NUR 238 PrepU Chapter 23: Nursing Care of the Newborn With Special Needs

Which assessment by the nurse will best monitor the nutrition and fluid balance in the postterm newborn?

Assess for decrease in urinary output.

A preterm infant will be hospitalized for an extended time. Assuming the infant's condition is improving, which environment would the nurse feel is most suitable for the child?

Provide a mobile the child can see no matter how he or she is turned.

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

The nurse notices while holding a 1-day-old infant upright that the baby has a significantly indented anterior fontanel (fontanelle). She immediately brings it to the attention of the health care provider. What does this finding indicate?

dehydration

Which symptom would most accurately indicate that a newborn has experienced meconium aspiration during the birth process?

meconium stained fluids followed by tachypnea

The nurse is admitting a newborn male for observation with the diagnosis of preterm. What assessment finding corresponds with this gestational age diagnosis?

undescended testes

Which maternal factors should the nurse consider contributory to a newborn being large for gestational age? Select all that apply.

diabetes postdates gestation prepregnancy obesity

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

An infant who is diagnosed with meconium aspiration displays which symptom?

intercostal and substernal retractions

The nurse observes a neonate born at 28 weeks' gestation. Which finding would the nurse expect to see?

The pinna of the ear is soft and flat and stays folded.

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

45 mg/100 ml whole blood

A client just gave birth to a preterm baby in the 30th week of gestation. Which nursing measures does the nurse anticipate for this newborn? Select all that apply.

Dress the baby in a stockinette cap. Carry and handle the baby frequently. Place the baby under isolette care. Estimate the urinary flow by weighing the diaper.

What action by the nurse provides the neonate with sensory stimulation of a human face?

assisting the mother to position the infant in an en face position

During the newborn's assessment, which finding would lead the nurse to suspect that a large-for-gestational-age newborn has experienced birth trauma?

asymmetrical movement

A nurse is administering prescribed enteral feedings to assist in preparing the gut of a preterm newborn. Which type of solution would the nurse most likely administer for the feeding?

breast milk

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

fontanels (fontanelles)

During an extended initial resuscitation, what additional complications may be experienced by the infant during the resuscitation? Select all that apply.

hypoglycemia dehydration

The nurse needs to conduct a procedure on a preterm newborn. Which measures would be most effective in reducing pain? Select all that apply.

swaddling the newborn closely offering a pacifier prior to a procedure encouraging skin-to-skin (kangaroo) care during procedures

Which finding would lead the nurse to suspect that a large-for-gestational-age newborn is developing hyperbilirubinemia?

tea-colored urine

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."

A newborn has scheduled heel sticks for bilirubin checks every 4 hours. The mother asks the nurse "what can be done to calm my baby after those heel pricks?" What is the nurse's most appropriate response?

"You can give your baby a sucrose solution by bottle for pain relief."

The nurse is concerned that a newborn is hypoglycemic. Which blood glucose level would support the nurse's intervention?

30 mg/dl (1.67 mmol/l)

A preterm infant has an umbilical vessel catheter inserted so that blood can be drawn readily. Which would be most important to implement during this procedure?

Ensure that the infant is kept warm.

A nurse is caring for an infant born with polycythemia. Which intervention is most appropriate when caring for this infant?

Focus on decreasing blood viscosity by increasing fluid volume.

The nurse in a newborn nursery is observing for developmentally appropriate care. Which is an example of self-regulation?

Infant has hand in mouth.

The neonatal intensive care nurse is admitting a large-for-gestational-age infant with respiratory distress who has difficulty with hypothermia, appears lethargic, is jittery, and is not feeding well. What would be the nurse's first action?

Obtain a blood glucose level.

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

hypoglycemia

The newborn nursery nurse is admitting a small-for-gestational-age (SGA) infant and is reviewing the maternal history. What factor in the maternal history would the nurse correlate as a risk factor for an SGA infant?

placental factors

The nurse is assessing a small-for-gestational age (SGA) newborn, 12 hours of age, and notes the newborn is lethargic with cyanosis of the extremities, jittery with handling, and a jaundiced, ruddy skin color. The nurse expects which diagnosis as a result of the findings?

polycythemia

A nursing student, observing care of a 30-week-gestation infant in the neonatal intensive care unit, asks the nurse, "Are premature infants more susceptible to infection as I have to wash my hands so often in this department?" What is the nurse's best response?

"That is correct; a 30-week-gestation infant lacks the protective antibody called IgG."

The obstetrics nurse has admitted a large-for-gestational-age infant, 1-hour old, for observation. The initial blood glucose level is 44 mg/dl (2.44 mmol). What is the nurse's priority action?

Begin supervised feedings for the newborn.

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 correct sequence of events in a neonatal resuscitation?

Dry the infant, establish an airway, expand the lungs, and initiate ventilation.

A woman who has given birth to a postterm newborn asks the nurse why her baby looks so thin with so little muscle. The nurse integrates understanding about which concept when responding to the mother?

With postterm birth, the fetus uses stored nutrients to stay alive, and wasting occurs.

Which condition may cause intrauterine asphyxia? Select all that apply.

cord compression placental abruption (abruptio placentae) intrauterine growth restriction (IUGR)

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

head larger than body

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 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

How does the nurse position the infant experiencing respiratory difficulty?

on the back with the head elevated 15 degrees

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

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.

A cesarean birth results in an infant weighing 4,990 g (11 lb). The nurse assesses the infant for which complication?

transient lung fluid

A nurse is caring for an infant. A serum blood sugar of 40 was noted at birth. What care should the nurse provide to this newborn?

Begin early feedings either by the breast or bottle.