PrepU Ch 23

A newborn has scheduled heel sticks for bilirubin checks every 4 hours. The mother asks the nurse "what can be done to calm my baby after those heel pricks?" What is the nurse's most appropriate response? a. "You can give your baby a sucrose solution by bottle for pain relief." b. "Offer your baby a feeding of sterile water solution by bottle." c. "The fussiness will go away shortly with tight swaddling." d. "Your baby is not feeling pain but irritated with all the handling."

"You can give your baby a sucrose solution by bottle for pain relief." Recent research suggests that infants be given administration of oral sucrose with and without nonnutritive sucking and warmth as a nonpharmacologic intervention for procedural pain relief in neonates. The recommended sucrose concentration is a 24% solution. Swaddling of the newborn is not recommended anymore according to the SIDS research. Newborns do feel pain and even more so than adults.

A cesarean birth results in an infant weighing 4,990 g (11 lb). The nurse assesses the infant for which complication? a. transient lung fluid b. diaphragmatic paralysis c. broken clavicle d. serum glucose 45 mg/dl (2.50 mmol/L)

transient lung fluid A large-for-gestational-age (LGA) infant born by cesarean is at risk for transient lung fluid. Broken clavicle and diaphragmatic paralysis are birth injuries associated with a vaginal birth of an LGA infant. All LGA infants are at risk for a serum glucose 45 mg/dl (2.50 mmol/L).

An infant is born with respiratory depression. The provider begins actions to maintain effective ventilation. When would the nurse initiate chest compressions? a. when the heart rate is less than 60 beats per minute b. when there is no cardiac activity detectable c. when no spontaneous respiratory effort is visible d. when the pulse oximetry reading is less than 80%

when the heart rate is less than 60 beats per minute In a newborn, cardiac compressions are initiated when the heart rate is less than 60 beats per minute.

A mother of a neonate who was born at 32 weeks' gestation is encouraged to perform skin-to-skin (kangaroo) care in the neonatal intensive care unit. What would best correlate with this suggestion? a. The infant will have more awake periods. b. There will be a decrease in episodes of apnea. c. Breastfeeding attempts will be enhanced. d. The infant will adjust better to the environment.

Breastfeeding attempts will be enhanced. To promote nutrition in the preterm newborn the newborn will attempt nuzzling at the breast in conjunction with kangaroo care if the newborn is stable. Skin-to-skin (kangaroo) care offers the most benefits for preterm and low-birth-weight infants with increased weight gain. Preterm infants who experience kangaroo care have improved sleep patterns and breastfeeding attempts. It will not assist in preventing apnea. At 32 weeks' gestation it will not be necessary to have the infant adjust to the environment. Nutrition through breastfeeding is the priority.

A nurse from the neonatal intensive care unit is called to the birth room for an infant requiring resuscitation. After placing the newborn in the sniffing position what would the nurse do next? a. Ventilate at a rate of 40 to 60 breaths per minute. b. Suction the mouth then the nose. c. Suction the nose then the mouth. d. Give 3 compressions with 1 breath every 3 seconds.

Suction the mouth then the nose. ABCDs of newborn resuscitation include: airway maintenance by placing infant's head in "sniffing" position; suction the mouth, then the nose; suction the trachea if meconium-stained and newborn is NOT vigorous (strong respiratory effort, good muscle tone, and heart rate 100 bpm). Breathing is assisted through the use of positive-pressure ventilation (PPV) for apnea, or pulse 100 bpm. The nurse should ventilate at rate of 40 to 60 breaths/minute. Listen for raising heart rate and audible breath sounds. Look for slight chest movement with each breath. Use carbon dioxide detector after intubation. The nurse should use circulation assistance through compressions if heart rate is 60 after 30 seconds of effective PPV. Give 3 compressions: 1 breath every 2 seconds. Compress one third of the anterior-posterior diameter of the chest.

The nursery nurse is providing shift handoff on a newborn documented as small for gestational age. Which clinical manifestations would the nurse expect to communicate about this newborn? Select all that apply. a. Sunken abdomen b. Narrow skull sutures c. Increased subcutaneous fat stores d. Poor muscle tone over buttocks e. Dry or thin umbilical cord

a. Sunken abdomen d. Poor muscle tone over buttocks e. Dry or thin umbilical cord A small-for-gestational-age newborn typically has a sunken abdomen, wide skull sutures, decreased subcutaneous fat stores, poor muscle tone over buttocks and cheeks, and a thin umbilical cord.

A preterm infant with enteral tube feedings is being monitored for weight gain. What are the priorities for the nurse to include in the infant's plan of care? Select all that apply. a. Weigh daily. b. Measure daily intake and output. c. Monitor weight weekly. d. Assess serum electrolytes. e. Monitor Coombs results. f. Assess for dehydration. g. Measure abdominal girth AC.

a. Weigh daily. b. Measure daily intake and output. d. Assess serum electrolytes. f. Assess for dehydration. g. Measure abdominal girth AC. To promote nutrition and fluid balance in the preterm newborn the nurse should measure daily weight. The nurse should monitor intake and calculate fluid intake daily. Fluid status is assessed by monitoring weight, daily urinary output, and laboratory test results such as serum electrolyte levels. Be alert for signs of dehydration. Continually assess for enteral feeding intolerance; measure abdominal girth, auscultate bowel sounds, and measure gastric residuals before the next tube feeding. The Coombs test does not belong in this scenario as it measures jaundice levels in the newborn. The Ballard scale is for gestational age.

The nurse is providing bag and mask ventilation during newborn resuscitation. What assessment data will the nurse collect to evaluate the effectiveness of this action? Select all that apply. a. adequate pulse oximetry readings b. presence of bilateral breath sounds c. heart rate greater than 100 bpm d. distal extremities are pink e. blood pressure greater than 50/30 mm Hg

a. adequate pulse oximetry readings b. presence of bilateral breath sounds c. heart rate greater than 100 bpm During effective bag and mask resuscitation there will be adequate oxygen saturation, bilateral breath sounds, and heart rate greater than 100 beats per minute. Distal extremities may exhibit acrocyanosis, and BP is not a direct measure of effectiveness of bag and mask resuscitation.

Which maternal factors should the nurse consider contributory to a newborn being large for gestational age? Select all that apply. a. diabetes b. postdates gestation c. alcohol use d. prepregnancy obesity e. renal infection

a. diabetes b. postdates gestation d. prepregnancy obesity Diabetes, postdates gestation, and prepregnancy obesity are the maternal factors the nurse should consider that could lead to a newborn being large for gestational age. Renal condition and maternal alcohol use are not factors associated with a newborn being large for gestational age.

What is a classic sign of neonatal respiratory distress syndrome? Select all that apply. a. expiratory grunting b. nasal flaring c. retractions d. tachypnea e. bradypnea

a. expiratory grunting b. nasal flaring c. retractions d. tachypnea The classic signs of respiratory distress are expiratory grunting, nasal flaring, retractions, and tachypnea.

When examining a neonate, which characteristic would indicate to the nurse that the infant is preterm? Select all that apply. a. extended extremities b. covered with vernix caseosa c. absence of sole creases d. bulging posterior fontanel (fontanelle) e. elevated breast bud

a. extended extremities b. covered with vernix caseosa c. absence of sole creases Characteristics of a preterm infant include extended extremities, presence of vernix caseosa, and the absence of sole creases. A bulging fontanel is a sign of increased intracranial pressure. An elevated breast bud is consistent with a full-term infant.

After an extended resuscitation, the infant's body temp is 96.4°F (35.8°C). What assessment finding would the nurse anticipate as a consequence of this temperature? Select all that apply. a. heart murmur b. hypoglycemia c. decreasing oxygen saturation d. hyperbilirubinemia e. leukocytosis

a. heart murmur b. hypoglycemia c. decreasing oxygen saturation An infant with a low body temperature needs to be assessed for heart murmurs, hypoglycemia, and falling oxygen saturation levels. Hyperbilirubinemia and leukocytosis are not consequences of low body temperature.

The obstetrical nurse admits a premature, small-for-gestational age infant to the observational unit for assessment. The maternal record reveals an obese 27-year-old homeless woman with limited prenatal, medical, or dental care. Her blood pressure on admission was 170/90 mm Hg. Which factors in the maternal history would have suggested a high-risk pregnancy? Select all that apply. a. lack of prenatal care b. homelessness c. maternal age d. periodontal disease e. maternal hypertension f. obesity

a. lack of prenatal care b. homelessness d. periodontal disease e. maternal hypertension f. obesity The factors for a high-risk pregnancy include: maternal nutrition (obesity), substandard living conditions (homelessness), maternal age of less than 20 or more than 35 years, periodontal disease, lack of prenatal care, and maternal disease (hypertension).

A neonate is being admitted to the observational nursery with the diagnosis of postmaturity. What would the nurse expect to find with this gestational age variation? Select all that apply. a. meconium-stained skin and fingernails b. abundant lanugo c. decreased breast tissue d. thin umbilical cord e. peeling, wrinkled skin f. abundant vernix caseosa g. few sole creases

a. meconium-stained skin and fingernails d. thin umbilical cord e. peeling, wrinkled skin Postterm newborns typically exhibit peeling skin, with vernix caseosa and lanugo being absent. The creases will cover the entire soles of the feet. The umbilical cord will be thin, and there will be limited vernix and lanugo. There will be meconium-stained skin and fingernails evident with a thin umbilical cord.

A newborn is designated as very-low-birth-weight. When weighing this newborn, the nurse would expect to find which weight? a. less than 1,500 g b. more than 4,000 g c. approximately 2,500 g d. less than 1,000 g

less than 1,500 g A very-low-birth-weight newborn weighs less than 1,500 g. A large-for-gestational-age newborn typically weighs more than 4,000 g. A small-for-gestational-age newborn or a low-birth-weight newborn typically weighs about 2,500 g. An extremely-low-birth-weight newborn weighs less than 1,000 g.

A nurse is caring for a baby girl born at 34 weeks' gestation. Which feature should the nurse identify as those of a preterm newborn? a. paper-thin eyelids b. shiny heels and palms c. closely approximated labia d. scant coating of vernix

shiny heels and palms A preterm newborn has shiny heels and palms with few creases. The eyelids of the preterm newborn are edematous, and not paper-thin. The external genitalia in the preterm baby girl appear large with widely spaced labia, and not closely approximated. Vernix is scant in postterm newborns and is excessive in premature infants.

Following resuscitation, an infant weighing 1,814 g (4 lb) is admitted to the NICU. The nurse would initiate enteral feedings based on which assessment? a. stabilized respiratory effort b. absence of apnea c. stabilized cardiac function d. presence of bowel sounds

stabilized respiratory effort Enteral feedings are initiated when respiratory effort is stabilized. Newborns have periodic breathing with apnea. Cardiac function is not an indicator of readiness for enteral feedings. Even with bowel sounds present, enteral feedings will be delayed if respiratory effort is unstable.

All infants need to be observed for hypoglycemia during the newborn period. Based on the facts obtained from pregnancy histories, which infant would be most likely to develop hypoglycemia? a. an infant whose labor began with ruptured membranes b. an infant who had difficulty establishing respirations at birth c. an infant who has marked acrocyanosis of his hands and feet d. an infant whose mother craved chocolate during pregnancy

an infant who had difficulty establishing respirations at birth Newborns use a great many calories in their effort to achieve effective respirations. Infants who had difficulty establishing respirations need to be assessed for hypoglycemia.

During an extended initial resuscitation, what additional complications may be experienced by the infant during the resuscitation? Select all that apply. a. hypoglycemia b. dehydration c. hypokalemia d. anemia e. leukocytosis

a. hypoglycemia b. dehydration The stress may cause accelerated metabolism of glucose stores and hypoglycemia. Dehydration may occur due to insensible water loss during ventilation and other resuscitative procedures. Hypokalemia, anemia, and leukocytosis are not complications during an initial resuscitation.

A preterm infant begins gagging, splaying fingers and toes, and goes limp when the parents are playing with the infant. What would the nurse teach the parents? a. These are signs the infant is stressed and needs to rest. b. These are signs the infant is enjoying the attention. c. These are signs the infant is hungry and needs to eat. d. There are signs the infant is hypoxic and needs oxygen.

These are signs the infant is stressed and needs to rest. These behaviors indicate that the infant is stressed and that the activity needs to stop so the infant can rest.

A preterm infant receives surfactant by lung lavage. Which interventions should the nurse perform immediately? Select all that apply. a. placing the infant in an upright position b. not suctioning the airway c. placing the infant in a prone position d. frequent suctioning of secretions e. placing the infant in a supine position

a. placing the infant in an upright position b. not suctioning the airway Following lung lavage, the infant needs to be placed in an upright position to facilitate dispersion of the surfactant. The airway is not suctioned for as long as safely possible to prevent removal of the surfactant.

When caring for a preterm infant, what intervention will best address the sensorimotor needs of the infant? a. rocking and massaging b. swaddling and positioning c. using minimal amount of tape d. using distraction through objects

a. rocking and massaging When preterm infants receive sensorimotor interventions such as rocking, massaging, holding, or sleeping on waterbeds, they gain weight faster, progress in feeding abilities more quickly, and show improved interactive behavior. Interventions such as swaddling and positioning, use of minimal amount of tape, and use of distraction through objects are related to pain management.

A nurse is assessing a preterm newborn's status based on the understanding that the newborn is at greatest risk for which complication? a. atelectasis b. infection c. intracranial hemorrhage d. hypoglycemia

atelectasis The respiratory system is the last system to mature. Therefore, the preterm newborn is at great risk for respiratory complications, one of which is atelectasis.

A nurse is caring for a large-for-gestational-age newborn. Which sign(s) leads the nurse to suspect that the newborn is experiencing hypoglycemia? Select all that apply. a. bulging fontanels b. high-pitched, shrill cry c. lethargy and stupor d. respiratory difficulty e. appearance of bruising

c. lethargy and stupor d. respiratory difficulty The features indicating hypoglycemia in large-for-gestational-age (LGA) infants include lethargy, stupor, fretfulness, and respiratory difficulty. The other features include poor feeding in a previously well-feeding infant and weak, whimpering cry. A high-pitched, shrill cry along with bulging fontanels and bruising are seen in increased intracranial pressure following head trauma in LGA infants.

Hypoglycemia in a mature infant is defined as a blood glucose level below which amount? a. 100 mg/100 ml whole blood b. 80 mg/100 ml whole blood c. 40 mg/100 ml whole blood d. 30 mg/100 ml whole blood

40 mg/100 ml whole blood Because newborns do not manifest symptoms of a reduced glucose level until it decreases well below adult levels, a finding below 40 mg/100 ml whole blood is considered hypoglycemia.

The nurse has been doing bag and mask resuscitation for over 2 minutes. What additional intervention will the nurse initiate? a. Insert an orogastric tube. b. Begin cardiac compressions. c. Raise the concentration of oxygen. d. Place an umbilical artery catheter.

Insert an orogastric tube. After 2 minutes of bag and mask resuscitation, an orogastric tube needs to be inserted to prevent distention of the gastric cavity, which inhibits effective ventilation. Cardiac compression is initiated only if the heart rate is less than 60 beats per minute.

Which assessment finding by the nurse would indicate that a neonate is being comforted? a. increased oxygen saturation b. decreased oxygen saturation c. increased heart rate d. decreased heart rate

a. increased oxygen saturation Pulse oximetry can be used to help the nurse recognize when an infant is comforted by handling (e.g., oxygen saturation remains steady or increases) and when the infant is growing tired (e.g., oxygen saturation falls)

The neonatal intensive care nurse admits an infant of a diabetic mother to the unit with symptoms of respiratory distress. The infant is jaundiced with a ruddy skin color. Which action would be a priority? a. Prepare for repeat hematocrit levels q12h. b. Continue to monitor blood glucose levels q6h. c. Review maternal history for bleeding disorders. d. Prepare for continued positive airway pressure.

Prepare for repeat hematocrit levels q12h. Newborn infants of diabetic mothers (IDM) are at risk for polycythemia. A priority for the nurse is to observe for clinical signs of polycythemia (respiratory distress, cyanosis, jitteriness, jaundice, ruddy skin color, and lethargy) and monitor blood results with hematocrit levels repeated every 12 hours. Blood glucose levels would be monitored more often than Q6H. Bleeding disorders do not correlate with the situation. CPAP may be needed but not as the priority.

A preterm infant is transferred to a distant hospital for care. When her parents visit her, which action would be most important for the nurse to urge them to do? a. Stand so the baby can see them. b. Call the baby by her name. c. Touch and, if possible, hold her. d. Bring a piece of clothing for her.

Touch and, if possible, hold her. Preterm infants may be hospitalized for an extended time, so parents need to be encouraged to touch and interact with the infant to begin bonding.

The nurse is assisting parents who have just experienced the death of their twin infants. What would be the most appropriate action for the nurse? a. Allow the parents to be present at medical rounds and the resuscitation. b. Encourage the parents to avoid exposure to their infants' medical care. c. Call the hospital clergy to initiate prayers with the parents. d. Encourage the father to support his wife by allowing her to cry and grieve.

a. Allow the parents to be present at medical rounds and the resuscitation In times of impending death and loss initiate spiritual comfort by calling the hospital clergy only if appropriate; offer to pray with the family only if appropriate. Have the parents participate in early and repeated care conferencing to reduce family stress. Allow the family to be present at both medical rounds and resuscitation; provide explanations of all procedures. Encourage the father to cry and grieve with his partner.

The nurse recognizes that maternal factors can increase the chance of a large-for-gestational-age newborn. When reviewing maternal history, the nurse would interpret which factors as placing a newborn at risk for being LGA? Select all that apply. a. diabetes b. multiparity c. history of postdates gestation d. female fetus e. history of microsomic infant

- diabetes - multiparity - history of postdates gestation Maternal factors that increase the chance of bearing an LGA newborn include maternal diabetes or glucose intolerance, multiparity, prior history of a macrosomic infant, postdate gestation, maternal obesity, male fetus, and genetics.

The neonate's respirations are gasping and irregular with a rate of 24 bpm. Which circulatory alteration will the nurse assess for in this infant? a. Blood flows from the aorta to the pulmonary artery. b. Blood flows from the pulmonary vein to the alveoli. c. Blood flows from the right atrium to the left atrium. d. Blood flows from the lungs to the left ventricle.

Blood flows from the aorta to the pulmonary artery. Inadequate respiratory effort results in hypoxia. During hypoxia, the ductus arteriosus does not close, resulting in blood flow from the aorta to the pulmonary artery and inadequate pump action of the heart. The pulmonary vein takes blood from the right ventricle to the lungs. The foramen ovale allows blood flow from right atrium to left atrium during fetal life and is not primarily impacted by hypoxia. Oxygenated blood flows from the lungs to the left ventricle to be pumped to the body.

A 24-hour-old, full-term, small-for-gestational-age neonate is being assessed. Which maternal factors would the nurse correlate with this gestational age variation? Select all that apply. a. blood pressure baseline of 140/90 mm Hg b. maternal age of 30 c. positive for TORCH infections d. hemoglobin 7g/dL (70 g/L) e. BMI under 17 f. Rh incompatibility

a. blood pressure baseline of 140/90 mm Hg c. positive for TORCH infections d. hemoglobin 7g/dL (70 g/L) e. BMI under 17 Factors that can contribute to the birth of an SGA newborn are dependent on genetic, placental, and maternal factors such as anemia, intrauterine viral infection, hypertension, and TORCH infections. Blood pressure of 140/90 mm Hg in a pregnant woman as a baseline warrants intervention. The BMI is very low for pregnancy, and the anemia is noted with a hemoglobin of 7g/dL. Rh incompatibility is not a factor in SGA.

A 33-week-gestation infant has just been born. The child's heartbeat is not audible. What is the priority nursing intervention? a. Depression of the sternum with both thumbs 1 to 2 cm at a rate of 100 times per minute b. Administration of IV epinephrine, as prescribed c. Transfer to a transitional or high-risk nursery for continuous cardiac surveillance d. Palpation for a femoral pulse

Depression of the sternum with both thumbs 1 to 2 cm at a rate of 100 times per minute If an infant has no audible heartbeat, or if the cardiac rate is below 60 beats per minute, closed-chest massage should be started. Hold the infant with fingers encircling the chest and wrapped around the back and depress the sternum with both your thumbs, on the lower third of the sternum approximately one third of its depth (1 or 2 cm) at a rate of 100 times per minute. If the pressure and the rate of massage are adequate, it should be possible, in addition, to palpate a femoral pulse. If heart sounds are not resumed above 60 beats per minute after 30 seconds of combined positive-pressure ventilation and cardiac compressions, intravenous epinephrine may be prescribed. Following cardio-resuscitation, newborns need to be transferred to a transitional or high-risk nursery for continuous cardiac surveillance to be certain cardiac function is maintained.

The nurse weighs the new infant and calculates the child's measurements. The new mom asks, "Did my baby grow well? The doctor said he was LGA. What does that mean?"What is the nurse's best response? a. "That means that your baby is lazy sometimes." b. "That means your baby is in the 5th percentile for weight." c. "That means your baby is over the 90th percentile for weight." d. "That means your baby is average for gestational age."

"That means your baby is over the 90th percentile for weight." LGA stands for large for gestational age. These infants are over the 90th percentile for weight. The other choices are not over the 90th percentile for weight or describe a different characteristic.

What is the correct sequence of events in a neonatal resuscitation? a. Dry the infant, establish an airway, expand the lungs, and initiate ventilation. b. Expand the lungs, establish an airway, initiate ventilation, and warm the infant. c. Initiate ventilation, expand the lungs, dry the infant, and establish an airway. d. Warm the infant, establish an airway, initiate ventilation, and expand the lungs.

Dry the infant, establish an airway, expand the lungs, and initiate ventilation. The infant is dried to prevent brown fat metabolism and acidosis. An airway is established to allow interventions to expand the lungs. Then ventilation is initiated.

A woman who has given birth to a postterm newborn asks the nurse why her baby looks so thin with so little muscle. The nurse integrates understanding about which concept when responding to the mother? a. With postterm birth, the fetus uses stored nutrients to stay alive, and wasting occurs. b. The newborn aspirated meconium, causing the wasted appearance. c. A postterm newborn has begun to break down red blood cells more quickly. d. The newborn was exposed to an infection while in utero.

With postterm birth, the fetus uses stored nutrients to stay alive, and wasting occurs. After 42 weeks' gestation, the placenta loses its ability to provide adequate oxygen and nutrients to the fetus, causing the fetus to use stored nutrients to stay alive. This leads to wasting. Meconium aspiration can occur with postterm newborns, but this is not the reason for the baby's wasted appearance. Hyperbilirubinemia occurs with the increased breakdown of red blood cells, but this too would not account for the wasted appearance. Exposure to an intrauterine infection is unrelated to the wasted appearance.

A client just gave birth to a preterm baby in the 30th week of gestation. Which nursing measures does the nurse anticipate for this newborn? Select all that apply. a. Dress the baby in a stockinette cap. b. Carry and handle the baby frequently. c. Place the baby under isolette care. d. Dress the baby to keep the body warm. d. Estimate the urinary flow by weighing the diaper.

a. Dress the baby in a stockinette cap. c. Place the baby under isolette care. d. Estimate the urinary flow by weighing the diaper. The nurse should dress the baby in a stockinette cap, place the baby under isolette care, and estimate the urinary flow by weighing the diaper. Controlling the temperature in high-risk newborns is often difficult; therefore, special care should be taken to keep these babies warm by dressing then in a stockinette cap and recording their temperature on a regular basis. Isolette care simulates the uterine environment as closely as possible, thus maintaining even levels of temperature, humidity, and oxygen for the newborn. The isolette is transparent, so the newborn is visible at all times. The kidneys of preterm infants are not fully developed; hence, they may have difficulty eliminating wastes. The nurse should determine accurate output by weighing the diaper before and after the infant urinates. The diaper's weight difference in grams is approximately equal to the number of milliliters voided. Frequently carrying and handling the baby should be avoided so that the infant can conserve energy. Generally, preterm newborns in the high-risk category are not dressed, so the attending nurse can observe their breathing.

The nurse assesses an infant's body temperature as 97.1°F (36.2°C) during an extended resuscitation at birth. What consequence of this temperature would the nurse anticipate? Select all that apply. a. Fetal shunts remain open. b. Anaerobic glycolysis occurs. c. Pulmonary perfusion decreases. d. Metabolism increases. e. Immune function decreases.

a. Fetal shunts remain open. b. Anaerobic glycolysis occurs. c. Pulmonary perfusion decreases. d. Metabolism increases. When the infant's body temperature is low, the fetal shunts remain open, anaerobic glycolysis occurs, pulmonary perfusion decreases, and metabolism increases. Immune function is not a consequence of body temperature.

A full-term infant with spontaneous respiration at birth begins exhibiting signs of respiratory distress syndrome (RDS) at 22 hours of age. Which condition would the nurse assess for in this infant? a. Group B streptococcus (GBS) infection b. meconium aspiration syndrome c. transient tachypnea of the newborn d. persistent pulmonary circulation

a. Group B streptococcus (GBS) infection A group B streptococcal infection may mimic RDS because this infection is so severe in newborns that it stops surfactant production. Meconium aspiration syndrome would be preceded by the presence of meconium in the amniotic fluid at birth.

A newborn is being admitted to the intensive care unit with the diagnosis of postterm infant. Which nursing actions would be the priority? Select all that apply. a. Monitor for hematocrit levels. b. Assess for jaundice. c. Initiate blood glucose monitoring. d. Check for Rh incompatibility. e. Observe for hypothermia.

a. Monitor for hematocrit levels. b. Assess for jaundice. c. Initiate blood glucose monitoring. Postterm infants will need to be monitored closely for alterations in blood glucose levels. The nurse should also closely assess the postterm infant for polycythemia, which contributes to hyperbilirubinemia, so jaundice would be an indicator. Hct levels will be monitored for the risk of polycythemia. RH factor is not a priority. Temperature monitoring is a standard for all newborn care.

A preterm infant is receiving indomethacin. What is a priority assessment following administration of indomethacin? Select all that apply. a. Monitor urine output. b. Observe for bleeding. c. Auscultate for bilateral breath sounds. d. Palpate for abdominal rigidity. e. Monitor blood pressure.

a. Monitor urine output. b. Observe for bleeding. Indomethacin is given cautiously to preterm infants because it has been associated with adverse effects such as decreased renal function, decreased platelet count, and gastric irritation. Therefore, the nurse monitors urine output and observes for bleeding, especially at injection sites, if this is prescribed.

The nurse is caring for a preterm neonate on an apnea monitor. When the monitor alarms, what action does the nurse take? Select all that apply. a. Performs a focused assessment of the neonate b. Silences the alarm c. Administers a dose of caffeine d. Counts the respiratory rate for a full minute e. Begins bag and mask ventilation

a. Performs a focused assessment of the neonate b. Silences the alarm d. Counts the respiratory rate for a full minute The nurse needs to perform a focused assessment to determine if the neonate is apneic and if position or other factors contributed to the episode. The respiratory rate is counted for a full minute as part of the assessment. The alarm is silenced to decrease environmental noise and stress. Bag and mask ventilation is used for respiratory arrest, not an episode of apnea. Many neonates with apnea are on caffeine, but the dose is scheduled and not given in response to an apneic episode.

A preterm infant of 32 weeks' gestation is admitted from the birth suite to the neonatal intensive care unit with symptoms of respiratory distress. What would the nurse expect to see during assessments? Select all that apply. a. pH 7 b. PaCO2 54 mm Hg c. heart rate 110 bpm d. respiratory rate 34 breaths/min e. temperature 99.5° F (37.5° C) f. PaO2 35

a. pH 7 b. PaCO2 54 mm Hg f. PaO2 35 The preterm newborn develops atelectasis quickly without alveoli stabilization leading to RDS with hypoxemia, respiratory acidosis, and hypercarbia. This change in the newborn's biochemical environment allows fetal circulation patterns to persist with bradycardia, tachypnea, and hypothermia developing. Respiratory acidosis occurs when the carbon dioxide (PaCO2) is elevated above the normal range (44 mm Hg) leading to a blood pH lower than 7.35. Bradycardia is a heart rate less than 100 bpm. Respiratory rates of 30 breaths per minute are considered worrisome in the newborn. Five minutes after delivery, the PaO2 is approximately 35 to 40, and the oxygen saturation is in the mid 80s.

The nurse caring for a small-for-gestational-age newborn in the special-care nursery. What characteristics are commonly documented? Select all that apply. a. poor skin turgor b. tight and moist skin c. sparse or absent hair d. narrow skull sutures e. diminished muscle tissue f. increased fatty tissue

a. poor skin turgor c. sparse or absent hair e. diminished muscle tissue Characteristics of the small for gestational age newborn include poor skin turgor, loose and dry skin, sparse or absent hair, wide skull sutures caused by inadequate bone growth, and diminished muscle and fatty tissue. Weight, length, and head circumference are below normal expectations as defined on growth charts.

A nurse is providing care to a postterm newborn. The nurse suspects that the newborn may be developing polycythemia based on which findings? Select all that apply. a. ruddy appearance b. strong sucking reflex c. hypertonia d. seizures e. jaundice

a. ruddy appearance d. seizures e. jaundice Findings associated with polycythemia include a ruddy appearance (plethora), a weak sucking reflex, hypotonia, seizures, and jaundice.

What is a typical feature of a small-for-gestational-age (SGA) newborn that differentiates it from a preterm baby with a low-birth-weight? a. decreased muscle mass b. face is angular and pinched c. decreased body temperature d. ability to tolerate early oral feeding

ability to tolerate early oral feeding Unlike preterm babies with low birth weights, a small-for-gestational-age baby can safely tolerate early oral feeding. It usually has a coordinated sucking and swallowing reflex. Decreased muscle mass, decreased body temperature, and an angular and pinched face are features common to both an SGA baby and a preterm baby.

A nurse is reviewing the maternal history and medical record of an SGA newborn. Which finding would the nurse identify as a placental factor contributing to the newborn's current state? a. maternal malnutrition b. TORCH infection c. abnormal cord insertion d. trisomy 18

abnormal cord insertion Abnormal cord insertion is a placental factor associated with SGA newborns. Maternal malnutrition and TORCH infection are considered maternal factors. Trisomy 18 would be considered a fetal factor.

The nurse places a newborn experiencing respiratory difficulty under a radiant warmer to prevent which complication? a. acidosis b. alkalosis c. hypoxia d. hypercapnia

acidosis A radiant warmer is use to keep the infant warm. When an infant is cold, brown fat metabolism leads to acidosis, which would further complicate respiratory difficulties.

A postterm newborn develops perinatal asphyxia. The nurse understands that this condition is most likely the result of: a. aging placenta. b. hypoxia from cord compression. c. loss of subcutaneous fat. d. increased production of red blood cells.

aging placenta. Complications associated with a postterm newborn include perinatal asphyxia (caused by placental aging or oligohydramnios/decreased amniotic fluid); hypoglycemia (caused by acute episodes of hypoxia related to cord compression, which exhausts carbohydrate reserves); hypothermia (caused by loss of subcutaneous fat); and polycythemia (caused by an increased production of red blood cells to compensate for a reduced oxygen environment).

A late preterm newborn is being prepared for discharge to home after being in the neonatal intensive care unit for 4 days. The nurse instructs the parents about the care of their newborn and emphasizes warning signs that should be reported to the pediatrician immediately. The nurse determines that additional teaching is needed based on which parental statement? a. "We will call 911 if we start to see that our newborn's lips or skin are looking bluish." b. "If our newborn's skin turns yellow, it is from the treatments and our newborn is okay." c. "If our newborn does not have a wet diaper in 12 hours, we will call our pediatrician." d. "We will let the pediatrician know if our newborn's temperature goes above 100.4°F (38°C)."

b. "If our newborn's skin turns yellow, it is from the treatments and our newborn is okay." The parents of a preterm newborn need teaching about when to notify their pediatrician or nurse practitioner. These include: displaying a yellow color to the skin (jaundice); having difficulty breathing or turning blue (call for emergency services in this case); having a temperature below 97°F (36.1°C) or above 100.4°F (38°C); and failing to void for 12 hours.

When caring for a 1-week-old infant with jaundice, the nurse observes the infant's urine to be dark in color. The nurse would also expect to assess which as indicative of significant hyperbilirubinemia? Select all that apply. a. Decreased volume of urination b. Poor feeding and lethargy c. Late passage of meconium stool d. Jaundice limited to the nose, eyes, and ears e. Light, tan-colored stool after milk intake

b. Poor feeding and lethargy c. Late passage of meconium stool e. Light, tan-colored stool after milk intake Poor feeding and lethargy, late passage of meconium stool, and light, tan-colored stool after milk intake are features of significant hyperbilirubinemia. Decrease in volume of urination is not seen with hyperbilirubinemia. Jaundice limited to the nose, eyes, and ears is physiologic jaundice and does not indicate significant hyperbilirubinemia.

Which factors in a maternal birth record are risks for fetal growth restriction? a. premature rupture of membranes, gestational diabetes, or multiparity b. twin pregnancy, gestational diabetes, or essential hypertension c. renal disease, maternal age over 35, or congenital malformations d. congenital malformations, infections, or placental insufficiency

congenital malformations, infections, or placental insufficiency Fetal growth restriction can result from aneuploidy, congenital malformations, infections, or uteroplacental insufficiency. Their size falls below the 10th percentile on growth charts. It is the pathological counterpart to a SGA. They are at risk for increased morbidity and mortality. The fetus is thought to have growth potential under normal circumstances. It is analogous to the failure to thrive in the infant. Newborns that experience nutritional deficiencies in utero and born with FGR are at risk of lifelong developmental deficits.

The nurse is performing a newborn assessment and the infant's lab work reveals a heelstick hematocrit of 66. What is the best response to this finding? a. The infant is suffering from polycythemia and needs a partial exchange transfusion to prevent complications. b. This is a normal lab value, and no intervention is needed. c. A capillary hematocrit needs to be rechecked in 8 hours to see if it increases or decreases. d. The hematocrit needs to be repeated as a venous stick to see what the central hematocrit level is.

d. The hematocrit needs to be repeated as a venous stick to see what the central hematocrit level is. A hematocrit above 65% is considered elevated and polycythemia is diagnosed. However, to get an accurate venous reading, a central venous hematocrit needs to be drawn to verify the value. Drawing the blood in 8 hours does not address the problem at present, and the infant does not need a partial exchange transfusion immediately. Health care providers will decide if this is needed after monitoring the infant for symptoms and following the central hematocrit levels.

A small-for-gestational-age neonate is admitted to the observational nursery for blood work. Which result would require further assessment? a. hematocrit: 80% (0.80) b. hemoglobin: 15.6 grams/dl (156 g/L) c. total bilirubin: 0.3 to 1.9 mg/dl (5.13 µmol/L to 32.50 µmol/L) d. serum glucose: 40 mg/dl (2.5 mmol/L)

hematocrit: 80% (0.80) Polycythemia is not uncommon and is a potentially serious disorder of newborns. It is defined as a venous hematocrit above 65% and hemoglobin of more than 20 grams. Polycythemia occurs in up to 12% of neonates, very commonly in SGA newborns 6 to 12 hours after birth. The other test results are normal for a newborn.