Chapter 25 - The High Risk Newborn (Maternity) EAQ's

A patient who used cocaine during pregnancy asks the nurse about feeding the infant. The infant is being treated for cocaine withdrawal symptoms. After further discussion, the nurse finds that the patient is not willing to participate in the drug rehabilitation program and still uses cocaine frequently. What does the nurse instruct the patient related to infant nutrition? 1 "Avoid breastfeeding the child." 2 "The child needs parenteral nutrition." 3 "Avoid using infant formulas for the child." 4 "Breastfeeding may be good for the child."

1 - "Avoid breastfeeding the child." pg 649 - The nurse instructs the parent to avoid breastfeeding the infant because significant amounts of cocaine are found in breast milk. Breastfeeding may expose the child to further complications. The nurse encourages the parent to use infant formulas because they are safe for the infant. Parenteral nutrition is not needed unless the infant is unable to feed orally.

What discharge instructions are given to the parents of an infant with facial paralysis? 1 "You need to administer eyedrops daily." 2 "You must avoid breastfeeding the child." 3 "You must initiate range-of-motion exercises." 4 "Always position the child on the affected side."

1 - "You need to administer eyedrops daily." pg 639 - In an infant with facial paralysis, sometimes the eyelid on the affected side does not close completely. Hence the nurse instructs the parents to instill eyedrops in the eyes daily to prevent drying of the conjunctiva, sclera, and cornea. The parent can breastfeed the child with assistance to help the infant grasp and compress the areolar area. Range-of-motion exercises are not necessary in facial palsy; they are necessary for an infant with brachial palsy. It is not necessary to place an infant with facial palsy on the affected side; however, in an infant with phrenic nerve palsy, placing the infant on the affected side will facilitate maximum expansion of the uninvolved lung.

The nurse is assessing an infant after a difficult birth. Which signs in the infant indicate Erb's palsy? Select all that apply. 1 A grasp reflex may be present in the infant. 2 The infant's arm hangs limp alongside the body. 3 The elbow is extended, and the forearm is pronated. 4 The hand muscles are paralyzed, and there is a wrist drop. 5 The shoulder and the arm are adducted and rotated internally.

1 - A grasp reflex may be present in the infant. 2 - The infant's arm hangs limp alongside the body. 3 - The elbow is extended, and the forearm is pronated. 5 - The shoulder and the arm are adducted and rotated internally. pg 639 - Erb's palsy is caused when the upper plexus is damaged. It results from stretching or pulling away of the shoulder from the head during a difficult birth. As a result the infant's arm hangs limp alongside the body. The shoulder and the arm are adducted and rotated internally because of the paralysis of the affected extremity. The elbow is extended, and the forearm is pronated with the wrist and fingers flexed. A grasp reflex may be present because the finger and wrist movement remain normal. The infant's hand muscles are paralyzed, and there is a wrist drop in lower-plexus palsy. This results from the stretching of the upper extremity while the trunk is less mobile.

Which infant has a higher possibility of sustaining a birth trauma? 1 An infant who was delivered by a vaginal birth 2 An infant who has low glucose levels at birth 3 An infant who has inborn errors of metabolism 4 An infant who was born to a patient with a urinary tract infection

1 - An infant who was delivered by a vaginal birth pg 637 - A vaginal birth increases the chance of injuries because of the use of forceps or vacuum extraction or because of pressure of the fetal skull against the maternal pelvis. An infant with low glucose levels at birth is hypoglycemic. Inborn errors of metabolism refer to an inherited disease and are not a birth trauma. An infant born to a patient with a urinary tract infection has a higher chance of acquiring the infection, but this is not a birth trauma.

Which condition may be seen in a newborn infant affected by hemolytic disease? Select all that apply. 1 Anemia 2 Jaundice 3 Macrosomia 4 Anencephaly 5 Hypoglycemia

1 - Anemia 2 - Jaundice 5 - Hypoglycemia pg 654/655 - The serum levels of unconjugated bilirubin rise rapidly in an infant with hemolytic disease after birth. The inability of the liver to conjugate and excrete the excess bilirubin results in jaundice in the infant. Anemia results from the hemolysis of large numbers of erythrocytes. Hypoglycemia may occur as a result of pancreatic cell hyperplasia. Macrosomia refers to excessive weight gain in the child after birth, most often seen in infants born to diabetic women. Anencephaly is a central nervous system anomaly seen in infants of diabetic mothers.

What precautions does the nurse take while providing skin care to a preterm infant? Select all that apply. 1 Avoids solvents to remove tape 2 Uses hydrocolloid adhesives on the skin 3 Uses small scissors to remove dressings 4 Uses alkaline-based soap to clean the skin 5 Rinses with water after using alcohol on the skin

1 - Avoids solvents to remove tape 2 - Uses hydrocolloid adhesives on the skin 5 - Rinses with water after using alcohol on the skin pg 675 - The use of alcohol may cause severe irritation and chemical burns on the infant's skin. Therefore the nurse rinses the skin with water. Hydrocolloid adhesives are safe because they mold well to skin contours and adhere in moist conditions. Solvents are not used to remove tape, because they dry and burn the skin. Alkaline-based soap is not used because it can destroy the acid mantle of the infant's skin. The use of scissors is unsafe because they may snip off tiny extremities.

Which maternal clinical tests does the nurse need to evaluate to identify Rh(D) sensitization in order to prevent fetal complications? Select all that apply. 1 Coombs' test 2 Ultrasonography 3 Meconium sampling 4 Kleihauer-Betke assay 5 Doppler ultrasonography

1 - Coombs' test 2 - Ultrasonography 5 - Doppler ultrasonography pg 655 - The Coombs' test is used to identify antibodies in the maternal blood, which can help detect the potential for isoimmunization. Ultrasonography helps detect alterations in the placenta, umbilical cord, and amniotic fluid volume, as well as the presence of fetal hydrops. This allows for early treatment and prevents the development of erythroblastosis. Doppler ultrasonography helps detect and measure fetal hemoglobin and therefore helps assess the risk for fetal anemia. The Kleihauer-Betke assay is used to assess transplacental bleeding, not Rh(D) sensitization. Meconium sampling is used to detect drug exposure in infants.

Which nursing interventions does the nurse include in the plan of care for an infant who is receiving an exchange transfusion because of hemolytic disease? Select all that apply. 1 Electronically monitors vital signs frequently 2 Assesses for cardiac or respiratory problems 3 Provides peripheral infusion of dextrose and electrolytes 4 Prepares the infant for the procedure and orients the family 5 Administers Rh immunoglobulin (RhIg) to the infant before the procedure

1 - Electronically monitors vital signs frequently 2 - Assesses for cardiac or respiratory problems 3 - Provides peripheral infusion of dextrose and electrolytes 4 - Prepares the infant for the procedure and orients the family pg 654/656 - The nurse prepares the infant and the family for the procedure so that they understand what is being done. A peripheral infusion of dextrose and electrolytes is necessary because the infant needs to receive nothing by mouth (NPO) during the procedure. The nurse needs to monitor the vital signs frequently because there is a risk for cardiac and respiratory problems. The nurse needs to assess the infant for cardiac or respiratory problems so that the procedure can be stopped immediately if needed to prevent further complications. RhIg is administered to unsensitized Rh-negative mothers to prevent the development of maternal sensitization to the Rh factor. RhIg is not administered to the infant.

Which nursing interventions are included in the plan of care of an infant with septicemia? Select all that apply. 1 Encouraging the parent to breastfeed the infant 2 Implementing isolation procedures as instructed 3 Administering fluids and antibiotics simultaneously 4 Performing routine suctioning to prevent complications 5 Administering antibiotics within 1 hour after they are prepared

1 - Encouraging the parent to breastfeed the infant 2 - Implementing isolation procedures as instructed 5 - Administering antibiotics within 1 hour after they are prepared pg 640 - The nurse administers antibiotics to the infant within 1 hour after they are prepared to avoid the loss of drug stability. The nurse implements isolation procedures as instructed to prevent the risk of infection in the infant. The nurse encourages the parent to breastfeed the infant because breast milk contains protective mechanisms that provide a barrier to infection. Fluids and antibiotics are not administered simultaneously because they may interact and deactivate the drug. Suctioning is performed only when it is needed because routine suctioning may cause hypoxia and thus increase intracranial pressure.

Which actions does the nurse take while counseling anxious parents who visit their preterm infant in an neonatal intensive care unit? Select all that apply. 1 Informs the parents of visiting hours. 2 Avoids telling the parents any unpleasant facts. 3 Encourages the parents to express their sadness. 4 Persuades the parents to touch and hold the infant. 5 Explains the function of each piece of equipment used.

1 - Informs the parents of visiting hours. 3 - Encourages the parents to express their sadness. 5 - Explains the function of each piece of equipment used. pg 677 - The nurse explains the function of each piece of equipment that is attached to the infant because this helps lessen fears and anxiety in the parents. The nurse may further alleviate their anxiety by informing them that they can visit the infant anytime. The nurse encourages the parents to express feelings of sadness so that they are better able to focus on their infant. The nurse needs to inform the parents honestly about all of the infant's conditions. The parents may not be ready to touch or hold the infant because of fear. Therefore the nurse should not persuade the parents to do so and should let the parents adjust to the infant's condition.

Which actions does the nurse take after an infant is delivered? Select all that apply. 1 Instills antibiotics in the infant's eyes 2 Uses cool water to clean the infant's body 3 Cleans the cord with a neutral pH cleanser 4 Uses nonmedicated soap to clean the infant 5 Rubs vernix caseosa vigorously to remove it

1 - Instills antibiotics in the infant's eyes 3 - Cleans the cord with a neutral pH cleanser 4 - Uses nonmedicated soap to clean the infant pg 643 - The nurse puts antibiotics in the infant's eyes 1 to 2 hours after the birth to prevent infection. A nonmedicated soap is used to clean the infant to avoid stinging the skin. The nurse cleans the cord with a neutral pH cleanser to prevent infection. The vernix caseosa is not rubbed vigorously to remove it because this may disrupt the properties of the skin. Cool water is not used to clean the infant because it may disturb the infant's thermal stability. Instead, warm water is used to clean the blood and meconium from the infant's face, head, and body.

Which interventions does the nurse incorporate in the plan of care to comfort the parents after the death of their preterm infant? Select all that apply. 1 Notifies a member of the clergy if the parents desire 2 Discusses the funeral arrangements with the parents 3 Encourages the parents to take a photograph with the infant 4 Avoids expressing grief for the infant in front of the parents 5 Takes the infant away if the mother is unwilling to see the infant

1 - Notifies a member of the clergy if the parents desire 2 - Discusses the funeral arrangements with the parents 3 - Encourages the parents to take a photograph with the infant pg 684/685 - The nurse encourages the parents to take a photograph with their infant to help them personalize the experience. The parents may not have any experience of infant death, so the nurse needs to talk to the parents about the funeral arrangements. The nurse will also notify a member of the clergy for any ritual if the parents desire. The nurse keeps the infant's body in the unit for a few hours even if the mother is unwilling to see the infant. The mother or the parents may want to see the infant after adjusting to the initial shock of loss. The nurse may experience grief and feel sorrowful. The nurse need not control the grief and should work through the grief process by attending the funeral or memorial service.

Which intervention does the nurse include while providing care for a preterm infant with a soft cranium? 1 Places the infant on a gel mattress 2 Places the infant on a soft mattress 3 Provides skin-to-skin (kangaroo) contact 4 Transfers the infant to a heated incubator

1 - Places the infant on a gel mattress pg 658 - A preterm infant with a soft cranium is at risk for deformation caused by positioning on a mattress. Therefore the nurse places the infant on a gel mattress, which reduces the risk of cranial molding. A soft mattress may not prevent deformation because the cranium is subject to molding at slight pressures. Skin-to-skin (kangaroo) contact is initiated to prevent cold stress in an infant and help the infant maintain body temperature. The nurse transfers an infant to a heated incubator to maintain thermal stability.

Which infants are classified as being high risk? Select all that apply. 1 Postterm (postmature) infants 2 Small-for-gestational-age (SGA) infants 3 Extremely low-birth-weight (ELBW) infants 4 Intrauterine growth restriction (IUGR) infants 5 Appropriate-for-gestational-age (AGA) infants

1 - Postterm (postmature) infants 2 - Small-for-gestational-age (SGA) infants 3 - Extremely low-birth-weight (ELBW) infants 4 - Intrauterine growth restriction (IUGR) infants pg 637/638 - ELBW infants have a birth weight less than 1000 g. They are susceptible to infections, environmental stress, and respiratory diseases. IUGR is a term for infants who have restricted intrauterine growth. The lack of maturity seen in these infants compromises their immune system. The birth weight of SGA infants falls below the 10th percentile on intrauterine growth curves. It makes these infants susceptible to respiratory disorders and other diseases. A postterm infant is born at 42 weeks' gestation, which extends beyond the full-term pregnancy. The infant may sometimes have progressive placental dysfunction. AGA infants are not high risk infants because their weights fall between the 10th and 90th percentiles on intrauterine growth curves.

The clinical reports of a pregnant patient who is Rh negative indicate Rh(D) sensitization. Which nursing intervention is a priority in this case? 1 Preparing the infant for intrauterine transfusion 2 Preparing the pregnant patient for phototherapy 3 Obtaining a prescription for phenobarbital (Luminal) 4 Administering Rh immunoglobulin (RhIg), a human gamma globulin concentrate

1 - Preparing the infant for intrauterine transfusion pg 656 - Intrauterine transfusion in the infant helps treat hyperbilirubinemia and hydrops caused by Rh incompatibility. RhIg is administered to unsensitized Rh-negative mothers to prevent the development of maternal sensitization to the Rh factor. Phototherapy is most effective to decrease bilirubin level in the infant. Phenobarbital (Luminal) is used to decrease drug withdrawal effects in an infant exposed to a drug in the uterus.

Which interventions does the nurse implement while providing care for an infant with neonatal abstinence syndrome (NAS)? Select all that apply. 1 Provides dim lights in the room 2 Avoids wrapping the infant tightly 3 Reduces noise levels in the room 4 Assesses the infant's skin regularly 5 Encourages the mother to breastfeed

1 - Provides dim lights in the room 3 - Reduces noise levels in the room 4 - Assesses the infant's skin regularly 5 - Encourages the mother to breastfeed pg 650 - NAS refers to certain behaviors exhibited by infants who were exposed to drugs in the uterus. The nurse provides dim lights and reduces the noise levels in the infant's room to decrease hyperactivity and irritability in the infant. The nurse encourages breastfeeding to promote mother-infant bonding. The nurse assesses the infant's skin regularly because rubbing on bed linens may cause skin breakdown in the infant. Wrapping tightly is beneficial because it limits the infant's ability to self-stimulate and decreases hyperactivity.

A preterm infant is receiving oxygen therapy for respiratory distress syndrome. Which are the important nursing interventions to be included in the plan of care? Select all that apply. 1 Providing mouth care 2 Suctioning twice a day 3 Monitoring continuously 4 Assessing skin regularly 5 Positioning the infant on the side

1 - Providing mouth care 3 - Monitoring continuously 4 - Assessing skin regularly 5 - Positioning the infant on the side pg 662/663 - The nurse needs to monitor the oxygen therapy continuously because the infant's status can change rapidly and the oxygen concentration parameters may need to be changed. The nurse also assesses the infant's skin regularly because excessive rubbing on the bedsheet can increase the risk of skin breakdown. The nurse provides good oral hygiene (mouth care) using sterile water to prevent the drying effect of the oxygen therapy. Positioning the infant on the side helps maintain an open airway. Suctioning is used only as needed because there is risk of increased intracranial pressure and hypoxia.

Which symptoms of septic shock are likely to be seen in a low-birth-weight infant with septicemia? Select all that apply. 1 Tachycardia 2 Hypotension 3 Hypoglycemia 4 Cool extremities 5 Respiratory distress

1 - Tachycardia 2 - Hypotension 4 - Cool extremities 5 - Respiratory distress pg 642 - Tachycardia and hypotension may be observed in a low-birth-weight infant with septicemia, which indicates septic shock. Septic shock occurs when toxins are released into the bloodstream. Hence, the nurse must report immediately to the primary health care provider. The other indication of septic shock is cool extremities, which indicate poor perfusion and respiratory distress and should be promptly reported so that oxygen therapy can be started. Hypoglycemia is seen in an infant born to a diabetic patient due to elevated levels of insulin during pregnancy.

Which intervention does the nurse include while providing care for a high risk infant who is receiving supplemental parenteral fluids? 1 Uses continuous infusion pumps and monitors hourly 2 Administers a one-time bolus infusion of 10% dextrose 3 Avoids phototherapy sessions when administering fluids 4 Uses the median cubital vein to administer medications

1 - Uses continuous infusion pumps and monitors hourly pg 672 - The nurse uses continuous infusion pumps that deliver fluids at a preset flow rate. The nurse also monitors the infusion hourly to prevent tissue damage from extravasation, fluid overload, or dehydration. A high risk infant may not be able to tolerate dextrose and may be at risk for glycosuria and osmotic diuresis. Infants receiving phototherapy have increased water loss. Therefore fluids are adjusted according to their needs. The peripheral veins, scalp veins, and antecubital veins, not the median cubital vein, are used to administer fluids intravenously.

The nurse is caring for a preterm infant who needs to have gavage feedings started and requires the insertion of a nasogastric (NG) tube. Place in correct order the steps for insertion of a nasogastric tube in a preterm infant. 1. Lubricate the tip of the tube with sterile water 2. Measure the length of the NG tube from the tip of the nose to the lobe of the ear to midpoint between the xyphoid process and the umbilicus 3. Check placement of the NG tube by aspirating gastric contents 4. Gently insert the NG tube through the mouth or nose

1. - Measure the length of the NG tube from the tip of the nose to the lobe of the ear to midpoint between the xyphoid process and the umbilicus 2. - Lubricate the tip of the tube with sterile water 3. - Gently insert the NG tube through the mouth or nose 4. - Check placement of the NG tube by aspirating gastric contents pg 674 - The infant is placed in a supine position. The NG tube is measured from the tip of the nose to the earlobe and to midpoint between the xiphoid process and the umbilicus. Tape may be used to mark the correct length on the tube. The tip of the tube is lubricated with sterile water and then is inserted through the mouth or nose. Placement of the tube is checked by aspirating gastric contents.

Which information about feeding does the nurse provide to the parent of a preterm infant with respiratory dysfunction syndrome? 1 "Parenteral therapy is unsafe." 2 "Avoid gavage feedings in your infant." 3 "Enteral feeding will not be beneficial." 4 "Breastfeed your infant every 3 hours."

2 - "Avoid gavage feedings in your infant." pg 661 - The nurse instructs the parent to avoid gavage feedings because they increase the respiratory rate and subject the infant to risk for respiratory distress. Breastfeeding is avoided because it also increases the risk for respiratory distress in the infant. Enteral feeding is beneficial because it helps enhance maturation of the infant's gastrointestinal system. Parenteral therapy is the safest way of feeding during the acute stage of the syndrome.

What does the nurse inform the parent of a preterm infant who has birth asphyxia and is at risk for necrotizing enterocolitis (NEC)? 1 "Report skin rashes immediately." 2 "Breast milk will be given enterally." 3 "Probiotics are not given after birth." 4 "Provide skin-to-skin (kangaroo) contact."

2 - "Breast milk will be given enterally." pg 668/669 - Breast milk provides passive immunity, macrophages, and lysosomes to the infant and helps prevent NEC. Probiotics such as Lactobacillus acidophilus and Bifidobacterium infantis are given enterally to reduce the severity of NEC in infants after birth. Lethargy and abdominal distention, not skin rashes, are symptoms of NEC. Skin-to-skin care does not help prevent NEC and is used to help infants maintain thermal stability.

Which statement by the student nurse about a diabetic pregnancy and the fetal side effects indicates effective learning? 1 "The infant is likely to have diabetes after birth." 2 "The euglycemic status will influence fetal well-being." 3 "The infant will be born with congenital malformations." 4 "Hyperglycemia is the only reason for fetal macrosomia."

2 - "The euglycemic status will influence fetal well-being." pg 656 - The euglycemic status will influence fetal well-being, because a decrease or increase in the blood glucose levels enhances the risks for complications in the fetus. Congenital malformations are more likely to be seen in infants exposed to alcohol, not as a result of diabetes. The infant is not likely to have diabetes after birth but may have hypoglycemia, because the infant's glucose supply is removed abruptly at the time of birth. Hyperglycemia is not the only reason for fetal macrosomia. Macrosomia is caused by maternal hyperlipidemia and increased lipid transfer to the fetus.

A newborn infant is prescribed tandem mass spectrometry. The parents ask the nurse about the test. Which is the best response by the nurse? 1 "The test will help determine whether the infant is at risk for diabetes." 2 "The test will help assess inborn errors of metabolism in the infant." 3 "The test will help assess whether the child has any neurologic disorders." 4 "The test will help assess whether the infant was exposed to any drugs."

2 - "The test will help assess inborn errors of metabolism in the infant." pg 682 - Tandem mass spectrometry helps detect more than 20 inborn errors of metabolism. Blood glucose tests are more effective in understanding the risk of diabetes in the infant. Electroencephalography and brain magnetic resonance imaging (MRI) are used to understand neurologic disorders. Meconium sampling helps assess whether the infant was exposed to any drugs during pregnancy.

What instruction does the nurse provide to parents of an infant who is being treated for galactosemia? 1 "Avoid any soy-protein formula." 2 "Use lactose-free infant formulas." 3 "Report respiratory distress at once." 4 "You need to breastfeed the child often."

2 - "Use lactose-free infant formulas." pg 683 - Galactosemia occurs because of increased levels of galactose in the blood. Therefore the nurse instructs the parents to use lactose-free infant formulas for feeding. Breastfeeding is avoided because breast milk contains lactose. An infant with galactosemia experiences vomiting, diarrhea, and weight loss. Respiratory distress is not seen in a child with galactosemia. Soy-protein formula is safe and effective for the infant, and the nurse encourages its use.

Concerning congenital abnormalities involving the central nervous system, nurses should be aware of what? 1 Microcephaly can be corrected with timely surgery. 2 A major preoperative nursing intervention for a neonate with myelomeningocele is to protect the protruding sac from injury. 3 Spina bifida cystica usually is asymptomatic and may not be diagnosed unless associated problems are present. 4 Although the death rate from most congenital anomalies has decreased over the past several decades, neural tube defects (NTDs) have gone up in the last few years.

2 - A major preoperative nursing intervention for a neonate with myelomeningocele is to protect the protruding sac from injury. pg 658 - The nurse protects the infant with myelomeningocele by laying the baby on his or her side. Most congenital anomalies have had a stable neonatal death rate since the 1930s; NTDs are declining because of mandatory food fortification with folic acid. Spina bifida occulta often is asymptomatic; spina bifida cystica has a visible sac. Microcephaly is a tiny head; there is no treatment.

Which infant is a likely candidate for receiving exogenous surfactant? 1 An infant with hypoglycemia born to a diabetic mother 2 A preterm infant with respiratory distress syndrome at birth 3 A preterm infant with a soft cranium who is at risk for cranial molding 4 An infant at risk for inborn errors of metabolism, such as galactosemia

2 - A preterm infant with respiratory distress syndrome at birth pg 661 - Exogenous surfactant helps maintain lung expansion in infants with respiratory distress syndrome. Oral glucose is used for an infant with hypoglycemia at birth. A preterm infant is placed on a waterbed or a gel mattress to minimize the risk of cranial molding. Galactosemia is managed by eliminating lactose-containing food and milk from the infant's diet.

An infant born to a diabetic patient is prescribed oral glucose for the treatment of hypoglycemia. On assessment the nurse finds that the infant's cardiorespiratory condition is stable. Which is a priority nursing intervention in this case? 1 Initiating dextrose infusion 2 Asking the parent to breastfeed 3 Lowering the dosage of oral glucose 4 Obtaining blood from the heel for testing

2 - Asking the parent to breastfeed pg 657 - The administration of oral glucose may trigger a massive insulin release and cause rebound hypoglycemia in the infant. Therefore the nurse instructs the parent to breastfeed if the infant's cardiorespiratory condition is stable. The nurse does not lower the dosage of oral glucose because a lower dosage may not have therapeutic effects. Dextrose infusion is necessary for infants born to women with poorly controlled diabetes. The aim is to maintain serum blood glucose levels between 40 and 50 mg/dL. Blood is obtained from the infant's heel for testing purposes to detect hypoglycemia in the infant, not after hypoglycemia is identified.

What does the nurse include in the plan of care of a high risk preterm infant? Select all that apply. 1 Maintain room temperature 2 Assess for respiratory distress 3 Routinely monitor blood pressure 4 Assess intake and output records 5 Encourage skin-to-skin (kangaroo) contact

2 - Assess for respiratory distress 3 - Routinely monitor blood pressure 4 - Assess intake and output records 5 - Encourage skin-to-skin (kangaroo) contact pg 670 - The nurse routinely monitors the infant's blood pressure to assess whether the values are increasing normally in the first month of life. Accurate intake and output records are necessary to understand the infant's fluid status. The preterm infant is at risk for respiratory distress. Therefore the nurse needs to assess the infant's respiratory function so that prompt actions can be taken. The nurse encourages the parents to provide skin-to-skin (kangaroo) contact with the infant to maintain thermal stability. A preterm infant needs application of external warmth. The room temperature may not be effective to maintain thermal stability. Therefore the infant is placed in a heated environment to prevent cold stress.

The nurse is informing a diabetic pregnant patient about the dietary changes, need for exercise, and possible risks to the fetus. Which fetal risks does the nurse need to inform the patient about? Select all that apply. 1 Galactosemia 2 Hypoglycemia 3 Phenylketonuria 4 Fetal macrosomia 5 Respiratory distress syndrome

2 - Hypoglycemia 4 - Fetal macrosomia 5 - Respiratory distress syndrome pg 656 - Fetal macrosomia is seen in some infants born to diabetic women due to maternal hyperlipidemia and increased lipid transfer to the fetus. Hypoglycemia is seen in infants of diabetic women at birth because the infant's glucose supply is removed abruptly at the time of birth. Hyperinsulinemia and hyperglycemia reduce fetal surfactant synthesis and cause respiratory distress syndrome in the infant of a diabetic woman. Galactosemia is an autosomal recessive disorder that results from various gene mutations. Phenylketonuria is an inborn error of metabolism.

Which conditions is the nurse alert for in a preterm infant with respiratory distress syndrome? Select all that apply. 1 Jaundice 2 Hypoxemia 3 Mucus plugging 4 Metabolic acidosis 5 Pulmonary hemorrhage

2 - Hypoxemia 4 - Metabolic acidosis pg 659 - Inadequate pulmonary perfusion and ventilation produce hypoxemia and hypercapnia in the preterm infant. Prolonged hypoxemia increases the amounts of lactic acid and results in metabolic acidosis. Pulmonary hemorrhage and mucus plugging are side effects of surfactant therapy used in an infant with respiratory distress syndrome. Jaundice is not caused by respiratory distress syndrome. It occurs because of an increase in bilirubin levels in the blood.

Which is a priority nursing intervention for an infant born to a patient with poorly controlled diabetes? 1 Evaluating urine reports 2 Initiating dextrose infusion 3 Encouraging breastfeeding 4 Initiating exchange transfusion

2 - Initiating dextrose infusion pg 657 - The blood glucose levels of an infant born to a mother with poorly controlled diabetes are very low. Therefore the nurse administers an infusion of 10% dextrose and water intravenously to maintain serum blood glucose levels between 40 and 50 mg/dL. Evaluating urine reports is not a priority in this case if the blood serum reports indicate hypoglycemia. Breastfeeding may not be feasible if the infant's cardiorespiratory condition is not stable. Exchange transfusion is a priority in an infant with a hemolytic disease.

The nurse is assessing a very low-birth-weight infant who had a preterm birth. Which condition is likely to be seen in the infant? 1 Macrosomia 2 Ischemic injury 3 Congenital sepsis 4 Facial nerve paralysis

2 - Ischemic injury pg 640 - The increase or decrease in cerebral blood flow subsequent to asphyxia makes preterm infants vulnerable to ischemic injury. Facial nerve paralysis is a birth trauma resulting from a difficult birth. Congenital sepsis in the infant may be caused by a maternal urinary tract infection. Macrosomia is seen in infants born to diabetic mothers.

The nurse is caring for an infant who is suspected to have neonatal sepsis. Which neonatal risk factor for an infant with suspected neonatal sepsis would the nurse expect to observe? 1 Singleton gestation and female 2 Multiple gestation and low birth weight 3 Small for gestational age (SGA) and intrauterine growth restriction 4 Large for gestational age (LGA) and an infant of a diabetic mother

2 - Multiple gestation and low birth weight pg 642 - Neonatal risk factors include multiple gestation and low birth weight. LGA and infant of a diabetic mother are not neonatal risk factors. SGA and intrauterine growth restriction are not neonatal risk factors. Singleton gestation and female are not neonatal risk factors

The nurse is caring for an infant born at 28 weeks of gestation. Which complication can the nurse expect to observe during the course of the infant's hospitalization? Select all that apply. 1 Polycythemia 2 Patent ductus arteriosus 3 Periventricular hemorrhage 4 Respiratory distress syndrome 5 Meconium aspiration syndrome 6 Persistent pulmonary hypertension

2 - Patent ductus arteriosus 3 = Periventricular hemorrhage 4 - Respiratory distress syndrome pg 659 - Respiratory distress syndrome, periventricular hemorrhage, and a patent ductus arteriosus are common complications with preterm infants. Polycythemia, meconium aspiration syndrome, and persistent pulmonary hypertension are complications of postmaturity.

Which condition in a preterm infant in the neonatal period can increase the risk for respiratory distress? 1 Jaundice 2 Pneumonia 3 Galactosemia 4 Fluid imbalance

2 - Pneumonia pg 659 - Pneumonia in a preterm infant causes respiratory distress due to bacterial or viral agents. Galactosemia is an autosomal recessive disorder that indicates a deficiency of galactose 1-phosphate uridyltransferase (GALT) and causes hepatic dysfunction. As a result the infant is more susceptible to jaundice, not respiratory distress. Fluid imbalance does not cause respiratory distress; it may cause dehydration in an infant. Jaundice is caused by an increase in bilirubin levels due to a hemolytic disease. It does not increase the risk for respiratory distress.

The nurse observes respiratory distress in an infant with phrenic nerve palsy. What action does the nurse take to facilitate expansion of the uninvolved lung? 1 Obtains inhaled nitric oxide (INO) 2 Positions the infant on the affected side 3 Provides skin-to-skin (kangaroo) contact 4 Obtains a prescription for oxygen therapy

2 - Positions the infant on the affected side pg 640 - In infants with phrenic nerve palsy, the lung on the affected side does not expand. Therefore the nurse positions the infant on the affected side to facilitate maximum expansion of the uninvolved lung. Oxygen therapy is initiated in case of severe respiratory distress if other measures to revive the infant fail. INO is effective for severe respiratory distress and respiratory failure in neonates. Skin-to-skin contact is helpful in maintaining appropriate body temperature; it does not facilitate respiration.

Which TORCH infection could be contracted by the infant because the mother owned a cat? 1 Rubella 2 Toxoplasmosis 3 Varicella-zoster 4 Parvovirus B19

2 - Toxoplasmosis pg 644/645 - Cats that eat birds infected with the Toxoplasma gondii protozoan excrete infective oocysts. Humans (including pregnant women) can become infected if they fail to wash their hands after cleaning the litter box. The infection is passed through the placenta. The varicella-zoster virus is responsible for chickenpox and shingles. Approximately 90% of childbearing women are immune. This virus cannot be contracted from a cat. During pregnancy infection with parvovirus can result in abortion, fetal anemia, hydrops, intrauterine growth restriction (IUGR), and stillbirth. This virus is spread by vertical transmission, not by felines. Since vaccination for rubella was begun in 1969, cases of congenital rubella infection have been reduced significantly. Vaccination failures, lack of compliance, and the migration of nonimmunized persons result in periodic outbreaks of rubella (German measles).

Which statement by the nursing student about the prevention of health care-associated infections (HAIs) in a nursery unit indicates effective learning? 1 "Nursery visitors are allowed if they wear masks." 2 "Changing used equipment often may cause HAIs." 3 "Hand washing helps prevent HAIs in a nursery unit." 4 "Soiled diapers are kept far from the children's beds."

3 - "Hand washing helps prevent HAIs in a nursery unit." pg 643 - Infants in the nursery unit are at a high risk for infections. Hence, the most effective way to prevent infection is effective hand washing. The equipment used for the infants, such as nasogastric and intravenous tubing, needs to be changed frequently because it may become contaminated and cause infections. Visitors should be instructed not to overcrowd the nursery and to wash their hands before entering. Keeping soiled diapers away from the children is not enough; only proper disposal will help prevent infections.

Which instruction about feeding does the nurse give to the parent of a low-birth-weight infant with septicemia? 1 "You may choose not to breastfeed at all." 2 "Use infant formulas for the first 2 weeks." 3 "You may breastfeed your infant every 3 hours." 4 "Don't breastfeed before administering the medications."

3 - "You may breastfeed your infant every 3 hours." pg 643 - Breast milk contains iron-binding proteins that exert a bacteriostatic effect on Escherichia coli. Breast milk also serves as a barrier to infection because it contains macrophages and lymphocytes. The infant can be breastfed every 3 hours to ensure proper rest between the feeding intervals. It is not necessary to stop breastfeeding while administering medications because the medicines do not interact with breast milk. Infant formulas are not advised because they do not contain protective mechanisms against infection. The nurse should encourage the mother to breastfeed because it is beneficial for the infant.

Necrotizing enterocolitis (NEC) is an inflammatory disease of the gastrointestinal mucosa. The signs of NEC are nonspecific. What are some generalized signs? 1 Hypertonia, tachycardia, and metabolic alkalosis 2 Hypertension, absence of apnea, and ruddy skin color 3 Abdominal distention, temperature instability, and grossly bloody stools 4 Scaphoid abdomen, no residual with feedings, and increased urinary output

3 - Abdominal distention, temperature instability, and grossly bloody stools pg 668/669 - Some generalized signs of NEC include decreased activity, hypotonia, pallor, recurrent apnea and bradycardia, decreased oxygen saturation values, respiratory distress, metabolic acidosis, oliguria, hypotension, decreased perfusion, temperature instability, cyanosis, abdominal distention, residual gastric aspirates, vomiting, grossly bloody stools, abdominal tenderness, and erythema of the abdominal wall. The infant may display hypotonia, bradycardia, and metabolic acidosis. Hypotension, apnea, and pallor are signs of NEC. Abdominal distention, residual gastric aspirates, and oliguria are signs of NEC.

The nurse is assessing an infant born after 42 weeks of gestation. Which characteristics may be seen in the infant? Select all that apply. 1 Soft cranium 2 Weak gag reflex 3 Green vernix caseosa 4 Small, scrawny appearance 5 Wasted physical appearance

3 - Green vernix caseosa 5 - Wasted physical appearance pg 670 - An infant born after 42 weeks of gestation is a postterm infant. The infant may have a wasted physical appearance that indicates intrauterine deprivation. There is little green or deep yellow vernix caseosa in the infant's skinfolds, which indicates meconium in the amniotic fluid. Weak gag reflex, small and scrawny appearance, and a soft cranium are characteristics of a preterm infant.

With regard to the classification of neonatal bacterial infection, nurses should be aware of what? 1 The clinical sign of a rapid, high fever makes infection easier to diagnose. 2 Congenital infection progresses slower than health care-associated infection. 3 Health care-associated infection can be prevented by effective hand washing. 4 Infections occur with about the same frequency in boy and girl infants, although female mortality is higher.

3 - Health care-associated infection can be prevented by effective hand washing. pg 643 - Hand washing is an effective preventive measure for health care-associated infections because these infections come from the environment around the infant. Congenital (early onset) infections progress more rapidly than health care-associated (late onset) infections. Infection occurs about twice as often in boys and results in higher mortality. Clinical signs of neonatal infection are nonspecific and similar to noninfectious problems, making diagnosis difficult.

Which therapy is the primary health care provider likely to prescribe for a late-preterm infant with persistent pulmonary hypertension? 1 Fluid therapy 2 Phototherapy 3 Inhaled nitric oxide 4 Skin-to-skin contact

3 - Inhaled nitric oxide pg 665 - Inhaled nitric oxide is blended with oxygen and administered through the ventilator circuit for the treatment of persistent pulmonary hypertension in late-preterm infants. Fluid therapy is more effective in infants with fluid imbalances, not pulmonary hypertension. Skin-to-skin contact is used to help infants maintain thermal stability. Phototherapy is an effective treatment for infants with jaundice because it helps decrease bilirubin levels.

The nurse observes fever, diarrhea, and vomiting in an infant 2 days after birth. On assessment the nurse finds that the mother used drugs during pregnancy. Which is the best screening method to determine the cause of the infant's condition? 1 Coombs' test 2 Urine toxicology 3 Meconium sampling 4 Kleihauer-Betke assay

3 - Meconium sampling pg 649 - An infant born to a parent who uses drugs is likely to have the withdrawal effects of the drug. Therefore meconium sampling is performed because it helps identify drug exposure. Coombs' test is used to identify antibodies in the blood. The Kleihauer-Betke assay is used to assess transplacental bleeding. Urine toxicology may be used to assess drug exposure, but it may provide less accurate results because it reflects only recent substance intake by the mother.

Which prescription will be included in an infant's plan of care to decrease the withdrawal effects of heroin in an infant? 1 Sildenafil (Revatio) 2 Methadone (Dolophine) 3 Phenobarbital (Luminal) 4 Levothyroxine sodium (Synthroid)

3 - Phenobarbital (Luminal) pg 649/650 - Phenobarbital (Luminal) is used in drug-exposed infants to decrease withdrawal effects. Levothyroxine sodium (Synthroid) is used in the treatment of thyroid conditions. Sildenafil (Revatio) is more effective in infants with persistent pulmonary hypertension. Methadone (Dolophine) is used for drug addiction detoxification.

Which action does the nurse take while assessing a 40-week-old infant who exhibits symptoms such as vomiting, dehydration, and poor nutrition a few days after birth? 1 Asks the parent to participate in a drug rehabilitation program 2 Evaluates the Kleihauer-Betke (KB) assay to understand the fetal history 3 Uses the Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS) 4 Evaluates maternal history for possibility of alcohol ingestion during pregnancy

3 - Uses the Neonatal Intensive Care Unit Network Neurobehavioral Scale (NNNS) pg 650 - The nurse uses NNNS to identify infants at risk due to intrauterine drug exposure. The tool measures stress, state, neurologic status, and muscle tone in the infant. The KB assay is not a priority after the infant is born because the test is used to detect transplacental bleeding. Evaluating maternal history for alcohol ingestion is secondary because the infant needs to be assessed for further risks. The nurse may advise the parent to participate in a drug rehabilitation program for the parent's well-being. However, it is secondary in this case.

Which dietary instruction does the nurse give to the parents of a child with phenylketonuria? 1 "Use artificial sweeteners instead of sugar." 2 "Include breads and hamburgers in child's diet." 3 "Include fruits and vegetables in the child's diet." 4 "Avoid meat and dairy products in the child's diet."

4 - "Avoid meat and dairy products in the child's diet." pg 681/682 - Meat and dairy products contain high protein levels, which increase phenylalanine levels. Therefore the nurse instructs the patient to eliminate these foods from the child's diet. Telling the patients to include any fruits and vegetables in the diet will be unsafe because some fruits may have high phenylalanine levels. Therefore the nurse needs to provide the patient with a proper food list. Artificial sweeteners are not safe for a child because they contain phenylalanine. Breads and hamburgers have low phenylalanine levels. However, they need to be measured to prevent high amounts of phenylalanine in the blood.

What instruction does the nurse provide to parents of a preterm infant who has physiologic immaturity? 1 "The child will have irreparable physiologic deformities." 2 "The child may be vulnerable to fluid and electrolyte imbalances later." 3 "The infant will have attention deficit hyperactivity disorder (ADHD)." 4 "The infant may need neurologic and developmental interventions later."

4 - "The infant may need neurologic and developmental interventions later." pg 675 - A preterm infant may have neurologic impairment after birth, which may result in behavioral and developmental problems later in life. Therefore the nurse instructs the parents that the infant may need neurologic and developmental interventions later. Telling the parents that the infant will have irreparable physiologic deformities will make the parents anxious. There may or may not be any deformities depending on the size and gestational age of infants at birth. Fluid and electrolyte imbalances are caused by fluid overload or dehydration and are treated with appropriate fluid replacement. The child may have ADHD or other neurologic problems depending on the degree of immaturity at birth.

In caring for a mother who has abused (or is abusing) alcohol and for her infant, what should nurses be aware of? 1 Two thirds of newborns with fetal alcohol syndrome (FAS) are boys. 2 The pattern of growth restriction of the fetus begun in prenatal life is halted after birth, and normal growth takes over. 3 Both the distinctive facial features of the FAS infant and the diminished mental capacities tend toward normal over time. 4 Alcohol-related neurodevelopmental disorders (ARNDs) not sufficient to meet FAS criteria (learning disabilities, speech and language problems) often are not detected until the child goes to school.

4 - Alcohol-related neurodevelopmental disorders (ARNDs) not sufficient to meet FAS criteria (learning disabilities, speech and language problems) often are not detected until the child goes to school. pg 651 - Some learning problems do not become evident until the child is in school. The pattern of growth restriction persists after birth. Two thirds of newborns with FAS are girls. Although the distinctive facial features of the FAS infant tend to become less evident, the mental capacities never become normal.

Which condition may be seen in an infant born to a patient who consumed excessive alcohol during pregnancy? 1 Skull fractures 2 Hypothyroidism 3 Respiratory distress 4 Congenital abnormalities

4 - Congenital abnormalities pg 650/651 - Infants born to mothers who are heavy alcohol drinkers are at risk for congenital abnormalities. Respiratory distress is not usually seen in an infant exposed to alcohol. Hypothyroidism is a genetic disorder not related to alcohol consumption. Skull fractures are sometimes caused during a difficult birth as a result of the pressure of the fetal skull against the maternal pelvis.

The nurse finds poor feeding, lethargy, and constipation in an infant. In reviewing the maternal history, the nurse finds that the infant's mother was treated for Graves' disease during pregnancy. Which condition does the nurse suspect in the infant? 1 Facial paralysis 2 Neonatal syphilis lesions 3 Cytomegalovirus infection 4 Congenital hypothyroidism

4 - Congenital hypothyroidism pg 680 - A pregnant patient with Graves' disease is treated with antithyroid drugs, which may cause congenital hypothyroidism in the infant due to thyroid dysgenesis. Facial paralysis is a birth trauma seen in an infant as a result of a difficult birth. Cytomegalovirus infection is a rash on the infant's body caused by fetal exposure to drugs. Neonatal syphilis lesions are seen in an infant born to a mother with secondary syphilis.

Newborns whose mothers are substance abusers frequently exhibit which behaviors? 1 Excessive sleep, weak cry, and diminished grasp reflex 2 Hypothermia, decreased muscle tone, and weak sucking reflex 3 Circumoral cyanosis, hyperactive Babinski reflex, and constipation 4 Decreased amounts of sleep, hyperactive Moro reflex, and difficulty feeding

4 - Decreased amounts of sleep, hyperactive Moro reflex, and difficulty feeding pg 652 - The infant exposed to drugs in utero often has poor sleeping patterns, hyperactive reflexes, hyperactive muscle tone, and uncoordinated sucking and swallowing behavior. They will have poor sleeping patterns, increased reflexes, and a high-pitched cry. They will have diarrhea, not constipation.

The medical history of a patient who has just delivered an infant indicates drug abuse in the last few weeks of pregnancy. The newborn shows no signs of withdrawal symptoms in the first week after birth, and therefore the infant and the mother are discharged. Which nursing intervention is important in this case? 1 Referring the parent to a drug rehabilitation program 2 Asking the parent to avoid breastfeeding for a month 3 Instilling antibiotics in the infant's eyes before discharge 4 Establishing rapport and maintaining contact with the family

4 - Establishing rapport and maintaining contact with the family pg 650 - If the parent uses drugs in the last weeks of pregnancy, it may take time for the withdrawal symptoms to appear in the child. The infant may have withdrawal symptoms after discharge, so the nurse needs to establish rapport and maintain contact with the family so that the family returns for treatment. Antibiotics are administered 1 hour after the infant is born to prevent infection. Referring the parent to a drug rehabilitation program is secondary in this case; it is more important to assess the infant's well-being. The nurse encourages breastfeeding as soon as the child is born if the mother is not using any illicit substances.

Which is a priority nursing intervention when providing care for a high risk infant? 1 Touching the infant often 2 Providing enteral feeding 3 Encouraging breastfeeding 4 Helping the infant conserve energy

4 - Helping the infant conserve energy pg 674 - Nursing interventions should be implemented in a way that facilitates the conservation of energy in a high risk infant. The infant can then use this energy for growth and development. To prevent stress the nurse avoids touching the infant often. Enteral feeding may be contraindicated in some infants to prevent complications. Breastfeeding may not be possible in infants with respiratory distress syndrome, and therefore parenteral nutrition may be required.

An infant weighing 4.1 kg was born 2 hours ago at 37 weeks of gestation. The infant appears chubby with a flushed complexion and is very tremulous. What are the tremors most likely the result of? 1 Seizures 2 Birth injury 3 Hypocalcemia 4 Hypoglycemia

4 - Hypoglycemia pg 657 - This infant is macrosomic and at risk for hypoglycemia. The tremors are jitteriness that is associated with hypoglycemia. Signs of hypoglycemia include jitteriness, apnea, tachypnea, and cyanosis. Tremors are not associated with seizures, birth injury, or hypocalcemia.

In the special care nursery, the nurse is assigned to care for an infant now 18 hours old. Although there is nothing specific for the nurse to report to the pediatric hospitalist, a number of clinical manifestations may indicate early warning signs of neonatal sepsis. Upon reviewing the mother's record, the nurse identifies a prenatal fever and rupture of membranes 36 hours before admission. Which finding in the newborn's clinical presentation does the nurse find to be normal, rather than an indication of possible sepsis? 1 Bradycardia 2 Grunting, nasal flaring 3 Temperature instability 4 Increased oxygen saturation

4 - Increased oxygen saturation pg 642 - Respiratory system manifestations of sepsis in the neonate include decreased O2 saturation, apnea, tachypnea, grunting, nasal flaring, retractions, and metabolic acidosis. Cardiovascular indicators include decreased cardiac output, tachycardia or bradycardia, hypotension, and decreased perfusion. Temperature instability, lethargy, hypotonia, irritability, and seizures are all central nervous system manifestations of sepsis. The earliest clinical signs of neonatal sepsis are characterized by their lack of specificity. If a thorough assessment of the infant indicates possible sepsis, the physician should be notified in order for appropriate laboratory work to be ordered.

A male infant at 26 weeks of gestation arrives from the delivery room intubated. The nurse weighs the infant, places him under the radiant warmer, and attaches him to the ventilator at the prescribed settings. A pulse oximeter and cardiorespiratory monitor are placed. The pulse oximeter is recording oxygen saturations of 80%. The prescribed saturations are 92%. What is the nurse's most appropriate action? 1 Notify the parents that their infant is not doing well 2 Continue to observe and make no changes until the saturations are 75% 3 Continue with the admission process to ensure that a thorough assessment is completed 4 Listen to breath sounds and ensure the patency of the endotracheal tube, increase oxygen, and notify the physician

4 - Listen to breath sounds and ensure the patency of the endotracheal tube, increase oxygen, and notify the physician pg 662 - Listening to breath sounds, ensuring the patency of the endotracheal tube, increasing oxygen, and notifying the physician are appropriate nursing interventions to assist in optimal O2 saturation of the infant. Oxygenation of the infant is crucial. O2 saturation should be maintained at more than 92%. The nurse should delay other tasks to stabilize the infant. Notifying the parents is not appropriate. Further assessment and intervention are warranted before determination of fetal status.

Which action does the nurse implement in the plan of care of a breastfeeding infant if the mother is taking selective serotonin reuptake inhibitors (SSRIs) for the treatment of depression? 1 Administers antibiotics to the infant 2 Asks the parent to avoid breastfeeding 3 Assesses the infant's skin for side effects 4 Monitors the infant for sleep disturbances

4 - Monitors the infant for sleep disturbances pg 654 - SSRIs are prescribed for depression. However, the drugs pass into the breast milk after the infant's birth and cause sleep disturbances, irritability, and poor feeding. Hence, the nurse needs to monitor the infant for these conditions. The nurse administers antibiotics to infants who have infections. SSRIs do not have any side effects on the infant's skin. The nurse does not ask the parent to avoid breastfeeding because breast milk is beneficial for the infant's health.

The nurse finds that a pregnant patient is Rh negative and the fetus is Rh positive. Which event would pose a potential risk to the fetus? 1 Cesarean birth 2 Fluid imbalance 3 Blood transfusion 4 Placental separation

4 - Placental separation pg 654 - Placental separation increases the risk of fetal blood being transferred to the maternal circulation. This may result in maternal antibody production, which may attack and destroy fetal erythrocytes. Blood transfusions help improve the condition of the affected fetus. Caesarean birth does not cause a hemolytic reaction in the newborn. Fluid imbalance does not present a risk to the Rh-negative mother and Rh-positive fetus. It can be treated with appropriate fluid replacement therapy.

Which skeletal injuries does the nurse assess for in an infant after a difficult birth? Select all that apply. 1 Anencephaly 2 Macrosomia 3 Galactosemia 4 Skull fractures 5 Clavicle fracture

4 - Skull fractures 5 - Clavicle fracture pg 637 - The infant may have a linear or depressed skull fracture from a difficult birth as a result of the pressure of the head on the bony pelvis. A clavicle fracture is sometimes seen in a difficult birth. There may be limited arm motion and an absence of the Moro reflex on the affected side. Anencephaly is a central nervous system anomaly seen in an infant of a diabetic mother. Macrosomia refers to excessive weight gain in the infant after birth, seen in the infants of diabetic mothers. Galactosemia is an autosomal recessive disorder.

With regard to hemolytic diseases of the newborn, what should nurses be aware of? 1 Exchange transfusions frequently are required in the treatment of hemolytic disorders. 2 ABO incompatibility is more likely than Rh incompatibility to precipitate significant anemia. 3 Rh incompatibility matters only when an Rh-negative offspring is born to an Rh-positive mother. 4 The indirect Coombs' test is performed on the mother before birth; the direct Coombs' test is performed on the cord blood after birth.

4 - The indirect Coombs' test is performed on the mother before birth; the direct Coombs' test is performed on the cord blood after birth. pg 654/655 - An indirect Coombs' test may be performed on the mother a few times during pregnancy. Only the Rh-positive offspring of an Rh-negative mother is at risk. ABO incompatibility is more common than Rh incompatibility but causes less severe problems; significant anemia, for instance, is rare with ABO. Exchange transfers are needed infrequently because of the decrease in the incidence of severe hemolytic disease in newborns from Rh incompatibility.

Which is a priority nursing action while assessing an infant with rubella infection? 1 Evaluating the infant's urine reports 2 Washing the infant with warm water 3 Evaluating the infant's blood reports 4 Wearing gloves before touching the infant

4 - Wearing gloves before touching the infant pg 645 - Rubella infection may easily transmit from one infant to the other if proper caution is not taken. Therefore the nurse wears gloves before touching the infant to avoid contact and prevent the risk of cross-contamination. The nurse evaluates the infant's blood and urine reports as a part of the assessment process. However, it is not a priority in this case. The nurse washes the infant with warm water after birth to remove the blood and meconium from the infant's body.