ob exam #3 ch 23,
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
A nurse is administering prescribed enteral feedings to assist in preparing the gut of a preterm newborn. The nurse integrates understanding of this measure, administering the feedings at which rate?
0.5 to 1 mL/kg/h
A small-for-gestational-age newborn or a low-birthweight newborn typically weighs about
2500 grams
Small-for-gestational-age newborns typically weigh less than
2500 grams
The nurse is concerned that a newborn is hypoglycemic. Which blood glucose level would support the nurse's suspicion?
30 mg/dL
The nurse recognizes that the group of infants born during which time frame are at a higher risk for morbidity and mortality?
34 to 37 weeks
A preterm newborn is one born before completion of
37 weeks
A term newborn is one born from the first day of the
38th week of gestation through 42 week
Hypoglycemia in a neonate is defined as blood glucose value below
40
A nurse is assisting with the resuscitation of a preterm newborn. The nurse is giving ventilations to the newborn at which rate?
40 to 60 breaths per minute
A large-for-gestational-age newborn typically weighs more than
4000 grams
A post-term newborn is one born after completion of
42 weeks gestation
due to poor placental perfusion, the newborn may experience
IUGR and be SGA.
Diabetes mellitus is commonly associated with
LGA newborns
When preparing to resuscitate a preterm newborn, the nurse would perform which action first
Place the newborn's head in a neutral position.
just know this about preterm newborn
The preterm newborn typically has smaller respiratory passages, leading to an increased risk for obstruction. have a limited ability to digest proteins. renal system is immature, which reduces his or her ability to concentrate urine and slow the gfr
A woman who has given birth to a post-term 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?
With post-term birth, the fetus uses stored nutrients to stay alive, and wasting occurs.
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
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
A post-term newborn develops perinatal asphyxia. The nurse understands that this condition is most likely the result of:
aging placenta.
Newborns who weigh from 2,500 g to 4,000 g are considered
appropriate for gestational age.
mmediate resuscitation is used to manage
asphyxia.
During the newborn's assessment, which finding would lead the nurse to suspect that a large-for-gestational-age newborn has experienced birth trauma?
asymmetrical movement
A nurse is assessing a preterm newborn's status based on the understanding that the newborn is at greatest risk for which complication?
atelectasis
A late preterm newborn is one who is born
between 34 and 37 weeks' gestation.
Sunken fontanels suggest
dehydration
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.
diabetes mellitus multiparity history of postdates gestation
Post-term 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 nurse is providing care to a preterm neonate. Which interventions would be most effective in minimizing the newborn's pain? Select all that apply.
encouraging kangaroo care during procedures removing tape gently from the skin using a colorful mobile for distraction
Trisomy 19 would be considered a
fetal factor
A nurse is assessing the fluid status of a preterm newborn. Which parameter would be most appropriate for the nurse to assess?
fontanels
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?
fragile cerebral blood vessels
Fetal growth is dependent on
genetic, placental, and maternal factors
Prevention and early identification of newborns at risk are necessary nursing functions. A nurse anticipates the need for newborn resuscitation secondary to birth asphyxia based on which prenatal risk factors? Select all that apply.
gestational hypertension maternal infection congenital heart disease
Epinephrine
given if the heart rate is less than 60 beats per minute after 30 seconds of compression and ventilation.
A small-for-gestational-age newborn typically has
has a sunken abdomen, wide skull sutures, decreased subcutaneous fat stores, poor muscle tone over buttocks and cheeks, and a thin umbilical cord.
The nurse begins intermittent oral feedings for a small-for-gestational-age newborn to prevent which occurrence?
hypoglycemia
Temperature instability, seizures, and feeble sucking suggest
hypoglycemia.
The respiratory system
is the last system to mature
Hyperbilirubinemia is associated with
jaundice and tea-colored urine
A nurse is assessing a preterm newborn. The nurse determines that the newborn is comfortable and without pain based on which finding?
lack of body posturing
A newborn whose weight is above the 90th percentile on growth charts is
large-for-gestational-age.
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 her newborn most likely be at risk for being:
large-for-gestational-age.
A newborn is designated as extremely low birthweight. The nurse understands that this newborn's weight is:
less than 1,000 g
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
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
Maternal malnutrition and TORCH infection are considered
maternal factors.
Resuscitation and suctioning are used to manage
meconium aspiration
Hyperextending the newborn's neck would
most likely close off the airway and is inappropriate.
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
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).
bulging fontanels suggest
over hydration
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?
paternal factors
Complications associated with a post-term 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).
Hydration and frequent monitoring of hematocrit are important to prevent
polycythemia
Preterm newborns have
ragile blood vessels in the brain, and fluctuations in blood pressure can predispose these vessels to rupture, causing intracranial hemorrhage.
the preterm newborn is at great risk for
respiratory complications, one of which is atelectasis.
A nurse is providing care to a post-term newborn. The nurse suspects that the newborn may be developing polycythemia based on which findings? Select all that apply.
ruddy appearance seizures jaundice
Findings associated with polycythemia include
ruddy appearance (plethora), a weak sucking reflex, hypotonia, seizures, and jaundice
Prenatal risk factors that can help identify the newborn that may need resuscitation include history
substance abuse, gestational hypertension, fetal distress due to hypoxia before birth, chronic maternal diseases, maternal or perinatal infection, placental problems, umbilical cord problems, difficult or traumatic birth, multiple births, congenital heart disease, maternal anesthesia or recent analgesia, or preterm or post-term birth.
The newborn may be in pain if the following are exhibited:
sudden highpitched 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.
Which findings would the nurse expect in a newborn who is considered small for gestational age? Select all that apply.
sunken abdomen poor muscle tone over buttocks dry or thin umbilical cord
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. Distraction using colorful mobiles or objects also can be effective.
The nurse needs to conduct a procedure on a preterm newborn. Which measures would be most effective in reducing pain? Select all that apply.
swaddling the newborn closely offering a pacifier prior to a procedure encouraging kangaroo care during procedures
Which finding would lead the nurse to suspect that a large-for-gestational-age newborn is developing hyperbilirubinemia?
tea-colored urine
A woman gives birth to a newborn at 39 weeks' gestation. The nurse classifies this newborn as:
term.
Hyperbilirubinemia occurs with
the increased breakdown of red blood cells, but this too would not account for the wasted appearance
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.
The nurse is assessing a post-term newborn. Which finding would the nurse be least likely to assess?
thick umbilical cord
Positive-pressure ventilation
used if the newborn is apneic or gasping or the pulse rate is less than 100 beats per minute.
Parents often vent their frustration and anger over the loss of their newborn on the nurse. The most appropriate reaction for the nurse is:
validate their feelings and refocus their anger.
Exposure to an intrauterine infection is unrelated to the
wasted appreance
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 2,400 g
A birth injury is typically characterized by
y asymmetrical movement
