Week 4 Quiz: Ch. 9, 10, and 11

Discuss the importance of surfactant to the preterm infant's lungs.

-Deficient surfactant production causes unequal inflation of alveoli on inspiration and the collapse of alveoli on end expiration. -Infants are unable to keep their lungs inflated and therefore exert a great deal of effort to reexpand the alveoli with each breath.

A primary objective in the care of high-risk infants is to maintain respiration. Describe how the nurse should complete the respiratory assessment.

-Describe shape of chest (barrel/concave), symmetry, presence of incisions, chest tubes or other deviation. -Describe use of accessory muscles: nasal flaring or substernal, intercoastal or subclavicular retractions. -determine respiratory rate and regularity -auscultate and describe breath sounds: Stridor, crackles, wheezing, diminished sounds, areas of absence of sound, grunting, diminished air entry, equality of breath sounds -Determine whether suctioning is needed. -describe ambient oxygen and method of delivery; if intubated, describe size of tube, type of ventilator and settings, and method of securing tube. -determine oxygen saturation by pulse oximetry

Baby girl Miller has been admitted to the NICU with low birth weight and possible infection. Parenteral fluids have been ordered for hydration and antibiotic administration. The nurse starts a peripheral line and places the neonate on an infusion pump to regulate the rate of IV administration. Ten minutes later the nurse observes for signs of infiltration. What signs should the nurse be looking for?

-Redness, edema or color changing at site -Blanching at site

Identify the two most critical objectives in caring for the high-risk infant.

1. Infant will exhibit adequate oxygenation. 2. Infant will maintain stable body temp.

Identify three major consequences produced by cold stress that create additional hazards for the neonate.

1. hypoxia 2. metabolic acidosis 3. hypoglycemia

A late and serious sign of respiratory distress in the neonate is: A. central cyanosis B. respiratory rate of 90 breaths/minute C. substernal retractions D. nasal flaring

A

At birth the newborn is immediately assessed to determine any apparent problems and to identify those that demand immediate attention. The assessment not usually conducted at birth or immediately after birth is: A. assignment of a gestational age score B. assignment of an APGAR score C. evaluation for obvious congenital anomalies D. evaluation for neonatal distress

A

Discharge instructions for the parents of the preterm infant should not include: A. warning parents that their infant may still be in danger and will need constant attention B. providing information to the parents on how to contact personnel for later questions C. instructions about car safety seats, including how these seats can be adapted for smaller infants with the placement of blanket rolls on each side of the infant to support the head and trunk D. providing adequate information about immunization needs

A

Infants diagnosed with bronchopulmonary dysplasia have special care needs. These needs include: A. adequate rest B. avoiding diuretics C. decreasing caloric intake D. rapid weaning from ventilator

A

Suctioning of the infant with respiratory distress syndrome: A. is performed by inserting the catheter to a predetermined depth B. is performed routinely every 30 minutes to keep the airway open C. is performed by gently inserting the catheter until resistance is felt D. is performed by advancing the catheter until resistance is met and then withdrawing

A

The amount to be fed to the infant by nipple is: A. determined by the infant's tolerance to previous feeding B. increased when the infant requires 25 minutes or more for feeding completion C. increased when the infant reaches the postnatal age of 34 weeks D. increased when prodding techniques are used to increase sucking and decrease aspiration

A

The best way to prevent infection in the high risk neonate begins with: A. meticulous and frequent hand washing of all persons coming in contact with the infant B. observing continually for signs of infection C. requiring everyone working in the NICU to put on fresh scrub clothes before entering the unit D. performing epidemiologic studies at least monthly

A

Which of the following is the best way for the nurse to promote a healthy parent-infant relationship for the family with a high-risk neonate? A. Reinforce parents during their caregiving activities and interactions with their infant B. help parents understand that the preterm infant offers no behavioral rewards C. reassure parents that the infant is doing well D. encourage the mother to stay by the infant's bedside to promote bonding

A

Low-birth weight infants are at a disadvantage for heat production when compared with full-term infants because they have: (Select all that apply) A. small muscle mass B. fewer deposits of brown fat C. less insulating subcutaneous fat D. poor reflex control of skin capillaries

A, B, C, D

A complication that develops with the use of the umbilical catheter is thrombi. This complication is best recognized by the appearance of: A. blanching of the buttocks and genitalia B. bluish discoloration seen in the toes, called " cath toes" C. bounding pedal pulses D. hemorrhage from the umbilical catheter area

B

A physical characteristic usually observed in the preterm infant and not observed in the full-term infant is: A. proportionately equal head in relation to the body B. skin that is translucent, smooth, and shiny with small blood vessels clearly visible underneath the epidermis C. distinct creases extending across the entire palms of the hands and down the soles of the feet D. absence of lanugo and little vernix caseosa

B

Feeding facilitation techniques for preterm infants include: A. using a pliable nipple with faster flow B. using a slightly firm nipple with slow flow C. manipulating the nipple frequently by twisting and turning when the infant stops sucking D. positioning the infant on the back with the head supported

B

Susie, a neonate born 20 minutes ago, was observed at birth to have meconium staining. If Susie has meconium in the lungs, this most likely will: A. prevent air from entering the lungs B. trap inspired air in the lungs C. cause no problems with breathing D. lead to respiratory alkalosis

B

The preterm infant is having respirations with absence of diaphragmatic muscle function. This is causing a lack of respiratory effort because the central nervous system is not transmitting signals to the respiratory muscles. What is this type of apnea called? A. Obstructive apnea B. Central apnea C. periodic apnea D. mixed apnea

B

Which of the following interventions is least likely to be effective for high risk neonates? A. keeping the infant on servocontrol in an incubator or radiant warmer B. placing the heat sensing probe on the infant's abdomen when the infant is in the prone position C. ensuring that the oxygen supplied to the infant via a hood around the head is warmed and humidified D. Warming all items that come in direct contact with the infant, including the hands of caregivers

B

_____________________ ___________________, a common preservative in bacteriostatic water and saline, has been shown to be toxic to newborn's and is not used to flush IV catheters or reconstitute meds.

Benzyl alcohol

An infant who weighs 1400g appears to be ready for enteral feedings. Which of the following should the nurse include in the implementation of gavage feedings? A. insert the tube into the unobstructed nares B. perform the procedure with the infant in a supine position with the head elevated 45 degrees C. aspirate the contents of the stomach, measure these contents, and replace the residual as part of the feeding D. allow the feeding to flow by gravity; then push a small amount of the feeding into the stomach; then allow the remainder of the feeding to flow by gravity

C

Brian, a two-day-old preterm infant being cared for in the NICU, had some periods of apnea yesterday. Today when you arrive to work, you learn in a report that the infant has had no further apneic episodes since yesterday. However, shortly after you begin your shift, Brian's apnea monitor alarm sounds. What should you do first? A. Use tactile stimulation, rubbing on the infant's back to stop the apneic spell B. suction his nose and oropharynx C. assess the infant for color and for presence of respiration D. place the infant on his abdomen

C

Introduction of minimal enteral feedings in the preterm infant: A. increases incidence of necrotizing enterocolitis B. increases mucosal atrophy incidence C. decreases incidence of necrotizing enterocolitis D. maintains serum glucose homeostasis

C

The administration of exogenous surfactant to preterm neonates with respiratory distress syndrome: A. shows no difference in improvement when synthetic surfactant is used versus natural surfactant B. is done by intravenous infusion C. requires adjustment of ventilator settings D. requires suctioning the infant during administration

C

To help parents deal with neonatal death, the nurse should: A. discourage the parents from staying with the infant before death to prevent over attachment B. explain to the parents that the infant would have had many developmental problems and it is better that the infant did not suffer C. give the parents the opportunity to hold and talk with the infant before and after death D. Force the parents to see the infant after death because closure is necessary

C

When a high-risk neonate needs transportation to a facility that can provide intensive care, the nurse recognizes that equipment for this neonate must include: A. Transfer of both mother and infant B. immediate transport, often before stabilization of the neonate C. Complete life support system available during transport D. Prevention of transport delay by carrying the infant in the nurse's arms to the waiting transport vehicle

C

Which of the following is a correct statement about persistent pulmonary hypertension of the newborn (PPHN)? A. PPHN is primarily a condition of preterm infants B. PPHN is rarely associated with meconium aspiration C. a loud pulmonary component of the second heart sound and a systolic ejection murmur may be present with PPHN D. ECMO is often used to decrease cardiac output

C

Reduce loss of heat by warming items with which infant has direct contact.

Conductive heat loss

Occurs when infants are exposed to drafts or when surrounding air is cool.

Convective heat loss

A cause of fetal and neonatal mortality in post-term infants as compared with term infants is: A. absence of lanugo B. skin cracking, parchmentlike, and peeling C. depletion of subcutaneous fat D. macrosomia and meconium aspiration syndrome

D

An important nursing function is close observation of neonates at risk for developing air leaks. These infants include: A. those with respiratory distress syndrome B. those with meconium-stained amniotic fluid C. those receiving continuous positive airway pressure (CPAP) or positive-pressure ventilation D. all of the above

D

Apnea in the preterm infant is defined as a lapse of spontaneous breathing lasting for how many seconds? A. 5 Seconds B. 10 seconds C. 15 seconds D. 20 seconds

D

Caring for a preterm infant's skin, the nurse knows to: A. use scissors to remove dressings or tape from the infant's extremities B. use solvents to remove tape from the neonate's skin C. use alkaline- based soaps in removal of stool D. use zinc oxide-based tape to secure monitoring equipment or intravenous infusions

D

What is the best measurement of feeding success in the infant? A. Soft abdomen B. no aspirated gastric residual C. ability to suck on pacifier D. coordinated sucking and swallowing ability

D

Which of the following is a neonatal intensive care facility that provides care for extremely low-birth-weight infants plus sustained life support and surgical repair of serious congenital cardiac malformations? A. Level I facility B. Level IIB facility C. Level IIIC facility D. Level IV facility

D

Which of the following is not used as a category in the classification of high-risk newborns? A. Birth size B. Gestational age C. Mortality D. Birth age

D

Which of the following is the correct nursing intervention to prevent skin damage in the neonate? A. Instruct parents before discharge on regular use of sunscreen for all infants under 6 months of age B. apply adhesive tape to protect arms, elbow, and knees from friction rubs C. use powder on diaper dermatitis areas as a moisture barrier D. use gel mattresses to decrease skin breakdown

D

Can be decreased by providing a high humidity atmosphere.

Evaporative heat loss

An infant whose birth weight is less than 1000 g (2.2lb)

Extremely low-birth-weight infant

True/False Containment or facilitated tucking positioning of the infant during procedures has been shown to increase physiologic and behavioral stressors.

False

True/False Developmental maturation for the young preterm infant is seen by a decrease in quiet sleep.

False

True/False Milk produced by mothers whose infants are born at term contains higher concentrations of protein, sodium chloride, and immunoglobulin A (IgA).

False

True/False Nurse should turn off alarm systems for electronic monitoring devices when their sounds disturb the infant's parents.

False

True/False Pasteurization of donor human milk serves little purpose, since all donors are carefully screened.

False

True/False Preterm infants have the same capacity to digest and absorb protein, carbohydrates, and fats as full-term infants.

False

True/False Preterm infants receiving continuous feedings show better weight gain than those receiving intermittent bolus feedings.

False

True/False Prolonged "clustering" of care for the ill infant promotes physiologic stability.

False

True/False Research has shown that infants receiving trophic feedings versus no feedings have an overall higher number of days to full feedings in a longer hospital stay.

False

True/False Sophisticated monitoring and life-support systems can replace the observations of the infant by nursing personnel.

False

True/False Studies have shown that infants receiving a heel puncture for blood collection demonstrated less pain response than those receiving a venipuncture.

False

True/False Using earmuffs in the NICU is an important intervention to prevent later speech and language difficulties.

False

True/False When hydrogel electrodes are used on the neonate's skin, they are easily removed by lifting the edge and wiping with alcohol.

False

An infant born between the 38th week and completion of the 42nd week of gestation

Full-term infant

Method that allows infant to breathe spontaneously at his/her own rate but provides mechanical cycled respirations and pressure at regular preset intervals by means of an endotracheal tube and ventilator.

Intermittent mandatory ventilation (IMV)

An infant whose birth weight falls above the 90th percentile on intrauterine growth curves

Large for gestational age infant (LGA)

An infant born between 34 0/7 and 36 6/7 weeks of gestation, regardless of birth weight

Late-preterm infant

Prenatal diagnostic test for lung maturity

Lecithin/sphingomyelin ratio

An infant whose birth weight is less than 2500 g (5.5lb), regardless of gestational age

Low-birth-weight infant

Signals respiratory distress/increased work of breathing

Nasal flaring

Death that occurs in the first 27 days of life

Neonatal death

Allows one to maintain normal core temperature with minimal oxygen consumption and caloric use.

Neutral thermal environment

The major source of increased production of heat during cold stress in the high risk neonate is ____________________ __________________.

Non-shivering thermogenesis

____________________ ______________________ decreases hospital stay, enhances transition from tube to bottle-feeding, and results in better bottle feeding performance in preterm infants.

Nonnutritive sucking

Describes the total number of fetal and early neonatal deaths per 1000 live births

Perinatal mortality

An infant born after 42 weeks of gestation

Post-term (post mature) infant

An infant born before completion of 37 weeks of gestation

Preterm (premature) infant

Condition that develops in the preterm infant with respiratory distress syndrome and immature lungs as a result of over distention of distal airways.

Pulmonary interstitial emphysema

Occurs by transfer of heat to a cooler object not in direct contact.

Radiant heat loss

An infant whose birth weight falls below the 10th percentile on intrauterine growth curves

Small for gestational age infant (SGA)

Infant-triggered ventilator with signal detector and assist/control mode

Synchronized intermittent mandatory ventilation (SIMV)

Capacity to balance heat production, heat conservation, and heat dissipation.

Thermal stability

True/False Although infants demonstrate some sucking and swallowing activities before birth, coordination of these mechanisms does not occur until approximately 32 to 34 weeks of gestation, and they are not fully synchronized until 36 to 37 weeks.

True

True/False An accurate output measurement can be obtained in the neonate by using a urine collecting bag or by weighing the infant's diaper (40g weight of urine would be recorded as 40mL of urine).

True

True/False Developmentally supportive care uses both physiologic and behavioral information to evaluate the needs of the infant in a NICU setting.

True

True/False Each infant is different; therefore supportive developmental care requires ongoing data collection by the nurse.

True

True/False Fortified human milk is mixed as close to feeding time as possible and stored in the refrigerator.

True

True/False Infants who are mechanically ventilated can have lower BP.

True

True/False Low birth weight infants (less than 1500g) who are fed only human milk demonstrate decreased growth rates and nutritional deficiencies.

True

True/False Milk produced by mothers of preterm infants changes in content over the first 30 days postnatally, until its content is similar to that of full-term human milk.

True

True/False Neonates under intensive observation are placed in a controlled environment and monitored for heart rate, respiratory activity, and temperature.

True

True/False Nursing care for the neonate should include modification of care to provide longer episodes of undisturbed sleep.

True

True/False Preterm infants are less responsive to visual stimulation and have less acuity and accommodation than full-term infants.

True

True/False Preterm infants who are fed fortified human milk have shorter hospital stays and less infection than infants given pre-term formulas.

True

True/False Stroking a preterm infant who is not physiologically stable can result in distress, including oxygen desaturation.

True

True/False Strong visual stimulation such as high contrast black-and-white patterns can evoke an obligatory staring response by the immature infant, who is unable to break away from it.

True

True/False Studies have shown that preterm infants who received human milk during their hospitalization demonstrated better intellectual performance scores at 7.5 to 8 years of age compared with children who received formula.

True

True/False The best time for care of an infant is when the infant is awake.

True

True/False The number of calories required for optimal growth in sick and very low birth weight infants is higher than for healthy infants.

True

True/False Therapeutic positioning for preterm and high-risk infants should provide support to maintain flexed and midline postures.

True

The term ______________________ _____________________ is used when parents show hesitancy to embark on a relationship with their infant, unconsciously preparing themselves for the infant's death.

anticipatory grief

Method that provides constant distending pressure by means of nasal prongs, a face mask, or an endotracheal tube.

continuous positive airway pressure (CPAP)

A thorough, systematic physical assessment is a must in the care of the high-risk neonate. Subtle changes in ______________________ _____________________, ____________________, _____________________, ________________________ ______________________, or __________________ _________________ often indicate an underlying problem.

feeding behavior; activity; color; O2 saturation (SpO2); vital signs

Death of a fetus after 20 weeks of gestation

fetal death

Method that delivers gas at very rapid rates to provide adequate minute volumes using lower proximal airway pressures

high-frequency ventilation (HFV) modalities

Oral or parenteral meds should be sufficiently diluted if they are ______________________ solutions to prevent necrotizing enterocolitis.

hyperosmolar

Lung distensibility

lung compliance

Method that provides increased end-expiratory pressure during expiration and between mandatory breaths, preventing alveolar collapse.

positive end-expiratory pressure (PEEP)

The ________________ sleeping position is recommended by the American Academy of Pediatrics for healthy infants in the 1st year of life a preventative measure for SIDS.

supine

The term _____________________ ________________ _________________ is applied to physically healthy children who are perceived by parents to be at high-risk for medical or developmental problems.

vulnerable child syndrome