OB: AQ Newborn complications
The nurse is preparing to discharge a 3-day-old infant who weighed 7 lb (3175 g) at birth. Which finding should be reported immediately to the healthcare provider? A) Weight of 6 lb 4 oz (2835 g) B) Hemoglobin of 16.2 g/dL (162 mmol/L) C) Three wet diapers over the last 12 hours D) Total serum bilirubin of 10 mg/dL (171 µmol/L)
A) Weight of 6 lb 4 oz (2835 g) A loss of 12 oz (340 g) since birth, or more than 10%, is higher than the acceptable figure of 5% to 6%. Hemoglobin of 16.2 g/dL (162 mmol/L), total serum bilirubin of 10 mg/dL (171 µmol/L), and three wet diapers over the last 12 hours are all normal and expected findings.
A neonate born at 39 weeks' gestation is small for gestational age. Which commonly occurring problem should the nurse anticipate when planning care for this infant? A) Anemia B) Hypoglycemia C) Protein deficiency D) Calcium deficiency
B) Hypoglycemia Hypoglycemia is common in newborns who are small for gestational age because of malnutrition in utero; the nurse can detect this with a blood glucose test and notify the primary healthcare provider. Polycythemia, not anemia, is more likely to occur. Although a protein deficiency may occur, it is not life threatening at this time. Although hypocalcemia may occur, it is not as common as hypoglycemia.
A small-for-gestational-age (SGA) newborn has just been admitted to the nursery. Nursing assessment reveals a high-pitched cry, jitteriness, and irregular respirations. With which condition are these signs associated? A) Hypervolemia B) Hypoglycemia C) Hypercalcemia D) Hypothyroidism
B) Hypoglycemia SGA infants may exhibit hypoglycemia, especially during the first 2 days of life, because of depleted glycogen stores and inhibited gluconeogenesis. These are not signs of hypervolemia. Hypervolemia is usually the result of excessive intravenous infusion. It is unlikely that a full-term SGA infant will need intravenous supplementation. Hypercalcemia is uncommon in newborns. These signs are unrelated to hypothyroidism; signs of hypothyroidism are difficult to identify in the newborn.
The nurse is caring for a client who has a newborn with a neurologic impairment. What is the most important nursing action at this time? A) Assisting the client with the grieving process B) Performing frequent neurologic assessments of the newborn C) Arranging for social services to discuss possible placement of the newborn D) Obtaining a prescription for an antidepressant to help the client cope with the depressing news
A) Assisting the client with the grieving process Grieving is expected and necessary whenever a newborn is born less than healthy. More information is needed to conclude that frequent neurologic assessments are warranted; the frequency of assessments depends on the severity and type of the neurologic problem. Arranging for social services to discuss possible placement of the newborn may be done later; however, it is not the priority at this time. Obtaining a prescription for an antidepressant to help the client cope with the depressing news could result in a delay in the client's ability to actively participate in dealing with feelings.
What should be included in a plan of care to limit the development of hyperbilirubinemia in the breastfed neonate? A) Encouraging more frequent breastfeeding during the first 2 days B) Instituting phototherapy for 30 minutes every 6 hours for 3 days C) Substituting formula feeding for breastfeeding on the second day D) Supplementing breastfeeding with glucose water during the first day
A) Encouraging more frequent breastfeeding during the first 2 days More frequent breastfeeding stimulates more frequent evacuation of meconium, thereby preventing resorption of bilirubin into the circulatory system. Phototherapy is the treatment for hyperbilirubinemia, and it is maintained continuously; it does not prevent the development of hyperbilirubinemia. It is not necessary to feed the infant formula. Early breastfeeding tends to keep the bilirubin level low by stimulating gastrointestinal activity. Increasing water intake does not limit the development of hyperbilirubinemia, because only small amounts of bilirubin are excreted by the kidneys.
A preterm newborn is admitted to the neonatal intensive care unit (NICU). Which concern is most commonly expressed by NICU parents? A) Fear of handling the infant B) Delayed ability to bond with the infant C) Prolonged hospital stay needed by the infant D) Inability to provide breast milk for the infant
A) Fear of handling the infant Because these infants are so tiny and frail, parents most commonly fear handling or touching them; they should be encouraged to do so by the NICU staff. The primary concern is the infant's fragility, not bonding; however, bonding should be encouraged. Although there may be concerns about a long hospital stay, they are not commonly expressed by mothers. The primary concern is the infant's fragility, not breast-feeding. Breasts may be pumped and breast milk given in gavage feedings.
The nurse assessing a newborn suspects Down syndrome. Which characteristics support this conclusion? Select all that apply. A) Hypotonia B) High-pitched cry C) Rocker-bottom feet D) Epicanthal eye folds E) Singe transverse palmar crease
A) Hypotonia D) Epicanthal eye folds E) Singe transverse palmar crease Hypotonia is typical of newborns with Down syndrome, Their muscle tone is flaccid; they have less control of the head than a healthy newborn does because of their weak muscles. The single crease across the palm of the hand is typical of newborns with Down syndrome. Epicanthal eye folds give the newborn with Down syndrome the typical slant-eyed appearance. A high-pitched cry is characteristic of newborns with brain damage, cerebral irritability (opioid withdrawal), and cerebral edema (hydrocephaly). Rocker-bottom feet are found in newborns with trisomy 18.
The nurse is testing newborns' heel blood for the level of glucose. Which newborn does the nurse anticipate will experience hypoglycemia? Select all that apply. A) Preterm infant B) Infant with Down syndrome C) Small-for-gestational-age infant D) Large-for-gestational-age infant E) Appropriate-for-gestational-age infant
A) Preterm infant B) Small-for-gestational-age infant C) Large-for-gestational-age infant Preterm infants have low glycogen stores. Small-for-gestational-age infants also have low glycogen stores. Large-for-gestational-age infants are prone to hyperinsulinemia; often they are born to mothers who have diabetes, meaning that they are exposed to a high circulating glucose level while in utero. After prolonged exposure to a high glucose level, hyperplasia of the pancreas occurs, resulting in hyperinsulinemia. Infants with Down syndrome are not at risk for hypoglycemia but are at risk for congenital cardiac defects. Appropriate-for-gestational-age infants are not at risk for hypoglycemia.
The nurse is assessing the newborn of a known opioid user for signs of withdrawal. What clinical manifestations does the nurse expect to identify? Select all that apply. A) Sneezing B) Hyperactivity C) High-pitched cry D) Exaggerated Moro reflex E) Reduced deep tendon reflexes
A) Sneezing B) Hyperactivity C) High-pitched cry D) Exaggerated Moro reflex Neurologic signs of withdrawal in the neonate of an opioid-addicted mother are manifested by sneezing, hyperactivity, jitteriness, and a shrill, high-pitched cry. The Moro reflex usually becomes exaggerated as the signs of withdrawal become apparent. The deep tendon reflexes are exaggerated during opioid withdrawal.
The nurse is caring for a newborn with a caput succedaneum. What is the priority nursing action? A) Supporting the parents B) Recording neurologic signs C) Applying a hard protective cap on the head D) Applying ice packs to the hematoma
A) Supporting the parents Parents need support and reassurance that their newborn is not permanently damaged. Caput succedaneum does not cause impaired neurologic function. No special protection of the head is required; routine safety measures are adequate.
A client has delivered her infant by cesarean birth. The nurse monitors the newborn's respiration closely, because infants born via the cesarean method are prone to atelectasis. Why does this occur? A) The ribcage is not compressed and released during birth. B) The sudden temperature change at birth causes aspiration. C) There is usually oxygen deprivation after a cesarean birth. D) There is no gravity during the birth to promote drainage from the lungs.
A) The ribcage is not compressed and released during birth. The release following compression of the chest during a vaginal birth is the mechanism for expansion of the newborn's lungs; because this does not occur during a cesarean birth, lung expansion may be incomplete, and atelectasis may result. Temperature change is not implicated in aspiration. The infant is monitored closely to prevent oxygen deprivation. The newborn's head may be held lower than the chest to allow gravity to promote drainage from the lungs after a cesarean birth.
A new mother's laboratory results indicate the presence of cocaine and alcohol. Which craniofacial characteristics indicate to the nurse that the newborn has fetal alcohol syndrome (FAS)? Select all that apply. A) Thin upper lip B) Wide-open eyes C) Small upturned nose D) Larger-than-average head E) Smooth vertical ridge in the upper lip
A) Thin upper lip C) Small upturned nose E) Smooth vertical ridge in the upper lip The abnormal facial characteristics associated with FAS include: a thin upper lip (vermilion), a small upturned nose, and a smooth vertical ridge (philtrum) in the upper lip, all of which are distinctive in these infants. Infants with FAS have small eyes with epicanthic folds, rather than wide-open eyes, as well as microcephaly (head circumference less than the tenth percentile), rather than a larger-than-average head.
Five minutes after birth, a newborn is pale; has irregular, slow respirations; has a heart rate of 120 beats/min; displays minimal flexion of the extremities; and has minimal reflex responses. What is this newborn's Apgar score? Record your answer using a whole number.
Apgar Score of 5 The Apgar score is 5. According to the Apgar scoring system, the newborn receives 2 points for heart rate, 0 for color, 1 for respiratory effort, 1 for muscle tone, and 1 for reflex irritability. An Apgar score of 3 is low. Scores of 5 and 6 are higher, but the newborn may still require stimulation and oxygen. A (activity) P (pulse) G (grimace) A (appearance) R (respiration)
Phototherapy is prescribed for a preterm neonate with hyperbilirubinemia. Which nursing intervention is appropriate to reduce the potentially harmful side effects of the phototherapy? A) Covering the trunk to prevent hypothermia B) Using shields on the eyes to protect them from the light C) Massaging vitamin E oil into the skin to minimize drying D) Turning after each feeding to reduce exposure of each surface area
B) Using shields on the eyes to protect them from the light The lights used for phototherapy can damage the infant's eyes, and eye shields are standard equipment. Maximal effectiveness is achieved when the infant's entire skin surface is exposed to the light. Vitamin E oil massage is contraindicated, because it can cause burns and result in an overdose of the vitamin. The infant should be turned every 2 hours regardless of feeding times so that all body surfaces are exposed to the light and no single body surface is overexposed.
Five minutes after birth, a newborn is given an Apgar score of 8. Twelve hours later the newborn becomes hyperactive and jittery, sneezes frequently, and has difficulty swallowing. What does the nurse suspect is the cause of these clinical findings? A) Cerebral palsy B) Neonatal syphilis C) Opioid drug withdrawal D) Fetal alcohol syndrome
C) Opioid drug withdrawal These adaptations indicate opioid drug withdrawal; the infant should be monitored for further withdrawal signs during the first 24 hours after birth. Signs of cerebral palsy usually manifest later in infancy. A low-grade fever and copious serosanguineous discharge from the nose are signs of syphilis. Growth deficiencies in length, weight, and head circumference are associated with fetal alcohol syndrome, as are certain facial abnormalities.
A newborn is admitted to the nursery. The newborn weighs 10 lb, 2 oz (4592 g), which is 2 lb (907 g) more than the birthweight of any of the neonate's siblings. Which intervention should the nurse implement in relation to this baby's birth weight? A) Document the findings B) Delay starting oral feedings C) Perform serial glucose readings D) Place the newborn in a heated crib
C) Perform serial glucose readings A large newborn may be the result of gestational diabetes; it is necessary to check the neonate for hypoglycemia, because maternal glucose is no longer available. The nurse should do more than document the findings; the primary healthcare provider should be notified after the serial glucose readings are taken. Placing the infant in a heated crib is indicated if the temperature is low and the newborn needs additional warmth. The infant may be hypoglycemic and require the glucose in an oral feeding immediately.
The most appropriate method for a nurse to evaluate the effects of the maternal blood glucose level in the infant of a diabetic mother is by performing a heel stick blood test on the newborn. What specifically does this test determine? A) Blood acidity B) Glucose tolerance C) Serum glucose level D) Glycosylated hemoglobin level
C) Serum glucose level Obtaining a blood glucose level is a simple, cost-effective method of testing newborns for suspected hypoglycemia. Although the acidity of the blood will indicate whether the newborn has metabolic acidosis as a result of hypoglycemia, it is more important to determine whether the newborn has hypoglycemia so it can be corrected before acidosis develops. The glucose tolerance test and glycosylated hemoglobin level test are not used in newborns.
A mother asks the neonatal nurse why her infant must be monitored so closely for hypoglycemia when her type 1 diabetes was in excellent control during the entire pregnancy. How should the nurse best respond? A) "A newborn's glucose level drops after birth, so we're being especially cautious with your baby because of your diabetes." B) "A newborn's pancreas produces an increased amount of insulin during the first day of birth, so we're checking to see whether hypoglycemia has occurred." C) "Babies of mothers with diabetes do not have large stores of glucose at birth, so it's difficult for them to maintain the blood glucose level within an acceptable range." D) "Babies of mothers with diabetes have a higher-than-average insulin level because of the excess glucose received from the mothers during pregnancy, so the glucose level may drop."
D) "Babies of mothers with diabetes have a higher-than-average insulin level because of the excess glucose received from the mothers during pregnancy, so the glucose level may drop." The infant of a diabetic mother (IDM) produces a higher level of insulin in response to the increased maternal glucose level; after birth it takes several hours for the newborn to adjust to the loss of the maternal glucose. A healthy newborn's glucose level does not drop significantly after birth. A newborn's pancreas usually produces more insulin as a response to the maternal glucose level, but this response is not specific to the IDM. IDMs have the same glucose stores as other newborns; their responses to the loss of maternal glucose levels differ.
Which finding in a newborn whose temperature over the last 4 hours has fluctuated between 98.0° F (36.7° C) and 97.4° F (36.3° C) would be considered critical? A) Respiratory rate of 60 breaths/min B)White blood count greater than 15,000 mm3 C) Serum calcium level of 8 mg/dL (2 mmol/L) D) Blood glucose level of 36 mg/dL (3.8 mmol/L)
D) Blood glucose level of 36 mg/dL (3.8 mmol/L) Instability of the newborn's temperature is an indication of hypoglycemia. A glucose level below 40 mg/dL (1.7 mmol/L) does not provide enough energy to maintain the body temperature at a normal level. A serum calcium level of 8 mg/dL (2 mmol/L), respiratory rate of 60 breaths/min, and a white blood cell count greater than 15,000 mm3 are all normal findings and do not affect body temperature.
The nurse is assessing a term newborn. Which sign should the nurse report to the pediatric primary healthcare provider? A) Temperature of 97.7° F (36.5° C) B) Pale-pink to rust-colored stain in the diaper C) Heart rate that decreases to 115 beats/min D) Breathing pattern with recurrent sternal retractions
D) Breathing pattern with recurrent sternal retractions A breathing pattern with recurrent sternal retractions is indicative of respiratory distress; the expected pattern is abdominal with synchronous chest movement. A temperature of 97.7° F (36.5° C) is within the expected range of 97.6° F (36.4° C) to 99° F (37.2° C) for a newborn. Pale-pink to rust-colored staining in the diaper is caused by uric acid crystals from the immature kidneys; it is a common occurrence. A decrease in heart rate to 115 beats/min is within the expected range of 110 to 160 beats/min for a newborn.
The nurse is caring for a neonate who is undergoing phototherapy. What specific care should the nurse plan for this infant? A) Applying mineral oil to the skin to prevent excoriation B) Covering the infant's head with a cap to minimize heat loss C) Regulating radiant heat to maintain optimum skin temperature D) Discontinuing therapy during feeding to meet the infant's emotional needs
D) Discontinuing therapy during feeding to meet the infant's emotional needs Discontinuing therapy during feedings is necessary to ensure psychosocial contact. Mineral oil may block light rays from acting on bilirubin deposits; cleansing after each voiding and defecation will prevent skin excoriation. All parts of the body may contain bilirubin deposits and should be exposed to the light. Radiant heaters are not used; a fluorescent light source is used. STUDY TIP: You have a great resource in your classmates. We all have different learning styles, strengths, and perspectives on the material. Participating in a study group can be a valuable addition to your nursing school experience.
A client exhibits oligohydramnios at 36 weeks' gestation. What newborn complication should the nurse anticipate? A) Spina bifida B) Imperforate anus C) Tracheoesophageal fistula D) Intrauterine growth restriction (IUGR)
D) Intrauterine growth restriction (IUGR) Oligohydramnios is associated with IUGR; risk factors for IUGR include inadequate maternal nutrition and other high-risk conditions such as diabetes and preeclampsia. Spina bifida does not affect amniotic fluid volume; it is associated with an increased alpha-fetoprotein level. Imperforate anus does not affect amniotic fluid volume. Tracheoesophageal fistula is often associated with polyhydramnios, which is excessive amniotic fluid.
Based on the assessment of a full-term infant, the nurse suspects a cardiac anomaly. Which clinical manifestation does the nurse identify that indicates a cardiac anomaly? A) Projectile vomiting B) Irregular respiratory rhythm C) Hyperreflexia of the extremities D) Unequal peripheral blood pressures
D) Unequal peripheral blood pressures A discrepancy in blood pressures from the arms to the legs indicates arterial stenosis caused by coarctation of the aorta. Projectile vomiting commonly results from pyloric stenosis; it is not of cardiac origin and does not occur immediately after birth. An irregular respiratory rhythm is common and expected in the healthy newborn. Hyperreflexia of the extremities may be indicative of a neurologic, not cardiac, problem.
A neonate born at 32 weeks' gestation and weighing 3 lb (1361 g) is admitted to the neonatal intensive care unit. When should the nurse take the neonate's mother to visit the infant? A) When the infant's condition has stabilized B) When the infant is out of immediate danger C) When the primary healthcare provider has provided written permission D) When the mother is well enough to be taken to the intensive care unit
D) When the mother is well enough to be taken to the intensive care unit The mother should see her infant as soon as possible so that she may acknowledge the reality of the birth and begin bonding. A delay impedes maternal-infant bonding. A prescription is not needed, because this is an independent nursing action. The infant's condition is not a controlling factor in determining when the mother initially visits.
An infant born in a birthing center is being transferred to a regional neonatal intensive care unit because of respiratory distress. Which nursing action best promotes parent-infant attachment? A) Encouraging the parents to call their infant by name B) Allowing the parents to hold their infant before departure C) Giving the parents a picture of their infant in the intensive care unit D) Instructing the parents to contact the neonatal intensive care unit daily
B) Allowing the parents to hold their infant before departure Because seeing and touching the newborn infant are species-specific behaviors for human attachment, allowing the parents to hold the infant will promote bonding. Although encouraging the parents to call the infant by name is a useful action, holding and touching will promote bonding more effectively. After touching and holding, having a picture of their infant in the intensive care unit contributes most to bonding. Actual holding and touching promote bonding more than just hearing about the infant's progress.
A neonate born at 35 weeks' gestation has Apgar scores of 8 and 9. At 4 hours of age the newborn begins to experience respiratory distress, has a below-normal temperature in a warm environment, and has a low blood glucose level. What problem does the nurse suspect? A) Hypoglycemia B) Bacterial sepsis C) Cocaine withdrawal D) Meconium aspiration
B) Bacterial sepsis Preterm neonates react to infection with respiratory distress and subnormal temperatures. Although hypothermia is one sign of hypoglycemia, the newborn is not exhibiting other signs, such as tremors and lethargy. The data do not indicate that meconium was present at birth. Four hours of age is too early for signs of cocaine withdrawal to occur.
The nurse is caring for the newborn of a mother with diabetes. For which signs of hypoglycemia should the nurse assess the newborn? Select all that apply. A) Pallor B) Irritability C) Hypotonia D) Ineffective sucking E) Excessive birth weight
B) Irritability C) Hypotonia D) Ineffective sucking An inadequate amount of cerebral glucose causes irritability and restlessness. Hypoglycemia affects the central and peripheral nervous systems, resulting in hypotonia. Feeding difficulties result from hypoglycemic effects on the fetal central nervous system. Hypoglycemia causes cyanosis, not pallor, in the newborn. Excessive birthweight is common but does not indicate hypoglycemia.
A newborn is admitted to the nursery and classified as small for gestational age (SGA). What is the priority nursing intervention for this infant? A) Testing the infant's stools for occult blood B) Monitoring the infant's blood glucose level C) Placing the infant in the Trendelenburg position D) Comparing the infant's head circumference and chest circumference
B) Monitoring the infant's blood glucose level SGA infants are prone to hypoglycemia, because they have little subcutaneous fat or glycogen stores. Intestinal bleeding is not common in SGA infants. Placing an SGA infant in the Trendelenburg position is of no therapeutic value. Hydrocephalus or microcephaly is not a characteristic of SGA infants.
An infant is admitted to the nursery after a difficult shoulder dystocia vaginal birth. Which condition should the nurse carefully assess this newborn for? A) Facial paralysis B) Cephalhematoma C) Brachial plexus injury D) Spinal cord syndrome
C) Brachial plexus injury Brachial plexus paralysis (Erb-Duchenne palsy) is the most common injury associated with dystocia related to a shoulder presentation; it is caused by pressure and traction on the brachial plexus during the birth process. The newborn's face is not involved with a shoulder presentation. Cephalhematoma is a soft-tissue injury of the head and is not related to shoulder dystocia. Spinal cord syndrome is associated with a breech presentation and is not related to shoulder dystocia. STUDY TIP: A helpful method for decreasing test stress is to practice self-affirmation. After you have adequately studied and really know the material, start looking in the mirror each time you pass one and say to yourself—preferably out loud—"I know this material, and I will do well on the test." After several times of watching and hearing yourself reaffirm your knowledge, you will gain inner confidence and be able to perform much better during the test period. This technique really works for students who are adventurous enough to use it. It may feel silly at first, but if it works, who cares? It will work for performing skills in clinical as well, as long as you have practiced the skill sufficiently
The nurse is planning to use a newborn's foot to obtain blood for the required newborn metabolic testing. Which part of the foot is the best site to use for the puncture? A) Big toe B) Foot pad C) Inner sole D) Outer heel
D) Outer heel The outer heel is well perfused and heals quickly. The big toe, foot pad, and inner sole are all inappropriate sites from which to obtain a blood specimen from a newborn.
