Chapter 9: The High-Risk Newborn and Family Review Questions
After 8 weeks in the neonatal intensive care unit, Chris will be soon discharged. His parents seem apprehensive and worry that he may still be in danger. What is this considered by the nurse? A: a common parental reaction B: suggestive of maladaptation C: a reason to postpone discharge D: suggestive of inadequate bonding
A: a common parental reaction Parents become apprehensive and excited as the time for discharge approaches. They have many concerns and insecurities regarding the care of their infant. A major concern is that they may be unable to recognize signs of illness or distress in their infant. This is a normal adaptive response. The neonatal intensive care unit nurses should facilitate discharge by involving the parents in care as soon as possible. Preparation for discharge should begin early and include helping the parents acquire the skills necessary for care.
Lung maturity may be enhanced by which of the following? (Select all that apply) A: antenatal (maternal) glucocorticoid administration B: maternal chorioamnionitis C: neonatal administration of exogenous surfactant D: maternal diabetes mellitus E: maternal tobacco smoking
A: antenatal (maternal) glucocorticoid administration C: neonatal administration of exogenous surfactant
A mother delivers an infant at 30 weeks gestation. The mothers ask the nurse for information on nutrition and if formula would be better since the baby is premature. What is the foundation for the response to the mother by the nurse? A: human milk is preferred over the other types of nutrition B: human milk lacks essential nutrients when the infant is preterm C: commercial infant formulas are preferred over other types of nutrition D: commercial infant formulas have not been designed to meet the nutritional needs of preterm infants
A: human milk is preferred over the other types of nutrition Human milk is the preferred food for infants. The mother should pump her breasts to provide milk for the infant. This can be given if the child is receiving enteral feedings. She will be able to breastfeed when the infant is able to coordinate breathing, sucking, and swallowing. Human milk has the essential ingredients that are necessary for the infant's stage of growth. Preterm infants fed commercial formula had longer hospital stays than those fed fortified human milk. Commercial formulas are available for preterm infants.
The nurse is assigned to care for an infant who is to be born to a mother with type 1 diabetes. The mother is in final stage of labor. What clinical manifestations would the nurse anticipate for this infant that would guide care plans for this infant? A: hypoglycemic and large for gestational age B: hyperglycemic and large for gestational age C: hypoglycemic and small for gestational age D: hyperglycemic and small for gestational age
A: hypoglycemic and large for gestational age The clinical manifestations of an infant born to a mother with diabetes include being large for gestational age, plump, and full faced; having abundant vernix caseosa; being listless and lethargic; and having hypoglycemia, which appears a short time after birth. The infant is hypoglycemic from increased fetal production of insulin and being large for gestational age.
An infant born at 27 weeks of gestation is now 3 weeks old and on supplemental oxygen by nasal cannula. Feedings are being administered by savage: 12 mL of expressed breast milk and human milk fortifier every 2 hours. On assessment the nurse notes that the infant's abdomen appears slightly distended, the infant's activity is decreased from previous assessment, and there is a prefeeding gastric residual of 6 mL. The infant's core temperature is 35.8 C (was 36.4 C 2 hours before). Based on these findings, what are the nurse's priority interventions? (Select all that apply) A: obtain a full set of vital signs, including BP and pulse oximetry B: withhold the next feeding (due now) C: discuss findings with the primary practitioner D: observe the infant closely and administer the current feeding E: measure the infant's abdominal girth
A: obtain a full set of vital signs, including BP and pulse oximetry B: withhold the next feeding (due now) C: discuss findings with the primary practitioner E: measure the infant's abdominal girth
What interventions would the nurse implement to maintain the skin integrity of a preterm infant born at 30 weeks? A: avoid cleaning skin B: bathe the infant with sterile water C: cleanse skin with gentle alkaline-based soap and water D: thoroughly rinse skin with plain water after bathing in a mild hexachlorophene solution
B: bathe the infant with sterile water A preterm infant is bathed no more than two or three times per week with a neutral pH solution such as sterile water. The eyes, oral and diaper areas, and pressure points should be cleansed daily. The infant's skin must be cleaned to remove stool and urine, which are irritating to the skin. Alkaline-based soaps might destroy the "acid mantle" of the skin, so they should not be used. The increased permeability of the skin facilitates absorption of the chemical ingredients.
The nurse is caring for an infant who was born 24 hr ago to a mother who received no prenatal care. The infant is a poor feeder but sucks avidly on his hands. Clinical manifestations also include hyperactive reflexes, tremors, sneezing, and a high-pitched shrill cry. What does the nurse consider as possible diagnosis for this infant? A: seizure disorder B: narcotic withdrawal C: placental insufficiency D: meconium aspiration syndrome
B: narcotic withdrawal Infants exposed to drugs in utero usually show no untoward effects until 12 to 24 hr after birth for heroin or much longer for methadone. The infant usually has nonspecific signs that may coexist with other conditions such as hypocalcemia and hypoglycemia. In addition, these infants may have loose stools; tachycardia; fever; projectile vomiting; sneezing; and generalized sweating, which is uncommon in newborns. These manifestations are not descriptive of seizure activity. Placental insufficiency usually results in a child who is small for gestational age, which was not a symptom given. Meconium aspiration syndrome usually has manifestations of respiratory distress.
A late-preterm infant (estimated 35 weeks of gestation) is admitted to the neonatal intensive care nursery at 2 hours of age with the following: respiratory rate 68; heart rate 132; bilateral nasal flaring; audible grunting on expiration; intercostal retractions; systolic blood pressure 35; hypotonia; and acrocyanosis and pulse oximetry reading of 89% on 30% inspired oxygen. The radiograph shows a diffuse ground glass appearance. The nurse recognizes these as signs of: A: hypoglycemia B: respiratory distress syndrome C: meconium aspiration D: apnea of prematurity
B: respiratory distress syndrome
What is a primary consideration for complications when planning nursing care for an infant with Meconium aspiration syndrome? A: hypoglycemia B: bowel obstruction C: airway obstruction D: carbon dioxide retention
C: airway obstruction After the passage of meconium into the amniotic fluid, the infant may inhale or swallow the fluid. Any gasping that occurs can cause the sticky meconium to become aspirated into the lower airways, causing a partial airway obstruction. Hypoglycemia is a metabolic condition not related to meconium aspiration. Bowel obstruction with meconium may be an indication of cystic fibrosis or Hirschsprung disease, not meconium aspiration. The infant may become hypoxemic as a result of the airway obstruction.
What rationale is the primary consideration of susceptibility to infections in neonates? A: increased humoral immunity B: overwhelming anti-inflammatory response C: diminished nonspecific and specific immunity D: excessive levels of immunoglobulin A and immunoglobulin M
C: diminished nonspecific and specific immunity Neonates have diminished inflammatory (nonspecific) and humoral (specific) immunity. They are unable to mount a local inflammatory reaction at the portal of entry to signal infection, and the resulting symptoms are vague and nonspecific, delaying diagnosis and treatment. Humoral and anti-inflammatory immune responses are diminished in neonates. Neonates have diminished or absent immunoglobulin A and immunoglobulin M.
The nurse is caring for a very low-birth-weight (VLBW) infant with a peripheral intravenous infusion. What nursing considerations regarding infiltration would included in planning IV care? A: infiltration occurs infrequently because VLBW infants are inactive B: continuous infusion pumps stop automatically when infiltration occurs C: hypertonic solution can cause severe tissue damage if infiltration occurs D: the infusion site should be checked for infiltration at least once per 8-hour shift
C: hypertonic solution can cause severe tissue damage if infiltration occurs Hypertonic fluids can damage cells if the fluid leaks from the vein. Careful monitoring is required to prevent severe tissue damage. Infiltrations occur for many reasons, not only activity. The vein, catheter, and fluid used all contribute to the possibility of infiltration. The continuous infusion pump may alarm when the pressure increases, but this does not alert the nurse to all infiltrations. Infusion rates and sites should be checked hourly to prevent tissue damage from extravasations, fluid overload, and dehydration.
An infant born at 27 weeks of gestation is now 3 weeks old and on supplemental oxygen by nasal cannula. Feedings are being administered by savage: 12 mL of expressed breast milk and human milk fortifier every 2 hours. On assessment the nurse notes that the infant's abdomen appears slightly distended, the infant's activity is decreased from previous assessment, and there is a prefeeding gastric residual of 6 mL. The infant's core temperature is 35.8 C (was 36.4 C 2 hours before). The nurse recognizes that these symptoms are most likely associated with: A: transient feeding intolerance B: respiratory distress syndrome C: necrotizing enterocolitis D: bronchopulmonary dysplasia
C: necrotizing enterocolitis
What is an important intervention in providing a neutral thermal environment for an LBW infant in an incubator? A: use wool blankets B: avoid using disposable diapers C: prevent heat loss D: closely monitor both incubator and rectal temperatures
C: prevent heat loss Prevention of heat loss in the distressed infant is essential for survival. Cotton blankets should be used. Disposable diapers do not affect temperature measurement. They are preferred to cloth diapers because there is not an evaporative loss of urine. Both the incubator and the infant's temperature are closely monitored. Skin temperature probes are used for the child.
In addition to hypoglycemia, the infant of a diabetic mother should be observed for: A: hydrocephalus B: hyperglycemia C: respiratory distress D: sepsis
C: respiratory distress
A thorough systemic physical assessment is necessary in the extremely low-birth-weight (ELBW) infant to detect what? A: weight gain reflective of fluid retention B: difficulties in maternal-child attachment C: subtle changes that may be indicative of an underlying problem D: changes in APGAR score over the first 24 hours of life
C: subtle changes that may be indicative of an underlying problem An ELBW infant is not able to handle prolonged physiologic stress. These infants manifest stress with subtle changes in feeding behavior, activity, color, oxygen saturation, or vital signs. Weight should be monitored as a reflection of genitourinary function. Usually one or two times per day is adequate. Although maternal-child attachment difficulties are a concern in ELBW infants, these observations are done with parental visits. The child's physiologic status is a priority. The Apgar score is used in the first minutes after birth to assess transition to extrauterine life. Its usefulness is limited after this period.
The apnea monitor alarm sounds on a neonate for the third time during this shift. What is the priority action by the nurse? A: provide tactile stimulation. B: administer flow of 100% oxygen. C: investigate possible causes of a false alarm. D: assess infant for color and presence of respirations.
D: assess infant for color and presence of respirations. The first action is to assess the infant for color and respirations. Only if these are the expected findings for the infant would other actions be taken. If the infant does have an apneic episode, then tactile stimulation is indicated. This occurs after the assessment. Administering the flow of 100% oxygen is not indicated until after respiratory status is assessed. After the nurse determines that the infant is not in distress, then possible causes of a false alarm are investigated.
What is the priority assessment for a nurse when caring for an infant suspected of having necrotizing enterocolitis (NEC)? A: increase feedings as tolerated. B: check gastric residuals every 2 hr. C: take rectal temperature every 2 hr. Incorrect D: closely monitor abdominal distention.
D: closely monitor abdominal distention. Monitoring the abdomen for signs of distention can aid in the prompt recognition of NEC. Feedings are held. Gastric residuals are checked before feedings. With NEC, the bowel wall is edematous and breaking down. Rectal temperatures are contraindicated.
What is a physical characteristic of infants whose mothers smoked during pregnancy? A: being large for gestational age B: growth restriction in weight only C: preterm but size appropriate for gestational age D: growth restriction in weight, length, and chest and head circumference
D: growth restriction in weight, length, and chest and head circumference Infants born to mothers who smoke have growth failure in weight, length, and chest circumference compared with infants of mothers who do not smoke. A dose-effect relation exists. Infants have significant growth failure, which is related to the number of cigarettes smoked.
Several types of seizures can occur in neonates. What is characteristic of clonic seizures? A: apnea B: tremors C: extension of all four limbs D: jerking that cannot be stopped by flexion of the affected limb
D: jerking that cannot be stopped by flexion of the affected limb Clonic seizures are characterized by slow, rhythmic, jerking movements that cannot be stopped by flexion of the affected limb. Apnea is a common manifestation of subtle seizures. Tremors are not characteristic of seizure activity. They may be indicative of hypoglycemia or hypocalcemia. A clonic seizure would have extension and contraction of the extremities, not just extension.
What term is appropriate terminology to use for an infant whose intrauterine growth rate was slowed and whose birth weight falls below the 10th percentile on intrauterine growth charts? A: postterm B: postmature C: low birth weight D: small for gestational age
D: small for gestational age A small for gestational age, or small-for-date, infant is any child whose intrauterine growth rate was slowed and whose birth weight falls below the 10th percentile on intrauterine growth curves. A postterm or postmature infant is any child born after 42 weeks of gestational age regardless of birth weight. A low-birth-weight infant is a child whose birth weight is less than 2500 g (5.5 pounds) regardless of gestational age.
What is the most appropriate nursing action when intermittently gavage feeding a preterm infant? A: allow formula to flow by gravity B: avoid letting the infant suck on the tube. C: insert the tube through the nares rather than the mouth. D: apply steady pressure to the syringe to deliver the formula to the stomach in a timely manner.
The formula is allowed to flow by gravity. The length of time to complete the feeding will vary. Passage of the tube through the mouth allows the nurse to observe and evaluate the sucking response. Preferably, the tube is inserted through the mouth. Neonates are obligatory nose breathers, and the presence of the tube in the nose irritates the nasal mucosa. The feeding should not be done under pressure. This procedure is not a timesaver for the nurse.