PN Pediatrics
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"
Four weeks before the birth of a client's already large child, the primary care provider has told the client that if the baby gets bigger and the baby's lungs are ready, the care provider would like to perform a cesarean birth. 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?
"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."
The nurse is caring for an infant diagnosed with a ventricular septal defect. Which assessment findings does the nurse anticipate?
A harsh murmur
The nurse is reviewing the medical record of the antepartum client with an abnormal alpha-fetoprotein test. The mother is distraught and states, "How bad can it be?" The nurse is correct to describe which?
A type of spina bifida
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 nasal flaring frequent yawning
The nursing instructor is teaching a session on techniques which the nursing students can use to properly address concerns of parents with children who are born with a congenital disorder. 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 and offer nonjudgmental support.
The nurse is monitoring a new mother changing her newborn's diaper and notices a musty smell to the infant's urine. Which condition should the nurse prioritize in further assessments to rule out?
Phenylketonuria
A nurse is caring for a newborn client after birth who is diagnosed with myelomeningocele. Which nursing intervention would protect the newborn from injury?
Place the newborn in a prone or lateral position.
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 familty 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 respiratory system
Which newborn would the nurse suspect to be most at risk for cognitive challenge due to the mother's actions during pregnancy?
the child of a client who admits to drinking a liter of alcohol daily during the pregnancy
A nurse working in the newborn observational unit is assigned four newborns closely being monitored. Which newborn is at greatest risk of developing respiratory distress syndrome?
the male preterm infant born by cesarean birth with cold stress
A newborn at 33 weeks' gestation has an Apgar score of 5 at 10 minutes of life. Which nursing action is a priority?
Begin resuscitation measures.
During a clinical conference, a group of nursing students are discussing a newborn that is large for gestational age. The instructor determines the students have successfully differentiated the potential cause after choosing which contributing maternal factor?
Being 30 pounds overweight before getting pregnant
A nursing student is caring for a newborn with a defect in the neural arch where the posterior laminae of the vertebrae have failed to close. The nurse knows that this infant is suffering from which disorder?
Spina bifida
The nurse is caring for a newborn client newly diagnosed with dysplasia of the hip. Which response by the nurse educates the parents on the correct plan of treatment for this diagnosis?
"Treatment will begin immediately."
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?
"We can probably start feeding him with the bottle about a day after the surgery."
Which of the following instructions would the nurse include in the teaching plan for a mother of a substance-exposed newborn?
"Wrap him snugly in a blanket and gently rock him if he is fussy" The newborn should be positioned upright with the chin down and supported to facilitate the newborn's sucking and swallowing. All newborns should sleep or nap on their back, not their stomachs. Snugly wrapping the newborn and gentle rocking help to decrease irritability behaviors. A pacifier is useful in satisfying the newborn's need for nonnutritive sucking.
Immediately after birth, the nurse is caring for a newborn with a myelomeningocele. What intervention should the nurse provide to prevent drying out of the sac to avoid damage?
Apply a sterile dressing moistened in a warm sterile saline solution.
The nurse caring for a newborn notes a distended abdomen approximately 24 hours after birth. Which action should the nurse prioritize after review of the medical record reveals an apparent healthy newborn at birth but no documentation of a bowel movement
Inform the RN and/or primary care provider immediately
When providing care to a newborn with necrotizing enterocolitis (NEC), the nurse would need to report which finding immediately?
abdomen appearing red and shiny
The parents are upset their newborn has a cleft lip. When describing the treatment, the nurse should mention that surgical repair can be done:
between the age of 6 to 12 weeks.
The nurse assesses an infant. Which finding may indicate heart failure?
diminished peripheral pulses
The nurse is assessing a newborn suspected of having meconium aspiration syndrome. What sign or symptom would be most suggestive of this condition?
expiratory grunting
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, mother who is type O
It would be best to place an infant with a myelomeningocele in which position prior to surgery?
on the stomach (prone)
The nurse is caring for a patient who has gone into labor 6 weeks early and whose amniocentesis has shown a lack of lecithin. Of the following interventions, which would the nurse most likely do first?
Administer a glucocorticosteroid to the mother
When planning preoperative care for a newborn with a cleft lip and palate, a major need for which the nurse would plan interventions is:
Nutrition
When planning preoperative care for a newborn with a cleft lip and palate, a major need for which you would plan interventions is
Nutrition An infant with a cleft lip is unable to suck effectively, so obtaining adequate nutrition is a major concern.
A ventilated 33 weeks' gestation newborn in the neonatal intensive care unit (NICU) receives surfactant therapy. Which would the nurse expect to assess as a positive response to this therapy?
Oxygen saturation levels are at 98%.
A nurse is caring for a newborn with a repaired cleft lip. What intervention can the nurse provide to facilitate drainage of mucus and secretions to prevent aspiration?
Position the child on the side
A nurse is assigned to care for a newborn with esophageal atresia. What preoperative nursing care is the priority for this newborn?
Prevent aspiration by elevating the head of the bed, and insert an NG tube to low suction.
The nurse is preparing a nursing care plan for an infant who was born with spina bifida with myelomeningocele. Which nursing goal should the nurse prioritize for this child?
Preventing infection
An infant is suspected of having persistent pulmonary hypertension of the newborn (PPHM). What intervention implemented by the nurse would be most beneficial in treating this client?
Provide oxygen by oxygen hood or ventilator.
The nurse assesses preterm infants as they come for routine well-baby checkups. The nurse will carefully assess the infant's vision to assess for which potential complication related to their birth?
Retinopathy
Four weeks before the birth of her already large child, the physician has told the pregnant woman that if the baby gets bigger and his lungs are ready, the physician would like to perform a cesarean to deliver the baby. The woman asks the nurse what the downside is to having a cesarean rather than a vaginal delivery. What is an appropriate response by the nurse?
"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." Rationale: Transient tachypnea of the newborn (TTN) involves the development of mild respiratory distress in a newborn. TTN results from a delay in absorption of fetal lung fluid after birth. As the fetus passes through the birth canal during delivery, some of the fluid is expelled as the thoracic area is compressed. TTN is commonly seen in newborns born by cesarean delivery. It typically occurs after birth with the greatest degree of distress occurring approximately 36 hours after birth. TTN commonly disappears spontaneously around the third day
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?
"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."
The nurse is working with an adult female who has PKU and desires to become pregnant. The nurse notes on her assessment her current serum phenylalanine level is 10 mg/dL. Which instruction should the nurse prioritize for this client?
"It will be best if you cut back on meat, fish, and dairy products before you become pregnant to get your serum phenylalanine level down under 8 mg."
The nurse is working with a group of parents of children who have congenital heart disorders. Which of the following statements made by the parents would most likely be an indication the child is showing signs of congestive heart failure
"She gets so tired when she is eating" Newborns with cardiac anomalies have a history of being poor eaters, tiring easily from the effort to suck, and failing to grow or thrive normally. A murmur is not a sign of congestive heart failure. At times during infancy the chest and head would measure the same without this being a concern. With a congenital dislocation of the hip, an audible click may be heard.
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?
"The bladder will covered in a sterile plastic bag to keep it moist."
A newborn is scheduled for casting to correct a talipes disorder. You would advise her parents that the cast will extend
Above the knee
A nursing instructor is teaching about newborn congenital disorders and realizes that the student needs further instruction upon making which of the following statements? a) All congenital disorders can be diagnosed at birth. b) Hydrocephalus may not be diagnosed until after a few weeks or months of life. c) Hydrocephalus may be recognized at birth. d) Congenital defects may be caused by genetic or environmental factors.
All congenital disorders can be diagnosed at birth All congenital disorders are not diagnosed at birth. Hydrocephalus is one such disorder that may be diagnosed at birth but also may not be diagnosed until after a few weeks or months. It is also true that congenital defects may be caused by both genetics and environmental factors.
A nursing instructor is teaching about newborn congenital disorders and realizes that the student needs further instruction after making which statement?
All congenital disorders can be diagnosed at birth.
Which clinical manifestation is seen in the child with hydrocephalus?
An extremely large and rapidly growing head
One of the clinical manifestations seen in the child with hydrocephalus is which of the following?
An extremely large and rapidly growing head An excessively large head at birth is suggestive of hydrocephalus. Rapid head growth with widening cranial sutures is also strongly suggestive and may be the first manifestation of this condition
What is the term for a small collection of blood that forms underneath the skull as a result of birth trauma?
Cephalhematoma
Which assessment findings are most prominent in the infant with Tetralogy of Fallot and significant pulmonary stenosis?
Dyspnea on limited exertion, fatigue, cyanosis
A nursing student has read that cleft lip is diagnosed at birth based on inspection of physical appearance and that cleft palate is diagnosed in which way?
Feeling the palate with a gloved finger or using a tongue blade
After assessing the status of a newborn, the nurse is concerned that this newborn has persistent pulmonary hypertension. When explaining it to the parents, the nurse would integrate knowledge about which event as having most likely occurred?
Foramen ovale has not closed.
The nurse is caring for a pregnant woman who is struggling with controlling her gestational diabetes mellitus. What effect does the nurse predict this situation may have on the fetus?
Grow to an unusually large size
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
You care for a child born with a tracheoesophageal fistula. Which finding during pregnancy would have caused you to suspect this might be present?
Hydramnios Rationale: Because a fetus swallows amniotic fluid, when there is an obstruction of the esophagus, amniotic fluid accumulates, leading to hydramnios.
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?
Hyperactive and irritable
The nurse is caring for a newborn of a substance abusing mother who is withdrawing from alcohol. Which of the following would the nurse likely see in this newborn?
Newborn is hyperactive and irritable The newborn that is withdrawing from alcohol typically is hyperactive, irritable, has trouble sleeping, and may have tremors or seizures. Characteristics of FAS include low birth weight, and small height and head circumference. This newborn is prone to respiratory difficulties, hypoglycemia, hypocalcemia, and hyperbilirubinemia.
The nurse who is caring for newborn Andrew notices that although he has seemed healthy at 18 hours of age, Andrew's abdomen is now distended. By 24 hours he has passed no stool. The nurse will
Inform the physician of the findings In some newborns, a shallow opening may occur in the anus with the rectum ending in a blind pouch some distance higher. Thus, being able to pass a thermometer into the rectum does not guarantee that the rectoanal canal is normal. More reliable presumptive evidence is obtained by watching carefully for the first meconium stool. Abdominal distention also occurs. If the newborn does not pass a stool within the first 24 hours, the physician should be notified. Definitive diagnosis is made by radiographic studies. In some newborns, a colostomy is performed and extensive abdominoperineal resection is delayed until 3-5 months of age or later.
A preterm newborn is noted to have hypotonia, apnea, bradycardia, a bulging fontanelle, cyanosis, and increased head circumference. These signs indicate the newborn has which complication?
Intraventricular hemorrhage (IVH)
An infant with hydrocephalus is scheduled to have a ventriculoperitoneal shunt inserted. Immediately following the procedure, which nursing action would best prevent decompression from excessive CSF flow?
Keeping the head of the infant level with the body Rationale: Keeping the infant's head fairly even with the rest of the body prevents gravity from moving more fluid into the shunt than necessary
The nurse is assessing the newborn male of a teen mother who was afraid to seek appropriate prenatal care. Which assessment finding should lead the nurse to question if this infant is preterm?
Lanugo on the back and shoulders
A newborn is diagnosed with congenital hypothyroidism prior to discharge from the hospital. What medication does the nurse anticipate administering to the newborn?
Levothyroxine rationale: The thyroid hormone must be replaced as soon as the diagnosis is made. Levothyroxine sodium, a synthetic thyroid hormone replacement, is the drug most commonly used.
The nurse cares for preterm infants and assesses them for potential complications to provide adequate countermeasures to prevent futher complications. Which complication should the nurse prioritize and initiate proper measures to protect the newborn?
Loss of body heat
The nurse is preparing to assess an infant who is diagnosed with a ventricular septal defect. Which assessment finding should the nurse be prepared to document?
Loud, harsh murmur
Which nursing measure is most effective in reducing newborn infections?
Maintain medical asepsis while providing care.
In the infant born with a cleft lip and a cleft palate, the highest priority of the nurse is related to which intervention?
Maintaining the nutritional needs if the infant
PKU will causes _______ ______if left untreated
Mental Retardation rationale: Phenylketonuria (PKU) is a recessive hereditary defect of metabolism that, if untreated, causes severe mental retardation. It is not related to congenital heart defects, increased intracranial pressure, or to a strangulated intestine.
A nursing student is caring for a newborn with a defect in the neural arch where the posterior laminae of the vertebrae have failed to close. The nurse knows that this infant is suffering from which of the following disorders?
Spina bifida rationale: Spina bifida is a failure of the posterior laminae of the vertebrae to close, leaving an opening through which the spinal meninges and spinal cord may protrude. Hydrocephalus is a condition characterized by excess cerebrospinal fluid (CSF) within the ventricular and subarachnoid spaces of the cranial cavity. Cleft palate is a result of failure of the primary and secondary palates to fuse. Esophageal atresia is the absence of a normal opening or abnormal closure of the esophagus.
The nurse manager at a family clinic is identifying ways to address the 2020 National Health Goals for the prevention of birth defects. Which action should the manager encourage all staff to perform when caring for pregnant patients?
Stress the importance of taking prenatal folic acid as prescribed.
The nurse is developing a plan of care for a neonate experiencing symptoms of drug withdrawal. What should be included in this plan?
Swaddle the infant between feedings.
The nurses at a local free clinic are concerned there may be an increase in small-for-gestational age infants in the community. When collecting data to research the situation, the nurses will exclude infants above which category?
The 10th percentile for gestational age
The nurse is caring for a newborn with retinopathy of prematurity (ROP). Which of the following is the best explanation of this disorder?
The infant has a degenerative disease of the retina Retinopathy of prematurity (ROP) is a form of retinopathy (degenerative disease of the retina) commonly associated with the preterm newborn. The immature liver in the preterm infant cannot manage all the bilirubin produced by hemolysis (destruction of red blood cells with the release of hemoglobin), making the infant prone to jaundice and high blood bilirubin levels. Intraventricular hemorrhage (IVH) is a complication of preterm birth in which there is bleeding into the brain's ventricles. In hyaline membrane disease, the premature infant's lungs are deficient in surfactant and thus collapse after each breath, greatly increasing the work of breathing.
The client brings her infant daughter to the pediatrician's office for her first visit since hospital discharge. At birth, the newborn was at the 8th percentile with a weight of 2,350 g. She was born at 36 weeks' gestation. Which documentation is most accurate?
The infant was a preterm, low birth weight and small for gestational age neonate.
The nurse is checking a newborn for the presence of Ortolani and Barlow signs. For which health problem are these assessments used?
The nurse is checking a newborn for the presence of Ortolani and Barlow signs. For which health problem are these assessments used?
A nurse is providing information for a pregnant woman who has just discovered that the fetus she's carrying is likely to have Down syndrome. Which statement by the nurse is most accurate regarding the possible concerns for a child with Down syndrome?
They have a higher risk of developing leukemia than those in the general population.
A meconium plug is an extremely hard portion of meconium that has completely blocked the intestinal lumen, causing bowel obstruction.
True
In working with the child or family of a child with a congenital disorder, the most effective nursing intervention for this child or family would be for the nurse to
Use reflective listening and offer nonjudgmental support rationale:Families are naturally apprehensive and find it difficult not to overprotect a child who is ill. They often increase the child's anxiety and cause fear in the child about participating in normal activities. Children are rather sensible about finding their own limitations and usually limit their activities to their capacity if they are not made unduly apprehensive. Some families can adjust well and provide guidance and security for the sick child. Others may become confused and frightened and show hostility, disinterest, or neglect; these families need guidance and counseling. The nurse has a great responsibility to support the family. The nurse's primary goal is to reduce anxiety in the child and family. This goal may be accomplished through open communication and ongoing contact.
Following birth, the newborn's independent circulatory system is established. If there is an abnormal opening between the chambers in the heart, which cardiac defect may occur?
Ventricular septal defect
Following birth the newborn's independent circulatory system is established. If there is an abnormal opening between the chambers in the heart, which of the following cardiac defects may occur?
Ventricular septal defect Explanation: A ventricular septal defect is the most common intracardiac defect. It consists of an abnormal opening in the septum between the two ventricles.
A nurse is caring for a neonate of 25 weeks' gestation who is at risk for intraventricular hemorrhage (IVH). Which assessment finding should be reported immediately?
a sudden drop in hemoglobin
When examining a newborn for developmental hip dysplasia, which motion would the newborn's hip be unable to accomplish?
abduction
When examining a newborn for developmental hip dysplasia, which of the following motions would the newborn's hip be unable to accomplish?
abduction rationale: Infants with shallow acetabulums are unable to abduct their hips.
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
A pregnant woman gives birth to a small for gestational age neonate who is admitted to the neonatal intensive care unit with seizure activity. The neonate appears to have abnormally small eyes and a thin upper lip. The infant is noted to be microcephalic. Based on these findings, which substance would the nurse suspect the women of using during pregnancy?
alcohol
Assessment reveals that a young mother has several risk factors for giving birth to an infant with a neural tube defect. Which laboratory test would the nurse expect to be used to monitor the fetus for this birth defect?
alpha-fetoprotein levels
A newborn with high serum bilirubin is receiving phototherapy. Which nursing intervention is the most appropriate for this client?
application of eye dressings to the infant
A preterm newborn is noted to be cyanotic. Which laboratory test will the nurse prepare the infant for to determine if the cyanosis is due to respiratory or circulatory problems?
arterial blood gases
The nurse suspects a preterm newborn receiving enteral feedings of having necrotizing enterocolitis (NEC). What assessment finding best correlates with this diagnosis?
bloody stools
A preterm newborn is being monitored for potential necrotizing enterocolitis. The nurse recognizes which factors as major pathologic mechanisms that could lead to this complication? Select all that apply.
bowel ischemia perinatal stressors formula feeding
The nurse is teaching the parents of a newborn who was born with a high type of imperforate anus the care the newborn will need at home after surgery. The parents need to be aware that the newborn will require which measure temporarily?
colostomy
The nurse is caring for an infant born to a mother who abused cocaine during her pregnancy. The nurse would likely notice that this infant:
cries when touched.
A nurse in the newborn nursery has noticed that an infant is frothing and appears to have excessive drooling. Further assessment reveals that the baby has episodes of respiratory distress with choking and cyanosis. What disorder should the nurse suspect based on these findings?
esophageal atresia
A nurse in the newborn nursery has noticed that an infant is frothing and appears to have excessive drooling. Further assessment reveals that the baby has episodes of respiratory distress with choking and cyanosis. What disorder should the nurse suspect based on these findings?
esophageal atresia Rationale: Any swallowed mucus or fluid enters the blind pouch of the esophagus when a newborn suffers from esophageal atresia. The newborn with this disorder will have frothing, excessive drooling, and periods of respiratory distress with choking and cyanosis. If this happens no feedings should be given until the newborn has been examined.
A nurse is assessing a newborn for jaundice. The nurse would first notice jaundice at which area?
face
The newborn nursery nurse suspects a newborn of having neonatal abstinence syndrome. What assessment findings would most correlate with the diagnosis?
frequent yawning and sneezing
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?
hydrocephalus
Over the course of an eight hour shift of postoperative care for a child who has had ventriculoatrial shunt placement, the nurse notes that the child's cry has become increasingly shrill and the child has projectile vomiting. The nurse would notify the physician immediately because of the possibility that the child might be experiencing
increased intracranial pressure Symptoms of increased intracranial pressure (IICP) may include irritability, restlessness, personality change, high-pitched cry, ataxia, projectile vomiting, failure to thrive, seizures, severe headache, changes in level of consciousness, and papilledema. At least every 2-4 hours, the nurse should monitor the newborn's level of consciousness, check the pupils for equality and reaction, monitor the neurologic status, and observe for a shrill cry, lethargy, or irritability.
When evaluating a newborn with congenital clubfoot, the nurse recognizes this condition usually involves:
internal rotation of leg.
A pre-term newborn is noted to have hypotonia, apnea, bradycardia, a bulging fontanelle, cyanosis, and increased head circumference. These signs indicate the newborn most likely has which of the following complications?
intraventricular hemorrhage (IVH) Signs that may accompany IVH include hypotonia, apnea, bradycardia, a full (or bulging) fontanelle, cyanosis, and increased head circumference.
It would be best to place an infant with a myelomeningocele in which position prior to surgery?
on the stomach (prone) Placing the infant prone prevents direct trauma to the lesion and reduces the chance that feces will contaminate the lesion.
A woman who has a history of cocaine abuse gives birth to a newborn. Which findings would the nurse expect to assess in the newborn? Select all that apply.
piercing cry poor sucking inconsolable
A 30 weeks' gestation neonate born with low Apgar scores is in the neonatal intensive care unit with respiratory distress syndrome and underwent an exchange transfusion for anemia. Which factors place the neonate at risk for necrotizing enterocolitis? Select all that apply
preterm birth respiratory distress syndrome low Apgar scores exchange transfusion
A nurse is providing preoperative care to a female newborn client with the congenital abnormality myelomeningocele. Which intervention is the priority?
preventing infection
