NU143- Chapter 23: Nursing Care of the Newborn with Special Needs

SGA and LGA newborns have an excessive number of red blood cells related to: a. Hypoxia b. Hypoglycemia c. Hypocalcemia d. Hypothermia

a. Hypoxia

The nurse is providing care to several newborns with variations in gestational age and birthweight. When developing the plan of care for these newborns, the nurse focuses on energy conservation to promote growth and development. Which measures would the nurse include in the nursing plans of care? Select all that apply. a. Keeping the handling of the newborn to a minimum b. Maintaining a neutral thermal environment c. Decreasing environmental stimuli d. Initiating early oral feedings e. Using thermal warmers in all cribs

a. Keeping the handling of the newborn to a minimum b. Maintaining a neutral thermal environment c. Decreasing environmental stimuli

A 24-hour-old, full-term, small-for-gestational-age neonate is being assessed. Which maternal factors would the nurse correlate with this gestational age variation? Select all that apply.

blood pressure baseline of 140/90 mm Hg positive for TORCH infections hemoglobin 7g/dL (70 g/L) BMI under 17

postterm newborn

born after completion of 42 weeks

late preterm newborn (near term)

born between 34 0/7 and 36 6/7 weeks of gestation

A newborn does not breathe spontaneously at birth. The nurse administers oxygen by bag and mask. If oxygen is entering the lungs, the nurse should notice that the:

chest rises with each bag compression.

Hypoglycemia in a mature infant is defined as a blood glucose level below which amount?

40 mg/100 ml whole blood

A common symptom that would alert the nurse that a preterm infant is developing respiratory distress syndrome is:

expiratory grunting.

preterm newborn

a newborn born before completion of 37 weeks

The nurse is teaching nursing students about the risks that late preterm infants may experience. The nurse feels confident learning has taken place when the students make which statement?

"A late preterm newborn may have more clinical problems compared with full-term newborns."

At a prenatal class the nurse describes the various birth weight terms that may be used to describe a newborn at birth. The nurse feels confident learning has occurred when a participant makes which statement?

"Newborns who are appropriate-for-gestational-age at birth have lower chance of complications than others."

The nurse realizes the educational session conducted on due dates was successful when a participant is overheard making which statement?

"The ability of my placenta to provide adequate oxygen and nutrients to my baby after 42 weeks' gestation is thought to be compromised."

A newborn with high serum bilirubin is receiving phototherapy. Which is the most appropriate nursing intervention for this client?

Application of eye dressings to the infant

The nurse has admitted a small-for-gestational-age infant (SGA) to the observation nursery from the birth room. Which action would the nurse prioritize in the newborn's care plan?

Closely monitor temperature.

What is the first action the nurse takes in surfactant administration?

Obtain and document baseline vital signs.

When caring for a 1-week-old infant with jaundice, the nurse observes the infant's urine to be dark in color. The nurse would also expect to assess which as indicative of significant hyperbilirubinemia? Select all that apply.

Poor feeding and lethargy Late passage of meconium stool Light, tan-colored stool after milk intake

An 18-year-old client has given birth at 28 weeks' gestation and her newborn is showing signs of respiratory distress syndrome (RDS). Which statement is true for a newborn with RDS?

RDS is caused by a lack of alveolar surfactant.

appropriate for gestational age (AGA)

a newborn with a weight that falls within the 10th to 90th percentile for that particular gestational age

Evidence-based practice refers to the use of which of the following to validate your practice? a. Research findings b. Written guidelines c. Traditional practices d. Institutional policies

a. Research findings

When documenting the newborn's weight on a growth chart, the nurse recognizes the newborn is large-for-gestational-size based on which percentile on growth charts?

above 90th percentile

Because subcutaneous and brown fat stores were used for survival in utero, the nurse would assess an SGA newborn for which of the following? a. Hyperbilirubinemia b. Hypothermia c. Polycythemia d. Hypoglycemia

b. Hypothermia

The nurse documents that a newborn is postterm based on the understanding that he was born after: a. 38 weeks' gestation b. 40 weeks' gestation c. 42 weeks' gestation d. 44 weeks' gestation

c. 42 weeks' gestation

In dealing with parents experiencing a perinatal loss, which of the following nursing interventions would be most appropriate? a. Sheltering the parents from the bad news b. Making all the decisions regarding care c. Encouraging them to participate in the newborn's care d. Leaving them by themselves to allow time to grieve

c. Encouraging them to participate in the newborn's care

Which of the following concepts would the nurse incorporate into the plan of care when assessing pain in a newborn with special needs? a. Newborns experience pain primarily with surgical procedures. b. Preterm newborns in the NICU are at least risk for pain. c. Pain assessment needs to be comprehensive and frequent. d. A newborn's facial expression is the primary indicator of pain.

c. Pain assessment needs to be comprehensive and frequent.

In assessing a preterm newborn, which of the following findings would be of greatest concern? a. Milia over the bridge of the nose b. Thin transparent skin c. Poor muscle tone d. Heart murmur

d. Heart murmur

A nurse is assessing the fluid status of a preterm newborn. Which parameter would be most appropriate for the nurse to assess?

fontanels (fontanelles)

A client has given birth to a small-for-gestation-age (SGA) newborn. Which finding would the nurse expect to assess?

head larger than body

The infant is born with copious secretions in the mouth and nose. When using a bulb syringe to remove secretions, the nurse might observe what response from the infant?

heart rate of 88 beats per minute

A client asks the nurse what surfactant is. Which explanation would the nurse give as the main role of surfactant in the neonate?

helps the lungs remain expanded after the initiation of breathing

A small-for-gestational-age neonate is admitted to the observational nursery for blood work. Which result would require further assessment?

hematocrit: 80% (0.80)

An obese woman with diabetes has just given birth to a term, large-for-gestational-age (LGA) newborn. Which condition should the nurse most expect to find in this infant?

hypoglycemia

The nurse begins frequent oral feedings for a small-for-gestational-age newborn to prevent which occurrence?

hypoglycemia

A nurse completes the initial assessment of a newborn. According to the due date on the antenatal record, the baby is 12 days' postmature. Which physical finding does not confirm that this newborn is 12 days' postmature?

increased amounts of vernix

A nurse is assessing a preterm newborn. The nurse determines that the newborn is comfortable and without pain based on which finding?

lack of body posturing

extremely low birth weight

less than 1,000 g (2 lb 3 oz)

very low birth weight

less than 1,500 g (3 lb 5 oz)

A 35-year-old client has just given birth to a healthy newborn during her 43rd week of gestation. What should the nurse expect when assessing the condition of the newborn?

meconium aspiration in utero or at birth

The nurse assesses a post-term newborn. What finding corresponds with this gestational age diagnosis?

meconium-stained skin and fingernails

small for gestational age (SGA)

newborns that typically weigh less than 2,500 g (5 lb 8 oz) at term due to less growth than expected in utero

large for gestational age (LGA)

newborns whose birthweight is above the 90th percentile on a growth chart and who weigh more than 4,000 g (8 lb 13 oz) at term due to accelerated overgrowth for length of gestation

A client has just given birth at 42 weeks' gestation. What would the nurse expect to find during her assessment of the neonate?

peeling and wrinkling of the neonate's epidermis

The nurse caring for a small-for-gestational-age newborn in the special-care nursery. What characteristics are commonly documented? Select all that apply.

poor skin turgor sparse or absent hair diminished muscle tissue

Which assessment finding would best validate a problem in a small-for-gestational age newborn secondary to meconium in the amniotic fluid?

respiratory rate of 60 to 70 bpm

A premature infant develops respiratory distress syndrome. With this condition, circulatory impairment is likely to occur because, with increased lung tension,:

the ductus arteriosus remains open.

fetal growth restriction

the rate of growth does not meet the expected growth pattern

The nurse is assessing a post-term newborn. Which finding would the nurse be least likely to assess?

thick umbilical cord

A late preterm newborn is being prepared for discharge to home after being in the neonatal intensive care unit for 4 days. The nurse instructs the parents about the care of their newborn and emphasizes warning signs that should be reported to the pediatrician immediately. The nurse determines that additional teaching is needed based on which parental statement?

"If our newborn's skin turns yellow, it is from the treatments and our newborn is okay."