OB - Chapter 23: Nursing Care of the Newborn With Special Needs

After teaching a group of students about the effects of prematurity on various body systems, the instructor determines that the class was successful when the students identify which of the following as an effect of prematurity? a) Rapid glomerular filtration rate b) Enhanced ability to digest proteins c) Enlarged respiratory passages d) Fragile cerebral blood vessels

Fragile cerebral blood vessels

Which of the following is a consequence of hypothermia in a newborn? a) Respirations of 46 b) Heart rate of 126 c) Skin pink and warm d) Holds breath 25 seconds

Holds breath 25 seconds

Which intervention should a nurse implement to promote thermal regulation in a preterm newborn? a) Observe for clinical signs of cold stress such as weak cry b) Check the blood pressure of the infant every 2 hours c) Assess the newborn's temperature every 8 hours until stable d) Set the temperature of the radiant warmer at a fixed level

Observe for clinical signs of cold stress such as weak cry

What is the first action the nurse takes in surfactant administration? a) Call pharmacy for medication. b) Obtain and document baseline vital signs. c) Change the infant's diaper. d) Hold feedings.

Obtain and document baseline vital signs.

A client has just given birth at 42 weeks' gestation. What would the nurse expect to find during her assessment of the neonate? a) A sleepy, lethargic neonate b) Vernix caseosa covering the neonate's body c) Peeling and wrinkling of the neonate's epidermis d) Lanugo covering the neonate's body

Peeling and wrinkling of the neonate's epidermis

A preterm infant is placed on ventilatory assistance for respiratory distress syndrome. In light of her lung pathology, which additional ventilatory measure would you anticipate planning? a) Administration of chilled oxygen to reduce lung spasm b) Administration of dry oxygen to avoid over-humidification c) Increased inspiratory pressure; decreased expiratory pressure d) Positive end-expiratory pressure to increase oxygenation

Positive end-expiratory pressure to increase oxygenation

Preterm infant deaths account for 80% to 90% of infant mortality in the first year of life. a) False b) True

True

Which of the following would be most effective in reducing pain in the preterm newborn? Select all that apply. a) Increasing the volume on device alarms b) Using cool blankets to soothe the newborn c) Swaddling the newborn closely d) Offering a pacifier prior to a procedure e) Encouraging kangaroo care during procedures f) Removing tape quickly from the skin

• Swaddling the newborn closely • Encouraging kangaroo care during procedures • Offering a pacifier prior to a procedure

Hypoglycemia in a mature infant is defined as a blood glucose level below which of the following? a) 100 mg/100 mL whole blood b) 80 mg/100 mL whole blood c) 40 mg/100 mL whole blood d) 30 mg/100 mL whole blood

40 mg/100 mL whole blood

Which of the following is a typical feature of a small for gestational age (SGA) newborn that differentiates it from a preterm baby with a low birth weight? a) Ability to tolerate early oral feeding b) Decreased body temperature c) Face is angular and pinched d) Decreased muscle mass

Ability to tolerate early oral feeding

Which of the following would lead the nurse to suspect that a large-for-gestational-age newborn has experienced birth trauma? a) Temperature instability b) Asymmetrical movement c) Feeble sucking d) Seizures

Asymmetrical movement

A nurse is caring for an infant. A serum blood sugar of 40 was noted at birth. What care should the nurse provide to this newborn? a) Focus on decreasing blood viscosity by introducing feedings b) Give dextrose intravenously before oral feedings c) Place infant on radiant warmer immediately d) Begin early feedings either by the breast or bottle

Begin early feedings either by the breast or bottle

When discussing heat loss in newborns, placing a newborn on a cold scale would be an example of what type of heat loss? a) Evaporation b) Conduction c) Radiation d) Convection

Conduction

A 33-week-gestation infant has just been born. The child's heartbeat is not audible. Which of the following is the priority nursing intervention? a) Palpation for a femoral pulse b) Administration of IV epinephrine, as prescribed c) Transfer to a transitional or high-risk nursery for continuous cardiac surveillance d) Depression of the sternum with both thumbs 1 to 2 cm at a rate of 100 times per minute

Depression of the sternum with both thumbs 1 to 2 cm at a rate of 100 times per minute

Infants of drug-dependent women tend to be large for gestational age. a) True b) False

False

A nurse is caring for an infant born with polycythemia. Which intervention is most appropriate when caring for this infant? a) Check blood glucose within 2 hours of birth by reagent test strip b) Repeat screening every 2 to 3 hours or before feeds c) Focus on decreasing blood viscosity by increasing fluid volume d) Focus on monitoring and maintaining blood glucose levels

Focus on decreasing blood viscosity by increasing fluid volume

A client has delivered a small for gestation age (SGA) newborn. Which of the following would the nurse expect to assess? a) Protuberant abdomen b) Brown lanugo body hair c) Round flushed face d) Head larger than body

Head larger than body

A client asks the nurse what surfactant is. Which explanation would the nurse give as the main role of surfactant in the neonate? a) Helps the lungs remain expanded after the initiation of breathing b) Assists with ciliary body maturation in the upper airways c) Helps maintain a rhythmic breathing pattern d) Promotes clearing of mucus from the respiratory tract

Helps the lungs remain expanded after the initiation of breathing

The nurse begins intermittent oral feedings for a small-for-gestational-age newborn to prevent which of the following? a) Hypoglycemia b) Polycythemia c) Asphyxia d) Meconium aspiration

Hypoglycemia

The nurse in a newborn nursery is observing for developmentally appropriate care. Which of the following is an example of self-regulation? a) Infant is kicking feet b) Infant has hand in mouth c) Infant is quiet d) Infant is crying

Infant has hand in mouth

A newborn is designated as very low birthweight. The nurse understands that this newborn's weight is: a) Less than 1,000 g b) Less than 1,500 g c) More than 4,000 g d) Approximately 2,500 g

Less than 1,500 g

A newborn is designated as very low birthweight. The nurse understands that this newborn's weight is: a) More than 4,000 g b) Less than 1,500 g c) Less than 1,000 g d) Approximately 2,500 g

Less than 1,500 g

Which of the following data is indicative of hypothermia of the preterm infant? a) Regular respirations b) Oxygen saturation of 95% c) Nasal flaring d) Pink skin

Nasal flaring

A preterm newborn receives oxygen therapy to treat respiratory distress syndrome (RDS). Which of the following should the nurse consider as a complication of oxygen administration at a high concentration? a) Bronchopulmonary dysplasia b) Necrotizing enterocolitis c) Retinopathy of prematurity d) Diminished erythropoiesis

Retinopathy of prematurity

A nurse is assessing an infant who has experienced asphyxia at birth. Which finding indicates that the resuscitation methods have been successful? a) Heart rate of 80 bpm b) Jitteriness c) Hypotonia d) Strong cry

Strong cry

A 20-year-old client gave birth to a baby boy during the 43rd week of gestation. Which of the following might the nurse observe in the newborn during routine assessment? a) The testes in the child may be undescended. b) The newborn may have short nails and hair. c) The infant may have excess of lanugo and vernix caseosa. d) The newborn may look wrinkled and old at birth.

The newborn may look wrinkled and old at birth.

A client delivers a newborn baby at term. The nurse records the weight of the baby as 1.2 kg, interpreting this to indicate that the newborn is of: a) Low birth weight b) Very low birth weight c) Normal birth weight d) Extremely low birth weight

Very low birth weight

A common symptom that would alert you that a preterm infant is developing respiratory distress syndrome is a) inspiratory "crowing." b) inspiratory stridor. c) expiratory grunting. d) expiratory wheezing.

expiratory grunting.

A nurse is preparing to administer epinephrine intravenously to a preterm newborn. The newborn weighs 1,500 g and the physician orders 0.1 mL/kg. How much would the nurse administer? a) 0.1 mL b) 0.25 mL c) 0.20 mL d) 0.15 mL

0.15 mL

What percentage of neonates requires some type of assistance to transition to extrauterine life? a) 25% b) 10% c) 5% d) 50%

10%

What percentage of neonates requires some type of assistance to transition to extrauterine life? a) 25% b) 5% c) 10% d) 50%

10%

With the administration of oxygen, a preterm infant's Pa02 level is monitored carefully. It is important to keep this level under which value to help prevent retinopathy of prematurity? a) 100 mm Hg b) 180 mm Hg c) 50 mm Hg d) 40 mm Hg

100 mm Hg

A baby who is declared AGA (appropriate for gestational age) falls in what weight percentile? a) 95 b) 5 c) 9 d) 20

20

Assessment of a newborn at 40 weeks' gestation reveals that he is a low birth weight newborn. Which of the following weights would the nurse identify as being low birth weight? a) 2400 g b) 3400 g c) 4400 g d) 1400 g

2400 g

Baby Eliza is 7 minutes old. Her heart rate is 92, her cry is weak, her muscles are limp and flaccid, she makes a face when she is stimulated, and her body and extremities are pink. What would the nurse assign as her Apgar score? a) 6 b) 3 c) 4 d) 5

5

A nurse is caring for a preterm infant. Which intervention will prepare the newborn's gastrointestinal tract to better tolerate feedings when initiated? a) Administer 0.5 ml/kg/hr of breast milk enterally b) Administer dextrose intravenously c) Administer iron supplements d) Administer vitamin D supplements

Administer 0.5 ml/kg/hr of breast milk enterally

A nurse is assessing a term newborn and finds the blood glucose level is 23 mg/dl. The newborn has a weak cry, is irritable, and exhibits bradycardia. Which intervention is most appropriate? a) Monitor the infant's hematocrit levels closely b) Place the infant on a radiant warmer c) Administer PO glucose water immediately d) Administer dextrose intravenously

Administer dextrose intravenously

All infants need to be observed for hypoglycemia during the newborn period. Based on the facts obtained from pregnancy histories, which infant would be most likely to develop hypoglycemia? a) An infant whose labor began with ruptured membranes b) An infant whose mother craved chocolate during pregnancy c) An infant who had difficulty establishing respirations at birth d) An infant who has marked acrocyanosis of his hands and feet

An infant who had difficulty establishing respirations at birth

The nurse examines a 26-week-old premature infant. The skin temperature is lowered. What could be a consequence of the infant being cold? a) Tachycardia b) Apnea c) Crying d) Sleepiness

Apnea

The nurse examines a 26-week-old premature infant. The skin temperature is lowered. What could be a consequence of the infant being cold? a) Tachycardia b) Apnea c) Sleepiness d) Crying

Apnea

A newborn with high serum bilirubin is receiving phototherapy. Which of the following is the most appropriate nursing intervention for this client? a) Gentle shaking of the baby b) Delay of feeding until bilirubin levels are normal c) Placing light 6 inches above the newborn's bassinet d) Application of eye dressings to the infant

Application of eye dressings to the infant

What assessment by the nurse will best monitor the nutrition and fluid balance in the postterm newborn? a) Monitor for fall in temperature, indicative of dehydration b) Assess for decrease in urinary output c) Assess for increased muscle tone d) Measure weight once every 2-3 days

Assess for decrease in urinary output

Which of the following is an example of developmental care in the NICU? a) Giving a bath b) Cluster care and activities c) Giving medications d) Holding the infant

Cluster care and activities

Which maternal factors should the nurse consider contributory to a newborn being large for gestational age? Select all that apply. a) Alcohol use b) Renal infection c) Diabetes mellitus d) Postdates gestation e) Prepregnancy obesity

Diabetes mellitus Postdates gestation Prepregnancy obesity

Which assessment finding would best validate a problem in a small-for-gestational age newborn secondary to meconium in the amniotic fluid? a) Respiratory rate of 60-70 bpm b) Total bilirubin level of 15 c) Heart rate of 162 bpm d) Hematocrit of 44%

Heart rate of 162 bpm

You care for a child born with a tracheoesophageal fistula. Which finding during pregnancy would have caused you to suspect this might be present? a) Oligohydramnios b) A difficult second stage of labor c) Hydramnios d) Bleeding at 32 weeks of pregnancy

Hydramnios

An obese woman with diabetes has just given birth to a term, large for gestational age (LGA) newborn. Which of the following conditions should the nurse most expect to find in this infant? a) Hypotension b) Hypertension c) Hypoglycemia d) Hyperglycemia

Hypoglycemia

A nurse completes the initial assessment of a newborn. According to the due date on the antenatal record, the baby is 12 days postmature. Which of the following physical findings does not confirm that this newborn is 12 days postmature? a) Hypoglycemia. b) Meconium aspiration. c) Absence of lanugo. d) Increased amounts of vernix.

Increased amounts of vernix.

An infant that is diagnosed with meconium aspiration displays which symptom? a) Pink skin b) No heart murmur c) Respirations of 45 d) Intercostal and substernal retractions

Intercostal and substernal retractions

A nurse assisting in a birth notices that the amniotic fluid is stained greenish black as the baby is being delivered. Which of the following interventions should the nurse implement as a result of this finding? a) Gently shaking the infant b) Flicking the sole of the infant's foot c) Administration of oxygen via a bag and mask d) Intubation and suctioning of the trachea

Intubation and suctioning of the trachea

When caring for a neonate of a mother with diabetes, which physiologic finding is most indicative of a hypoglycemic episode? a) Hyperalert state b) Jitteriness c) Loud and forceful crying d) Serum glucose level of 60 mg/dl

Jitteriness

When reviewing the medical record of a newborn who is large for gestational age (LGA), which of the following factors would the nurse identify as having increased the newborn's risk for being LGA? a) Low weight gain during pregnancy b) Fetal exposure to low estrogen levels c) Low maternal birth weight d) Maternal pregravid obesity

Maternal pregravid obesity

A 35-year-old client has just given birth to a healthy newborn during her 43rd week of gestation. Which of the following should the nurse expect when assessing the condition of the newborn? a) Tremors, irritability, and high-pitched cry b) Seizures, respiratory distress, cyanosis, and shrill cry c) Meconium aspiration in utero or at birth d) Yellow appearance of the newborn's skin

Meconium aspiration in utero or at birth

When preparing to resuscitate a preterm newborn, which of the following would the nurse do first? a) Administer epinephrine. b) Hyperextend the newborn's neck. c) Place the newborn's head in a neutral position. d) Use positive-pressure ventilation.

Place the newborn's head in a neutral position.

The small-for-gestation neonate is at increased risk for which complication during the transitional period? a) Polycythemia probably due to chronic fetal hypoxia b) Hyperthermia due to decreased glycogen stores c) Hyperglycemia due to decreased glycogen stores d) Anemia probably due to chronic fetal hypoxia

Polycythemia probably due to chronic fetal hypoxia

What would be appropriate for the nurse to document in a child suffering from meconium aspiration syndrome? a) Skin as pink b) Respirations as increased and high c) Chest expansion as normal d) Heart rate as normal

Respirations as increased and high

A newborn is being monitored for retinopathy of prematurity. Which of the following conditions predisposes an infant to this condition? a) Down syndrome b) Esophageal atresia c) Hydrocephalus d) Respiratory distress syndrome

Respiratory distress syndrome

When caring for a preterm infant, what intervention will best address the sensorimotor needs of the infant? a) Using minimal amount of tape b) Rocking and massaging c) Using distraction through objects d) Swaddling and positioning

Rocking and massaging

A nurse is caring for a preterm newborn who has developed rapid, irregular respirations with periods of apnea. Which of the following additional signs should the nurse consider as indications of respiratory distress syndrome (RDS) in the newborn? a) Sternal retraction b) Deep inspiration c) Expiratory lag d) Inspiratory grunt

Sternal retraction

Meconium is the first stool passed in a newborn. What would be the correct documentation of the meconium? a) Formed green b) Soft brown c) Seedy yellow d) Sticky forest green

Sticky forest green

A newborn girl who was born at 38 weeks of gestation weighs 2000 g and is below the 10th percentile in weight. The nurse recognizes that this girl will most likely be classified as which of the following? a) Late preterm, large for gestational age, and low-birth-weight infant b) Term, small for gestational age, and low-birth-weight infant c) Late preterm and appropriate for gestational age d) Term, small for gestational age, and very-low-birth-weight infant

Term, small for gestational age, and low-birth-weight infant

The nurse observes a neonate delivered at 28 weeks' gestation. Which finding would the nurse expect to see? a) The pinna of the ear is soft and flat and stays folded. b) The skin is pale, and no vessels show through it. c) The neonate has 7 to 10 mm of breast tissue. d) Creases appear on the interior two-thirds of the sole.

The pinna of the ear is soft and flat and stays folded.

A preterm newborn has just received synthetic surfactant through an endotracheal tube by a syringe. Which of the following interventions should the nurse implement at this point? a) Take a blood sample b) Immediately suction the infant's airway c) Place the infant supine in a radiant heat warmer d) Tip the infant into an upright position

Tip the infant into an upright position

A preterm infant is transferred to a distant hospital for care. When her parents visit her, which of the following would be most important for you to urge them to do? a) Stand so the baby can see them. b) Touch and, if possible, hold her. c) Bring a piece of clothing for her. d) Call the baby by her name.

Touch and, if possible, hold her.

A premature infant develops respiratory distress syndrome. With this condition, circulatory impairment is likely to occur because with increased lung tension, the a) aorta or aortic valve strictures. b) foramen ovale closes prematurely. c) pulmonary artery closes. d) ductus arteriosus remains open.

ductus arteriosus remains open.

A client just delivered a preterm baby in the 30th week of gestation. The nurse knows that which nursing measures will be performed for this infant? Select all that apply. a) Dress the baby in a stockinette cap. b) Carry and handle the baby frequently. c) Place the baby under isolette care. d) Dress the baby to keep the body warm. e) Estimate the urinary flow by weighing the diaper.

• Dress the baby in a stockinette cap. • Place the baby under isolette care. • Estimate the urinary flow by weighing the diaper.

A nurse is caring for an infant born with an elevated bilirubin level. When planning the infant's care, what interventions will assist in reducing the bilirubin level? Select all that apply. a) Offer early feedings b) Stop breastfeeding until jaundice resolves c) Increase the infant's hydration d) Initiate phototherapy e) Administer vitamin supplements

• Increase the infant's hydration • Offer early feedings • Initiate phototherapy

The nurse caring for newborns on an obstetrical ward assesses a SGA newborn. What characteristics are typical for this classification of newborn? Select all that apply. a) Tight and moist skin b) Diminished muscle tissue c) Narrow skull sutures d) Poor skin turgor e) Increased fatty tissue f) Sparse or absent hair

• Poor skin turgor • Sparse or absent hair • Diminished muscle tissue

Which of the following would the nurse expect to find in a newborn who is considered small for gestational age? Select all that apply. a) Dry or thin umbilical cord b) Poor muscle tone over buttocks c) Sunken abdomen d) Increased subcutaneous fat stores e) Narrow skull sutures

• Sunken abdomen • Poor muscle tone over buttocks • Dry or thin umbilical cord

The nurse in the NICU is caring for preterm newborns. Which of the following are recommended guidelines for care of these newborns? Select all that apply. a) Give the newborn a warm bath immediately. b) Discourage contact with parents to maintain asepsis. c) Take the newborn's temperature often. d) Dress the newborn in ways to preserve warmth. e) Supply oxygen for the newborn, if necessary. f) Handle the newborn as much as possible.

• Take the newborn's temperature often. • Dress the newborn in ways to preserve warmth. • Supply oxygen for the newborn, if necessary.

Which safety precautions should a nurse take to prevent infection in a newborn? Select all that apply. a) Avoid using disposable equipment b) Use sterile gloves for an invasive procedure c) Avoid coming to work when ill d) Cover jewelry while washing hands e) Initiate universal precautions when caring for the infant

• Use sterile gloves for an invasive procedure • Avoid coming to work when ill • Initiate universal precautions when caring for the infant