Lippincott Newborn at risk

What would the nurse expect to find during the physical examination of a preterm male neonate born at 28 weeks' gestation? descended testicles thin, wasted appearance numerous scrotal rugae abundance of scalp hair

thin, wasted appearance

What should the nurse expect to find in a premature female neonate born at 30 weeks' gestation who is small for gestational age? elbows brought to chest midline with resistance past the midline prominent creases on the soles and heels fine, downy hair over the upper arms and back firm cartilage to the edge of the ear pinna

fine, downy hair over the upper arms and back

The nurse explains to the mother of a neonate diagnosed with erythroblastosis fetalis that the exchange transfusion is necessary to prevent damage primarily to which organ in the neonate? brain lungs kidneys liver

brain

A newborn diagnosed with phenylketonuria (PKU) is placed on a low-phenylalanine formula. The mother asks the nurse how long her infant will need to have dietary restriction. Which response would be most appropriate? "He can switch to a regular diet when his phenylalanine levels remain normal for 6 months." "Once your child has stopped growing he can come off the phenylalanine restricted diet." "Most likely he will need to follow a low phenylalanine diet for the rest of his life." "Your baby needs to stay on low phenylalanine formula until he is taking solid foods well."

"Most likely he will need to follow a low phenylalanine diet for the rest of his life."

While the nurse is caring for a neonate at 32 weeks' gestation in an isolette with continuous oxygen administration, the neonate's mother asks why the neonate's oxygen is humidified. What should the nurse should tell the mother? "Circulation to the baby's heart is improved with humidified oxygen." "Oxygen is drying to the mucous membranes unless it is humidified." "The humidity promotes expansion of the neonate's immature lungs." "The humidity helps to prevent viral or bacterial pneumonia."

"Oxygen is drying to the mucous membranes unless it is humidified."

A nurse places a neonate with hyperbilirubinemia under a phototherapy lamp, covering the eyes and gonads for protection. The parents asked the nurse to tell them how their baby will benefit from having phototherapy done. Which statement by the nurse is the most appropriate response about phototherapy? "Phototherapy prevents hypothermia." "Phototherapy decreases the serum unconjugated bilirubin level." "Phototherapy increases the baby's iron level." "Phototherapy promotes respiratory stability."

"Phototherapy decreases the serum unconjugated bilirubin level."

A newborn weighing 6.5 lb (2,950 g) is to be given naloxone due to respiratory depression as a result of a narcotic given to the mother shortly before birth. The drug is to be given 0.01 mg/kg into the umbilical vein. The vial is marked 0.4 mg/mL. How many milligrams would the newborn receive? Record your answer using two decimal places.

0.03

After receiving a change-of-shift report in the normal newborn nursery, the nurse should see which neonate first? 3-hour-old neonate , 30 minutes of age with increased respiratory grunting 12-hour-old neonate with a temperature of 97.4°F (36.4°C) 6-hour-old neonate with a blood glucose of 25 mg/dL (1.38 mmol/L) 24-hour-old neonate with no urine output for the past 12 hours

6-hour-old neonate with a blood glucose of 25 mg/dL (1.38 mmol/L)

Which measure would be most effective in helping the infant with a cleft lip and palate to retain oral feedings? Feed the infant small amounts at one time. Burp the infant at frequent intervals. Maintain the infant in a supine position while feeding. Place the end of the nipple far to the back of the infant's tongue

Burp the infant at frequent intervals.

The nurse plans the discharge of a newborn diagnosed with torticollis (wry neck). Which action should the nurse take? Teach the parent the side effects of botulinum toxin. Demonstrate the use of positioning wedges for sleep. Coordinate outpatient physical therapy. Verify the date for corrective surgery.

Coordinate outpatient physical therapy.

When developing the plan of care for an infant diagnosed with myelomeningocele and the parents who have just been informed of the infant's diagnosis, the nurse should include which action as the priority when the parents visit the infant for the first time? Emphasize the infant's normal and positive features. Reinforce the health care provider's (HCP's) explanation of the defect. Encourage the parents to discuss their fears and concerns. Have the parents feed their infant.

Emphasize the infant's normal and positive features.

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

Gavage feedings using breast milk can be given until the neonate can coordinate sucking and swallowing.

Immediately after the first oral feeding after corrective surgery for pyloric stenosis, a 4-week-old infant is fussy and restless. What action would be most appropriate at this time? Encourage the parents to hold the infant. Hang a mobile over the infant's crib. Give the infant a pacifier to suck on. Give the infant more to eat.

Give the infant a pacifier to suck on.

A neonate was admitted to the pediatric unit with an unexpected congenital defect. What is the best way to involve the parents in the neonate's care? Assume the parents have already been told how to care for their neonate. Offer the parents opportunities to be involved with the neonate's care while they adjust to his unexpected condition. Tell the parents that they'll be shown one time how to do everything for the neonate before they take him home. Don't show the parents how to care for the neonate at this time.

Offer the parents opportunities to be involved with the neonate's care while they adjust to his unexpected condition.

A newborn who is 20 hours old has a respiratory rate of 66 breaths/min, is grunting when exhaling, and has occasional nasal flaring. The newborn's temperature is 98° F (36.6° C); he is breathing room air and is pink with acrocyanosis. The mother had membranes that were ruptured 26 hours before birth. What nursing actions are most indicated? Arrange a transfer to the neonatal intensive care unit with diagnosis of possible sepsis. Draw a complete blood count (CBC) with differential and feed the infant. Continue recording vital signs, voiding, stooling, and eating patterns every 4 hours. Place a pulse oximeter, and contact the health care provider (HCP) for a prescription to draw blood cultures.

Place a pulse oximeter, and contact the health care provider (HCP) for a prescription to draw blood cultures.

The charge nurse observes that a nurse caring for a very sick infant is making inappropriate remarks and acting bizarrely. What is the first action the charge nurse should take? Report this nurse to the supervisor. Remove this nurse from the client assignment. Call security. Talk with the nurse to determine why this behavior is occurring.

Remove this nurse from the client assignment.

While caring for a neonate of a woman with diabetes soon after birth, the nurse has fed the newborn formula to prevent hypoglycemia. The nurse checks the neonate's blood glucose level, and it is 60 mg/dL (3.3 mmol/L), but the neonate continues to exhibit jitteriness and tremors. What should the nurse do first? Refeed the infant. Assess the neonate's temperature. Request a prescription for a blood calcium level. Administer intravenous glucose.

Request a prescription for a blood calcium level.

A term neonate's mother is O-negative, and cord studies indicate that the neonate is A-positive. Which finding indicates that the neonate developed hemolytic disease? Weight loss of less than 10% Increased activity Frequent feeding patterns Signs of kernicterus

Signs of kernicterus

A nurse is assessing a neonate born 1 day ago to a client who smoked one pack of cigarettes daily during pregnancy. Which finding is most common in neonates whose mothers smoked during pregnancy? Appropriate size for gestational age Small size for gestational age Large size for gestational age Postterm birth

Small size for gestational age

A male neonate born at 36 weeks' gestation is admitted to the neonatal intensive care nursery with a diagnosis of probable fetal alcohol syndrome (FAS). The mother visits the nursery soon after the neonate is admitted. Which instructions should the nurse expect to include when developing the teaching plan for the mother about FAS? Large-for-gestational-age size is common with this condition. Facial deformities associated with FAS can be corrected by plastic surgery. Withdrawal symptoms usually do not occur until 7 days postpartum. Symptoms of withdrawal include tremors, sleeplessness, and seizures.

Symptoms of withdrawal include tremors, sleeplessness, and seizures.

Which assessment finding would lead a nurse to suspect dehydration in a preterm neonate? Bulging fontanels Urine output below 1 ml/hour Excessive weight gain Urine specific gravity below 1.012

Urine output below 1 ml/hour

newborn admitted with pyloric stenosis is lethargic and has poor skin turgor. The health care provider (HCP) has prescribed IV fluids of dextrose water with sodium and potassium. The baby's admission potassium level is 3.4 mEq/L (3.4 mmol/L). What should the nurse do first? Verify that the infant has urinated. Administer the prescribed fluids. Have the potassium level redrawn. Notify the HCP.

Verify that the infant has urinated.

The nurse determines that a newborn is experiencing hypoglycemia based on which findings? Select all that apply. irregular respirations, tremors, and hypothermia internal fetal monitor tracing a blood glucose reading of less than 30 mg/dL (1.7 mmol/L) or less at 1 hour family history of insulin-dependent diabetes large for gestational age

a blood glucose reading of less than 30 mg/dL (1.7 mmol/L) or less at 1 hour irregular respirations, tremors, and hypothermia

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 (RDS)? a neonate experiencing apneic episodes a neonate born by cesarean section a neonate born at 36 weeks' gestation a neonate who is 42 weeks' gestation

a neonate born at 36 weeks' gestation

A nurse caring for a preterm neonate knows that positioning can benefit high-risk neonates. Which position is appropriate for a preterm neonate? abduction and flexion of the arms with flattened shoulders neck extension and back arching with flattened shoulders hyperabduction and extension of the arms with external rotation of the hips adduction and flexion of the extremities with gently rounded shoulders

adduction and flexion of the extremities with gently rounded shoulders

The mother of a newborn is concerned about the number of persons with heart disease in her family. She asks the nurse when she should start her baby on a low-fat, low-cholesterol diet to lower the risk of heart disease. At what age does the nurse should tell the client to start modifying her child's diet? age 2 years age 5 years age 10 years birth

age 2 years

A preterm neonate is having frequent blood draws for laboratory specimens. What is most important for the nurse to document about the blood draws? color of each blood specimen amount of blood drawn for each specimen vital signs before each blood draw time of last feeding before each specimen

amount of blood drawn for each specimen

For an infant who's about to undergo a lumbar puncture, the nurse should place the infant in: a prone position, with the head over the edge of the bed. a mummy restraint. an arched, side-lying position, avoiding flexion of the neck onto the chest. an arched, side-lying position, with the neck flexed onto the chest.

an arched, side-lying position, avoiding flexion of the neck onto the chest.

The nurse should assess a newborn with esophageal atresia and tracheoesophageal fistula (TEF) for which complications? Select all that apply. copious frothy mucus episodes of cyanosis several loose stools distended abdomen poor gag reflex

copious frothy mucus episodes of cyanosis distended abdomen

The nurse provides a neonate with an initial feeding. The nurse would suspect a tracheoesophageal fistula if the neonate demonstrated which behavior? sucking attempts that are too poorly coordinated to be effective sleeping that occurs after taking 10 mL of formula coughing, choking, and cyanosis that occur after several swallows of formula projectile vomiting that occurs after drinking 4 oz (120 mL)

coughing, choking, and cyanosis that occur after several swallows of formula

A mother with a history of gestational hypertension gives birth to a neonate at 26 weeks' gestation. After the neonate receives surfactant through an endotracheal tube in the delivery room, a nurse takes the neonate to the neonatal intensive care unit (NICU), places the neonate on an overbed warmer, and provides mechanical ventilation. When the mother arrives in the NICU for the first time, the nurse's priority should be to explain the NICU visiting policy for the mother and family. question the mother about her preterm labor. obtain a family medical history. enhance bonding by pointing out the neonate's features.

enhance bonding by pointing out the neonate's features.

When performing an assessment on a one-day old newborn, which finding would be most suggestive of an imperforate anus? abdominal distention failure to pass a meconium stool hydrocele ribbon-like stools

failure to pass a meconium stool

A primigravid client has completed her first prenatal visit and blood work. Her laboratory test for the hepatitis B surface antigen (HBsAg) is positive. The nurse can advise the client that the plan of care for this newborn will include which interventions? Select all that apply. standard/routine precautions for mother and infant contraindication for breastfeeding hepatitis B screening when born isolation of infant during hospitalization series of three hepatitis B vaccinations per recommended schedule hepatitis B immune globulin at birth

hepatitis B immune globulin at birth series of three hepatitis B vaccinations per recommended schedule standard/routine precautions for mother and infant

While assessing a neonate weighing 3,175 g (7 lb) who was born at 39 weeks' gestation to a primiparous client who admits to opiate use during pregnancy, which finding would alert the nurse to possible opiate withdrawal? sluggishness bradycardia hypocalcemia high-pitched cry

high-pitched cry

What conditions would the nurse expect to find in in a preterm neonate suffering from cold stress? hyperactivity and twitching slowed respirations increased abdominal girth yellowish undercast to the skin color

hyperactivity and twitching

A septic preterm neonate's IV was removed due to infiltration. The nurse prioritizes restarting the IV to help which complication? fever hypoglycemia hyperkalemia tachycardia

hypoglycemia

Which finding provides the most evidence that a fetus might have a gastrointestinal tract anomaly? low implantation of the placenta preeclampsia in the last trimester increased amount of amniotic fluid meconium in the amniotic fluid

increased amount of amniotic fluid

The nurse is caring for a newborn of a primiparous woman with insulin-dependent diabetes. When the mother visits the neonate at 1 hour after birth, the nurse explains to the mother that the neonate is being closely monitored for symptoms of hypoglycemia because of which reason? a normal response that occurs during transition from intrauterine to extrauterine life increased use of glucose stores during a difficult labor and birth process increased pancreatic enzyme production caused by decreased glucose stores interrupted supply of maternal glucose and continued high neonatal insulin production

interrupted supply of maternal glucose and continued high neonatal insulin productio

While assessing a 4-day-old neonate born at 28 weeks' gestation, the nurse cannot elicit the neonate's Moro reflex, which was present 1 hour after birth. The nurse notifies the health care provider (HCP) because this may indicate which complication? intracranial hemorrhage facial nerve paralysis skull fracture postnatal asphyxia

intracranial hemorrhage

A viable neonate born to a 28-year-old multiparous client by cesarean birth because of placenta previa is diagnosed with respiratory distress syndrome (RDS). Which factor would the nurse explain as the factor placing the neonate at the greatest risk for this syndrome? mother's development of placenta previa mother receiving analgesia 4 hours before birth neonate born preterm neonate with sluggish respiratory efforts after birth

neonate born preterm

Sick and preterm neonates who experience continuity of nursing care directly benefit from higher levels of professional satisfaction among nurses. decreased hospital liability for professional malpractice. nursing recognition of subtle changes in high-risk neonates' conditions. higher levels of parent satisfaction with nursing care.

nursing recognition of subtle changes in high-risk neonates' conditions.

While caring for several preterm infants in the special care nursery, which action is most important for preventing nosocomial infections in these neonates? performing thorough handwashing before giving infant care donning cover gowns for nurses and visitors to the unit wearing a mask, and changing it frequently when giving care using sterile supplies for all treatments

performing thorough handwashing before giving infant care

A neonate born at 28 weeks' gestation has been receiving 80% to 100% oxygen via mechanical ventilation for the past 2 weeks. The neonate also has received multiple blood transfusions to treat anemia and has experienced several episodes of apnea. The nurse caring for the neonate should anticipate which iatrogenic complication? transient tachypnea retinopathy of prematurity hyperbilirubinemia neonatal asphyxia

retinopathy of prematurity

The nurse carefully documents the premature neonate's response to oxygen therapy, delivering only as much oxygen as is necessary to prevent the development of which complication? ophthalmia neonatorum retinopathy of prematurity glaucoma cataracts

retinopathy of prematurity

Twenty-four hours after cesarean birth, a neonate at 30 weeks' gestation is diagnosed with respiratory distress syndrome (RDS). When explaining to the parents about the cause of this syndrome, the nurse should include a discussion about an alteration in the body's secretion of which substance? somatotropin testosterone surfactant progesterone

surfactant

A client has admitted use of cocaine prior to beginning labor. After the infant is born, the nurse should anticipate the need to include which action in the infant's plan of care? notifying hospital security contacting local law enforcement limiting contact with visitors urine toxicology screening

urine toxicology screening

What should the nurse assess in a newborn diagnosed with an anorectal malformation? Select all that apply. loose stools vomiting meconium in the urine abdominal distension meconium stools

vomiting meconium in the urine abdominal distension