Mod 16; CH 24
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."
The nurse is teaching the caregivers of an infant diagnosed with hypospadias how to properly care for the infant. The nurse determines the session is successful when the caregivers make which statement?
"Being able to most likely correct this in one stage rather than several is reassuring."
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 nurse is explaining to the parents the preoperative care for their infant born with bladder exstrophy. The parents ask, "What will happen to the bladder while waiting for the surgery?" What is the nurse's best response?
"The bladder will be covered in a sterile plastic bag to keep it moist."
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."
Immediately after birth, the nurse is caring for a newborn with a myelomeningocele. What intervention should the nurse provide to prevent drying out of the sac to avoid damage?
Apply a sterile dressing moistened in a warm, sterile saline solution.
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.
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
Which nursing measure is most effective in reducing newborn infections?
Maintain medical asepsis while providing care.
At birth, a neonate is diagnosed with brachial plexus palsy. The parent asks how the nurse knows the neonate's positioning of the arm is a result of the palsy and not just a preferred position. The nurse would show the parent that the neonate has asymmetry of which neonatal reflex?
Moro
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 providing postoperative care to an infant who had a ventriculoarterial shunt placed. Approximately 8 hours after surgery, the nurse notes on assessment shrill crying and projective vomiting. Which response should the nurse prioritize at this time?
Notify the primary care provider immediately.
Which nursing interventions are essential when caring for a newborn with macrosomia born to a mother with diabetes? Select all that apply.
Obtain blood glucose reading. Obtain IV glucose for potential infusion. Assess for respiratory distress. Anticipate supplemental oxygen.
The nurse is monitoring a new mother changing her newborn's diaper and notices a musty smell to the infant's urine. Which condition should the nurse prioritize in further assessments to rule out?
Phenylketonuria
A nurse is caring for a newborn with a repaired cleft lip. What intervention can the nurse provide to facilitate drainage of mucus and secretions to prevent aspiration?
Position the child on the side.
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.
Which environmental consideration is most helpful to promoting comfort when the neonate is withdrawing from alcohol and drugs?
Provide a dark, quiet environment
A nurse is providing care to a newborn who was born by cesarean at 39 weeks' gestation about 6 hours ago. Which assessment finding(s) supports the nurse's suspicion that the newborn is experiencing transient tachypnea of the newborn? Select all that apply.
Respiratory rate: 100 breaths/min Breath sounds: Slightly diminished bilaterally Chest-x-ray: Mild symmetric overaeration
A nurse is caring for a newborn with necrotizing enterocolitis (NEC) who is scheduled to undergo surgery for a bowel resection. The infant's parents wish to know the implications of the surgery. What information should the nurse provide to the parents regarding this surgery?
Surgery requires placement of a proximal enterostomy.
The nurse is developing a plan of care for a neonate experiencing symptoms of drug withdrawal. What should be included in this plan?
Swaddle the infant between feedings.
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's mother probably had diabetes.
The nurse is caring for a newborn who is large-for-gestational-age (LGA). Which characteristics are documented as a contributing factor? Select all that apply.
The mother has had previous large-for-gestational-age neonates. The mother has poorly controlled diabetes. Both parents are of a larger stature and size.
The nurse is caring for a neonate with an exstrophy of the bladder. When the nurse is planning care, which client goal is the priority?
The neonate will be free from infection.
Which assessment finding within the first 24 hours of birth requires immediate health care provider notification?
The skin is jaundiced.
The nurse is reinforcing discharge teaching with the mother of an infant who is being discharged prior to having a required blood test done. The nurse explains to this mother that she needs to bring the newborn back to check the infant's phenylalanine level. Which statement is most accurately related to this blood test?
The test is done after the newborn has ingested protein.
The nurse is preparing to teach the young parents of a newborn who is diagnosed with spinal bifida occulta how to care for their newborn. Which information should the nurse prioritize when explaining this defect?
There is a bony defect that occurs without soft-tissue involvement.
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.
Which congenital condition is an immediate emergency requiring notification of the health care provider?
Tracheoesophageal fistula
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 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
A pregnant woman gives birth to a small-for-gestational-age neonate who is admitted to the neonatal intensive care unit with seizure activity. The neonate appears to have abnormally small eyes and a thin upper lip. The infant is noted to be microcephalic. Based on these findings, which substance would the nurse suspect the women of using during pregnancy?
alcohol
The priority for the nurse caring for a newborn with esophageal atresia is to observe for which finding?
aspiration
The nurse suspects a preterm newborn receiving enteral feedings of having necrotizing enterocolitis (NEC). What assessment finding best correlates with this diagnosis?
bloody stools
A preterm newborn is being monitored for potential necrotizing enterocolitis. The nurse recognizes which factors as major pathologic mechanisms that could lead to this complication? Select all that apply.
bowel ischemia perinatal stressors formula feeding
What is the term for a small collection of blood that forms underneath the skull as a result of birth trauma?
cephalohematoma
A nurse is caring for a newborn who was diagnosed with an imperforate anus. Assessment reveals drooling, copious bubbles of mucus in mouth, rattling respirations, and abdominal distention. During feeding, the newborn coughs and becomes cyanotic. Which action by the nurse would be appropriate?
clear the airway
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.
The nurse assesses an infant. Which finding may indicate heart failure?
diminished peripheral pulses
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
A newborn admitted to the neonatal intensive care unit is diagnosed with persistent pulmonary hypertension of the newborn (PPHN). What findings in the mother's prenatal history would best correlate with this diagnosis?
fluoxetine use during last trimester of pregnancy
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
Following anastomosis repair of a tracheoesophageal fistula, the nurse assesses the infant for which potential complication?
gastroesophageal reflux
The nurse is caring for a pregnant woman who is struggling with controlling gestational diabetes mellitus. What effect does the nurse predict this situation may have on the fetus?
grow to an unusually large size
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
The nurse is caring for a 22-hour-old neonate male and notes on assessment at the beginning of the shift: Apgar score of 9, nursing without difficulty, and appeared healthy. As the nurse's shift goes on, subsequent assessment reveals his sclera and skin have begun to take on a yellow hue. The nurse would report this as a possible indication of what condition?
hemolytic disease
A nurse is assigned to care for a high-risk newborn with a periventricular-intraventricular hemorrhage (PVH-IVH) in the home environment after discharge. For which condition should the nurse monitor the infant?
hydrocephalus
A neonate undergoing phototherapy treatment must be monitored for which adverse effect?
increased insensible water loss
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)
What would the nurse expect to prioritize in the assessment of a newborn who has a positive Coombs test?
jaundice development
A nursing instructor is teaching students about cardiac congenital disorders in newborns and informs them that, like other diseases, risk factors increase the incidence of heart defects. Which of these are considered risk factors? Select all that apply.
maternal alcoholism maternal irradiation ingestion of certain drugs during pregnancy maternal diabetes advanced maternal age (older than 40 years)
The use of breast milk for premature neonates helps prevent which condition?
necrotizing enterocolitis
The nurse should carefully monitor which neonate for hyperbilirubinemia?
neonate with ABO incompatibility
A newborn is found to have hemolytic disease. Which combination would be found related to the blood types of this newborn and the parents of the newborn?
newborn who is type A, mother who is type O
When planning preoperative care for a newborn with a cleft lip and palate, the nurse would plan interventions for which major need?
nutrition
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%
What would the nurse use as evidence of effective resuscitation?
pink tongue
The nurse reviews the antenatal chart of a mother with a newborn diagnosed with necrotizing enterocolitis. What would the nurse expect to find in the chart because it correlates with the diagnosis?
preeclampsia
A nurse is providing preoperative care to a female newborn client with the congenital abnormality myelomeningocele. Which intervention is the priority?
preventing infection
The nurse assesses preterm infants as they come for routine well-baby checkups. The nurse will carefully assess the infant's vision to assess for which potential complication related to their birth?
retinopathy
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
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
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
Following birth, the newborn's independent circulatory system is established. If there is an abnormal opening between the chambers in the heart, which cardiac defect may occur?
ventricular septal defect
