OB EX3 CHaptet 24

CHAPTER 18 Blueprint The nurse is teaching the caregivers of an infant diagnosed with hypospadias how to properly care for the infant. The nurse determines the session is successful when the caregivers make which statement? "At least he won't have to have surgery until he is almost ready to start school." "Being able to most likely correct this in one stage rather than several is reassuring." "It is upsetting to me that he is in pain when he urinates." "We hadn't decided about circumcision, but he will have to be circumcised before they do the surgery."

"Being able to most likely correct this in one stage rather than several is reassuring."

A client who gave birth 2 hours ago expresses concern about her baby developing jaundice. Which response from the nurse would be best? "I understand your concern because as many as 50% of babies can develop jaundice." "You don't need to worry about your baby developing jaundice because you are both fine." "If you are concerned about your baby developing jaundice, don't breastfeed your baby until you get home." "We will monitor the baby now, and your baby will not develop jaundice after the first 24 hours of life."

"I understand your concern because as many as 50% of babies can develop jaundice."

The nurse teaches the parents of a newborn with hyperbilirubinemia about home phototherapy using bilirubin lights. Which statement indicates that the teaching was successful? "We'll place the lights so that they are about 5 inches above our baby at all times." "We will turn him every ½ hour to make sure that his whole body is exposed." "We'll take off the patches on his eyes when we're feeding him so he can look at us." "We should see reddened areas on his skin, which means the treatment is working."

"We'll take off the patches on his eyes when we're feeding him so he can look at us." The lights are to be positioned about 12 to 30 inches above the newborn. The newborn is turned every 2 hours while under the bilirubin lights. Eye patches are removed during feedings so that the newborn can interact with the caregiver. Evidence of effectiveness is indicated by loose, green stools indicating that the bilirubin is being broken down.

A nurse makes a home visit to a new mother and her 5-day-old newborn. Assessment of the newborn reveals slight yellowing of the skin on the face and forehead and slowed skin turgor. The mother tells the nurse that she's been having trouble breastfeeding the newborn. "My baby's been feeding about every 4 to 5 hours." Additional assessment reveals about 3 wet diapers per day and 1 to 2 stools per day. Which action by the nurse would be the priority? Call the provider to obtain a prescription for a bilirubin level. Arrange for home phototherapy. Evaluate the mother's technique for breastfeeding. Measure the newborn's abdominal girth.

Call the provider to obtain a prescription for a bilirubin level.

A nurse is caring for a preterm newborn born at 29 weeks' gestation. Which nursing diagnosis would have the highest priority? Grieving related to the loss of "a healthy full-term newborn" Ineffective thermoregulation related to decreased amount of subcutaneous fat Risk for injury related to the very thin epidermis layer of skin Imbalanced nutrition: Less than body requirements related to the premature digestive system

Ineffective thermoregulation related to decreased amount of subcutaneous fat

The nurse caring for a newborn notes a distended abdomen approximately 24 hours after birth. Which action should the nurse take after review of the medical record reveals an apparent healthy newborn at birth but no documentation of a bowel movement? Attempt to take a rectal temperature. Inform the health care provider immediately. Schedule radiography to diagnose the problem. Inform the parents that the newborn might need surgery.

Inform the health care provider immediately.

A nurse is caring for a newborn with jaundice undergoing phototherapy. What intervention is appropriate when caring for the newborn? Expose the newborn's skin minimally. Shield the newborn's eyes. Discourage feeding the newborn. Discontinue therapy if stools are loose, green, and frequent.

Shield the newborn's eyes.

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.

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 lungs are hyperextended due to increased load of work. The infant has inherited allergies from the mother. The lungs are immature and deficient in surfactant. The mother has a history of asthma which interfered in lung development.

The lungs are immature and deficient in surfactant.

The nurse is caring for a preterm neonate and has chosen the following goal: improvement of the neonate's respiratory function. Which expected outcome is most appropriate for the first week? The neonate will not use accessory muscles when breathing. The neonate will have 99% oxygen saturation. The neonate will sleep without apnea periods. The neonate will maintain a temperature under 99.5°F (37.5°C).

The neonate will not use accessory muscles when breathing.

As the nurse examines the birth records, which newborn would the nurse expect to monitor closely for respiratory distress syndrome (RDS)? a term male newborn, born by a repeat cesarean birth, whose mother has diabetes mellitus a term female newborn, born vaginally, whose mother has chronic obstructive pulmonary disease the term female newborn, born by a mid-forceps assist, whose mother has hypothyroidism the term male newborn, born by cesarean birth, whose mother has respiratory allergies

a term male newborn, born by a repeat cesarean birth, whose mother has diabetes mellitus

A newborn is diagnosed with a birth injury secondary to shoulder dystocia. Assessment of the newborn's reflexes reveals the following: Present Moro reflex Absent grasp reflex Absent radial reflex Present bicep reflex The nurse suspects an upper brachial plexus injury based on which finding? present Moro reflex absent grasp reflex absent radial reflex present bicep reflex

absent radial reflex With an upper brachial plexus injury, also known as Erb palsy, the involved extremity usually presents adducted, prone, and internally rotated; shoulder movement is absent; Moro, bicep, and radial reflexes are absent, but the grasp reflex is usually present

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? alcohol smoking recreational drugs obesity

alcohol

A nurse is conducting a review program for a group of neonatal nurses about pulmonary complications associated with preterm birth, explaining that the most common severe adverse pulmonary outcome of preterm birth is bronchopulmonary dysplasia. Which information would the nurse address as a preventive measure? antepartum administration of steroids to the mother administrating tocolytics to the mother before birth start resuscitation with 100% oxygen immediately after birth immediate intubation after birth

antepartum administration of steroids to the mother

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

cries when touched.

A 3-day-old neonate needs phototherapy for hyperbilirubinemia. Nursery care of a neonate receiving phototherapy includes which treatment? tube feedings mask over the mouth eye patches to prevent retinal damage temperature monitored every 6 hours during phototherapy

eye patches to prevent retinal damage

A nurse is assessing a newborn who was born to a woman with diabetes mellitus. The newborn is large-for-gestational age and has a ruddy skin color, short neck, buffalo hump, and distended upper abdomen. Laboratory testing has been completed and the results are as follows: Glucose: 30 mg/dL (1.67 mmol/L) Calcium: 7.2 mg/dL (1.80 mmol/L) Magnesium: 1.5 mg/dL (0.62 mmol/L) Bilirubin: 15 mg/dL (256.56 µmol/L) Hematocrit: 75% (0.75) Which result(s) would the nurse immediately report to the provider? Select all that apply. glucose calcium magnesium bilirubin hematocrit

glucose bilirubin hematocrit The newborn's glucose level is low suggesting hypoglycemia, bilirubin level is high suggesting hyperbilirubinemia, and hematocrit is high suggesting polycythemia. These three results should be reported. The newborn's calcium and magnesium levels are within acceptable parameters and are not a cause for concern.

The nurse is admitting to the nursery a newborn of a mother who continued to drink alcohol during her pregnancy. Which finding does the nurse predict to encounter on the newborn's assessment? above average birth weight large head circumference lethargic and sleepy hyperactive and irritable

hyperactive and irritable

A neonate undergoing phototherapy treatment must be monitored for which adverse effect? hyperglycemia increased insensible water loss severe decrease in platelet count increased GI transit time

increased insensible water loss

A newborn is diagnosed with respiratory distress syndrome (RDS). While assessing the newborn, the nurse realizes that which maternal factor would most place the infant at risk for RDS? maternal gestational diabetes maternal opioid addiction maternal smoking prolonged rupture of membranes

maternal gestational diabetes

A labor and birth nurse is admitting a client in active labor. Which factor(s) in the maternal history will lessen the neonate's risk for developing respiratory distress syndrome (RDS)? Select all that apply. maternal opioid abuse disorder maternal hypertension ruptured membranes preterm birth absent prenatal care maternal age

maternal hypertension ruptured membranes maternal opioid abuse disorder

A nurse is caring for a newborn whose chest X-ray reveals marked hyperaeration mixed with areas of atelectasis. The infant's arterial blood gas analysis indicates metabolic acidosis. For which dangerous condition should the nurse prepare when providing care to this newborn? choanal atresia diaphragmatic hernia meconium aspiration syndrome pneumonia

meconium aspiration syndrome Explanation: The nurse should assess for meconium aspiration syndrome in the newborn. Meconium aspiration involves patchy, fluffy infiltrates unevenly distributed throughout the lungs and marked hyperaeration mixed with areas of atelectasis that can be seen through chest X-rays. Direct visualization of the vocal cords for meconium staining using a laryngoscope can confirm aspiration. Lung auscultation typically reveals coarse crackles and rhonchi. Arterial blood gas analysis will indicate metabolic acidosis with a low blood pH, decreased PaO2, and increased PaCO2. Newborns with choanal atresia, diaphragmatic hernia, and pneumonia do not exhibit these manifestations.

A neonate born addicted to cocaine is now being treated with medication for acute neonatal abstinence syndrome. Which medication will be prescribed to relieve withdrawal symptoms? meperidine epinephrine naloxone morphine sulphate

morphine sulphate Explanation: Pharmacologic treatment is warranted if conservative measures are not adequate. Common medications used in the management of newborn withdrawal include an opioid (morphine or methadone) and phenobarbital as a second drug if the opiate does not adequately control symptoms. The other drugs are not used in NAS treatment.

The nursing instructor is conducting a session with a group of nursing students researching potential respiratory difficulties in newborns. The instructor determines the session is successful after the students correctly choose which contributing factor for transient tachypnea of the newborn? usually occurs with maternal history of hypertension associated with fetal distress during labor often seen with advanced gestational age often seen with cesarean births

often seen with cesarean births

At the breech forceps birth of a 32 weeks' gestation neonate, the nurse notes oligohydramnios with green thick amniotic fluid. The maternal history reveals a mother of Hispanic ethnicity with marked hypertension, who admits to using cocaine daily. Which factor(s) may contribute to meconium aspiration syndrome (MAS)? Select all that apply. the preterm pregnancy the forceps breech birth maternal cocaine use maternal hypertension Hispanic ethnicity oligohydramnios present

oligohydramnios present the forceps breech birth maternal cocaine use maternal hypertension

A 32 weeks' gestation newborn is admitted to the neonatal intensive care unit. The assessment reveals a pale dyspneic newborn with marked tremors, a bulging anterior fontanel (fontanelle), and a high-pitched cry. What diagnosis best correlates with the assessment findings? periventricular-intraventricular hemorrhage persistent pulmonary hypertension of the newborn meconium aspiration syndrome respiratory distress syndrome

periventricular-intraventricular hemorrhage

When caring for a neonate receiving phototherapy, the nurse should remember to: decrease the amount of formula. dress the neonate warmly. massage the neonate's skin with lotion. reposition the neonate frequently.

reposition the neonate frequently. Phototherapy works by the chemical interaction between a light source and the bilirubin in the neonate's skin. Therefore, the larger the skin area exposed to light, the more effective the treatment. Changing the neonate's position frequently ensures maximum exposure.

When assessing a newborn, the nurse determines that the newborn is most likely experiencing respiratory distress syndrome (RDS) based on which finding? respiratory distress occurring by 6 hours of age slightly diminished breath sounds see-saw respirations peripheral cyanosis

see-saw respirations

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

short, palpebral fissures

Which sign appears early in a neonate with respiratory distress syndrome? bilateral crackles pale gray skin color tachypnea more than 60 breaths/minute poor capillary filling time (3 to 4 seconds)

tachypnea more than 60 breaths/minute

A nurse is assessing a newborn. The nurse suspects that the newborn was exposed to drugs while in utero based on which findings? Select all that apply. tremors frequent yawning coordinated sucking respirations of 43 breaths per minute nasal flaring

tremors frequent yawning nasal flaring

A neonatal intensive care nurse is caring for a preterm newborn diagnosed with transient tachypnea who is NPO and receiving intravenous fluid therapy. When would the nurse expect the newborn to begin oral feedings? when the respiratory rate is 44 BPM when the oxygen saturation level is at 92% when serum glucose is 30 mg/dl (1.7 mmol) when intake and output correlate

when the respiratory rate is 44 BPM