotic fluid Pg. 746 Screening for significant levels of maternal serum alpha-fetoprotein is 90% effective in detecting neural tube defects. Prenatal screening includes a combination of maternal serum and amniotic fluid levels, amniocentesis, amniography, and ultrasonography and has been relatively successful in diagnosing the defect. Flat plate X-rays of the abdomen, L/S ratio, and maternal serum albumin levels aren't diagnostic for the defect.

30. Which diagnostic measure is most accurate in detecting neural tube defects? a) Flat plate of the lower abdomen after the 23rd week of gestation b) Amniocentesis for lecithin-sphingomyelin (L/S) ratio c) High maternal levels of albumin after 12th week of gestation d) Significant level of maternal serum alpha-fetoprotein present in amniotic fluid

b) The neonate will be free from infection Pg. 1300-1301 The highest priority goal is that the neonate will be free from infection. This neonate has open mucosa of the bladder. In addition, the neonate's urinary tract is developed and leads to the bladder and then the kidneys. Nursing intervention must include frequent vital signs; inspection of the site; observation for drainage, color and clarity of urine in diaper; and frequent urinalysis as ordered until surgical correction. Bonding is always a goal when caring for a neonate and family. Having an adequate urine output is an appropriate goal. Due to the sensitive nature of the mucosa, it is important for the neonate to not experience discomfort, particularly when the area is being cleansed.

31. The nurse is caring for a neonate with an exstrophy of the bladder. When the nurse is planning care, which client goal is the priority? a) The neonate will not cry during diapering b) The neonate will be free from infection c) The neonate will urinate 2 to 3 ml/kg/hour d) The neonate will exhibit signs of bonding with parents

d) Vomiting Pg. 732 The parents of a child with a hernia need to be instructed about the signs of strangulation. These signs include vomiting, pain, and an irreducible mass. The parents should be instructed to contact the health care provider immediately if strangulation is suspected. Flatulence is a normal finding, particularly in infants. Diarrhea and constipation are gastrointestinal issues that are unrelated to strangulation.

32. An infant with an umbilical hernia is being discharged. The nurse teaches the parents to notify the health care provider if which symptom occurs? a) Diarrhea b) Flatulence c) Constipation d) Vomiting

d) Heart rate of 70 beats/min Pg. 673-674 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.

33. 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? a) Respiratory rate 50 breaths/min b) Pink tongue c) Vigorous cry d) Heart rate of 70 beats/min

b) Risk for delayed growth and development d) Risk for impaired skin integrity Pg. 721 Nursing diagnosis for this newborn would include Risk for delayed growth and development, and Risk for impaired skin integrity. Risk for aspiration, imbalanced nutrition, and fluid volume excess are not related to congenital hip dysplasia.

34. The nurse is caring for a newborn with congenital hip dysplasia. Which nursing diagnoses would the nurse prioritize for this infant after the application of a hip spica cast? Select all that apply. a) Risk for imbalanced nutrition b) Risk for delayed growth and development c) Risk for fluid volume excess d) Risk for impaired skin integrity e) Risk for aspiration

b) Call the provider to obtain a prescription for a bilirubin level Pg. 441 The assessment findings and report from the mother suggest late-onset breastfeeding jaundice. The nurse should report the findings to the provider and obtain a prescription for a bilirubin level. Once the results are obtained, then the decision for home phototherapy can be made. Although it would be helpful to evaluate the mother's breastfeeding technique to promote enhanced breastfeeding, the priority is to confirm hyperbilirubinemia and institute measures to lower the bilirubin level. Measuring the newborn's abdominal girth would be unnecessary.

35. A nurse makes a home visit to a new mother and her 5-day-old newborn. Assessment of the newborn reveals slight yellowing of the skin on the face and forehead and slowed skin turgor. The mother tells the nurse that she's been having trouble breastfeeding the newborn. "My baby's been feeding about every 4 to 5 hours." Additional assessment reveals about 3 wet diapers per day and 1 to 2 stools per day. Which action by the nurse would be the priority? a) Evaluate the mother's technique for breastfeeding b) Call the provider to obtain a prescription for a bilirubin level c) Measure the newborn's abdominal girth d) Arrange for home phototherapy

90 degrees Pg. 722 When assessing Barlow sign, the nurse lays the infant supine and flexes the knees to 90° at the hips. A feeling of the femur head slipping out of the socket posterolaterally is a positive Barlow sign.

36. When assessing Barlow sign, the nurse lays the infant supine and flexes the knees. To which degree does the nurse flex the knees at the hips?

a) Gluteal fold higher on one side than the other Pg. 720 Signs that indicate DDH include asymmetry of the gluteal skin folds (higher on the affected side), limited abduction of the affected hip, and shortening of the femur.

37. The nurse is doing an examination on an infant with a diagnosis of developmental dysplasia of the hip (DDH). Which finding would be an indication of this diagnosis? a) Gluteal fold higher on one side than the other b) Respiratory rate of 30 breaths per minute c) Head circumference of 18 inches (46 cm) d) Sac protruding on the lower back

c) The neonate delivered by cesarean section Pg. 698, 701 While every neonate has the respiratory system assessed, some are at higher risk of complications than others. The neonate born via cesarean section is at highest risk for TTN since this infant did not have the opportunity of having fluid expressed from the lungs as he/she descended down the birth canal. The other options are not in the high-risk category.

38. The nurse is most correct to assess for transient tachypnea of the newborn (TTN) in which neonate? a) The large-for-gestational-age neonate b) The neonate whose mother received limited prenatal care c) The neonate delivered by cesarean section d) The neonate born at 41 weeks' gestation

a) Hyperactive and irritable Pg. 739 The newborn that is withdrawing from alcohol typically is hyperactive, irritable, has trouble sleeping, and may have tremors or seizures. Characteristics of fetal alcohol spectrum disorder include low birth weight, and small height and head circumference. This newborn is prone to respiratory difficulties, hypoglycemia, hypocalcemia, and hyperbilirubinemia.

39. The nurse is admitting to the nursery a newborn of a mother who continued to drink alcohol during her pregnancy. Which finding does the nurse predict to encounter on the newborn's assessment? a) Hyperactive and irritable b) Large head circumference c) Lethargic and sleepy d) Above average birth weight

d) Provide a dark, quiet environment Pg. 709-710 A dark and quiet environment provides relaxation and allows the opportunity for the neonate to withdraw from the alcohol and drugs without becoming overstimulated. Massage and tactile stimulation can stimulate the neonate, leading to seizures. A dark environment is more helpful than soothing music.

4. Which environmental consideration is most helpful to promoting comfort when the neonate is withdrawing from alcohol and drugs? a) Offer tactile stimulation b) Incorporate a massage c) Play soothing music d) Provide a dark, quiet environment

d) Oxygen and nutrient deficiency prior to birth Pg. 716 The most common cause of a small for gestational age neonate is oxygen and nutrition deficiency prior to birth. Though not stated, this broad category includes mothers who smoke, mothers with a poor diet through pregnancy, or a mother with an illness not allowing proper nutrition to be available for the neonate. Genetic characteristics typically do not cause a small-for-gestational-age neonate. Genetic characteristics may result in the infant's height of shorter stature or the neonate's weight lower, but not below the 10th percentile. Although a few chromosomal abnormalities may result in a small-for-gestational-age neonate, these abnormalities are not a common cause of this outcome. A mother with diabetes commonly results in a large-for-gestational-age neonate.

41. The nurse is caring for a neonate that is small for gestational age due to intrauterine growth restriction. Which is the most common cause? a) Chromosomal abnormalities b) Mother with diabetes c) Genetic characteristics d) Oxygen and nutrient deficiency prior to birth

a) Breech birth Pg. 616 Midclavicular fractions most often occur during breech births or shoulder dystocia in newborns with macrosomia. Amniotomy or oxytocin augmentation are not associated with this type of fracture. The newborn's APGAR scores indicate a healthy newborn and are unrelated to the birth injury.

5. The nurse is providing care to a newborn with macrosomia who has sustained a midclavicular fracture. When reviewing the mother's labor and birth record, the nurse notes the following information: - Breech birth - Amniotomy - APGAR score: 7 at 1 minute; 8 at 5 minutes - Oxytocin augmentation Which information would the nurse correlate with the newborn's current injury? a) Breech birth b) APGAR score: 7 at 1 minute; 8 at 5 minutes c) Oxytocin augmentation d) Amniotomy

c) Relieving surgical pain Pg. 727 The most important postoperative goal is to relieve surgical pain. If the pain is relieved, the client will be more willing to suck/eat, therefore obtaining nutrition and fluid volume. Bonding is always encouraged but pain and nutrition are higher priorities.

6. Which postoperative goal is most important following surgical repair of a cleft lip and palate? a) Obtaining adequate nutrition b) Monitoring fluid volume c) Relieving surgical pain d) Encouraging family bonding

c) The infant was a preterm, low-birth-weight and small-for-gestational-age neonate Pg. Born at 36 weeks' gestation is a preterm age (under 37 weeks). The infant was a low-birth-weight (under 2,500 g) and small-for-gestational-age infant at the 8th percentile (under the 10th percentile). The other documentations are not accurate.

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

c) Report the findings to the pediatric health care provider Pg. 718 These findings are consistent with craniosynostosis, or premature fusion of the cranial sutures. Intervention is needed to prevent damage to the growing brain. Waiting 24 hours to reassess will delay treatment. In microcephaly, the head circumference is small, but the fontanels (fontanelles) and suture line are palpable.

8. During the newborn examination, the nurse notes that an infant who is appropriate for gestational age by birth weight has a head circumference below the 10th percentile and the fontanels (fontanelles) are not palpable. What action would the nurse take? a) Tell the parent the infant's brain is underdeveloped b) Reassess the head circumference in 24 hours c) Report the findings to the pediatric health care provider d) Document that the infant has microcephaly

c) Swaddle and decrease stimulation Pg. 709-710 Swaddling and decreasing stimulation is helpful in providing relaxation and comfort for the newborn withdrawing from alcohol. Benzodiazepines are to prevent seizure activity. Providing small amounts of formula frequently supports weight gain. Promoting parental bonding is important for the newborn and parents to help the infant meet developmental milestones.

9. The nurse is working in the special care nursery caring for a newborn withdrawing from alcohol. Which nursing intervention promotes client comfort? a) Provide 1 ounce of formula b) Administer benzodiazepines c) Swaddle and decrease stimulation d) Promote parental bonding