High-risk newborn chapter 10 NCLEX book

The nurse administers Lanoxin (digoxin) to a baby in the NICU that has a cardiac defect. The baby vomits shortly after receiving the medication. Which of the following actions should the nurse perform next? 1. Give a repeat dose. 2. Notify the physician. 3. Assess the apical and brachial pulses concurrently. 4. Check the vomitus for streaks of blood.

2. Notify the physician. the nurse should notify the physician that the baby has vomited the digoxin

A 30-week-gestation neonate, 2 hours old, has received exogenous surfactant. Which of the following would indicate a positive response to the medication? 1. Axillary temperature 98.0°F 2. Oxygen saturation 96%. 3. Apical heart rate 154 bpm. 4. Serum potassium 4.0 mEq/L

2. Oxygen saturation 96%. a normal oxygen saturation level would be considered a positive result of the medication

A client who received an intravenous analgesic 4 hours ago has had recurrent late decelerations in labor. She will deliver her baby shortly. Which of the following is the priority action for the delivery room nurse to take? 1. Preheat the overhead warmer. 2. Page the neonatologist on call. 3. Draw up Narcan (naloxone) for injection. 4. Assemble the neonatal eye prophylaxis.

2. Page the neonatologist on call. the neonatologist must be called to the delivery room so that he or she arrives before the baby is delivered

An 18-hour-old baby is placed under the bili-lights with an elevated bilirubin level. Which of the following is an expected nursing action in these circumstances? 1. Give the baby oral rehydration therapy after all feedings. 2. Rotate the baby from side to back to side to front every two hours. 3. Apply restraints to keep the baby under the light source. 4. Administer intravenous fluids via pump per doctor orders.

2. Rotate the baby from side to back to side to front every two hours. rotating the baby's position maximizes the therapeutic response because the more skin surface that is exposed to the light source, the better the results are

Four babies are born with distinctive skin markings. Identify which marking matches its description: 1. cafe au lait spot 2. hemangioma 3. mongolian spots 4. port wine stain. a. raised, blood vessel-filled lesion b. flat, sharply demarcated red-to-purple lesion c. multiple grayis-hblue, hyperpigmented skin areas d. pale tan-to coffee- colored marking

1 matched with D 2 is matched with A 3 is matched with C 4 is matched with B

in the special care nursery, a nurse is caring for preterm neonates receiving ventilatory support from a variety of different methods. please identify which ventilation method matches its description: 1. continuous positive airway pressure (CPAP) 2. noninvasive positive airway pressure (NIPP) 3. extracorporeal membrane oxygenation (ECMO) 4. mechanical ventilation a. augments babies' spontaneous breaths b. keeps alveoli open during exhalation c. requires endotracheal tube insertion d. form of cardiopulmonary bypass

1 matches B 2 matches A 3 matches D 4 matches C

For which of the following reasons would a nurse in the well-baby nursery report to the neonatologist that a newborn appears to be preterm? 1. Baby has a square window angle of 90° 2. Baby has leathery and cracked skin. 3. Baby has popliteal angle of 90° 4. Baby has pronounced plantar creases.

1. Baby has a square window angle of 90° a baby whose square window sign is 90 degrees is preterm

42. a baby at 42 weeks' gestation weighing 5 lbs 3 oz (2,400 grams) is admitted inot the NICU. The baby's mother had no prenatal care. the neonatologist orders blood work. which of the following laboratory findings would the nurse expect to see? 1. Blood glucose 30 mg/dL (1.7 mmol/L). 2. Leukocyte count 1,000 cells/mm3. 3. Hematocrit 30%. 4. Serum pH 7.8.

1. Blood glucose 30 mg/dL (1.7 mmol/L). this baby is small for gestational age. full-term babies (40 weeks' gestation) should weigh between 2,500 and 4,000 grams. it is very likely that this baby's placenta was less than optimal from the start of the pregnancy for any number of reasons. in addition, as the placenta aged and calcified past term, the fetus used up its glycogen stores in utero to survive, since an aging placenta is unable to deliver sufficient nutrients to the fetus. for up to 48 hours after the birth, the newborn's pancreas continues to secrete the same higher insulin levels that were required before birth, in spite of no longer receiving that amount of glucose. having used up its glycogen stores to sustain prenatal life, and no longer receiving any glucose from the mother's blood now that it's born, the newborn is at high risk for hypoglycemia after birth.

A neonate is being assessed for necrotizing enterocolitis (NEC). Which of the following actions by the nurse is appropriate? (Select all that apply) 1. Perform hemoccult test on stools. 2. Monitor for an increase in abdominal girth. 3. Measure gastric contents before each feed. 4. Assess bowel sounds before each feed. 5. Assess for anal fissures daily.

1. Perform hemoccult test on stools. 2. Monitor for an increase in abdominal girth. 3. Measure gastric contents before each feed. 4. Assess bowel sounds before each feed. -babies with NEC have blood in their stools -the abdominal girth measurements of babies with NEC, they have increasingly larger undigested gastric contents after feeds - when babies have NEC, the have increasingly larger undigested gastric contents after feeds - the neonates' bowel sounds are diminished with NEC

A 6-month-old child is being seen in the pediatrician's office. The child was born preterm and remained in the neonatal intensive care unit for the first 5 months of life. The child is being monitored for 5 chronic problems. Which of the following problems are directly related to the prematurity? (Select all that apply) 1. Bronchopulmonary dysplasia. 2. Cerebral palsy. 3. Retinopathy. 4. Hypothyroidism. 5. Seizure disorders.

1. Bronchopulmonary dysplasia. 2. Cerebral palsy. 3. Retinopathy. 5. Seizure disorders. -bronchopulmonary dysplasia often is a consequence of the respiratory therapy that preemies receive in the NICU -cerebral palsy results from a hypoxic insult that likely occurred as a result of the baby's prematurity -retinopathy is a disease resulting from the immaturity of the vascular system of the eye -seizure disorders can result either from a hypoxic insult to the brain or from a ventricular bleed. both of these conditions likely occurred as a result of the prematurity

A baby is born with a suspected coarctation of the aorta. Which of the following assessments should be done by the nurse? 1. Check blood pressures in all four limbs. 2. Palpate the anterior fontanel for bulging. 3. Assess hematocrit and hemoglobin values. 4. Monitor for harlequin color changes.

1. Check blood pressures in all four limbs. the blood pressures in all four quadrants should be assessed

A baby with hemolytic jaundice is being treated with fluorescent phototherapy. To provide safe newborn care, which of the following actions should the nurse perform? 1. Cover the baby's eyes with eye pads. 2. Turn the lights on for ten minutes every hour. 3. Clothe the baby in a shirt and diaper only. 4. Tightly swaddle the baby in a baby blanket.

1. Cover the baby's eyes with eye pads. when phototherapy is administered, the baby's eyes must be protected from the light source

A preterm infant has a patent ductus arteriosus (PDA). You are orienting a nurse new to the unit and are listening to the nurse's explanation of the condition to the parents. Which of the following explanations the nurse give to the parents about the condition requires follow-up with the nurse and with the parents? Select all that apply 1. Hole has developed between the left and right ventricles. 2. Hypoxemia occurs as a result of the poor systemic circulation. 3. Oxygenated blood is reentering the pulmonary system. 4. Blood is shunting from the right side of the heart to the left.

1. Hole has developed between the left and right ventricles. 2. Hypoxemia occurs as a result of the poor systemic circulation. 4. Blood is shunting from the right side of the heart to the left. - a hole between the left and right ventricles is called a ventricular septal defect (VSD), not a PDA -unless the baby is decompensating, this defect rarely results in cyanosis. the blood is being oxygenated and, although there is mixed blood, the baby is sufficiently oxygenated -this is referring to the foramen ovale, not a PDA. the foramen ovale is a normal shunt in fetal circulation, in order for most of the oxygenated blood entering the right atrium from the umbilical vein to bypass the lungs. a physical right-to-left- shunt is normal in the fetal heart, but when the term is used to refer to the newborn's heart condition, it is not always a literal reference to left and right sides of the heart. for example, the ductus arteriosus is outside of the heart, and not on either the left of the right side. see the appendix for more information

A baby is born to a mother with type 1 diabetes mellitus (T1DM) and poor blood sugar control. If a blood sample was drawn, which of the following laboratory values would the nurse expect the neonate to exhibit during the immediate postpartum period? 1. Plasma glucose 30 mg/dL. 2. Red blood cell count 1 million/mm3. 3. White blood cell count 2,000/mm3. 4. Hemoglobin 8 g/dL.

1. Plasma glucose 30 mg/dL. the nurse should anticipate that the plasma glucose levels would be low

Based on maternal history of alcohol abuse, a baby in the neonatal nursery is being monitored for signs of fetal alcohol syndrome (FAS). The nurse should assess this baby for which of the following? 1. Poor suck reflex. 2. Ambiguous genitalia. 3. Webbed neck. 4. Absent Moro reflex.

1. Poor suck reflex. babies with fetal alcohol syndrome (FAS) usually have a very weak suck

During neonatal cardiopulmonary resuscitation, which of the following actions should be performed? 1. Provide assisted ventilation at 40 to 60 breaths per minute. 2. Begin chest compressions when heart rate is 0 to 20 beats per minute. 3. Compress the chest using the three-finger technique. 4. Administer compressions and breaths in a 5:1 ratio.

1. Provide assisted ventilation at 40 to 60 breaths per minute. assisted ventilation should be administered at an approximate rate of 30 breaths per minute.

A neonate that is admitted to the neonatal nursery is noted to have a 2-vessel cord. The nurse notifies the neonatologist to get an order for which of the following assessments? 1. Renal function tests. 2. Echocardiogram. 3. Glucose tolerance test. 4. Electroencephalogram.

1. Renal function tests. -babies with 2-vessel cords are at high risk for renal defects -babies with 2-vessel cords are at high risk for cardiac defects

A neonate is being given intravenous fluids through the dorsal vein of the wrist. Which of the following actions by the nurse is essential? 1. Tape the arm to an arm board. 2. Change the tubing every 24 hours. 3. Monitor the site every 5 minutes. 4. Infuse the fluid intermittently.

1. Tape the arm to an arm board. neonates are incapable of controlling their movements. to maintain a patent IV site, it is essential to tape the baby's arm to an arm board. this can prevent the need to restart the IV too often

Four 38-week-gestation gravidas have just delivered. Which of the babies should be monitored closely by the nurse for respiratory distress? 1. The baby whose mother has diabetes mellitus. 2. The baby whose mother has lung cancer. 3. The baby whose mother has hypothyroidism. 4. The baby whose mother has asthma.

1. The baby whose mother has diabetes mellitus. the lung maturation of infants of diabetic mothers is often delayed. these babies must be monitored at birth for respiratory distress.

A baby's blood type is B negative. The baby is at risk for hemolytic jaundice if the mother has which of the following blood types? 1. Type O negative. 2. Type A negative. 3. Type B positive. 4. Type AB positive.

1. Type O negative. significant ABO incompatibility can occur when the mother is type O and the baby is either type A or type B, regardless of Rh factor

A baby has been admitted to the neonatal intensive care unit (NICU) with a diagnosis of symmetrical intrauterine growth restriction (IUGR). Which of the following pregnancy complications would be consistent with this diagnosis? 1. Severe preeclampsia. 2. Chromosomal defect. 3. Infarcts in an aging placenta. 4. Premature rupture of the membranes.

2. Chromosomal defect. chromosomal abnormalities are associated with symmetrical IUGR

A baby is suspected of having esophageal atresia. The nurse would expect to see which of the following signs/symptoms? (Select all that apply) 1. Frequent vomiting. 2. Excessive mucus. 3. Ruddy complexion. 4. Abdominal distention. 5. Pigeon chest.

2. Excessive mucus. 4. Abdominal distention. -babies with esophageal atresia would be expected to expel large amounts of mucus from the mouth because they can't swallow it into the stomach - abdominal distention can be seen with esophageal atresia because air enters the stomach via the trachea

A neonate has just been born with a meningomyelocele. Which of the following nursing diagnoses should the nurse identify as related to this medical diagnosis? 1. Deficient fluid volume. 2. High risk for infection. 3. Ineffective breathing pattern. 4. Imbalanced nutrition: less than body requirements.

2. High risk for infection. if the fragile sac is injured, the baby is at very high risk for infection

Thirty seconds after birth a baby, who appears preterm, has exhibited no effort to breathe even after being stimulated. The heart rate is assessed at 50 bpm. Which of the following actions should the nurse perform first? 1. Perform a gestational age assessment. 2. Inflate the lungs with positive pressure. 3. Provide external chest compressions. 4. Assess the oxygen saturation level.

2. Inflate the lungs with positive pressure. the baby's airway should be established by inflating the lungs with an ambu bag

An infant admitted to the newborn nursery has a blood glucose level of 35 mg/dL. The nurse should monitor this baby carefully for which of the following? 1. Jaundice. 2. Jitters. 3. Erythema toxicum. 4. Subconjunctival hemorrhages

2. Jitters. babies who are hypoglycemic will often develop jitters (tremors)

In the delivery room, which of the following infant care interventions must a nurse perform when a neonate with a meningomyelocele is born? 1. Perform nasogastric suctioning. 2. Place baby in the prone position. 3. Administer oxygen via face mask. 4. Swaddle the baby in warmed blankets.

2. Place baby in the prone position. the baby should be lain prone, on its tummy to prevent injury to the sac

A baby has just been born to a type 1 diabetic mother with retinopathy and nephropathy. Which of the following neonatal findings would the nurse expect to see? 1. Hyperalbuminemia. 2. Polycythemia. 3. Hypercalcemia. 4. Hypoinsulinemia.

2. Polycythemia. the mother's diagnoses of retinopathy and nephropathy indicate a very serious diabetic condition. as such, the placenta is likely to be functioning less than optimally. it is highly likely that the baby will be polycythemic, having increased its red blood cells to improve the oxygen carrying capacity of the blood in utero

A baby is born with caudal agenesis. Which of the following maternal complications is associated with this defect? 1. Poorly controlled myasthenia gravis. 2. Poorly controlled diabetes mellitus. 3. Poorly controlled splenic syndrome. 4. Poorly controlled hypothyroidism.

2. Poorly controlled diabetes mellitus. hyperglycemia associated with poorly controlled maternal important predisposing factors for caudal agenesis in the fetus

a baby is born to a mother with a history of depression. the mother was prescribed fluoxetine to control her symptoms. for which of the following signs and symptoms should the nurse monitor the neonate in the neonatal nursery? 1. elevated blood pressure is the upper extremities 2. marked systemic cyanosis 3. pronounced mucus production immediately after birth 4. flaccid tone of all musculature

2. marked systemic cyanosis marked systemic cyanosis is a sign of persistent pulmonary hypertension of the newborn (PPHN), a complication seen in babies exposed to selective serotonin reuptake inhibitors (SSRIs), especially during the third trimester

monochorionic twins whose gestation was complicated by twin-to-twin transfusion are admitted to the neonatal intensive care unit. which of the following characteristic findings would the nurse expect to see? 1. recipient twin has petechial rash 2. recipient twin is larger than the donor twin 3. donor twin has 30% higher hematocrit than recipient twin 4. donor twin is ruddy and plethoric

2. recipient twin is larger than the donor twin the recipient is likely to be larger than the donor twin

A baby has been diagnosed with developmental dysplasia of the hip (DDH). Which of the following findings would the nurse expect to see? 1. Pronounced hip abduction. 2. Swelling at the site. 3. Asymmetrical leg folds. 4. Weak femoral pulses.

3. Asymmetrical leg folds. the leg folds of the baby, both anteriorly and posteriorly, are frequently asymmetrical

An infant in the neonatal nursery has low-set ears, Simian creases, and slanted eyes. The nurse should monitor this infant carefully for which of the following signs/symptoms? 1. Blood-tinged urine. 2. Hemispheric paralysis. 3. Cardiac murmur. 4. Hemolytic jaundice.

3. Cardiac murmur. cardiac anomalies occur much frequently in babies with Down's syndrome (trisomy 21) than in other babies

During a health maintenance visit at the pediatrician's office, the nurse notes that a breastfeeding baby has thrush. Which of the following actions should the nurse take? 1. Nothing because thrush is a benign problem. 2. Advise the mother to bottle feed until the thrush is cured. 3. Obtain an order for antifungals for both mother and baby. 4. Assess for other evidence of immunosuppression.

3. Obtain an order for antifungals for both mother and baby. candida is a fungal infection, and it is important to treat both the mother's breasts and the baby's mouth to prevent the infection from being transmitted back and forth between the two

A neonate whose mother is HIV positive is admitted to the NICU. Which of the following interventions should the nurse include as a result of the baby's perinatal exposure to HIV?AIDS? 1. Monitor daily viral load laboratory reports. 2. Check the baby's viral antibody status. 3. Obtain an order for antiviral medication. 4. Place the baby on strict precautions.

3. Obtain an order for antiviral medication. the standard of care for neonates born to mothers with HIV?AIDS is to being them on anti-AIDS medication. the mother will be advised to continue to give the baby the medication after discharge.

Which of the following neonates is at highest risk for cold stress syndrome? 1. Infant of diabetic mother. 2. Infant with Rh incompatibility. 3. Postdates neonate. 4. Down syndrome neonate.

3. Postdates neonate. postdates babies are at high risk for cold stress syndrome because while still in utero they often metabolize the brown adipose tissue for energy when the placental function deteriorates

A nurse hears a heart murmur on a full-term neonate in the well-baby nursery. The baby's color is pink while at rest and while feeding. Which of the following cardiac defects is consistent with the nurse's findings? (Select all that apply) 1. Transposition of the great vessels. 2. Tetralogy of Fallot. 3. Ventricular septal defect. 4. Pulmonic stenosis. 5. Patent ductus arteriosus.

3. Ventricular septal defect. 5. Patent ductus arteriosus. -ventricular septal defect (VSD) is the most common cardiac defect in neonates. It is an a cyanotic defect with a left to right shunt. already oxygenated blood reenters the right ventricle. this extra blood is pumped back into the lungs, forcing both the heart and lungs to work harder. -patent ductus arteriosus (PDA) is a very common cardiac defect with a left to right shunt. already oxygenated blood reenters the pulmonary system through the ductus arteriosus.

The nurse must perform nasopharyngeal suctioning of a newborn with profuse secretions. Place the following nursing actions for nasopharyngeal suctioning in chronological order. 1. Slowly rotate and remove the suction catheter. 2. Place thumb over the suction control on the catheter. 3. Assess type and amount of secretions. 4. Insert free end of the tubing through the nose.

4. Insert free end of the tubing through the nose. 2. Place thumb over the suction control on the catheter. 1. Slowly rotate and remove the suction catheter 3. Assess type and amount of secretions. - inserting the free end of the tubing through the nose is the first step in nasopharyngeal suctioning process -the nurse should place a thumb over the suction control on the catheter after inserting the free end of the tubing through the nose-and before the other two steps are taken - rotation and removal of the suction catheter should be done after the tubing has been inserted through the nose and a thumb placed over the suction control on the catheter -assessment and documentation of the type and amount of secretions is the last step in the process.

A newborn admitted to the nursery has a positive direct Coombs' test. Which of the following is an appropriate action by the nurse?1. Monitor the baby for jitters. 2. Assess the blood glucose level. 3. Assess the rectal temperature. 4. Monitor the baby for jaundice.

4. Monitor the baby for jaundice. when the neonatal bloodstream contains antibodies, hemolysis of the red blood cells occurs and jaundice develops

The neonatologist has ordered 12.5 micrograms of digoxin po for a neonate in congestive heart failure. The medication is available in the following elixir—0.05 mg/mL.How many milliliters (mL) should the nurse administer? (Calculate to the nearest hundredth.)_____________ mL.

0.25 mL

A full-term neonate in the NICU has been diagnosed with congestive heart failure secondary to a cyanotic heart defect. Which of the following activities is most likely to result in a cyanotic episode? 1. Feeding. 2. Sleeping in the supine position. 3. Rocking in an infant swing. 4. Swaddling.

1. Feeding. babies who have cyanotic cardiac defects frequently feed poorly. and when they do feed, they frequently become cyanotic

A newborn in the NICU has just had a ventriculoperitoneal shunt inserted. Which of the following signs indicates that the shunt is functioning properly? 1. Decrease of the baby's head circumference. 2. Absence of cardiac arrhythmias. 3. Rise of the baby's blood pressure. 4. Appearance of setting sun sign.

1. Decrease of the baby's head circumference. ventriculoperitoneal (VP) shunts are inserted for the treatment of hydrocephalus. A positive finding therefore, would be decreasing head circumferences

The nurse assessed four newborns admitted to the neonatal nursery and called the neonatologist for a consult on the baby, who exhibited which of the following? 1. Excessive amounts of frothy saliva from the mouth. 2. Blood-tinged discharge from the vaginal canal. 3. Secretion of a milk-like substance from both breasts. 4. Heart rate that sped during inhalation and slowed with exhalation

1. Excessive amounts of frothy saliva from the mouth. excessive amounts of frothy saliva may indicate that the child has esophageal atresia

A full-term infant admitted to the newborn nursery has a blood glucose level of 35 mg/dL. Which of the following actions should the nurse perform at this time? 1. Feed the baby formula or breast milk. 2. Assess the baby's blood pressure. 3. Tightly swaddle the baby. 4. Monitor the baby's urinary output.

1. Feed the baby formula or breast milk. a baby with a blood glucose of 35 mg/dL (1.9 mmol/L) is hypoglycemic. the action of choice is to feed the baby either breast milk or formula

A client is visiting the NICU to see her baby for the first time. He was born the day before at 26 weeks gestation. Which of the following methods would the nurse expect the mother to use when first making physical contact with her baby? 1. Fingertip touch. 2. Palmar touch. 3. Kangaroo hold. 4. Cradle hold.

1. Fingertip touch. most mothers, even those of full-term babies, usually use fingertip touch during their first physical contact with their babies

Which of the following laboratory findings would the nurse expect to see in a baby diagnosed with erythroblastosis fetalis? 1. Hematocrit 24%. 2. Leukocyte count 45,000 cells/mm3. 3. Sodium 125 mEq/L. 4. Potassium 5.5 mEq/L.

1. Hematocrit 24%. the baby with erythroblastosis fetalis would exhibit signs of severe anemia, which is reflected by a hematocrit of 24%

A newborn in the nursery is exhibiting signs of neonatal abstinence syndrome. Which of the following signs/symptoms is the nurse observing? (Select all that apply) 1. Hyperphagia (excessive Hunger) 2. Lethargy. 3. Prolonged periods of sleep. 4. Hyporeflexia. 5. Persistent shrill cry

1. Hyperphagia (excessive Hunger) 5. Persistent shrill cry - babies with signs of neonatal abstinence syndrome repeatedly exhibit signs of hunger -babies with signs of neonatal abstinence syndrome often have a shrill cry that may continue for prolonged periods.

A baby was just born to a mother who had positive vaginal cultures for group B streptococcus (GBS). The mother was admitted to the labor room 2 hours before the birth. For which of the following should the nursery nurse closely observe this baby? 1. Hypothermia. 2. Mottling. 3. Omphalocele. 4. Stomatitis.

1. Hypothermia. hypothermia in a neonate may be indicative of sepsis

The nurse suspects that a newborn in the nursery has a clubbed right foot because the foot is plantar flexed as well as which of the following? 1. Inability to move the foot into alignment. 2. Positive Ortolani sign on the right. 3. Shortened right metatarsal arch. 4. Positive Babinski reflex on the right.

1. Inability to move the foot into alignment. during neonatal physical assessment, the nurse is unable to move a clubfoot into proper alignment

Four babies are in the newborn nursery. The nurse pages the neonatologist to see the baby who exhibits which of the following? 1. Intercostal retractions. 2. Erythema toxicum. 3. Pseudostrabismus. 4. Vernix caseosa.

1. Intercostal retractions. intercostal retractions are symptomatic of respiratory distress syndrome

A baby in the NICU, who is exhibiting signs of congestive heart failure from an atrioventricular canal defect, is receiving a diuretic. In the plan of care, the nurse should include that the desired outcome for the child will be which of the following? 1. Loss of body weight. 2. Drop in serum sodium level. 3. Rise in urine specific gravity. 4. Increase in blood pressure.

1. Loss of body weight. a diuretic will increase urinary output, which, in turn , will lead to weight loss

A nurse is inserting a gavage tube into a preterm baby who is unable to suck and swallow. Which of the following actions must the nurse take during the procedure? 1. Measure the distance from the tip of the ear to the nose. 2. Lubricate the tube with an oil-based solution. 3. Insert the tube quickly if the baby becomes cyanotic. 4. Inject a small amount of sterile water to check placement.

1. Measure the distance from the tip of the ear to the nose the gavage tubing must be measured to approximate the length of the insertion

The parents of a baby born with bilateral club foot ask the nurse what medical care the baby will likely need. Which of the following should the nurse tell the parents? The baby will: 1. Need a series of leg casts until the correction is accomplished. 2. Have a Harrington rod inserted when the child is about three years old. 3. Have a Pavlik harness fitted before discharge from the nursery. 4. Need to wear braces on both legs until the child begins to walk.

1. Need a series of leg casts until the correction is accomplished. the initial treatment plan for clubfoot (also called talipes equinovarus) usually includes a series of casts that slowly move the foot into proper alignment

The neonatologist assesses a newborn for Hirschsprung's disease after the baby exhibited which of the following signs/symptoms? 1. Passed meconium at 50 hours of age. 2. Apical heart rate of 200 beats per minute. 3. Maculopapular rash. 4. Asymmetrical leg folds.

1. Passed meconium at 50 hours of age. babies who have delayed meconium excretion may have hirshsprung's

The nurse is caring for a baby diagnosed with developmental dysplasia of the hip (DDH). Which of the following therapeutic interventions should the nurse expect to perform? 1. Place the baby's legs in abduction. 2. Administer pain medication as needed. 3. Assist with bilateral leg casting. 4. Monitor pedal pulses bilaterally.

1. Place the baby's legs in abduction. to treat developmental dysplasia of the hip (DDH), babies' legs are maintained in a state of abduction

a neonate at 37 weeks' gestation who had Apgars of 1 and 3, is admitted to the neonatal intensive care nursery. the neonatologist orders induced hypothermia to prevent which of the following complications of hypoxic-ischemic encephalopathy: (HIE)? select all that apply. 1. cerebral palsy 2. blindness 3. deafness 4. bipolar disease 5. reduced intellectual disability

1. cerebral palsy 2. blindness 3. deafness 5. reduced intellectual disability - induced hypothermia is administered to prevent neurodevelopmental complications such as cerebral palsy -induced hypothermia is administered to prevent or reduce blindness -induced hypothermia is administered to prevent or reduce deafness -induced hypothermia is administered to prevent limited intellectual disability

Four full-term babies were admitted to the neonatal nursery. The mothers of each of the babies had labors of 4 hours or less. The nursery nurse should carefully monitor which of the babies for hypothermia? 1. The baby whose mother cultured positive for group B strep during her third trimester. 2. The baby whose mother had gestational diabetes. 3. The baby whose mother was hospitalized for 3 months with complete placenta previa. 4. The baby whose mother previously had a stillbirth.

1. The baby whose mother cultured positive for group B strep during her third trimester. Group B streptococci cause severe infections in the newborn. neonates who are sepetic often develop signs of respiratory distress. tachypneas is one sign of respiratory distress.

a baby admitted to the nursey was diagnosed with galactomesimia. which of the following actions must the nurse take? 1. feed the baby a specialty formula 2. monitor the baby for central cyanosis 3. do hemoccult testing on every stool 4. monitor the baby for signs of abdominal pain

1. feed the baby a specialty formula galactosemia is one of the few diseases that is a contraindication for the intake of breast milk or any milk-based formula

A baby is in the NICU whose mother was addicted to heroin during the pregnancy. Which of the following nursing actions would be appropriate to perform? 1. Tightly swaddle the baby. 2. Place the baby prone in the crib. 3. Provide needed stimulation to the baby. 4. Feed the baby half-strength formula.

1. Tightly swaddle the baby. tightly swaddling drug-dependent babies often helps to control the hyperreflexia that they may exhibit

A baby was born 24 hours ago to a mother who received no prenatal care. The infant has tremors, sneezes excessively, constantly mouths for food, and has a shrill, highpitched cry. The baby's serum glucose levels are normal. For which of the following should the nurse request an order from the pediatrician? 1. Urine drug toxicology test. 2. Biophysical profile test. 3. Chest and abdominal ultrasound evaluations. 4. Oxygen saturation and blood gas assessments.

1. Urine drug toxicology test. the symptoms are characteristic of neonatal abstinence syndrome. a urine toxicology would provide evidence of drug exposure

On admission to the nursery, a baby's head and chest circumferences are 39 cm and 32 cm, respectively. which of the following actions should the nurse take next? 1. assess the anterior fontanel 2. measure the abdominal girth 3. check the apical pulse rate 4. monitor the respiratory effort

1. assess the anterior fontanel because the head circumference is significantly larger than the chest circumference, the nurse should assess for another sign of hydrocephalus. A markedly enlarged or bulging fontanel is one of those signs

a neonate is found to have choanal atresia. which of the following physiological actions will be hampered by this condition? 1. feeding 2. digestion 3. immune response 4. glomerular filtration

1. feeding choanal atresia will affect the baby's ability to feed

A baby at 30 weeks' gestation is admitted to the neonatal intensive care unit. the mother had been treated with a tocolytic intravenous magnesium sulfate for the preceding 10 days. for which of the following laboratory findings should the nurse assess the neonate? 1. hypocalcemia 2. hyperkalemia 3. hypochloremia 4. hypernatremia

1. hypocalcemia the neonate should be monitored for signs and symptoms of hypocalcemia

a baby born at 3,199 grams, now weighs 2,746 grams. the baby is being monitored for dehydration because of the following percent weight loss. calculate to the nearest hundredth. ________%

14.16%

A neonatologist requests Narcan (naloxone) during a neonatal resuscitation effort for a baby weighing 3 kg. The recommended dosage of naloxone for a neonate is 0.01 mg/kg to 0.1 mg/kg. Which of the following dosages would be within the range of safety for the nurse to prepare? 1. 4 micrograms. 2. 40 micrograms. 3. 4 milligrams. 4. 40 milligrams.

2. 40 micrograms. the 40-microgram dose is within the range of safety

The nurse assessed four newborns in the neonatal nursery. The nurse called the neonatologist for a cardiology consult on the baby, who exhibited which of the following signs/symptoms? 1. Setting sun sign. 2. Anasarca 3. Flaccid extremities. 4. Polydactyly

2. Anasarca anasarca refers to overall, systemic edema. it is seen in severe cardiovascular disease. a cardiac consult would be appropriate for this baby as would, perhaps, a renal consult

A baby is born with erythroblastosis fetalis. Which of the following signs/symptoms would the nurse expect to see? 1. Ruddy complexion. 2. Anasarca. 3. Alopecia. 4. Erythema toxicum

2. Anasarca. babies born with erythroblastosis fetalis are often in severe congestive heart failure and, therefore, exhibit extreme, generalized edema

The birth of a baby who weighed 9 lbs 9 oz (4,500 grams), was complicated by shoulder dystocia. Which of the following neonatal complications should the nursery nurse observe for? 1. Leg deformities. 2. Brachial palsy. 3. Fractured radius. 4. Buccal abrasions.

2. Brachial palsy. during a difficult delivery with shoulder dystocia, the brachial nerve can become stretched and may even be severed. the nurse should, therefore, observe the baby for signs of brachial palsy, such as limited movement of the affected arm.

four babies in the well-baby nursery were born with congenital defects. which of the babies' complications developed as a result of the delivery method? 1. clubfoot 2. brachial palsy 3. gastroschisis 4. hydrocele

2. brachial palsy brachial palsy can result from either a traumatic vertex or breech delivery

Which of the following actions would the NICU nurse expect to perform when caring for a neonate with esophageal atresia and tracheoesophageal fistula (TEF)? 1. Position the baby flat on the left side. 2. Maintain low nasogastric suction. 3. Give small, frequent feedings. 4. Place on hypothermia blanket.

2. Maintain low nasogastric suction. Low nasogastric suction is usually maintained to minimize the amount of the baby's oral secretions

A nurse in the newborn nursery suspects that a new admission, 42 weeks' gestation, was exposed to meconium in utero. What would lead the nurse to suspect this? 1. The baby is bradycardic. 2. The baby's umbilical cord is green. 3. The baby's anterior fontanel is sunken. 4. The baby is desquamating.

2. The baby's umbilical cord is green. because meconium is a dark-green color, the white tissue that makes up the umbilical cord- the Wharton's jelly-- can be stained green when meconium is expelled in utero

A baby in the newborn nursery was born to a mother with spontaneous rupture of membranes for 14 hours. The woman has Candida vaginitis. For which of the following should the baby be assessed? 1. Papular facial rash. 2. Thrush. 3. Fungal conjunctivitis. 4. Dehydration.

2. Thrush. thrush is commonly seen in babies whose mothers have candida vaginitis

Intravenous magnesium sulfate has been ordered for a client at 31 weeks' gestation in preterm labor. the client's vital signs are: TPR 98.6 F (37 C), 92, 22; BP 110/70. the nurse knows that, in addition to its tocolytic action, the rationale for its administration is to prevent which of the following neonatal complications? 1. hypoxemia 2. cerebral palsy 3. cold stress syndrome 4. necrotizing enterocolitis

2. cerebral palsy the goal of administering IV magnesium sulfate to the mother is to prevent cerebral palsy in the neonate

21. A newborn nursery nurse notes that a 36-hour-old baby's body is jaundiced. Which of the following nursing interventions will be most therapeutic? 1. Maintain a warm ambient environment. 2. Have the mother feed the baby frequently. 3. Have the mother hold the baby skin to skin. 4. Place the baby naked by a closed sunlit window.

2. have mother feed the baby frequently bilirubin is excreted through the bowel. the more the baby consumes, the more therapeutic since the more feces the baby excretes, the more bilirubin the baby will expel, and less of it will be re-absorbed.

19. A jaundice neonate must have a heel stick to assess bilirubin levels. Which of the following actions should the nurse make during the procedure? 1. Cover the foot with an iced wrap for one minute prior to the procedure. 2. Avoid puncturing the lateral heel to prevent damaging sensitive structures. 3. Blot the site with a dry gauze after rubbing it with an alcohol swab. 4. Firmly grasp the calf of the baby during the procedure to prevent injury.

3. Blot the site with a dry gauze after rubbing it with an alcohol swab. alcohol can irritate the punctured skin and can cause hemolysis, so it must dry first before puncturing the skin

A baby is born with a meningomyelocele at L2. In assessing the baby, which of the following would the nurse expect to see? 1. Sensory loss in all four extremities. 2. Tuft of hair over the lumbosacral region. 3. Flaccid paralysis of the legs. 4. Positive Moro reflex.

3. Flaccid paralysis of the legs. with a defect at L2, the nurse would expect to see paralysis of the legs

A neonate has asymmetrical intrauterine growth restriction secondary to placental insufficiency. Which of the following signs/symptoms should the nurse expect to observe at delivery? (Select all that apply) 1. Thrombocytopenia. 2. Neutropenia. 3. Polycythemia. 4. Hypoglycemia. 5. Hyperlipidemia

3. Polycythemia. 4. Hypoglycemia. -babies who have lied in utero with a dysfunctional placenta usually are born with polycythemia - babies who have lived in utero with a dysfunctional placenta will often demonstrate hypoglycemia after the birth

A baby has just been admitted into the neonatal intensive care unit with a diagnosis of intrauterine growth restriction (IUGR). Which of the following maternal factors would predispose the baby to this diagnosis? (Select all that apply) 1. Hyperopia. 2. Gestational diabetes. 3. Substance abuse. 4. Chronic hypertension. 5. Advanced maternal age.

3. Substance abuse. 4. Chronic hypertension. 5. Advanced maternal age. -placental function is affected by the vasoconstrictive properties of many illicit drugs as well as by cigarette smoke -placental function is diminished in women who have chronic hypertension -placental function has been found to be diminished in women of advanced maternal age

A child has been diagnosed with a small ventricular septal defect (VSD). Which of the following symptoms would the nurse expect to see? 1. Cyanosis and clubbing of the fingers. 2. Respiratory distress and extreme fatigue. 3. Systolic murmur with no other obvious symptoms. 4. Feeding difficulties with marked polycythemia.

3. Systolic murmur with no other obvious symptoms. the nurse can expect to hear a systolic murmur with no other obvious symptoms

Which of the following would lead the nurse to suspect cold stress syndrome in a newborn with a temperature of 96.5°F (38.5 C)? 1. Blood glucose of 50 mg/dL (2.8 mmol/L) 2. Acrocyanosis. 3. Tachypnea. 4. Oxygen saturation of 96%

3. Tachypnea. babies who have cold stress will develop respiratory distress. one symptom of the distress is tachypnea

7. A 1-day-old neonate, 32 weeks' gestation, is in an overhead warmer. The nurse assesses the morning axillary temperature as 96.9°F. Which of the following could explain this assessment finding? 1. This is a normal temperature for a preterm neonate. 2. Axillary temperatures are not valid for preterm babies. 3. The supply of brown adipose tissue is incomplete. 4. Conduction heat loss is pronounced in the baby.

3. The supply of brown adipose tissue is incomplete. preterm babies are born with an insufficient supply of brown adipose tissue that is needed for thermogenesis, or heat generation

A breastfeeding mother of a newborn states, I was good all during my pregnancy. I stopped drinking alcohol and I quit smoking marijuana during my pregnancy. now that I'm no longer pregnant, one of the first thins I'm going to do when I get home is have a joint. Which of the following responses is appropriate for the nurse to give? 1. I am proud of you for waiting to have those things. It must have been hard for you to abstain for so many months 2. you are making the nest choice since marijuana is safe while breastfeeding but alcohol is contraindicated 3. because the drug in marijuana does get into breast milk and can alter a baby's development, it is best not to use the drug while breastfeeding 4. both alcohol and marijuana are removed from the body within about two hours. It would be best to wait that long before breastfeeding after consuming either of them

3. because the drug in marijuana does get into breast milk and can alter a baby's development, it is best not to use the drug while breastfeeding this statement is appropriate. because the drug in marijuana does get into breast milk and can alter a baby's development, it is best not to use the drug while breastfeeding.

The nurse caring for a neonate with congestive heart failure identifies which of the following nursing diagnoses as highest priority? 1. Fatigue. 2. Activity intolerance. 3. Sleep pattern disturbance. 4. Altered tissue perfusion.

4. Altered tissue perfusion. altered tissue perfusion is the priority

A neonate is under phototherapy for elevated bilirubin levels. The baby's stools are now loose and green. Which of the following actions should the nurse take at this time? 1. Discontinue the phototherapy. 2. Notify the health care practitioner. 3. Take the baby's temperature. 4. Assess the baby's skin integrity.

4. Assess the baby's skin integrity. the stools can be very caustic to the baby's delicate skin. the nurse should cleanse the area well and inspect the skin for any sign that the skin is breaking down.

A baby is grunting in the neonatal nursery. Which of the following actions by the nurse is appropriate? 1. Place a pacifier in the baby's mouth. 2. Check the baby's diaper. 3. Have the mother feed the baby. 4. Assess the respiratory rate.

4. Assess the respiratory rate. grunting is often accompanied by tachypnea, another sign of respiratory distress

When examining a nenonate in the well-baby nursery, the nurse notes that the sclerae of the baby's eyes are visible above the iris of the eyes. Which of the following assessments is highest priority for the nurse to make next? 1. Babinski and tonic neck reflexes. 2. Evaluation of bilateral eye coordination. 3. Blood type and Coombs' test results. 4. Circumferences of the head and chest.

4. Circumferences of the head and chest. the baby should be assessed for signs of hydrocephalus, especially a disparity between the circumferences of the neonatal head and the neonatal chest.

The nurse is providing discharge teaching to the parents of a baby born with a cleft lip and palate. Which of the following should be included in the teaching? 1. Correct technique for the administration of a gastrostomy feeding. 2. Need to watch for the appearance of blood-stained mucus from the nose. 3. Optimal position for burping after nasogastric feedings. 4. Need to give the baby sufficient time to rest during each feeding.

4. Need to give the baby sufficient time to rest during each feeding. cleft lip and palate babies require additional time to rest as well as to such and swallow when being fed.

A macrosomic infant of a non-insulin dependent diabetic mother has been admitted to the neonatal nursery. The baby's glucose level on admission to the nursery is 25 mg/dL and after a feeding of mother's expressed breast milk is 35 mg/dL. Which of the following actions should the nurse take at this time? 1. Nothing, because the glucose level is normal for an infant of a diabetic mother. 2. Administer intravenous glucagon slowly over five minutes. 3. Feed the baby a bottle of dextrose and water and reassess the glucose level. 4. Notify the neonatologist of the abnormal glucose levels.

4. Notify the neonatologist of the abnormal glucose levels. if the glucose level has not risen to normal as a result of the feeding, the nurse should notify the physician and anticipate that the doctor will order an intravenous infusion of dextrose and water

A baby has been admitted to the neonatal intensive care unit with a diagnosis of postmaturity. The nurse expects to find which of the following during the initial newborn assessment? 1. Abundant lanugo. 2. Flat breast tissue. 3. Prominent clitoris. 4. Wrinkled skin.

4. Wrinkled skin. the post-term baby does have dry, wrinkled, and often peeling skin due to progressive placental deterioration and often reduced amounts of amniotic fluid

A nurse is caring for a baby born by vacuum extraction. the nurse should assess this baby for which of the following? 1. pedal abrasions 2. hypobilirubinemia 3. hyperglycemia 4. cephalohematoma

4. cephalohematoma babies born via vacuum are at high risk for cephalohematoma

a baby is born to a mother who was diagnosed with oligohydramnios during her pregnancy. the nurse notifies the neonatologist to order tests to assess the functioning of which of the following systems? 1. gastrointestinal 2. hepatic 3. endocrine 4. renal

4. renal some defects of the renal system can lead to oligohydraminos

a newborn is noted to have a chignon. the nurse concludes that the baby was born via which of the following methods? 1. cesarean section 2. high forceps delivery 3. low forceps delivery 4. vacuum extraction

4. vacuum extraction babies born via vacuum extraction often do develop chignons

A neonatologist prescribes Garamycin (gentamicin) for a 2-day-old, septic preterm infant who weighs 1,653 grams and is 38 centimeters long. The drug reference states: Neonatal dosage of Garamycin for babies less than 1 week of age is 2.5 mg/kg q 12-24 hours.Calculate the safe daily dosage of this medication. (Calculate to the nearest hundredth.)_____________ mg q 24 hours.

4.13

The nurse caring for an infant with a congenital cardiac defect is monitoring the child for which of the following early signs of congestive heart failure? (Select all that apply) 1. Palpitations. 2. Tachypnea. 3. Tachycardia. 4. Diaphoresis. 5. Irritability

2. Tachypnea. 3. Tachycardia. 4. Diaphoresis. -no matter whether a baby or an adult were developing CHF, the client would be tadchypneic -no matter whether a baby or an adult were developing CHF, the client would be tachycardic -no matter whether a baby or an adult were developing CHF, teh client would be diaphoretic

A nurse is assisting a mother to feed a baby born with cleft lip and palate. Which of the following should the nurse teach the mother? 1. The baby is likely to cry from pain during the feeding. 2. The baby is likely to expel milk through the nose. 3. The baby will feed more quickly than other babies. 4. The baby will need to be fed high calorie formula.

2. The baby is likely to expel milk through the nose. it is likely that milk will be expelled from the baby's nose during feedings

36. A Roman Catholic couple has just delivered a baby with an Apgar score of 1 at 1 minute, 2 at 5 minutes, and 2 at 10 minutes. Which of the following interventions is appropriate at this time? 1. Advise the parents that they should pray very hard so that everything turns out well. 2. Ask the parents whether they would like the nurse to baptize the baby. 3. Leave the parents alone to work through their thoughts and feelings. 4. Inform the parents that a priest will listen to their confessions whenever they are ready.

2. Ask the parents whether they would like the nurse to baptize the baby. this baby's apgar score is very low. there is a chance that the baby will not survive. because the parents are known to be roman catholic, it is appropriate to ask them if they would like their baby baptized.

A nurse makes the following observations when admitting a full-term, breastfeeding baby into the neonatal nursery: 9 lb 2 oz, 21 inches long, TPR: 96.6°F, 158, 62, jittery, pink body with bluish hands and feet, crying. Which of the following actions is of highest probability? 1. Swaddle the baby to provide warmth. 2. Assess the glucose level of the baby. 3. Take the baby to the mother for feeding. 4. Administer the neonatal medications.

2. Assess the glucose level of the baby. the glucose level should be assessed to determine whether or not this baby's jitteriness is because of hypoglycemia. the glucose can be evaluated while the baby is on the mother's chest or under the warmer

A 2 lb 2 oz (1,000-gram) neonate is being admitted to the neonatal intensive care unit. A surfactant Survanta (beractant) has just been prescribed to prevent respiratory distress syndrome. Which of the following actions should the nurse take while administering this medication? 1. Flush the intravenous line with normal saline solution. 2. Assist the neonatologist during the intubation procedure. 3. Inject the medication deep into the vastus lateralis muscle. 4. Administer the reconstituted liquid via an oral syringe.

2. Assist the neonatologist during the intubation procedure. surfactant is administered intratracheally, the baby must first be intubated. the nurse would assist the neonatal care provider with the procedure

A client whose baby was born at 32 weeks gestation is expressing breast milk (EBM) for the baby. The neonatologist is recommending that fortifier be added to the milk because which of the following needs of the baby are not met by the EBM? 1. Need for iron and zinc. 2. Need for calcium and phosphorus. 3. Need for protein and fat. 4. Need for sodium and potassium.

2. Need for calcium and phosphorus. calcium and phosphorus in EBM are in quantities that are less than body requirements for the very low birth weight baby. therefore, a fortifier may need to be added to the EBM

A nurse is preparing a 6-month-old child with a medical history of newborn kernicterus for a medical exam. Which of the following tests can the nurse anticipate will be done to determine whether or not this child has developed any sequelae to the illness? 1. Blood urea nitrogen and serum creatinine. 2. Alkaline phosphatase and bilirubin. 3. Hearing testing and vision assessment. 4. Peak expiratory flow and blood gas assessments.

3. Hearing testing and vision assessment. because the central nervous system (CNS) may have been damaged by the high bilirubin levels, testing of the senses as well as motor and cognitive assessments are appropriate

The nurse is developing a teaching plan for parents of an infant with a tetralogy of Fallot. In which of the following positions should parents be taught to place the infant during a "blue," or "tet," spell? 1. Supine. 2. Prone. 3. Knee-chest. 4. Semi-Fowler's.

3. Knee-chest. parents should place an infant during "tet" spell into the knee-chest position

A mother of a preterm baby is performing kangaroo care in the neonatal nursery. Which of the following responses would the nurse evaluate as a positive neonatal outcome? 1. Respiratory rate of 70. 2. Temperature of 97.0°F. 3. Licking of mother's nipples. 4. Flaring of the baby's nares.

3. Licking of mother's nipples. the baby is showing signs of interest in breastfeeding. this is a positive sign

There is a baby in the neonatal intensive care unit (NICU) who is exhibiting signs of neonatal abstinence syndrome. Which of the following medications is contraindicated for this neonate?1. Morphine. 2. Opium. 3. Narcan. 4. Phenobarbital.

3. Narcan. narcan is an opiate-antagonist. if it were to be given to the neonate with neonatal abstinence syndrome, the baby would go into a traumatic withdrawal

A woman who has recently received fentanyl, 50 mcg IV, for labor pain is about to deliver. which of the following medications is highest priority for the nurse to prepare in case it must be administered to the baby following delivery? 1. oxytocin 2. xylocaine 3. naloxone 4. butorphanol

3. naloxone naloxone is an opiate antagonist. it may be administered to a depressed baby at delivery

The nurse is teaching a couple about the special health care needs of their newborn child with Down syndrome (trisomy 21). The nurse knows that the teaching was successful when the parents state that the child will need which of the following? 1. Yearly three-hour glucose tolerance testing. 2. Immediate intervention during bleeding episodes. 3. A formula that is low in lactose and phenylalanine. 4. Prompt treatment of upper respiratory infections.

4. Prompt treatment of upper respiratory infections. because of hypotonia of the respiratory accessory muscles, babies with Down's syndrome (trisomy 21) often need medical intervention when they have respiratory infections

A neonatologist prescribes Platinol-AQ (cisplatin) for a neonate born with a neuro blastoma. The baby's current weight is 3,476 grams and the baby is 57 centimeters long. The drug reference states: Children: IV 30 mg/m2 q week.Calculate the safe dosage of this medication. (Calculate to the nearest tenth.)____________ mg q week.

6.9 mg

a baby is born with a diaphragmatic hernia. which of the following signs/symptoms would the nurse observe in the delivery room? 1. projectile vomiting 2. high-pitched crying 3. respiratory 4. fecal incontinence

3. respiratory the baby will develop respiratory distress very shortly after delivery

A preterm baby is to receive 4 mg Garamycin (gentamicin) IV every 24 hours. The medication is being injected into an IV soluset. A total of 5 mL is to be administered via IV pump over 90 minutes.The pump should be set at what rate? (Calculate to the nearest hundredth.)_____________ mL/hr.

3.33 mL/hr

a macrosomic baby in the nursery is suspected of having a fractured clavicle from a traumatic delivery. which of the following signs/symptoms would the nurse expect to see> select all that apply 1. pain with movement 2. hard lump at the fracture site 3. malpositioning of the arm 4. asymmetrical moro reflex 5. marked localized ecchymosis

1. paina with movement 2. hard lump at the fracture site 3. malpositioning of the arm 4. asymmetrical moro reflex -the baby will demonstrate pain when the site is touched -if not in the immediate period after the injury, within a few days there may be a palpable lump on the bone at the site of the break -because of the break, the baby is likely to position the arm in an atypical posture -because of the injury to the bone, the baby is unable to respond with symmetrical arm movements

monochorionic twins whose gestation was complicated by twin-to-twin transfusion are admitted to the neonatal intensive care unit. which of the following characteristic findings would the nurse expect to see in the smaller twin? 1. pallor 2. jaundice 3. opisthotonus 4. hydrocephalus

1. pallor in twin-to-twin transfusion, the smaller twin has "donated" part of his or her blood supply to the larger twin. as a result, the smaller twin may show pallor

a baby who is receiving phototherapy for hyperbilirubinemia must have a venipuncture to obtain a blood specimen. which of the following nursing care actions should the nurse perform at this time? 1. provide the baby with a sucrose-covered pacifier to suck on 2. advise the baby's mother to leave the room while the procedure is being performed 3. administer oxygen to the baby via face mask throughout the procedure 4. remove the eye patches while the procedure is being performed

1. provide the baby with a sucrose-covered pacifier to suck on the nurse should provide the baby with sucrose-covered pacifier, frequently called "sucrose soothies," to suck on

A nurse is preparing a care plan for a 5-day-old newborn under phototherapy. which of the following client outcomes should be included in the nursing plan? during the next 24 hour period, the baby will: 1. have at least 6 wet diapers 2. Breastfeeds 2 to 4 times. 3.lose less than 12% of the baby's birth weight 4. have an apical heart rate of 160 to 170 bpm

1. have at least 6 wet diapers healthy, hydrated neonates saturate their diapers a minimum of 6 times in 24 hours

an infant in the neonatal intensive care unit has had a peripherally inserted central catheter (PICC) inserted. the nurse caring for the baby carefully monitors the neonate for which of the following complications related tot he procedure? select all that apply 1. infection 2. tip migration 3. myocardial perforation 4. paralysis of the diaphragm 5. neurological complications related to scalp vein insertions

1. infection 2. tip migration 3. myocardial perforation 4. paralysis of the diaphragm -catheter-related bloodstream infection is the most common complication associated with PICCs -tip migration is a common complication. the catheter, either spontaneously or as a result of external manipulation, can move in the body either farther inward or outward -myocardial perforation can occur at any time. it most commonly occurs 3 days after the PICC was inserted - although relatively rare, paralysis of the diaphragm can occur when the PICC is inserted into the subclavian vein.

a full-term, 36-hour-old neonate's bilirubin level is 13 mg/dL (222.3 umol/L) which of the following signs and symptoms would the nurse expect to see? select all that apply 1. lethargy 2. jaundice 3. polyphagia 4. diarrhea 5. excessive yawning

1. lethargy 2. jaundice -babies who have hyperbilirubinemia are usually very lethargic -babies who have hyperbilirubinemia are jaundiced

A baby born addicted to cocaine is being given oral morphine therapeutically. The nurse knows that which of the following are the main reasons for its use in newborns? select all that apply 1. oral morphine contains no alcohol 2. oral morphine is nonsedating 3. oral morphine improves respiratory effort 4. oral morphine helps to control seizures

1. oral morphine contains no alcohol 4. oral morphine helps to control seizures -this statement is correct. while older medications, for example, paregoric, were effective, they contained alcohol, oral morphine does not -oral morphine helps to control seizures

A client is delivering her baby at 42 weeks' gestation. A nurse and pediatrician are present at the birth. the amniotic fluid is green and thick. The baby fails to breathe spontaneously. Which of the following actions should the nurse take next? 1. stimulate the baby to breathe 2. assess neonatal heart rate 3. prepare to assist with intubation 4. place the baby in the prone position 5. place the baby under the overhead warmer.

1. stimulate the baby to breathe 2. assess neonatal heart rate 3. prepare to assist with intubation 5. place the baby under the overhead warmer. -even though meconium is present in the amniotic fluid, the baby should be stimulated to breathe -the baby's heart rate is a critical piece of information. if the heart rate is below 100 bpm, positive pressure ventilation and pulse oximetry should be initiated. in addition, direct ECG assessment may be appropriate -although not universally recommended, the physician may determine that intubation is needed to remove meconium-contaminated fluid from the baby's airway and/or to provide direct ventilation. it is always best to be prepared, whether or not the intervention is done -hypothermic neonates are at high risk of morbidity and mortality. when in need of resuscitation, they should be kept warm under an overhead heat source.

a baby is born with esophageal atresia and tracheoesophageal fistula. which of the following complications of pregnancy would the nurse expect to note in the mother's history? 1. pre-eclampsia 2. idiopathic thrombocytopenia 3. polyhydramnios 4. severe iron deficiency anemia

3. polyhydramnios polyhydramnios, also called hydramnios, is often seen in pregnancies complicated by a fetus with a digestive blockage.

A baby has been admitted to the neonatal nursery whose mother is hepatitis B-surface antigen positive. Which of the following actions by the nurse should be taken at this time? 1. Monitor the baby for signs of hepatitis B. 2. Place the baby on contact isolation. 3. Obtain an order for the hepatitis B vaccine and the immune globulin. 4. Advise the mother that breastfeeding is absolutely contraindicated.

3. Obtain an order for the hepatitis B vaccine and the immune globulin. babies exposed to hepatitis B in utero should receive the first dose of hepatitis B vaccine as well as hepatitis B immune globulin (HBIG) within 12 hours of delivery to reduce transmission of the virus

A baby at 42 weeks' gestation has been admitted to the neonatal intensive care unit. At delivery, thick green amniotic fluid was noted. Which of the following actions by the nurse is critical at this time? 1. Bath to remove meconium-contaminated fluid from the skin. 2. Ophthalmic assessment to check for conjunctival irritation. 3. Rectal temperature to assess for septic hyperthermia. 4. Respiratory evaluation to monitor for respiratory distress.

4. Respiratory evaluation to monitor for respiratory distress. meconium aspiration syndrome (MAS) is a rare but serious complication seen in post-term neonates who are exposed to meconium-stained fluid. respiratory distress would indicate that the baby has likely developed MAS

The staff on the maternity unit is developing a protocol for nurses to follow after a baby is delivered who fails to breathe spontaneously. Which of the following should be included in the protocol as the first action for the nurse to take? 1. Prepare epinephrine for administration. 2. Provide positive pressure oxygen. 3. Administer chest compressions. 4. Rub the back and feet of the baby

4. Rub the back and feet of the baby the first interventions when a neonate fails to breathe include providing tactile stimulation