Chapter 14: The Newborn with a Perinatal Injury or Congenital Malformation

A 3-month-old infant is diagnosed with developmental hip dysplasia. The nurse knows that what is the usual treatment for an infant with this diagnosis? a. A Pavlik harness b. A body spica cast c. Traction d. Triple-diapering

ANS: A In infants who are more than 2 months of age, longer-term immobilization with a Pavlik harness is required.

What assessment made by the nurse would lead the nurse to suspect hip dysplasia? a. Asymmetrical gluteal folds b. Limited adduction of the affected side c. Foot turned inward d. Deep inguinal creases

ANS: A The gluteal folds are asymmetrical because the head of the femur has slipped out of the acetabulum. There is also limited abduction of the affected side, and when the legs are flexed the affected leg seems to be shorter.

Which statement indicates that parents understand how to feed their infant who had a surgical repair for a cleft lip? a. "We are feeding the baby with a dropper for 2 weeks." b. "We resumed bottle feeding after discharge." c. "We started the baby on solid food yesterday." d. "The baby is drinking well from a straw."

ANS: A The infant is fed with a dropper until the incision is completely healed about 1 to 2 weeks after surgery.

The nurse is caring for a macrosomic newborn whose mother has diabetes. What should the nurse assess for with this neonate? a. Hypoglycemia b. Erythroblastosis fetalis c. Intracranial hemorrhage d. Pancreatic failure

ANS: A The newborn of a mother with diabetes is prone to hypoglycemia.

An 18-month-old child had a surgical repair of a cleft palate and is now allowed to eat a regular diet. What nursing action is the most appropriate? a. Feed solid foods with the spoon at the side of the mouth. b. Puree foods and offer them through a straw. c. Place small bites of food in the mouth with a tongue blade. d. Offer small, frequent meals of finger foods.

ANS: A The primary concern with feeding is to protect the operative site. The child can be fed with a spoon, but only the side of the spoon is placed into the mouth at the side of the mouth. The spoon must not touch the roof of the mouth.

What manifestations of increasing ICP in the hydrocephalic child should the nurse be aware of? (Select all that apply.) a. High-pitched cry b. Unequal pupils c. Bulging fontanelles d. Diarrhea e. Hiccups

ANS: A, B, C Increased ICP is manifested by high-pitched cry, inequality of pupils, and bulging fontanelles.

The nurse in the newborn nursery is watchful for neonatal abstinence syndrome in the newborn of a mother who took opioids during pregnancy. What would be the manifestations of this syndrome? (Select all that apply.) a. Body tremors b. Excessive sneezing c. Hyperirritability d. Drowsiness e. Excessive appetite

ANS: A, B, C The neonate with abstinence syndrome will have tremors, be hyperirritable and wakeful, have excessive sneezing or yawning, and have no appetite.

What would be included in the plan of care for a child just returned to the floor from surgery in which a clubfoot was repaired? (Select all that apply.) a. Keep cast uncovered to allow drying. b. Check toes for capillary refill. c. Circle with a pen any area of bleeding on the cast. d. Keep casted leg lowered. e. Observe for skin irritation.

ANS: A, B, C, E The casted leg should be kept elevated. All the other options are necessary nursing interventions for a child who is freshly casted.

What characteristics are typical in a child diagnosed with Down syndrome? (Select all that apply.) a. Close-set eyes b. Simian creases c. Wide-spaced front teeth d. Protruding tongue e. Curved, small fingers

ANS: A, B, D, E Children with Down syndrome have close-set upturned eyes, simian creases in palms of hands, protruding tongue, and curved, small fingers. They also have a wide space between their first and second toe and a high incidence of heart defects.

What will the nurse include in the plan of care when caring for an infant with an intracranial hemorrhage? (Select all that apply.) a. Keep positioned with head elevated. b. Feed slowly to reduce possibility of vomiting. c. Stimulate often to maintain level of consciousness. d. Hold and coddle frequently to stimulate. e. Observe for increased intracranial pressure.

ANS: A, B, E These children should be kept positioned with the head elevated, fed slowly, and monitored for increased intracranial pressure. Children with intracranial hemorrhages are not stimulated and are kept in a quiet environment.

The nurse is obtaining intake information on a new patient being seen for preconception care and notes a family history of neural tube defects. What interventions can the nurse suggest to this woman to help prevent neural tube anomalies in a developing fetus? (Select all that apply.) a. Avoid drug use. b. Follow a low-calorie, low-protein diet. c. Take a folic acid supplement every day. d. Exercise daily. e. Maintain bed rest during the first trimester.

ANS: A, C The use of drugs during early pregnancy and poor nutrition may contribute to the development of a neural tube defect. The American Academy of Pediatrics (AAP) recommends that all women of childbearing age take a daily multivitamin that contains 0.4 mg of folic acid and continue the intake of folic acid until the 12th week of pregnancy, when basic neural tube development is completed. Studies have shown that the intake of folic acid before conception dramatically decreases the occurrence of neural tube defects such as spina bifida. Daily exercise and bed rest do not decrease the risk of neural tube anomalies.

Parents of a newborn with a unilateral cleft lip are concerned about having the defect repaired. The nurse explains that a child with a cleft lip usually undergoes surgical repair at which time? a. Immediately after birth b. By 3 months of age c. After 12 months of age d. Varies in every case

ANS: B A cleft lip is repaired by 3 months of age when weight gain is established and the infant is free of infection.

After delivery, a mother asks the nurse about newborn screening tests. The nurse explains that what is the optimal time for testing for phenylketonuria? a. In the first 24 hours of life b. After 2 to 3 days c. At 4 to 6 weeks of age d. At 2 months of age

ANS: B Blood tests for phenylketonuria should be obtained 48 to 72 hours after birth. The newborn will have had enough time to ingest protein through feedings, and the chance of false-negative results will be reduced.

The nurse is providing education to parents of a child with cleft palate. What will the nurse instruct the parents to report immediately? a. Facial paralysis b. Ear infections c. Increased intracranial pressure (ICP) d. Drooling

ANS: B Children with cleft palate are at risk of ear infections and dental disorders. Parents should be instructed to take the child to the health care provider at the first sign of earache.

The parents of a child diagnosed with cystic fibrosis ask the nurse what caused this disorder. What is the most appropriate response? a. "Cystic fibrosis is a chromosomal defect." b. "Cystic fibrosis is a metabolic defect." c. "Cystic fibrosis is a malformation present at birth." d. "Cystic fibrosis is a blood disorder."

ANS: B Inborn errors of metabolism include a number of inherited diseases that affect body chemistry. There may be an absence or a deficiency of a substance necessary for cell metabolism. The deficient substance is usually an enzyme. Almost any organ of the body may be damaged. Examples of inborn errors of metabolism include cystic fibrosis and phenylketonuria (PKU). In disorders of the blood, there is a reduced or missing blood component or an inability of a component to function adequately. Sickle cell disease, thalassemia, and hemophilia fall into this category. Chromosomal abnormalities number in the thousands. Most involve some type of mental retardation, and others are incompatible with life. The newborn with Turner's syndrome or Klinefelter's syndrome may have impaired physical growth and sexual development. Malformations at birth include several types of structural defects.

Parents of a 2-month-old infant with Down syndrome are attending a well visit at the pediatric clinic. What should they be instructed to provide special attention to in regard to the generalized hypotonicity of the child? a. Preventing hyperthermia b. Respiratory care c. Prevention of diarrhea d. Incontinence care

ANS: B The child with Down syndrome has generalized hypotonicity, which caused mucus accumulation and respiratory problems.

The nurse is caring for an infant with hydrocephalus. What nursing action is most important for this nurse to implement? a. Align the limbs. b. Support the head. c. Keep the head lower than the hip. d. Check intake and output.

ANS: B The child with hydrocephalus has a heavy head on a small body with poor muscle tone; the head must be supported when feeding and moving the child to prevent injury to the neck.

The nurse is caring for an Rh-negative mother on the labor and birth unit. What scenario indicates this patient will require RhoGAM administration? a. She has had one Rh-negative child and is pregnant with an Rh-negative child. b. She has had an Rh-positive infant and is pregnant with an Rh-positive fetus. c. She has had an O-negative child and is pregnant with a B-negative child. d. She is a primipara with an O-negative child.

ANS: B The only woman with antibodies against the Rh-positive infant is the Rh-negative woman who has had one Rh-positive child and is now pregnant with another.

When bathing an infant, what sign does the nurse recognize as a sign of developmental hip dysplasia? a. Hypotonicity of the leg muscles b. One leg is shorter than the other c. Broadening and flattening of the buttocks d. Two skinfolds on the back of each thigh

ANS: B When developmental hip dysplasia is present, the leg on the affected side will appear shorter than the leg on the unaffected side.

The home health nurse is educating parents on home phototherapy. What will the nurse include when providing information to these parents? a. Cover the infant's eyes when under the light. b. Use a three-prong plug. c. Keep a diaper in place. d. Place the light source on an absorbent surface. e. Expose as much skin as possible.

ANS: B, C, E Parents should be instructed to use a three-prong plug for safety, keep a diaper in place, and expose as much skin as possible. The light source should be placed on a nonabsorbent surface, not on carpet or in a crib. It is not necessary to cover the infant's eyes when under the light.

The nurse is caring for a macrosomic newborn of a woman diagnosed with gestational diabetes immediately after birth. What assessment findings can the nurse anticipate? (Select all that apply.) a. High blood glucose levels b. Weight of 9 pounds or more c. Decreased subcutaneous fat d. Hypocalcemia e. Hyperbilirubinemia

ANS: B, D, E Many newborn infants of diabetic mothers have serious complications. When the mother is hyperglycemic, large amounts of glucose are transferred to the fetus. After delivery the infant often has low blood glucose levels because of the abrupt loss of maternal glucose and hypertrophy of the pancreatic islet cells, which results in a temporary overproduction of insulin. Hyperinsulinism, along with excess production of protein and fatty acids, often results in a newborn infant who weighs more than 4082 g (9 lb). These infants suffer from hypoglycemia, hypocalcemia, and hyperbilirubinemia.

What nursing action will the nurse implement after feeding an infant with hydrocephalus? a. Position the infant sitting upright in an infant seat. b. Place the infant over the shoulder to burp. c. Leave the infant in a side-lying position. d. Stimulate the infant by rubbing its feet.

ANS: C Because children with hydrocephalus are prone to vomiting, the child is fed and then positioned in the side-lying position in a quiet atmosphere to reduce the incidence of vomiting

The nurse is providing care to a child with Down syndrome. What body system has the highest risk of congenital anomaly in a child with Down syndrome? a. Reproductive system b. Genitourinary system c. Cardiovascular system d. Gastrointestinal system

ANS: C Down syndrome children are prone to deformities of the cardiovascular system.

Postoperative nursing care of the infant following surgical repair of a cleft lip would include: a. Feeding the infant with a spoon to avoid sucking. b. Positioning the infant on the abdomen to facilitate drainage. c. Applying elbow restraints to protect the surgical area. d. Providing minimal stimulation to prevent injury to the incision.

ANS: C Elbow restraints are used postoperatively to prevent the infant from damaging the operative area.

A newborn was just admitted to the neonatal intensive care unit with a meningomyelocele. What is the priority preoperative nursing care of this newborn? a. Keep the sac dry. b. Diaper snugly. c. Position prone in an incubator. d. Move from side to side every hour.

ANS: C The infant is placed prone in a humidified incubator, and the sac is covered with dressings of sterile saline. The infant's hips are kept lower than the lesion, and the infant is usually not in diapers.

Phototherapy is instituted for an infant. What is the most appropriate nursing action for the infant having phototherapy? a. Cover the infant's head with a hat. b. Dress the infant lightly in a T-shirt. c. Keep the infant's eyes covered. d. Reposition the infant at least every 4 to 8 hours.

ANS: C The infant's eyes are protected with patches to prevent damage from the high-intensity lights

The nurse is advising parents about feeding their infant with phenylketonuria. What formula and/or diet should the nurse suggest? a. Lifelong high-protein diet b. A formula that is low in the amino acid leucine c. A soy-based formula d. Substitute Lofenalac for some protein foods

ANS: D A synthetic food providing enough protein for growth and tissue repair, but little phenylalanine, is substituted for natural protein foods.

The nurse is caring for a child who has had a ventriculoperitoneal shunt (VP) for hydrocephalus and observes an increasing abdominal girth. What is the most appropriate response? a. Elevate the child's head. b. Check bowel sounds. c. Record retention of feeding. d. Notify the charge nurse of possible malabsorption.

ANS: D An increasing abdominal girth in a child with a VP shunt may be indicative of malabsorption of the cerebrospinal fluid (CSF) that is being shunted to the peritoneum.

What occurrence results from obstruction within the ventricles of the brain or inadequate reabsorption of cerebrospinal fluid? a. Meningitis b. Meningocele c. Spina bifida occulta d. Hydrocephalus

ANS: D Hydrocephalus is characterized by an increase in cerebrospinal fluid in the ventricles of the brain.

The nurse observes that the infant's anterior fontanelle is bulging after placement of a ventriculoperitoneal shunt. How should the nurse position this infant? a. Prone, with the head of the bed elevated b. Supine, with the head flat c. Side-lying on the operative side d. In a semi-Fowler's position

ANS: D If the fontanelles are bulging, the child will be positioned in a semi-Fowler's position to promote drainage from the ventricles through the shunt.

Parents ask the nursery staff what the light does for their jaundiced infant. What is the nurse's best response? a. "The light increases the infant's metabolism." b. "The light stimulates liver function." c. "The light dilates blood vessels." d. "The light breaks down bilirubin."

ANS: D Severe jaundice can cause kernicterus, an accumulation of bilirubin in the brain tissue, which can lead to serious brain damage. The light breaks down excess bilirubin so that it can be excreted.

What would the nurse include when instructing parents about positioning their toddler who has just had a body spica cast applied? a. Prop the child upright with pillows for meals. b. Use the bar between the legs to turn the child. c. Put the child on her abdomen to sleep. d. Change the child's position frequently.

ANS: D The child's position must be changed frequently to relieve pressure and promote circulation