Chapter 24: Nursing Management of the Newborn at Risk: Acquired and Congenital Newborn Conditions - ML5

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.

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.

In completing the newborn assessment checklist, the nurse documents a meconium stool. This documentation rules out which condition?

Imperforate anus

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

The nurse caring for a newborn notes a distended abdomen approximately 24 hours after birth. Which action should the nurse take after review of the medical record reveals an apparent healthy newborn at birth but no documentation of a bowel movement?

Inform the health care provider immediately.

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.

The nurse is caring for a preterm infant and notes frothing and excessive drooling. Which additional assessment finding should the nurse prioritize and report immediately?

Severe cyanosis

A client at 6 weeks' gestation asks the nurse what foods she should eat to help prevent neural tube disorders in her growing baby. The nurse would recommend which foods?

Spinach, oranges, and beans

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.

A client who gave birth 2 hours ago expresses concern about her baby developing jaundice. Which response from the nurse would be best?

"I understand your concern because as many as 50% of babies can develop jaundice."

A newborn boy is diagnosed with esophageal atresia and tracheoesophageal fistula. After the nurse provides preoperative teaching, which statement indicates that the parents need additional teaching?

"We can probably start feeding him with the bottle about a day after the surgery."

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

A neonatal nurse admits a preterm infant with the diagnosis of respiratory distress syndrome and reviews the maternal labor and birth record. Which factors in the record would the nurse correlate with this diagnosis? Select all that apply.

1) 32 weeks' gestation 2) cesarean birth 3) male gender 4) newborn asphyxia 5) maternal diabetes

Which nursing actions limit overstimulation of the preterm infant? Select all that apply.

1) Speak softly to the infant. 2) Keep lights low in the nursery. 3) Coordinate nursing care.

A perinatal nurse is working as a member of a local community health task force to address the impact of substance use during pregnancy. The group is to come up with recommendations for programs that will have a positive impact. After reviewing current research on the topic, on which area(s) will the group likely focus?

1) heroin 2) alcohol 3) cocaine

A nurse is caring for a 25-year-old G1P0 at 37 weeks' gestation. The client's history indicates that the client has had alcohol abuse disorder throughout their pregnancy. What signs and symptoms does the nurse expect the newborn to exhibit?

1) thin upper lip 2) flat midface 3) jitteriness 4) high-pitched, shrill cry

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

A nurse is caring for a neonate of 25 weeks' gestation who is at risk for intraventricular hemorrhage (IVH). Which assessment finding should be reported immediately?

a sudden drop in hematocrit

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

The nurse suspects a preterm newborn receiving enteral feedings of having necrotizing enterocolitis (NEC). What assessment finding best correlates with this diagnosis?

bloody stools

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

A woman with hydramnios has just given birth. The nurse recognizes that the infant must be assessed for which condition?

esophageal atresia

The nurse is assessing a newborn suspected of having meconium aspiration syndrome. What sign or symptom would be most suggestive of this condition?

expiratory grunting

When caring for a neonate of a mother with diabetes, which physiologic finding is most indicative of a hypoglycemic episode?

jitteriness

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

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."

A newborn at 33 weeks' gestation has an Apgar score of 5 at 10 minutes of life. Which nursing action is a priority?

Begin resuscitation measures.

Which nursing measure is most effective in reducing newborn infections?

Maintain medical asepsis while providing care.

Which intervention is helpful for the neonate experiencing drug withdrawal?

Place the isolette in a quiet area of the nursery.

Which nursing action is required when caring for the post-term infant?

Serial blood glucose levels

Which congenital condition is an immediate emergency requiring notification of the health care provider?

Tracheoesophageal fistula

After birth, an infant experiences meconium aspiration. What does the nurse anticipate the primary care provider prescribing prophylactically to prevent pneumonia?

antibiotics

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

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

A nurse is caring for a child born with a tracheoesophageal fistula. Which finding during pregnancy would have caused the nurse to suspect this might be present?

hydramnios

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?

hyperactive and irritable

A neonate undergoing phototherapy treatment must be monitored for which adverse effect?

increased insensible water loss

What would the nurse expect to prioritize in the assessment of a newborn who has a positive Coombs test?

jaundice development

While caring for a neonate born of a mother with diabetes, the nurse should monitor the neonate for which complication?

macrosomia

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

Which facial change is characteristic in a neonate with fetal alcohol spectrum disorder?

short, palpebral fissures

Which sign appears early in a neonate with respiratory distress syndrome?

tachypnea more than 60 breaths/minute

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."

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

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.

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.

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)

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?

breech birth

A nurse is assessing a newborn for jaundice. The nurse would first notice jaundice at which area?

face

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

A newborn has not passed any stools in the first 24 hours after birth, and his abdomen is becoming distended. The nurse recognizes that which condition could explain such findings?

imperforate anus

A nurse is caring for a newborn whose chest X-ray reveals marked hyperaeration mixed with areas of atelectasis. The infant's arterial blood gas analysis indicates metabolic acidosis. For which dangerous condition should the nurse prepare when providing care to this newborn?

meconium aspiration syndrome

The nursing instructor is conducting a session with a group of nursing students researching potential respiratory difficulties in newborns. The instructor determines the session is successful after the students correctly choose which contributing factor for transient tachypnea of the newborn?

often seen with cesarean births

A newborn, born at 33 weeks' gestation, is on a ventilator in the neonatal intensive care unit (NICU). The newborn receives surfactant therapy. Which would the nurse expect to assess as a positive response to this therapy?

oxygen saturation 98%

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