Newborn Complications
what are some maternal diseases that can predispose a fetus to be SGA?
(1) Heart disease (2) Substance abuse (3) Sickle cell anemia (4) Phenylketonuria (PKU) (5) Asymptomatic pyelonephtitis (6) Lupus erythematosus (7) PIH (8) DM
what is Transient Tachypnea of the Newborn (TTN)?
Occurs when an AGA/LGA or near-term infant develops progressive respiratory distress than can clinically resemble Respiratory Distress Syndrome.
what are some long term complications?
(1) respiratory problems (2) thermoregulation = hypothermia and Cold Stress (3) GI problems: necrotizing enterocolitis (NEC) (4) renal problems
A newborn in the well-baby nursery is noted to have a chignon. The nurse concludes that the baby was born via which of the following methods? 1. Cesarean section. 2. High forceps delivery. 3. Low forceps delivery. 4. Vacuum extraction
ANS: 4 1. Babies born via cesarean section usually have round, unmolded heads. 2. High forceps are not used in obstetrics today. High forceps, applied to babies' heads that are not well descended, are no longer used because of the high incidence of fetal damage that results. Instead, babies who fail to descend are now delivered via cesarean section. 3. Low forceps are applied when engagement is +2 or greater. The baby may develop forceps marks but would not develop a chignon. 4. Babies born via vacuum extraction often do develop chignons. TEST-TAKING TIP: In common language, a chignon is a hairstyle that is characterized by a bun or knot of hair worn on the back of the head or nape of the neck. In obstetrics, a chignon is a round, bruised caput seen on the crown of the baby's head. It results from the pressure exerted on the scalp during a vacuum-assisted delivery
what are some tests done to diagnose sepsis neonatorum?
CBC, Electrolytes, Urine Analysis, Urine Culture, Blood Culture, Stool Culture, Chest X-Ray, and Lumbar Puncture = These tests are done to rule out sepsis
what are some causes of hyperbilirubinemia ?
Hemolytic disease of the newborn, Erythroblastosis fetalis, Hydrops fetalis
what is the treatment for pathologic jaundice?
May require exchange transfusion (done when bili levels reach 20 mg/dl) & or phototherapy
what is Patent ductus arteriosus (PDA)?
Shunts blood away from lungs. Doesn't close and remains open. Treat with meds (Indocin) a prostaglandin synthetase inhibitor. If meds don't work then surgical ligation.
what is Meconium Aspiration Syndrome?
The presence of meconium in amniotic fluid indicates an asphyxial insult to the fetus before or during labor unless the baby is in the breech presentation The physiologic response to asphyxia is increased intestinal peristalsis, relaxation of the anal sphincter and passage of meconium into the amniotic fluid. Meconium stained fluid may be aspirated into the fetus' lungs in utero or during the 1st few breaths taken by the newborn. Affects primarily term, SGA, post-term infants and those who have experienced a long labor.
what medications are normally presccribed for infants with sepsis neonatorum ?
(1) Ampicillin 50-100mg/kg IV Q8-12 hrs. Effective against gram + organisms. (2) Gentamycin 5mg/kg IV Q12-24hrs (doses vary). Effective against gram - organisms. (3) Peak & Trough: MUST be done and is usually done with the 3rd dose. Peak is usually done 30-60 minutes after the completion of the 3rd dose and the trough is done 30 minutes before giving the 4th dose.
what can cause Congenital Hypothyroidism (CH)?
(1) An inborn enzymatic defect, (2) lack of maternal dietary iodine (3) maternal ingestion of drugs that depress or destroy thyroid tissue
what are some signs of improvement from RDS?
(1) Assess for increase in urination since this can be an early sign of improvement. This is because as the fluid moves out of the lungs to the bloodstream, the alveoli open & thus the kidney perfusion increases. (2) Assess chest wall expansion closely & if there is an increase in chest expansion make sure to notify the MD so that the ventilator settings are decreased to prevent a pneumothorax.
what are some complications of post-term infants?
(1) Hypoglycemia (2) Meconium Aspiration Syndrome (3) Polycythemia = While in utero, the infant who is hypoxic will compensate by producing more red blood cells (4) Congenital Anomalies (5) Seizures (6) Cold Stress (7) CPD and Shoulder dystocia
what are worsening or late signs of RDS?
(1) See saw breathing, (2) decreased urinary output (1-2ml/kg/hr), (3) Pallor/ashy gray color, (4) Apnea (Lasting longer than 20 seconds), (5) Bradycardia, (6) Hypotension, (7) Flacid/hypotonic muscle tone, Unresponsive to stimulation, (8) Hypertonia, (9) Seizure activity
what are some placental factors that can cause a SGA baby?
(1) Small placenta (2) Infarcted areas (3) Abnormal cord insertions (4) Placenta previa (5) Thrombosis (6) Single umbilical artery (7) Reverse end diastolic blood flow (8) Inherited coagulopathy
how is RDS managed and treated?
(1) Steroid therapy in utero & after birth can be beneficial to a pre-term infant (betamethasone to produce surfactant) (2) Oxygen administration (3) Continuous C/R/S at monitoring (4) Artificial surfactant therapy (4ml/kg) (5) Ventilator support & management (High frequency ventilation w/morphine or fentanyl as pain/sedative agent) (6) Prevention of hypothermia & hypoglycemia (7) Minimal touch and stimulation (8) Medication administration with Morphine or Fentanyl for sedation (9) Pancuronium or Vecuronium can be used as a muscle relaxant however is very controversial (10) Nitric Oxide Therapy can be used as a potent pulmonary vasodilator
what are the manifestation of Meconium Aspiration Syndrome?
(1) Sudden increase then decrease in fetal activity, (2) Slowing or weak/irregular fetal heart beat, (3) Loss of beat-to-beat variability, (4) Meconium stained fluid, (5) Tachypnea, (6) Over distended and barrel shaped chest, (7) Diminished air movement, (8) Prominent Rales & Rhonchi, (9) Yellowish or pale green staining of the skin, nails and umbilical cord, (10) Rib retractions
what pH level suggests to be an ominous sign of intrauterine asphyxia?
7.20 or less
For which of the following reasons would a nurse in the well-baby nursery report to the neonatologist that a newborn appears to be preterm? 1. Baby has a square window angle of 90°. 2. Baby has leathery and cracked skin. 3. Baby has popliteal angle of 90°. 4. Baby has pronounced plantar creases.
ANS: 1 1. A baby whose square window sign is 90˚ is preterm. 2. A baby whose skin is cracked and leathery is exhibiting a sign of postmaturity. 3. A baby whose popliteal angle is 90˚ is full term. 4. A baby whose plantar creases are pronounced is full term.
A baby's blood type is B negative. The baby is at risk for hemolytic jaundice if the mother has which of the following blood types? 1. Type O negative. 2. Type A negative. 3. Type B positive. 4. Type AB positive.
ANS: 1 1. ABO incompatibility can arise when the mother is type O and the baby is either type A or type B. 2. Hemolytic jaundice from ABO incompatibility is rarely seen when the maternal blood type is anything other than type O. Rh incompatibility can occur only if the mother is Rh-negative and the baby is Rh-positive. 3. Hemolytic jaundice from ABO incompatibility is rarely seen when the maternal blood type is anything other than type O. Rh incompatibility can only occur if the mother is Rh-negative and the baby is Rh-positive. 4. Hemolytic jaundice from ABO incompatibility is rarely seen when the maternal blood type is anything other than type O. Rh incompatibility can only occur if the mother is Rh-negative and the baby is Rh-positive. TEST-TAKING TIP: A mother whose blood type is O, the blood type that is antigen negative, will produce anti-A and/or antiB antibodies against blood types A and/or B, respectively. The anti-A (and/or anti-B) that passes into the baby's bloodstream via the placenta can attack the baby's red blood cells if he or she is type A or B. As a result of the blood cell destruction, the baby becomes jaundiced.
he neonatologist assesses a newborn for Hirschsprung's disease after the baby exhibited which of the following signs/symptoms? 1. Passed meconium at 50 hours of age. 2. Apical heart rate of 200 beats per minute. 3. Maculopapular rash. 4. Asymmetrical leg folds.
ANS: 1 1. Babies who have delayed meconium excretion may have Hirshsprung's disease. 2. Tachycardia is not associated with Hirshsprung's disease. 3. Rashes are not associated with Hirshsprung's disease 4. Asymmetrical leg folds are related to developmental dysplasia of the hip, not to Hirshsprung's disease.
A neonate that is admitted to the neonatal nursery is noted to have a 2-vessel cord. The nurse notifies the neonatologist to get an order for which of the following assessments? 1. Renal function tests. 2. Echocardiogram. 3. Glucose tolerance test. 4. Electroencephalogram.
ANS: 1 1. Babies with 2-vessel cords are at high risk for renal defects. 2. There is no relationship between a 2-vessel cord and a cardiac defect. 3. There is no relationship between a 2-vessel cord and glucose tolerance. 4. There is no relationship between a 2-vessel cord and the brain.
what is PKU?
baby cannot digest phenylalanine and has to have a special diet for the rest of its life. if it is diagnosed before 1 month of age, CNS damage can be minimized
what is pathologic jaundice?
seen immediately, seen in first 24 hours. Level is greater than 12mg/dL. Caused in utero and the infant is born with problem
what are some complications of a LGA birth?
(1) Birth Trauma due to CPD and macrosomia: prone to shoulder dystocia, breech presentation. These complications may result in asphyxia, fractured clavicles, brachial plexus palsy, facial paralysis, depressed skull fractures, cephalohematoma, intracranial hemorrhage due to birth trauma. (2) Increased incidence of C/S's and/or oxytocin-induced births due to fetal size (3) Hypoglycemia, Polycythemia, Hyperviscosity = These 3 are most often seen in infants of diabetic moms and with erythroblastosis fetalis
what is the treatment of hypoglycemia?
(1) Check blood glucose levels as follows: Every 1 hour for 4 hours. Every 4 hours for 24 hours. If infant is high risk then check levels every 2,4,6,8,10,12,24 hours. (2) Early feeds is one of the major preventions (3) If blood glucose levels <40mg/dL then IV bolus of D10W is given based on body weight in kg. (1-2cc/kg/dose) (NICU) (4) Glucose measurements obtained within 30-60 min after feeding
what are the early S/S of RDS?
(1) Hypothermia, (2) Cyanosis, (3) Nasal Flaring, (4) Expiratory grunting, (5) Sternal & or subcostal retractions, (6)Apnea, and Tachypnea (RR greater than 60/min)
what are the S/S of fetal alcohol syndrome?
*In 1st week of life may show symptoms that include: (1) Sleeplessness, (2) Excessive arousal states, (3) Inconsolable crying, (4) Abnormal reflexes, (5) Hyperactivity, (6) Jitteriness, (7) Abdominal distension, and Exaggerated mouthing behaviors such as hyperactive rooting and increased nonnutritive sucking
what is the management and treatment of Meconium Aspiration Syndrome?
(1) Immediate suction of mouth and nares @ the perineum with vaginal delivery or C-Section prior to the infant taking their first breath (2) After birth if infant is vigorous and crying repeat suction and continue with assessment (3) After birth if infant is in distress, floppy, not crying DO NOT STIMULATE TO CRY & direct visualization of vocal cords is done by MD/ARNP and the infant is suctioned below the vocal cords (4) Provide ventilation if necessary (5) Surfactant therapy (6) Mechanical ventilation (High oxygen concentration and High pressure ventilation) (7) Central line placement through umbilical artery or umbilical vein (8) Nitric oxide therapy may be considered (9) Blood pressure support should be considered (10) ECMO may be required if infant not responding to conventional ventilator and should be considered if infant is not responsive to alternative therapy (11) Chest percussion to remove debris
what are the S/S of hypothermia/Cold Stress?
(1) Increased movements and respirations (2) Decreased skin temperature and peripheral perfusion (3) Development of hypoglycemia (4) Possibly development of metabolic acidosis
what are some causes of TTN?
(1) Intrauterine/Intrapartal asphyxia that is R/T the following reasons: Over sedation, Maternal bleeding, Prolapsed Cord, Breech presentation, and Maternal Diabetes (2) Resultant effect is failure to clear the airway of excessive lung fluid, mucus and other debris or an excess of fluid in the lungs due to aspiration of amniotic or tracheal fluid. (3) More prevalent in infants born via cesarean section R/T not having the thoracic squeeze that occurs during vaginal delivery, which removes lung fluid.
what are the S/S of hypoglycemia?
(1) Lethargy/jitteriness (2) Poor feeding/poor sucking (3) Vomiting (4) Hypothermia (5) Pallor (6) Apnea, irregular respirations, respiratory distress, cyanosis (7) Hypotonia, possible loss of swallowing reflex (8) High pitched cry (9) Tremors, jerkiness, seizure activity (10) Infants of diabetic mother's appear fat, ruddy, macrosomic (11) Ruddy color could be due to polycythemia (12) Exaggerated Moro reflex (13) Temperature instability
what are some characteristics that may be present in drug dependent newborns?
(1) Low Apgar scores, (2) Respiratory distress, (3)Jaundice R/T prematurity, (4) Congenital anomalies, (5) Growth restriction, (6) Behavioral abnormalities, and Withdrawal
what is some nursing care methods for a drug dependent newborn?
(1) Management of complications. Monitor vital signs. Small frequent feeds. (2) Medications as indicated (Phenobarbital) (3) Positioning to prevent aspiration. Monitor weight loss & vomiting. (4) Swaddling/rocking in quiet/dim area. Observe for problems associated with SGA/LGA.
what are the predisposing factors to a LGA baby?
(1) Maternal diabetes (2) Genetic predisposition (Hispanics) (3) Multiparous women (have 2-3 times the number of LGA infants as primigravidas) (4) Male infants (5) Infants with erythroblastosis fetalis (Beckwith-Wiedemann su=yndrome) are usually large
what are some ways to manage and treat TTN?
(1) Oxygen therapy by oxyhood with ambient oxygen concentrations of 30-50% to correct mild hypoxemia (2) Oral feedings are C/I because of rapid respiratory rate and risk of aspiration (3) IV fluids with electrolyte replacements (D10W) (4) CXR & lab work to R/O infectious causes (5) Repositioning of the infant (6) Chest physiotherapy (7) Important to make the infant cry and release the excessive amount of fluid from the lungs. (8) Infant should be improving by 8-24 hr. Duration of the clinical course of TTN is approx. 72 hours (9) PPHN (Persistent Pulmonary Hypertension) should be considered if the is NO resolution of TTN within 48-72 hours and ventilatory support may be required.
what are the S/S of sepsis neonatorum?
(1) Pallor/dusky look (2) Lethargy (3) Temperature fluctuations (4) Skin cool and clammy (5) Hypotensive (6) Decreased fluid intake (7) Diarrhea (8) Vomiting (9) Poor feeding (10) Hyperbilirubinemia (11) Hypotonic (12) Jitteriness (13) Tremors (14) Seizures (15) Tachycardia then Bradycardia (16) Tachypnea (17) Labored Respirations (18) Apnea (19) Cyanosis
what are some complications of preterm infants ?
(1) Patent ductus arteriosus (PDA) (2) Apnea of the newborn (3) Intraventricular hemorrhage (IVH)
what are some maternal factors that predispose SGA?
(1) Primiparity (2) Grand multiparity/multiple gestation (3) Lack of prenatal care (4) Age extremes = under 16 and over 40 (5) Low socioeconomic status (6) Genetics
what are some causes of SGA?
(1) SGA/IUGR: commonly seen in mothers who smoke or have gestational hypertension (2) Symmetric (proportional) IUGR: cause by long term maternal conditions (3) Asymmetric (disproportional) IUGR: caused by compromise of uteroplacental blood flow
what are some manifestations of TTN?
(1) Usually infant has little or no difficulty at onset of breathing. (2) Shortly after birth, may note: Expiratory grunting, Nasal flaring, Mild cyanosis (Circumoral Cyanosis = around the mouth), Retractions, Increase in anterior/posterior chest diameter (air trapped) (3) Tachypnea is usually present by 6 hrs of age with resp rates as high as 100-140bpm (4) Mild respiratory & metabolic acidosis may be present at 6 hours of life (5) Initial X-ray findings are similar to those showing RDS within the first 3 hours (6) Usually within 12-24hrs return to normal, mild cases 48-72 hours, severe up to 1 week
what are some complications of a baby that is SGA?
(1) perinatal asphyxia (2) aspiration syndorme (3) heat loss= hypothermia (4) hypoglycemia (5) polycythemia
what are the manifestations of Congenital Hypothyroidism (CH)?
(1) prolonged newborn jaundice, (2) poor feeding, (3) constipation, (4) low-pitched cry, (5) poor weight gain, (6) inactivity, and delayed motor development
what are the manifestations of galactosemia?
(1) vomiting soon after ingestion of milk-based formula or breast milk, (2) diarrhea, (3) poor weight gain, (4) hepatosplenomegaly, (5) jaundice (6) mental retardation.
what are the withdrawal symptoms that drug dependent newborns experience?
**infant begins to exhibit them at around 24hrs of age.** (1) exaggerated reflexes, (2) hyperirritability (3) excessive oral secretions.
what is an exchange transfusion?
*Used to treat anemia with red blood cells that: (1) Are not susceptible to maternal antibodies (2) Remove sensitized RBC's that would be lysed soon (3) Remove serum bilirubin (4) Provide bilirubin-free albumin and increase the binding sites for bilirubin
On admission to the nursery, a baby's head and chest circumferences are 39 cm and 32 cm, respectively. Which of the following actions should the nurse take next? 1. Assess the anterior fontanel. 2. Measure the abdominal girth. 3. Check the apical pulse rate. 4. Monitor the respiratory effort.
ANS: 1 1. Because the head circumference is significantly larger than the chest circumference, the nurse should assess for another sign of hydrocephalus. A markedly enlarged or bulging fontanel is one of those signs. 2. Abdominal girth does not change when a child has hydrocephalus. 3. Hydrocephalus is not a cardiovascular problem. 4. Hydrocephalus is not a respiratory problem.
A neonate is found to have choanal atresia on admission to the nursery. Which of the following physiological actions will be hampered by this diagnosis? 1. Feeding. 2. Digestion. 3. Immune response. 4. Glomerular filtration.
ANS: 1 1. Choanal atresia will affect the baby's ability to feed. 2. Digestion is unaffected by choanal atresia, a structural defect. 3. The immune response is unaffected by choanal atresia, a structural defect. 4. The renal system is unaffected by choanal atresia, a structural defect
The nurse suspects that a newborn in the nursery has a clubbed right foot because the foot is plantar flexed as well as which of the following? 1. Inability to move the foot into alignment. 2. Positive Ortolani sign on the right. 3. Shortened right metatarsal arch. 4. Positive Babinski reflex on the right.
ANS: 1 1. During the neonatal physical assessment, the nurse is unable to move a clubfoot into proper alignment. 2. A positive Ortolani sign indicates the presence of developmental dysplasia of the hip. 3. A shortened metatarsal arch is not diagnostic of clubfoot. 4. The Babinski reflex is positive in all neonates.
Based on maternal history of alcohol addiction, a baby in the neonatal nursery is being monitored for signs of fetal alcohol syndrome (FAS). The nurse should assess this baby for which of the following? 1. Poor suck reflex. 2. Ambiguous genitalia. 3. Webbed neck. 4. Absent Moro reflex.
ANS: 1 1. FAS babies usually have a very weak suck. 2. Ambiguous genitalia is not a characteristic anomaly seen in FAS. 3. A webbed neck is not a characteristic anomaly seen in FAS. 4. FAS babies usually have an intact CNS system with a positive Moro reflex.
A nursing diagnosis for a 5-day-old newborn under phototherapy is: Risk for fluid volume deficit. For which of the following client outcomes should the nurse plan to monitor the baby? 1. 6 saturated diapers in 24 hours. 2. Breastfeeds 6 times in 24 hours. 3. 12% weight loss since birth. 4. Apical heart rate of 176 bpm.
ANS: 1 1. Healthy, hydrated neonates saturate their diapers a minimum of 6 times in 24 hours. 2. To consume enough fluid and nutrients for growth and hydration, babies should breastfeed at least 8 times in 24 hours. 3. A weight loss of over 10% is indicative of dehydration. 4. Tachycardia can indicate dehydration.
A baby was just born to a mother who had positive vaginal cultures for group B streptococcus. The mother was admitted to the labor room 2 hours before the birth. For which of the following should the nursery nurse closely observe this baby? 1. Hypothermia. 2. Mottling. 3. Omphalocele. 4. Stomatitis.
ANS: 1 1. Hypothermia in a neonate may be indicative of sepsis. 2. Mottling is commonly seen in neonates shortly after birth. It is considered a normal finding. 3. Omphalocele is not related to group B strep exposure. 4. Stomatitis is not a sign associated with group B strep exposure.
Which of the following laboratory findings would the nurse expect to see in a baby diagnosed with erythroblastosis fetalis? 1. Hematocrit 24%. 2. Leukocyte count 45,000 cells/mm3. 3. Sodium 125 mEq/L. 4. Potassium 5.5 mEq/L.
ANS: 1 1. The baby with erythroblastosis fetalis would exhibit signs of severe anemia, which a hematocrit of 24% reflects. 2. Erythroblastosis fetalis is not an infectious condition. Leukocytosis is not a part of the clinical picture. 3. Hyponatremia is not part of the disorder. 4. Hyperkalemia is not part of the disorder.
The parents of a baby born with bilateral talipes equinovarus ask the nurse what medical care the baby will likely need. Which of the following should the nurse tell the parents? The baby will: 1. Need a series of leg casts until the correction is accomplished. 2. Have a Harrington rod inserted when the child is about three years old. 3. Have a Pavlik harness fitted before discharge from the nursery. 4. Need to wear braces on both legs until the child begins to walk.
ANS: 1 1. The initial treatment plan for clubfoot usually includes a series of casts that slowly move the foot into proper alignment. 2. Harrington rod insertion has been used to treat scoliosis, not talipes equinovarus. 3. Pavlik harness is a therapy for a baby with developmental dysplasia of the hip. 4. Long-term bracing is not a common therapy for clubfoot.
A baby is born to a type 1 diabetic mother. Which of the following lab values would the nurse expect the neonate to exhibit? 1. Plasma glucose 30 mg/dL. 2. Red blood cell count 1 million/mm3. 3. White blood cell count 2,000/mm3. 4. Hemoglobin 8 g/dL.
ANS: 1 1. The nurse should anticipate that the plasma glucose levels would be low. 2. The nurse would expect to see elevated red blood cell counts rather than low red blood cell counts. 3. The white blood cell count should be within normal limits. 4. The nurse would expect to see elevated hemoglobin levels rather than low levels of hemoglobin.
A newborn in the NICU has just had a ventriculoperitoneal shunt inserted. Which of the following signs indicates that the shunt is functioning properly? 1. Decrease of the baby's head circumference. 2. Absence of cardiac arrhythmias. 3. Rise of the baby's blood pressure. 4. Appearance of setting sun sign.
ANS: 1 1. Ventriculoperitoneal (VP) shunts are inserted for the treatment of hydrocephalus. A positive finding, therefore, would be decreasing head circumferences. 2. VP shunts are not inserted for the treatment of cardiac arrhythmias or cardiac anomalies. 3. VP shunts are not inserted for the treatment of hypertension. 4. Setting sun sign is a sign of hydrocephalus. Appearance of setting sun sign would indicate that the shunt is functioning improperly.
A baby exhibits weak rooting and sucking reflexes. Which of the following nursing diagnoses would be appropriate? 1. Risk for deficient fluid volume. 2. Activity intolerance. 3. Risk for aspiration. 4. Feeding self-care deficit.
ANS: 1 1. When a baby roots and sucks poorly, the baby is unable to transfer milk effectively. Because milk intake is the baby's source of fluid, the baby is high risk for fluid volume deficit. 2. Although a baby exhibiting fluid volume deficit may become activity intolerant, this is not the best answer. 3. Even when babies have poor rooting and sucking reflexes, they do not necessarily have poor gagging reflexes. 4. Babies are incapable of self-care.
A newborn in the nursery is exhibiting signs of neonatal abstinence syndrome. Which of the following signs/symptoms is the nurse observing? Select all that apply. 1. Hyperphagia. 2. Lethargy. 3. Prolonged periods of sleep. 4. Hyporeflexia. 5. Persistent shrill cry.
ANS: 1 and 5 are correct. 1. Babies with signs of neonatal abstinence syndrome repeatedly exhibit signs of hunger. 2. Babies with neonatal abstinence syndrome are hyperactive, not lethargic. 3. Babies with neonatal abstinence syndrome often exhibit sleep disturbances rather than prolonged periods of sleep. 4. Babies with signs of neonatal abstinence syndrome are hyperreflexic, not hyporeflexic. 5. Babies with signs of neonatal abstinence syndrome often have a shrill cry that may continue for prolonged periods
A neonate is being assessed for necrotizing enterocolitis (NEC). Which of the following actions by the nurse is appropriate? Select all that apply. 1. Perform hemoccult test on stools. 2. Monitor for an increase in abdominal girth. 3. Measure gastric contents before each feed. 4. Assess bowel sounds before each feed. 5. Assess for anal fissures daily.
ANS: 1, 2, 3, and 4 are correct. 1. Babies with NEC have blood in their stools. 2. The abdominal girth measurements of babies with NEC increase. 3. When babies have NEC, they have increasingly larger undigested gastric contents after feeds. 4. The neonates' bowel sounds are diminished with NEC. 5. The presence of anal fissures is unrelated to NEC.
A 6-month-old child is being seen in the pediatrician's office. The child was born preterm and remained in the neonatal intensive care unit for the first 5 months of life. The child is being monitored for 5 chronic problems. Which of the following problems are directly related to the prematurity? Select all that apply. 1. Bronchopulmonary dysplasia. 2. Cerebral palsy. 3. Retinopathy. 4. Hypothyroidism. 5. Seizure disorders.
ANS: 1, 2, 3, and 5 are correct. 1. Bronchopulmonary dysplasia often is a consequence of the respiratory therapy that preemies receive in the NICU. 2. Cerebral palsy results from a hypoxic insult that likely occurred as a result of the baby's prematurity. 3. Retinopathy of the premature is a disease resulting from the immaturity of the vascular system of the eye. 4. Hypothyroidism is one of the diseases assessed for in the neonatal screen. It is very unlikely that this problem resulted from the baby's stay in the NICU. 5. Seizure disorders can result either from a hypoxic insult to the brain or from a ventricular bleed. Both of these conditions likely occurred as a result of the prematurity.
Which of the following actions would the NICU nurse expect to perform when caring for a neonate with esophageal atresia and tracheoesophageal fistula (TEF)? 1. Position the baby flat on the left side. 2. Maintain low nasogastric suction. 3. Give small, frequent feedings. 4. Place on hypothermia blanket.
ANS: 2 1. Babies with TEF usually have the heads of their cribs elevated. The babies may be placed on one of their sides but should not be lain flat. 2. Low nasogastric suction is usually maintained to minimize the amount of the baby's oral secretions. 3. Babies that are born with TEF are kept NPO (nothing by mouth). 4. There is no reason to place a TEF baby on a hypothermia blanket.
A baby is born with erythroblastosis fetalis. Which of the following signs/symptoms would the nurse expect to see? 1. Ruddy complexion. 2. Anasarca. 3. Alopecia. 4. Erythema toxicum.
ANS: 2 1. Babies born with erythroblastosis fetalis are markedly anemic. They are not ruddy in appearance. 2. Babies born with erythroblastosis fetalis often are in severe congestive heart failure and, therefore, exhibit anasarca. 3. Babies with erythroblastosis fetalis are not at high risk for alopecia. 4. Erythema toxicum is a normal newborn rash that many healthy newborns have. TEST-TAKING TIP: A baby with erythroblastosis fetalis has marked red blood cell destruction in utero secondary to the presence of maternal antibodies against the baby's blood. The severe anemia that results often leads to congestive heart failure of the fetus in utero.
A nurse in the newborn nursery suspects that a new admission, 42 weeks' gestation, was exposed to meconium in utero. What would lead the nurse to suspect this? 1. The baby is bradycardic. 2. The baby's umbilical cord is green. 3. The baby's anterior fontanel is sunken. 4. The baby is desquamating
ANS: 2 1. Bradycardia is a sign of neonatal distress but it is not related to meconium exposure. 2. Because meconium is a dark green color, when it is expelled in utero, the baby can be stained green. 3. A sunken fontanel is an indication of dehydration, not of meconium exposure. 4. A baby's skin often desquamates when he or she is post-term. Although meconium may be expelled by a post-term baby, desquamation is not related to the meconium.
A woman whose 32-week-gestation neonate is to begin oral feedings is expressing breast milk (EBM) for the baby. The neonatologist is recommending that fortifier be added to the milk because which of the following needs of the baby are not met by the EBM? 1. Need for iron and zinc. 2. Need for calcium and phosphorus. 3. Need for protein and fat. 4. Need for sodium and potassium.
ANS: 2 1. EBM is sufficient in iron and zinc. 2. Calcium and phosphorus in EBM are in quantities that are less than bod requirements for the very low birth weight baby. Therefore, a fortifier may need to be added to the EBM. 3. Protein and fat are sufficient in EBM. 4. Sodium and potassium are sufficient in EBM.
A baby is born with caudal agenesis. Which of the following maternal complications is associated with this defect? 1. Poorly controlled myasthenia gravis. 2. Poorly controlled diabetes mellitus. 3. Poorly controlled splenic syndrome. 4. Poorly controlled hypothyroidism.
ANS: 2 1. Myasthenia gravis is not associated with caudal agenesis in the fetus. 2. Poorly controlled maternal diabetes mellitus is one of the most important predisposing factors for caudal agenesis in the fetus. 3. Splenic syndrome is sometimes seen in patients with sickle cell disease. It is not related to caudal agenesis in the fetus. 4. Hypothyroidism is not related to caudal agenesis in the fetus.
A baby born addicted to cocaine is being given paregoric. The nurse knows that which of the following is a rationale for its use? 1. Paregoric is nonaddictive. 2. Paregoric corrects diarrhea. 3. Paregoric is nonsedating. 4. Paregoric suppresses the cough reflex.
ANS: 2 1. Paregoric contains morphine. It is addictive. 2. Paregoric does help to control the diarrhea seen in drug-addicted neonates. 3. Paregoric does cause drowsiness. 4. Sneezing is a symptom seen in drugaddicted neonates, not coughing. TEST-TAKING TIP: Paregoric, a liquid form of morphine, is an especially effective therapy for a baby who is experiencing severe neonatal abstinence syndrome. The narcotic relieves the cravings that the baby has for the addicted drug; in addition, paregoric is effective against the diarrhea that many addicted babies experience.
A baby has been admitted to the neonatal intensive care unit with a diagnosis of symmetrical intrauterine growth restriction (IUGR). Which of the following pregnancy complications would be consistent with this diagnosis? 1. Severe preeclampsia. 2. Chromosomal defect. 3. Infarcts in an aging placenta. 4. Premature rupture of the membranes.
ANS: 2 1. Severe preeclampsia is associated with asymmetrical IUGR. 2. Chromosomal abnormalities are associated with symmetrical IUGR. 3. An aging placenta is associated with asymmetrical IUGR. 4. PPROM is associated with asymmetrical IUGR. TEST-TAKING TIP: There is a distinct difference between symmetrical and asymmetrical IUGR. Babies with chromosomal defects often grow poorly from the time of conception. Their entire bodies, therefore, will grow poorly and will be small. Babies that are exposed to complications like preeclampsia or an aging placenta during the pregnancy will grow normally during the beginning of the pregnancy but start to grow poorly at the time of the insult. Their growth, therefore, will be disproportionally affected.
A newborn nursery nurse notes that a 36-hour-old baby's body is jaundiced. Which of the following nursing interventions will be most therapeutic? 1. Maintain a warm ambient environment. 2. Have the mother feed the baby frequently. 3. Have the mother hold the baby skin to skin. 4. Place the baby naked by a closed sunlit window
ANS: 2 1. The ambient temperature will affect the baby's temperature, but it will not affect the bilirubin level. 2. Bilirubin is excreted through the bowel. The more the baby consumes, the more stools she or he will produce; in other words, the more feces the baby excretes, the more bilirubin the baby will expel. 3. Holding the baby skin to skin has no direct affect on the bilirubin level. 4. The bilirubin levels of babies exposed to direct sunlight will drop. It is unsafe, however, to expose a baby's skin to direct sunlight.
A baby has just been born to a type 1 diabetic mother with retinopathy and nephropathy. Which of the following neonatal findings would the nurse expect to see? 1. Hyperalbuminemia. 2. Polycythemia. 3. Hypercalcemia. 4. Hypoinsulinemia.
ANS: 2 1. The baby's serum protein levels should be normal. 2. Because the placenta is likely to be functioning less than optimally, it is highly likely that the baby will be polycythemic. The increase in red blood cells would improve the baby's oxygenation in utero. 3. Rather than hypercalcemia, the nurse would expect to see hypocalcemia. 4. Rather than hypoinsulinemia, if the maternal glucose levels are higher than normal, the nurse would expect to see hyperinsulinemia in the neonate.
An 18-hour-old baby is placed under the bili-lights with an elevated bilirubin level. Which of the following is an expected nursing action in these circumstances? 1. Give the baby oral rehydration therapy after all feedings. 2. Rotate the baby from side to back to side to front every two hours. 3. Apply restraints to keep the baby under the light source. 4. Administer intravenous fluids via pump per doctor orders.
ANS: 2 1. The neonate needs nourishment with formula and/or breast milk. 2. Rotating the baby's position maximizes the therapeutic response because the more skin surface that is exposed to the light source, the better the results are. 3. It is unnecessary to restrain the baby while under the bili-lights. 4. Intravenous fluids would be administered only under extreme circumstances.
A woman who received an intravenous analgesic 4 hours ago has had prolonged late decelerations in labor. She will deliver her baby shortly. Which of the following is the priority action for the delivery room nurse to take? 1. Preheat the overhead warmer. 2. Page the neonatologist on call. 3. Draw up Narcan (naloxone) for injection. 4. Assemble the neonatal eye prophylaxis.
ANS: 2 1. The warmer must be preheated, but that is not the priority at this time. 2. The neonatologist must be called to the delivery room so that he or she arrives before the baby is delivered. 3. The woman did receive a narcotic analgesic 4 hours ago. Although Narcan may be needed, she has likely metabolized most of the medication by this time. The medication is not a priority at this time. 4. The eye prophylaxis can wait until this baby is at least 1 hour old. It is not a priority at this time.
A 1,000-gram neonate is being admitted to the neonatal intensive care unit. The surfactant Survanta (beractant) has just been prescribed to prevent respiratory distress syndrome. Which of the following actions should the nurse take while administering this medication? 1. Flush the intravenous line with normal saline solution. 2. Assist the neonatologist during the intubation procedure. 3. Inject the medication deep into the vastus lateralis muscle. 4. Administer the reconstituted liquid via an oral syringe.
ANS: 2 1. Surfactant is not administered intravenously. 2. Surfactant is administered intratracheally. The baby must first be intubated. The nurse would assist the doctor with the procedure. 3. Surfactant is not administered parenterally. 4. Surfactant is not administered orally.
A baby is suspected of having esophageal atresia. The nurse would expect to see which of the following signs/symptoms? Select all that apply. 1. Frequent vomiting. 2. Excessive mucus. 3. Ruddy complexion. 4. Abdominal distention. 5. Pigeon chest.
ANS: 2 and 4 are correct. 1. Vomiting is literally impossible. 2. Babies with esophageal atresia would be expected to expel large amounts of mucus from the mouth. 3. A ruddy complexion is related to polycythemia, not esophageal atresia. 4. Abdominal distention can be seen with esophageal atresia as air enters the stomach via the trachea. 5. Pigeon chest is not associated with esophageal atresia.
The nurse caring for an infant with a congenital cardiac defect is monitoring the child for which of the following early signs of congestive heart failure? Select all that apply. 1. Palpitations. 2. Tachypnea. 3. Tachycardia. 4. Diaphoresis. 5. Irritability
ANS: 2, 3, and 4 are correct. 1. Palpitations are not an early sign of congestive heart failure (CHF). 2. No matter whether a baby or an adult were developing CHF, the patient would be tachypneic. 3. No matter whether a baby or an adult were developing CHF, the patient would be tachycardic. 4. No matter whether a baby or an adult were developing CHF, the patient would be diaphoretic. 5. Irritability is not an early sign of CHF.
A preterm infant has a patent ductus arteriosus (PDA). Which of the following explanations should the nurse give to the parents about the condition? 1. Hole has developed between the left and right ventricles. 2. Hypoxemia occurs as a result of the poor systemic circulation. 3. Oxygenated blood is reentering the pulmonary system. 4. Blood is shunting from the right side of the heart to the left.
ANS: 3 1. A hole between the left and right ventricles is called a ventricular septal defect (VSD). 2. Unless the baby is decompensating, this defect rarely results in cyanosis. The blood is being oxygenated and, although there is mixed blood, the baby is sufficiently oxygenated. 3. There is a left to right shunt of blood with a PDA, resulting in oxygenated blood reentering the pulmonary system. 4. There is a left to right shunt rather than a right to left shunt.
A 42-week gravida is delivering her baby. A nurse and pediatrician are present at the birth. The amniotic fluid is green and thick. The baby fails to breathe spontaneously. Which of the following actions should the nurse take next? 1. Stimulate the baby to breathe. 2. Assess neonatal heart rate. 3. Assist with intubation. 4. Place the baby in the prone position.
ANS: 3 1. Because meconium is present in the amniotic fluid, the baby should not be stimulated to breathe. 2. Although the heart rate is important, cardiac function is secondary to respiratory function. 3. Before breathing, the baby must be intubated so that the meconiumcontaminated fluid can be aspirated from the baby's airway 4. The baby is kept in a head-down, supine position.
A 6-month-old child developed kernicterus immediately after birth. Which of the following tests should be done to determine whether or not this child has developed any sequelae to the illness? 1. Blood urea nitrogen and serum creatinine. 2. Alkaline phosphatase and bilirubin. 3. Hearing testing and vision assessment. 4. Peak expiratory flow and blood gas assessments.
ANS: 3 1. Blood urea nitrogen and serum creatinine tests are done to assess the renal system. Kernicterus does not affect the renal system. It results from an infiltration of bilirubin into the central nervous system. 2. Although alkaline phosphatase and bilirubin would be evaluated when a child is jaundiced, they are not appropriate as assessment tests for the child who has developed kernicterus. 3. Because the central nervous system (CNS) may have been damaged by the high bilirubin levels, testing of the senses as well as motor and cognitive assessments are appropriate. 4. The respiratory system is unaffected by high bilirubin levels.
A child has been diagnosed with a small ventricular septal defect (VSD). Which of the following symptoms would the nurse expect to see? 1. Cyanosis and clubbing of the fingers. 2. Respiratory distress and extreme fatigue. 3. Systolic murmur with no other obvious symptoms. 4. Feeding difficulties with marked polycythemia.
ANS: 3 1. Cyanosis and clubbing are seen in children suffering from severe cyanotic defects and are not likely to develop with a small VSD. 2. These symptoms will unlikely develop with a small VSD. 3. This response is correct. 4. Feeding difficulties and polycythemia are seen in children suffering from severe cyanotic defects. TEST-TAKING TIP: The VSD—an opening between the ventricles of the heart—is the most common acyanotic heart defect seen. The defect leads to a left-to-right shunt as the left side of the heart is more powerful than the right side of the heart, causing a murmur. Small VSDs rarely result in severe symptoms and, in fact, oft
A baby is born with a diaphragmatic hernia. Which of the following signs/symptoms would the nurse observe in the delivery room? 1. Projectile vomiting. 2. High-pitched crying. 3. Respiratory distress. 4. Fecal incontinence.
ANS: 3 1. Digestive symptoms are not associated with a congenital diaphragmatic hernia. 2. High-pitched cries are associated with prematurity and some retardation syndromes. 3. The baby will develop respiratory distress very shortly after delivery. 4. Fecal incontinence is not associated with diaphragmatic hernia. TEST-TAKING TIP: Abdominal organs are displaced into the thoracic cavity when a baby is born with a diaphragmatic hernia. Because of the defect, the respiratory tree does not develop completely. The newly delivered baby, therefore, is unable to breathe effectively.
Which of the following neonates is at highest risk for cold stress syndrome? 1. Infant of diabetic mother. 2. Infant with Rh incompatibility. 3. Postdates neonate. 4. Down syndrome neonate.
ANS: 3 1. Infants of diabetic mothers are often largefor-gestational age, but they are not especially at high risk for cold stress syndrome. 2. Infants born with Rh incompatibility are not especially at high risk for cold stress syndrome. 3. Postdate babies are at high risk for cold stress syndrome because while still in utero they often metabolize the brown adipose tissue for nourishment when the placental function deteriorates. 4. Down syndrome babies are hypotonic, but they are not especially at high risk for cold stress syndrome.
There is a baby in the neonatal intensive care unit (NICU) who is exhibiting signs of neonatal abstinence syndrome. Which of the following medications is contraindicated for this neonate? 1. Morphine. 2. Opium. 3. Narcan. 4. Phenobarbital.
ANS: 3 1. Morphine is an opiate narcotic. It may be administered to an addicted baby to control diarrhea associated with neonatal abstinence syndrome. 2. Opium is administered to neonates who are exhibiting signs of severe neonatal abstinence syndrome. 3. Narcan is an opiate. If it were to be given to the neonate with neonatal abstinence syndrome, the baby would go into a traumatic withdrawal. 4. Phenobarbital is sometimes administered to drug-exposed neonates to control seizures. TEST-TAKING TIP: "Neonatal abstinence syndrome" is the term used to describe the many behaviors exhibited by neonates who are born drug addicted. The behaviors range from hyperreflexia to excessive sneezing and yawning to loose diarrheal stools. Medications may or may not be administered to control the many signs/ symptoms of the syndrome.
A baby is born with esophageal atresia and tracheoesophageal fistula. Which of the following complications of pregnancy would the nurse expect to note in the mother's history? 1. Preeclampsia. 2. Idiopathic thrombocytopenia. 3. Polyhydramnios. 4. Severe iron deficiency anemia.
ANS: 3 1. Preeclampsia is not associated with esophageal atresia. 2. Idiopathic thrombocytopenia is not associated with esophageal atresia. 3. Polyhydramnios is often seen in pregnancies complicated by a fetus with a digestive blockage. 4. Severe anemia is not associated with esophageal atresia.
A neonate whose mother is HIV positive is admitted to the NICU. A nursing diagnosis: Risk for infection related to perinatal exposure to HIV/AIDS is made. Which of the following interventions should the nurse make in relation to the diagnosis? 1. Monitor daily viral load laboratory reports. 2. Check the baby's viral antibody status. 3. Obtain an order for antiviral medication. 4. Place the baby on strict precautions.
ANS: 3 1. The baby will have a positive antibody titer, as a result of passive immunity through the placenta, but there will be no evidence of active viral production that early in the newborn's life. 2. There is no need to assess the antibody titer. It will definitely be positive because the mother has HIV/AIDS. 3. The standard of care for neonates born to mothers with HIV/AIDS is to begin them on anti-AIDS medication in the nursery. The mother will be advised to continue to give the baby the medication after discharge. 4. There is no need to place the baby on strict precautions. The institution of standard precautions in the well-baby nursery is sufficient.
A 1-day-old neonate, 32 weeks' gestation, is in an overhead warmer. The nurse assesses the morning axillary temperature as 96.9°F. Which of the following could explain this assessment finding? 1. This is a normal temperature for a preterm neonate. 2. Axillary temperatures are not valid for preterm babies. 3. The supply of brown adipose tissue is incomplete. 4. Conduction heat loss is pronounced in the baby.
ANS: 3 1. The normal temperature of a premature baby is the same as a full-term baby. 2. Axillary temperatures, when performed correctly, provide accurate information. 3. Preterm babies are born with an insufficient supply of brown adipose tissue that is needed for thermogenesis, or heat generation. 4. There is nothing in the question that would explain conduction heat loss.
A baby has just been admitted into the neonatal intensive care unit with a diagnosis of intrauterine growth restriction (IUGR). Which of the following maternal factors would predispose the baby to this diagnosis? Select all that apply. 1. Hyperopia. 2. Gestational diabetes. 3. Substance abuse. 4. Chronic hypertension. 5. Advanced maternal age.
ANS: 3, 4, and 5 are correct. 1. Hyperopia, another name for farsightedness, is unrelated to placental function. 2. If the mother had gestational diabetes, the nurse would expect the baby to be macrosomic, not to have IUGR. 3. Placental function is affected by the vasoconstrictive properties of many illicit drugs, as well as by cigarette smoke. 4. Placental function is diminished in women who have chronic hypertension. 5. Placental function has been found to be diminished in women of advanced maternal age.
A baby is born to a mother who was diagnosed with oligohydramnios during her pregnancy. The nurse notifies the neonatologist to order tests to assess the functioning of which of the following systems? 1. Gastrointestinal. 2. Hepatic. 3. Endocrine. 4. Renal.
ANS: 4 1. A blockage in the gastrointestinal system may lead to polyhydramnios rather than oligohydramnios. 2. Oligohydramnios is not related to a defect in the hepatic system. 3. Oligohydramnios is not related to a defect in the endocrine system. Pregnancies of mothers with diabetes often are complicated by polyhydramnios. 4. Some defects of the renal system can lead to oligohydramnios.
When examining a nenonate in the well-baby nursery, the nurse notes that the sclerae of the baby's eyes are visible above the iris of the eyes. Which of the following assessments is highest priority for the nurse to make next? 1. Babinski and tonic neck reflexes. 2. Evaluation of bilateral eye coordination. 3. Blood type and Coombs' test results. 4. Circumferences of the head and chest.
ANS: 4 1. Babinski and tonic neck reflexes are unrelated to the eye. 2. Pseudostrabismus is normally seen in the neonate. 3. Blood typing and Coombs' testing are unrelated to the eye. 4. The baby should be assessed for signs of hydrocephalus, especially a disparity between the circumferences of the neonatal head and the neonatal chest.
The staff on the maternity unit is developing a protocol for nurses to follow after a baby is delivered who fails to breathe spontaneously. Which of the following should be included in the protocol as the first action for the nurse to take? 1. Prepare epinephrine for administration. 2. Provide positive pressure oxygen. 3. Administer chest compressions. 4. Rub the back and feet of the baby.
ANS: 4 1. Epinephrine is administered only after other resuscitation measures have been instituted. 2. Positive pressure oxygen is administered only after initial interventions of tactile stimulation and warmth have failed. 3. Chest compressions are administered only after initial interventions have failed. 4. The first interventions when a neonate fails to breathe include providing tactile stimulation.
The nurse is providing discharge teaching to the parents of a baby born with a cleft lip and palate. Which of the following should be included in the teaching? 1. Correct technique for the administration of a gastrostomy feeding. 2. Need to watch for the appearance of blood-stained mucus from the nose. 3. Optimal position for burping after nasogastric feedings. 4. Need to give the baby sufficient time to rest during each feeding.
ANS: 4 1. It is not necessary to feed these babies via gastrostomy tubes. 2. Blood-stained mucus is not associated with cleft lip or palate. 3. It is not necessary to feed these babies via nasogastric tubes. 4. Cleft lip and palate babies require additional time to rest as well as to suck and swallow when being fed.
A neonate is under phototherapy for elevated bilirubin levels. The baby's stools are now loose and green. Which of the following actions should the nurse take at this time? 1. Discontinue the phototherapy. 2. Notify the health care practitioner. 3. Take the baby's temperature. 4. Assess the baby's skin integrity.
ANS: 4 1. The stools are green from the increase in excreted bilirubin. 2. There is no need to inform the health care practitioner. Green stools are an expected finding. 3. Although green stools can be seen with diarrheal illnesses, in this situation, the green stools are expected and not related to an infectious state. 4. The stools can be very caustic to the baby's delicate skin. The nurse should cleanse the area well and inspect the skin for any sign that the skin is breaking down.