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A nurse is completing the initial assessment on a neonate of a mother with type 1 diabetes. Important assessment areas for this neonate include which of the following? (Select all that apply) a. Assessment of cardiovascular system. b. assessment of respiratory system. c. Assessment of musculoskeletal system. d. Assessment of neurological system.

a. Assessment of cardiovascular system. b. assessment of respiratory system. c. Assessment of musculoskeletal system. d. Assessment of neurological system. -Neonates of mothers with type 1 diabetes are at high risk for cardiac anomalies, risk for RDS due to a delay in surfactant production related to high maternal glucose levels, are usually large and are at risk for a fractures clavicle, and at higher risk for neurological damage and seizures due to neonatal hyperinsulinism.

A nurse is caring for a 10-day-old neonate who was born at 33 weeks' gestation. Which of the following actions assist the nurse in assessing for signs of feeding tolerance? (Select all that apply) a. Check for presence of bowel sounds. b. Assess temperature. c. Check gastric residual by aspirating stomach contents. d. Assess stools.

a. Check for presence of bowel sounds. c. Check gastric residual by aspirating stomach contents. d. Assess stools. -Feedings should be held and physician notified if bowel sounds are absent. Aspirated stomach contents are assessed for amount, color, and consistency. This assists in the evaluation of the degree of digestion and absorption. Stools are assessed for consistency, amount, and frequency. This assists in the evaluation of the degree of digestion and absorption.

Which of the following are common assessment findings of postmature neonates? (Select all that apply) a. Dry and peeling skin. b. Abundant vernix caseosa. c. Hypoglycemia. d. Thin, wasted appearance.

a. Dry and peeling skin. b. Abundant vernix caseosa. c. Hypoglycemia. d. Thin, wasted appearance. -Vernix caseosa covers the fetus' body around 17 to 20 weeks' gestation; as pregnancy advances, the amount of vernix decreases. Vernix prevents water loss from the skin to the amniotic fluid; as the amount of vernix decreases, an increasing amount of water is lost from the skin. This contributes to the dry and peeling skin seen in postmaster neonates. Placental insufficiency related to the aging of the placenta may result in post-maturity syndrome, in which the fetus begins to use its subcutaneous fat stores and glycemic stores. This results in the thin and waster appearance of the neonate and risk for hypoglycemia during the first few hours post-birth.

Which of the following factors increases the risk of necrotizing enterocolitis (NEC) in very premature neonates? (Select all that apply) a. Early oral feedings with formula. b. Prolonged use of mechanical ventilation. c. Hyerbilirubinemia. d. Nasogastric feedings.

a. Early oral feedings with formula. d. Nasogastric feedings. -Preterm neonates have a decreased ability to digest and absorb formula. Undigested formula can cause a blockage in the intestines leading to necrosis of the bowel. Bacterial colonization in the intestines can occur from contaminated feedings tubes causing an inflammatory response in the bowel.

A nurse is caring for a 2-day-old neonate who was born at 31 weeks' gestation. The neonate has a diagnosis of respiratory distress syndrome (RDS). Which of the following medical treatments would the nurse anticipate for this neonate? (Select all that apply) a. Exogenous surfactant. b. Corticosteroids. c. Continuous positive airway pressure (CPAP). d. Bronchodilators.

a. Exogenous surfactant. c. Continuous positive airway pressure (CPAP). -This is a common treatment for RDS. CPAP is used to assist neonates with RDS.

A baby boy was just born to a mother who had positive vaginal cultures for group B streptococci. The mother was admitted to the labor room 30 minutes before the birth. For which of the following should the nursery nurse closely observe this baby? a. Grunting. b. Acrocyanosis. c. Pseudostrabismus. d. Hydrocele.

a. Grunting. -This infant is high risk for respiratory distress. The nurse should observe this baby carefully for grunting.

A neonate is born at 33 weeks' gestation with a birth weight of 2400 grams. This neonate would be classified as: a. Low birth weight. b. Very low birth weight. c. Extremely low birth weight. d. Very premature.

a. Low birth weight. -Neonates with a birth weight of less than 2500 grams but greater than 1500 grams are classified as low birth weight.

A 42-week-old gestation is admitted to the NICU. This neonate is at risk for which complication? a. Meconium aspiration syndrome. b. Failure to thrive. c. Necrotizing entercolitis. d. Intraventricular hemorrhage.

a. Meconium aspiration syndrome. -Although there is nothing in the scenario that states that the amniotic fluid is green tinged, post-term babes are high risk for meconium aspiration syndrome.

A nurse is caring for a 40 weeks' gestation neonate. The neonate is 12 hours post-birth and has been admitted to the NICU for meconium aspiration. The nurse recalls that the following are potential complications related to meconium aspiration (Select all that apply): a. Obstructed airway. b. Hyperinflation of the alveoli. c. Hypoinflation of the alveoli. d. Decreased surfactant proteins.

a. Obstructed airway. b. Hyperinflation of the alveoli. d. Decreased surfactant proteins. -The presence of meconium in the neonate's lungs can cause a partial obstruction of the lower airway that leads to a trapping of air and a hyperinflation of the alveoli. It can also cause a chemical pneumonitis and inhibit surfactant production.

The perinatal nurse is assisting the student nurse with completion of documentation. The laboring woman has just given to a 2700 grams infant at 36 weeks' gestation. The most appropriate term for this is: a. Preterm infant. b. Term birth. c. Small for gestational age infant. d. Large for gestational age infant.

a. Preterm infant. -A preterm infant is an infant with gestational age of fewer than 36 completed weeks.

The laboratory reported that the L/S ration (lecithin/sphingomyelin) results from an amniocentesis of a gravid client with preeclampsia are 2:1. The nurse interprets the result as which of the following? a. The baby's lung fields are mature. b. The mother is high risk for hemorrhage. c. The baby's kidneys are functioning poorly. d. The mother is high risk for eclampsia.

a. The baby's lung fields are mature. -An L/S ratio of 2:1 usually indicates that the fetal lungs are mature.

Nursing actions that decrease the risk of skin breakdown include which of the following? (Select all that apply) a. Using gelled mattresses. b. Using emollients in groin and thigh areas. c. Using transparent dressings. d. Drying thoroughly.

a. Using gelled mattresses. b. Using emollients in groin and thigh areas. c. Using transparent dressings. -Use of gelled mattresses decreases the risk of pressure sores. Use of emollients reduces the risk of irritation from urine. Use of transparent dressing reduces the risk of friction injuries.

The perinatal nurse caring for Emily, a 24-year-old mother of an infant born at 26 weeks' gestation, is providing discharge teaching. Emily is going to travel to the specialty center approximately 200 miles away where her daughter is receiving care. The nurse tells Emily that it is normal for Emily to feel (select all that apply); a. In control. b. Anxious. c. Guilty. d. Overwhelmed.

b. Anxious. c. Guilty. d. Overwhelmed.

A full-term neonate who is 30 hours old has a bilirubin level of 10 mg/dL. The neonate has a yellowish tint to the skin of the face. The mother is breastfeeding her newborn. The nurse caring for this neonate would anticipate which of the following interventions? a. Phototherapy. b. Feeding neonate every 2 to 3 hours. c. Switch from breastfeeding to bottle-feeding. d. Assess red blood cell count.

b. Feeding neonate every 2 to 3 hours. -Adequate hydration promotes excretion of bilirubin in the urine.

A baby has just been admitted into the NICU with a diagnosis of intrauterine growth restriction (IGUR). Which of the following maternal problems could have resulted in this complication? a. Cholecystitis. b. Hypertension. c. Cigarette smoker. d. Candidiasis. e. Cerebral palsy.

b. Hypertension. c. Cigarette smoker. -Babies born to women with PIH or who smoke are high risk for IUGR. Babies born to women with cholecystitis, candidiasis, or cerebral palsy are not especially high risk for IUGR.

Which of the following neonatal signs or symptoms would the nurse expect to see in a neonate with an elevated bilirubin level? a. Low glucose. b. Poor feeding. c. Hyperactivity. d. Hyperthermia.

b. Poor feeding. -The baby is likely to feed poorly. An elevated bilirubin level adversely affects the central nervous system. Babies are often sleepy and feed poorly when the bilirubin level is elevated.

A NICU nurse is caring for a full-term neonate being treated for group B streptococcus. The mother of the neonate is crying and shares that she cannot understand how her baby became infected. The best response by the nurse is: a. "Newborns are more susceptible to infections due to an immature immune system." b. "The infection was transmitted to your baby during the birthing process. Do you have a history of sexual transmitted infections?" c. "Approximately 10% to 30% of women are asymptomatic carries of group B streptococcus which is found in the vaginal area. What other questions do you have regarding your baby's health?" d. "I see that this is very upsetting for you. I will come back later and answer your questions."

c. "Approximately 10% to 30% of women are asymptomatic carries of group B streptococcus which is found in the vaginal area. What other questions do you have regarding your baby's health?" -This response answers her questions and allows her to ask additional questions about her baby's health.

It is noted that the amniotic fluid of a 42-week gestation baby, born 30 seconds ago, is thick and green. Which of the following actions by the nurse is critical at this time? a. Perform a gavage feeding immediately. b. Assess the brachial pulse. c. Assist a physician with intubation. d. Stimulate the baby to cry.

c. Assist a physician with intubation. -The baby needs to be intubated in order for deep suctioning to be performed by the physician. A nurse would not intubate and suction but rather would assist with the procedures.

A multipara, 26 weeks' gestation and accompanied by her husband, has just delivered a fetal demise. Which of the following nursing actions is appropriate at this time? a. Encourage the parents to pray for the baby's soul. b. Advise the parents that it is better for the baby to have died than to have had to live with a defect. c. Encourage the parents to hold the baby. d. Advise the parents to refrain from discussing the baby's death with their other children.

c. Encourage the parents to hold the baby. -Encouraging parents to spend time with their baby and hold their baby is an action that supports the parents during the grieving process.

The nurse is assessing a baby girl on admission to the newborn nursery. Which of the following findings should the nurse report to the neonatologist? a. Intermittent strabismus. b. Startling. c. Grunting. d. Vaginal bleeding.

c. Grunting. -Grunting is a sign of respiratory distress. The neonatologist should be notified.

Nursing actions that minimize oxygen demands in the neonate include which of the following? (Select all that apply) a. Providing frequent rest breaks when feeding. b. Placing neonate on back for sleeping. c. Maintaining a neutral thermal environment (NTE). d. Clustering nursing care.

c. Maintaining a neutral thermal environment (NTE). d. Clustering nursing care. -A decrease in environmental temperature leads to a decrease in the neonate's body temperature which leads to an increase in respiratory and heart rate that leads to an increase in oxygen consumption. Clustering of nursing care decreases stress which decreases oxygen requirements.

A baby was born 4 days ago at 34 weeks' gestation. She is receiving phototherapy as ordered by the physician for physiological jaundice. She has symptoms of temperature instability, dry skin, poor feeding, lethargy, and irritability. The nurse's priority nursing action(s) is (are) to (select all that apply): a. Verify laboratory results to check for hypo magnesia. b. Verify laboratory results to check for hypoglycemia. c. Monitor the baby's temperature to check for hypothermia. d. Calculate 24-hour intake to check for dehydration.

c. Monitor the baby's temperature to check for hypothermia. d. Calculate 24-hour intake to check for dehydration. -There are two primary nursing interventions for hyperbilirubinemia. Hydration status is important if the newborn shows signs of dehydration such as dry skin and mucus membranes, poor intake, concentrated urine or limited urine output, and irritability. The newborn should also be kept warm while receiving phototherapy. When an infant is under phototherapy, the temperature needs to be monitored closely because the lights give off extra heat, but if the newborn is in an open crib and undressed, hypothermia may occur.

A 1-day-old neonate in the well-baby nursery is suspected of suffering from drug withdrawal because he is markedly hyperreflexic and is exhibiting which of the following additional sign or symptom? a. Prolonged periods of sleep. b. Hypovolemic anemia. c. Repeated bouts of diarrhea. d. Pronounced pustular rash.

c. Repeated bouts of diarrhea. -Babies who are experiencing withdrawal often experience bouts of diarrhea.

The NICU nurse recognizes that respiratory distress syndrome results from a developmental lack of: a. Lecithin. b. Calcium c. Surfactant. d. Magnesium.

c. Surfactant. -Respiratory Distress Syndrome (RDS) is a developmental respiratory disorder that affects preterm newborns due to lack of lung surfactant. The pathology of RDS is that there is diffuse atelectasis with congestion and edema in the lung spaces. On deflation, the alveoli collapse, and there is decreased lung compliance.

The NICU nurse is providing care to a 35-week-old infant who has been in the neonatal intensive care unit for the past 3 weeks. His mother wants to breastfeed her son naturally but is currently pumping her breasts to obtain milk. His mother is concerned that she is only producing about 1 ounce of milk every 3 hours. The nurse's best response to the patient's mother would be a. "Pumping is hard work and you are doing very well. It is good to get about 1 ounce of milk every 3 hours." b. "Natural breastfeeding will be a challenging goal for your baby. Beginning today, you will need to begin to pump your breasts more often." c. "Your baby will not be ready to go home for at least another week. You can begin to pump more often in the next few days in preparation for taking your child home." d. "You have been working hard to give your son breast milk. We can map out a schedule to help you begin today to pump more often to prepare to take your baby home."

d. "You have been working hard to give your son breast milk. We can map out a schedule to help you begin today to pump more often to prepare to take your baby home." -The mother should be praised for her efforts to breastfeed and encouraged to continue to pump her milk. A determined schedule for pumping the milk will help the mother keep her milk flow steady and provide enough nutrients for the infant after discharge.

The following four babies are in the neonatal nursery. Which of the babies should be seen by the neonatologist as soon as possible? a. 1-day-old, HR 170 bpm, crying. b. 2-day-old, T 98.9 F, slightly jaundice. c. 3-day-old, breastfeeding q2h, rooting. d. 4-day-old, RR 70 rpm, dusky coloring.

d. 4-day-old, RR 70 rpm, dusky coloring. -A dusky skin color is abnormal in any neonate, whether or not the respiration rate is normal, although this baby is also slightly tachypneic.

A nurse assesses that a 3-day-old neonate who was born at 34 weeks' gestation has abdominal distention and vomiting. These assessment findings are most likely related to: a. Respiratory Distress Syndrome (RDS). b. Bronchopulmonary Dysplasia (BPD). c. Periventricular Hemorrhage (PVH). d. Necrotizing Enterocolitis (NEC).

d. Necrotizing Enterocolitis (NEC). -Assessment findings related to NEC include abdominal distention, blood stools, abdominal distention, vomiting, and increased gastric residual. These signs and symptoms are related to the premature neonate's inability to full digest stomach contents and limitation in absorptive function.

A nursery nurse observes that a full-term AGA neonate has nasal congestion, hypertonia, and tremors and is extremely irritable. Based on these observations, the nurse suspects which of the following? a. Hypoglycemia. b. Hypercalcemia. c. Cold stressed. d. Neonatal withdrawal.

d. Neonatal withdrawal. -These are common signs and symptoms of neonatal withdrawal.