Preterm neonate + some alternative NB

1 (When O2 is administered it should be humidified to prevent drying of the nasal passages and mucous membranes. Because the neonate is under a radiant warmer, a stocking cap is not necessar. Temp, continuously monitored by skin prope attached to the radiant warmer, is recorded every 30-60 mins initially. Although the O2 hood requires close monitoring and measurement of blood gases, checking the blood glucose level is not necessary)

A preterm neonate who has been stabilized is placed in a radiant warmer and is receiving O2 via an oxygen hood. Which action should the nurse take while administering oxygen in this manner? 1. humidify the air being delivered 2. cover the neonates scalp with a warm cap 3. record the neonates temp every 3-4 mins 4. assess the neonates blood glucose level

1,3,4,5,6

The nurse is caring for a NB boy of hispanic heritage. According to the beliefs of this heritage, which would the nurse expect? select all 1. the maternal elders offer advice to the new mother 2. the neonate will be circucumcised by a medicine man 3. The umbilical cord will be kept covered by snug clothing 4. breastfeeding is common and strongly encouraged 5. the neonate must be bundled at all times 6. the neonate will wear a red or pink bracelet

3,4,6 (perinatal asphyxia is an insult to the fetus or NB because of lack of oxygen. If the neonates toes do not curl downward when the soles of the feet are touched and the neonate does not respond to a loud sound, neuro damage from asphyxia may have occurred. A normal neuro response would be the downward curling of the toes when touched and extension of the arma and legs in response to a loud noise. Weak ineffective sucking is another sign of neuro damage. A neonate would grasp a persons finger when it is placed in the palm of the neonates hand, do stepping movements when held upright and turn towards the nurses finger when touching the cheek.

A nurse performing a neurologic assessment on a 1 day old neonate in the nursery. Which findings would indicate possible asphyxia in utero? select all 1. the neonate grasps the nurses finger when put in the palm of the neonate's hand 2. The neonate does stepping movements when held upright with the sole of the foot touching a surface 3. The neonates toes do not curl downward when the sides of the feet are touched 4. The neonate does not respond when the nurse claps hands 5. The neonate turns toward the nurses finger when touching the cheek 6. The neonoate displays weak, ineffective sucking

2,4,5

The charge nurse in the NB nursery has an UAP with her for the shift. Under their care are 8 babies rooming in with their mothers. and one infant in the nursery for the night on tube feedings. There is a new client whose infant will be brought to the nursery in 15 mins. Which tasks would the nurse assign to the UAP? select all 1. newborn admission 2. VS on all stable infants 3. tube feeding 4. document feedings of infants 5. record voids/stools 6. bath and initial feeding for new admission

3,4,5 (a nurse from peidatrics would have a less complicated assignment then a nurse who regulary staffs that unit. )

The pediatric nurse is being pulled to the nursery for the day. The census is 6 neonates. Which 3 neonates are the best client care assignment for the pediatric nurse?select all 1. an 18 hr postterm jaundiced breastfed neonate 2. A 2 day old who has not passed meconium stool 3. A recent admission with Apgar score of 8 and 10 4. A 1 day old with caput succedaneum 5. A 4 hr old with a bluish appearance to the hands and feet 6. A 1 day old with a cleft palate and cleft lip

1 (because the retina may become detached with ROP, lasar therapy has been used successfully in some medical centers to treat ROP. Anti inflammatory eye drops may be used to treat seasonal allergy. ROP is not assoc with glaucoma, it eye vessels affected not corneas)

Which subject should the nurse include when teaching the mother of a neonate diagnosed with retinopathy of prematurity (ROP) about possible treatment complications? 1. laser therapy 2. anti-inflammatory eye drops 3. frequent testing for glaucoma 4. corneal transplants

1 (chest compressions should be alternated with ventilation ensure breathing and circ. Two fingers or two thumbs encircling hands, not the palm of the hand, are used to compress a neonates sternum. The chest is compressed 100-120 times/min. The proper technique recommended by the Neonatal Resuscitation Program is to use enough pressure to depress the sternum to a depth of approx 1/3 of the anterior-posterior diameter of the chest)

Which action should the nurse take when performing external chest compressions on a neonate born at 28 weeks gestation? 1. maintain a compression to ventilation ration of 3:1 2. compress the sternum with the palm of the hand 3. compress the chest 70-80 times per min 4. displace the chest wall half the depth of the anterior posterior diameter of the chest

3 (common finding is bulging fontanelle. Most common site of hemorrhage is the periventricular subependymal germinal matrix where there is arich blood supply and where capillary walls are thin an fragile. Rapid volume expansion, hypercarbia, and hypoglycemia contribute to the development of IVH. Other common manifestations include neuro signs such as hypotonia, lethargy, temp instability, nystagmus, apnea, bradycardia, decreased hct, and increasing hypoxia. Seizures may also occur. Hyperbilirubinemia may be seen if bleeding was severe)

Which finding would the nurse most expect to find in a neonate born at 28 weeks gestation who is diagnosed with IVH, intraventricular hemorrhage? 1. increased muscle tone 2. hyperbilirubinemia 3. bulging fontanelles 4. hyperactivity

3

While the nurse is caring for a neonate at 32 weeks gestation in an isolette with continuous oxygen administration, the neontaes mother asks why the neonates o2 is humidified. The nurse should tell the mother: 1. The humidity promotes expansion of the neonates immature lungs 2. The humidity helps to prevent viral or bacterial pneumonia 3. oxygen is drying to the mucous membranes unless it is humidified 4. circulation to the babys heart is imporved with humidified o2

1 (The preterm neonate is at greatest risk for developing RDS (hyaline membrane) as the lungs are immature and unable to produce surfactant to reduce surface tension in the lungs and promote the stability of the alveoli.

The nurse is making clinical rounds on a group of clients in a newborn nursery. Which infant is at greatest risk of developing respiratory distress syndrome? 1. A neonate born at 36 weeks 2. A neonate born by cesarean 3. A neonate experiencing apneic episodes 4. A neonate born at 42 weeks

3 (decreased protein is a sign of overhydration which can lead to patent ductus arteriosus or CHF. Bulging fontanelles, decreased serum sodium, decreased urine specific gravity, and decreased hematocrit are other signs of overhydration. Hypernatremia etc would indicate dehydration. Polycythemia evidenced by an elevated hct would suggest hypoxia or congenital heart disorder)

What findings would lead the nurse to suspect that a neonate born at 34 weeks gestation receiving IV fluids has developed overhydration? 1. hypernatremia 2. polycythemia 3. hypoproteinemia 4. increased urine specific gravity

1 (ROP is associated with multiple risk factors including high arterial blood o2 levels, prematurity, and very low birth weigh (less than 1500 g). In the early acute stages of ROP the neonates immature retinal vessels constrict. If vasoconstriction is sustained, vascular closure follows, and irreversible capillary endothelial damage occurs. Normal room air is 21%. Acidosis not alkalosis is commonly seen in preterm neonates, but is not related to development of ROP. Phototherapy is not related to the development of ROP, however, during phototherapy the neonates eyes should be contantly covered to prevent damage from lights)

What is the best reason for assessing a neonate weighing 1500 g at 32 weeks gestation for retinopathy of prematurity (ROP)? 1. The neonate is at risk because of multiple factors 2. O2 is being administered at a level of 21% 3. The neonate was alkalotic immed after birth 4. Phototherapy is likely to be prescribed by the HCP

2 (BPD is a chronic illness that may require prolonged hospitalization and permanent assisted ventilation. The disease typically occurs in compromised very low birth weight neonates who require o2 therapy and assisted ventilation for treatment of respiratory distress syndrome. The cause is multifactorial, and the disease has four stages. The neonates activities may be limited by the disease. Antibiotics may be prescribed and bronchodilators may be used but these meds will not cure the chronic disease state. Seizure activity is assoc with periventricular-intraventricular hemorrhage, not BPD

Which statement by the mother of a neonate diagnosed with bronchopulmonary dysplasia (BPD) indicates effective teaching? 1. BPD is an acute disease that can be treated with antibiotics 2. My baby may require long-term respiratory support 3. Bronchodilators can cure my babys condition 4. My baby may have seizures later on in life because of this condition

2,3,4,5

The nurse in a postpartum couplet room is making rounds prior to ending the shift. Which finding indicate that the safety needs of the clients have been met? select all that apply 1. infant lying on abdomen 2. security tags in place 3. identification system on mother and infant 4. bulb syringe in sight 5. someone in the room to care for the infant 6. infant in mothers arms both asleep

2 (RDS is a developmental condition that primarily affects preterm infants before 35 weeks gestation because of inadequate lung development from deficient surfactant production. Placenta previa has little correlation with development of RDS. The neonates sluggish respiratory activity postpartum in not likely the cause of but may be a sign the infant has the condition)

A viable male neonate born to a 28 year old multiparous client by cesarean section because of placenta previa is diagnosed with RDS (hyaline membrane disease) AKA respiratory distress syndrome. Which factor would the nurse explain as the factor placing theneonate at the greatest risk for this syndrome? 1. mothers development of placenta previa 2. neonates born preterm 3. mother receiving analgesia 4 hrs before birth 4. neonate with sluggish respiratory efforts after birth

1 (neonates who weigh less than 1500 g and born at less than 34 weeks are susceptible to IVH. Cranial ultrasound scanning can confirm the diagnosis. The spinal fluid will show an increased number of RBC's.)

3 days after admission of a neonate born at 30 weeks gestation, the neonatologist plans to assess the neonate for intraventricular hemorrhage (IVH). The nurse should plan to assist the neonatologist by preparing the neonate for which test? 1. cranial ultrasonography 2. arterial blood specimen collection 3. radiographs of the skull 4. CBC specimen collection

3 (The nurse should round first and assess the neonate with the resp rate of 62. The RR is out of the normal range and needs reevaluation. The nurse hsould next assess the NB with the low temp to determine if the temp is increasing. The large newborn still has 15 mins until the next feed and much can be done before then. And the 36 week should be fed right on time)

The nurse received report on a group of newborns. The nurse should make rounds on which client first? 1. A newborn large for gestational age who needs a repeat blood glucose prior to the next feed in 15 mins 2. A neonate born at 36 weeks gestation weighing 5 lbs who is due to breast feed for the first time in 15 mins 3. A neonate who born 24 hrs ago by cesarean and had a respiratory rate of 62, 30 mins ago 4. A newborn who had a borderline low temp and was double wrapped with a hat half an hour ago to bring up the temp

3 (neonate at high risk for sepsis.Temp instability at 38 weeks gestation is an early sign of sepsis. Other signs include; tachycardia, hypotension, poor feeding, vomiting and diarrhea. Late signs include: jaundice, seizures, enlarged liver and spleen, respiratory failure and shock. Alkalosis is not typically seen in neonates who develop sepsis. Acidosis and respiratory distress may develop unless Tx such as antibiotics are started. )

2 hours ago, a neonate at 38 weeks gestation and weighing 7 lbs was born to a primiparous client who tested positive for betal-hemolytic Streptococcus. Which finding would alert the nurse to notify the HCP? 1. alkalosis 2. increased muscle tone 3. temp instability 4. positive Babinskis reflex

1,2,4,5

Following admission assessment of a NB at 42 weeks gestation, the nurse documents which findings as normal? 1. 3 vessel cord 2. peeling of skin on the feet 3. absence of sole creases 4. absence of vernix caseosa 5. cyanosis of hands and feet 6. large amounts of frothy secretions

4 (data supports pneumothorax, a accumulation of air in the thoracic cavity between the parietal and visceral pleurae and requires immed removal of the accumulated air. Resolution is initiated with insertion of a chest tube connected to continuous negative pressure. The goal is to reinflate the collapsed lung.)

A preterm infant born 2 hrs ago at 34 weeks gestation is experiencing rapid respirations, grunting, no breath sounds on one side, and a shift in location of heart sounds. The nurse should prepare to assist in which procedure? 1. placement of the neonate on a ventilator 2. administration of bronchodilators thru the nares 3. suctioning of the neonates nares with wall suction 4. insertion of a chest tube into the neonate

4 (The neonate is place on the back with the neck slightly extended in the sniffing or neutral position. This position optimizes lung expansion and places the upper respiratory tract in the best position for receiving O2. Placing a small rolled towel under the neonates shoulders help to extend the neck properly without overextending it. Once stabilized and transferred to an isolette in the NICU the neonate can be positioned in the prone position, which allows for lung expansion in the oxygenated environment. )

After a vaginal birth a preterm neonate is to recieve O2, the nurse would place the neonate in which postion? 1. left side, with the neck slightly flexed 2. back, with the head turned to the left side 3. abdomen, with the head down 4. back, with the neck slightly extended

1 (With an absent apical pulse left of the midclavicular line accompanied by cyanosis, grunting and diminished breath sounds, the neonate is most likely experiencing pneumothorax. Pneumothorax occurs when alveoli are overdistended and subsequently the lung collapses, compressing the heart and lung and compromising the venous return to the right side of the heart. This condition can be confirmed by x ray. IF the xray did not reveal respiratory causes then an ECG. Repositioning may open the airway, but until pneumothorax is resolved the other s/s will continue)

Assessment of a 2 day neonate born at 34 weeks gestation reveals absent apical pulse left of the midclavicular line, cyanosis, grunting, and diminished breath sounds. After beginning oxygen the priority intervention is to : 1. obtain a prescription for a stat chest x ray 2. reposition the neonate and then assess if the grunting and cyanosis resolve 3. obtain a prescription for an echocardiogram 4. obtain a CBC to determine infection

2 (RDS, previously called hyaline membrane disease, is a developmental condition involving a decrease in lung surfactant leading to improper expansion of the lung alveoli. Surfactant contains a group of surface active phospholipids ,of which one component, lecithin, is the most critical for alveolar stability. Surfactant production peaks about 35 weeks gestation. This syndrome primarily attacks preterm neonates, although it can also affect term and postterm neonates. Altered somatotropin secretion is assoc with growth disorders such as gigantism or dwarfism. Altered testosterone secretion is associated with masculinization. Altered progesterone is associated with spontaneous abortion during pregnancy)

24 hrs after cesarean birth, a neonate at 30 weeks gestation is diagnosed with respiratory distress syndrome; AKA hyaline membrane disease. When explaining to the parents about the cause of this syndrome, the nurse should include a discussion about an alteration in the bodys secretion of which substance? 1. somatotropin 2. surfactant 3. testosterone 4. progesterone

1,2,3,4 (neonatal narcotic withdrawal syndrome includes symptoms of irritability a high pitched cry, tremors, poor feeding with vomiting and diarrhea, and nasal stuffiness. Nursing interventions include to swaddle and/or offer pacifier to soothe the neonate, decrease handling and environmental stimuli, and maintain IV fluids with regular feedings. The nurse would also administer morphine to ease the withdrawal symptoms and potential seizure activity)

A nurse is caring for a neonate born addicted to opiates in the special care nursery. The neonate is exhibiting signs of withdrawal. when planning care which nursing interventions would the nurse expect to be included? select all 1. maintain IV fluids 2 administer morphine 3. swaddle and/or provide pacifier 4. feed every 1-2 hrs 5. increase environmental stimuli 6. encourage parental handling

2,3 (NB with DDH will have a positive ortolani test and positive barlow test, asymmetrical skin folds in the thigh. The affected leg has limited abduction and appears shorter than the unaffected leg)

A nurse is completing a physical assessment of a neonate following birth. When completing the musculoskeletal assessment which findings would indicate developmental dysplasia of the hip? 1. negative ortolani test 2. positive barlow test 3. asymmetrical leg skin folds 4. limitation in adduction of the affected leg 5. lengthening of the affected leg

1,4,6 (The diaper would be below the cord to allow it to air dry. Sponge bathe until cord falls off. Soap and water would be used as cord care, evidence based practice states that alcohol is no longer indicated for cord care. Never pull on the cord let it fall off naturally. Antibiotic creams are contraindicated unless there are s/s of infection)

A nurse is evaluating the return demonstration of cord care by the mother of a neonate. Which action would the nurse encourage the mother to perform? select all 1. placint the diaper below the cord 2. tugging gently on the cord as it begins to dry 3. applying antibiotic cream to the cord twice daily 4. sponge bathing the infant until the cord falls off 5. cleaning the length of the cord with alcohol several times daily 6. washing the cord with mild soap or water

4 (recommend mother pump her breasts, store the milk and bring to the unit so the neonate can be fed with it, even if neonate fed with gavage. Secretory immunoglobulin A found in breast milk is an important immunoglobulin that can provide immunity to the mucosal surfaces of the GI tract. It can protect the neonate from enteric infections, such as those caused by escherichia coli and shigella species. Some studies also show that breastfed preterm neonates maintain transutaneous o2 pressurs and body temp better than bottle fed neonates. There is some evidence that breast milk can decrease the incidence of necrotizing enterocolitis. The preterm neonate does not need additional fat in the diet, however some neonates may need an increased calorie intake. In such cases breast milk can be forified with an additive to provide additional calories. During feeding supplemental O2 can be delivered by nasal canula.)

A preterm neonate admitted to the neonatla intensive care unit at about 30 weeks gestation is placed in an oxygenated isolette. The neonates mother tells the nurse that she was planning to breast feed the neonate. Which instructions about breast feeding would be most appropriate? 1. Breast-feeding is not recommended because the neonate needs increased fat in the diet 2. Once the neonate no longer needs oxygen and continuous monitoring, breast-feeding can be done 3. Breast-feeding is contraindicated because the neonate needs a high calorie formula every 2 hrs 4. Gavage feeding using breast milk can be given until the neonate can coordinate sucking and swallowing

2 (The blood glucose of 25 is the most critical. Glucose is the only fuel that the brain can use. It is important to protet the CNS, and levels less than 30 in the first 6 hrs of life of a neonate indicate hypoglycemia. Occasional grunting at 1/2 hr of age may be normal transitioning to extrauterine life. A temp of 97.4 us only slightly low for a neonate this age, 95% of all neonates will void at least once in the first 24 hrs. So this is not unusual at this age)

After receiving a change of shift report in the normal NB nursery, which neonate should the nurse see first? 1. neonate A, 1/2 hr of age with occasional respiratory grunting 2. neonate B, 4 hrs of age with a blood glucose of 25 3. neonate C, 12 hrs of age with a temp of 97.4 4. neonate D, 24 hrs of agge with no urine output for past 12 hrs

2,4,5 (Nonnutritive sucking has been seen in infants as early as 28 weeks, and ultrasounds have shown thumb sucking in utero even eariler. Nonnutritive sucking provides oral stimulation and allows the baby to maintain the sucking reflex needed for breast or bottle feedings later. It does not teach the infant how to suck or swallow. Sucking is thought to help with gastric emptying by stimulating secretions of GI peptides)

An infant born at 34 weeks premature is receiving gavage feedings. the client holding her infant asks why the nurse places a pacifier in the infants mouth during these feedings. The nurse replaies that the pacifier helps in what ways? select all that apply 1. teaches the infant to coordinate the swallow 2. provides oral stimulation 3. keeps oral mucous membranes moist while the tube is in place 4. reminds the infant how to suck 5. stimulates secretions that help gastric emptying

4 1 3 2 (Based on report by preceding nurse the nurse should plan to prioritize all clients and first make rounds on the client needing the highest level of care. The nurse can then make rounds on all other clients. The nurse can then check for new prescriptions and finally inspect the room in which the next client will be admitted to be sure all equipment available)

The NB nurse has just received shift report about a group of NB's and is to receive antother admission in 30 mins. In order to provided the safest care and plan for the new admission, the nurse should do which tasks in order of first to last? All options must be used 1. move quickly from room to room and assess all clients 2. check the room to which the new client will be admitted to be sure all supplies and equipment are available 3. log on to the clinical info system and determine if there are new prescriptions 4. review notes from shift report and prioritize all clients, make rounds on the most critical first

2 (The mother demonstrates signs of full bladder and vaginal bleeding and requires assist with bladder emptying and uterine massage to assess the origination of the bleeding. The NB requires further assessment because turning dusky when quiet and RR of 70 indicate the beginning signs of respiratory distress and requires prompt intervention. All other mothers are recovering normally. While bilateral crackles in a NB could indicate excessive fluid, a pink color indicates good oxygenation. Normal RR is 30-60. While a RR of 67 is slightly elevated, the baby has no other s/s of respiratory distress. The NB with acrocyanosis (bluish hands and feet) is a normal NB finding and shows the ability to maintain oxygenation. RR of 70 and intermittent expiratory grunt would indicate close observation but does not require immed intervention if the infant is pink. the last NB is maintaining oxygenation with RR slightly above normal. Periodic breathing, featuring pauses in breathing of less than 15 sec is a normal NB finding)

The nurse is assigned to care for 4 mothers and their term NB's. Which mother and newborn couplet requires the nurses attention first? 1. Mother fundus firm 2 cm below the umbilicus, minimal lochia rubra. Infant; color pink on room air, respirations 67, bilateral crackles on auscultation. 2. Mother: fundus firm 3 cm above umbilicus and to the right, moderate rubra lochia. Infant: color pink when active, currently dusky while quiet, RR 70 3. Mother: fundus firm 1 cm above umbilicus, small amount lochia rubra. Infant: pink with acrocyanosis, RR 68 min and intermittent expiratory grunting 4. Mother: fundus firm at umbilicus, small amount lochia rubra. Infant: pale pink, quiet alert, RR 65, periodic breathing noted

3 (A temp of 96.6, and jitteriness are signs of hypoglycemia. The nurse must first obtain a heel stick blood sample for blood glucose. Breast feeding preferably skin to skin should be initiated immed following the heel stick to Tx the suspected hypoglycemia. The HCP can be notified once the value is known and the infant is successfully breastfeeding. Normal NB temps range from 97.7 to 99.1. A temp of 96.6 is low and a sign of hypoglycemia, however breastfeeding takes precedence over the radiant heater. Also skin to skin contact has been found to be the most effective way to maintain a NB temp)

The nurse is caring for a 2 hr old full term breastfeeding infant. The nurse notes the following assessments; apical pulse 122 bpm, axilla temp 96.6, jitteriness. Based on this assessment the nurse should first: 1. assist the NB to breastfeed 2. notify the HCP 3. obtain a blood glucose sample 4. place the NB under a radiant heater

1,3,4,5 (Kangaroo care is skin to skin holding of a neonate by one of the parents. Research has shown increased bonding, physiological stability, decreased length of stay, and improved breast feeding for neonates who experience this method of holding. Research has not shown an increased IQ as a developmental outcome. The experience is usually limited to 1-2 hrs, two or three times a day.)

The nurse is discussing kangaroo care with the parents of a premature neonate. The nurse should tell the parents that the advantages of kangaroo care include which benefits? select all 1. enhanced bonding 2. increased IQ 3. improved physiologic stability 4. decreased length of stay in the neonatal ICU 5. improved breast feeding

4 (Indications of NEC include abdominal distention with gastric retention and vomiting. Other signs may include lethargy, irritability, positive blood culture in stool, absent or diminished bowel sounds, apnea, diarrhea, metabolic acidosis, and unstable temp. A gastric residual of 1 mL is not significant. Jaundice is assoc with the neonates immature liver and increased bilirubin, not NEC. )

While caring for a neonate born at 32 weeks gestatino, which finding would most suggest the infant is developing necrotizing enterocolitis (NEC)? 1. The presence of 1 mL of gastric residual before a gavage feeding 2. jaundice appearing on the face and chest 3. an increase in bowel peristalsis 4. abdominal distension