Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn

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? "I'm sure the baby will grow out of it." "Can we schedule follow-up vision screenings with the pediatric ophthalmologist now?" "We'll make sure to administer eye drops each day for the next few weeks." "We can fix the problem with surgery."

"Can we schedule follow-up vision screenings with the pediatric ophthalmologist now?" Explanation: 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. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 555-556

A newborn with high serum bilirubin is receiving phototherapy. Which is the most appropriate nursing intervention for this client? Gentle shaking of the baby Application of eye dressings to the infant Delay of feeding until bilirubin levels are normal Placing light 6 inches above the newborn's bassinet

Application of eye dressings to the infant Explanation: Continuous exposure to bright lights by phototherapy may be harmful to a newborn's retina, so the infant's eyes must always be covered while under bilirubin lights. Eye dressings or cotton balls can be firmly secured in place by an infant mask. The lights are placed 12 to 30 inches above the newborn's bassinet or incubator. Bilirubin is removed from the body by being incorporated into feces. Therefore, the sooner bowel elimination begins, the sooner bilirubin removal begins. Early feeding (either breast milk or formula), therefore, stimulates bowel peristalsis and helps to accomplish this. Gently shaking the infant is a method of stimulating breathing in an infant experiencing apnea. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 550

A nurse identifies the urethral opening of a male newborn to be on the dorsum of the shaft of the penis. How does the nurse document this finding? Epispadias Hydrocephalus Talipes equinovarus Omphalocele

Epispadias Explanation: The newborn has epispadias. Hypospadias and epispadias are congenital anomalies in which the urethral opening is malpositioned. Urethral placement may be anywhere along the glands or shaft of the penis. In epispadias, the urethra opens on the dorsal aspect of the penis. In hypospadias, the urethra opens on the ventral aspect of the penis. Talipes equinovarus is a congenital skeletal deformity with the foot in a downward and inward flexed position. Hydrocephalus is an anomaly with infants having an abnormally large head. Omphalocele is a congenital anomaly of the abdominal wall, in which the abdominal contents contained within the peritoneal sac protrude through the external abdominal surface at the base of the umbilical cord. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 590

A woman may safely consume three alcoholic drinks per week during pregnancy. TRUE FALSE

False

All congenital heart defects are discovered during routine newborn screening done by pulse oximetry. TRUE FALSE

False

Breastfeeding should not be recommended for women who take selective serotonin reuptake inhibitors. TRUE FALSE

False

------dysplasia that is not corrected in childhood may result in pain, osteoarthritis, and functional disability later on.

Hip

A nurse is caring for an infant born with an elevated bilirubin level. When planning the infant's care, what interventions will assist in reducing the bilirubin level? Select all that apply. Stop breastfeeding until jaundice resolves. Initiate phototherapy. Offer early feedings. Administer vitamin supplements. Increase the infant's hydration.

Increase the infant's hydration. Offer early feedings. Initiate phototherapy. Explanation: Hydration, early feedings, and phototherapy are measures that the nurse should take to reduce bilirubin levels in the newborn. Stopping breastfeeding or administering vitamin supplements will not help reduce bilirubin levels in the infant. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 550-551

A pregnant client has been diagnosed with gonorrhea. Which nursing interventions should be performed to prevent gonococcal ophthalmia neonatorum in the baby? Perform cesarean birth to prevent infection. Instill a prophylactic agent in the eyes of the newborn. Administer an antiretroviral syrup to the newborn. Administer cephalosporins to mother during pregnancy.

Instill a prophylactic agent in the eyes of the newborn. Explanation: To prevent gonococcal ophthalmia neonatorum in the baby, the nurse should instill a prophylactic agent in the eyes of the newborn. Cephalosporins are administered to the mother during pregnancy to treat gonorrhea but not to prevent infection in the newborn. Performing a cesarean birth will not prevent gonococcal ophthalmia neonatorum in the newborn. An antiretroviral syrup is administered to the newborn only if the mother is HIV positive and will not help prevent gonococcal ophthalmia neonatorum in the baby. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 570

A client at 34 weeks' gestation has recently been diagnosed with human immunodeficiency virus (HIV). The client asks how HIV would be transmitted to the newborn. Which statement would be the nurse's best response? "The risk of your newborn being infected with HIV infection is about 1%." "It is not transmitted to your newborn as it is protected in the uterus." "It is only transmitted through the birth canal so a cesarean birth will be scheduled." It is recommended to formula-feed your newborn as it is transmitted through your breast milk."

It is recommended to formula-feed your newborn as it is transmitted through your breast milk." Explanation: An infected mother can transmit HIV infection to her newborn before or during birth and through breastfeeding. The risk of perinatal transmission of HIV from an infected mother to her newborn is about 25%. This risk falls to less than 1% if the mother receives antiretroviral therapy during pregnancy. HIV can be spread to the infant through breastfeeding. HIV-infected mothers should be counseled to avoid breastfeeding and use formula instead. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 572

Newborns receive an antibiotic in their eyes within the first hour after birth to prevent neonatorum ophthalmia. Which type of bacteria is most likely to cause this condition? Trichomonas vaginalis Escherichia coli Neisseria gonorrhoeae group B streptococcus (GBS)

Neisseria gonorrhoeae Explanation: N. gonorrhoeae and Chlamydia trachomatis are the organisms that cause neonatorum ophthalmia. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 569

A nurse is providing care to a 34-week newborn diagnosed with neonatal abstinence syndrome (NAS). What is most important for the nurse to consider for successful management of the newborn with NAS? Parents should be encouraged to participate in care. Pharmacologic therapy is preferred for newborns with NAS. Nursing care should be supportive and client specific. Collaboration with social services is important.

Nursing care should be supportive and client specific. Explanation: The most important thing for the nurse to consider is that it is essential for care to be supportive and specific to the newborn. Parents should be encouraged to participate in care when possible and the nurse should collaborate with social services but it is most important that the nurse provide care that is specific to the newborn. Most newborns diagnosed with NAS do not require pharmacologic therapy and are treated with supportive measures until they finish withdrawal. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 561

The most common method of treatment for clubfoot, the ----method, utilizes casting and bracing.

Ponseti

Which condition of delivery would predispose a neonate to respiratory distress syndrome (RDS)? First born of twins Vaginal delivery Postdate pregnancy Premature birth

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. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 551

The nursery nurse notes that one of the newborn infants has white patches on his tongue that look like milk curds. What action would be appropriate for the nurse to take? Wipe the tongue off vigorously to remove the white patches. Rinse the tongue off with sterile water and a cotton swab. Report the finding to the pediatrician. Since it looks like a milk curd, no action is needed.

Report the finding to the pediatrician. Explanation: Although the finding looks like a milk curd, if the white patch remains after feeding, the pediatrician needs to be notified. The likely cause of the white patch on the tongue is a fungal infection called Candida albicans, which the newborn probably contracted while passing through the birth canal. The nurse should not try to remove the patches. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 575

Opioid withdrawal symptoms in a newborn may not appear until 48 to 72 hours after birth. TRUE FALSE

TRUE

Treatment for a clubfoot deformity begins at approximately 6 months of life. TRUE FALSE

TRUE

A baby is born with congenital rubella. Which of the following would be an important assessment to be made before hospital discharge? hearing assessment intravenous pyelogram for kidney function assessment for cerebral palsy skin assessment for hemangiomas

hearing assessment Explanation: Congenital rubella (German measles) is strongly associated with hearing disorders. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 574

The most common type of spina bifida is ----.

myelomengocele

---is a safe intervention used to treat hyperbilirubinemia in the newborn.

phototherapy

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 cyanotic discoloration of the hands and feet positive Babinski and Moro reflexes vigorous rooting and feeding

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. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 561

A nurse is conducting an in-service presentation to a group of perinatal nurses about sexually transmitted infections and their effect on pregnancy. The nurse determines that the teaching was successful when the group identifies which infection as being responsible for ophthalmia neonatorum? syphilis gonorrhea chlamydia HPV

gonorrhea Explanation: Infection with gonorrhea during pregnancy can cause ophthalmia neonatorum in the newborn from birth through an infected birth canal. Infection with syphilis can cause congenital syphilis in the neonate. Infection with chlamydia can lead to conjunctivitis or pneumonia in the newborn. Exposure to HPV during birth is associated with laryngeal papillomas. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 569

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? The nurse recognizes the newborn is exhibiting signs and symptoms of fetal alcohol syndrome, which include , , , and . high-pitched, shrill cry flat midface jitteriness Thin upper lip large,narrow-spaced eyes easily consoled increased appetitie

high-pitched, shrill cry flat midface jitteriness Thin upper lip Explanation: Fetal alcohol syndrome (FAS) is caused by intake of alcohol by the pregnant parent during pregnancy; alcohol consumption may be periodic or chronic. Newborns born with FAS have characteristic facial features, are more susceptible to congenital defects, and often have developmental delays. Newborns with FAS have a high-pitched and shrill cry and are generally jittery. Newborns with FAS have a flat midface and a thin upper lip. Newborns with FAS have small and wide-spaced eyes not large narrow-spaced eyes. Newborns with FAS are not easily consoled and have a poor, not an increased appetite. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 560

The nurse is caring for a newborn with fetal alcohol spectrum disorder. The nurse knows that the newborn will demonstrate: hyperglycemia. hyperactivity. lethargy. jitteriness. a large head circumference.

hyperactivity. Explanation: Newborns with fetal alcohol spectrum disorder exhibit hyperactivity, a small height and head circumference, hypoglycemia, and irritability. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 562-564

Cytomegalovirus infection can result in different congenital anomalies. It can also be transmitted via different routes. When discussing this infection with a pregnant woman, the nurse integrates understanding that permanent fetal disability can occur with which type of transmission of CMV? with any transmission in utero transmission after birth transmission during birth transmission

in utero transmission Explanation: There are three time periods during which mother-to-child transmission can occur; however, permanent disability occurs only in association with in utero infection. Such disability can result from maternal infection during any point in the pregnancy, but more severe disabilities are usually associated with maternal infection during the first trimester. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 573

Which of the following would lead you to suspect that a newborn has developmental hip dysplasia? continual drawing of his legs under him while prone inward rotation of his right foot crying on straightening of the right leg inability of the right hip to abduct

inability of the right hip to abduct Explanation: Newborns whose acetabulums are shallow cannot abduct their hip joint. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 592

A neonate undergoing phototherapy treatment must be monitored for which adverse effect? increased GI transit time severe decrease in platelet count hyperglycemia increased insensible water loss

increased insensible water loss Explanation: Increased insensible water loss is due to absorbed photon energy from the lights. Hyperglycemia isn't a characteristic effect of phototherapy treatment. Phototherapy may cause a mild decrease in platelet count. GI transit time may decrease with the use of phototherapy. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 550-551

What would the nurse expect to prioritize in the assessment of a newborn who has a positive Coombs test? jaundice development phenylketonuria hyperglycemia tremor activity

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. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 550

A client with group AB blood whose husband has group O blood has just given birth. Which complication or test result is a major sign of ABO blood incompatibility that the nurse should look for when assessing this neonate? jaundice within the first 24 hours of life negative Coombs test bleeding from the nose or ear jaundice after the first 24 hours of life

jaundice within the first 24 hours of life Explanation: The neonate with an ABO blood incompatibility with its mother will have jaundice within the first 24 hours of life. The neonate would have a positive Coombs test result. Jaundice after the first 24 hours of life is physiologic jaundice. Bleeding from the nose and ear should be investigated for possible causes but probably isn't related to ABO incompatibility. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 548

A newborn is suspected to have fetal alcohol syndrome as a result of maternal use of alcohol during pregnancy. Which of the following would the nurse expect to assess? thick upper lip long nose large bulging eyes low nasal bridge

low nasal bridge Explanation: A low nasal bridge is seen in fetal alcohol syndrome (FAS). The other features of FAS include thin, flat upper lip, small eyes with short palpebral fissure, flattened midface with a short nose. The facial features result from damage to the embryonic cells in early pregnancy. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 564

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? pneumonia choanal atresia diaphragmatic hernia meconium aspiration syndrome

meconium aspiration syndrome Explanation: The nurse should assess for meconium aspiration syndrome in the newborn. Meconium aspiration involves patchy, fluffy infiltrates unevenly distributed throughout the lungs and marked hyperaeration mixed with areas of atelectasis that can be seen through chest X-rays. Direct visualization of the vocal cords for meconium staining using a laryngoscope can confirm aspiration. Lung auscultation typically reveals coarse crackles and rhonchi. Arterial blood gas analysis will indicate metabolic acidosis with a low blood pH, decreased PaO2, and increased PaCO2. Newborns with choanal atresia, diaphragmatic hernia, and pneumonia do not exhibit these manifestations. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 554

Which symptom would most accurately indicate that a newborn has experienced meconium aspiration during the birth process? meconium stained fluids followed by tachypnea bluish skin discoloration listlessness or lethargy stained umbilical cord and skin

meconium stained fluids followed by tachypnea Explanation: Meconium stained cord and skin indicates a potential of meconium aspiration, and the nurse should inform the primary care provider. But if the infant actually experiences respiratory distress following a birth with meconium stained fluids, the likelihood of meconium aspiration is greatly increased. Listlessness or lethargy by themselves does not indicate meconium aspiration. Bluish skin discoloration is normal in infants shortly after birth until the infant's respiratory system clears out all the amniotic fluid. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 551

Which sign(s) and symptom(s) can be associated with cytomegalovirus (CMV) infection in an infant? Select all that apply. patent ductus arteriosus chronic liver disease microcephaly pulmonary stenosis hearing impairment leading to deafness

microcephaly hearing impairment leading to deafness chronic liver disease Explanation: If a woman acquires a primary CMV infection during pregnancy, and if the virus crosses the placenta, the infant may be born with severe neurologic challenges (e.g., hydrocephalus, microcephaly, or spasticity) or with eye damage, hearing impairment, or chronic liver disease. The rubella virus has teratogenic effects on a fetus such as hearing impairment, cognitive and motor challenges, cataracts, and cardiac defects (most commonly patent ductus arteriosus and pulmonary stenosis). Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 573

A newborn is discharged from a healthcare center following treatment for bronchopulmonary dysplasia. Which of the following interventions would be most important for the home care nurse to do when caring for this newborn? administering intravenous antibiotics monitoring the arterial blood gas level monitoring oxygen saturation levels weekly administering surfactant on a weekly basis

monitoring oxygen saturation levels weekly Explanation: Newborns treated and discharged for bronchopulmonary dysplasia require home health care. The nurses providing home health care must monitor the oxygen saturation level weekly in infants, which should be in the range of 94%-95%. Surfactant therapy is given to preterm infants with respiratory distress syndrome to reduce lung surface tension. Monitoring of arterial blood gas levels and administering intravenous antibiotics may be necessary but only if additional complications arise. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 551-553

The nurse should carefully monitor which neonate for hyperbilirubinemia? neonate with ABO incompatibility neonate of African descent neonate of an Rh-positive mother neonate with Apgar scores 9 and 10 at 1 and 5 minutes

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. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 548

Assessment of a pregnant client reveals that she has tested positive for a sexually transmitted infection (STI). The nurse understands that the client's newborn is at risk for which of the following? hypertension diabetes neurologic damage low birth weight

neurologic damage Explanation: The nurse should inform the client that children born of mothers with STIs are often born with neurologic damage, congenital abnormalities, and meningitis. Children born of STI mothers are not known to be born with diabetes or hypertension. Low birth weight is associated with smoking during pregnancy. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 570-571

When caring for a newborn, the nurse observes that the neonate has developed white patches on the mucus membranes of the mouth. Which condition is the newborn most likely experiencing? cytomegalovirus infection oral candidiasis (thrush) toxoplasmosis rubella

oral candidiasis (thrush) Explanation: Monilial vaginitis is a benign fungal condition that is uncomfortable for women; it can be transmitted from an infected mother to her newborn at birth. Neonates develop an oral infection known as thrush, which presents as white patches on the mucous membranes of the mouth. Although rubella, toxoplasmosis, and cytomegalovirus are infections transmitted to the newborn by the mother, this newborn is not experiencing any of these infections. Rubella causes fetal defects, known as congenital rubella syndrome; common defects of rubella are cataracts, deafness, congenital heart defects, cardiac disease, and intellectual disability. Possible fetal effects due to toxoplasmosis include stillbirth, premature delivery, microcephaly, hydrocephaly, seizures, and intellectual disability, whereas possible effects of cytomegalovirus infection include small for gestational age (SGA), microcephaly, hydrocephaly, and intellectual disability. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 575

The nurse reviews the prenatal record in anticipation of a birth. Which finding would alert the nurse to the possibility of an intestinal obstruction in the infant? Select all that apply. hyperemesis gravidarum placenta previa meconium-stained amniotic fluid polyhydramnios sibling with cystic fibrosis

polyhydramnios sibling with cystic fibrosis Explanation: Intestinal obstruction may be anticipated if the mother had polyhydramnios during pregnancy. Cystic fibrosis is also associated with intestinal obstructions. Since cystic fibrosis is genetic, a sibling with the disease is a significant finding. Placenta previa, meconium stained fluid, and hyperemesis gravidarium are not associated with a higher incidence of intestinal obstruction. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 585-586

A nurse is providing preoperative care to a female newborn client with the congenital abnormality myelomeningocele. Which intervention is the priority? preventing infection promoting newborn nutrition maximizing newborn motor function preserving newborn GI function

preventing infection Explanation: A congenital condition of the newborn with a spinal deformity puts the newborn at risk for infection. A myelomeningocele is a fluid-filled sac on the spine that includes part of the spinal cord defect and the meninges. This cyst on the outside of the newborn requires surgical intervention. Although nutrition, GI function, and motor function are all important to the health of the newborn, the spinal and meninges defect puts the newborn at high risk for infection. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 583-584

When caring for a neonate receiving phototherapy, the nurse should remember to: massage the neonate's skin with lotion. decrease the amount of formula. dress the neonate warmly. reposition the neonate frequently.

reposition the neonate frequently. Explanation: Phototherapy works by the chemical interaction between a light source and the bilirubin in the neonate's skin. Therefore, the larger the skin area exposed to light, the more effective the treatment. Changing the neonate's position frequently ensures maximum exposure. Because the neonate will lose water through the skin as a result of evaporation, the amount of formula or water may need to be increased. The neonate is typically undressed to ensure maximum skin exposure. The eyes are covered to protect them from light, and an abbreviated diaper is used to prevent soiling. The skin should be clean and patted dry. Use of lotions would interfere with phototherapy. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 550 - 551

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

respiratory rate of 60 to 70 breaths/min Explanation: The nurse should identify respiratory complications such as tachypnea as a symptom of meconium aspiration in the newborn that results from the presence of meconium in the amniotic fluid. Tachycardia, elevated bilirubin levels, and polycythemia are some of the common problems faced by an SGA newborn, but these are not related to meconium in the amniotic fluid. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 551

A nurse is caring for a newborn with fetal alcohol spectrum disorder. What characteristic of the fetal alcohol spectrum disorder should the nurse assess for in the newborn? poor breathing pattern small head circumference decreased blood glucose level wide eyes

small head circumference Explanation: The nurse should assess for small head circumference in a newborn being assessed for fetal alcohol spectrum disorder. Fetal alcohol spectrum disorder does not cause decreased blood glucose level, a poor breathing pattern, or wide eyes. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 563

The nurse is caring for a client in the early stages of labor. What maternal history factors will alert the nurse to plan for the possibility of a small-for-gestational-age (SGA) newborn? Select all that apply. asthma exacerbations during pregnancy smoking during pregnancy pregnancy weight gain of 25 lb (11 kg) hypotension upon admission drug use

smoking during pregnancy asthma exacerbations during pregnancy drug use Explanation: The nurse should be alert to the possibility of an SGA newborn if the history of the mother reveals smoking, chronic medical conditions (such as asthma), and a substance use disorder. Additional maternal factors that increase the risk for an SGA newborn include hypertension, genetic disorders, and multiple gestations. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 560-561

A nursing student is caring for a newborn with a defect in the neural arch where the posterior laminae of the vertebrae have failed to close. The nurse knows that this infant is suffering from which disorder? cleft palate spina bifida esophageal atresia hydrocephalus

spina bifida Explanation: Spina bifida is a failure of the posterior laminae of the vertebrae to close, leaving an opening through which the spinal meninges and spinal cord may protrude. Hydrocephalus is a condition characterized by excess cerebrospinal fluid (CSF) within the ventricular and subarachnoid spaces of the cranial cavity. Cleft palate is a result of failure of the primary and secondary palates to fuse. Esophageal atresia is the absence of a normal opening or abnormal closure of the esophagus. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 583

A nurse is conducting a presentation at a community health center about congenital malformations. The nurse describes that some common congenital malformations can occur and are recognized to be caused by multiple genetic and environmental factors. Which example would the nurse most likely cite? hemophilia color blindness spina bifida cystic fibrosis

spina bifida Explanation: Spina bifida is a multifactorial inherited disorder thought to be due to multiple genetic and environmental factors. Cystic fibrosis is considered an autosomal recessive inherited disorder, while color blindness and hemophilia are considered X-linked inheritance disorders. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 583-584

A nurse is performing a newborn assessment and notices a small dimple on the sacral area. The infant has a normal neurological assessment and moves all extremities well. What does the nurse suspect that the dimple indicates? spina bifida occulta a normal spinal closure spina bifida with myelomeningocele spina bifida with meningocele

spina bifida occulta Explanation: Spina bifida occulta is a bony defect that occurs without soft-tissue involvement. A dimple in the skin or a tuft of hair over the site may arouse suspicion of its presence, or it may be overlooked entirely. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 583

While caring for a newborn with cleft lip, the nurse would assess which activity that may be compromised due to the cleft lip? respiratory status sucking ability locomotion GI function

sucking ability Explanation: A cleft lip prevents a tight seal around the nipple and therefore compromises the newborn's ability to suck. Respiratory status, locomotion, and GI function are not compromised. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 585

The nurse is assessing a newborn of a woman who is suspected of abusing alcohol. Which newborn finding would provide additional evidence to support this suspicion? elongated nose protruding jaw thin upper lip wide, large eyes

thin upper lip Explanation: Newborn characteristics suggesting fetal alcohol spectrum disorder include thin upper lip, small head circumference, small eyes, receding jaw, and short nose. Other features include a low nasal bridge, short palpebral fissures, flat midface, epicanthal folds, and minor ear abnormalities. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 562

A cesarean birth results in an infant weighing 4,990 g (11 lb). The nurse assesses the infant for which complication? transient lung fluid serum glucose 45 mg/dl (2.50 mmol/L) diaphragmatic paralysis broken clavicle

transient lung fluid Explanation: A large-for-gestational-age (LGA) infant born by cesarean is at risk for transient lung fluid. Broken clavicle and diaphragmatic paralysis are birth injuries associated with a vaginal birth of an LGA infant. All LGA infants are at risk for a serum glucose 45 mg/dl (2.50 mmol/L). Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 553

A newborn is admitted to the nursery. Maternal history reveals the use of opioids. When assessing this newborn for symptoms of opioid withdrawal, which of the following does the nurse expect the newborn to exhibit first? diarrhea poor feeding weight loss tremors

tremors Explanation: With opioid withdrawal, CNS symptoms appear first, followed by gastrointestinal disturbances. The most common symptom of neonatal abstinence syndrome is tremors. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 561

The nurse is caring for a small-for-gestational-age infant born to a drug-dependent client. For which manifestations should the nurse assess as evidence of withdrawal symptoms in the newborn? Select all that apply. high-pitched cry convulsions constant movement sluggish respiratory rate tremors

tremors convulsions high-pitched cry constant movement Explanation: Infants of drug-dependent women tend to be small for gestational age. If the client took a drug close to birth, the infant may show withdrawal symptoms shortly after birth that include tremors, convulsions, high-pitched cry, and constant movement. Respiratory rate would be rapid and not sluggish. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 560-565

The nurse is assigned an infant born with a meningomyelocele. When establishing a plan of care, what assessment is most important to continue to check throughout the day? fussiness indicating pain positive tonic neck reflex urinary status via voiding pattern any changes in vision

urinary status via voiding pattern Explanation: A meningomyelocele is a defect that is equated with spina bifida and is the most common birth defect affecting the central nervous system. With this disorder, the meninges protrude through the vertebrae, and the spinal cord usually ends at the point of protrusion. Motor and sensory function will be decreased or absent beyond this point. The child will have loss of bowel and bladder control, and urine and stools will continually dribble because of lack of sphincter control. This defect is not known to affect vision. Assessing for pain is not a priority with this defect. This defect does not affect the neck region of the spinal cord. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 583-584

A pregnant client has tested positive for hepatitis B virus. When discussing the situation with the client, the nurse explains that her newborn will be vaccinated with an initial HBV vaccine dose at which time? within 12 hours of birth within 36 hours of birth within 24 hours of birth within 48 hours of birth

within 12 hours of birth Explanation: If a woman tests positive for HBV, the newborn will receive HBV vaccine within 12 hours of birth. The second dose will be given at 1 month and the third dose at 6 months. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 572

A client at 32 weeks' gestation has recently been diagnosed with acute herpes type 2. The client asks what can happen to the baby as a result of this infection. How should the nurse bestrespond? "You may carry the pregnancy beyond your due date." "There may be a chance your baby will be a heavier birth weight." "Your infant is protected from this infection during pregnancy." "There is a chance your baby may have a form of intellectual disability."

"There is a chance your baby may have a form of intellectual disability." Explanation: Herpes type 2 (genital herpes) contamination can occur during birth. The infant is susceptible to intellectual disability, premature birth, low birth weight, blindness, or even death as a result of this infection. The infant is not protected from the infection as it is contaminated during vaginal birth. Premature birth is a risk, not postdate birth.

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 may have experienced birth trauma. The infant's mother probably had diabetes. The infant's mother must have had a long labor. The infant may have been exposed to alcohol during pregnancy.

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. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 559-560

A 36-week neonate born weighing 1,800 g has microcephaly and microphthalmia. Based on these findings, which risk factor might be expected in the maternal history? use of alcohol positive group B streptococci use of marijuana gestational diabetes

use of alcohol Explanation: The most common sign of the effects of alcohol on fetal development is restricted growth in weight, length, and head circumference. Intrauterine growth restriction is not characteristic of marijuana use. Gestational diabetes usually produces large-for-gestational-age neonates. Positive group B streptococcus is not a relevant risk factor. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 562-564

A woman at 15 weeks' gestation who works at a daycare center thinks she may have just been exposed to rubella at work. The client asks how this may affect her fetus. What is the bestresponse the nurse can give? "Your health care provider will let you know if there are any problems with your baby." "We will need to perform some additional tests." "We will have to see what gestational age your baby was at exposure." "By the end of the eighth week all of the organ systems and major structures are present, so exposure to any teratogen can lead to birth defects. More assessments are needed."

"By the end of the eighth week all of the organ systems and major structures are present, so exposure to any teratogen can lead to birth defects. More assessments are needed." Explanation: All organ systems are complete at 8 weeks gestation. During this time of organogenesis the growing structure is most vulnerable to invasion by teratogens. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 574

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 would be good to stop smoking before getting pregnant." "It's important to keep insulin levels controlled during pregnancy." "It's a good idea to stop drinking alcohol 3 months before trying to get pregnant." "It's important to add iron and vitamin B supplements to your diet."

"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. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 562-563

A woman's baby is HIV positive at birth. She asks the nurse if this means the baby will develop AIDS. Which statement would be the nurse's best answer? "HIV is transmitted at birth; having a cesarean birth prevented transmission." "She already has AIDS. That's what being HIV positive means." "The antibodies may be those transferred across the placenta; the baby may not develop AIDS." "HIV antibodies do not cross the placenta; this means the baby will develop AIDS."

"The antibodies may be those transferred across the placenta; the baby may not develop AIDS." Explanation: Infants born of HIV-positive women test positive for HIV antibodies at birth because these have crossed the placenta. An accurate disease status cannot be determined until the antibodies fade at about 18 months. Testing positive for HIV antibodies does not mean the infant has AIDS. Having a cesarean birth does decrease the risk of transmitting the virus to the infant at birth; it does not prevent the transmission of the disease. HIV antibodies do cross the placenta, which is why babies born of HIV positive mothers are HIV positive. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 572-573

The pregnant woman with diabetes asks the nurse why her last baby weighed 11 pounds. What is the best response by the nurse? "There is no way to control the amount of glucose the mother is producing, because she can't take insulin while she is pregnant and the baby gains too much weight." "Your baby weighed so much because of how you were eating. You must eat less with this child." "The fetus increases insulin production in response to elevated glucose levels of the mother, which acts as a fetal growth hormone." "The fetus maintains elevated levels of glucose in response to the mother's eating patterns and gains too much weight."

"The fetus increases insulin production in response to elevated glucose levels of the mother, which acts as a fetal growth hormone." Explanation: Consistently elevated fetal insulin levels cause the distinctive growth pattern. Because maternal glucose levels are elevated and glucose readily crosses the placenta, the fetus responds by increasing insulin production. Because insulin acts as a fetal growth hormone, consistently high levels cause fetal macrosomia, birth weight of greater than 4,500 g. Insulin also causes disproportionate fat buildup to the shoulders and upper body, increasing the risk for shoulder dystocia and birth trauma. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 559-560

A gravida woman in her second trimester has shared that she still enjoys a glass of wine about once a week with dinner. What response by the nurse is most appropriate? "The best thing for you to do is to reduce the amount of alcohol you are drinking." "Now that you have reached the second trimester you are at a reduced risk for causing complications to your fetus." "There is no amount of alcohol consumption in pregnancy that is considered safe for the fetus." "As long as you do not increase the amount of alcohol you are drinking there is little risk."

"There is no amount of alcohol consumption in pregnancy that is considered safe for the fetus." Explanation: Alcohol ingestion during the pregnancy is considered unsafe at all points in the pregnancy. Alcohol can impact the fetus during each of trimester of pregnancy. There are no exact amounts of alcohol that can be ingested safely. Alcohol impacts each pregnancy and fetus differently. The best course of action is to share the dangers with the woman. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 562

The nurse is caring for a newborn client newly diagnosed with developmental dysplasia of the hip (DDH). Which response by the nurse educates the parents on the correct plan of treatment for this diagnosis? "Treatment will start once your child can bear weight." "Treatment will consist of surgery when your child weighs about 10 pounds." "Treatment will include bilateral casts at 1 month of age." "Treatment will begin immediately."

"Treatment will begin immediately." Explanation: Developmental dysplasia of the hip (DDH) is a congenital newborn condition that requires immediate intervention. The development of the acetabulum of the hip is defective, and it may or may not be dislocated. Treatment of the defect and dislocated hips involves positioning the hip into a flexed, abducted (externally rotated) position to attempt to press the femur into the acetabulum. This involves splints and halters as the first line of treatment. Treatment should not be delayed. Surgery and casts are typically not used as the first line of treatment. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 592-593

A client in labor with chronic back pain tells the nurse about taking a dose of hydrocodone/acetaminophen for labor pain prior to coming to the hospital. What should the nurse prepare to do once the fetus is born? Select all that apply. Coach the client in breathing techniques because other pain medication is contraindicated. Request that the health care prescribe the same medication to be used for pain during labor. Inform the health care provider so that liver effects can be monitored. Evaluate the neonate for withdrawal symptoms. Suggest that no additional opioid pain medication be provided during labor.

Evaluate the neonate for withdrawal symptoms. Inform the health care provider so that liver effects can be monitored. Explanation: A typical prescription drug abused by women is hydrocodone/acetaminophen, because this is frequently prescribed for chronic back pain. The half-life of this drug is about 2 hours in addicted women. Even though it appears to have little effect on neonates, the neonate needs to be observed for both withdrawal and liver effects. The client can receive other opioid pain medication during labor. Other pain medication is not contraindicated for this client. There are other, safer pain medications that can be prescribed for the client and fetus during labor. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 561

A nurse assisting in a birth notices that the amniotic fluid is stained greenish black as the neonate is being born. Which intervention should the nurse implement as a result of this finding? Administer oxygen via a bag and mask Flick the sole of the neonate's foot Provide supplemental oxygen and monitor respiratory status Gently shake the neonate

Provide supplemental oxygen and monitor respiratory status Explanation: When the amniotic fluid is stained greenish black, the neonate is at risk for meconium aspiration syndrome (MAS). Treatment for MAS depends on severity, but standard guidelines include supplemental oxygen and close monitoring of respiratory status. Additional treatment depends on the severity of respiratory compromise. The health care provider would determine if additional treatment is needed. The nurse should not administer oxygen under pressure (bag and mask) until the neonate has been intubated and suctioned, so the pressure of the oxygen does not drive small plugs of meconium farther down into the lungs, worsening the irritation and obstruction. Gently shaking the neonate and flicking the sole of the foot are methods of stimulating breathing in a neonate experiencing apnea. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 551-554

A nurse in the hospital is caring for a client at 37 weeks gestation who experienced premature rupture of the membranes (PROM) more than 24 hours prior to coming to the hospital. The client presents with a fever of 100.4°F (38°C). Complete the following sentence(s) by choosing from the list of options. Due to the client's PROM more than 24 hours prior to arriving to the hospital, the nurse determines the client is at risk for contracting Select A...bacterial vaginosis group B streptococcus trichomoniasis chlamydia and should plan to implement Select...request fluconazole for external use administer metronidazole recommend including probiotics in their diet administer intravenous antibiotics to prevent complications. Select A: Bacterial vaginosis broup B streptococcus trichomoniasis chlamydia Select B: request fluconazole for external use administer metronidazole recommend including probiotics in their diet administering intravenous antibiotics

Select A: group B streptococcus Select B: administer intravenous antibiotics Explanation: Group B streptococcus infection is a bacterial infection that can be transmitted to the fetus during labor. This can have cause serious complications to the newborn, including respiratory distress and sepsis. Group B streptococcus infection can be transmitted to the fetus during labor. The client is at risk for contracting group B streptococcus due to premature rupture of membranes (PROM) more than 24 hours prior to arriving at the hospital. The nurse will plan to administer intravenous antibiotics to the client prior to birth of the fetus. Chlamydia, trichomoniasis, and bacterial vaginosis are sexually transmitted infections (STIs). Unlike group B streptococcus infection, these infections are not transmitted to the fetus during labor. As STIs, the client is not at risk for contracting these infections because of PROM. Metronidazole is an anti-infective that is used to treat bacterial vaginosis, not group B streptococcus. Probiotics are used to maintain natural flora in the gastrointestinal (GI) system, not to treat group B streptococcus. Fluconazole is used to treat vaginal candidiasis, not group B streptococcus infections. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 567-568

The nurse is conducting a class for pregnant women on problems associated with infections seen in women during gestation. One mother tells the nurse that she has never had chickenpox (varicella) and is worried she will contract it before she delivers. What would the nurse explain to this mother to ease her anxiety? She needs to let her physician know that she has not had varicella so she can get immunized at her next visit. Even if she does get varicella, her baby will be fine since varicella is not passed on to the fetus. She can receive her varicella vaccine immediately after delivery, followed by a second dose at her 6-week postpartum visit. The likelihood of her catching varicella is very slim, so tell her not to worry.

She can receive her varicella vaccine immediately after delivery, followed by a second dose at her 6-week postpartum visit. Explanation: Varicella zoster is spread by respiratory droplets and is easily contracted if the mother is exposed. If the mother does contract varicella, especially from weeks 12 to 20 of gestation, it can be devastating to the fetus. Birth defects, central nervous system damage, low birth weight, cognitive delays and deafness can all occur. However, a mother cannot receive a varicella immunization during pregnancy since the immunization can cross the placenta and act like the actual disease, causing the same effects. The mother is immunized prior to discharge after delivery and at her 6-week postpartum visit. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 574-575

A nurse is preparing a presentation for a group of neonatal nurses on clubfoot (congenital talipes equinovarus). The nurse determines that the presentation was successful when the group makes which statement? The exact cause of clubfoot is not known. Clubfoot is a common genetic disorder. The intrinsic form can be manually reduced. The condition affects girls more often than boys.

The exact cause of clubfoot is not known. Explanation: Clubfoot (congenital talipes equinovarus) is a complex, multifactorial deformity with genetic and intrauterine factors. Heredity and race seem to factor into the incidence, but the means of transmission and the etiology are unknown. Most newborns with clubfoot have no identifiable genetic, syndromal, or extrinsic cause. Clubfoot affects boys twice as often as girls. With the intrinsic type, manual reduction is not possible. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 593

The nurse has administered erythromycin ointment to a newborn. What outcome indicates this nursing intervention has been effective? The newborn does not contract ophthalmia neonatorum. The newborn is about to produce sufficient tears. The newborn's sclerae do not appear yellow. The newborn's active eye infection resolves.

The newborn does not contract ophthalmia neonatorum. Explanation: Eye prophylaxis is given to prevent (not treat) ophthalmia neonatorum, a severe eye infection contracted in the birth canal of a woman with gonorrhea or chlamydia. This is unrelated to tear production or jaundice. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 569

A newborn delivered of a diabetic mother by cesarean section 90 minutes ago is exhibiting nasal flaring, expiratory grunting, and tachypnea. Lungs are clear on auscultation and oxygen saturation is 95% on room air. What inference can the nurse make about the newborn's condition? The newborn will likely need treatment for pneumonia. Oxygen supplementation will be needed to maintain current oxygen saturation levels. The newborn will be monitored with an expectation of improvement within 24-48 hours. Administration of diuretics will be part of the treatment regimen.

The newborn will be monitored with an expectation of improvement within 24-48 hours. Explanation: Based on the newborn's history, transient tachypnea of the newborn (TTN) is the likely diagnosis. TTN is a self-limited and benign condition that manifests within 2 hours of birth with symptoms of respiratory distress including tachypnea, nasal flaring, and expiratory grunting that usually resolve within 24-48 hours. Infants with TTN usually do not require oxygen supplementation at greater than 40% to maintain oxygen saturation above 90%. This newborn is at 95% on room air. If the newborn's condition does not improve within 24 hours evaluation for pneumonia and sepsis will be warranted. Diuretics have not been shown to improve outcomes for this population. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 553-554

The nurse is preparing a presentation for a health fair presenting the risks which can lead to sudden infant death syndrome (SIDS). Which factors would the nurse include as increasing the risk for SIDS? a low-birth-weight baby girl, March birth, middle-class, 25-year-old G2P2 nonsmoker an average weight baby boy, January birth, a poor, 16-year-old G1P1 nonsmoker An average weight baby boy, April birth, poor, 27 year old G2P2 nonsmoker a low-birth-weight baby boy, November birth, wealthy, educated, 19-year-old G1P1 smoker

a low-birth-weight baby boy, November birth, wealthy, educated, 19-year-old G1P1 smoker Explanation: No single cause of SIDS has been identified but there are contributing factors. Infants who die of SIDS are usually 2 to 4 months old, although some deaths have occurred during the first or second week of life. Few infants older than 6 months of age die of SIDS. It is a greater threat to low-birth-weight infants than to term infants. It occurs more often in winter and affects more male infants than female infants as well as more infants from minority and lower socioeconomic groups. Infants born to mothers younger than 20 years of age, infants who are not a firstborn child, and infants whose mothers smoked during pregnancy also have been found to be at greater risk. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 562

Women with a history of herpes simplex virus are instructed to take to suppress outbreaks and viral shedding from 36 weeks' gestation until delivery.

acyclovir

A pregnant woman in her 39th week of pregnancy presents to the clinic with a vaginal infection. She tests positive for chlamydia. What would this disease make her infant at risk for? chickenpox deafness blindness neonatal laryngeal papillomas

blindness Explanation: A pregnant woman who contracts chlamydia is at increased risk for spontaneous abortion (miscarriage), preterm rupture of membranes, and preterm labor. The postpartum woman is at higher risk for endometritis (Fletcher & Ball, 2006). The fetus can encounter bacteria in the vagina during the birth process. If this happens, the newborn can develop pneumonia or conjunctivitis that can lead to blindness. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 570

A nurse is preparing a presentation for a group of young adult pregnant women about common infections and their effect on pregnancy. When describing the infections, which infection would the nurse include as the most common congenital and perinatal viral infection in the world? cytomegalovirus hepatitis B rubella parvovirus B19

cytomegalovirus Explanation: Although rubella, hepatitis B, and parvovirus B19 can affect pregnant women and their fetuses, cytomegalovirus (CMV) is the most common congenital and perinatal viral infection in the world. CMV is the leading cause of congenital infection, with morbidity and mortality at birth and sequelae. Each year approximately 1% to 7% of pregnant women acquire a primary CMV infection. Of these, about 30% to 40% transmits infection to their fetuses. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 573

In an effort to decrease complications for the infant right after birth, the nurse would expect to administer which medication for prophylaxis of potential eye conditions? silver nitrate solution vitamin K gentamicin ophthalmic ointment erythromycin ophthalmic ointment

erythromycin ophthalmic ointment Explanation: Erythromycin ophthalmic ointment is the only drug approved by the U.S. Food and Drug Administration (FDA) for the prophylaxis of gonococcal neonatorum in the United States. Silver nitrate solution was once used for eye prophylaxis, but it is no longer used because it has little efficacy in preventing chlamydial eye disease. Vitamin K is used to promote blood clotting in the newborn. Gentamicin is not used for newborn eye prophylaxis. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 569

The nurse is assessing a newborn suspected of having meconium aspiration syndrome. What sign or symptom would be most suggestive of this condition? bile-stained emesis high-pitched, shrill cry intermittent tachypnea expiratory grunting

expiratory grunting Explanation: Expiratory grunting, a barrel-shaped chest with an increased anterior-posterior chest diameter, prolonged tachypnea, progression from mild-to-severe respiratory distress, intercostal retractions, cyanosis, surfactant dysfunction, airway obstruction, hypoxia, and chemical pneumonitis with inflammation of pulmonary tissues are seen in a newborn with meconium aspiration syndrome. A high-pitched cry may be noted in periventricular hemorrhage/intraventricular hemorrhage. Bile-stained emesis occurs in necrotizing enterocolitis. Intermittent tachypnea can be indicative of transient tachypnea of the newborn or any mild respiratory distress problem. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 554

A nurse is conducting a presentation about prenatal care and preexisting maternal conditions. When discussing the various risks to the mother and infant, the nurse would include information about which condition as the leading cause of intellectual disability in the United States? pregnancy category X medications maternal drug addiction fetal alcohol spectrum disorder genetic anomalies

fetal alcohol spectrum disorder Explanation: Fetal alcohol spectrum disorder is a lifelong yet completely preventable set of physical, mental, and neurobehavioral birth defects. It is the leading cause of intellectual disability in the United States. Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn - Page 562-563