OB Chapter 24: Nursing Management of the Newborn at Risk: Acquired and Congenital Newborn Conditions

A nurse is providing care to a newborn who was born by cesarean at 39 weeks' gestation about 6 hours ago. Which assessment finding(s) supports the nurse's suspicion that the newborn is experiencing transient tachypnea of the newborn? Select all that apply.

Respiratory rate: 100 breaths/min Breath sounds: Slightly diminished bilaterally Chest-x-ray: Mild symmetric overaeration

Upon shift handoff the nurse reports meconium staining of the amniotic fluid. Which neonatal system requires close monitoring by the incoming nurse?

Respiratory system

A nurse is assigned to care for a newborn with hyperbilirubinemia. The newborn is relatively large in size and shows signs of listlessness. What most likely occurred?

The infant's mother probably had diabetes.

A nurse is caring for a neonate of 25 weeks' gestation who is at risk for intraventricular hemorrhage (IVH). Which assessment finding should be reported immediately?

a sudden drop in hematocrit

The nurse is caring for a pregnant woman who is struggling with controlling gestational diabetes mellitus. What effect does the nurse predict this situation may have on the fetus?

grow to an unusually large size

A newborn requires resuscitation secondary to asphyxia. The resuscitation team frequently assesses the newborn's response and continues resuscitation efforts based on which assessment finding?

heart rate of 70 beats/min

A nurse is caring for a newborn whose chest X-ray reveals marked hyperaeration mixed with areas of atelectasis. The infant's arterial blood gas analysis indicates metabolic acidosis. For which dangerous condition should the nurse prepare when providing care to this newborn?

meconium aspiration syndrome

When caring for a neonate receiving phototherapy, the nurse should remember to:

reposition the neonate frequently.

The use of breast milk for premature neonates helps prevent which condition?

necrotizing enterocolitis

A woman with hydramnios has just given birth. The nurse recognizes that the infant must be assessed for which condition?

esophageal atresia

Rescue treatment with surfactant administration for an infant with established respiratory distress syndrome (RDS) who requires mechanical ventilation is administered within how many hours after birth?

2 hours and repeated in 4 hours

A nurse is caring for a newborn with asphyxia. Which nursing management is involved when treating a newborn with asphyxia?

Ensure effective resuscitation measures.

After assessing the status of a newborn, the nurse is concerned that this newborn has persistent pulmonary hypertension. When explaining it to the parents, the nurse would integrate knowledge about which event as having most likely occurred?

Foramen ovale has not closed.

A nurse is caring for a child born with a tracheoesophageal fistula. Which finding during pregnancy would have caused the nurse to suspect this might be present?

Hydramnios

A nurse is caring for a preterm newborn born at 29 weeks' gestation. Which nursing diagnosis would have the highest priority?

Ineffective thermoregulation related to decreased amount of subcutaneous fat

At birth, a neonate is diagnosed with brachial plexus palsy. The parent asks how the nurse knows the neonate's positioning of the arm is a result of the palsy and not just a preferred position. The nurse would show the parent that the neonate has asymmetry of which neonatal reflex?

Moro

When providing care to the newborn withdrawing from a drug such as cocaine or heroin, which drug is given to ease the symptoms and prevent complications?

Morphine

The nurse is caring for a neonate with epispadias. In which location will the nurse assess the anomaly?

On the dorsal end of the penis

Which intervention is helpful for the neonate experiencing drug withdrawal?

Place the isolette in a quiet area of the nursery.

A term newborn is diagnosed with esophageal atresia. When reviewing the mother's prenatal records, which maternal complication would correlate with the diagnosis?

Polyhydramnios

The nurse is caring for a neonate. Which is the most important step the nurse can take to prevent and control infection?

Practice meticulous handwashing.

A nurse is assigned to care for a newborn with esophageal atresia. What preoperative nursing care is the priority for this newborn?

Prevent aspiration by elevating the head of the bed, and inserting an NG tube to low suction.

Which environmental consideration is most helpful to promoting comfort when the neonate is withdrawing from alcohol and drugs?

Provide a dark, quiet environment

Which nursing action is required when caring for the post-term infant?

Serial blood glucose levels

The nurse is assessing a newborn suspected of having meconium aspiration syndrome. What sign or symptom would be most suggestive of this condition?

expiratory grunting

The newborn nursery nurse suspects a newborn of having neonatal abstinence syndrome. What assessment findings would most correlate with the diagnosis?

frequent yawning and sneezing

Following anastomosis repair of a tracheoesophageal fistula, the nurse assesses the infant for which potential complication?

gastroesophageal reflux

The nurse is caring for a 22-hour-old neonate male and notes on assessment at the beginning of the shift: Apgar score of 9, nursing without difficulty, and appeared healthy. As the nurse's shift goes on, subsequent assessment reveals his sclera and skin have begun to take on a yellow hue. The nurse would report this as a possible indication of what condition?

hemolytic disease

A nurse is concerned that a 1-day-old newborn is becoming ill and may be septic. What sign of distress would validate the nurse's concerns?

Temperature instability

The nurse is examining a newborn and notes that there is bruising and swelling on the newborn's head, limited to the right side of the scalp and does not cross the suture lines. How will the nurse interpret this finding?

This is a cephalohematoma that typically spontaneously resolves without interventions.

Which congenital condition is an immediate emergency requiring notification of the health care provider?

Tracheoesophageal fistula

Which condition would place a neonate at the least risk for developing respiratory distress syndrome (RDS)?

chronic maternal hypertension

A nurse is explaining to the parents the preoperative care for their infant born with bladder exstrophy. The parents ask, "What will happen to the bladder while waiting for the surgery?" What is the nurse's best response?

"The bladder will be covered in a sterile plastic bag to keep it moist."

A nurse is caring for a newborn who was diagnosed with an imperforate anus. Assessment reveals drooling, copious bubbles of mucus in mouth, rattling respirations, and abdominal distention. During feeding, the newborn coughs and becomes cyanotic. Which action by the nurse would be appropriate?

clear the airway

The nurse is instructing a mother with diabetes on the complications associated with uncontrolled blood glucose levels. Which complication is most concerning?

Delayed lung maturity

A newborn at 33 weeks' gestation has an Apgar score of 5 at 10 minutes of life. Which nursing action is a priority?

Begin resuscitation measures.

A nurse makes a home visit to a new mother and her 5-day-old newborn. Assessment of the newborn reveals slight yellowing of the skin on the face and forehead and slowed skin turgor. The mother tells the nurse that she's been having trouble breastfeeding the newborn. "My baby's been feeding about every 4 to 5 hours." Additional assessment reveals about 3 wet diapers per day and 1 to 2 stools per day. Which action by the nurse would be the priority?

Call the provider to obtain a prescription for a bilirubin level.

A newborn is suspected of having gastroschisis at birth. How would the nurse differentiate this problem from other congenital defects?

The intestines appear reddened and swollen and have no sac around them.

The nurse is most correct to assess for transient tachypnea of the newborn (TTN) in which neonate?

The neonate delivered by cesarean section

The nurse is completing gavage feedings for the preterm neonate every 2 hours. Which rationale is most correct?

The neonate requires food in the gut to avoid atrophy of the mucosa.

The nurse is caring for a neonate with an exstrophy of the bladder. When the nurse is planning care, which client goal is the priority?

The neonate will be free from infection.

The nurse is caring for a preterm neonate and has chosen the following goal: improvement of the neonate's respiratory function. Which expected outcome is most appropriate for the first week?

The neonate will not use accessory muscles when breathing.

A nurse is caring for a 25-year-old G1P0 at 37 weeks' gestation. The client's history indicates that the client has had alcohol abuse disorder throughout their pregnancy. What signs and symptoms does the nurse expect the newborn to exhibit? Drag words from the choices below to fill in each blank in the following sentence.

The nurse recognizes the newborn is exhibiting signs and symptoms of fetal alcohol syndrome, which include flat midface jitteriness thin upper lip and high-pitched shrill cry.

Which assessment finding within the first 24 hours of birth requires immediate health care provider notification?

The skin is jaundiced.

The nursing instructor is teaching a session on techniques that the nursing students can use to properly address concerns of parents with children who are born with a cleft lip and palate. The instructor determines the session is successful when the students correctly choose which nursing intervention as being the most effective in these situations?

Use reflective listening with nonjudgmental support.

Periventricular-intraventricular hemorrhage is suspected in a newborn of 30 weeks' gestation. The nurse would anticipate preparing the newborn for which diagnostic tool to confirm the diagnosis?

cranial ultrasound

The nurse is caring for an infant born to a mother with cocaine use disorder during her pregnancy. The nurse would likely notice that this infant:

cries when touched.

When providing postpartum teaching to a couple, the nurse correctly identifies what time as when pathologic jaundice may be found in the newborn?

during the first 24 hours of life

A birth room nurse notes the presence of thick green amniotic fluid with the rupture of membranes during a vaginal birth. What nursing action is a priority at this time?

Wipe the nares and then posterior pharynx immediately and gently.

As the nurse examines the birth records, which newborn would the nurse expect to monitor closely for respiratory distress syndrome (RDS)?

a term male newborn, born by a repeat cesarean birth, whose mother has diabetes mellitus

A nurse is caring for a full-term neonate who's receiving phototherapy for hyperbilirubinemia. Which finding should the nurse report immediately?

absent Moro reflex

A newborn is diagnosed with a birth injury secondary to shoulder dystocia. Assessment of the newborn's reflexes reveals the following: Present Moro reflex Absent grasp reflex Absent radial reflex Present bicep reflex The nurse suspects an upper brachial plexus injury based on which finding?

absent radial reflex

Which measure would the nurse expect to be included in the plan of care for an infant of a mother with diabetes who has a serum calcium level of 6.2 mg/dl (1.55 mmol/l)?

administration of calcium gluconate

A nurse is reading a journal article about birth defects and finds that some birth defects are preventable. Which risk factor would the nurse expect to find as being cited as the current leading preventable cause of birth defects?

alcohol

After birth, an infant experiences meconium aspiration. What does the nurse anticipate the primary care provider prescribing prophylactically to prevent pneumonia?

antibiotics

A newborn with high serum bilirubin is receiving phototherapy. Which nursing intervention is the most appropriate for this client?

application of eye dressings to the infant

A nursing instructor is teaching about newborn congenital disorders and realizes that the student needs further instruction after making which statement?

"All congenital disorders can be diagnosed at birth."

Four weeks before the birth of a client's already large child, the health care provider has told the client that if the baby gets bigger and the baby's lungs are ready, a cesarean birth is preferred. The woman asks the nurse what the downside is to having a cesarean rather than a vaginal birth. What is an appropriate response by the nurse?

"As the baby passes through the birth canal some of the excess fluid is expelled from the lungs; if that doesn't happen there's a higher risk of respiratory distress."

The nurse is assessing a toddler at a well-child visit and notes the following: small in stature, appears mildly developmentally delayed; short eyelid folds; and the nose is flat. Which advice should the nurse prioritize to the mother in response to her questions about having another baby?

"It's a good idea to stop drinking alcohol 3 months before trying to get pregnant."

The nurse is screening an expectant mother for the extent of current substance use. Which statement made by the mother is most concerning?

"Since I have learned that I am pregnant, I have only binged a few times."

A woman gave birth to a healthy term newborn about 2 hours ago. She asks the nurse about the appearance of her newborn's head. Assessment reveals swelling of the head that extends across the midline. Which response by the nurse would be appropriate?

"The swelling in your newborn's head is due to the head pressing against your cervix during labor and birth. It will go away on its own in a few days."

A newborn boy is diagnosed with esophageal atresia and tracheoesophageal fistula. After the nurse provides preoperative teaching, which statement indicates that the parents need additional teaching?

"We can probably start feeding him with the bottle about a day after the surgery."

The nurse is teaching the parents of a newborn diagnosed with a right midclavicular fracture about care of the newborn at home. The nurse determines that the teaching was successful based on which statement by the parents?

"We will pin the right sleeve of the shirt to the front of the shirt to keep it secure."

The nurse should carefully monitor which neonate for hyperbilirubinemia.

neonate with ABO incompatibility

An infant is suspected of having persistent pulmonary hypertension of the newborn (PPHN). What intervention implemented by the nurse would be appropriate for treating this client?

Provide oxygen by oxygen hood or ventilator.

The nurse is caring for a preterm infant and notes frothing and excessive drooling. Which additional assessment finding should the nurse prioritize and report immediately?

Severe cyanosis

A client at 6 weeks' gestation asks the nurse what foods she should eat to help prevent neural tube disorders in her growing baby. The nurse would recommend which foods?

Spinach, oranges, and beans

A nurse in a local health care facility is caring for a newborn with periventricular hemorrhage/intraventricular hemorrhage (PVH/IVH), who has recently been discharged from a local NICU. For which likely complications should the nurse assess? Select all that apply.

hydrocephalus vision or hearing deficits cerebral palsy

The nurse is admitting to the nursery a newborn of a mother who continued to drink alcohol during her pregnancy. Which finding does the nurse predict to encounter on the newborn's assessment?

hyperactive and irritable

A newborn has not passed any stools in the first 24 hours after birth, and his abdomen is becoming distended. The nurse recognizes that which condition could explain such findings?

imperforate anus

A neonate undergoing phototherapy treatment must be monitored for which adverse effect?

increased insensible water loss

A preterm newborn is noted to have hypotonia, apnea, bradycardia, a bulging fontanel (fontanelle), cyanosis, and increased head circumference. These signs indicate the newborn has which complication?

intraventricular hemorrhage (IVH)

What would the nurse expect to prioritize in the assessment of a newborn who has a positive Coombs test?

jaundice development

A client with group AB blood whose husband has group O blood has just given birth. Which complication or test result is a major sign of ABO blood incompatibility that the nurse should look for when assessing this neonate?

jaundice within the first 24 hours of life

A nurse caring for a client in premature labor knows that the best indicator of fetal lung maturity is which data?

lecithin to sphingomyelin ratio of more than 2:1

What would the nurse suspect as a cause of meconium aspiration syndrome (MAS) after reviewing the maternal history of a client whose newborn is diagnosed with MAS?

maternal hypertension

By preventing fetal distress during the intrapartum period, which condition is less likely?

meconium aspiration syndrome

What assessment findings would the nurse expect to find in a newborn born to a cocaine-addicted mother?

microcephaly genitals not well-formed high-pitched cry

The perinatal nurse is assessing a large-for-gestational age infant born by breech birth and notes that the infant is irritable and does not move the right arm. For what would the nurse assess?

midclavicular fracture

Which medication would be included in the plan of care for a newborn with acute neonatal abstinence syndrome who is not responding to conservative nursing approaches?

morphine sulphate

A premature infant in the neonatal intensive care unit exhibits worsening respiratory distress and is noted to have abdominal distention, absent bowel sounds, and frequent diarrhea stools that are positive for hemoccult. What diagnosis would be most likely to correlate with the symptoms?

necrotizing enterocolitis

A 32 weeks' gestation newborn is admitted to the neonatal intensive care unit. The assessment reveals a pale dyspneic newborn with marked tremors, a bulging anterior fontanel (fontanelle), and a high-pitched cry. What diagnosis best correlates with the assessment findings?

periventricular-intraventricular hemorrhage

When attempting to interact with a neonate experiencing drug withdrawal, which behavior would indicate that the neonate is willing to interact?

quiet, alert state

When assessing a newborn, the nurse determines that the newborn is most likely experiencing respiratory distress syndrome (RDS) based on which finding?

see-saw respirations

Which facial change is characteristic in a neonate with fetal alcohol spectrum disorder?

short, palpebral fissures

Which sign appears early in a neonate with respiratory distress syndrome?

tachypnea more than 60 breaths/minute

Which action should nurses advocate to help the nation achieve the 2020 National Health Goals? Select all that apply.

teaching about folic acid supplementation prior to conception obtaining early prenatal care providing support after the diagnosis of a fetal disorder

Which newborn would the nurse suspect to be most at risk for intellectual disability due to the mother's actions during pregnancy?

the child of a client who admits to drinking a liter of alcohol daily during the pregnancy

A nurse is assessing a newborn. The nurse suspects that the newborn was exposed to drugs while in utero based on which findings? Select all that apply.

tremors frequent yawning nasal flaring

A 36-week neonate born weighing 1,800 g has microcephaly and microphthalmia. Based on these findings, which risk factor might be expected in the maternal history?

use of alcohol

A neonatal intensive care nurse is caring for a preterm newborn diagnosed with transient tachypnea who is NPO and receiving intravenous fluid therapy. When would the nurse expect the newborn to begin oral feedings?

when the respiratory rate is 44 BPM