Recommended Newborn Success Questions Chapter 10: High-Risk Newborn

3. The supply of brown adipose tissue is incomplete. Preterm babies are born with an insufficient supply of brown adipose tissue that is needed for thermogenesis, or heat generation.

A 1-day-old neonate, 32 weeks' gestation, is in an overhead warmer. The nurse assesses the morning axillary temperature as 96.9ºF. Which of the following could explain this assessment finding? 1. This is a normal temperature for a preterm neonate. 2. Axillary temperatures are not valid for preterm babies. 3. The supply of brown adipose tissue is incomplete. 4. Conduction heat loss is pronounced in the baby.

4. Respiratory evaluation to monitor for respiratory distress. Meconium aspiration syndrome (MAS) is a serious complication seen in post-term neonates who are exposed to meconium-stained fluid. Respiratory distress would indicate that the baby has likely developed MAS.

A 42-week-gestation baby has been admitted to the neonatal intensive care unit. At delivery, thick green amniotic fluid was noted. Which of the following actions by the nurse is critical at this time? 1. Bath to remove meconium-contaminated fluid from the skin. 2. Ophthalmic assessment to check for conjunctival irritation. 3. Rectal temperature to assess for septic hyperthermia. 4. Respiratory evaluation to monitor for respiratory distress.

3. Obtain an order for the hepatitis B vaccine and the immune globulin. Babies exposed to hepatitis B in utero should receive the first dose of hepatitis B vaccine as well as hepatitis B immune globulin (HBIG) within 12 hours of delivery to reduce transmission of the virus.

A baby has been admitted to the neonatal nursery whose mother is hepatitis B-surface antigen positive. Which of the following actions by the nurse should be taken at this time? 1. Monitor the baby for signs of hepatitis B. 2. Place the baby on contact isolation. 3. Obtain an order for the hepatitis B vaccine and the immune globulin. 4. Advise the mother that breastfeeding is absolutely contraindicated.

3, 4, and 5 are correct. Explanation: 1. Hyperopia, another name for farsightedness, is unrelated to placental function. 2. If the mother had gestational diabetes, the nurse would expect the baby to be macrosomic, not to have IUGR. 3. Placental function is affected by the vasoconstrictive properties of many illicit drugs, as well as by cigarette smoke. 4. Placental function is diminished in women who have chronic hypertension. 5. Placental function has been found to be diminished in women of advanced maternal age.

A baby has just been admitted into the neonatal intensive care unit with a diagnosis of intrauterine growth restriction (IUGR). Which of the following maternal factors would predispose the baby to this diagnosis? Select all that apply. 1. Hyperopia. 2. Gestational diabetes. 3. Substance abuse. 4. Chronic hypertension. 5. Advanced maternal age.

1. Check blood pressures in all four limbs. The pathophysiology of coarctation of the aorta provides the rationale for the assessment of the blood pressures. Since the narrowing of the aorta is usually distal to the ascending aorta, blood is able to pass unimpeded into the upper body but is unable to pass through the descending aorta toward the lower body. The blood pressures of the upper body, therefore, are much higher than the blood pressures in the lower extremities.

A baby is born with a suspected coarctation of the aorta. Which of the following assessments should be done by the nurse? 1. Check blood pressures in all four limbs. 2. Palpate the anterior fontanel for bulging. 3. Assess hematocrit and hemoglobin values. 4. Monitor for harlequin color changes.

4. Assess the respiratory rate. Grunting is often accompanied by tachypnea, another sign of respiratory distress. Essentially, the baby is producing his or her own positive end-expiratory pressure (PEEP) in order to maximize his or her respiratory function.

A baby is grunting in the neonatal nursery. Which of the following actions by the nurse is appropriate? 1. Place a pacifier in the baby's mouth. 2. Check the baby's diaper. 3. Have the mother feed the baby. 4. Assess the respiratory rate.

1. Tightly swaddle the baby. Tightly swaddling drug-addicted babies often helps to control the hyperreflexia that they may exhibit.

A baby is in the NICU whose mother was addicted to heroin during the pregnancy. Which of the following nursing actions would be appropriate? 1. Tightly swaddle the baby. 2. Place the baby prone in the crib. 3. Provide needed stimulation to the baby. 4. Feed the baby half-strength formula.

1. Urine drug toxicology test. The symptoms are characteristic of neonatal abstinence syndrome. A urine toxicology would provide evidence of drug exposure. This child has normal serum glucose levels. When babies exhibit tremors, the first thing the nurse should consider is hypoglycemia. Once that has been ruled out, and since the baby is exhibiting other signs of drug withdrawal, the nurse should consider drug exposure.

A baby was born 24 hours ago to a mother who received no prenatal care. The infant has tremors, sneezes excessively, constantly mouths for food, and has a shrill, high-pitched cry. The baby's serum glucose levels are normal. For which of the following should the nurse request an order from the pediatrician? 1. Urine drug toxicology test. 2. Biophysical profile test. 3. Chest and abdominal ultrasound evaluations. 4. Oxygen saturation and blood gas assessments.

1. Type O negative. ABO incompatibility can arise when the mother is type O and the baby is either type A or type B.

A baby's blood type is B negative. The baby is at risk for hemolytic jaundice if the mother has which of the following blood types? 1. Type O negative. 2. Type A negative. 3. Type B positive. 4. Type AB positive.

1. Feed the baby formula or breast milk. A baby with a blood glucose of 35 mg/dL is hypoglycemic. The action of choice is to feed the baby either formula or breast milk.

A full-term infant admitted to the newborn nursery has a blood glucose level of 35 mg/dL. Which of the following actions should the nurse perform at this time? 1. Feed the baby formula or breast milk. 2. Assess the baby's blood pressure. 3. Tightly swaddle the baby. 4. Monitor the baby's urinary output.

4. Notify the neonatalogist of the abnormal glucose levels. If the glucose level has not risen to normal as a result of the feeding, the nurse should notify the physician and anticipate that the doctor will order an intravenous of dextrose and water. Hypoglycemia is a common problem seen in infants, especially macrosomic infants and infants of diabetic mothers.

A macrosomic infant of a non-insulin dependent diabetic mother has been admitted to the neonatal nursery. The baby's glucose level on admission to the nursery is 25 mg/dL and after a feeding of mother's expressed breast milk is 35 mg/dL. Which of the following actions should the nurse take at this time? 1. Nothing because the glucose level is normal for an infant of a diabetic mother. 2. Administer intravenous glucagon slowly over five minutes. 3. Feed the baby a bottle of dextrose and water and reassess the glucose level. 4. Notify the neonatalogist of the abnormal glucose levels.

4. Monitor the baby for jaundice. When the neonatal bloodstream contains antibodies, hemolysis of the red blood cells occurs and jaundice develops. The indirect Coombs' test is performed on the pregnant woman to detect whether or not she carries antibodies against her fetus' red blood cells. The direct Coombs' test is performed on the newborn to detect whether or not he or she carries maternal antibodies in his or her blood.

A newborn admitted to the nursery has a positive direct Coombs' test. Which of the following is an appropriate action by the nurse? 1. Monitor the baby for jitters. 2. Assess the blood glucose level. 3. Assess the rectal temperature. 4. Monitor the baby for jaundice.

1 and 5 are correct. 1. Hyperphagia. Babies with signs of neonatal abstinence syndrome repeatedly exhibit signs of hunger. 5. Persistent shrill cry. Babies with signs of neonatal abstinence syndrome often have a shrill cry that may continue for prolonged periods.

A newborn in the nursery is exhibiting signs of neonatal abstinence syndrome. Which of the following signs/symptoms is the nurse observing? Select all that apply. 1. Hyperphagia. 2. Lethargy. 3. Prolonged periods of sleep. 4. Hyporeflexia. 5. Persistent shrill cry

2. Have the mother feed the baby frequently. Bilirubin is excreted through the bowel. The more the baby consumes, the more stools, and therefore the more bilirubin the baby will expel.

A newborn nursery nurse notes that a baby's body is jaundiced at 36 hours of life. Which of the following nursing interventions will be most therapeutic? 1. Maintain a warm ambient environment. 2. Have the mother feed the baby frequently. 3. Have the mother hold the baby skin to skin. 4. Place the baby naked by a closed sunlit window.

2. Assess the glucose level of the baby. The glucose level should be assessed to determine whether or not this baby is hypoglycemic. A feeding will elevate the glucose level if it is below normal. The nurse does need to assess the level, however, in order to make a clear determination of the problem.

A nurse makes the following observations when admitting a full-term, breastfeeding baby into the neonatal nursery: 9 lbs 2 oz, 21 inches long, TPR: 96.6ºF, 158, 62, jittery, pink body with bluish hands and feet, crying. Which of the following actions should the nurse perform first? 1. Swaddle the baby to provide warmth. 2. Assess the glucose level of the baby. 3. Take the baby to the mother for feeding. 4. Administer the neonatal medications.

1. The baby whose mother cultured positive for group B strep during her third trimester. Group B streptococcus causes severe infections in the newborn. A sign of neonatal sepsis is hypothermia. Babies whose mothers had gestational diabetes (GDM) should be carefully monitored for hypoglycemia rather than for hypothermia. Babies with neonatal sepsis often become hypothermic, while babies born to mothers with GDM become hypoglycemic.

Four full-term babies were admitted to the neonatal nursery. The mothers of each of the babies had labors of 4 hours or less. The nursery nurse should carefully monitor which of the babies for hypothermia? 1. The baby whose mother cultured positive for group B strep during her third trimester. 2. The baby whose mother had gestational diabetes. 3. The baby whose mother was hospitalized for 3 months with complete placenta previa. 4. The baby whose mother previously had a stillbirth.

2. Place baby in the prone position. The baby should be lain prone to prevent injury to the sac. The baby with meningomyelocele is born with an opening at the base of the spine through which a sac protrudes. The sac contains cerebral spinal fluid and nerve endings from the spinal cord. It is essential that the nurse not injure the sac; therefore, the baby should be placed in a prone position immediately after birth.

In the delivery room, which of the following infant care interventions must a nurse perform when a neonate with a meningomyelocele is born? 1. Perform nasogastric suctioning. 2. Place baby in the prone position. 3. Administer oxygen via face mask. 4. Swaddle the baby in warm blankets.

1. Passed meconium at 50 hours of age. Babies who have delayed meconium excretion may have Hirshsprung's disease. Hirshsprung's disease is defined as a congenital lack of parasympathetic innervation to the distal colon. Peristalsis, therefore, ceases at the end of the intestine. Because of the absence of peristalsis, the passage of meconium is delayed.

The neonatalogist assesses a newborn for Hirschsprung's disease after the baby exhibited which of the following signs/symptoms? 1. Passed meconium at 50 hours of age. 2. Apical heart rate of 200 beats per minute. 3. Maculopapular rash. 4. Asymmetrical leg folds.

1. Excessive amounts of frothy saliva from the mouth. Excessive amounts of frothy saliva may indicate that the child has esophageal atresia. A baby whose esophagus ends in a blind pouch is unable to swallow his or her saliva. Instead, the mucus bubbles and drools from the mouth. Healthy babies, on the other hand, swallow without difficulty

The nurse assessed four newborns admitted to the neonatal nursery and called the neonatalogist for a consult on the baby who exhibited which of the following? 1. Excessive amounts of frothy saliva from the mouth. 2. Blood-tinged discharge from the vaginal canal. 3. Secretion of a milk-like substance from both breasts. 4. Heart rate that sped during inhalation and slowed with exhalation.

3. Narcan. Narcan is an opioid antagonist. If it were to be given to the neonate with neonatal abstinence syndrome, the baby would go into a traumatic withdrawal.

There is a baby in the neonatal intensive care unit (NICU) who is exhibiting signs of neonatal abstinence syndrome. Which of the following medications is contraindicated for this neonate? 1. Morphine. 2. Opium. 3. Narcan. 4. Phenobarbital.

3. Tachypnea. Babies who have cold stress syndrome will develop respiratory distress. One symptom of the distress is tachypnea.

Which of the following would lead the nurse to suspect cold stress syndrome in a newborn with a temperature of 96.5ºF? 1. Blood glucose of 50 mg/dL. 2. Acrocyanosis. 3. Tachypnea. 4. Oxygen saturation of 96%.