PN Pediatrics

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A nurse is caring for a child with complex esophageal atresia who will be undergoing surgery for repair. What comment by the parents indicates further teaching is required?

"After this surgery is done tomorrow, my baby will be able to eat and drink"

Four weeks before the birth of a client's already large child, the primary care provider has told the client that if the baby gets bigger and the baby's lungs are ready, the care provider would like to perform a cesarean birth. 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 caring for an infant diagnosed with a ventricular septal defect. Which assessment findings does the nurse anticipate?

A harsh murmur

The nurse is reviewing the medical record of the antepartum client with an abnormal alpha-fetoprotein test. The mother is distraught and states, "How bad can it be?" The nurse is correct to describe which?

A type of spina bifida

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 nasal flaring frequent yawning

The nursing instructor is teaching a session on techniques which the nursing students can use to properly address concerns of parents with children who are born with a congenital disorder. 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 and offer nonjudgmental support.

The nurse is monitoring a new mother changing her newborn's diaper and notices a musty smell to the infant's urine. Which condition should the nurse prioritize in further assessments to rule out?

Phenylketonuria

A nurse is caring for a newborn client after birth who is diagnosed with myelomeningocele. Which nursing intervention would protect the newborn from injury?

Place the newborn in a prone or lateral position.

The nursing instructor is leading a discussion with a group of nursing students who are analyzing the preterm infant's physiologic immaturity and the associated difficulties the newborn and familty must deal with. The instructor determines the session is successful when the students correctly choose which body system that presents with the most critical concerns related to this immaturity?

The respiratory system

Which newborn would the nurse suspect to be most at risk for cognitive challenge 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 working in the newborn observational unit is assigned four newborns closely being monitored. Which newborn is at greatest risk of developing respiratory distress syndrome?

the male preterm infant born by cesarean birth with cold stress

A nurse is caring for a child with complex esophageal atresia who will be undergoing surgery for repair. What comment by the parents indicates further teaching is required?

"After this surgery is done tomorrow, my baby will be able to eat and drink" The newborn will need IV fluids to maintain optimal hydration. The first stage of surgery may involve a gastrostomy and a method of draining the proximal esophageal pouch. A chest tube is inserted to drain chest fluids. If the repair is complex, surgery may need to be done in stages.

The prenatal health nurse is conducting an educational session focusing on alcohol use during pregnancy. The nurse feels the session was a success when a participant makes which statement?

"Alcohol use could cause my baby to be cognitively challenged." Disorders included in the grouping fetal alcohol spectrum disorders are alcohol-related neurodevelopmental disorders (ARND). Children with ARND primarily display intellectual disabilities related to behavior and learning. Fetal alcohol syndrome is one of the most common known causes of cognitive challenge. Counsel girls and women to avoid any alcohol use during pregnancy. Participating in programs for at-risk groups, including adolescents, especially about the serious effects of substance abuse, especially alcohol, during pregnancy.

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." All congenital disorders are not diagnosed at birth. Hydrocephalus is one such disorder that may be diagnosed at birth but also may not be diagnosed until after a few weeks or months. It is also true that congenital defects may be caused by both genetics and environmental factors.

The nurse is doing teaching with the caregivers of an infant diagnosed with hypospadias. Which statement made by the caregivers is accurate regarding hypospadias?

"Being able to most likely correct this in one stage rather than several is reassuring." Surgical repair is often accomplished in one stage and is often done as outpatient surgery. Surgical repair is desirable between the ages of 6-18 months, before body image and castration anxiety become problems. Urination is not affected, but the boy cannot void while standing in the normal male fashion. These newborns should not be circumcised because the foreskin is used in the repair.

A client who gave birth 2 hours ago expresses concern about her baby developing jaundice. Which response from the nurse would be best?

"I understand your concern because as many as 50% of babies can develop jaundice." As many as 50% of term newborns will develop physiologic jaundice. Physiologic jaundice occurs after the first 24 hours of life and is not pathologic. Pathologic jaundice will develop within the first 24 hours of life.

In examining her newborn son, a mother becomes concerned that the frenulum, under his tongue, is too short. She points it out to the nurse. Which of the following should the nurse say in response to this mother's concern?

"In most cases, a short frenulum does not cause problems and does not need to be corrected." Ankyloglossia is an abnormal restriction of the tongue occurring in a small number of newborns, caused by an abnormally tight frenulum, the membrane attached to the lower anterior tip of the tongue. Assuming the infant is sucking well, a short newborn frenulum does not need to be corrected. This condition may rarely cause difficulty with breastfeeding or unclear speech. If it does, then surgical release can be performed in the newborn period or at about 4 years of age.

A woman with a history of PKU tells the nurse that she has decided to try to become pregnant. Her serum phenylalanine level is 10 mg/dL. Which of the following is an appropriate response for the nurse to make?

"It will be best if you cut back on meat, fish, and dairy products before you become pregnant to get your serum phenylalanine level down under 8 mg." If a woman who has PKU decides to have a child and is not following a diet low in phenylalanine, she should return to following the dietary treatment for at least three months before becoming pregnant. A low-phenylalanine diet is a very restricted one; foods to be omitted are breads, meat, fish, dairy products, nuts, and legumes. The diet is continued through the pregnancy to help prevent the child from being born with a mental impairment. Routine blood testing is done to maintain the serum phenylalanine level at 2 to 8 mg/dL. A formula low in phenylalanine should be started as soon as the condition is detected; Lofenalac and Phenyl-free are low-phenylalanine formulas. Best results are obtained if the special formula is started before the newborn is three weeks of age.

The nurse is working with a group of parents of children who have congenital heart disorders. Which of the following statements made by the parents would most likely be an indication the child is showing signs of congestive heart failure.

"She gets so tired when she is eating" Hydrocephalus has the clinical manifestations of a larger head than normal with widening cranial sutures. As the head enlarges, the suture lines separate and the spaces are felt through the scalp. The anterior fontanelle becomes tense and bulging, the skull enlarges, the scalp becomes shiny, and its veins dilate. If pressure continues, the eyes appear to be pushed downward slightly and the sclerae visible above the irises. Spina bifida is a defect in the neural arch and is a failure of the posterior laminae of the vertebrae to close. Both septal defect and coarctation are both defects that involve the heart.

"She gets so tired when she is eating" Newborns with cardiac anomalies have a history of being poor eaters, tiring easily from the effort to suck, and failing to grow or thrive normally. A murmur is not a sign of congestive heart failure. At times during infancy the chest and head would measure the same without this being a concern. With a congenital dislocation of the hip, an audible click may be heard.

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 covered in a sterile plastic bag to keep it moist." In the preoperative period, the infant care is focused on protecting the exstrophied bladder and preventing infection. The infant is kept in a supine position, and the bladder is kept moist and covered with a sterile plastic bag. Change soiled diapers immediately to prevent contamination of the bladder with feces. Sponge-bathe the infant only rather than immersing him or her in water to prevent pathogens in the bath water from entering the bladder. Consult the ostomy nurse if necessary.

A group of nursing students is discussing hydrocephalus. The students make the following statements related to the noncommunicating type of congenital hydrocephalus. Which statement is the most accurate?

"There is an obstruction that keeps cerebrospinal fluid from passing between the ventricles and the spinal cord." In the noncommunicating type of congenital hydrocephalus, an obstruction occurs and CSF is not able to pass between the ventricles and the spinal cord. The blockage causes increased pressure on the brain or spinal cord. In the communicating type of hydrocephalus, no obstruction of the free flow of CSF exists between the ventricles and the spinal theca; rather the condition is caused by defective absorption of CSF. There is no concern of decreased production of CSF and no opening between the ventricles and spinal cord in hydrocephalus.

A group of nursing students is discussing hydrocephalus. Which statement made by the students related to the noncommunicating type of congenital hydrocephalus is the most accurate?

"There is an obstruction that keeps cerebrospinal fluid from passing between the ventricles and the spinal cord." In the noncommunicating type of congenital hydrocephalus, an obstruction occurs, and CSF is not able to pass between the ventricles and the spinal cord. The blockage causes increased pressure on the brain or spinal cord. In the communicating type of hydrocephalus, no obstruction of the free flow of CSF exists between the ventricles and the spinal theca; rather, the condition is caused by defective absorption of CSF. There is no concern of decreased production of CSF and no opening between the ventricles and spinal cord in hydrocephalus

The nurse is caring for a newborn client newly diagnosed with dysplasia of the hip. Which response by the nurse educates the parents on the correct plan of treatment for this diagnosis?

"Treatment will begin immediately." Dysplasia of the hip is a congenital newborn condition that requires immediate intervention. The development of the acetabulum of the hip is defective, and it may or may not be dislocated. Treatment of the defect and dislocated hips involves positioning the hip into a flexed, abducted (externally rotated) position to attempt to press the femur into the acetabulum. This involves splints and halters as the first line of treatment. Treatment should not be delayed. Surgery and casts are typically not used as the first line of treatment.

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." Preoperatively, the newborn is at risk for pneumonitis due to aspiration of food and secretions. Antibiotics are typically given until the anastomosis is proven intact and patent. Oral feedings are usually started within a week after surgery once the esophageal anastomosis is proven to be intact and patent. Proper position with elevation of the head is important for the newborn with esophageal atresia and tracheoesophageal fistula because he is at risk for aspiration of food and secretions. Using a pacifier to provide nonnutritive sucking helps to meet the newborn's need to suck.

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

The nurse teaches the parents of a newborn with hyperbilirubinemia about home phototherapy using bilirubin lights. Which statement indicates that the teaching was successful?

"We'll take off the patches on his eyes when we're feeding him so he can look at us." The lights are to be positioned about 12 to 30 inches above the newborn. The newborn is turned every 2 hours while under the bilirubin lights. Eye patches are removed during feedings so that the newborn can interact with the caregiver. Evidence of effectiveness is indicated by loose, green stools indicating that the bilirubin is being broken down.

An infant was born with a severely deformed hand. He is now 6 months old. The nurse informs the parents that the orthopedic surgeon has recommended amputation of the hand and fitting of a prosthesis. The mother objects and tells the nurse that they would like to wait and see how the hand develops. Which of the following should the nurse say in response?

"With a deformity such as this, the hand is highly unlikely to improve." Depending on the condition, in many children, there is a potential for better function if the malformed portion of an extremity is amputated before a prosthesis is fitted. This creates a difficult decision for parents because it is one they cannot undo later. They need assurance hands with malformed fingers, for example, will not later grow to become normal and a well-fitted prosthesis will allow their child a more usual childhood and adult life than if the original disorder was left unchanged. It is not the nurse's place to insert her opinion about the matter.

An older infant is scheduled to have a cleft palate repair. The mother asks if she will still be able to breastfeed the baby during the postoperative phase. What is the best response by the nurse?

"You will not be able to breastfeed but immediately after, but you can pump and feed the child with a cup." For an infant who has had a palate repair, no nipples, spoons, or straws are permitted; only a drinking glass or a cup is recommended. A favorite cup from home may be reassuring to the older infant.

A nursing student is learning about congenital disorders in newborns and correctly associates the causes for central nervous system defects to be which of the following? (Select all that apply.)

*imbalanced cerebrospinal fluid *malformation of the neural tube during embryonic development Central nervous system defects include disorders resulting from an imbalance of cerebrospinal fluid (eg, hydrocephalus) and a range of disorders resulting from malformations of the neural tube during embryonic development (often called neural tube defects). The other options do not cause defects of the central nervous system.

In the infant diagnosed with spina bifida with myelomeningocele, the infant will likely have which of the following?

A partial to complete paralysis in the lower extremities Correct Explanation: In spina bifida with myelomeningocele, there is a protrusion of the spinal cord and the meninges, with nerve roots embedded in the wall of the cyst. The effects of this defect vary in severity from sensory loss or partial paralysis below the lesion to complete flaccid paralysis of all muscles below the lesion.

A newborn is scheduled for casting to correct a talipes disorder. You would advise her parents that the cast will extend

Above the knee A cast for a talipes deformity typically extends above the knee to stabilize the knee, ankle, and foot.

Which of the following would the nurse expect to be included in the plan of care for an infant of a diabetic mother who has a serum calcium level of 6.2 mg/dL?

Administration of calcium gluconate Serum calcium levels less than 7 mg/dL indicate the need for supplementation with oral or IV calcium gluconate. Phototherapy would be used if the newborn develops hyperbilirubinemia. Intravenous glucose solutions would be used to stabilize the newborn's blood glucose levels and prevent hypoglycemia. Feedings help to control glucose levels, reduce hematocrit, and promote bilirubin excretion

A nursing instructor is teaching about newborn congenital disorders and realizes that the student needs further instruction upon making which of the following statements?

All congenital disorders can be diagnosed at birth. All congenital disorders are not diagnosed at birth. Hydrocephalus is one such disorder that may be diagnosed at birth but also may not be diagnosed until after a few weeks or months. It is also true that congenital defects may be caused by both genetics and environmental factors.

After delivery, an infant experiences meconium aspiration. What does the nurse anticipate the physician ordering prophylactically to prevent pneumonia?

Antibiotics Prophylactic antibiotics may prevent development of pneumonia.

The nurse is caring for a newborn diagnosed with congenital talipes equinovarus. Which of the following treatments would the nurse most likely expect for this newborn?

Application of a cast Congenital talipes equinovarus is the most common congenital foot deformity. Treatment is started during the neonatal period, correction usually may be accomplished by manipulation and bandaging or by application of a cast. The child is not put in Bryant's traction. Passive range of motion is used for positional deformities and although special shoes may be used later in treatment, the treatment for the newborn is casting.

Immediately after delivery, the nurse is caring for a newborn with a myeolomeningocele. What intervention should the nurse provide to prevent drying out of the sac to avoid damage?

Apply a sterile dressing moistened in a warm sterile saline solution Until surgery is performed, the sac must be covered with a sterile dressing moistened in a warm sterile solution (often saline). The nurse should change this dressing every 2 hours and not allow it to dry to avoid damage to the covering of the sac.

In caring for the child with esophageal atresia, the nurse recognizes the priority assessment is which?

Assessment for respiratory distress. Children with esophageal atresia have periods of respiratory distress with choking and cyanosis. This is a priority assessment as the implications include the highest risk. Excessive bleeding, cardiac status for anomolies, and feeding difficulties are not concerns in the child with esophageal atresia.

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. Determine the Apgar score at 1 and 5 minutes; if less than 7 at 5 minutes, repeat the assessment at 10 minutes of age. If the initial assessment is poor, begin resuscitation measures until the Apgar score is above 7. The Ballard score would not be performed at this time. Reviewing the L & D records or repeating the Apgar are not priorities.

The nurse is doing teaching with the caregivers of an infant diagnosed with hypospadias. Which of the following statements made by the caregivers is accurate regarding hypospadias?

Being able to most likely correct this in one stage rather than several is reassuring Surgical repair is often accomplished in one stage and is often done as outpatient surgery. Surgical repair is desirable between the ages of 6-18 months, before body image and castration anxiety become problems. Urination is not affected, but the boy cannot void while standing in the normal male fashion. These newborns should not be circumcised because the foreskin is used in the repair.

In the child diagnosed with hydrocephalus, an obstruction occurs that blocks the normal process of which of the following?

Cerebrospinal fluid

The nurse is caring for a group of infants. It is noted that one of the infants has chronic constipation and abdomen enlargement. These findings are characteristic of which of the following disorders?

Congenital hypothyroidism Two common features see in the infant with congenital hypothyroidism are chronic constipation and abdomen enlargement caused by poor muscle tone. These are not characteristic findings in the other disorders.

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

Cranial ultrasound The diagnostic tool of choice to detect periventricular hemorrhage is a cranial ultrasound. Arterial blood gases would be helpful in evaluating for metabolic acidosis. Blood glucose levels provide information about the newborn's glucose stability. Chest x-ray would provide no information related to bleeding in the brain.

After conferring with the care provider, the nurse who is caring for the newborn with spina bifida can best increase the baby's comfort and development by teaching the parents how to

Cuddle the baby in a chest-to-chest position The family of a newborn with such a major anomaly is in a state of shock on first learning of the problems. Be especially sensitive to their needs and emotions. Encourage family members to express their feelings and emotions as openly as possible. If possible, encourage the family members to cuddle or touch the newborn using proper precautions for the safety of the defect. With the permission of the physician, the newborn may be held in a chest-to-chest position to provide closer contact. The preoperative goals for care of the newborn with myelomeningocele include preventing infection, maintaining skin integrity, preventing trauma related to disuse, increasing family coping skills, education about the condition, and support. Diapering is not advisable with a low defect

A baby is born with spina bifida with meningocele. The parents are visibly upset. The father states, "What did we do wrong? How will I ever love this child?" What is the priority action by the nurse?

Encourage the parents to express their feelings and emotions openly The family of a newborn with such a major anomaly is in a state of shock on first learning of the problems. The nurse should be especially sensitive to their needs and emotions. He or she should encourage family members to express their feelings and emotions as openly as possible.

A nurse in the newborn nursery has noticed that an infant is frothing and appears to have excessive drooling. Further assessment reveals that the baby has episodes of respiratory distress with choking and cyanosis. What disorder should the nurse suspect based on these findings?

Esophageal atresia Any swallowed mucus or fluid enters the blind pouch of the esophagus when a newborn suffers from esophageal atresia. The newborn with this disorder will have frothing, excessive drooling, and periods of respiratory distress with choking and cyanosis. If this happens no feedings should be given until the newborn has been examined.

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

Esophageal atresia Correct Explanation: Esophageal atresia must be ruled out in any infant born to a woman with hydramnios (excessive amniotic fluid). Hydramnios occurs because, normally, a fetus swallows amniotic fluid during intrauterine life. A fetus with esophageal atresia cannot effectively swallow, so the amount of amniotic fluid can grow abnormally large. The other conditions listed are not associated with hydramnios

Since the inclusion of calcium in prenatal vitamins and all cereal and grain products, the incidence of neural tube disorders has fallen dramatically in the United States.

False Since the inclusion of folic acid in prenatal vitamins and all cereal and grain products, the incidence of neural tube disorders has fallen dramatically in the United States.

A nursing student has read that cleft lip is diagnosed at birth based on inspection of physical appearance and that cleft palate is diagnosed in which way?

Feeling the palate with a gloved finger or using a tongue blade

A nursing student has read that cleft lip is diagnosed at birth based on inspection of physical appearance, and that cleft palate is diagnosed in which of the following ways?

Feeling the palate with a gloved finger or using a tongue blade Diagnosis of cleft palate is made at birth with the close inspection of the newborn's palate. To be certain that a cleft palate is not missed, the examiner must insert a gloved finger into the newborn's mouth to feel the palate to determine that it is intact. The other tests cannot confirm a cleft palate.

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.

The nurse is caring for a pregnant woman with gestational diabetes mellitus, which the woman is having great difficulty keeping under control. What effect is the woman's condition most likely to have on the fetus? The fetus might

Grow to an unsusually large size Maternal diabetes is the most widely known contributing factor to large-for-gestational-age newborns. LGA babies are frequently born to diabetic mothers with poor glucose control. Continued high blood glucose levels in the mother lead to an increase in insulin production in the fetus. Increased insulin levels act as a fetal growth hormone causing macrosomia, an unusually large newborn with a birth weight of greater than 4,500 grams (9 pounds, 14 ounces). The incidence of birth defects in the gestational diabetic is not greatly increased. IUGR is not a typical outcome of uncontrolled gestational diabetes. It is more likely that the baby will be large-for-gestational-age

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

Grow to an unusually large size

At a preconception counseling class, a client expresses concern and wonders how Healthy People 2020 will improve maternal infant outcomes. Which responses by the nurse are appropriate? Select all that apply.

Healthy People 2020 will reduce the rate of fetal and infant deaths. Healthy People 2020 will decrease the number of all infant deaths (within 1 year). Healthy People 2020 will decrease the number of neonatal deaths (within the first year). Healthy People 2020 will foster early and consistent prenatal care. One of the leading health indicators as identified by Healthy People 2020 refers to decreasing the number of infant deaths. Acquired and congenital conditions account for a significant percentage of infant deaths.

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 male newborn is born with hypospadias. The nurse doing the newborn physical assessment notes that the penis is also curved downward. What information would the nurse provide the parents for this infant?

His ability to void and have an erection in adulthood may be impaired and surgery is needed. Hypospadias is a relatively common malformation of the male genital organ. It is an abnormal positioning of the urinary meatus on the underside of the penis. It is often accompanied by a downward bowing of the penis (chordee), which can lead to urination and erection problems in adulthood. There are no maneuvers that will improve the penis curvature, surgery is definitely warranted and needed, and infants with hypospadius are never circumcised because the foreskin may be needed for later repairs.

You care for a child born with a tracheoesophageal fistula. Which finding during pregnancy would have caused you to suspect this might be present?

Hydramnios Rationale: Because a fetus swallows amniotic fluid, when there is an obstruction of the esophagus, amniotic fluid accumulates, leading to hydramnios.

A nursing student is learning about newborn congenital defects. The defect with symptoms that include a shiny scalp, dilated scalp veins, a bulging anterior fontanelle, and eyes pushed downward with the sclerae visible above the irises is known as which of the following?

Hydrocephalus Hydrocephalus has the clinical manifestations of a larger head than normal with widening cranial sutures. As the head enlarges, the suture lines separate and the spaces are felt through the scalp. The anterior fontanelle becomes tense and bulging, the skull enlarges, the scalp becomes shiny, and its veins dilate. If pressure continues, the eyes appear to be pushed downward slightly and the sclerae visible above the irises. Spina bifida is a defect in the neural arch and is a failure of the posterior laminae of the vertebrae to close. Both septal defect and coarctation are both defects that involve the heart

For which of the following would you commonly assess in an infant following surgery for a myelomeningocele?

Hydrocephalus Correct Explanation: Surgery includes removing a portion of the meninges; without the surface to absorb cerebral spinal fluid, hydrocephalus can result.

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

In addition to newborns of diabetic mothers being at risk for hypoglycemia, these newborns are also at risk for which of the following?

Hypocalcemia The newborn of the diabetic mother is at risk for hypocalcemia, hypomagnesemia, polycythemia with hyperviscosity, and hyperbilirubinemia. Potassium concerns are not a risk for these newborns

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 of the following conditions could explain such findings?

Imperforate anus Imperforate anus is stricture of or absence of the anus. Although the condition can be detected by a prenatal sonogram and other assessments, some instances of the stricture will not be detected at birth as the anus appears as usual and the stricture exists so far inside it can't be seen. In this case, by 24 hours, no stool will be passed; abdominal distention will become evident. The other conditions listed would not produce the symptoms described above.

The nurse who is caring for newborn Andrew notices that although he has seemed healthy at 18 hours of age, Andrew's abdomen is now distended. By 24 hours he has passed no stool. The nurse will

Inform the physician of the findings In some newborns, a shallow opening may occur in the anus with the rectum ending in a blind pouch some distance higher. Thus, being able to pass a thermometer into the rectum does not guarantee that the rectoanal canal is normal. More reliable presumptive evidence is obtained by watching carefully for the first meconium stool. Abdominal distention also occurs. If the newborn does not pass a stool within the first 24 hours, the physician should be notified. Definitive diagnosis is made by radiographic studies. In some newborns, a colostomy is performed and extensive abdominoperineal resection is delayed until 3-5 months of age or later.

In the infant with congenital hip dysplasia, which of the following signs would likely be noted in this child?

Limited abduction of the affected hip The infant with congenital hip dysplasia usually has limited abduction of the affected hip. They have asymmetry of the gluteal skin folds and shortening of the femur. Adduction is not a concern.

The nurse is preparing to assess an infant who is diagnosed with a ventricular septal defect. Which assessment finding should the nurse be prepared to document?

Loud, harsh murmur

Which of the following is a common finding in the child who has a ventricular septal defect?

Loud, harsh murmur Children with ventricular septal defects have a characteristic loud, harsh murmur. Fatigue and dyspnea, delayed growth and development and a bounding pulse are seen in the child with patent ductus arteriosus

Which nursing measure is most effective in reducing newborn infections?

Maintain medical asepsis while providing care.

Which nursing measure is most effective in reducing newborn infections?

Maintain medical asepsis while providing care. Nurses possess the education and assessment tools to decrease the incidence of and reduce the impact of newborn infections. Nurses should implement measures for prevention and early recognition, including maintaining medical and surgical asepsis for all providing care. Nurses should outline and carry out measures to prevent hospital-acquired infections, such as thorough hand-washing hygiene for all staff.

In the infant born with a cleft lip and a cleft palate, the highest priority of the nurse is related to which intervention?

Maintaining the nutritional needs if the infant

Which of the following actions would be most important to do for an infant following surgery for myelomeningocele?

Measure a daily head circumference Because some meningocele absorbing surface is removed with surgery, cerebrospinal fluid can accumulate and lead to hydrocephalus.

PKU will causes _______ ______if left untreated

Mental Retardation rationale: Phenylketonuria (PKU) is a recessive hereditary defect of metabolism that, if untreated, causes severe mental retardation. It is not related to congenital heart defects, increased intracranial pressure, or to a strangulated intestine.

The hereditary defect known as Phenylketonuria (PKU) will cause which of the following if left untreated?

Mental retardation Phenylketonuria (PKU) is a recessive hereditary defect of metabolism that, if untreated, causes severe mental retardation. It is not related to congenital heart defects, increased intracranial pressure, or to a strangulated intestine.

The nurse is caring for a newborn of a substance abusing mother who is withdrawing from alcohol. Which of the following would the nurse likely see in this newborn?

Newborn is hyperactive and irritable The newborn that is withdrawing from alcohol typically is hyperactive, irritable, has trouble sleeping, and may have tremors or seizures. Characteristics of FAS include low birth weight, and small height and head circumference. This newborn is prone to respiratory difficulties, hypoglycemia, hypocalcemia, and hyperbilirubinemia.

A newborn is found to have hemolytic disease. Which of the following would most likely be found related to the blood types of this newborn and the parents of the newborn?

Newborn who is type A, mother who is type O Hemolytic disease today is principally the result of ABO incompatibility. The most common incompatibility in the newborn occurs between a woman with type O blood and an infant with type A or B blood.

A 3-month-old girl is found to have an umbilical hernia at a well visit. On examination, the nurse discovers that the fascial ring through which the intestine protrudes is about 1 cm in diameter. Which of the following should she mention to the girl's father as the likely intervention required to correct this condition?

No intervention is needed, as the opening will most likely close spontaneously An umbilical hernia is a protrusion of a portion of the intestine through the umbilical ring, muscle, and fascia surrounding the umbilical cord. If the fascial ring through which the intestine protrudes is less than 2 cm, closure will usually occur spontaneously after the child begins to walk so no repair of the disorder will be necessary. If the fascial ring is larger than 2 cm, ambulatory surgery for repair is generally indicated to prevent herniation and intestinal obstruction or bowel strangulation. This is usually done at 1 to 2 years of age. Some parents believe holding an umbilical hernia in place by using "belly bands" or taping a silver dollar over the area will help reduce the hernia. These actions can actually lead to bowel strangulation so should be avoided.

A ventilated 33 weeks' gestation newborn in the neonatal intensive care unit (NICU) receives surfactant therapy. Which would the nurse expect to assess as a positive response to this therapy?

Oxygen saturation levels are at 98%. Rescue treatment is indicated for newborns with established RDS who require mechanical ventilation and supplemental oxygen. The earlier the surfactant is administered, the better the effect on gas exchange with an aim to have the O2 saturation level of 98%. Glucose level assessment does not correlate with this therapy. The HR of 60 bpm is an abnormal finding and not a positive result of the therapy. The PaCO2 indicates respiratory acidosis

The nurse is changing the diaper on a newborn and notices that there is a musty smell to the infant's urine. This finding is a characteristic sign of which of the following disorders?

Phenylketonuria There is a characteristic musty smell to the urine in the child with Phenylketonuria. None of the other disorders effect the urine or the smell of the urine.

An infant is diagnosed with Pierre Robin sequence. Which of the following is the most important instruction for the nurse to give to the infant's mother?

Place the child in a side-lying position for sleep Obstruction is most likely to occur when the child sleeps in a supine position. Unlike well infants, therefore, infants with this syndrome should not be placed in a supine position to sleep as they are in grave danger of anoxia if left in this position. Use a side-lying position instead. The other answers refer to interventions for other conditions, such as torticollis (looking toward the affected side) and talipes (passive stretching of the foot and examining for signs of poor circulation)

A nurse is caring for a newborn client after birth who is diagnosed with myelomeningocele. Which nursing intervention would protect the newborn from injury?

Place the newborn in a prone or lateral position. The nurse should place the newborn in a prone or lateral position to keep pressure off the spinal sac and avoid newborn injury. Parents should be allowed to hold the stable infant with assistance. The spinal sac should be kept covered and moist until surgery to avoid rupture. Collecting urine decreases the risk of urine stasis, which is sometimes common in spinal defects

A nurse is caring for a newborn with a repaired cleft lip. What intervention can the nurse provide to facilitate drainage of mucus and secretions to prevent aspiration?

Position the child on the side To facilitate drainage of mucus and secretions, the nurse should position the infant on the side, never on the abdomen, after a cleft lip repair.

A nurse is caring for a newborn with a repaired cleft lip. What intervention can the nurse provide to facilitate drainage of mucus and secretions to prevent aspiration?

Position the child on the side. To facilitate drainage of mucus and secretions, the nurse should position the infant on the side, never on the abdomen, after a cleft lip repair.

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 insert an NG tube to low suction. The preoperative nursing care focuses on preventing aspiration by elevating the head of the bed and insertion of an NG tube to low suction to prevent aspiration. Documenting the amount and color of drainage is not needed with the NG tube in place. An infant with esophageal atresia is NPO and fed nothing until after repairing the defect. Administering antibiotics and total parenteral nutrition is a postoperative nursing intervention when caring for a newborn with esophageal atresia.

A nurse is working with a child who has spina bifida. The highest priority nursing goal for this child would be which of the following?

Preventing infection The highest priority nursing goal is preventing infection because of the vulnerability of the myelomeningocele sac. Promoting comfort is important but not as high a priority because the child does not usually have severe pain with this diagnosis. Reducing anxiety and teaching are lower priorities; physical is a higher priority than psychosocial.

An infant is suspected of having persistent pulmonary hypertension of the newborn (PPHM). What intervention implemented by the nurse would be most beneficial in treating this client?

Provide oxygen by oxygen hood or ventilator. The nurse should administer oxygen to the infant in whatever manner needed to help maintain the infant's oxygen levels. Anticonvulsants are not necessary in treating this disorder. The infant's physical environment should be warm, not cool, and stimulation should be limited for these clients.

In the pre-term newborn, which of the following body systems are the most critical complications related to?

Respiratory The pre-term newborn's physiologic immaturity causes many difficulties involving virtually all body systems, the most critical of which is the respiratory system.

An infant has just been born with a cleft lip and palate. The birthing room suddenly becomes very quiet, and the birth team seem somber. The health care provider is busy examining the newborn, but the mother is obviously aware that something is not right. What should the nurse do?

Say to the parents, "Your son has been born with a cleft lip and palate. This condition is highly treatable by surgery, however, and he is otherwise in excellent health." Nurses need to be familiar with the most frequently encountered physical or developmental anomalies which are present at birth so, as the person who at that moment in the birth process is most available for client education, they can explain the problem to parents. It is a good rule to explain to parents what the disorder consists of and what the usual prognosis is before showing the baby to them as parents may find it hard to look at an infant with a cleft lip or palate or exposed abdominal contents, for example, and listen at the same time.

An infant has just been born with a cleft lip and palate. The birthing room suddenly becomes very quiet, and the birth team seem somber. The physician is busy examining the newborn, but the mother is obviously aware that something is not right. Which of the following should the nurse do?

Say to the parents, "Your son has been born with a cleft lip and palate. This condition is highly treatable by surgery, however, and he is otherwise in excellent health." Nurses need to be familiar with the most frequently encountered physical or developmental anomalies which are present at birth so, as the person who at that moment in the birth process is most available for patient education, they can explain the problem to parents. It is a good rule to explain to parents what the disorder consists of and what the usual prognosis is before showing the baby to them as parents may find it hard to look at an infant with a cleft lip or palate or exposed abdominal contents, for example, and listen at the same time.

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

See-saw respirations Typically the newborn with RDS demonstrates signs and symptoms of severe respiratory distress at birth or within a few hours of birth. Fine, inspiratory crackles are noted on auscultation of a newborn with RDS. See-saw respirations are characteristic of RDS. A newborn with RDS typically demonstrates generalized cyanosis

What treatment can the nurse anticipate assisting with for a newborn with congenital talipes equinovarus?

Serial casting Treatment for congenital talipes equinovarus starts during the neonatal period. Correction can usually be accomplished by manipulation and bandaging or by application of a cast. Casts are changed frequently to provide gradual, atraumatic correction--every few days for the first several weeks

A nurse is caring for a newborn with jaundice undergoing phototherapy. What intervention is appropriate when caring for the newborn?

Shield the newborn's eyes The nurse should shield the newborn's eyes and cover the genitals to protect these areas from becoming irritated or burned when using direct lights and to ensure exposure of the greatest surface area. The nurse should place the newborn under the lights or on the fiberoptic blanket, exposing as much skin as possible. Breast or bottle feedings should be encouraged every 2 to 3 hours. Loose, green, and frequent stools indicate the presence of unconjugated bilirubin in the feces. This is normal; therefore, there is no need for therapy to be discontinued. Lack of frequent green stools is a cause for concern.

A newborn with newly diagnosed hemolytic jaundice is being treated with phototherapy. Which actions should the nurse take? Select all that apply.

Shield the newborn's genitals and eyes during phototherapy sessions. Encourage the mother to breastfeed (8 to 12 feedings per day). Supplement breast milk with formula. Expose as much of the newborn's skin as possible. For the newborn receiving phototherapy, place the newborn under the lights or on the fiber-optic blanket, exposing as much skin as possible. Cover the newborn's genitals and shield the eyes to protect these areas from becoming irritated or burned when using direct lights. Assess the intensity of the light source to prevent burns and excoriation. Turn the newborn every 2 hours to maximize the area of exposure, removing the newborn from the lights only for feedings. Maintain a neutral thermal environment to decrease energy expenditure, and assess the newborn's neurologic status frequently. Research is finding that intermittent versus continuous phototherapy is as efficacious to lower bilirubin levels. Assess the newborn's temperature every 3 to 4 hours as indicated. Monitor fluid intake and output closely.

A nurse is performing a newborn assessment and notices a small dimple on the sacral area. The infant has a normal neurological assessment and moves all extremities well. What does the nurse suspect that the dimple indicates?

Spina bifida occulta Spina bifida occulta is a bony defect that occurs without soft-tissue involvement. A dimple in the skin or a tuft of hair over the site may arous suspicion of its presence, or it may be overlooked entirely

A 6-week gestation client 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 Folic acid assists in preventing the incidence of neural tube disorders. These foods include green, leafy vegetables, citrus fruits, beans, and fortified breads, cereals, rice, and pasta. Milk, yogurt, and cheese are high in calcium. Bananas, avocados, and coconut are high in potassium. Pork, beans, and poultry are high in iron.

While the nurse is weighing and measuring a toddler during his annual checkup, the toddler's mother mentions that she is thinking of having another child. The toddler is small in stature and seems mildly developmentally delayed. His eyelid folds are short and his nose is flat. What do the toddler's characteristics suggest is the best advice the nurse can give this mother about pregnancy?

Stop drinking alcohol 3 months before trying to get pregnant Alcohol is one of the many teratogenic substances that cross the placenta to the fetus. Fetal alcohol syndrome is often apparent in newborns of mothers with chronic alcoholism and sometimes appears in newborns whose mothers are low-to-moderate consumers of alcohol. No amount of alcohol is believed to be safe, and women should stop drinking at least 3 months before they plan to become pregnant. The ability of the mother's liver to detoxify the alcohol is apparently of greater importance than the actual amount consumed. Fetal alcohol syndrome is characterized by low birth weight, smaller height and head circumference, short palpebral fissures (eyelid folds), reduced ocular growth, and a flattened nasal bridge. These newborns are prone to respiratory difficulties, hypoglycemia, hypocalcemia, and hyperbilirubinemia. Their growth continues to be slow and their mental development is retarded despite expert care and nutrition.

What medication does the nurse anticipate administering to the preterm newborn as an inhalant to improve the lungs' ability to mature?

Surfactant Treatment begins shortly after birth with synthetic or natural surfactant, obtained from animal sources or extracted from human amniotic fluid. The newborn receives surfactant as an inhalant through a catheter inserted into an endotracheal tube. The therapy may be preventive for development of respiratory distress syndrome in the newborn at risk.

The nurse is developing a plan of care for a neonate experiencing symptoms of drug withdrawal. What should be included in this plan?

Swaddle the infant between feedings. Supportive interventions to promote comfort include swaddling, low lighting, gentle handling, quiet environment with minimal stimulation, use of soft voices, pacifiers to promote "self-soothing," frequent small feedings, and vertical rocking, which will soothe the newborn's neurological system.

After teaching a group of students about the physiologic jaundice in breast-fed and bottle-fed newborns, the instructor determines that the teaching was successful when the students state which of the following?

The decline in bilirubin levels occurs more quickly in bottle-fed newborns Breast-fed newborns typically have peak bilirubin levels on the fourth day of life; bottle-fed newborns usually have peak bilirubin levels on the third day of life. The rate of bilirubin decline is less rapid in breast-fed newborns compared with bottle-fed newborns. Jaundice associated with breastfeeding presents in two distinct patterns: early-onset and late-onset. Bottle-fed newborns have more frequent bowel movements, thus reducing the bilirubin levels more quickly than breast-fed newborns.

The nurse is caring for an infant born to a mother who abused cocaine during her pregnancy. Which of the following characteristics would the nurse likely see in this infant?

The infant cries when touched

The nurse is caring for a newborn with retinopathy of prematurity (ROP). Which of the following is the best explanation of this disorder?

The infant has a degenerative disease of the retina Retinopathy of prematurity (ROP) is a form of retinopathy (degenerative disease of the retina) commonly associated with the preterm newborn. The immature liver in the preterm infant cannot manage all the bilirubin produced by hemolysis (destruction of red blood cells with the release of hemoglobin), making the infant prone to jaundice and high blood bilirubin levels. Intraventricular hemorrhage (IVH) is a complication of preterm birth in which there is bleeding into the brain's ventricles. In hyaline membrane disease, the premature infant's lungs are deficient in surfactant and thus collapse after each breath, greatly increasing the work of breathing.

The nurse is caring for a newborn with respiratory distress syndrome (RDS). Which explanation best explains this disorder?

The infant's lungs are immature and deficient in surfactant. In RDS, the premature infant's lungs are deficient in surfactant and thus collapse after each breath, greatly increasing the work of breathing. The immature liver in the preterm infant cannot manage all the bilirubin produced by hemolysis (destruction of red blood cells with the release of hemoglobin), making the infant prone to jaundice and high blood bilirubin levels. Intraventricular hemorrhage (IVH) is a complication of preterm birth in which there is bleeding into the brain's ventricles. Retinopathy of prematurity (ROP) is a form of retinopathy (degenerative disease of the retina) commonly associated with the preterm newborn.

The nurse is caring for a newborn with hyaline membrane disease. Which of the following is the best explanation of this disorder?

The infant's lungs are immature and deficient in surfactent In hyaline membrane disease, the premature infant's lungs are deficient in surfactant and thus collapse after each breath, greatly increasing the work of breathing. The immature liver in the preterm infant cannot manage all the bilirubin produced by hemolysis (destruction of red blood cells with the release of hemoglobin), making the infant prone to jaundice and high blood bilirubin levels. Intraventricular hemorrhage (IVH) is a complication of preterm birth in which there is bleeding into the brain's ventricles. Retinopathy of prematurity (ROP) is a form of retinopathy (degenerative disease of the retina) commonly associated with the preterm newborn

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. The nurse should know that the infant's mother more than likely was a diabetic. The large size of the infant born to a diabetic mother is secondary to exposure to high levels of maternal glucose crossing the placenta into the fetal circulation. Common problems among infants of diabetic mothers include macrosomia, respiratory distress syndrome, birth trauma, hypoglycemia, hypocalcemia and hypomagnesemia, polycythemia, hyperbilirubinemia, and congenital anomalies. Listlessness is also a common symptom noted in these infants. Infants born to clients who have abused alcohol, infants who have experienced birth traumas, or infants whose mothers have had long labors are not known to exhibit these particular characteristics, although these conditions do not produce very positive pregnancy outcomes. Infants with fetal alcohol syndrome or alcohol exposure during pregnancy do not usually have hypoglycemia problems.

The nurse is caring for a newborn who was small for gestational age and has been determined to have the condition intrauterine growth restriction (IUGR). Which of the following factors would most likely have contributed to this condition?

The mother of this newborn has a history of abnormal blood glucose levels Uncontrolled maternal diabetes can be a contributing factor for the infant with intrauterine growth restriction. Smoking during pregnancy could be a contributing factor, but being a previous smoker would not affect this pregnancy. Inadequate maternal nutrition is a contributing factor, but because this mother was on a food stamp program she was more likely to have had adequate nutrition during pregnancy. Previous pregnancies with a history of IUGR or other poor pregnancy outcomes would be a possible contributing factor, but not normal pregnancies

A nurse is assessing a newly admitted newborn who is 2 hours old. Which assessment findings would concern the nurse? Select all that apply.

The newborn has visible bilateral nasal flaring. The newborn has visible chest retractions The signs and symptoms of respiratory distress include tachypnea, periodic breathing, apnea, retractions, nasal flaring, grunting, pallor, and cyanosis. These findings require interventions. The blue hands and feet, apical pulse rate, and minimal response to voices are all appropriate for a newborn who is two hours old.

The nurse is checking a newborn for the presence of Ortolani and Barlow signs. For which health problem are these assessments used?

The nurse is caring for a newborn with hemolytic disease of the newborn who is receiving phototherapy. Which of the following nursing interventions would be most appropriate for the nurse to do?

The nurse turns the newborn every 3 or 4 hours Turn the newborn every 3 or 4 hours to rotate the area of exposure. Do not turn off the lights except to feed and to change the diaper. The infant is nude to maximize the skin surface area exposed to the light. Remove the patches every four hours to cleanse the eyes and examine for irritation, inflammation, and/or dryness. Clean and change the patches daily.

The nurse is caring for a newborn with hemolytic disease of the newborn who is receiving phototherapy. Which nursing intervention would be the most appropriate for the nurse to do?

The nurse turns the newborn every 3 or 4 hours. The nurse should turn the newborn every 3 or 4 hours to rotate the area of exposure. Do not turn off the lights except to feed and to change the diaper. The infant is nude to maximize the skin surface area exposed to the light. Remove the patches every four hours to cleanse the eyes and examine for irritation, inflammation, and/or dryness. Clean and change the patches daily.

Which of the following best describes the disorder known as spina bifida with meningocele?

The spinal meninges protrude through the bony defect and form a cystic sac When part of the spinal meninges protrudes through the bony defect and forms a cystic sac, the condition is termed spina bifida with meningocele. In spina bifida with myelomeningocele, there is a protrusion of the spinal cord and the meninges, with nerve roots embedded in the wall of the cyst. A bony defect that occurs without soft-tissue involvement is called spina bifida occulta

The nurse is reinforcing discharge teaching with the mother of an infant who is being discharged prior to having a required blood test done. The nurse explains to this mother that she needs to bring the newborn back to check the infant's phenylalanine level. Which of the following is most accurate related to this blood test?

The test is done after the newborn has ingested protein. As soon as the newborn with phenylketonuria begins to take milk, phenylalanine builds up in the blood serum to as much as 20 times the normal level. This build-up occurs so quickly that increased levels of phenylalanine appear in the blood after only one or two days of ingestion of milk.

The nurse is reinforcing discharge teaching with the mother of an infant who is being discharged prior to having a required blood test done. The nurse explains to this mother that she needs to bring the newborn back to check the infant's phenylalanine level. Which statement is most accurate related to this blood test?

A nurse is providing information for a pregnant woman who has just discovered that the fetus she's carrying is likely to have Down syndrome. Which statement by the nurse is most accurate regarding the possible concerns for a child with Down syndrome?

They have a higher risk of developing leukemia than those in the general population.

The nurse is caring for a newborn who has transient tachypnea of the newborn. In discussing the contributing factors for this disorder which of the following statements is most accurate?

This disorder is often seen in newborns born by cesarean delivery TTN commonly occurs in newborns born by cesarean delivery. The newborn does not experience the compression of the thoracic cavity that occurs with passage through the birth canal, so he or she retains some fluid in the lungs that usually squeezes out as the thoracic area is compressed during a vaginal delivery. Meconium aspiration syndrome is associated with fetal distress during labor, a maternal history of diabetes or hypertension, difficult delivery, and advanced gestational age,

A procedure used in the treatment of the child with hydrocephalus is to surgically insert a shunt that drains cerebrospinal fluid into a chamber in the heart. This type of shunt procedure is referred to as which of the following?

Ventriculoatrial In ventriculoatrial shunting, CSF drains into the right atrium of the heart. In ventriculoperitoneal shunting, the CSF is drained from a lateral ventricle in the brain; the CSF runs through the subcutaneous catheter and empties into the peritoneal cavity. Ventricular septal and Atrial septal refer to congenital heart defects

An infant develops hydrocephalus at 2 weeks of age. Which of the following would you expect to assess?

White sclera showing above the pupils As accumulating cerebrospinal fluid puts pressure on the posterior surface of the eye globes, they tip downward; white sclera shows above the pupils

The neonatal intensive care nurse is assessing a new admission and suspects the newborn to have meconium aspiration syndrome. Which assessment finding would correlate with the nurse's suspicion?

a barrel-shaped chest with an increased anterior-posterior chest diameter Observe the newborn with MAS for a barrel-shaped chest with an increased anterior-posterior chest diameter, prolonged tachypnea, progression of respiratory distress, intercostal retractions, end-expiratory grunting, and cyanosis. Arterial blood gas analysis will indicate metabolic acidosis with a low blood pH, decreased PaO2, and increased PaCO2. The arterial blood gas values listed are normal as well as the vital signs. Acrocynosis is a normal expectation of a newborn immediately after birth.

In the infant diagnosed with spina bifida with myelomeningocele, the infant will likely have:

a partial to complete paralysis in the lower extremities. In spina bifida with myelomeningocele, there is a protrusion of the spinal cord and the meninges, with nerve roots embedded in the wall of the cyst. The effects of this defect vary in severity from sensory loss or partial paralysis below the lesion to complete flaccid paralysis of all muscles below the lesion.

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 hemoglobin The signs and symptoms of IVH include a sudden decrease in hematocrit, a severe and sudden unexplained deterioration of vital signs, bulging fontanels, changes in activity level, and sudden lethargy. The diagnosis is confirmed by cranial ultrasonography. Pink skin with blue extremities is not a critical sign of IVH, nor is the routine calculation of intake and output a critical assessment for IVH.

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 It is necessary to review the maternal history for risk factors associated with RDS. Risk factors in the term infant placing the infant at most risk include a cesarean birth in the absence of preceding labor, male gender, and maternal diabetes, which produces high levels of insulin which inhibit surfactant production. The other infant situations would not be the priority.

When providing care to a newborn with necrotizing enterocolitis (NEC), the nurse would need to report which finding immediately?

abdomen appearing red and shiny An abdomen that appears red and shiny in a newborn with NEC indicates peritonitis and must be reported immediately. A decrease in abdominal girth, stools negative for blood, and active bowel sounds suggest that the condition is resolving.

When providing care to a newborn with necrotizing enterocolitis (NEC), which of the following would the nurse need to report immediately?

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

A pregnant woman gives birth to a small for gestational age neonate who is admitted to the neonatal intensive care unit with seizure activity. The neonate appears to have abnormally small eyes and a thin upper lip. The infant is noted to be microcephalic. Based on these findings, which substance would the nurse suspect the women of using during pregnancy?

alcohol

alcohol Alcohol is now recognized as the leading preventable cause of birth defects and developmental disorders in the United States. Smoking, recreational drugs, and obesity are also contributing factors.

Assessment reveals that a young mother has several risk factors for giving birth to an infant with a neural tube defect. Which laboratory test would the nurse expect to be used to monitor the fetus for this birth defect?

alpha-fetoprotein levels

alpha-fetoprotein levels In pregnancies in which the fetus has neural tube defect, the level of alpha-fetoprotein in the amniotic fluid and maternal serum is elevated. By monitoring this level throughout the pregnancy, it is possible to be aware of this defect before the birth. Genetic studies, folic acid levels, and cultures for infections are not utilized to detect neural tube defects.

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

antibiotics Prophylactic antibiotics may prevent development of pneumonia.

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 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 Continuous exposure to bright lights by phototherapy may be harmful to a newborn's retina, so the infant's eyes must always be covered while under bilirubin lights. Eye dressings or cotton balls can be firmly secured in place by an infant mask. The lights are placed 12 to 30 inches above the newborn's bassinet or incubator. Bilirubin is removed from the body by being incorporated into feces. Therefore, the sooner bowel elimination begins, the sooner bilirubin removal begins. Early feeding (either breast milk or formula), therefore, stimulates bowel peristalsis and helps to accomplish this. Gently shaking the infant is a method of stimulating breathing in an infant experiencing apnea.

A preterm newborn is noted to be cyanotic. Which laboratory test will the nurse prepare the infant for to determine if the cyanosis is due to respiratory or circulatory problems?

arterial blood gases

A preterm newborn is noted to be cyanotic. Which laboratory test will the nurse prepare the infant for to determine if the cyanosis is due to respiratory or circulatory problems?

arterial blood gases Arterial blood gases are obtained to determine the oxygenation levels and to help differentiate lung disease from heart disease. Chest X-rays will help identify cardiac size, shape, and position. An echocardiogram will evaluate the heart anatomy and flow defects. An angiography will be conducted to prepare for cardiac surgery, if needed.

What are the causes of retinopathy of the preterm newborn? Select all that apply.

assistive ventilation with high oxygen content fragility of blood vessels in the eyes in response to changes on oxygenation. shock Retinopathy of the preterm newborn typically develops in both the eyes secondary to an injury such as hyperoxemia resulting from prolonged assistive ventilation and high oxygen exposure, fragility of retinal blood vessels in response to changes in oxygentaion, and shock. Alkalosis does not contribute to this problem- acidosis does.

What objective data gathered by the nurse could indicate a diagnosis of developmental dysplasia of the hip? Select all that apply.

asymmetry of the gluteal skin folds limited abduction of the affected hip apparent shortening of the femur Signs that are useful after age 1 month are asymmetry of the gluteal skin folds, limited abduction of the affected hip, and apparent shortening of the femur.

The parents are upset their newborn has a cleft lip. When describing the treatment, the nurse should mention that surgical repair can be done:

between the age of 6 to 12 weeks. Treatment of cleft lip is surgical repair between the ages of 6 to 12 weeks. It is important to repair this anomaly as soon as possible to facilitate bonding between the newborn and the parents and to improve nutritional status.

The nurse suspects a preterm newborn receiving enteral feedings of having necrotizing enterocolitis (NEC). What assessment finding best correlates with this diagnosis?

bloody stools

The nurse suspects a preterm newborn receiving enteral feedings of having necrotizing enterocolitis (NEC). What assessment finding best correlates with this diagnosis?

bloody stools NEC assessment includes assessing the newborn's health history and physical examination as well as laboratory and diagnostic testing. The onset of NEC is demonstrated by the development of feeding intolerance, abdominal distention, and bloody stools in a preterm infant receiving enteral feedings. As the disease worsens, the infant develops signs and symptoms of septic shock with RDS, temperature instability, lethargy, hypotension, and oliguria.

A preterm newborn is being monitored for potential necrotizing enterocolitis. The nurse recognizes which factors as major pathologic mechanisms that could lead to this complication? Select all that apply.

bowel ischemia perinatal stressors formula feeding

What is the term for a small collection of blood that forms underneath the skull as a result of birth trauma?

cephalhematoma Vernix caseosa is a thick white substance found on a newborn. Erythema toxicum is a newborn rash. Caput succedaneum is molding or edema.

Periventricular 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 diagnostic tool of choice to detect periventricular hemorrhage is a cranial ultrasound. Arterial blood gases would be helpful in evaluating for metabolic acidosis. Blood glucose levels provide information about the newborn's glucose stability. Chest X-ray would provide no information related to bleeding in the brain.

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

cries when touched. Developmental delays occur in young children of substance abusers. Infants of cocaine abusers do not like to be touched or held and avoid the caregiver's gaze, which contributes to bonding delays. Infants of cocaine abusers are often restless and below average weight when born.

The nurse assesses an infant. Which finding may indicate heart failure?

diminished peripheral pulses After birth, the nurse should carefully assess the newborn's cardiovascular and respiratory systems, looking for signs and symptoms of respiratory distress, cyanosis, or congestive heart failure that might indicate a cardiac anomaly. Assess rate, rhythm, and heart sounds, reporting any abnormalities immediately. Note any signs of heart failure, including edema, diminished peripheral pulses, hepatomegaly, tachycardia, diaphoresis, respiratory distress with tachypnea, peripheral pallor, and irritability. Capillary refill time and the color of the infant's hands and feet are important to note, but do not indicate possible heart failure and neither does the blood glucose level.

The nurse is feeding a 2-day-old in the nursery when the infant begins choking and becomes cyanotic. Frothy sputum is observed coming from the mouth. What congenital malformation does the nurse understand these symptoms indicate?

esophageal atresia Any mucus or fluid that a newborn with esophageal atresial swallows enters the blind pouch of the esophagus. The pouch fills and overflows, usually resulting in aspiration into the trachea. The newborn with this disorder has frothing, excessive drooling, and periods of respiratory distress with choking and cyanosis.

esophageal atresia Any swallowed mucus or fluid enters the blind pouch of the esophagus when a newborn suffers from esophageal atresia. The newborn with this disorder will have frothing, excessive drooling, and periods of respiratory distress with choking and cyanosis. If this happens no feedings should be given until the newborn has been examined.

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 Expiratory grunting, a barrel-shaped chest with an increased anterior-posterior chest diameter, prolonged tachypnea, progression from mild-to-severe respiratory distress, intercostal retractions, cyanosis, surfactant dysfunction, airway obstruction, hypoxia, and chemical pneumonitis with inflammation of pulmonary tissues are seen in a newborn with meconium aspiration syndrome. A high-pitched cry may be noted in periventricular hemorrhage/intraventricular hemorrhage. Bile-stained emesis occurs in necrotizing enterocolitis. Intermittent tachypnea can be indicative of transient tachypnea of the newborn or any mild respiratory distress problem.

A nurse is assessing a newborn for jaundice. The nurse would first notice jaundice at which area?

face Neonatal jaundice first becomes visible in the face and forehead. Identification is aided by pressure on the skin, since blanching reveals the underlying color. Jaundice then gradually becomes visible on the trunk and extremities.

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 Manifestations of neonatal abstinence syndrome include: CNS dysfunction such as hyperactive reflexes resulting in exaggerated Babinski and Moro reflexes; hypertonic muscle tone and constant movement; metabolic, vasomotor, and respiratory disturbances with frequent yawning and sneezing; gastrointestinal dysfunction, including poor feeding; and frantic sucking or rooting. Acrocyanosis is a normal newborn finding which is cyanotic discoloration of the extremities.

The nurse is caring for a newborn who was small for gestational age and has been determined to have the condition intrauterine growth restriction (IUGR). It is most likely that the mother of this newborn:

has a history of abnormal blood glucose levels. Uncontrolled maternal diabetes can be a contributing factor for the infant with intrauterine growth restriction. Smoking during pregnancy could be a contributing factor, but being a previous smoker would not affect this pregnancy. Inadequate maternal nutrition is a contributing factor, but because this mother was on a food stamp program she was more likely to have had adequate nutrition during pregnancy. Previous pregnancies with a history of IUGR or other poor pregnancy outcomes would be a possible contributing factor, but not normal pregnancies.

The nurse is caring for 22-hour-old neonate Antonio, who had a good Apgar score, nursed without difficulty, and seemed healthy when the nursing shift began. As the nurse's shift goes on, the nurse notices that the whites of his eyes and his skin have begun to take on a yellow hue. The nurse would report this as a possible indication of what condition?

hemolytic disease Any infant admitted to the newborn nursery should be examined for jaundice during the first 36 hours or more. Early development of jaundice (within the first 24-48 hours) is a probable indication of hemolytic disease. Heroin withdrawal symptoms commonly include tremors, restlessness, hyperactivity, disorganized or hyperactive reflexes, increased muscle tone, sneezing, tachypnea, vomiting, diarrhea, disturbed sleep patterns, and a shrill high-pitched cry. The hypoglycemic newborn's blood glucose would be low and a newborn with hypoxia would show signs of respiratory distress.

A nurse is assigned to care for a high-risk newborn with a periventricular-intraventricular hemorrhage (PVH-IVH) in the home environment after discharge. For which condition should the nurse monitor the infant?

hydrocephalus A significant number of newborns with PVH-INH will incur brain injury, leading to complications that may include hydrocephalus. The nurse should monitor for the incidence of hydrocephalus in this high-risk newborn. Urinary tract infection is not condition that persists after discharge. Spina bifida is most often noted at birth and would not to need to be assessed for by the nurse. Formula intolerance is not specific to high-risk newborns.

For which condition would the nurse commonly assess in an infant following surgery for a myelomeningocele?

hydrocephalus Surgery includes removing a portion of the meninges; without the surface to absorb cerebral spinal fluid, hydrocephalus can result.

The nurse is caring for a newborn of a substance-abusing mother who is withdrawing from alcohol. Which finding would the nurse likely see in this newborn?

hyperactive and irritable The newborn that is withdrawing from alcohol typically is hyperactive, irritable, has trouble sleeping, and may have tremors or seizures. Characteristics of FAS include low birth weight, and small height and head circumference. This newborn is prone to respiratory difficulties, hypoglycemia, hypocalcemia, and hyperbilirubinemia.

In addition to newborns of diabetic mothers being at risk for hypoglycemia, these newborns are also at risk for which condition?

hypocalcemia The newborn of the diabetic mother is at risk for hypocalcemia, hypomagnesemia, polycythemia with hyperviscosity, and hyperbilirubinemia. Potassium concerns are not a risk for these newborns.

Over the course of an eight-hour shift of postoperative care for a child who has had ventriculoatrial shunt placement, the nurse notes that the child's cry has become increasingly shrill and the child has projectile vomiting. The nurse would notify the primary care provider immediately because of the possibility that the child might be experiencing:

increased intracranial pressure. Symptoms of increased intracranial pressure (IICP) may include irritability, restlessness, personality change, high-pitched cry, ataxia, projectile vomiting, failure to thrive, seizures, severe headache, changes in level of consciousness, and papilledema. At least every 2-4 hours, the nurse should monitor the newborn's level of consciousness, check the pupils for equality and reaction, monitor the neurologic status, and observe for a shrill cry, lethargy, or irritability.

A pre-term newborn is noted to have hypotonia, apnea, bradycardia, a bulging fontanelle, cyanosis, and increased head circumference. These signs indicate the newborn most likely has which of the following complications?

intraventricular hemorrhage (IVH) Signs that may accompany IVH include hypotonia, apnea, bradycardia, a full (or bulging) fontanelle, cyanosis, and increased head circumference.

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

intraventricular hemorrhage (IVH) Signs that may accompany IVH include hypotonia, apnea, bradycardia, a full (or bulging) fontanelle, cyanosis, and increased head circumference.

In the infant with developmental dysplasia of the hip (DDH), which sign would likely be noted?

limited abduction of the affected hip The infant with DDH usually has limited abduction of the affected hip. They have asymmetry of the gluteal skin folds and shortening of the femur. Adduction is not a concern.

Which finding is common in the child who has a ventricular septal defect?

loud, harsh murmur Children with ventricular septal defects have a characteristic loud, harsh murmur. Fatigue and dyspnea, delayed growth and development, and a bounding pulse are seen in the child with patent ductus arteriosus

A newborn is diagnosed with respiratory distress syndrome (RDS). While assessing the newborn, the nurse realizes that which maternal factor would most place the infant at risk for RDS?

maternal gestational diabetes Prolonged rupture of membranes, gestational or chronic maternal hypertension, maternal narcotic addiction, and the use of prenatal corticosteroids reduces the newborn's risk for RDS because of the physiologic stress imposed on the fetus. Chronic stress experienced by the fetus in utero accelerates the production of surfactant before 35 weeks' gestation and thus reduces the incidence of RDS at birth. Maternal diabetes produces high levels of insulin that inhibits surfactant production thus placing the newborn more at risk for developing RDS.

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 The nurse should assess for meconium aspiration syndrome in the newborn. Meconium aspiration involves patchy, fluffy infiltrates unevenly distributed throughout the lungs and marked hyperaeration mixed with areas of atelectasis that can be seen through chest X-rays. Direct visualization of the vocal cords for meconium staining using a laryngoscope can confirm aspiration. Lung auscultation typically reveals coarse crackles and rhonchi. Arterial blood gas analysis will indicate metabolic acidosis with a low blood pH, decreased PaO2, and increased PaCO2. Newborns with choanal atresia, diaphragmatic hernia, and pneumonia do not exhibit to exhibit these manifestations.

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 Midclavicular fractures most often occur during births of newborns with macrosomia. The newborn is irritable and does not move the arm on the affected side either spontaneously or when the Moro reflex is elicited. A brachial plexus injury usually presents with the extremity adducted and internally rotated with absent shoulder movement. Phrenic nerve palsy is not associated with birth injuries and is caused by lesions along the phrenic nerve. The newborn does not demonstrate signs of cranial nerve trauma, which would be evident in the face.

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 Observations for the developemnt of NEC in the preamture newborn may include feeding intolerance with abdominal distention tenderness and bloody or hemoccult-positive stools. Diarrhea is present with NEC and worsening of respiratory distress. Decreased or absent bowel sounds are noted. Rotavirus causes inflammation of a child's stomach and digestive tract, usually triggering vomiting, diarrhea, and fever and not seen in a preterm infant. Garamycin-resistant bacteria is usually seen in older adults.

A newborn is found to have hemolytic disease. Which combination would be found related to the blood types of this newborn and the parents of the newborn?

newborn who is type A, mother who is type O Hemolytic disease today is principally the result of ABO incompatibility. The most common incompatibility in the newborn occurs between a woman with type O blood and an infant with type A or B blood.

When planning preoperative care for a newborn with a cleft lip and palate, a major need for which the nurse would plan interventions is:

nutrition. An infant with a cleft lip is unable to suck effectively, so obtaining adequate nutrition is a major concern

The nurse is changing the diaper on a newborn and notices that there is a musty smell to the infant's urine. This finding is a characteristic sign of which disorder?

phenylketonuria There is a characteristic musty smell to the urine in the child with phenylketonuria. None of the other disorders affect the urine or the smell of the urine.

A woman who has a history of cocaine abuse gives birth to a newborn. Which findings would the nurse expect to assess in the newborn? Select all that apply.

piercing cry poor sucking inconsolable

A 30 weeks' gestation neonate born with low Apgar scores is in the neonatal intensive care unit with respiratory distress syndrome and underwent an exchange transfusion for anemia. Which factors place the neonate at risk for necrotizing enterocolitis? Select all that apply

preterm birth respiratory distress syndrome low Apgar scores exchange transfusion

preterm birth respiratory distress syndrome low Apgar scores exchange transfusion The predisposing factors for the development of necrotizing enterocolitis include preterm labor, respiratory distress syndrome, exchange transfusion, and low birth weight. Low Apgar scores, hypothermia, and hypoglycemia are also risk factors.

A nurse is providing preoperative care to a female newborn client with the congenital abnormality myelomeningocele. Which intervention is the priority?

preventing infection

A nurse is working with a child who has spina bifida. Which nursing goal for this child would have the highest priority?

preventing infection The highest priority nursing goal is preventing infection because of the vulnerability of the myelomeningocele sac. Promoting comfort is important but not as high a priority because the child does not usually have severe pain with this diagnosis. Reducing anxiety and teaching are lower priorities; physical is a higher priority than psychosocial.

The nurse is caring for a baby born to a mother with a history of alcohol abuse. For what characteristics should the nurse observe to determine if the newborn has fetal alcohol syndrome? Select all that apply.

reduced ocular growth short palpebral fissures flattened nasal bridge The newborn withdrawing from alcohol typically is hyperactive and irritable, has trouble sleeping, and may have tremors or seizures. Characteristics of fetal alcohol syndrome (FAS) include low birth weight, small height and head circumference, short palpebral fissures, reduced ocular growth, and a flattened nasal bridge.

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 Typically the newborn with RDS demonstrates signs and symptoms of severe respiratory distress at birth or within a few hours of birth. Fine, inspiratory crackles are noted on auscultation of a newborn with RDS. See-saw respirations are characteristic of RDS. A newborn with RDS typically demonstrates generalized cyanosis.

What treatment can the nurse anticipate assisting with for a newborn with congenital talipes equinovarus?

serial casting Treatment for congenital talipes equinovarus starts during the neonatal period. Correction can usually be accomplished by manipulation and bandaging or by application of a cast. Casts are changed frequently to provide gradual, atraumatic correction—every few days for the first several weeks.

Which newborn would the nurse suspect to be most at risk for cognitive challenge 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 Fetal alcohol syndrome is one of the most common known causes of cognitive challenge. The newborn is also at risk for fetal alcohol spectrum disorder and other alcohol-related birth defects. The other illicit drugs are not linked to mental retardation but have many other teratogenic effects on the fetus/newborn. Marijuana has not shown to have teratogenic effects on the fetus.

A nurse working in the newborn observational unit is assigned four newborns closely being monitored. Which newborn is at greatest risk of developing respiratory distress syndrome?

the male preterm infant born by cesarean birth with cold stress The most common factor is a premature birth with additional factors of cesarean births and cold stress. Vaginal births and a parental history of asthma do not correlate with RDS. A positive Babinski reflex is normal in newborns and children up to 2 years old. Maternal hypertension with a term birth as well do not correlate.

Following birth, the newborn's independent circulatory system is established. If there is an abnormal opening between the chambers in the heart, which cardiac defect may occur?

ventricular septal defect A ventricular septal defect is the most common intracardiac defect. It consists of an abnormal opening in the septum between the two ventricles.

An infant is born with a myelomeningocele. An important nursing assessment you would make with her would be to see if she

voids continually or at spaced intervals. Infants without innervation to the lower spinal cord do not have bladder control and thus void continually.

An infant develops hydrocephalus at 2 weeks of age. Which finding would the nurse expect to assess?

white sclera showing above the pupils As accumulating cerebrospinal fluid puts pressure on the posterior surface of the eye globes, they tip downward; white sclera shows above the pupils.

A mother brings her 1-month-old daughter in for a visit to the doctor's office and mentions that her daughter tends to tilt her head to one side and rotates her chin to the opposite side. The nurse explains that this is a condition called torticollis and explains the interventions that are commonly used to correct this condition. Which of the following should she mention to the mother? (Select all that apply.)

• Performing passive stretching exercises • Feeding the child in such a way as to cause her to look toward the affected shoulder • Placing a mobile on the child's crib on the affected side Torticollis (wry neck) occurs as a congenital anomaly when the sternocleidomastoid muscle is injured and bleeds during birth. The infant holds the head tilted to the same side as the muscle which is involved; the chin rotates to the opposite side. To relieve torticollis, parents need to begin a program of passive stretching exercises, laying the infant on a flat surface and rotating the head through a full range of motion. In addition, parents should always encourage the infant to look in the direction of the affected muscle. They can encourage this by holding the child to feed in such a position the child must look in the desired direction. Placing a mobile on the child's crib can encourage the child to look toward the affected side. Speaking to and handing the child objects from the affected side is another helpful exercises. Botulism injections are not recommended or necessary for most infants. An ice pack application would not be effective in treating this condition.

A woman who has a history of cocaine abuse gives birth to a newborn. Which of the following would the nurse expect to assess in the newborn? Select all that apply.

• Piercing cry • Poor sucking • Inconsolable The cocaine-exposed newborn typically is fussy, irritable, and inconsolable. The newborn has a piercing cry and difficulty coordinating sucking and swallowing. He or she has poor sleep patterns and demonstrates stiff, hyperextended positioning.

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.

During a clinical conference, a group of nursing students are discussing a newborn that is large for gestational age. The instructor determines the students have successfully differentiated the potential cause after choosing which contributing maternal factor?

Being 30 pounds overweight before getting pregnant

A nursing student is caring for a newborn with a defect in the neural arch where the posterior laminae of the vertebrae have failed to close. The nurse knows that this infant is suffering from which disorder?

Spina bifida

The nurse is caring for a newborn client newly diagnosed with dysplasia of the hip. Which response by the nurse educates the parents on the correct plan of treatment for this diagnosis?

"Treatment will begin immediately."

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."

Which of the following instructions would the nurse include in the teaching plan for a mother of a substance-exposed newborn?

"Wrap him snugly in a blanket and gently rock him if he is fussy" The newborn should be positioned upright with the chin down and supported to facilitate the newborn's sucking and swallowing. All newborns should sleep or nap on their back, not their stomachs. Snugly wrapping the newborn and gentle rocking help to decrease irritability behaviors. A pacifier is useful in satisfying the newborn's need for nonnutritive sucking.

Immediately after birth, the nurse is caring for a newborn with a myelomeningocele. What intervention should the nurse provide to prevent drying out of the sac to avoid damage?

Apply a sterile dressing moistened in a warm sterile saline solution.

The nurse caring for a newborn notes a distended abdomen approximately 24 hours after birth. Which action should the nurse prioritize after review of the medical record reveals an apparent healthy newborn at birth but no documentation of a bowel movement

Inform the RN and/or primary care provider immediately

When providing care to a newborn with necrotizing enterocolitis (NEC), the nurse would need to report which finding immediately?

abdomen appearing red and shiny

The parents are upset their newborn has a cleft lip. When describing the treatment, the nurse should mention that surgical repair can be done:

between the age of 6 to 12 weeks.

The nurse assesses an infant. Which finding may indicate heart failure?

diminished peripheral pulses

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

A newborn is found to have hemolytic disease. Which combination would be found related to the blood types of this newborn and the parents of the newborn?

newborn who is type A, mother who is type O

It would be best to place an infant with a myelomeningocele in which position prior to surgery?

on the stomach (prone)

The nurse is caring for a patient who has gone into labor 6 weeks early and whose amniocentesis has shown a lack of lecithin. Of the following interventions, which would the nurse most likely do first?

Administer a glucocorticosteroid to the mother

When planning preoperative care for a newborn with a cleft lip and palate, a major need for which the nurse would plan interventions is:

Nutrition

When planning preoperative care for a newborn with a cleft lip and palate, a major need for which you would plan interventions is

Nutrition An infant with a cleft lip is unable to suck effectively, so obtaining adequate nutrition is a major concern.

A ventilated 33 weeks' gestation newborn in the neonatal intensive care unit (NICU) receives surfactant therapy. Which would the nurse expect to assess as a positive response to this therapy?

Oxygen saturation levels are at 98%.

A nurse is caring for a newborn with a repaired cleft lip. What intervention can the nurse provide to facilitate drainage of mucus and secretions to prevent aspiration?

Position the child on the side

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 insert an NG tube to low suction.

The nurse is preparing a nursing care plan for an infant who was born with spina bifida with myelomeningocele. Which nursing goal should the nurse prioritize for this child?

Preventing infection

An infant is suspected of having persistent pulmonary hypertension of the newborn (PPHM). What intervention implemented by the nurse would be most beneficial in treating this client?

Provide oxygen by oxygen hood or ventilator.

The nurse assesses preterm infants as they come for routine well-baby checkups. The nurse will carefully assess the infant's vision to assess for which potential complication related to their birth?

Retinopathy

Four weeks before the birth of her already large child, the physician has told the pregnant woman that if the baby gets bigger and his lungs are ready, the physician would like to perform a cesarean to deliver the baby. The woman asks the nurse what the downside is to having a cesarean rather than a vaginal delivery. 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." Rationale: Transient tachypnea of the newborn (TTN) involves the development of mild respiratory distress in a newborn. TTN results from a delay in absorption of fetal lung fluid after birth. As the fetus passes through the birth canal during delivery, some of the fluid is expelled as the thoracic area is compressed. TTN is commonly seen in newborns born by cesarean delivery. It typically occurs after birth with the greatest degree of distress occurring approximately 36 hours after birth. TTN commonly disappears spontaneously around the third day

The nurse is teaching the caregivers of an infant diagnosed with hypospadias how to properly care for the infant. The nurse determines the session is successful when the caregivers make which statement?

"Being able to most likely correct this in one stage rather than several is reassuring."

A client who gave birth 2 hours ago expresses concern about her baby developing jaundice. Which response from the nurse would be best?

"I understand your concern because as many as 50% of babies can develop jaundice."

The nurse is working with an adult female who has PKU and desires to become pregnant. The nurse notes on her assessment her current serum phenylalanine level is 10 mg/dL. Which instruction should the nurse prioritize for this client?

"It will be best if you cut back on meat, fish, and dairy products before you become pregnant to get your serum phenylalanine level down under 8 mg."

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

A newborn is scheduled for casting to correct a talipes disorder. You would advise her parents that the cast will extend

Above the knee

A nursing instructor is teaching about newborn congenital disorders and realizes that the student needs further instruction upon making which of the following statements? a) All congenital disorders can be diagnosed at birth. b) Hydrocephalus may not be diagnosed until after a few weeks or months of life. c) Hydrocephalus may be recognized at birth. d) Congenital defects may be caused by genetic or environmental factors.

All congenital disorders can be diagnosed at birth All congenital disorders are not diagnosed at birth. Hydrocephalus is one such disorder that may be diagnosed at birth but also may not be diagnosed until after a few weeks or months. It is also true that congenital defects may be caused by both genetics and environmental factors.

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.

Which clinical manifestation is seen in the child with hydrocephalus?

An extremely large and rapidly growing head

One of the clinical manifestations seen in the child with hydrocephalus is which of the following?

An extremely large and rapidly growing head An excessively large head at birth is suggestive of hydrocephalus. Rapid head growth with widening cranial sutures is also strongly suggestive and may be the first manifestation of this condition

What is the term for a small collection of blood that forms underneath the skull as a result of birth trauma?

Cephalhematoma

Which assessment findings are most prominent in the infant with Tetralogy of Fallot and significant pulmonary stenosis?

Dyspnea on limited exertion, fatigue, cyanosis

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

Intraventricular hemorrhage (IVH)

An infant with hydrocephalus is scheduled to have a ventriculoperitoneal shunt inserted. Immediately following the procedure, which nursing action would best prevent decompression from excessive CSF flow?

Keeping the head of the infant level with the body Rationale: Keeping the infant's head fairly even with the rest of the body prevents gravity from moving more fluid into the shunt than necessary

The nurse is assessing the newborn male of a teen mother who was afraid to seek appropriate prenatal care. Which assessment finding should lead the nurse to question if this infant is preterm?

Lanugo on the back and shoulders

A newborn is diagnosed with congenital hypothyroidism prior to discharge from the hospital. What medication does the nurse anticipate administering to the newborn?

Levothyroxine rationale: The thyroid hormone must be replaced as soon as the diagnosis is made. Levothyroxine sodium, a synthetic thyroid hormone replacement, is the drug most commonly used.

The nurse cares for preterm infants and assesses them for potential complications to provide adequate countermeasures to prevent futher complications. Which complication should the nurse prioritize and initiate proper measures to protect the newborn?

Loss of body heat

Spina bifida rationale: Spina bifida is a failure of the posterior laminae of the vertebrae to close, leaving an opening through which the spinal meninges and spinal cord may protrude. Hydrocephalus is a condition characterized by excess cerebrospinal fluid (CSF) within the ventricular and subarachnoid spaces of the cranial cavity. Cleft palate is a result of failure of the primary and secondary palates to fuse. Esophageal atresia is the absence of a normal opening or abnormal closure of the esophagus.

The nurse manager at a family clinic is identifying ways to address the 2020 National Health Goals for the prevention of birth defects. Which action should the manager encourage all staff to perform when caring for pregnant patients?

Stress the importance of taking prenatal folic acid as prescribed.

The nurse is developing a plan of care for a neonate experiencing symptoms of drug withdrawal. What should be included in this plan?

Swaddle the infant between feedings.

The nurses at a local free clinic are concerned there may be an increase in small-for-gestational age infants in the community. When collecting data to research the situation, the nurses will exclude infants above which category?

The 10th percentile for gestational age

The client brings her infant daughter to the pediatrician's office for her first visit since hospital discharge. At birth, the newborn was at the 8th percentile with a weight of 2,350 g. She was born at 36 weeks' gestation. Which documentation is most accurate?

The infant was a preterm, low birth weight and small for gestational age neonate.

A meconium plug is an extremely hard portion of meconium that has completely blocked the intestinal lumen, causing bowel obstruction.

True

In working with the child or family of a child with a congenital disorder, the most effective nursing intervention for this child or family would be for the nurse to

Use reflective listening and offer nonjudgmental support rationale:Families are naturally apprehensive and find it difficult not to overprotect a child who is ill. They often increase the child's anxiety and cause fear in the child about participating in normal activities. Children are rather sensible about finding their own limitations and usually limit their activities to their capacity if they are not made unduly apprehensive. Some families can adjust well and provide guidance and security for the sick child. Others may become confused and frightened and show hostility, disinterest, or neglect; these families need guidance and counseling. The nurse has a great responsibility to support the family. The nurse's primary goal is to reduce anxiety in the child and family. This goal may be accomplished through open communication and ongoing contact.

Following birth, the newborn's independent circulatory system is established. If there is an abnormal opening between the chambers in the heart, which cardiac defect may occur?

Ventricular septal defect

Following birth the newborn's independent circulatory system is established. If there is an abnormal opening between the chambers in the heart, which of the following cardiac defects may occur?

Ventricular septal defect Explanation: A ventricular septal defect is the most common intracardiac defect. It consists of an abnormal opening in the septum between the two ventricles.

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 hemoglobin

When examining a newborn for developmental hip dysplasia, which motion would the newborn's hip be unable to accomplish?

abduction

When examining a newborn for developmental hip dysplasia, which of the following motions would the newborn's hip be unable to accomplish?

abduction rationale: Infants with shallow acetabulums are unable to abduct their hips.

The nurse is teaching the parents of a newborn who was born with a high type of imperforate anus the care the newborn will need at home after surgery. The parents need to be aware that the newborn will require which measure temporarily?

colostomy

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

cries when touched.

esophageal atresia

esophageal atresia Rationale: Any swallowed mucus or fluid enters the blind pouch of the esophagus when a newborn suffers from esophageal atresia. The newborn with this disorder will have frothing, excessive drooling, and periods of respiratory distress with choking and cyanosis. If this happens no feedings should be given until the newborn has been examined.

A nurse is assessing a newborn for jaundice. The nurse would first notice jaundice at which area?

face

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

hydrocephalus

Over the course of an eight hour shift of postoperative care for a child who has had ventriculoatrial shunt placement, the nurse notes that the child's cry has become increasingly shrill and the child has projectile vomiting. The nurse would notify the physician immediately because of the possibility that the child might be experiencing

increased intracranial pressure Symptoms of increased intracranial pressure (IICP) may include irritability, restlessness, personality change, high-pitched cry, ataxia, projectile vomiting, failure to thrive, seizures, severe headache, changes in level of consciousness, and papilledema. At least every 2-4 hours, the nurse should monitor the newborn's level of consciousness, check the pupils for equality and reaction, monitor the neurologic status, and observe for a shrill cry, lethargy, or irritability.

When evaluating a newborn with congenital clubfoot, the nurse recognizes this condition usually involves:

internal rotation of leg.

It would be best to place an infant with a myelomeningocele in which position prior to surgery?

on the stomach (prone) Placing the infant prone prevents direct trauma to the lesion and reduces the chance that feces will contaminate the lesion.

PN Pediatrics

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