Nursing Management of the Newborn at Risk: Acquired and Congenital Newborn Conditions

A nurse is caring for a child with complex esophageal atresia who will be undergoing surgery for repair. What comment by the parents indicates further teaching is required? "After this surgery is done tomorrow, my baby will be able to eat and drink." "Intravenous fluids are going to be needed so that the baby won't get dehydrated." "They will be placing a tube in the stomach during surgery." "The baby will have tubes in the chest to drain chest fluids."

"After this surgery is done tomorrow, my baby will be able to eat and drink."

A nursing instructor is teaching about newborn congenital disorders and realizes that the student needs further instruction after making which statement? "Congenital defects may be caused by genetic or environmental factors." "All congenital disorders can be diagnosed at birth." "Hydrocephalus may be recognized at birth." "Hydrocephalus may not be diagnosed until after a few weeks or months of life."

"All congenital disorders can be diagnosed at birth."

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? "The procedure isn't risky for the baby, but your healing takes longer, and you'll have a scar." "If the health care provider has recommended the procedure, it's likely that the benefits outweigh the risks." "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." "Some women don't have any problem giving birth to large babies. You might want to get a second opinion."

"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."

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? "Disturbances to the bladder with diaper changes will be kept to a minimum." "Your baby will be cared for in the prone position with a cover over the bladder." "We will care for the bladder with frequent sterile tub baths to keep it moist." "The bladder will be covered in a sterile plastic bag to keep it moist."

"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? "The head of his bed will be elevated to prevent him from aspirating." "We can give him a pacifier to help satisfy his need to suck." "He'll need antibiotics for a bit after the surgery to prevent infection." "We can probably start feeding him with the bottle about a day after the surgery."

"We can probably start feeding him with the bottle about a day after the surgery."

A newborn at 33 weeks' gestation has an Apgar score of 5 at 10 minutes of life. Which nursing action is a priority? Assess the Apgar score again in 5 minutes. Complete the Ballard score. Begin resuscitation measures. Review the labor and birth records.

Begin resuscitation measures.

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 rooting stepping Babinski

Moro

The nurse is caring for a neonate with epispadias. In which location will the nurse assess the anomaly? On the anterior scrotum At the distal end of the testes On the ventral surface near the chordee On the dorsal end of the penis

On the dorsal end of the penis

Which intervention is helpful for the neonate experiencing drug withdrawal? Dress the neonate in loose clothing so the infant will not feel restricted. Withhold all medication to help the liver metabolize drugs. Place the isolette in a quiet area of the nursery. Place the isolette near the nurses' station for frequent contact with health care workers.

Place the isolette in a quiet area of the nursery.

A nurse is assigned to care for a newborn with esophageal atresia. What preoperative nursing care is the priority for this newborn? Document the amount and color of esophageal drainage. Provide NG feedings only. Administer antibiotics and total parenteral nutrition as prescribed. Prevent aspiration by elevating the head of the bed, and inserting an NG tube to low suction.

Prevent aspiration by elevating the head of the bed, and inserting an NG tube to low suction.

An infant is suspected of having persistent pulmonary hypertension of the newborn (PPHN). What intervention implemented by the nurse would be appropriate for treating this client? Provide oxygen by oxygen hood or ventilator. Place the infant in a cool environment to prevent overheating. Encourage the parents to hold the infant for bonding. Administer anticonvulsants as prescribed.

Provide oxygen by oxygen hood or ventilator.

Which nursing actions limit overstimulation of the preterm infant? Select all that apply. Keep lights low in the nursery. Coordinate nursing care. Speak softly to the infant. Frequently open the isolette portholes. Tap on the isolette before opening the door.

Speak softly to the infant. Keep lights low in the nursery. Coordinate nursing care.

A nurse is concerned that a 1-day-old newborn is becoming ill and may be septic. What sign of distress would validate the nurse's concerns? Temperature instability Heart rate of 152 beats/min Respiratory rate of 40 breaths/min Erythema toxicum

Temperature instability

After teaching a group of new mothers about the physiologic jaundice in breastfed and bottle-fed newborns, the nurse determines that the teaching was successful when the mothers state which information? Jaundice associated with bottle feeding occurs in two distinct patterns. Peak bilirubin levels occur earlier for bottle-fed newborns than for breastfed newborns. The decline in bilirubin levels occurs more quickly in bottle-fed newborns. Breastfed newborns tend to have more frequent bowel movements.

The decline in bilirubin levels occurs more quickly in bottle-fed newborns.

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 must have had a long labor. The infant's mother probably had diabetes. The infant may have experienced birth trauma. The infant may have been exposed to alcohol during pregnancy.

The infant's mother probably had diabetes.

A newborn is suspected of having gastroschisis at birth. How would the nurse differentiate this problem from other congenital defects? The intestines appear reddened and swollen and have no sac around them. The abdominal contents are contained within a thin, transparent sac. The skin over the abdomen is wrinkled and looks like a prune. The umbilical cord comes out of middle of the defect.

The intestines appear reddened and swollen and have no sac around them.

The nurse is teaching new parents about their premature newborn who was born with respiratory distress syndrome (RDS). The nurse determines the teaching session is successful when the parents correctly choose which explanation as being the cause of their newborn's condition? The infant has inherited allergies from the mother. The mother has a history of asthma which interfered in lung development. The lungs are immature and deficient in surfactant. The lungs are hyperextended due to increased load of work.

The lungs are immature and deficient in surfactant.

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. Help the child to understand his or her limitations. Keep the family informed about new and effective treatments. Model good medical practices for the child's family.

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? obesity smoking alcohol recreational drugs

alcohol

What is the term for a small collection of blood that forms underneath the skull as a result of birth trauma? vernix caseosa cephalohematoma erythema toxicum caput succedaneum

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? prepare for endotracheal intubation give gavage feedings suction the throat clear the airway

clear the airway

Periventricular-intraventricular hemorrhage is suspected in a newborn of 30 weeks' gestation. The nurse would anticipate preparing the newborn for which diagnostic tool to confirm the diagnosis? arterial blood gases blood glucose level cranial ultrasound chest X-ray

cranial ultrasound

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: weighed above average when born. has facial deformities. cries when touched. sleeps for long periods of time.

cries when touched.

When providing postpartum teaching to a couple, the nurse correctly identifies what time as when pathologic jaundice may be found in the newborn? between 2 and 4 days of life often with formula-fed babies after 5 days postpartum during the first 24 hours of life

during the first 24 hours of life

The newborn nursery nurse suspects a newborn of having neonatal abstinence syndrome. What assessment findings would most correlate with the diagnosis? cyanotic discoloration of the hands and feet positive Babinski and Moro reflexes vigorous rooting and feeding frequent yawning and sneezing

frequent yawning and sneezing

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 pink tongue vigorous cry respiratory rate 50 breaths/min

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 heroin withdrawal hypoglycemia hypoxia

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? urinary tract infection formula intolerance spina bifida hydrocephalus

hydrocephalus

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? respiratory distress syndrome cold stress intraventricular hemorrhage (IVH) retinopathy of prematurity (ROP)

intraventricular hemorrhage (IVH)

When assessing a newborn for meconium aspiration syndrome, the nurse would most likely note which finding? maternal hypertension Apgar of 8 preterm birth polyhydramnios

maternal hypertension

A premature infant in the neonatal intensive care unit exhibits worsening respiratory distress and is noted to have abdominal distention, absent bowel sounds, and frequent diarrhea stools that are positive for hemoccult. What diagnosis would be most likely to correlate with the symptoms? respiratory distress syndrome garamycin-resistant bacteria rotavirus infection necrotizing enterocolitis

necrotizing enterocolitis

The nurse should carefully monitor which neonate for hyperbilirubinemia? neonate of an Rh-positive mother neonate with ABO incompatibility neonate of African descent neonate with Apgar scores 9 and 10 at 1 and 5 minutes

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, father who is type O newborn who is type O, father who is type A newborn who is type O, mother who is type O newborn who is type A, mother who is type O

newborn who is type A, mother who is type O

Which facial change is characteristic in a neonate with fetal alcohol spectrum disorder? well-developed philtrum large upper lip wide, palpebral fissures short, palpebral fissures

short, palpebral fissures

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 teenage client who used marijuana through her pregnancy to cope with stress the child of a client who admits to drinking a liter of alcohol daily during the pregnancy the newborn of a client who used cocaine occasionally during her pregnancy the newborn of a client addicted to heroin and in the methadone maintenance program

the child of a client who admits to drinking a liter of alcohol daily during the pregnancy

The nursing instructor is leading a discussion with a group of nursing students who are analyzing the preterm infant's physiologic immaturity and the associated difficulties the newborn and family must deal with. The instructor determines the session is successful when the students correctly choose which body system that presents with the most critical concerns related to this immaturity? the genitourinary system the respiratory system the musculoskeletal system the endocrine system

the respiratory system

An infant with a tracheoesophageal fistula is carefully examined to identify other teratogenic effects at the same week in gestation. Which systems need to be examined? Select all that apply. respiratory legs anal cardiac vertebral

vertebral cardiac anal legs