Chapter 20: The Newborn at Risk: Gestational and Acquired Disorders

When providing postpartum teaching to a couple, the nurse correctly identifies what time as when pathologic jaundice may be found in the newborn?

during the first 24 hours of life

At which point is the treatment Rho(D) immune globulin for hemolytic disease of the newborn finished?

during the postpartum period

A newborn is admitted to the nursery after being born at 43 weeks' gestation. This newborn is classified as which of the following?

post-term

The registered nurse (RN) is determining a newborn's gestational age. What tool would be best used to evaluate this?

the Ballard scoring system

A newborn has been diagnosed recently with transient tachypnea of the newborn. How should the nurse counsel the parents?

"I know it's scary now, but this condition most likely will resolve on its own without affecting your baby in the long run."

The parents of an 8-month-old tell the nurse that they have a fear that the infant will develop sudden infant death syndrome (SIDS). What is the best response by the nurse?

"Infants who die from SIDS are usually 2 to 4 months old, but I understand your concern."

The nurse is screening an expectant mother for the extent of current substance use. Which statement made by the mother is most concerning?

"Since I have learned that I am pregnant, I have only binged a few times."

The pregnant woman with diabetes asks the nurse why her last baby weighed 11 pounds. What is the best response by the nurse?

"The fetus increases insulin production in response to elevated glucose levels of the mother, which acts as a fetal growth hormone."

A nurse notices a mother in the NICU crying next to her premature 25-week-old neonate. What is the most appropriate response by the nurse?

"This situation must be difficult for you. Can you tell me what concerns you have right now?"

A newborn has been diagnosed with retinopathy of prematurity. The nurse is teaching the parents about this condition. Which statement would the nurse most likely include in the teaching?

"You'll need to schedule follow-up eye examinations with the pediatric ophthalmologist."

The nurse is completing accurate output on a preterm client. The nurse changed the client's diaper, which weighs 50 g. The dry diaper weighs 22 g. Which amount does the nurse record under output? Record your answer using a whole number.

28

Extremely low birth weight, or ELBW, describes a newborn who weighs less than _______ g.

1000

The incidence of sudden infant death syndrome (SIDS) peaks at what age?

2 to 4 months

A newborn who is large for gestational age will weigh more than ______ grams.

4000

The nurse is caring for a client who is at her due date. The client asks. "How long is the health care provider going to let me go?" The nurse is correct to state that typical a mother should not pass how many weeks' gestation?

42 weeks

Why is thermoregulation a problem for the preterm newborn?

A preterm infant is not born with brown fat.

The licensed practical nurse (LPN) is caring for a neonate who is 24 hours old and notes the apnea and bradycardia monitor alarming. Upon entering the room, the nurse reads a respiratory rate of 84 breaths/minute and a heart rate of 200 beats/minute on the client's monitor. Which action will the LPN take next?

Auscultate the neonate's lungs and heart.

A nurse makes a home visit to a new mother and her 5-day-old newborn. Assessment of the newborn reveals slight yellowing of the skin on the face and forehead and slowed skin turgor. The mother tells the nurse that she's been having trouble breastfeeding the newborn. "My baby's been feeding about every 4 to 5 hours." Additional assessment reveals about 3 wet diapers per day and 1 to 2 stools per day. Which action by the nurse would be the priority?

Call the provider to obtain a prescription for a bilirubin level.

For which potential neonatal infection does the nurse anticipate using ophthalmic erythromycin?

Chlamydia trachomatis

The nurse is assessing the plantar creases on the newborns for documentation on the Ballard Scale. Which documentation is interpreted as evidence of a full-term infant?

Creases covering two-thirds of the anterior foot

What intervention can the nurse provide to reduce pain and stress in the preterm infant?

Create minimal stimulation and reduce procedures that cause pain.

The nurse is teaching gavage feedings to the mother of a preterm infant. Which instruction is most important?

Gastric residual present

A nurse is caring for a preterm newborn born at 29 weeks' gestation. Which nursing diagnosis would have the highest priority?

Ineffective thermoregulation related to decreased amount of subcutaneous fat

When interacting with parents caring for their newborn in opioid withdrawal, which nursing action is most essential?

Instruct the parents with a nonjudgmental, caring attitude.

A term infant had thick meconium when the amniotic membranes ruptured. The mother is in the birth process for this infant. Place in order the steps to reduce the risk for meconium aspiration during this infant's birth. Use all options.

Keep the infant's head below the body at birth. Suction the nose and pharynx prior to the birth of the body. Assess for spontaneous respiration. Place on mother's chest. Keep infant warm and dry.

The nurse is caring for a premature infant born at 29 weeks' gestation. What intervention(s) will be used for the goal of preventing retinopathy of prematurity (ROP)? Select all that apply.

Maintain oxygen saturation at 92%. Refer the infant to an ophthalmologist at 31 weeks' corrected age.

At birth, a neonate is diagnosed with brachial plexus palsy. The parent asks how the nurse knows the neonate's positioning of the arm is a result of the palsy and not just a preferred position. The nurse would show the parent that the neonate has asymmetry of which neonatal reflex?

Moro

When providing care to the newborn withdrawing from a drug such as cocaine or heroin, which drug is given to ease the symptoms and prevent complications?

Morphine

Which nursing interventions are essential when caring for a newborn with macrosomia born to a mother with diabetes? Select all that apply.

Obtain blood glucose reading. Obtain IV glucose for potential infusion. Assess for respiratory distress. Anticipate supplemental oxygen.

Which teaching is most helpful in preventing sudden infant death syndrome (SIDS)?

Place the infant on the back for sleep.

Which classification for gestational age is correct?

Preterm is a newborn born before 37 weeks. Post-term is a newborn born after 42 weeks.

Which environmental consideration is most helpful to promoting comfort when the neonate is withdrawing from alcohol and drugs?

Provide a dark, quiet environment

A pregnant client with diabetes is preparing for the birth of a large-for-gestational-age newborn. What intervention(s) will the nurse include in the initial postbirth plan of care for the newborn? Select all that apply.

Provide thermoregulation. Maintain blood glucose. Assess respiratory status.

The nurse is caring for an intrapartum mother whose fetus has asymmetrical intrauterine growth restriction (IUGR) after the 24th week of gestation. Which nursing action is best?

Regular assessment of the fetal monitor tracings and preparation for a cesarean birth, if needed.

Upon shift handoff the nurse reports meconium staining of the amniotic fluid. Which neonatal system requires close monitoring by the incoming nurse?

Respiratory system

The student nurse is performing a Ballard scale on a newborn. The instructor assesses that the student understands methods to check neuromuscular maturity when she gently pulls the newborn's arm in front of and across the top portion of the body until resistance is met and identifies this action as:

Scarf sign.

Which nursing action is required when caring for the post-term infant?

Serial blood glucose levels

Which nursing actions limit overstimulation of the preterm infant? Select all that apply.

Speak softly to the infant. Keep lights low in the nursery. Coordinate nursing care.

The nurse is working in the special care nursery caring for a newborn withdrawing from alcohol. Which nursing intervention promotes client comfort?

Swaddle and decrease stimulation

The client brings her infant daughter to the pediatrician's office for her first visit since hospital discharge. At birth, the newborn was at the 8th percentile with a weight of 2,350 g. She was born at 36 weeks' gestation. Which documentation is most accurate?

The infant was a preterm, low-birth-weight and small-for-gestational-age neonate

In doing the Ballard assessment of gestational age, which of the following is done to assess what is called the scarf sign?

The infant's arm is pulled gently in front of and across the top portion of the body until resistance is met.

The nurse is caring for a newborn who is large-for-gestational-age (LGA). Which characteristics are documented as a contributing factor? Select all that apply.

The mother has had previous large-for-gestational-age neonates. The mother has poorly controlled diabetes. Both parents are of a larger stature and size.

The nurse is most correct to assess for transient tachypnea of the newborn (TTN) in which neonate?

The neonate delivered by cesarean section

The nurse is assessing a male neonate using the Ballard gestational age assessment tool. The neonate has the following characteristics: Deep cracking skin, no vessels Thinning lanugo Creases on the plantar surface Raised areola Formed ear, instant recoil Testes down, good rugae From the above characteristics, which can the nurse determine?

The neonate is a term newborn.

The nurse is caring for a preterm neonate and has chosen the following goal: improvement of the neonate's respiratory function. Which expected outcome is most appropriate for the first week?

The neonate will not use accessory muscles when breathing.

Which assessment finding within the first 24 hours of birth requires immediate health care provider notification?

The skin is jaundiced.

A nurse is caring for a neonate of 25 weeks' gestation who is at risk for intraventricular hemorrhage (IVH). Which assessment finding should be reported immediately?

a sudden drop in hematocrit

After birth, an infant experiences meconium aspiration. What does the nurse anticipate the primary care provider prescribing prophylactically to prevent pneumonia?

antibiotics

If a newborn whose weight, length, and head circumference falls into the 15th percentile for gestational age, the newborn would be said to be which of the following?

appropriate for gestational age

A late preterm newborn is born at:

between 34 and 37 weeks.

The nurse is caring for an infant born to a mother with cocaine use disorder during her pregnancy. The nurse would likely notice that this infant:

cries when touched.

A nurse is assessing a newborn. What gestational age assessment findings indicate that the newborn has reached term?

flexible wrist with a small angle at a range of 15 degrees

Which of the following best describes the time between fertilization of the egg and birth?

gestational age

Newborns born to a mother with diabetes are at risk for which of the following?

hypoglycemia, delayed fetal lung maturity, respiratory distress, and shoulder dystocia

What is the most common reason why an infant will be small-for-gestational-age (SGA)?

intrauterine growth restriction

A preterm newborn is noted to have hypotonia, apnea, bradycardia, a bulging fontanel (fontanelle), cyanosis, and increased head circumference. These signs indicate the newborn has which complication?

intraventricular hemorrhage (IVH)

Why does breathing require greater effort for the preterm newborn?

lack of surfactant

A newborn admitted to the nursery weighs 2,000 grams. This newborn is classified as which of the following?

low birth weight

The nursing students describe the infant they are caring for as weighing 2000 g. The instructor knows that effective communication among staff members suggests that what term be used to describe the infant?

low-birth-weight (LBW)

Which contributing factor in large-for-gestational-age (LGA) infants accounts for the greatest number of cases?

maternal diabetes

By preventing fetal distress during the intrapartum period, which condition is less likely?

meconium aspiration syndrome

What would the nurse suspect in a premature newborn who has difficulty feeding and maintaining a stable temperature and is vomiting bile?

necrotizing enterocolitis

The nurse in the newborn nursery has used the Ballard scoring system to assess the newborn. This gestational assessment evaluation includes which of the following categories of maturity of the newborn?

neuromuscular and physical

The nurse is caring for a neonate that is small for gestational age due to intrauterine growth restriction. Which is the most common cause?

oxygen and nutrient deficiency prior to birth

The nurse is providing care to a newborn with severe meconium aspiration syndrome (MAS). The nurse is reviewing the newborn's diagnostic test results. Which finding would the nurse expect?

patchy, fluffy infiltrates on chest X-ray

All of the following complications are more likely to develop in a large-for-gestational-age (LGA) newborn as opposed to an appropriate-for-gestational-age (AGA) newborn except:

polycythemia

When a fetus has chronic hypoxia in utero, what response does the nurse expect to see after birth?

polycythemia

Which of the following is not a way to determine physical maturity in a newborn using the Ballard scoring system?

posture

A pregnant woman at 41 weeks' gestation is scheduled for labor induction. What does the nurse monitor after the birth of the baby?

serial blood glucose levels

Which preventable cause of intrauterine growth restriction (IUGR) is most common?

smoking

All of the following are characteristics of a preterm newborn except:

the head is disproportionately small.