Chapter 23: Nursing Care of the Newborn With Special Needs

When assessing a postterm newborn, which of the following would the nurse correlate with this gestational age variation? A) Moist, supple, plum skin appearance B) Abundant lanugo and vernix C) Thin umbilical cord D) Absence of sole creases

C) Thin umbilical cord

The preterm newborn loses heat via ................. if placed on a cold examining table.

Conduction

Preterm newborns have a limited ability to digest .................

proteins

One maternal factor increasing the chance of bearing a large-for-gestational-age newborn is being postterm. TRUE FALSE

TRUE Maternal factors increasing the chance of bearing an LGA newborn include diabetes mellitus or glucose intolerance, genetics, gestational weight gain, male fetus, maternal obesity, multiparity, paternal height, postterm gestation, and prior history of a macrosomic infant.

Fetal distress during labor may indicate perinatal asphyxia. FALSE TRUE

TRUE If the fetus experiences bradycardia, or late or variable decelerations, it may indicate perinatal asphyxia is occurring.

When documenting the newborn's weight on a growth chart, the nurse recognizes the newborn is large-for-gestational-size based on which percentile on growth charts? above 95th percentile above 90th percentile above 80th percentile above 85th percentile

above 90th percentile A newborn whose weight is above the 90th percentile on growth charts is defined as large-for-gestational-age.

Small-for-gestational-age newborns have difficulty with thermoregulation as they have less ............... fat than appropriate for gestational age newborns

brown

A nurse is developing a plan of care for a preterm newborn to address the nursing diagnosis of risk for delayed development. Which of the following would the nurse include? (Select all that apply.) A) Clustering care to promote rest B) Positioning newborn in extension C) Using kangaroo care D) Loosely covering the newborn with blankets E) Providing nonnutritive sucking

A) Clustering care to promote rest C) Using kangaroo care E) Providing nonnutritive sucking

After determining that a newborn is in need of resuscitation, which of the following would the nurse do first? A) Dry the newborn thoroughly B) Suction the airway C) Administer ventilations D) Give volume expanders

A) Dry the newborn thoroughly

The nurse is reviewing the medical record of a newborn born 2 hours ago. The nurse notes that the newborn was delivered at 35 weeks' gestation. The nurse would classify this newborn as which of the following? A) Preterm B) Late preterm C) Full term D) Postterm

B) Late preterm

A newborn born at 41 weeks' gestation would be classified as postterm. FALSE TRUE

FALSE

The nurse in a newborn nursery is observing for developmentally appropriate care. Which is an example of self-regulation? Infant is crying. Infant has hand in mouth. Infant is quiet. Infant is kicking feet.

Infant has hand in mouth. Self-regulation is a form of self-soothing for an infant, such as sucking on hands or putting hand to mouth.

A perinatal nurse is providing care for a large-for-gestational-age neonate admitted to the observational unit after a complicated vaginal birth resulting in shoulder dystocia. Which assessment would be a priority for the nurse to perform? Moro assessment Ballard assessment suck assessment Dubowitz assessment

Moro assessment Thoroughly assess the LGA newborn at birth to identify traumatic birth injuries such as fractured clavicles resulting from the trauma. Shoulder injury may result and can be identified with an absent Moro reflex on the injured side. The Ballard Scale is a commonly used technique of gestational age assessment. The Dubowitz assessment is a neurological assessment included in the Ballard assessment. Testing the suck reflex would not be a priority.

Evidence-based practice refers to the use of which of the following to validate your practice? Research findings Written guidelines Traditional practices Institutional policies

Research findings Research validates evidence-based practice.

Newborns who are small for gestational age have fetal growth restriction. TRUE FALSE

FALSE Small for gestational age (SGA) describes newborns weighing less than 2,500 g (5 lb, 8 oz) at term due to less growth than expected in utero or birth weight at or below the 10th percentile as correlated with the number of weeks of gestation. These infants are constitutionally small, but otherwise healthy. Fetal growth restriction is the pathologic counterpart to SGA.

The nurse is caring for a large-for-gestational-age newborn (also known as macrosomia). What maternal condition is the usual cause of this condition? hypertension celiac disease diabetes alcohol use

diabetes In the condition known as macrosomia, a newborn is born large-for-gestational-age (LGA). These newborns are those with birth weights that exceed the 90th percentile of newborns of the same gestational age. They are born most often to mothers with diabetes.

The nurse is weighing a newborn and documents AGA (appropriate for gestational age) on the newborn record. Which weight percentile is anticipated? 5th 20th 95th 9th

20th Appropriate for gestation age infants fall between the 10th and 90th percentile for weight.

The nurse is concerned that a newborn is hypoglycemic. Which blood glucose level would support the nurse's intervention? 40 mg/dl (2.25 mmol/l) 50 mg/dl (2.77 mmol/l) 60 mg/dl (3.33 mmol/l) 30 mg/dl (1.67 mmol/l)

30 mg/dl (1.67 mmol/l) Hypoglycemia in a neonate is defined as blood glucose value typically below 35 to 45 mg/dl (1.94 to 2.50 mmol/l). The American Academy of Pediatrics recommends intervening for a blood glucose less than 40 mg/dl (2.25 mmol/l) in the first 4 hours of life, and less than 45 mg/dl (mmol/l) at ages 4 hours to 24 hours.

An LGA newborn has a blood glucose level of 30 mg/dL and is exhibiting symptoms of hypoglycemia. Which of the following would the nurse do next? A) Administer intravenous glucose immediately. B) Feed the newborn 2 ounces of formula. C) Initiate blow-by oxygen therapy. D) Place the newborn under a radiant warmer.

A) Administer intravenous glucose immediately.

10. When planning the care for an SGA newborn, which action would the nurse determine as a priority? A) Preventing hypoglycemia with early feedings B) Observing for respiratory distress syndrome C) Promoting bonding between the parents and the newborn D) Monitoring vital signs every 2 hours

A) Preventing hypoglycemia with early feedings

While caring for a preterm newborn receiving oxygen therapy, the nurse monitors the oxygen therapy duration closely based on the understanding that the newborn is at risk for which of the following? A) Retinopathy of prematurity B) Metabolic acidosis C) Infection D) Cold stress

A) Retinopathy of prematurity

A nurse suspects that a preterm newborn is having problems with thermal regulation. Which of the following would support the nurse's suspicion? (Select all that apply.) A) Shallow, slow respirations B) Cyanotic hands and feet C) Irritability D) Hypertonicity E) Feeble cry

A) Shallow, slow respirations B) Cyanotic hands and feet E) Feeble cry

A nursing instructor is describing common problems associated with preterm birth. When describing the preterm newborn's risk for perinatal asphyxia, the instructor includes which of the following as contributing to the newborn's risk? (Select all that apply.) A) Surfactant deficiency B) Placental deprivation C) Immaturity of the respiratory control centers D) Decreased amounts of brown fat E) Depleted glycogen stores

A) Surfactant deficiency C) Immaturity of the respiratory control centers

A nurse is assessing a newborn who has been classified as small for gestational age. Which of the following would the nurse expect to find? (Select all that apply.) A) Wasted extremity appearance B) Increased amount of breast tissue C) Sunken abdomen D) Adequate muscle tone over buttocks E) Narrow skull sutures

A) Wasted extremity appearance C) Sunken abdomen E) Narrow skull sutures

Which of the following, if noted in the maternal history, would the nurse identify as possibly contributing to the birth of an LGA newborn? A) Drug abuse B) Diabetes C) Preeclampsia D) Infection

B) Diabetes

The nurse prepares to assess a newborn who is considered to be large for gestational age (LGA). Which of the following would the nurse correlate with this gestational age variation? A) Strong, brisk motor skills B) Difficulty in arousing to a quiet alert state C) Birth weight of 7 lb 14 oz D) Wasted appearance of extremities

B) Difficulty in arousing to a quiet alert state

When describing newborns with birth-weight variations to a group of nursing students, the instructor identifies which variation if the newborn weighs 5.2 lb at any gestational age? A) Small for gestational age B) Low birth weight C) Very low birth weight D) Extremely low birth weight

B) Low birth weight

Which of the following would be most appropriate for the nurse to do when assisting parents who have experienced the loss of their preterm newborn? A) Avoid using the terms "death" or "dying." B) Provide opportunities for them to hold the newborn. C) Refrain from initiating conversations with the parents. D) Quickly refocus the parents to a more pleasant topic.

B) Provide opportunities for them to hold the newborn.

A nurse is caring for an infant. A serum blood sugar of 40 was noted at birth. What care should the nurse provide to this newborn? Give dextrose intravenously before oral feedings. Begin early feedings either by the breast or bottle. Place infant on radiant warmer immediately. Focus on decreasing blood viscosity by introducing feedings.

Begin early feedings either by the breast or bottle. The nurse should provide some nutrition to any infant born with hypoglycemia. Dextrose should be given intravenously only if the infant refuses oral feedings, not before offering the infant oral feedings. Placing the infant on a radiant warmer will not help maintain blood glucose levels. The nurse should focus on decreasing blood viscosity in an infant who is at risk for polycythemia, not hypoglycemia.

A nurse is caring for an infant. A serum blood sugar of 40 was noted at birth. What care should the nurse provide to this newborn? Focus on decreasing blood viscosity by introducing feedings. Place infant on radiant warmer immediately. Begin early feedings either by the breast or bottle. Give dextrose intravenously before oral feedings

Begin early feedings either by the breast or bottle. The nurse should provide some nutrition to any infant born with hypoglycemia. Dextrose should be given intravenously only if the infant refuses oral feedings, not before offering the infant oral feedings. Placing the infant on a radiant warmer will not help maintain blood glucose levels. The nurse should focus on decreasing blood viscosity in an infant who is at risk for polycythemia, not hypoglycemia.

The obstetrics nurse has admitted a large-for-gestational-age infant, 1-hour old, for observation. The initial blood glucose level is 44 mg/dl (2.44 mmol). What is the nurse's priority action? Transfer the newborn to the neonatal intensive care unit. Begin supervised feedings for the newborn. Recheck the newborn's blood glucose in 4 hours. Return the newborn to its parents for bonding.

Begin supervised feedings for the newborn. Hypoglycemia in a neonate is defined as a blood glucose value below 40 mg/dL (2.22 mmol/L). Supervised breastfeeding or formula feeding may be the initial treatment options in asymptomatic hypoglycemia. Hypoglycemia has been linked to poor neurodevelopmental outcomes, and hence aggressive screening and treatment are recommended. Monitor blood glucose levels within 30 minutes of birth, and repeat the screening every hour. Recheck levels before feedings and also immediately in any infant suspected of having or showing clinical signs of hypoglycemia.

The nurse is assessing a preterm newborn's fluid and hydration status. Which of the following would alert the nurse to possible overhydration? A) Decreased urine output B) Tachypnea C) Bulging fontanels D) Elevated temperature

C) Bulging fontanels

The nurse frequently assesses the respiratory status of a preterm newborn based on the understanding that the newborn is at increased risk for respiratory distress syndrome because of which of the following? A) Inability to clear fluids B) Immature respiratory control center C) Deficiency of surfactant D) Smaller respiratory passages

C) Deficiency of surfactant

The parents of a preterm newborn being cared for in the neonatal intensive care unit (NICU. are coming to visit for the first time. The newborn is receiving mechanical ventilation and intravenous fluids and medications and is being monitored electronically by various devices. Which action by the nurse would be most appropriate? A) Suggest that the parents stay for just a few minutes to reduce their anxiety. B) Reassure them that their newborn is progressing well. C) Encourage the parents to touch their preterm newborn. D) Discuss the care they will be giving the newborn upon discharge.

C) Encourage the parents to touch their preterm newborn.

A group of nursing students are reviewing the literature in preparation for a class presentation on newborn pain prevention and management. Which of the following would the students be most likely to find about this topic? A) Newborn pain is frequently recognized and treated B) Newborns rarely experience pain with procedures C) Pain is frequently mistaken for irritability or agitation D) Newborns may be less sensitive to pain than adult

C) Pain is frequently mistaken for irritability or agitation

The nurse has admitted a small-for-gestational-age infant (SGA) to the observation nursery from the birth room. Which action would the nurse prioritize in the newborn's care plan? Observe feeding tolerance. Assess for hyperglycemia. Monitor intake and output. Closely monitor temperature.

Closely monitor temperature. Difficulty with thermoregulation in SGA newborns is common due to less muscle mass, less brown fat, less heat-preserving subcutaneous fat, and limited ability to control skin capillaries. The priority would be to closely monitor the newborn's temperature. It is also associated with depleted glycogen stores; therefore, this is hypoglycemia not hyperglycemia. Immaturity of CNS (temperature-regulating center) interferes with the ability to regulate body temperature. Intake and output monitoring and observing feeding are not the priority.

What action by the nurse provides the neonate with sensory stimulation of a human face? assisting the mother to position the infant in an en face position encouraging the mother to view the baby through the isolette dome having mothers look at the infant through the isolette's porthole teaching parents to maintain a distance of 18 inches (7 cm) from the baby's face

Correct response: assisting the mother to position the infant in an en face position To allow the infant to see a human face, assist the mother to assume an en face position with the infant. Mother and child need to be in the same plane and about 6 to 10 inches (15 to 25 cm) apart. Looking through the isolette dome or porthole distorts the image. Infants need to see objects within 12 inches (30 cm) to focus clearly.

A nurse is assisting the anxious parents of a preterm newborn to cope with the situation. Which statement by the nurse would be least appropriate? A) "I'll be here to help you all along the way." B) "What has helped you to deal with stressful situations in the past?" C) "Let me tell you about what you will see when you visit your baby." D) "Forget about what's happened in the past and focus on the now."

D) "Forget about what's happened in the past and focus on the now."

The nurse is teaching a group of students about the differences between a full-term newborn and a preterm newborn. The nurse determines that the teaching is effective when the students state that the preterm newborn has: A) Fewer visible blood vessels through the skin B) More subcutaneous fat in the neck and abdomen C) Well-developed flexor muscles in the extremities D) Greater surface area in proportion to weight

D) Greater surface area in proportion to weight

The respiratory system is one of the first systems to mature in the fetus. TRUE FALSE

FALSE The respiratory system is one of the last body systems to mature in the fetus.

If the nurse manages a newborn with low blood sugar, which intervention would be appropriate to prevent hypoglycemia? Feed the neonate. Give antibiotics. Check the heart rate. Hold all feedings.

Feed the neonate. The newborn could be fed either breast milk or formula to prevent low blood sugar. If unable to feed well, the neonate can receive intravenous fluids. The other choices do not raise blood sugar.

A preterm newborn has just received synthetic surfactant through an endotracheal tube by a syringe. Which intervention should the nurse implement at this point? Place the infant in an elevated position. Place the infant supine in a radiant heat warmer. Immediately suction the infant's airway. Take a blood sample.

Place the infant in an elevated position. It's important the newborn placed in an elevated position following administration by elevating the head of the incubator or warmer and the infant's airway is not suctioned for as long as safely possible after administration of surfactant to help it reach the lower lung areas and to avoid suctioning the drug away. A blood sample may be taken to rule out a streptococcal infection, which mimics the signs of RDS, but this would have been done before administration of surfactant. The infant should not be placed supine in a radiant heat warmer at this time but should be held in an upright position.

A preterm newborn has just received synthetic surfactant through an endotracheal tube by a syringe. Which intervention should the nurse implement at this point? Place the infant supine in a radiant heat warmer. Immediately suction the infant's airway. Place the infant in an elevated position. Take a blood sample.

Place the infant in an elevated position. It's important the newborn placed in an elevated position following administration by elevating the head of the incubator or warmer and the infant's airway is not suctioned for as long as safely possible after administration of surfactant to help it reach the lower lung areas and to avoid suctioning the drug away. A blood sample may be taken to rule out a streptococcal infection, which mimics the signs of RDS, but this would have been done before administration of surfactant. The infant should not be placed supine in a radiant heat warmer at this time but should be held in an upright position.

A nurse assisting in a birth notices that the amniotic fluid is stained greenish black as the neonate is being born. Which intervention should the nurse implement as a result of this finding? Flick the sole of the neonate's foot Administer oxygen via a bag and mask Provide supplemental oxygen and monitor respiratory status Gently shake the neonate

Provide supplemental oxygen and monitor respiratory status When the amniotic fluid is stained greenish black, the neonate is at risk for meconium aspiration syndrome (MAS). Treatment for MAS depends on severity, but standard guidelines include supplemental oxygen and close monitoring of respiratory status. Additional treatment depends on the severity of respiratory compromise. The health care provider would determine if additional treatment is needed. The nurse should not administer oxygen under pressure (bag and mask) until the neonate has been intubated and suctioned, so the pressure of the oxygen does not drive small plugs of meconium farther down into the lungs, worsening the irritation and obstruction. Gently shaking the neonate and flicking the sole of the foot are methods of stimulating breathing in a neonate experiencing apnea.

An 18-year-old client has given birth at 28 weeks' gestation and her newborn is showing signs of respiratory distress syndrome (RDS). Which statement is true for a newborn with RDS? RDS is caused by a lack of alveolar surfactant. Respiratory symptoms of RDS typically improve within a short period of time. Glucocorticoid (GC) is given to the newborn following birth. RDS is characterized by heart rates below 50 beats per minute.

RDS is caused by a lack of alveolar surfactant. Respiratory distress syndrome (RDS) is a serious breathing disorder caused by a lack of alveolar surfactant. Betamethasone, a glucocorticoid, is often given to the mother 12 to 24 hours before a preterm birth to help reduce the severity of RDS, not to the newborn following birth. Respiratory symptoms in the newborn with RDS typically worsen, not improve, within a short period of time after birth. Diagnosis of RDS is made based on a chest X-ray and the clinical symptoms of increasing respiratory distress, crackles, generalized cyanosis, and heart rates exceeding 150 beats per minute (not below 50 beats per minute).

A nurse is caring for a preterm newborn who has developed rapid, irregular respirations with periods of apnea. Which additional assessment finding should the nurse identify as an indication of respiratory distress syndrome (RDS)? Inspiratory grunt Expiratory lag Sternal retraction Deep inspiration

Sternal retraction The nurse should identify sternal retraction as a sign of respiratory distress syndrome in the preterm newborn. Deep inspiration is not seen during respiratory distress; rather, a shallow and rapid respiration is seen. There is an inspiratory lag, instead of an expiratory lag, during respiratory distress. There is a grunting heard when the air is breathed out, which is during expiration and not during inspiration.

A preterm newborn has abundant vernix caseosa. FALSE TRUE

TRUE Newborns who are born early often have abundant vernix caseosa.

At birth, the newborn was at the 8th percentile with a weight of 2350 g and born at 36 weeks' gestation. Which documentation is most accurate? The infant was a preterm, very-low-birthweight and small-for-gestational-age The infant was born at term but at a very low birth weight and small-for-gestational-age The infant was born at term but at a low birth weight and small-for-gestational age The infant was a preterm, low-birth-weight and small-for-gestational-age

The infant was a preterm, low-birth-weight and small-for-gestational-age Born at 36 weeks' gestation is a preterm age (under 37 weeks). The infant was a low birthweight (under 2500 g) and small-for-gestational-age at the 8th percentile (under the 10th percentile). The other documentation is not accurate.

At birth, the newborn was at the 8th percentile with a weight of 2350 g and born at 36 weeks' gestation. Which documentation is most accurate? The infant was a preterm, low-birth-weight and small-for-gestational-age The infant was born at term but at a low birth weight and small-for-gestational age The infant was born at term but at a very low birth weight and small-for-gestational-age The infant was a preterm, very-low-birthweight and small-for-gestational-age

The infant was a preterm, low-birth-weight and small-for-gestational-age Born at 36 weeks' gestation is a preterm age (under 37 weeks). The infant was a low birthweight (under 2500 g) and small-for-gestational-age at the 8th percentile (under the 10th percentile). The other documentation is not accurate.

A 20-year-old client gave birth to a baby boy at 43 weeks' gestation. What might the nurse observe in the newborn during routine assessment? The newborn may look wrinkled and old at birth. The infant may have excess of lanugo and vernix caseosa. The newborn may have short nails and hair. The testes in the child may be undescended.

The newborn may look wrinkled and old at birth. Postterm babies are those born past 42 weeks' gestation. These babies often appear wrinkled and old at birth. They often have long fingernails and hair, dry parched skin, and no vernix caseosa. Both the quantity of lanugo and the amount of vernix decrease with gestational age. Undescended testes are usually not seen in postterm newborns; however, they are highly prevalent in preterm infants.

At a prenatal class the nurse describes the various birth weight terms that may be used to describe a newborn at birth. The nurse feels confident learning has occurred when a participant makes which statement? "Appropriate-for-gestational-age describes a newborn with a weight over the 90th percentile at birth." "Newborns who are appropriate-for-gestational-age at birth have lower chance of complications than others." "Infants who are larger-for-gestational-age at birth have fewer complications than the other groups." "Appropriate-for-gestational-age means a newborn is born with a weight that falls in the 10th percentile."

"Newborns who are appropriate-for-gestational-age at birth have lower chance of complications than others." Birth weight variations include appropriate-for-gestational-age (AGA), which describes a newborn with a weight that falls within the 10th to 90th percentile for that particular gestational age. This describes approximately 80% of all newborns. Infants who are appropriate-for-gestational-age have lower morbidity and mortality than other groups.

At a prenatal class the nurse describes the various birth weight terms that may be used to describe a newborn at birth. The nurse feels confident learning has occurred when a participant makes which statement? "Appropriate-for-gestational-age means a newborn is born with a weight that falls in the 10th percentile." "Newborns who are appropriate-for-gestational-age at birth have lower chance of complications than others." "Appropriate-for-gestational-age describes a newborn with a weight over the 90th percentile at birth." "Infants who are larger-for-gestational-age at birth have fewer complications than the other groups."

"Newborns who are appropriate-for-gestational-age at birth have lower chance of complications than others." Birth weight variations include appropriate-for-gestational-age (AGA), which describes a newborn with a weight that falls within the 10th to 90th percentile for that particular gestational age. This describes approximately 80% of all newborns. Infants who are appropriate-for-gestational-age have lower morbidity and mortality than other groups.

A nursing student, observing care of a 30-week-gestation infant in the neonatal intensive care unit, asks the nurse, "Are premature infants more susceptible to infection as I have to wash my hands so often in this department?" What is the nurse's best response? "Not really, as premature infants are cared for in an isolate, protecting them from infection." "Yes, as they lack the antibody called IdD that acts as protection from infections." "That is correct; a 30-week-gestation infant lacks the protective antibody called IgG." "Feeding premature infants breast milk establishes the best protective mechanisms."

"That is correct; a 30-week-gestation infant lacks the protective antibody called IgG." The preterm newborn's immune system is very immature, increasing his or her susceptibility to infections. A deficiency of IgG may occur because transplacental transfer does not occur until after 34 weeks' gestation. This protection is lacking if the baby was born before this time. Preterm newborns have an impaired ability to manufacture antibodies to fight infection if they were exposed to pathogens during the birth process. The preterm newborn's thin skin and fragile blood vessels provide a limited protective barrier, adding to the increased risk for infection. Anticipating and preventing infections is the goal with frequent handwashing. Breastfeeding will eventually establish some protective mechanisms.

The nurse realizes the educational session conducted on due dates was successful when a participant is overheard making which statement? "The ability of my umbilical cord to provide adequate oxygen and nutrients to my baby after 42 weeks' gestation is thought to be compromised." "The ability of my amniotic fluid to provide adequate oxygen and nutrients to my baby after 42 weeks' gestation is thought to be compromised." "The ability of my body to provide adequate oxygen and nutrients to my baby after 42 weeks' gestation is thought to be increased." "The ability of my placenta to provide adequate oxygen and nutrients to my baby after 42 weeks' gestation is thought to be compromised."

"The ability of my placenta to provide adequate oxygen and nutrients to my baby after 42 weeks' gestation is thought to be compromised." The ability of the placenta to provide adequate oxygen and nutrients to the fetus after 42 weeks' gestation is thought to be compromised, leading to perinatal mortality and morbidity. After 42 weeks the placenta begins aging. Deposits of fibrin and calcium, along with hemorrhagic infarcts, occur and the placental blood vessels begin to degenerate. All of these changes affect diffusion of oxygen to the fetus. As the placenta loses its ability to nourish the fetus, the fetus uses stored nutrients to stay alive, and wasting occurs.

The nurse observes a neonate born at 28 weeks' gestation. Which finding would the nurse expect to see? The pinna of the ear is soft and flat and stays folded. Creases appear on the interior two-thirds of the sole. The skin is pale, and no vessels show through it. The neonate has 7 to 10 mm of breast tissue.

The pinna of the ear is soft and flat and stays folded. Pale skin with no vessels showing through and 7 to 10 mm of breast tissue are characteristic of a neonate at 40 weeks' gestation. Creases on the anterior two-thirds of the sole are characteristic of a neonate at 36 weeks' gestation.

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? an infant whose labor began with ruptured membranes an infant whose mother craved chocolate during pregnancy an infant who has marked acrocyanosis of his hands and feet an infant who had difficulty establishing respirations at birth

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

What action by the nurse provides the neonate with sensory stimulation of a human face? having mothers look at the infant through the isolette's porthole teaching parents to maintain a distance of 18 inches (7 cm) from the baby's face encouraging the mother to view the baby through the isolette dome assisting the mother to position the infant in an en face position

assisting the mother to position the infant in an en face position To allow the infant to see a human face, assist the mother to assume an en face position with the infant. Mother and child need to be in the same place and about 6 to 10 inches (15 to 25 cm) apart. Looking through the isolette dome or porthole distorts the image. Infants need to see objects within 12 inches (30 cm) to focus clearly.

A nurse is administering prescribed enteral feedings to assist in preparing the gut of a preterm newborn. Which type of solution would the nurse most likely administer for the feeding? sterile water breast milk normal saline formula

breast milk Currently, minimal enteral feeding is used to prepare the preterm newborn's gut to overcome the many feeding difficulties associated with gastrointestinal immaturity. It involves the introduction of small amounts of breast milk or enteral feeding to induce surges in gut hormones that enhance maturation of the intestine. This minute amount of breast milk or formula given via gavage (tube) feeding prepares the gut to absorb future introduction of nutrients. It builds mucosal bulk, stimulates development of enzymes, enhances pancreatic function, stimulates maturation of gastrointestinal hormones, reduces gastrointestinal distention and malabsorption, and enhances transition to oral feedings. All of the expert committees recommend the use of human milk, which reduces the risk of necrotizing enterocolitis, a serious disease of preterm infants in the neonatal period. Saline or sterile water are not used.

The nurse is caring for a large-for-gestational-age newborn (also known as macrosomia). What maternal condition is the usual cause of this condition? celiac disease alcohol use hypertension diabetes

diabetes In the condition known as macrosomia, a newborn is born large-for-gestational-age (LGA). These newborns are those with birth weights that exceed the 90th percentile of newborns of the same gestational age. They are born most often to mothers with diabetes.

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

diabetes postdates gestation 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.

A nurse in the hospital nursery cares for a preterm newborn, born at 30 weeks' gestation. The newborn had an APGAR score of 6 at 1 minute (1 point for color, 1 point for respiratory effort, 1 point for muscle tone, 1 point for reflex, 2 points for heart rate) and 8 at 5 minutes. The newborn has a lot of vernix on the whole body, acrocyanosis of the hands, a glucose level of 40 mg/dl (2.22 mmol/l), and a temperature of 96.1°F (35.6°C). Drag words from the choices below to fill in each blank in the following sentence. To prevent problems for the newborn, the action that the nurse must implement first is followed by next. Nursing Actions observe for hyperglycemia observe for hypothermia monitor the newborn's glucose level monitor for acrocyanosis dry newborn to prevent hypothermia observe for respiratory distress

dry newborn to prevent hypothermia observe for respiratory distress Lung maturity does not occur until week 37 of gestation, so preterm newborns, which are newborns born prior to 37 weeks, are at high risk for respiratory distress and may require surfactant. Preterm newborns are at high risk for respiratory distress due to undeveloped lungs and a lack of surfactant. Preterm newborns are at risk for hypothermia. Nursing interventions are to dry the newborn, change the blanket, and apply the hat. The preterm newborn is at risk for hypothermia, but this is not the best answer. Nursing interventions that support respiratory function should be a priority. The preterm newborn is at risk for hypoglycemia, not hyperglycemia. A glucose level of 40 mg/dl (2.22 mmol/l) is within normal range for a newborn. Acrocyanosis (bluish discoloration of the extremities) is a normal finding in a newborn.

A common symptom that would alert the nurse that a preterm infant is developing respiratory distress syndrome is: expiratory grunting. inspiratory stridor. expiratory wheezing. inspiratory "crowing."

expiratory grunting. Expiratory grunting is a physiologic measure to ensure alveoli do not fully close on expiration (so they require less energy expenditure to reopen).

A client has given birth to a small-for-gestational-age (SGA) newborn. Which finding would the nurse expect to assess? head larger than body round flushed face brown lanugo body hair protuberant abdomen

head larger than body A small-for-gestational-age (SGA) newborn will typically have a head that is larger than the rest of his or her body. SGA newborns weigh below the 10th percentile on the intrauterine growth chart for gestational age. They have an angular and pinched face and not a rounded and flushed face. Round flushed face and protuberant abdomen are the characteristic features of large-for-gestational-age (LGA) newborns. Preterm newborns, and not SGA newborns, are covered with brown lanugo hair all over the body.

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. leukocytosis decreasing oxygen saturation hypoglycemia heart murmur hyperbilirubinemia

heart murmur hypoglycemia 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.

An obese woman with diabetes has just given birth to a term, large-for-gestational-age (LGA) newborn. Which condition should the nurse most expect to find in this infant? hypertension hyperglycemia hypoglycemia hypotension

hypoglycemia LGA infants also need to be carefully assessed for hypoglycemia in the early hours of life because large infants require large amounts of nutritional stores to sustain their weight. If the mother had diabetes that was poorly controlled (the cause of the large size), the infant would have had an increased blood glucose level in utero to match the mother's; this caused the infant to produce elevated levels of insulin. After birth, these increased insulin levels will continue for up to 24 hours of life, possibly causing rebound hypoglycemia. Reference:

A nurse assists with immediate interventions when a newborn is unable to initiate and maintain adequate respiratory function based on the understanding that these interventions are important to prevent which event(s)? Select all that apply. acidosis hyperglycemia hypoxemia hypercarbia hyperkalemia hypoxia

hypoxia hypoxemia acidosis hypercarbia The inability to initiate and establish respirations leads to hypoxemia and ultimately hypoxia (decreased oxygen), acidosis (decreased pH), and hypercarbia (increased carbon dioxide). Hyperglycemia and hyperkalemia are not involved.

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

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).

A nurse is assessing a preterm newborn. The nurse determines that the newborn is comfortable and without pain based on which finding? sudden high-pitched cry increased muscle tone lack of body posturing fussiness

lack of body posturing The newborn may be in pain if the following are exhibited: sudden high-pitched cry; facial grimace with furrowing of brown and quivering chin; increased muscle tone; oxygen desaturation; body posturing, such as squirming, kicking, and arching; limb withdrawal and thrashing movements; increase in heart rate, blood pressure, pulse, and respirations; fussiness and irritability.

A 35-year-old client has just given birth to a healthy newborn during her 43rd week of gestation. What should the nurse expect when assessing the condition of the newborn? tremors, irritability, and high-pitched cry meconium aspiration in utero or at birth seizures, respiratory distress, cyanosis, and shrill cry yellow appearance of the newborn's skin

meconium aspiration in utero or at birth Infants born after 42 weeks of pregnancy are postterm. These infants are at a higher risk of swallowing or aspirating meconium in utero or after birth. As soon as the infant is born, the nurse usually suctions out the secretions and fluids in the newborn's mouth and throat before the first breath to avoid aspiration of meconium and amniotic fluid into the lungs. Seizures, respiratory distress, cyanosis, and shrill cry are signs and symptoms of infants with intracranial hemorrhage. Intracranial hemorrhage can be a dangerous birth injury that is primarily a problem for preterm newborns, not postterm neonates. Yellow appearance of the newborn's skin is usually seen in infants with jaundice. Tremors, irritability, high-pitched or weak cry, and eye rolling are seen in infants with hypoglycemia.

How does the nurse position the infant experiencing respiratory difficulty? on the back with the head elevated 15 degrees on the stomach with the head lowered 30 degrees and head turned to the side on the left side with the head elevated 45 degrees on the right side with the head lower than the body

on the back with the head elevated 15 degrees Positioning the infant on the back allows bilateral lung expansion. Elevating the head 15 degrees enhances movement of the diaphragm. Positioning the infant on the side or on the stomach restricts lung expansion.

A client has just given birth at 42 weeks' gestation. What would the nurse expect to find during her assessment of the neonate? vernix caseosa covering the neonate's body peeling and wrinkling of the neonate's epidermis lanugo covering the neonate's body a sleepy, lethargic neonate

peeling and wrinkling of the neonate's epidermis Postdate neonates lose the vernix caseosa, and the epidermis may become peeled and wrinkled. A neonate at 42 weeks' gestation is usually very alert and missing lanugo.

The newborn nursery nurse is admitting a small-for-gestational-age (SGA) infant and is reviewing the maternal history. What factor in the maternal history would the nurse correlate as a risk factor for an SGA infant? grand multiparity blood group incompatibility age of 30 years placental factors

placental factors Assessment of the SGA infant begins by reviewing the maternal history to identify risk factors such as placental factors with abnormal umbilical cord insertion, chronic placental abruption (abruptio placentae), malformed and smaller placentas, with placenta previa or placental insufficiency being the main placental causes. Blood group incompatibility, having many pregnancies, and being over the age of 30 will not cause an SGA infant.

The newborn nursery nurse is admitting a small-for-gestational-age (SGA) infant and is reviewing the maternal history. What factor in the maternal history would the nurse correlate as a risk factor for an SGA infant? grand multiparity placental factors age of 30 years blood group incompatibility

placental factors Assessment of the SGA infant begins by reviewing the maternal history to identify risk factors such as placental factors with abnormal umbilical cord insertion, chronic placental abruption (abruptio placentae), malformed and smaller placentas, with placenta previa or placental insufficiency being the main placental causes. Blood group incompatibility, having many pregnancies, and being over the age of 30 will not cause an SGA infant.

At birth, the infant has dry, cracked skin, absence of vernix, lack of subcutaneous fat, fingernail extending beyond the fingertips, and poor skin turgor. Based on these findings, how would the nurse would classify this neonate? preterm SGA postterm LGA

postterm These characteristics are consistent with a postterm infant. An SGA infant has some of these same characteristics but does not exhibit long fingernails. A preterm infant has translucent skin, An LGA infant has excessive subcutaneous fat.

The nurse is providing feedback for the design of a new neonatal intensive care unit. What will the nurse suggest to meet the developmental needs of preterm neonates and their families? Select all that apply. breast milk pumping room seating and space for caregivers to visit central sound system to play soothing music private rooms for preterm neonates bright lights to facilitate assessments

private rooms for preterm neonates seating and space for caregivers to visit breast milk pumping room Providing seating and space for parental visits and a breast milk pumping room facilitates caregiver visits to the preterm neonate. Private rooms help to limit noise and promote bonding. Preterm neonates are sensitive to noise and light, and private rooms may help to protect them from excessive noise. Bright lights and central sound systems may expose the preterm neonate to excessive environmental stimulation.

A newborn is being monitored for retinopathy of prematurity. Which condition predisposes an infant to this condition? esophageal atresia respiratory distress syndrome hydrocephalus Down syndrome

respiratory distress syndrome Retinopathy of prematurity (ROP) is a complication that can occur when high concentrations of oxygen are given during the course of treatment for respiratory distress syndrome (RDS). ROP is caused by separation and fibrosis of the retinal blood vessels and can often result in blindness.

A neonate receiving oxygen at concentrations greater than 70% is at risk for developing which complication? Select all that apply. cerebral palsy pulmonary edema pulmonary hypoplasia intraventricular hemorrhage retinopathy of prematurity

retinopathy of prematurity pulmonary edema Giving a high level of oxygen to preterm infants during resuscitation or to maintain respirations presents the danger of pulmonary edema and retinopathy of prematurity. Intraventricular hemorrhage, pulmonary hypoplasia, and cerebral palsy are not caused by the concentration of oxygen administered.

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? closely approximated labia scant coating of vernix paper-thin eyelids shiny heels and palms

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.

The nurse is caring for a client in the early stages of labor. What maternal history factors will alert the nurse to plan for the possibility of a small-for-gestational-age (SGA) newborn? Select all that apply. hypotension upon admission smoking during pregnancy pregnancy weight gain of 25 lb (11 kg) asthma exacerbations during pregnancy drug use

smoking during pregnancy asthma exacerbations during pregnancy drug use The nurse should be alert to the possibility of an SGA newborn if the history of the mother reveals smoking, chronic medical conditions (such as asthma), and a substance use disorder. Additional maternal factors that increase the risk for an SGA newborn include hypertension, genetic disorders, and multiple gestations.

Preterm newborns can develop respiratory distress syndrome due to a deficiency of ...............

surfactant

A nurse initiates bag and mask ventilation with an anesthesia bag on a newborn with no spontaneous respiratory effort. What controls the pressure of breaths delivered by an anesthesia bag? the blow-off valve, which limits the pressure in the apparatus the pressure the nurse uses when the hand squeezes against the bag the flow rate of air into the inflatable bag on the apparatus the pressure setting on the dial at the point where the mask connects to the bag

the pressure the nurse uses when the hand squeezes against the bag The pressure exerted by the nurse's hand squeezing the bag controls the pressure delivered by an anesthesia bag. An ambu or resusci bag has a blow-off value that limits the pressure administered.

Preterm infants tend to have ..............., transparent skin with prominent veins.

thin

The nurse determines a newborn is small-for-gestational-age based on which characteristics? normal subcutaneous fat stores, cord-like umbilical cord, and increased development to extremities reduced subcutaneous fat stores to buttocks, thicker umbilical cord, and smaller head compared to body wasted appearance of extremities, thin umbilical cord, and reduced subcutaneous fat stores wasted appearance of extremities, gelatinous umbilical cord, and abundant subcutaneous fat stores

wasted appearance of extremities, thin umbilical cord, and reduced subcutaneous fat stores The nurse should perform a thorough physical examination of the newborn and closely observe the newborn for typical SGA characteristics, which include the following: a newborn head that is disproportionately large compared with rest of body; a wasted appearance of extremities with reduced subcutaneous fat stores; a reduced amount of breast tissue; poor muscle tone over buttocks and cheeks; and a thin umbilical cord.

The nurse determines a newborn is small-for-gestational-age based on which characteristics? normal subcutaneous fat stores, cord-like umbilical cord, and increased development to extremities wasted appearance of extremities, gelatinous umbilical cord, and abundant subcutaneous fat stores reduced subcutaneous fat stores to buttocks, thicker umbilical cord, and smaller head compared to body wasted appearance of extremities, thin umbilical cord, and reduced subcutaneous fat stores

wasted appearance of extremities, thin umbilical cord, and reduced subcutaneous fat stores The nurse should perform a thorough physical examination of the newborn and closely observe the newborn for typical SGA characteristics, which include the following: a newborn head that is disproportionately large compared with rest of body; a wasted appearance of extremities with reduced subcutaneous fat stores; a reduced amount of breast tissue; poor muscle tone over buttocks and cheeks; and a thin umbilical cord.

The nurse is teaching nursing students about the risks that late preterm infants may experience. The nurse feels confident learning has taken place when the students make which statement? "Late preterm newborns have fewer clinical problems leading to shorter hospital stays." "A late preterm newborn may have more clinical problems compared with full-term newborns." "The late preterm infant is more mature and able to cope as well as a full-term infant." "Late preterm infant complications are considered minor compared to the preterm newborn."

"A late preterm newborn may have more clinical problems compared with full-term newborns." The most common complications for late preterm infants are cold stress, respiratory distress, hypoglycemia, sepsis, cognitive delays, hyperbilirubinemia, and feeding difficulties. These are similar to those facing the preterm newborn and require similar management. Late preterm newborns have more clinical problems, longer lengths of stay, higher costs when compared with full-term newborns, and increased mortalities.

The nurse documents that a newborn is postterm based on the understanding that he was born after: 38 weeks' gestation 40 weeks' gestation 42 weeks' gestation 44 weeks' gestation

42 weeks' gestation A postterm infant is one born after the 42nd week of gestation. Birth between 38 and 41 weeks is considered within a normal range for a term newborn. A gestation of 44 weeks would be considered extremely long if the dates were calculated correctly.

The nurse is assessing a preterm newborn who is in the neonatal intensive care unit (NICU. for signs and symptoms of overstimulation. Which of the following would the nurse be least likely to assess? A) Increased respirations B) Flaying hands C) Periods of apnea D) Decreased heart rate

A) Increased respirations

A newborn is returned to the observational nursery demonstrating signs of cold stress after a prolonged bath. Which action would be a priority for the nurse? Assess blood sugar level. Assess feeding patterns. Request arterial blood gases. Perform a neurological assessment.

Assess blood sugar level. For a client with hypothermia, a nurse would observe for clinical signs of cold stress, such as hypoglycemia. Hypoglycemia occurs due to depleted glycogen stores from the cold stress. At this time a blood sugar assessment is the priority. A neurological assessment would not be a priority nor would an assessment of feeding patterns. ABG assessment would be warranted if RDS was to become a problem.

A woman gives birth to a newborn at 36 weeks' gestation. She tells the nurse, "I'm so glad that my baby isn't premature." Which response by the nurse would be most appropriate? A) "You are lucky to have given birth to a term newborn." B) "We still need to monitor him closely for problems." C) "How do you feel about delivering your baby at 36 weeks?" D) "Your baby is premature and needs monitoring in the NICU."

B) "We still need to monitor him closely for problems."

A nurse is developing a plan of care for a preterm infant experiencing respiratory distress. Which of the following would the nurse be least likely to include in this plan? A) Stimulate the infant with frequent handling. B) Keep the newborn in a warmed isolette. C) Administer oxygen using a oxygen hood. D) Give gavage or continous tube feedings.

C) Administer oxygen using a oxygen hood.

A group of pregnant women are discussing high-risk newborn conditions as part of a prenatal class. When describing the complications that can occur in these newborns to the group, which would the nurse include as being at lowest risk? A) Small-for-gestational-age (SGA. newborns B) Large-for-gestational-age (LGA. newborns C) Appropriate-for-gestational-age (AGA. newborns D) Low-birth-weight newborns

C) Appropriate-for-gestational-age (AGA. newborns

The nurse has admitted a small-for-gestational-age infant (SGA) to the observation nursery from the birth room. Which action would the nurse prioritize in the newborn's care plan? Observe feeding tolerance. Closely monitor temperature. Monitor intake and output. Assess for hyperglycemia.

Closely monitor temperature. Difficulty with thermoregulation in SGA newborns is common due to less muscle mass, less brown fat, less heat-preserving subcutaneous fat, and limited ability to control skin capillaries. The priority would be to closely monitor the newborn's temperature. It is also associated with depleted glycogen stores; therefore, this is hypoglycemia not hyperglycemia. Immaturity of CNS (temperature-regulating center) interferes with the ability to regulate body temperature. Intake and output monitoring and observing feeding are not the priority.

When performing newborn resuscitation, which action would the nurse do first? A) Intubate with an appropriate-sized endotracheal tube. B) Give chest compressions at a rate of 80 times per minute. C) Administer epinephrine intravenously. D) Suction the mouth and then the nose.

D) Suction the mouth and then the nose.

Which of the following would alert the nurse to suspect that a preterm newborn is in pain? A) Bradycardia B) Oxygen saturation level of 94% C) Decreased muscle tone D) Sudden high-pitched cry

D) Sudden high-pitched cry

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

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.

In dealing with parents experiencing a perinatal loss, which of the following nursing interventions would be most appropriate? Sheltering the parents from the bad news Making all the decisions regarding care Encouraging them to participate in the newborn's care Leaving them by themselves to allow time to grieve

Encouraging them to participate in the newborn's care The parents need to validate the experience of loss. The best way to do this is to encourage them to participate in their newborn's care so that the grieving process can take place. Avoiding the experience of loss inhibits the grieving process. Avoidance prolongs the experience of loss and does not allow the parents to vent their feelings so that they can progress through their grief. It is not the nurse's responsibility, nor is it healthy for the family, to take over decisions for a family. Family members need to support each other and need to decide what is best for their situation. Leaving the family alone can be viewed as abandonment; privacy is important, but leaving them totally alone is not therapeutic.

A preterm infant has an umbilical vessel catheter inserted so that blood can be drawn readily. Which would be most important to implement during this procedure? Ensure that the infant is kept warm. Assess the infant's cranial vascular tension. Evaluate the infant's urinary output. Prevent the infant from crying.

Ensure that the infant is kept warm. Preterm infants must be protected from chilling during all procedures, because maintaining warmth is a major concern because of immaturity.

Postterm newborns and large-for-gestational-age newborns are at increased risk for meconium aspiration. TRUE FALSE

FALSE Postterm newborns and small-for-gestational-age newborns are at increased risk for meconium aspiration due to in utero stress.

In assessing a preterm newborn, which of the following findings would be of greatest concern? Milia over the bridge of the nose Thin transparent skin Poor muscle tone Heart murmur

Heart murmur When a newborn is born too soon, fetal circulation may persist into extrauterine life. The ductus arteriosus and foramen ovale may remain open if pulmonary vascular resistance remains high and oxygen levels remain low. This would be manifested by a heart murmur.

Because subcutaneous and brown fat stores were used for survival in utero, the nurse would assess an SGA newborn for which of the following? Hyperbilirubinemia Hypothermia Polycythemia Hypoglycemia

Hypothermia Subcutaneous and brown fat stores may be used by the stressed fetus to survive in utero and thus will not be available to provide extrauterine warmth. Excessive red blood cell breakdown is responsible for hyperbilirubinemia, not the breakdown of brown fat stores. Polycythemia is caused by a buildup of red blood cells in response to a hypoxic state in utero; it is not linked to loss of subcutaneous and brown fat stores. Glycogen stores are used for survival in an environment with depleted glycogen and are unrelated to brown fat stores.

SGA and LGA newborns have an excessive number of red blood cells related to Hypoxia Hypoglycemia Hypocalcemia Hypothermia

Hypoxia The fetus's body, in an attempt to compensate for the low oxygen level, produces more red blood cells to carry the limited amount of oxygen available. Thus, polycythemia will be present at birth in a fetus experiencing hypoxia in utero. Hypoglycemia is typically caused by inadequate stores of glycogen and overuse while living in a hostile environment. Low serum calcium levels are associated with perinatal asphyxia and not an increase in red blood cells. Hypothermia is associated with a decrease in body fat, particularly brown fat stores, and is not linked to increased production of red blood cells.

The nurse is caring for a small-for-gestational-age infant at 1 hour old, after a difficult birth, with a glucose level of 40 mg/dL (2.5 mmol/L). Which nursing action would be the priority? Initiate daily newborn weights. Initiate early oral feedings. Monitor the infant at feedings. Ensure feedings are on demand.

Initiate early oral feedings. Metabolic needs are increased for catch-up growth in the SGA newborn. Initiate early and frequent oral feedings. Neonatal hypoglycemia is a major cause of brain injury since the brain needs glucose continuously as a primary source of energy. A newborn stressed at birth uses up available glucose stores quickly with resulting hypoglycemia. A plasma glucose concentration at or below 40 mg/dL (2.5 mmol/L) necessitates and frequent oral feedings. With the loss of the placenta at birth, the newborn now must assume control of glucose homeostasis through oral feedings. The others at this time are not a priority.

The nurse is providing care to several newborns with variations in gestational age and birthweight. When developing the plan of care for these newborns, the nurse focuses on energy conservation to promote growth and development. Which measures would the nurse include in the nursing plans of care? Select all that apply Keeping the handling of the newborn to a minimum Maintaining a neutral thermal environment Decreasing environmental stimuli Initiating early oral feedings Using thermal warmers in all cribs

Keeping the handling of the newborn to a minimum Maintaining a neutral thermal environment Decreasing environmental stimuli Minimal handling, maintaining a neutral thermal environment, and decreasing environmental stimuli are important measures to conserve energy in newborns with variations in birth weight and gestational age. Feeding and digestion will increase energy demands. Thermal warmers may produce hypothermia and thus increase energy demands. Preventing parents from visiting their newborn is not a plan to reduce energy expenditure and could increase stress for both parents and newborn.

At the birth of a high-risk newborn, what is the nurse's priority action to prevent cerebral hypoxia? Maintain adequate thermoregulation. Maintain adequate cerebral perfusion. Maintain adequate respirations. Maintain adequate cardiac activity.

Maintain adequate respirations. At birth, maintaining adequate respirations is the priority to prevent cerebral hypoxia. Cerebral perfusion and cardiac activity are dependent on adequate respiratory effort. Thermoregulation is important at birth, but it does not prevent cerebral hypoxia.

Which of the following concepts would the nurse incorporate into the plan of care when assessing pain in a newborn with special needs? Newborns experience pain primarily with surgical procedures. Preterm newborns in the NICU are at least risk for pain. Pain assessment needs to be comprehensive and frequent. A newborn's facial expression is the primary indicator of pain

Pain assessment needs to be comprehensive and frequent. Newborns feel pain and require the same level of pain assessment and pain management as adults. Pain assessment, which is comprehensive, involves observations of changes in vital signs, behavior, facial expression, and body movement. It is considered the "fifth vital sign" and should be checked as frequently as the other four signs. All newborns experience pain, not just newborns undergoing surgical procedures. Preterm newborns have an increased risk of pain because they are subjected to repeat procedures and exposed to noxious stimuli.

When preparing to resuscitate a preterm newborn, the nurse would perform which action first? Administer epinephrine. Prepare to insert an endotracheal tube (ETT). Place the newborn's head in a neutral position. Hyperextend the newborn's neck.

Place the newborn's head in a neutral position. When preparing to resuscitate a preterm newborn, the nurse should position the head in a neutral position to open the airway. Hyperextending the newborn's neck would most likely close off the airway and is inappropriate. Positive pressure ventilation would be used before endotracheal tube (ETT) insertion. ETT insertion is used if the newborn remains apneic or positive pressure ventilation is ineffective. Epinephrine is given after chest compressions are initiated.

A large-for-gestational-age newborn typically weighs more than 4,000 g (8 lb 13 oz). FALSE TRUE

TRUE Birth weight greater than 4,000 g (8 lb, 13 oz) defines large-for-gestational age.

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? These are signs the infant is hungry and needs to eat. There are signs the infant is hypoxic and needs oxygen. These are signs the infant is stressed and needs to rest. These are signs the infant is enjoying the attention.

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 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? Touch and, if possible, hold her. Call the baby by her name. Stand so the baby can see them. 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.

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

expiratory grunting nasal flaring retractions tachypnea The classic signs of respiratory distress are expiratory grunting, nasal flaring, retractions, and tachypnea

The nurse is teaching a group of parents who have preterm newborns about the differences between a full-term newborn and a preterm newborn. Which characteristic would the nurse describe as associated with a preterm newborn but not a term newborn? A. fewer visible blood vessels through the skin B. more subcutaneous fat in the neck and abdomen C. well-developed flexor muscles in the extremities D. greater body surface area in proportion to weight

greater body surface area in proportion to weight Preterm newborns have large body surface areas compared to weight, which allows an increased transfer of heat from their bodies to the environment. Preterm newborns often have thin transparent skin with numerous visible veins, minimal subcutaneous fat, and poor muscle tone

Preterm newborns have an ........... risk for drug toxicity.

increased

A nurse is assessing a preterm newborn. The nurse determines that the newborn is comfortable and without pain based on which finding? increased muscle tone lack of body posturing sudden high-pitched cry fussiness

lack of body posturing The newborn may be in pain if the following are exhibited: sudden high-pitched cry; facial grimace with furrowing of brown and quivering chin; increased muscle tone; oxygen desaturation; body posturing, such as squirming, kicking, and arching; limb withdrawal and thrashing movements; increase in heart rate, blood pressure, pulse, and respirations; fussiness and irritability.

A baby born at 35 weeks' gestation is classified as a preterm newborn.

late

Which finding is indicative of hypothermia of the preterm neonate? nasal flaring regular respirations pink skin oxygen saturation of 95%

nasal flaring Nasal flaring is a sign of respiratory distress. Neonates with hypothermia show signs of respiratory distress (cyanosis, increased respirations, low oxygen saturation, nasal flaring, and grunting). The other choices are normal findings.

A nurse is assisting with the resuscitation of a preterm newborn. Which assessment would help assist the team in determining that the resuscitation efforts have been successful? pulse rate of 110 beats per minute respiratory rate of 10 breaths per minute pink conjunctiva weak cry effort

pulse rate of 110 beats per minute Resuscitation measures are continued until the newborn has a pulse above 100 bpm, a good healthy cry or good breathing efforts, and a pink tongue. This last sign indicates a good oxygen supply to the brain. Conjunctival assessment would be of no benefit. A respiratory rate of 10 breaths per minute alone does not indicate the respiratory effort.

Male neonate at 39+1 weeks' gestation born via booked repeat cesarean at 0835. Apgar 8 + 9, clear amniotic fluid, weight 9lb 1oz (4105g), centrally pink acrocyanosis present. Muscle tone well-flexed. Mild retractions and nasal flaring with respirations. Complete blood count drawn. Orders received from pediatrician for transfer to neonatal nursery for observation, chest x-ray, and capillary blood gases The nurse admits a term neonate to the nursery at 30 minutes of age (above). What does the nurse anticipate is the cause of these assessment findings? transient tachypnea of the newborn meconium aspiration syndrome group B streptococcal pneumonia hypoglycemia

transient tachypnea of the newborn This neonate is exhibiting symptoms of transient tachypnea of the newborn (TTN): increased respiratory rate, nasal flaring, and mild retractions, while maintaining normal oxygen saturation and other vital signs. Neonates born via cesarean are at increased risk of TTN. The amniotic fluid was clear, so meconium aspiration is unlikely. The blood work shows normal white blood cell count; this count would be elevated in the case of infection such as group B streptococcal pneumonia. Because the neonate is large for gestational age, the neonate is at risk of hypoglycemia, but the respiratory symptoms are unrelated to this risk.