Chapter 24 point questions Maternal Newborn Nursing

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.

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

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.

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" 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 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 newborn is diagnosed with esophageal atresia and tracheoesophageal fistula. After providing 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.

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.

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.

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? 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 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.

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

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.

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 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.

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

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.

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.

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

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.

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.

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 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.

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.

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 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 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.

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 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 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 of the following disorders?

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.

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

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.

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 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

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

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.

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 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 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 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 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

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

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 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.

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.

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.

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.

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.

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.

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.