Chapter 26: The Newborn at Risk: Conditions Present at Birth

14) The family of a newborn has just been told their infant has tetralogy of Fallot. The family does not seem to understand the explanation given by the physician. What statement by the nurse is best? 1. "With this defect, not enough of the blood circulates through the lungs, leading to a lack of oxygen in the baby's body." 2. "The baby's aorta has a narrowing in a section near the heart that makes the left side of the heart work harder." 3. "The blood vessels that attach to the ventricles of the heart are positioned on the wrong sides of the heart." 4. "Your baby's heart doesn't circulate blood well because the left ventricle is smaller and thinner than normal."

Answer: 1 Explanation: 1. Tetralogy of Fallot is a cyanotic heart defect that is comprised of four abnormalities: pulmonary stenosis, ventricular septal defect, overriding aorta, and right ventricle hypertrophy. Deoxygenated blood is shunted from the right ventricle through the VSD into the left ventricle, bypassing the lungs and circulating de-oxygenated blood.

1) The nurse is caring for pregnant clients. Which of these clients should the nurse anticipate is most likely to have a newborn at risk for mortality or morbidity? 1. 37-year-old G8 P2323, works in a chemical factory 2. 23-year-old primipara, low socioeconomic status, unmarried 3. 16-year-old primipara, began prenatal care at 30 weeks 4. 28-year-old G2 P1001, history of gestational diabetes

Answer: 1 Explanation: 1. This client is at greatest risk because she has multiple risk factors: age older than 35, high parity, history of preterm birth, and exposure to chemicals that might be toxic.

6) The client at 41 weeks' gestation is scheduled for labor induction. She asks the nurse if induction is really necessary. What response by the nurse is best? 1. "Babies can develop postmaturity syndrome, which increases their chances of having complications after birth." 2. "When infants are born two or more weeks after their due date, they have meconium in the amniotic fluid." 3. "Sometimes the placenta ages excessively, and we want to take care of that problem before it happens." 4. "The doctor wants to be proactive in preventing any problems with your baby if he gets any bigger."

Answer: 1 Explanation: 1. This statement is correct.

13) Which of the following should be considered potentially infectious when providing nursing care for a newborn with an HIV-positive mother? Select all that apply. 1. Soiled linens 2. Urine 3. Blood 4. Mask worn while caring for infant 5. Feces

Answer: 1, 2, 3, 5

17) Intrauterine growth restriction (IUGR) may be caused by maternal factors and may not be apparent antenatally. The client asks the nurse what factors cause IUGR? These factors include (select all that apply): 1. Multiple gestation pregnancy 2. Age extremes 3. Hyperglycemia 4. Lifting more than 50 pounds 5. Low socioeconomic status

Answer: 1, 2, 4, 5

12) The nurse is caring for a newborn born to a drug-addicted mother. Which of the following assessment findings would be common for this newborn? Select all that apply. 1. Hyperirritability 2. Decreased muscle tone 3. Exaggerated reflexes 4. Depressed respiratory effort 5. Transient tachypnea

Answer: 1, 3, 5 Explanation: 1. Newborns born to drug-addicted mothers exhibit hyperirritability, exaggerated reflexes, and transient tachypnea. 3. Newborns born to drug-addicted mothers exhibit hyperirritability, exaggerated reflexes, and transient tachypnea. 5. Newborns born to drug-addicted mothers exhibit hyperirritability, exaggerated reflexes, and transient tachypnea.

16) Match the term with its definition. According to the newborn classification and neonatal mortality risk chart, gestation is divided as follows: 1. 34 to 36 weeks, 6 days 2. 39 weeks, 0 days through 40 weeks, 6 days 3. 42 weeks, 0 days and beyond 4. Less than or equal to 36 weeks, 6 days 5. 37 weeks, 0 days through 38 weeks, 6 days 6. 41 weeks, 0 through 6 days ________ A. Preterm ________ B. Late preterm ________ C. Early term ________ D. Full term ________ E. Late term ________ F. Postterm

Answer: 1/B, 2/D, 3/F, 4/A 5/C, 6/E Explanation: 1: Late preterm: 34 to 36 weeks, 6 days 2: Full Term: 39 weeks, 0 days through 40 weeks, 6 days 3: Postterm: 42 weeks, 0 days and beyond 4: Preterm: less than or equal to 36 weeks, 6 days 5: Early Term: 37 weeks, 0 days through 38 weeks, 6 days 6: Late Term: 41 weeks, 0 through 6 days

15) The nurse is preparing an educational session on phenylketonuria for a family whose neonate has been found to have the condition. Which statement indicates that teaching was effective? 1. "This condition occurs more frequently among Japanese people." 2. "We must be very careful to avoid most proteins to prevent brain damage." 3. "This condition will resolve itself by the time my child reaches the age of 5." 4. "The thyroid gland of our baby isn't functioning properly."

Answer: 2 2. PKU is the inability to metabolize phenylalanine, an amino acid found in most dietary protein sources. High phenylalanine levels cause brain damage and severe neurologic abnormalities.

2) Small-for-gestational-age infants often have complications at birth, but they may also experience long-term complications. The long-term effect that is most likely to occur in SGA infants is: 1. Change from thin and underweight as a child to overweight or obese as adolescents. 2. Poor fine motor coordination. 3. Paralysis below the hips. 4. Permanent disfiguration.

Answer: 2 2. SGA infants are likely to develop cognitive disabilities such as poor fine motor coordination, hyperactivity, learning disabilities, and hearing loss.

5) An infant was born at 31-weeks' gestation and weighed 1430 g. What is the correct initial feeding regimen for this infant? 1. 10 mg/kg/day of premature formula 24 kcal/oz. 2. 20 mg/kg/day of premature formula 24 kcal/oz. 3. 40 mg/kg/day of postdischarge formula 22 kcal/oz. 4. 50 mg/kg/day of term formula 20 kcal/oz.

Answer: 2 2. This is the correct initial feeding regimen for preterm infants with a birth weight between 1251 and 1500 g.

9) The nurse is assessing a 36-week gestational age newborn. Upon auscultation, she hears a late systolic murmur in the left intrascapular area with no femoral pulse but increased brachial pulses. What treatment should this infant receive? 1. Indomethacin with surgical ligation 2. Lanoxin with surgical closure with a Dacron patch 3. Prostaglandin E1 and surgical resection of the aorta 4. Palliative surgery to increase blood flow to the lungs followed by corrective surgery

Answer: 3 3. This is the correct treatment for an infant with coarctation of aorta.

7) The nurse is working with a family that just experienced the birth of their first child at 34 weeks. Which statements indicate that additional teaching is needed? Select all that apply. 1. "Our baby will be in an isolette to keep him warm." 2. "Breathing might be harder for our baby because he is early." 3. "The growth of our baby will be faster than if he were term." 4. "Tube feedings will be required because his stomach is small." 5. "Because he came early, he will not produce urine for two days."

Answer: 3, 4, 5 Explanation: 1. Preterm infants have little subcutaneous fat and have difficulty maintaining their body temperature. An isolette or overhead warmer is used to keep the baby warm. 2. Surfactant production might not be complete at 34 weeks, which leads to respiratory distress syndrome. In addition, respiratory effort is increased when the ductus arteriosus remains patent, which is common in preterm infants.

4) A 7 pound 14 ounce girl was born to an insulin-dependent type 2 diabetic mother 2 hours ago. The infant's blood sugar is 45mg/dL. The best nursing action is: 1. Recheck the blood sugar in four hours. 2. Begin an IV of 10 percent dextrose. 3. Feed the baby one ounce of formula. 4. Document the findings in the chart.

Answer: 4 4. A blood sugar of 45 mg/dL is a normal finding; documentation is an appropriate action.

11) Parents have been told their child has fetal alcohol syndrome (FAS). Which statement indicates that additional teaching is required? 1. "Our baby's heart murmur is from this syndrome." 2. "He might be a fussy baby because of this." 3. "His face looks like it does due to this problem." 4. "Cuddling and rocking will help him stay calm."

Answer: 4 4. FAS babies are easily overstimulated and tend to cry more if swaddled, cuddled, or rocked. A dark and quiet environment helps keep the child calm.

3) A 38-week newborn is found to be small for gestational age. Which of the following nursing interventions should be included in the care of this newborn? 1. Monitor for feeding difficulties. 2. Assess for facial paralysis. 3. Monitor for signs of hyperglycemia. 4. Maintain a warm environment.

Answer: 4 4. Hypothermia is a common complication of the SGA newborn; therefore, the newborn's environment must remain warm to decrease heat loss.

10) The nurse is caring for a newborn in the special care nursery. The infant is positioned prone and has hydrocephalus. The nurse is especially careful to cleanse all stool after bowel movements. This care is most appropriate for an infant born with: 1. Omphalocele. 2. Gastroschisis. 3. Diaphragmatic hernia. 4. Myelomeningocele.

Answer: 4 4. Myelomeningocele is a neural tube defect in which the meninges and spinal cord are exposed. Surgical repair is undertaken to prevent encephalitis. Meticulous cleaning of the perineum helps prevent infection. The infant is positioned prone to prevent pressure on the defect. Hydrocephalus often is present.

8) The nurse is caring for an infant with abdominal contents protruding out approximately at the location of the umbilicus. What is the primary mechanism used to differentiate between omphalocele or gastroschisis? 1. With omphalocele, the abdominal contents are covered with a sac; with gastroschisis, the abdominal contents are not covered by a sac. 2. With omphalocele, the abdominal contents are not covered with a sac; with gastroschisis, the abdominal contents are covered by a sac. 3. With omphalocele, the abdominal contents protrude to the right of an intact umbilical cord; with gastroschisis, the abdominal contents protrude into the base of the umbilical cord. 4. With omphalocele, the abdominal contents protrude into the base of the umbilical cord; with gastroschisis, the abdominal contents protrude to the right of an intact umbilical cord.

Answer: 4 4. This is a correct way to differentiate between omphalocele and gastroschisis.