Newborn at Risk

After receiving a change-of-shift report in the normal newborn nursery, the nurse should see which neonate first?

6-hour-old neonate with a blood glucose of 25 mg/dL (1.38 mmol/L)

A septic preterm neonate's IV was removed due to infiltration. The nurse prioritizes restarting the IV to help which complication?

hypoglycemia

The nurse explains to the mother of a neonate diagnosed with erythroblastosis fetalis that the exchange transfusion is necessary to prevent damage primarily to which organ in the neonate?

brain

A client has admitted use of cocaine prior to beginning labor. After the infant is born, the nurse should anticipate the need to include which action in the infant's plan of care?

urine toxicology screening

While the nurse is caring for a neonate at 32 weeks' gestation in an isolette with continuous oxygen administration, the neonate's mother asks why the neonate's oxygen is humidified. What should the nurse should tell the mother?

"Oxygen is drying to the mucous membranes unless it is humidified."

A nurse places a neonate with hyperbilirubinemia under a phototherapy lamp, covering the eyes and gonads for protection. The parents asked the nurse to tell them how their baby will benefit from having phototherapy done. Which statement by the nurse is the most appropriate response about phototherapy?

"Phototherapy decreases the serum unconjugated bilirubin level."

A newborn weighing 6.5 lb (2,950 g) is to be given naloxone due to respiratory depression as a result of a narcotic given to the mother shortly before birth. The drug is to be given 0.01 mg/kg into the umbilical vein. The vial is marked 0.4 mg/mL. How many milligrams would the newborn receive? Record your answer using two decimal places.

0.03

The mother of a newborn is concerned about the number of persons with heart disease in her family. She asks the nurse when she should start her baby on a low-fat, low-cholesterol diet to lower the risk of heart disease. At what age does the nurse should tell the client to start modifying her child's diet?

2 years of age

Which measure would be most effective in helping the infant with a cleft lip and palate to retain oral feedings?

Burp the infant at frequent intervals.

The nurse plans the discharge of a newborn diagnosed with torticollis (wry neck). Which action should the nurse take?

Coordinate outpatient physical therapy.

When developing the plan of care for an infant diagnosed with myelomeningocele and the parents who have just been informed of the infant's diagnosis, the nurse should include which action as the priority when the parents visit the infant for the first time?

Emphasize the infant's normal and positive features.

A preterm neonate admitted to the neonatal intensive care unit at about 30 weeks' gestation is placed in an oxygenated isolette. The neonate's mother tells the nurse that she was planning to breastfeed the neonate. Which instructions about breastfeeding would be most appropriate?

Gavage feedings using breast milk can be given until the neonate can coordinate sucking and swallowing.

Immediately after the first oral feeding after corrective surgery for pyloric stenosis, a 4-week-old infant is fussy and restless. What action would be most appropriate at this time?

Give the infant a pacifier to suck on.

A newborn diagnosed with phenylketonuria (PKU) is placed on a low-phenylalanine formula. The mother asks the nurse how long her infant will need to have dietary restriction. Which response would be most appropriate?

Most likely he will need to follow a low phenylalanine diet for the rest of his life.

A neonate was admitted to the pediatric unit with an unexpected congenital defect. What is the best way to involve the parents in the neonate's care?

Offer the parents opportunities to be involved with the neonate's care while they adjust to his unexpected condition.

A newborn who is 20 hours old has a respiratory rate of 66 breaths/min, is grunting when exhaling, and has occasional nasal flaring. The newborn's temperature is 98° F (36.6° C); he is breathing room air and is pink with acrocyanosis. The mother had membranes that were ruptured 26 hours before birth. What nursing actions are most indicated?

Place a pulse oximeter, and contact the health care provider (HCP) for a prescription to draw blood cultures.

The charge nurse observes that a nurse caring for a very sick infant is making inappropriate remarks and acting bizarrely. What is the first action the charge nurse should take?

Remove this nurse from the client assignment.

While caring for a neonate of a woman with diabetes soon after birth, the nurse has fed the newborn formula to prevent hypoglycemia. The nurse checks the neonate's blood glucose level, and it is 60 mg/dL (3.3 mmol/L), but the neonate continues to exhibit jitteriness and tremors. What should the nurse do first?

Request a prescription for a blood calcium level.

A term neonate's mother is O-negative, and cord studies indicate that the neonate is A-positive. Which finding indicates that the neonate developed hemolytic disease?

Signs of kernicterus

A male neonate born at 36 weeks' gestation is admitted to the neonatal intensive care nursery with a diagnosis of probable fetal alcohol syndrome (FAS). The mother visits the nursery soon after the neonate is admitted. Which instructions should the nurse expect to include when developing the teaching plan for the mother about FAS?

Symptoms of withdrawal include tremors, sleeplessness, and seizures.

Which assessment finding would lead a nurse to suspect dehydration in a preterm neonate?

Urine output below 1 ml/hour

A newborn admitted with pyloric stenosis is lethargic and has poor skin turgor. The health care provider (HCP) has prescribed IV fluids of dextrose water with sodium and potassium. The baby's admission potassium level is 3.4 mEq/L (3.4 mmol/L). What should the nurse do first?

Verify that the infant has urinated.

The nurse determines that a newborn is experiencing hypoglycemia based on which findings? Select all that apply.

a blood glucose reading of less than 30 mg/dL (1.7 mmol/L) or less at 1 hour irregular respirations, tremors, and hypothermia

The nurse is making clinical rounds on a group of clients in a newborn nursery. Which infant is at greatest risk of developing respiratory distress syndrome (RDS)?

a neonate born at 36 weeks' gestation

What should the nurse assess in a newborn diagnosed with an anorectal malformation? Select all that apply.

abdominal distension vomiting meconium in the urine

A nurse caring for a preterm neonate knows that positioning can benefit high-risk neonates. Which position is appropriate for a preterm neonate?

adduction and flexion of the extremities with gently rounded shoulders

A preterm neonate is having frequent blood draws for laboratory specimens. What is most important for the nurse to document about the blood draws?

amount of blood drawn for each specimen

For an infant who's about to undergo a lumbar puncture, the nurse should place the infant in:

an arched, side-lying position, avoiding flexion of the neck onto the chest.

The nurse should assess a newborn with esophageal atresia and tracheoesophageal fistula (TEF) for which complications? Select all that apply.

copious frothy mucus episodes of cyanosis distended abdomen

The nurse provides a neonate with an initial feeding. The nurse would suspect a tracheoesophageal fistula if the neonate demonstrated which behavior?

coughing, choking, and cyanosis that occur after several swallows of formula

A mother with a history of gestational hypertension gives birth to a neonate at 26 weeks' gestation. After the neonate receives surfactant through an endotracheal tube in the delivery room, a nurse takes the neonate to the neonatal intensive care unit (NICU), places the neonate on an overbed warmer, and provides mechanical ventilation. When the mother arrives in the NICU for the first time, the nurse's priority should be to

enhance bonding by pointing out the neonate's features.

When performing an assessment on a one-day old newborn, which finding would be most suggestive of an imperforate anus?

failure to pass a meconium stool

What should the nurse expect to find in a premature female neonate born at 30 weeks' gestation who is small for gestational age?

fine, downy hair over the upper arms and back

A primigravid client has completed her first prenatal visit and blood work. Her laboratory test for the hepatitis B surface antigen (HBsAg) is positive. The nurse can advise the client that the plan of care for this newborn will include which interventions? Select all that apply.

hepatitis B immune globulin at birth series of three hepatitis B vaccinations per recommended schedule standard/routine precautions for mother and infant

While assessing a neonate weighing 3,175 g (7 lb) who was born at 39 weeks' gestation to a primiparous client who admits to opiate use during pregnancy, which finding would alert the nurse to possible opiate withdrawal?

high pitched cry

What conditions would the nurse expect to find in in a preterm neonate suffering from cold stress?

hyperactivity and twitching

Which finding provides the most evidence that a fetus might have a gastrointestinal tract anomaly?

increased amount of amniotic fluid

The nurse is caring for a newborn of a primiparous woman with insulin-dependent diabetes. When the mother visits the neonate at 1 hour after birth, the nurse explains to the mother that the neonate is being closely monitored for symptoms of hypoglycemia because of which reason?

interrupted supply of maternal glucose and continued high neonatal insulin production

While assessing a 4-day-old neonate born at 28 weeks' gestation, the nurse cannot elicit the neonate's Moro reflex, which was present 1 hour after birth. The nurse notifies the health care provider (HCP) because this may indicate which complication?

intracranial hemorrhage

A viable neonate born to a 28-year-old multiparous client by cesarean birth because of placenta previa is diagnosed with respiratory distress syndrome (RDS). Which factor would the nurse explain as the factor placing the neonate at the greatest risk for this syndrome?

neonate born preterm

Sick and preterm neonates who experience continuity of nursing care directly benefit from

nursing recognition of subtle changes in high-risk neonates' conditions.

While caring for several preterm infants in the special care nursery, which action is most important for preventing nosocomial infections in these neonates?

performing thorough handwashing before giving infant care

A neonate born at 28 weeks' gestation has been receiving 80% to 100% oxygen via mechanical ventilation for the past 2 weeks. The neonate also has received multiple blood transfusions to treat anemia and has experienced several episodes of apnea. The nurse caring for the neonate should anticipate which iatrogenic complication?

retinopathy of prematurity

The nurse carefully documents the premature neonate's response to oxygen therapy, delivering only as much oxygen as is necessary to prevent the development of which complication?

retinopathy of prematurity

A nurse is assessing a neonate born 1 day ago to a client who smoked one pack of cigarettes daily during pregnancy. Which finding is most common in neonates whose mothers smoked during pregnancy?

small for gestational age

Twenty-four hours after cesarean birth, a neonate at 30 weeks' gestation is diagnosed with respiratory distress syndrome (RDS). When explaining to the parents about the cause of this syndrome, the nurse should include a discussion about an alteration in the body's secretion of which substance?

surfactant

What would the nurse expect to find during the physical examination of a preterm male neonate born at 28 weeks' gestation?

thin wasted apperence