chapter 23 ob

A nurse is assisting with the resuscitation of a preterm newborn. Which assessment would help assist the team in determining that the resuscitation efforts have been successful? Pulse rate of 110 beats per minute Pink conjunctiva Respiratory rate of 10 breaths per minute Weak cry effort

Pulse rate of 110 beats per minute Resuscitation measures are continued until the newborn has a pulse above 100 bpm, a good healthy cry or good breathing efforts, and a pink tongue. This last sign indicates a good oxygen supply to the brain. Conjunctival assessment would be of no benefit. Respiratory rate of 10 breaths per minute alone does not indicate the respiratory effort.

After completing an assessment of a newborn, the nurse determines that the newborn is small-for-gestational-age based on which weight assessment? weight of 2,800 g weight of 2,600 g weight of 3,000 g weight of 2,400 g

weight of 2,400 g Rationale:Small-for-gestational-age newborns typically weigh less than 2,500 g (5 lb 8 oz) at term due to less growth in utero than expected. Newborns who weigh from 2,500 g to 4,000 g are considered appropriate for gestational age. Infants over 4,000 g are described as large-for-gestational-age newborns.

A nurse is preparing to administer epinephrine intravenously to a preterm newborn. The newborn weighs 1,500 g, and the primary care provider prescribes 0.1 mL/kg. How much would the nurse administer? 0.15 mL 0.1 mL 0.25 mL 0.20 mL

0.15 mL

The nurse is concerned that a newborn is hypoglycemic. Which blood glucose level would support the nurse's intervention? 60 mg/dl (3.33 mmol/l) 30 mg/dl (1.67 mmol/l) 50 mg/dl (2.77 mmol/l) 40 mg/dl (2.25 mmol/l)

30 mg/dl (1.67 mmol/l) Hypoglycemia in a neonate is defined as blood glucose value typically below 35 to 45 mg/dl (1.94 to 2.50 mmol/l). The American Academy of Pediatrics recommends intervening for a blood glucose less than 40 mg/dl (2.25 mmol/l) in the first 4 hours of life, and less than 45 mg/dl (mmol/l) at ages 4 hours to 24 hours.

The nursery nurse is providing shift handoff on a newborn documented as small for gestational age. Which clinical manifestations would the nurse expect to communicate about this newborn? Select all that apply. Increased subcutaneous fat stores Narrow skull sutures Dry or thin umbilical cord Sunken abdomen Poor muscle tone over buttocks

Dry or thin umbilical cord Sunken abdomen Poor muscle tone over buttocks A small-for-gestational-age newborn typically has a sunken abdomen, wide skull sutures, decreased subcutaneous fat stores, poor muscle tone over buttocks and cheeks, and a thin umbilical cord.

A nurse assists with immediate interventions when a newborn is unable to initiate and maintain adequate respiratory function based on the understanding that these interventions are important to prevent which event(s)? Select all that apply. Hyperglycemia Hypoxia Hypoxemia Acidosis Hypercarbia Hyperkalemia

Hypoxia Hypoxemia Acidosis Hypercarbia The inability to initiate and establish respirations leads to hypoxemia and ultimately hypoxia (decreased oxygen), acidosis (decreased pH), and hypercarbia (increased carbon dioxide). Hyperglycemia and hyperkalemia are not involved.

When preparing to resuscitate a preterm newborn, the nurse would perform which action first? Administer epinephrine. Prepare to insert an endotracheal tube (ETT). Hyperextend the newborn's neck. Place the newborn's head in a neutral position.

Place the newborn's head in a neutral position. When preparing to resuscitate a preterm newborn, the nurse should position the head in a neutral position to open the airway. Hyperextending the newborn's neck would most likely close off the airway and is inappropriate. Positive pressure ventilation would be used before endotracheal tube (ETT) insertion. ETT insertion is used if the newborn remains apneic or positive pressure ventilation is ineffective. Epinephrine is given after chest compressions are initiated

A nurse is conducting an assessment of a newborn born at 31 weeks' gestation. Which finding would the nurse correlate with the newborn's gestational age? Wide soft fontanels Limited vernix caseosa Wide-eyed alert expression Absent lanugo

Wide soft fontanels An infant born at 31 weeks' gestation is considered very preterm. Typical assessment findings would include: wide, soft fontanels, abundant vernix and lanugo, and fused eyelids. Absent or limited vernix and lanugo and a wide-eyed alert expression would be characteristic of a postterm newborn.

A woman who has given birth to a postterm newborn asks the nurse why her baby looks so thin with so little muscle. The nurse integrates understanding about which concept when responding to the mother? The newborn was exposed to an infection while in utero. A postterm newborn has begun to break down red blood cells more quickly. The newborn aspirated meconium, causing the wasted appearance. With postterm birth, the fetus uses stored nutrients to stay alive, and wasting occurs.

With postterm birth, the fetus uses stored nutrients to stay alive, and wasting occurs. After 42 weeks' gestation, the placenta loses its ability to provide adequate oxygen and nutrients to the fetus, causing the fetus to use stored nutrients to stay alive. This leads to wasting. Meconium aspiration can occur with postterm newborns, but this is not the reason for the baby's wasted appearance. Hyperbilirubinemia occurs with the increased breakdown of red blood cells, but this too would not account for the wasted appearance. Exposure to an intrauterine infection is unrelated to the wasted appearance.

A nurse is reviewing the maternal history and medical record of an SGA newborn. Which finding would the nurse identify as a placental factor contributing to the newborn's current state? abnormal cord insertion maternal malnutrition trisomy 18 TORCH infection

abnormal cord insertion Abnormal cord insertion is a placental factor associated with SGA newborns. Maternal malnutrition and TORCH infection are considered maternal factors. Trisomy 19 would be considered a fetal factor.

When documenting the newborn's weight on a growth chart, the nurse recognizes the newborn is large-for-gestational-size based on which percentile on growth charts? above 90th percentile above 80th percentile above 95th percentile above 85th percentile

above 90th percentile A newborn whose weight is above the 90th percentile on growth charts is defined as large-for-gestational-age.

During the newborn's assessment, which finding would lead the nurse to suspect that a large-for-gestational-age newborn has experienced birth trauma? temperature instability feeble sucking asymmetrical movement seizures

asymmetrical movement A birth injury is typically characterized by asymmetrical movement. Temperature instability, seizures, and feeble sucking suggest hypoglycemia.

A nurse is assessing a preterm newborn's status based on the understanding that the newborn is at greatest risk for which complication? atelectasis intracranial hemorrhage hypoglycemia infection

atelectasis The respiratory system is the last system to mature. Therefore, the preterm newborn is at great risk for respiratory complications, one of which is atelectasis.

The nurse recognizes that maternal factors can increase the chance of a large-for-gestational-age newborn. When reviewing maternal history, the nurse would interpret which factors as placing a newborn at risk for being LGA? Select all that apply. history of microsomic infant diabetes mellitus female fetus multiparity history of postdates gestation

diabetes mellitus multiparity history of postdates gestation Maternal factors that increase the chance of bearing an LGA newborn include maternal diabetes mellitus or glucose intolerance, multiparity, prior history of a macrosomic infant, postdate gestation, maternal obesity, male fetus, and genetics.

The nurse begins frequent oral feedings for a small-for-gestational-age newborn to prevent which occurrence? hypoglycemia meconium aspiration polycythemia asphyxia

hypoglycemia Intermittent oral feedings are initiated to prevent hypoglycemia as the newborn now must assume control of glucose homeostasis. Hydration and frequent monitoring of hematocrit are important to prevent polycythemia. Resuscitation and suctioning are used to manage meconium aspiration. Immediate resuscitation is used to manage asphyxia.

The nurse needs to conduct a procedure on a preterm newborn. Which measures would be most effective in reducing pain? Select all that apply. offering a pacifier prior to a procedure swaddling the newborn closely removing tape quickly from the skin increasing the volume on device alarms encouraging kangaroo care during procedures

offering a pacifier prior to a procedure swaddling the newborn closely encouraging kangaroo care during procedures Interventions to reduce pain in the preterm newborn include swaddling the newborn closely to establish physical boundaries; using gentle handling, rocking, caressing, and cuddling; encouraging kangaroo care during procedures; and offering a pacifier for nonnutritive sucking prior to a procedure. Tape should be used minimally and should be removed gently to prevent skin tearing. Environmental stimuli need to be reduced, such as by turning down the volumes on alarms. Warm rather than cool blankets facilitate relaxation.

A nurse is conducting a class for a group of expectant couples on fetal growth and development. The nurse determines that additional teaching is needed when the class identifies which factor as playing an important role in fetal growth and development? maternal factors genetic factors placental factors paternal factors

paternal factors Fetal growth is dependent on genetic, placental, and maternal factors.

The nurse is assessing a postterm newborn. Which finding would the nurse be least likely to assess? absent lanugo meconium-stained skin creases on entire soles of feet thick umbilical cord

thick umbilical cord Postterm newborns typically exhibit the following characteristics: dry, cracked, peeling, wrinkled skin; vernix caseosa and lanugo are absent; long, thin extremities; creases that cover the entire soles of the feet; wide-eyed, alert expression and abundant hair on scalp; thin umbilical cord; limited vernix and lanugo; meconium-stained skin and fingernails.

A postterm newborn develops perinatal asphyxia. The nurse understands that this condition is most likely the result of: loss of subcutaneous fat. aging placenta. increased production of red blood cells. hypoxia from cord compression.

aging placenta. Complications associated with a postterm newborn include perinatal asphyxia (caused by placental aging or oligohydramnios [decreased amniotic fluid]), hypoglycemia (caused by acute episodes of hypoxia related to cord compression, which exhausts carbohydrate reserves), hypothermia (caused by loss of subcutaneous fat), and polycythemia (caused by an increased production of red blood cells to compensate for a reduced oxygen environment).

A nurse is assessing a preterm newborn. The nurse determines that the newborn is comfortable and without pain based on which finding? fussiness lack of body posturing sudden high-pitched cry increased muscle tone

lack of body posturing The newborn may be in pain if the following are exhibited: sudden high-pitched cry; facial grimace with furrowing of brown and quivering chin; increased muscle tone; oxygen desaturation; body posturing, such as squirming, kicking, and arching; limb withdrawal and thrashing movements; increase in heart rate, blood pressure, pulse, and respirations; fussiness and irritability.

A nurse is providing care to a preterm neonate. Which interventions would be most effective in minimizing the newborn's pain? Select all that apply. removing tape gently from the skin encouraging kangaroo care during procedures covering the newborn loosely with a blanket using cool blankets to soothe the newborn increasing the volume on device alarms

removing tape gently from the skin encouraging kangaroo care during procedures Interventions to reduce pain in the preterm newborn include swaddling the newborn closely to establish physical boundaries, using gentle handling, rocking, caressing, and cuddling, encouraging kangaroo care during procedures, and offering a pacifier for nonnutritive sucking prior to a procedure. Tape should be used minimally and should be removed gently to prevent skin tearing. Environmental stimuli need to be reduced, such as by turning down the volumes on alarms. Warm rather than cool blankets facilitate relaxation.

Which finding would lead the nurse to suspect that a large-for-gestational-age newborn is developing hyperbilirubinemia? feeble sucking seizures temperature instability tea-colored urine

tea-colored urine Hyperbilirubinemia is associated with jaundice and tea-colored urine. Temperature instability, seizures, and feeble sucking suggest hypoglycemia.

A nurse is assessing the fluid status of a preterm newborn. Which parameter would be most appropriate for the nurse to assess? urinary output fluid intake skin turgor fontanels

fontanels Rationale:When assessing the fluid status of a preterm newborn, the nurse palpates the fontanels. Sunken fontanels suggest dehydration; bulging fontanels suggest overhydration.

A pregnant client is in labor. The nurse reviews a mother's prenatal history and finds that the client has diabetes mellitus. The nurse anticipates that the newborn is at risk for being: large-for-gestational-age. very-large-for-gestational-age. appropriate-for-gestational-age. small-for-gestational-age

large-for-gestational-age. Diabetes mellitus is commonly associated with LGA newborns. However, due to poor placental perfusion, the newborn may experience IUGR and be SGA

A newborn is designated as very low birth weight. When weighing this newborn, the nurse would expect to find which weight? less than 1,500 g approximately 2,500 g more than 4,000 g less than 1,000 g

less than 1,500 g A very-low-birth-weight newborn weighs less than 1,500 g. A large-for-gestational-age newborn typically weighs more than 4,000 g. A small-for-gestational-age newborn or a low-birth-weight newborn typically weighs about 2,500 g. An extremely-low-birth-weight newborn weighs less than 1,000 g.

Losing a newborn is perhaps one of the most difficult situations for a family. Which action by the nurse would be the most appropriate if a newborn dies? offering mementos to the family of the newborn keeping time parents spend with infant to short periods avoiding contact with the family strictly adhering to facility policies for handling the body

offering mementos to the family of the newborn Rationale:Essential nursing interventions at the time of grief can include openness to expressions of grief, including addressing any cultural aspects, helping couples mobilize support, offer mementos to the couple (lock of hair, name card, photo, ID bracelet). The nurse should also be willing to be available for the couple and assist them to find the resources they will need to grieve and move forward. Allowing them to spend as much time as they need with the infant will also help with the grieving process.

Parents often vent their frustration and anger over the loss of their newborn on the nurse. The most appropriate reaction for the nurse is: leave the couple alone as they grieve. ignore their grief and ask them to leave. refer them to the health care provider. validate their feelings and refocus their anger.

validate their feelings and refocus their anger. During a crisis, individuals are often more sensitive to other people's reactions. Parents may need to vent their frustrations and anger, and the nurse may become the target. Validate their feelings and attempt to reframe or refocus the anger toward the real issue of loss. Doing so helps to defuse the anger while allowing them to express their feelings.

A nurse is administering prescribed enteral feedings to assist in preparing the gut of a preterm newborn. Which type of solution would the nurse most likely administer for the feeding? Sterile water Normal saline Breast milk Formula

Breast milk Currently, minimal enteral feeding is used to prepare the preterm newborn's gut to overcome the many feeding difficulties associated with gastrointestinal immaturity. It involves the introduction of small amounts of breast milk or enteral feeding to induce surges in gut hormones that enhance maturation of the intestine. This minute amount of breast milk or formula given via gavage (tube) feeding prepares the gut to absorb future introduction of nutrients. It builds mucosal bulk, stimulates development of enzymes, enhances pancreatic function, stimulates maturation of gastrointestinal hormones, reduces gastrointestinal distention and malabsorption, and enhances transition to oral feedings. All of the expert committees recommend the use of human milk, which reduces the risk of necrotizing enterocolitis, a serious disease of preterm infants in the neonatal period. Saline or sterile water are not used.

A nurse is conducting an in-service presentation for a group of neonatal nurses. After teaching the group about the effects of prematurity on various body systems, the nurse determines that the class was successful when the group identifies which condition as an effect of prematurity? rapid glomerular filtration rate enlarged respiratory passages enhanced ability to digest proteins fragile cerebral blood vessels

fragile cerebral blood vessels Preterm newborns have fragile blood vessels in the brain, and fluctuations in blood pressure can predispose these vessels to rupture, causing intracranial hemorrhage. The preterm newborn typically has smaller respiratory passages, leading to an increased risk for obstruction. Preterm newborns have a limited ability to digest proteins. The preterm newborn's renal system is immature, which reduces his or her ability to concentrate urine and slow the glomerular filtration rate.

A woman gives birth to a newborn at 39 weeks' gestation. The nurse classifies this newborn as: late preterm. postterm. preterm. full term.

full term. A full term newborn is one born from the first day of the 38th week of gestation through 41 weeks. A postterm newborn is one born after completion of 42 weeks' gestation. A preterm newborn is one born before completion of 37 weeks' gestation. A late preterm newborn is one who is born between 34 and 36 6/7 weeks' gestation.

A nurse is providing care to a postterm newborn. The nurse suspects that the newborn may be developing polycythemia based on which findings? Select all that apply. strong sucking reflex seizures hypertonia ruddy appearance jaundice

seizures ruddy appearance jaundice Findings associated with polycythemia include a ruddy appearance (plethora), a weak sucking reflex, hypotonia, seizures, and jaundice.