Chapter 24: Nursing Management of the Newborn at Risk

18. 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? A. alcohol B. cocaine C. heroin D. methamphetamine

A Alcohol Rationale: This child's features match those of fetal alcohol syndrome, including microcephaly, small palpebral (eyelid) fissures, abnormally small eyes, and fetal growth restriction

After teaching the parents of a newborn with retinopathy of prematurity (ROP) about the disorder and treatment, which statement by the parents indicates that the teaching was successful? A) "Can we schedule follow-up eye examinations with the pediatric ophthalmologist now?" B) "We can fix the problem with surgery." C) "We'll make sure to administer eye drops each day for the next few weeks." D) "I'm sure the baby will grow out of it."

A) "Can we schedule follow-up eye examinations with the pediatric ophthalmologist now?" Ans: A Feedback: Parents of a newborn with suspected retinopathy of prematurity (ROP) should schedule follow-up vision screenings with a pediatric ophthalmologist every 2 to 3 weeks, depending on the severity of the findings at the initial examination.

A nurse is explaining to the parents of a child with bladder exstrophy about the care their infant requires. Which of the following would the nurse include in the explanation? (Select all that apply.) A) Covering the area with a sterile, clear, nonadherent dressing B) Irrigating the surface with sterile saline twice a day C) Monitoring drainage through the suprapubic catheter D) Administering prescribed antibiotic therapy E) Preparing for surgical intervention in about 2 weeks

A) Covering the area with a sterile, clear, nonadherent dressing C) Monitoring drainage through the suprapubic catheter D) Administering prescribed antibiotic therapy Ans: A, C, D Feedback: Care for an infant with bladder exstrophy includes covering the area with a sterile, clear, nonadherent dressing and irrigating the bladder surface with sterile saline after each diaper change to prevent infection, assisting with insertion and monitoring drainage from suprapubic catheter, administering prescribed antibiotic therapy, and preparing the parents and infant for surgery within 48 hours after birth.

A newborn with severe meconium aspiration syndrome (MAS) is not responding to conventional treatment. Which of the following would the nurse anticipate as possibly necessary for this newborn? A) Extracorporeal membrane oxygenation (ECMO) B) Respiratory support with a ventilator C) Insertion of a laryngoscope for deep suctioning D) Replacement of an endotracheal tube via x-ray

A) Extracorporeal membrane oxygenation (ECMO) Ans: A Feedback: If conventional measures are ineffective, then the nurse would need to prepare the newborn for ECMO. Hyperoxygenation, ventilatory support, and suctioning are typically used initially to promote tissue perfusion. However, if these are ineffective, ECMO would be the next step.

A nurse is developing a plan of care for a newborn with omphalocele. Which of the following would the nurse include? A) Placing the newborn into a sterile drawstring bowel bag B) Using clean technique for dressing changes C) Preparing the newborn for incision and drainage D) Instituting gavage feedings

A) Placing the newborn into a sterile drawstring bowel bag Ans: A Feedback: An infant with an omphalocele is placed in a sterile drawstring bowel bag that maintains a sterile environment for the exposed contents, allows visualization, reduces heat and moisture loss, and allows heat from radiant warmers to reach the newborn. The newborn is placed feet-first into the bag and the drawstring is secured around the torso. Strict sterile technique is necessary to prevent contamination of the exposed abdominal contents. An orogastric tube attached to low suction is used to prevent intestinal distention. IV therapy is administered to maintain fluid and electrolyte balance and provide a route for antibiotic therapy. Surgery is done to repair the defect, not incise and drain it.

While reviewing a newborn's medical record, the nurse notes that the chest x-ray shows a ground glass pattern. The nurse interprets this as indicative of: A) Respiratory distress syndrome B) Transient tachypnea of the newborn C) Asphyxia D) Persistent pulmonary hypertension

A) Respiratory distress syndrome Ans: A Feedback: The chest x-ray of a newborn with RDS reveals a reticular (ground glass) pattern. For TTN, the chest x-ray shows lung overaeration and prominent perihilar interstitial markings and streakings. A chest x-ray for asphyxia would reveal possible structural abnormalities that might interfere with respiration, but the results are highly variable. An echocardiogram would be done to evaluate persistent pulmonary hypertension.

Which action would be most appropriate for the nurse to take when a newborn has an unexpected anomaly at birth? A) Show the newborn to the parents as soon as possible while explaining the defect. B) Remove the newborn from the birthing area immediately. C) Inform the parents that there is nothing wrong at the moment. D) Tell the parents that the newborn must go to the nursery immediately.

A) Show the newborn to the parents as soon as possible while explaining the defect. Ans: A Feedback: When an anomaly is identified at or after birth, parents need to be informed promptly and given a realistic appraisal of the severity of the condition, the prognosis, and treatment options so that they can participate in all decisions concerning their child. Removing the newborn from the area or telling them that the newborn needs to go to the nursery immediately is inappropriate and would only add to the parents' anxieties and fears. Telling them that nothing is wrong is inappropriate because it violates their right to know.

The nurse is assessing a newborn and suspects that the newborn was exposed to drugs in utero because the newborn is exhibiting signs of neonatal abstinence syndrome. Which of the following would the nurse expect to assess? (Select all that apply.) A) Tremors B) Diminished sucking C) Regurgitation D) Shrill, high-pitched cry E) Hypothermia F) Frequent sneezing

A) Tremors C) Regurgitation D) Shrill, high-pitched cry F) Frequent sneezing Ans: A, C, D, F Feedback: Signs and symptoms of neonatal abstinence syndrome include tremors, frantic sucking, regurgitation or projectile vomiting, shrill high-pitched cry, fever, and frequent sneezing.

A newborn was diagnosed with a congenital heart defect and will undergo surgery at a later time. The nurse is teaching the parents about signs and symptoms that need to be reported. The nurse determines that the parents have understood the instructions when they state that they will report which of the following? (Select all that apply.) A) Weight loss B) Pale skin C) Fever D) Absence of edema E) Increased respiratory rate

A) Weight loss C) Fever E) Increased respiratory rate Ans: A, C, E Feedback: Signs and symptoms that need to be reported include weight loss, poor feeding, cyanosis, breathing difficulties, irritability, increased respiratory rate, and fever.

16. At a preconception counseling class, a client expresses concern and wonders how Healthy People 2030 will improve maternal-infant outcomes. Which response(s) by the nurse is appropriate? Select all that apply. A. Healthy People 2030 will reduce the rate of fetal and infant deaths. B. Healthy People 2030 will decrease the number of all infant deaths (within 1 year). C. Healthy People 2030 will decrease the number of neonatal deaths (within the first year). D. Healthy People 2030 will

A. Healthy People 2030 will reduce the rate of fetal and infant deaths. B. Healthy People 2030 will decrease the number of all infant deaths (within 1 year). C. Healthy People 2030 will decrease the number of neonatal deaths (within the first year). D. Healthy People 2030 will foster early and consistent prenatal care. Rationale: One of the leading health indicators as identified by Healthy People 2030 refers to decreasing the number of infant deaths. Acquired and congenital conditions account for a significant percentage of infant deaths. Specific objectives include reducing the rate of fetal deaths at 20 or more weeks of gestation though the nursing action of fostering early and consistent prenatal care; reducing the rate of all infant deaths (within 1 year) through the nursing actions of including education to place infants on their backs for naps and sleep to prevent sudden infant death syndrome (SIDS), avoiding exposing newborns to cigarette smoke, and ensuring that inf

28. A 2-hour-old neonate born via caesarean birth has begun having a respiratory rate of 110 breaths/min and is in respiratory distress. What intervention(s) is a priority for the nurse to include in this neonates's care? Select all that apply. A. Keep the head in a "sniff" position B. Administer oxygen C. Insert an orogastric tube D. Ensure thermoregulation E. Obtain an arterial blood gas

A. Keep the head in a "sniff" position. B. Administer oxygen. D. Ensure thermoregulation. Rationale: This neonate is experiencing manifestations of transient tachypnea of the newborn (TTN). It occurs from delayed clearing of the lungs from fluid, and can be seen in neonates born via cesarean birth, because they have not had the experience of the compression on the thorax during vaginal delivery. This starts within the first 6 hours of life and can last up to 72 hours. The priority interventions for this neonate are oxygen, thermoregulation and minimal stimulation. Keeping the head in a neutral or "sniff " position allows for optimal airway. If the neonate becomes cold, then respiratory distress and or sepsis can develop. Minimal stimulation conserves the neonate's respiratory and heat requirements. The neonate may need placement of a peripheral IV for hydration and/or a feeding tube for formula or breast milk. The neonate should not be nipple fed until the respirations are u

26. The nurse in the neonatal intensive care unit is caring for a neonate she suspects is at risk for an intraventricular hemorrhage (IVH). Which nursing actions would be priorities? Select all that apply. A. Maintain fetal flexed position. B. Administer fluids slowly. C. Assess for bulging fontanel. D. Measure head circumference daily. E. Assess Moro reflex. F. Measure intake and output.

A. Maintain fetal flexed position. B. Administer fluids slowly. C. Assess for bulging fontanel. D. Measure head circumference daily Rationale: Care of the newborn with IVH is primarily supportive. Correct anemia, acidosis, and hypotension with fluids and medications. Administer fluids slowly to prevent fluctuations in blood pressure. Avoid rapid volume expansion to minimize changes in cerebral blood flow. Keep the newborn in a flexed, contained position with the head elevated to prevent or minimize fluctuations in intracranial pressure. Continuously monitor the newborn for signs of hemorrhage, such as changes in the level of consciousness, bulging fontanel, seizures, apnea, and reduced activity level. Also, measuring head circumference daily to assess for expansion in size is essential in identifying complications early. Moro reflex and intake and output are routine and not associated with IVH.

23. A 33 weeks' gestation neonate is being assessed for necrotizing enterocolitis (NEC). Which nursing actions would the nurse implement? Select all that apply. A. Perform hemoccult tests on stools. B. Monitor abdominal girth. C. Measure gastric residual before feeds. D. Assess bowel sounds before each feed. E. Assess urine output.

A. Perform hemoccult tests on stools. B. Monitor abdominal girth. C. Measure gastric residual before feeds. D. Assess bowel sounds before each feed. Rationale: Always keep the possibility of NEC in mind when dealing with preterm newborns, especially when enteral feedings are being administered. Note feeding intolerance, diarrhea, bilestained emesis, or grossly bloody stools. Perform hemoccult tests on the bloody stool. Assess the neonate's abdomen for distention, tenderness, and visible loops of bowel. Measure the abdominal circumference, noting an increase. Listen to bowel sounds before each feeding. Determine residual gastric volume prior to feeding; when it is elevated, be suspicious for NEC. Assessing urine output is not essential.

25. A preterm newborn is admitted to the neonatal intensive care with the diagnosis of an omphalocele. What nursing actions would the nurse perform? Select all that apply. A. The abdominal contents are protected. B. Fluid loss of the neonate will be minimized. C. Perfusion to the exposed abdominal contents will be maintained. D. Neonatal weight loss will be prevented. E. Assessment of hyperbilirubinemia will be monitored.

A. The abdominal contents are protected. B. Fluid loss of the neonate will be minimized. C. Perfusion to the exposed abdominal contents will be maintained. Rationale: Nursing management of newborns with omphalocele or gastroschisis focuses on preventing hypothermia, maintaining perfusion to the eviscerated abdominal contents by minimizing fluid loss, and protecting the exposed abdominal contents from trauma and infection. Weight loss at this point is not a priority, and neither is assessing bilirubin.

24. 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 A. preterm birth B. respiratory distress syndrome C. low Apgar scores D. hyperthermia E. hyperglycemia F. exchange transfusion

A. preterm birth B. respiratory distress syndrome C. low Apgar scores F. Exchange transfusion Rationale: 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.

29. A newborn infant has been diagnosed with persistent pulmonary hypertension of the newborn (PPHN). In providing care for this newborn what intervention should be the nurse's priority? A. Measure blood pressure B. Obtain arterial blood gases C. Monitor oxygen saturation D. Suction the newborn

ANS: A Measure blood pressure Rationale: PPHN occurs when there is persistent fetal circulation after birth. The pulmonary pressures do not decrease at birth when the newborn begins breathing causing hypoxemia, acidosis and vasoconstriction of the pulmonary artery. This newborn requires much care and possibly extracorporeal membrane oxygenation (ECMO). The nurse should monitor the newborn's blood pressure regularly, because hypotension can occur from ensuing heart failure and the persistent hypoxemia. Vasopressors may be needed for this newborn. The newborn should not be suctioned. Doing so causes more stimulation and worsens respiratory issues. Arterial blood gases will be obtained regularly, but they are not a priority nursing intervention. Oxygen saturation should always be monitored in a newborn with respiratory distress.

30. A newborn is exhibiting symptoms of withdrawal and toxicology test have been prescribed. Which type of specimen should the nurse collect to obtain the most accurate results? A. Meconium B. Blood C. Urine D. Sputum

ANS: A Meconium Rationale: Toxicology screening of a newborn can include testing from blood, urine and meconium. These tests identify which drugs the newborn has been exposed to in utero. A meconium sample can detect which drugs the mother has been using from the second trimester of pregnancy until birth. It is the preferred method of testing. A urine screen identifies only the drugs the mother has used recently. The nurse should be careful not to mix the meconium sample with urine as it alters the results of the test. Blood samples can be taken and they will yield results of current drugs in the newborn's system, but they are invasive and noninvasive testing will provide the same results. If possible, testing on the mother is preferred. This testing provides quick results of what drugs the mother has been exposing the fetus to in utero. This will help in planning and providing care for the drug-exposed newborn. Sputum is not used for toxicology studies.

31. A neonate is diagnosed with Erb's palsy after birth. The parents are concerned about their neonate's limp arm. The nurse explains the neonate will be scheduled to receive what recommended treatment for this condition first? A. Physical therapy to the joint and extremity B. Nothing but time and let nature take its course C. Surgery to correct the joint and muscle alignment D. Immobilization of the shoulder and arm

ANS: D Immobilization of the shoulder and arm Rationale: Treatment for a neonate with Erb palsy usually involves immobilization of the upper arm across the upper abdomen/chest to protect the shoulder from excessive motion for the first week; then gentle passive range-of-motion exercises are performed daily to prevent contractures. Surgery is not needed to regain function since there is no structural injury. Doing nothing will not help the neonate regain function in the extremity.

The pediatrician prescribes morphine sulphate 0.2 mg/kg orally q 4 hour for a neonate suffering from drug withdrawal. The neonate weighs 3,800 grams. How much of drug will the nurse give in 24 hours? Record your answer using two decimal places.

Answer: 4.56 Rationale: 3800 grams = 3.8 kg 3.8 kg/kg x 0.20 mg x 6 doses = 4.56 mg in 24 hours

After teaching the parents of a newborn with periventricular hemorrhage about the disorder and treatment, which statement by the parents indicates that the teaching was successful? A) "We'll make sure to cover both of his eyes to protect them." B) "Our newborn could develop a learning disability later on." C) "Once the bleeding ceases, there won't be any more worries." D) "We need to get family members to donate blood for transfusion.

B) "Our newborn could develop a learning disability later on." Ans: B Feedback: Periventricular-intraventricular hemorrhage has long-term sequelae such as seizures, hydrocephalus, periventricular leukomalacia, cerebral palsy, learning disabilities, vision or hearing deficits, and mental retardation. Covering the eyes is more appropriate for the newborn receiving phototherapy. The bleeding in the brain can lead to serious long-term effects. Blood transfusions are not used to treat periventricular hemorrhage.

A nurse is assisting in the resuscitation of a newborn. The nurse would expect to stop resuscitation efforts when the newborn has no heartbeat and respiratory effort after which time frame? A) 5 minutes B) 10 minutes C) 15 minutes D) 20 minutes

B) 10 minutes Ans: B Feedback: According to the American Heart Association and American Academy of Pediatrics Guidelines for Neonatal Resuscitation, resuscitation efforts may be stopped if the newborn exhibits no heartbeat and no respiratory effort after 10 minutes of continuous and adequate resuscitation.

When developing the plan of care for a newborn with an acquired condition, which of the following would the nurse include to promote participation by the parents? A) Use verbal instructions primarily for explanations B) Assist with decision making process C) Provide personal views about their decisions D) Encourage them to refrain from showing emotions

B) Assist with decision making process Ans: B Feedback: To promote parental participation, the nurse should assist them with making decisions about treatment, and support their decisions for the newborn's care. Imposing personal views about their decisions is inappropriate and undermines the nurse-client relationship. In addition, the nurse would assess their ability to cope with the diagnosis, encourage them to verbalize their feelings about the newborn's condition and treatment and educate them about the newborn's condition using written information and pictures to enhance understanding.

A newborn has an Apgar score of 6 at 5 minutes. Which of the following is the priority? A) Initiating IV fluid therapy B) Beginning resuscitative measures C) Promoting kangaroo care D) Obtaining a blood culture

B) Beginning resuscitative measures Ans: B Feedback: An Apgar score below 7 at 1 or 5 minutes indicates the need for resuscitation. Intravenous fluid therapy and blood cultures may be done once resuscitation is started. Kangaroo care would be appropriate once the newborn is stable.

The nurse is assessing the newborn of a mother who had gestational diabetes. Which of the following would the nurse expect to find? (Select all that apply.) A) Pale skin color B) Buffalo hump C) Distended upper abdomen D) Excessive subcutaneous fat E) Long slender neck

B) Buffalo hump C) Distended upper abdomen D) Excessive subcutaneous fat Ans: B, C, D Feedback: Infants of diabetic mothers exhibit full rosy cheeks with a ruddy skin color, short neck, buffalo hump over the nape of the neck, massive shoulders, distended upper abdomen, and excessive subcutaneous fat tissue.

Which of the following would the nurse include in the plan of care for a newborn receiving phototherapy? A) Keeping the newborn in the supine position B) Covering the newborn's eyes while under the bililights C) Ensuring that the newborn is covered or clothed D) Reducing the amount of fluid intake to 8 ounces daily

B) Covering the newborn's eyes while under the bililights Ans: B Feedback: During phototherapy, the newborn's eyes are covered to protect them from the lights. The newborn is turned every 2 hours to expose all areas of the body to the lights and is kept undressed, except for the diaper area, to provide maximum body exposure to the lights. Fluid intake is increased to allow for added fluid, protein, and calories.

Which of the following would not be considered a risk factor for bronchopulmonary dysplasia (chronic lung disease)? A) Preterm birth (less than 32 weeks) B) Female gender C) White race D) Sepsis

B) Female gender Ans: B Feedback: Male gender is more commonly associated with bronchopulmonary dysplasia. Preterm birth of less than 32 weeks' gestation, sepsis, white race, excessive fluid intake during the first few days of life, severe RDS with mechanical ventilation for more than 1 week, and patent ductus arteriosus are all risk factors associated with chronic lung disease in the newborn.

The nurse prepares to administer a gavage feeding for a newborn with transient tachypnea based on the understanding that this type of feeding is necessary for which reason? A) Lactase enzymatic activity is not adequate. B) Oxygen demands need to be reduced. C) Renal solute lead must be considered. D) Hyperbilirubinemia is likely to develop.

B) Oxygen demands need to be reduced. Ans: B Feedback: For the newborn with transient tachypnea, the newborn's respiratory rate is high, increasing his oxygen demand. Thus, measures are initiated to reduce this demand. Gavage feedings are one way to do so. With transient tachypnea, enzyme activity and kidney function are not affected. This condition typically resolves within 72 hours. The risk for hyperbilirubinemia is not increased.

Which of the following would the nurse include when teaching a new mother about the difference between pathologic and physiologic jaundice? A) Physiologic jaundice results in kernicterus. B) Pathologic jaundice appears within 24 hours after birth. C) Both are treated with exchange transfusions of maternal O- blood. D) Physiologic jaundice requires transfer to the NICU.

B) Pathologic jaundice appears within 24 hours after birth. Ans: B Feedback: Pathologic jaundice appears within 24 hours after birth, whereas physiologic jaundice commonly appears around the third to fourth days of life. Kernicterus is more commonly associated with pathologic jaundice. An exchange transfusion is used only if the total serum bilirubin level remains elevated after intensive phototherapy. With this procedure, the newborn's blood is removed and replaced with nonhemolyzed red blood cells from a donor. Physiologic jaundice often is treated at home.

A newborn is diagnosed with meconium aspiration syndrome. When assessing this newborn, which of the following would the nurse expect to find? (Select all that apply.) A) Pigeon chest B) Prolonged tachypnea C) Intercostal retractions D) High blood pH level E) Coarse crackles on auscultation

B) Prolonged tachypnea C) Intercostal retractions E) Coarse crackles on auscultation Ans: B, C, E Feedback: Assessment findings associated with meconium aspiration syndrome include barrel-shaped chest with an increased anterior-posterior (AP) chest diameter (similar to that found in a client with chronic obstructive pulmonary disease), prolonged tachypnea, progression from mild to severe respiratory distress, intercostal retractions, end-expiratory grunting, and cyanosis. Coarse crackles and rhonchi are noted on lung auscultation.

A group of nursing students are reviewing the different types of congenital heart disease in infants. The students demonstrate a need for additional review when they identify which of the following as an example of increased pulmonary blood flow (left-to-right shunting)? A) Atrial septal defect B) Tetralogy of Fallot C) Ventricular septal defect D) Patent ductus arteriosus

B) Tetralogy of Fallot Ans: B Feedback: Tetralogy of Fallot is a congenital heart condition that results from decreased, not increased, pulmonary blood flow. Atrial septal defect, ventricular septal defect, and patent ductus arteriosus are heart conditions that involve increased blood flow from higher pressure (left side of heart) to lower pressure (right side of heart), resulting in left-to-right shunting.

When planning the care of a newborn addicted to cocaine who is experiencing withdrawal, which of the following would be least appropriate to include? A) Wrapping the newborn snugly in a blanket B) Waking the newborn every hour C) Checking the newborn's fontanels D) Offering a pacifier

B) Waking the newborn every hour Ans: B Feedback: Stimuli need to be decreased. Waking the newborn every hour would most likely be too stimulating. Measures such as swaddling the newborn tightly and offering a pacifier help to decrease irritable behaviors. A pacifier also helps to satisfy the newborn's need for nonnutritive sucking. Checking the fontanels provides evidence of hydration.

17. A neonate is exhibiting signs of neonatal abstinence syndrome. Which findings would confirm this diagnosis? Select all that apply. A. adequate rooting and sucking B. frequent sneezing C. persistant fever D. shrill, high-pitched cry E. hypotonic reflexes F. frequent yawning

B. frequent sneezing C. persistent fever D. shrill, high-pitched cry F. frequent yawning Rationale: Manifestations of neonatal abstinence syndrome include a shrill, high-pitched cry; persistent fever; frequent yawning; and frequent sneezing. Rather than adequate rooting and sucking, these actions will be frantic in a neonate with abstinence syndrome. In addition, these neonates will have hypertonic muscle tone, not hypotonic reflexes

27. At the breech forceps birth of a 32 weeks' gestation neonate, the nurse notes olygohydramnios with green thick amniotic fluid. The maternal history reveals a mother of Hispanic ethnicity with marked hypertension, who admits to using cocaine daily. Which factor(s) may contribute to meconium aspiration syndrome (MAS)? Select all that apply. A. the preterm pregnancy B. the forceps breech birth C. maternal cocaine use D. maternal hypertension E. Hispanic ethnicity F. oligohydramnios pres

B. the forceps breech birth C. maternal cocaine use D. maternal hypertension F. oligohydramnios present Rationale: The predisposing factors for meconium aspiration syndrome include postterm pregnancy and breech presentation with forceps. Ethnicity (Pacific Islander, Indigenous Australian, Black African) is a factor. Postterm neonates are at risk for MAS, but preterm neonates are not. Exposure to drugs during pregnancy, especially tobacco and cocaine, predispose the neeonate to MAS. Maternal hypertension and oligohydramnios also contribute to MAS

19. The nurse is developing a plan of care for a neonate experiencing symptoms of drug withdrawal. What should be included in this plan? A. Administer glucose between feedings. B. Schedule feedings every 4 to 6 hours. C. Swaddle the infant between feedings. D. Rock horizontally.

C Swaddle the infant between feedings. Rationale: 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.

The nurse is assessing a newborn who is large for gestational age. The newborn was born breech. The nurse suspects that the newborn may have experienced trauma to the upper brachial plexus based on which assessment findings? A) Absent grasp reflex B) Hand weakness C) Absent Moro reflex D) Facial asymmetry

C) Absent Moro reflex Ans: C Feedback: An injury to the upper brachial plexus, or Erb's palsy, is manifested by adduction, pronation, and internal rotation of the affected extremity, absent shoulder movement, absent Moro reflex and positive grasp reflex. An absent grasp reflex and hand weakness is noted with a lower brachial plexus injury. Facial asymmetry is associated with a cranial nerve injury.

Assessment of newborn reveals a large protruding tongue, slow reflexes, distended abdomen, poor feeding, hoarse cry, goiter and dry skin. Which of the following would the nurse suspect? A) Phenylketonuria B) Galactosemia C) Congenital hypothyroidism D) Maple syrup urine disease

C) Congenital hypothyroidism Ans: C Feedback: The manifestations listed correlate with congenital hypothyroidism. With phenylketonuria, the infant appears normal at birth but by 6 months of age, signs of slow mental development are evident. Vomiting, poor feeding, failure to thrive, overactivity and musty-smelling urine are additional signs. With maple syrup urine disease, signs and symptoms include lethargy, poor feeding, vomiting, weight loss, seizures, shrill cry, shallow respirations, loss of reflexes, and a sweet maple syrup odor to the urine. With galactosemia, manifestations include vomiting, hypoglycemia, hyperbilirubinemia, poor weight gain, cataracts, and frequent infections.

A newborn is suspected of developing persistent pulmonary hypertension. The nurse would expect to prepare the newborn for which of the following to confirm the suspicion? A) Chest x-ray B) Blood cultures C) Echocardiogram D) Stool for occult blood

C) Echocardiogram Ans: C Feedback: An echocardiogram is used to reveal right-to-left shunting of blood to confirm the diagnosis of persistent pulmonary hypertension. Chest x-ray would be most likely used to aid in the diagnosis of RDS or TTN. Blood cultures would be helpful in evaluating for neonatal sepsis. Stool for occult blood may be done to evaluate for NEC.

A newborn is suspected of having fetal alcohol syndrome. Which of the following would the nurse expect to assess? A) Bradypnea B) Hydrocephaly C) Flattened maxilla D) Hypoactivity

C) Flattened maxilla Ans: C Feedback: A newborn with fetal alcohol syndrome exhibits characteristic facial features such as microcephaly (not hydrocephaly), small palpebral fissures, and abnormally small eyes, flattened or absent maxilla, epicanthal folds, thin upper lip, and missing vertical groove in the median portion of the upper lip. Bradypnea is not typically associated with fetal alcohol syndrome. Fine and gross motor development is delayed, and the newborn shows poor hand-eye coordination but not hypoactivity.

Which of the following would the nurse expect to assess in a newborn who develops sepsis? A) Increased urinary output B) Interest in feeding C) Hypothermia/temp instability D) Wakefulness

C) Hypothermia/temp instability Ans: C Feedback: Manifestations of sepsis are typically nonspecific and may include hypothermia (temperature instability), oliguria or anuria, lack of interest in feeding, and lethargy.

A nurse is teaching the mother of a newborn diagnosed with galactosemia about dietary restrictions. The nurse determines that the mother has understood the teaching when she identifies which of the following as needing to be restricted? A) Phenylalanine B) Protein C) Lactose D) Iodine

C) Lactose Ans: C Feedback: Lifelong restriction of lactose is required for galactosemia. Phenylalanine is restricted for those with phenylketonuria. Low protein is needed with maple syrup urine disease. Iodine would not be restricted for any inborn error of metabolism

A group of students are reviewing information about the effects of substances on the newborn. The students demonstrate understanding of the information when they identify which drug as not being associated with teratogenic effects on the fetus? A) Alcohol B) Nicotine C) Marijuana D) Cocaine

C) Marijuana Ans: C Feedback: Marijuana has not been shown to have teratogenic effects on the fetus. Alcohol, nicotine and cocaine do affect the fetus.

A nursing student is preparing a presentation for the class on clubfoot. The student determines that the presentation was successful when the class states which of the following? A) Clubfoot is a common genetic disorder. B) The condition affects girls more often than boys. C) The exact cause of clubfoot is not known. D) The intrinsic form can be manually reduced.

C) The exact cause of clubfoot is not known. Ans: C Feedback: Clubfoot is a complex, multifactorial deformity with genetic and intrauterine factors. Heredity and race seem to factor into the incidence, but the means of transmission and the etiology are unknown. Most newborns with clubfoot have no identifiable genetic, syndromal, or extrinsic cause. Clubfoot affects boys twice as often as girls. With the intrinsic type, manual reduction is not possible.

15. The nurse frequently assesses the respiratory status of a preterm newborn based on the understanding that the newborn is at increased risk for respiratory distress syndrome because of: A. inability to clear fluids. B. immature respiratory control center. C. deficiency of surfactant. D. smaller respiratory passages.

C. Deficiency of surfactant Rationale: A preterm newborn is at increased risk for respiratory distress syndrome (RDS) because of a surfactant deficiency. Surfactant helps to keep the alveoli open and maintain lung expansion. With a deficiency, the alveoli collapse, predisposing the newborn to RDS. An inability to clear fluids can lead to transient tachypnea. Immature respirator y control centers lead to an increased risk for apnea. Smaller respiratory passages led to an increased risk for obstruction.

14. A preterm newborn is receiving enteral feedings. Which finding would alert the nurse to suspect that the newborn is developing NEC? A. irritability B. sunken abdomen C. clay-colored stools D. feeding intolerance

D feeding intolerance Rationale: The newborn with NEC may exhibit feeding intolerance with lethargy, abdominal distention and tenderness, and bloody stools.

Which of the following would alert the nurse to suspect that a newborn has developed NEC? A) Irritability B) Sunken abdomen C) Clay-colored stools D) Bilious vomiting

D) Bilious vomiting Ans: D Feedback: The newborn with NEC may exhibit bilious vomiting with lethargy, abdominal distention and tenderness, and bloody stools.

A newborn has been diagnosed with a Group B streptococcal infection shortly after birth. The nurse understands that the newborn most likely acquired this infection from which of the following? A) Improper handwashing B) Contaminated formula C) Nonsterile catheter insertion D) Mother's birth canal

D) Mother's birth canal Ans: D Feedback: Most often, a newborn develops a Group B streptococcus infection during the birthing process when the newborn comes into contact with an infected birth canal. Improper handwashing, contaminated formula, and nonsterile catheter insertion would most likely lead to a late-onset infection, which typically occurs in the nursery due to horizontal transmission.

20. A neonate born addicted to cocaine is now being treated with medication for acute neonatal abstinence syndrome. Which medication will be prescribed to relieve withdrawal symptoms? A. meperidine B. adrenalin C. naloxone D. morphine sulphate

D. Morphine sulphate Rationale: Pharmacologic treatment is warranted if conservative measures are not adequate. Common medications used in the management of newborn withdrawal include an opioid (morphine or methadone) and phenobarbital as a second drug if the opiate does not adequately control symptoms. The other drugs are not used in NAS treatment.

22. The nurse is admitting a term, large-for-gestational-age neonate weighing 4,610 g (10 lb, 2 oz), born vaginally with a mid-forceps assist, to a 15-year-old primipara. What would the nurse anticipate as a result of the birth? A. fracture of the tibia B. fracture of the femur C. fracture of a rib D. midclavicular fracture

D. Midclavicular fracture Rationale: Trauma to the newborn may result from the use of mechanical forces, such as forceps during birth. Primarily injuries are found in large babies and babies with shoulder dystocia. Associated traumatic injuries include fracture of the clavicle or humerus or subluxations of the shoulder or cervical spine