Chapter 25: Acquired Conditions and Congenital Abnormalities in the Newborn: PREPU

A nurse is providing preoperative care to a female newborn client with the congenital abnormality myelomeningocele. Which intervention is the priority? 1 preventing infection 2 promoting newborn nutrition 3 preserving newborn GI function 4 maximizing newborn motor function

1

A nurse identifies the urethral opening of a male newborn to be on the dorsum of the shaft of the penis. The nurse documents this finding as which of the following? 1 Hypospadias 2 Talipes equinovarus 3 Hydrocephalus 4 Omphalocele

1

Assessment of a pregnant woman and her fetus reveals tachycardia and hypertension. There is also evidence suggesting vasoconstriction. The nurse would question the woman about use of which substance? 1 marijuana 2 alcohol 3 heroin 4 cocaine

4

The nurse is preparing to administer a tube feeding to a preterm infant. When checking for residual prior to the feeding, there is a residual of 3 mL. What action should the nurse take? 1 Administer the tube feeding. 2 Take the tube out. 3 Reduce the amount of the tube feeding by half. 4 Call the physician.

4 The nurse should report immediately gradually increasing residual and abdominal girth or return of more than 2 mL of undigested formula. These signs indicate feeding intolerance and could herald the onset of necrotizing enterocolitis (NEC).

A newborn with high serum bilirubin is receiving phototherapy. Which is the most appropriate nursing intervention for this client? 1 Application of eye dressings to the infant 3 Placing light 6 inches above the newborn's bassinet 4 Delay of feeding until bilirubin levels are normal 5 Gentle shaking of the baby

1

A nurse assisting in a birth notices that the amniotic fluid is stained greenish black as the baby is being born. Which intervention should the nurse implement as a result of this finding? 1 intubation and suctioning of the trachea 2 administration of oxygen via a bag and mask 3 gently shaking the infant 4 flicking the sole of the infant's foot

1

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. 1 Thick upper lip 2 Large bulging eyes 3 Low nasal bridge 4 Long nose

3

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? 1 choanal atresia 2 diaphragmatic hernia 3 meconium aspiration syndrome 4 pneumonia

3

When caring for a neonate receiving phototherapy, the nurse should remember to: 1 decrease the amount of formula. 2 dress the neonate warmly. 3 massage the neonate's skin with lotion. 4 reposition the neonate frequently.

4

A 36-week neonate born weighing 1,800 g has microcephaly and microophthalmia. Based on these findings, which risk factor might be expected in the maternal history? 1 Use of alcohol 2 Use of marijuana 3 Gestational diabetes 4 Positive group B streptococci

1

A nurse is caring for a newborn client who is diagnosed with myelomeningocele. Which nursing intervention would protect the newborn from injury? 1 Place the newborn in a prone or lateral position. 2 Delay the parents from holding the newborn. 3 Place petroleum jelly gauze on the spinal sac to keep it moist. 4 Place a urine collection bag on newborn for the continuous leakage.

1

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? 1 fetal alcohol spectrum disorder 2 genetic anomalies 3 maternal drug addiction 4 pregnancy category X medications

1

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? 1 spina bifida 2 cystic fibrosis 3 color blindness 4 hemophilia

1

A nurse is conducting a review class for a group of perinatal nurses working at the local clinic. The clinic sees a high population of women who are HIV positive. After discussing the recommendations for antiretroviral therapy with the group, the nurse determines that the teaching was successful when the group identifies which rationale as the underlying principle for the therapy? 1 reduction in viral loads in the blood 2 treatment of opportunistic infections 3 adjunct therapy to radiation and chemotherapy 4 can cure acute HIV/AIDS infections

1

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? 1 "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." 2 "Your health care provider will let you know if there are any problems with your baby." 3 "We will have to see what gestational age your baby was at exposure." 4 "We will need to perform some additional tests."

1

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? 1 in utero transmission 2 during birth transmission 3 after birth transmission 4 with any transmission

1

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? 1 tetracycline ophthalmic ointment 2 silver nitrate solution 3 vitamin K 4 gentamicin ophthalmic ointment

1

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? 1 The infant was a preterm, low birth weight and small for gestational age neonate. 2 The infant was born at term but at a low birth weight and small for gestational age. 3 The infant was born at term but a very low birth weight and small for gestational age. 4 The infant was a preterm, very low birth weight and small for gestational age.

1

The neonatal intensive care nurse is assessing a new admission and suspects the newborn to have meconium aspiration syndrome. Which assessment finding would correlate with the nurse's suspicion? 1 a barrel-shaped chest with an increased anterior-posterior chest diameter 2 a sunken chest with a decreased anterior-posterior chest diameter 3 PaO2 90 mm/Hg, PaCO2 40 mm/Hg, O2 saturation 96% 4 heart rate 110 bpm, respiratory rate 56 breaths/minute, acrocynosis present

1

The newborn nursery nurse suspects a newborn of having neonatal abstinence syndrome. What assessment findings would most correlate with the diagnosis? 1 frequent yawning and sneezing 3 vigorous rooting and feeding 4 positive Babinski and Moro refelxes 5 cyanotic discoloration of the hands and feet

1

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? 1 "It's a good idea to stop drinking alcohol 3 months before trying to get pregnant." 2 "It's important to add iron and vitamin B supplements to your diet." 3 "It would be good to stop smoking before getting pregnant." 4 "It's important to keep insulin levels controlled during pregnancy."

1

The nurse suspects a preterm newborn receiving enteral feedings of having necrotizing enterocolitis (NEC). What assessment finding best correlates with this diagnosis? 1 bloody stools 2 poor suck reflex 3 high-pitched cry 4 meconium stools

1

Which intervention is helpful for the neonate experiencing drug withdrawal? 1 Place the Isolette in a quiet area of the nursery. 2 Withhold all medication to help the liver metabolize drugs. 3 Dress the neonate in loose clothing so he won't feel restricted. 4 Place the Isolette near the nurses' station for frequent contact with health care workers.

1

Which newborn would the nurse suspect to be most at risk for intellectual disability due to the mother's actions during pregnancy? 1 the child of a client who admits to drinking a liter of alcohol daily during the pregnancy 2 the child of a teenage client who used marijuana through her pregnancy to cope with stress 3 the newborn of a client addicted to heroin and in the methadone maintenance program 4 the newborn of a client who used cocaine occasionally during her pregnancy

1

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. 1 polyhydramnios 2 sibling with cystic fibrosis 3 placenta previa 4 meconium-stained amniotic fluid 5 hyperemesis gravidarium

1, 2

The parents of a newborn are upset that their newborn needs treatment for ophthalmia neonatorum. The nurse should explain this is related to which maternal infection? Select all that apply. 1 Chlamydia 2 Gonorrhea 3 Trichomonas 4 Syphilis 5 Candidiasis

1, 2

A nurse in the newborn nursery has noticed that an infant is frothing and appears to have excessive drooling. Further assessment reveals that the baby has episodes of respiratory distress with choking and cyanosis. What disorder should the nurse suspect based on these findings? 1 cleft palate 2 esophageal atresia 3 cleft lip 4 coarctation of the aorta

2

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? 1 The infant's mother must have had a long labor. 2 The infant's mother probably had diabetes. 3 The infant may have experienced birth trauma. 4 The infant may have been exposed to alcohol during pregnancy.

2

A nurse is conducting a presentation for a group of pregnant women about measures to prevent toxoplasmosis. The nurse determines that additional teaching is needed when the group identifies which measure as preventive? 1 washing raw fruits and vegetables before eating them 2 cooking all meat to an internal temperature of 125° F (52° C) 3 wearing gardening gloves when working in the soil 4 avoiding contact with a cat's litter box

2

A nurse is teaching the mother of a newborn experiencing cocaine withdrawal about caring for the neonate at home. The mother stopped using cocaine near the end of her pregnancy. The nurse determines that additional teaching is needed when the mother identifies which action as appropriate for her newborn? 1 wrapping the newborn snugly in a blanket 2 waking the newborn every hour 3 checking the newborn's fontanels 4 offering a pacifier

2

A pregnant client has been diagnosed with gonorrhea. Which nursing interventions should be performed to prevent gonococcal ophthalmia neonatorum in the baby? 1 Administer cephalosporins to mother during pregnancy. 2 Instill a prophylactic agent in the eyes of the newborn. 3 Perform cesarean birth to prevent infection. 4 Administer an antiretroviral syrup to the newborn.

2

A pregnant woman diagnosed with syphilis comes to the clinic for a visit. The nurse discusses the risk of transmitting the infection to her newborn, explaining that this infection is transmitted to the newborn through the: 1 amniotic fluid. 2 placenta. 3 birth canal. 4 breast milk.

2

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? 1 "She already has AIDS. That's what being HIV positive means." 2 "The antibodies may be those transferred across the placenta; the baby may not develop AIDS." 3 "HIV is transmitted at birth; having a cesarean birth prevented transmission." 4 "HIV antibodies do not cross the placenta; this means the baby will develop AIDS."

2

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? 1 wide, large eyes 2 thin upper lip 3 protruding jaw 4 elongated nose

2

The nurse is caring for a newborn client newly diagnosed with developmental dysplasia of the hip. Which response by the nurse educates the parents on the correct plan of treatment for this diagnosis? 1 "Treatment will start once your child can bear weight." 2 "Treatment will begin immediately." 3 "Treatment will consist of surgery when your child weighs about 10 pounds." 4 "Treatment will include bilateral casts at 1 month of age."

2

The pregnant woman with diabetes asks the nurse why her last baby weighed 11 pounds. What is the best response by the nurse? 1 "Your baby weighed so much because of how you were eating. You must eat less with this child." 2 "The fetus increases insulin production in response to elevated glucose levels of the mother, which acts as a fetal growth hormone." 3 "The fetus maintains elevated levels of glucose in response to the mother's eating patterns and gains too much weight." 4 "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."

2

Which assessment finding would best validate a problem in a small-for-gestational age newborn secondary to meconium in the amniotic fluid? 1 total bilirubin level of 15 2 respiratory rate of 60 to 70 bpm 3 heart rate of 162 bpm 4 hematocrit of 44%

2

Which finding would lead the nurse to suspect that a large-for-gestational-age newborn is developing hyperbilirubinemia? 1 temperature instability 2 tea-colored urine 3 seizures 4 feeble sucking

2 The others are signs of hypoglycemia

A newborn is diagnosed with ophthalmia neonatorum. The nurse understands that this newborn was exposed to which infection? 1 syphilis 2 Candida albicans 3 gonorrhea 4 human immunodeficiency virus

3

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? 1 a normal spinal closure 2 spina bifida with menigocele 3 spina bifida occulta 4 spina bifida with myelomeningocele

3

A nurse is preparing a presentation for a group of neonatal nurses on congenital clubfoot. The nurse determines that the presentation was successful when the group makes which statement? 1 Clubfoot is a common genetic disorder. 2 The condition affects girls more often than boys. 3 The exact cause of clubfoot is not known. 4 The intrinsic form can be manually reduced.

3

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? 1 rubella 2 hepatitis B 3 cytomegalovirus 4 parvovirus B19

3

A nurse is teaching a group of pregnant women about the adverse effects of substances on the fetus. The nurse determines that additional teaching is needed when the the group identifies which substance as being teratogenic? 1 alcohol 2 nicotine 3 marijuana 4 cocaine

3

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? 1 Diabetes 2 Hypertension 3 Neurologic damage 4 Low birth weight

3

What would the nurse expect to prioritize in the assessment of a newborn who has a positive Coombs test? 1 tremor activity 2 hyperglycemia 3 jaundice development 4 phenylketonuria

3

A nurse is caring for a pregnant client who is human immunodeficiency virus (HIV) positive. What is a priority issue that the nurse should discuss with the client? 1 the client's relationship with the spouse 2 the amount of physical contact that should occur with the infant 3 the client's plan for future pregnancies 4 the need for the client to avoid breastfeeding

4

A nurse is caring for an infant with an elevated bilirubin level who is under phototherapy. What evaluation data would best indicate that the newborn's jaundice is improving? 1 Reticulocyte count is 6%. 2 Hematocrit is 38. 3 Skin looks less jaundiced. 4 Bilirubin level went from 15 to 11.

4

A pregnant single mom living alone tells the nurse she is considering getting a cat for her 2-year-old daughter. Which is the best response by the nurse? 1 "The exposure to the cat litter may cause you to need a C-section." 2 "This will cut down on the jealousy for your two-year-old when the baby comes." 3 "If you don't think caring for a cat is too much work, that would be great." 4 "You should wait until after you give birth to obtain the cat for your daughter."

4

A pregnant woman asks the nurse, "I'm a big coffee drinker. Will the caffeine in my coffee hurt my baby?" Which response by the nurse would be most appropriate? 1 "The caffeine in coffee has been linked to birth defects." 2 "Caffeine has been shown to cause growth restriction in the fetus." 3 "Caffeine is a stimulant and needs to be avoided completely." 4 "If you keep your intake to less than 300 mg/day, you should be okay."

4

The nurse is assessing a newborn suspected of having meconium aspiration syndrome. What sign or symptom would be most suggestive of this condition? 1 high-pitched, shrill cry 2 bile-stained emesis 3 intermittent tachypnea 4 expiratory grunting

4

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? 1 Wipe the tongue off vigorously to remove the white patches. 2 Rinse the tongue off with sterile water and a cotton swab. 3 Since it looks like a milk curd, no action is needed. 4 Report the finding to the pediatrician.

4

When providing care to a newborn with necrotizing enterocolitis (NEC), the nurse would need to report which finding immediately? 1 decrease in abdominal girth 2 stools negative for blood 3 bowel sounds in all four quadrants 4 abdomen appearing red and shiny

4

Which assessment findings are most prominent in the infant with Tetralogy of Fallot and significant pulmonary stenosis? 1 Irregular heart rate, fatigue, pink tinged skin 2 Dry mucous membranes, poor urine output 3 Poor weight gain, nausea, decreased muscle tone 4 Dyspnea on limited exertion, fatigue, cyanosis

4

A nurse is providing postoperative care to an infant who had a ventriculoatrial 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? 1 Assess surgical site for signs of infection. 2 Increase the flow of IV fluids and maintain NPO status. 3 Assess and administer pain medication. 4 Notify the primary care provider immediately.

4 The projectile vomiting should raise suspicions of increasing intracranial pressure and requires emergent intervention, so the nurse should notify the primary care provider immediately.

A premature, 38-week-gestation neonate is admitted to the observational nursery and placed under bili-lights with evidence of hyperbilirubinemia. Which assessment findings would the neonate demonstrate? Select all that apply. 1 increased serum bilirubin levels 2 clay-colored stools 3 tea-colored urine 4 cyanosis 5 Mongolian spots

1, 2 ,3

A neonate undergoing phototherapy treatment must be monitored for which adverse effect? 1 Hyperglycemia 2 Increased insensible water loss 3 Severe decrease in platelet count 4 Increased GI transit time

2

When providing care for a newborn to a mother who was a smoker during her pregnancy, the nurse will anticipate the size of the infant to be what? 1 Larger than average 2 Smaller than average 3 Average

2

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? 1 A low birth weight baby girl, March birth, middle-class, 25-year-old G2P2 nonsmoker 2 An average weight baby boy, January birth, a poor, 16-year-old G1P1 nonsmoker 3 A low birth weight baby boy, November birth, wealthy, educated, 19-year-old G1P1 smoker 4 An average weight baby boy, April birth, poor, 27 year old G2P2 nonsmoker

3