Maternity/OB: Newborn Adaptive quiz

Which clinical findings are associated with necrotizing enterocolitis? Select all that apply. 1. Abdominal distention 2. Jaundice 3. Decreased urine output 4. Diarrhea 5. Bilious vomitus 6. Bloody stools

1, 4, 5, 6 -Abdominal distention -Diarrhea -Bilious vomitus -Bloody stools P. 315

Which factors interfere with ventilation during neonatal oxygenation? Select all that apply. 1. Tremors 2. Edema 3. Atelectasis 4. Sternal retractions 5. Thickened lung membranes

2, 3, 5 -Edema -Atelectasis -Thickened lung membranes **Tremors and convulsions are signs of hypoglycemia. **Sternal retractions and nasal flaring are signs of respiratory distress syndrome. P. 312

Which treatment strategy would the nurse expect to be beneficial for a newborn experiencing neonatal abstinence syndrome, including symptoms of tremors and irritability? Select all that apply. 1. Performing amnioinfusion in the mother. 2. Swaddling the infant in a calm and quiet environment. 3. Reducing the amount of external stimuli to the infant. 4. Administering acetazolamide (Diamox) to the infant. 5. Administering methadone (Methadose) to the breast-feeding mother.

2, 3, 5 -Swaddling the infant in a calm and quiet environment. -Reducing the amount of external stimuli to the patient. -Administering methadone (Methadose) to the breast-feeding mother. P. 350

Which diagnosis is confirmed by a positive Barlow maneuver? 1. Clubfoot 2. Cleft palate 3. Developmental hip dysplasia 4. Spina bifida

Developmental hip dysplasia. --This screens for developmental hip dysplasia, a positive test confirms the diagnosis. P. 338

A preterm infant has a distended abdomen, immature respiratory center, and a weak gag reflex. Which treatment strategy would be beneficial for the infant? 1. Intravenous antimicrobials 2. Intravenous calcium gluconate 3. Nasal bevacizumab (Avastin) 4. Nasal warm, humidified oxygen

Nasal warm, humidified oxygen (to prevent respiratory distress and promote oxygenation). --These symptoms are indicative of impaired respiratory function. --Warm and humidified oxygen prevents mucous membranes from drying out and prevents hypoxia in the infant. P. 310

Which condition is the nurse concerned about in a preterm infant with a desaturated hemoglobin blood level of 3 g/dL. Select all that apply. 1. Anemia 2. Hypoxia 3. Cyanosis 4. Kernicterus 5. Hyperthermia

1 & 2 -Anemia -Hypoxia --The lab report for the preterm infant indicates the infant has less than 5 g/dL of desaturated hemoglobin levels. P. 312

Which complications would the nurse anticipate in a neonate whose body has little downy hair and whose skin is dry, pale, and covered with very little vernix caseosa? Select all that apply. 1. Hypoxia 2. Polycythemia 3. Hypoglycemia 4. Hypocalcemia 5. Hyponatremia

1, 2, 3 -Hypoxia (due to reduced blood supply). -Polycythemia (due to increased production of RBC to supply adequate amounts of oxygen). -Hypoglycemia (due to the fetus not receiving adequate amount of nutrients due to reduced blood supply and the use of glycogen reserves). --All signs of postterm neonates, they are at risk for post-mature syndrome. P. 309

Which clinical findings in an infant are associated with hyperbilirubinemia? Select all that apply. 1. Lethargy 2. Irritability 3. Poor feeding 4. Hyperglycemia 5. Hyperthermia

1, 2, 3 -Lethargy -Irritability -Poor feeding --As well as nausea and vomiting. P. 346

Which physical characteristics would be observed in an infant with respiratory distress syndrome? Select all that apply. 1. Respiratory rate above 60 breaths/min. 2. Grunting and sternal retractions. 3. Edema 4. Meconium-stained sputum. 5. Runny nose.

1, 2, 3 -Respiratory rate above 60 breaths/min. -Grunting and sternal retractions. -Edema --Also include: Tachypnea, nasal flaring, and cyanosis. --Later signs include: Edema and apnea. P. 312

Which findings are associated with hypoglycemia in a preterm infant? Select all that apply. 1. Tremors 2. Convulsions 3. Lethargy 4. Bradycardia 5. Mottling of skin

1, 2, 3 -Tremors -Convulsions -Lethargy --Also a weak cry. **Bradycardia and mottling of the skin are observed in preterm infants with cold stress. P. 315

Which signs are associated with neonatal abstinence syndrome? Select all that apply. 1. Yawning 2. Sneezing 3. Hyperthermia 4. Hyperirritability 5. Muscle weakness

1, 2, 4 -Yawning -Sneezing -Hyperirritability --These symptoms are caused by impaired functioning of the CNS. P. 350

Transferring a child with spina bifida to a rehabilitation center following surgery accomplishes which goal? Select all that apply. 1. Minimizes the child's disability. 2. Maximizes the use of healthy body parts. 3. Reduces the risk for infection. 4. Reduces interactions with others 5. Improves the child's self-esteem.

1, 2, 5 -Minimizes the child's disability. -Maximizes the use of healthy body parts. -Improves the child's self-esteem. P. 333

Which findings in a 2-day-old preterm infant would the nurse report immediately to the health care provider? Select all that apply. 1. Sternal retractions 2. Heart rate of 120 beats/min 3. Temperature of 37* C 4. Plasma glucose level lower than 30 mg/dL 5. Respiratory rate of 60 breaths/min with nasal flaring

1, 4, 5 -Sternal retractions -Plasma glucose level lower than 30 mg/dL -Respiratory rate of 60 breaths/min with nasal flaring --Sternal retraction: An inward movement of the sternum during inspiration, which indicates the infant has respiratory distress. --Plasma glucose levels of 30 mg/dL indicates hypoglycemia. --Respiratory rate of 60 breaths/min with nasal flaring indicates the infant has tachypnea. P. 312, 314

Which signs of galactosemia manifest early in the development of the disorder? Select all that apply. 1. Edema 2. Vomiting 3. Diarrhea 4. Hypotonia 5. Poor feeding

2, 3, 4 -Vomiting (Due to not being able to digest lactose). -Diarrhea (Due to not being able to digest lactose). -Hypotonia (Due to reduction in calcium levels). --Galactosemia: A genetic disorder where the body is unable to break down and use carbs such as galactose and lactose. P. 342

Which physical characteristics are commonly observed in preterm infants? Select all that apply. 1. Firm skin 2. Prominent genitalia 3. Protruding abdomen 4. Abundant vernix caseosa 5. Presence of superficial veins

3, 4, 5 -Protruding abdomen (due to muscles and bones that are not well developed). -Abundant vernix caseosa (A thick cheese-like covering that protects the infant from the intrauterine environment). -Presence of superficial veins (Due to transparent and loose skin, it is most visible beneath the infant's abdomen and scalp). P. 309

The nurse is collecting data on a neonate using the New Ballard Score. After performing maturational assessment, the nurse documents the total neuromuscular maturity score as 20 and the total physical maturity score as 25. What is the gestational age of the neonate? Record your answer as a whole number with no punctuation. _________ weeks

42. --In this system the nurse checks neuromuscular development and physical maturity and gives a score for each. --> The two scores are added to find the total maturity score and the gestational age of the newborn. P. 309-310

How many weeks' gestation would the nurse estimate after observing long, meconium stained nails in a newborn? 1. 30 2. 42 3. 36 4. 38

42. --Characteristics of a postterm infant due to them passing meconium in the uterus itself. P. 322

A 4-month-old infant has just undergone a cheiloplasty. Which order would the nurse need to clarify with the health care provider? 1. Providing IV pain relief as ordered 2. Arranging for parents to hold the infant 3. Using elbow restraints 4. Allowing the infant to breast-feed as tolerated.

Allowing the infant to breast-feed as tolerated. --The infant will be fed by dropper for 1 to 2 weeks to decrease suction on the incision. P. 335

A child with hydrocephalus has increased blood pressure, decreased pulse rate, and decreased respirations. Which condition would the nurse further assess for? 1. Respiratory infection 2. Improper positioning 3. Emotional stress 4. Increased intracranial pressure

Increase intracranial pressure. P. 331

Which condition is a 4-day-old preterm infant with hypoxia at risk for developing? 1. Enterocolitis 2. Hypoglycemia 3. Late hypocalcemia 4. Early hypocalcemia

Early hypocalcemia. --This is caused by impaired parathyroid function, increased calcitonin levels, and altered serum levels of magnesium and phosphorus. **Enterocolitis: An acute inflammation of the bowel that leads to bowel necrosis. **Hypoglycemia: A result of decreased plasma glucose levels. **Late hypocalcemia: Occurs in infants who feed on cow's milk because it increases serum phosphate levels, decreasing calcium levels. P. 314

A newborn is found to have eczema, decreased skin elasticity, and seizures activity. The nurse observes that the infant has signs of intellectual disability. Which diagnostic test would the nurse expect to be ordered for the infant? 1. Quad test. 2. Coombs' test 3. Barlow's test 4. Guthrie test

Guthrie test. --PKU is a metabolic genetic disorder caused by the impaired metabolism of the amino acid phenylalanine. --The Guthrie test measures the amount of phenylalanine present in the blood and helps identify whether the infant has PKU. **Quad's test: Measures the levels of alpha-fetoprotein and helps identify chromosomal abnormalities such as Down syndrome. **Coombs' test: Helps detect Rh sensitization in the fetus & also helps determine whether the infant is at risk for erythroblastosis fetalis. **Barlow's test: Helps detect the presence of hip dysplasia in the infant by bringing the thighs of the infant towards the midline and applies a light pressure on the knees. P. 341

Which condition in an infant is associated with assessment findings of Ortolani's sign and a positive Barlow's test? 1. Clubfoot 2. Hip dysplasia 3. Spina bifida cystica 4. Spina bifida occulta

Hip dysplasia. --Help diagnose hip dysplasia. --Barlow's test: Infant's feet are abducted and extended to feel the dislocation. --Ortolan's sign: Associated with a characteristic clicking sound when the femoral head moves back into acetabulum. --If an infant has flexed knees and hips along with positive Barlow's test and Ortolani's sign, then these findings indicate that the infant has hip dysplasia. P. 338

A 6-day-old preterm infant is lethargic with a weak cry and experiencing convulsions and tremors. The nurse also finds that the infant is crying weakly. Which complication of preterm birth would the nurse be concerned about? 1. Enterocolitis 2. Hypoglycemia 3. Hypocalcemia 4. Respiratory distress syndrome

Hypoglycemia. --Plasma glucose levels less than 30 mg/dL in preterm infants is defined as hypoglycemia and manifests as lethargy, convulsions, tremors, and a weak cry. P. 314

Which condition is the nurse concerned about when the mother with a multigestational pregnancy has a malformed placenta seen on ultrasound? 1. Postterm birth 2. Discordant twins 3. Hyperglycemia in the infant 4. Hypercalcemia in the infant

Discordant twins. --These twins would have variations in their size and weight. **A patient with multifetal gestation has an overdistended uterus, resulting in preterm delivery. **Infants develop hypoglycemia due to a decreased supply of nutrients and glucose through the placenta. **Infants develop hypocalcemia due to a deficient supply of nutrients through the placenta. P. 309

Which condition is associated with findings in the newborn including a thin body and enlarged head, a shrill cry, poor muscle tone, vomiting, and anorexia? 1. Hypospadias 2. Cystic fibrosis 3. Hydrocephalus 4. Hyelodysplasia

Hydrocephalus. --A congenital malformation that occurs as a result of the accumulation of cerebrospinal fluid (CSF) in the ventricles of the brain (resulting in an enlarged head). --This is associated with impaired functioning of the nervous system, resulting in poor muscle tone, shrill cry, vomiting, and anorexia in the infant. P. 329

An infant who is fed cow's milk has an increased serum phosphate level. Which condition may develop in the infant that would concern the nurse? 1. Hypocalcemia 2. Hypoglycemia 3. Hypomagnesaemia 4. Hyponatremia

Hypocalcemia. --Cow's milk increases the serum potassium levels, which increases the excretion of calcium. P. 314

Which nursing intervention promotes circadian rhythms in a preterm infant placed in an incubator? 1. Lowering the door of the incubator. 2. Opening the head and foot of the incubator. 3. Adjusting the levers under the mattress. 4. Placing the blanket on the top of the incubator.

Placing the blanket on the top of the incubator. --This acts as a barrier and protects the infant from environmental light. P. 317

Which complication would the nurse assess for in a neonate whose mother had a prolonged labor and fetal circulation was interrupted by cord compression? 1. Klinefelter's syndrome 2. Dandy-Walker syndrome 3. Neonatal abstinence syndrome 4. Meconium aspiration syndrome

Meconium aspiration syndrome. --Prolonged labor and compression of the umbilical cord the fetus will likely pass meconium in the uterus. --Cord compression may lead to decreased blood supply to the fetus resulting in gasping movements due to asphyxia and aspiration of meconium stained amniotic fluid in the lungs. **Klinefelter's syndrome: A chromosomal abnormality. **Dandy-Walker syndrome: Congenital malformation of the brain. **Neonatal abstinence syndrome: When a patient consumes opiates, amphetamines, and tranquilizers during pregnancy. P. 350

Which complication would the nurse monitor for in an infant who has had calcium lactate powder added to the formula but this practice has been discontinued by the health care provider? 1. Hypoglycemia 2. Neonatal tetany 3. Neonatal hypoxia 4. Hypothyroidism

Neonatal tetany. --Calcium lactate to formula helps alleviate the symptoms of hypocalcemia, and promotes growth and development in the infant. --Discontinuing calcium lactate may decrease the calcium levels and cause tetany in the infant. P. 315

A preterm infant has early onset jaundice. Which instruction would the nurse provide to the newborn's mother? 1. "Breast-feed the infant frequently." 2. "Give glucose water to the infant." 3. "Feed formula to the infant." 4. "Place the infant's bed near the window."

"Breast-feed the infant frequently." --Preterm infants may not be able to suckle and latch onto the nipples, which makes feeding ineffective and may reduce the infant's immunity, or even lead to jaundice. --> The nurse may suggest that the mother breast-feed the infant frequently. P. 316

A preterm newborn with respiratory distress is placed in the prone position during care. The newborn stabilizes and the nurse to gradually changes the newborn's sleeping position from prone to supine. Which outcome is being addressed with this change in positioning? 1. Prevention of regurgitation in the newborn. 2. Promotion of body flexion of the newborn. 3. Promotion of thermoregulation. 4. Prevention of sudden infant death syndrome.

Prevention of sudden infant death syndrome. --Placing a newborn in the prone position improves oxygenation and prevents breathlessness. --> This may exert pressure on the abdomen and increase the risk of sudden infant death syndrome (SIDS). -->So the nurse will position the sleeping newborn to the supine position. **Side-lying position prevents regurgitation and aspiration. **Providing an enclosed sleeping area or nesting prevents heat loss, provides warmth to the newborn & promotes flexion. P. 320

A female newborn has sticky, friable transparent skin with sparse lanugo. The newborn also has imperceptible breasts, a prominent clitoris, and flat labia. The newborn's eyelids are open, and the pinna is flat and stays folded. The plantar surface is found to be 55 mm without any crease. What is the total physical maturity score of the newborn? Record your answer to the nearest whole number. ____________.

-3. --The true physical maturity score is calculated by adding the score for skin texture, thickness of plantar surface, appearance of lanugo, breast, eye/ears, and genitals. --Sticky, irritable, transparent skin = -1 --Presence of sparse lanugo = 0 --Plantar surface is 55 mm without any crease = 0 --Imperceptible breasts = -1 --Eye and eyelids are open & pinna is flat and stays folded = 0 --Prominent clitoris and flat labia = -1 -1+0+0+ (-1) + 0+ (-1) = -3 P. 310

An infant who has undergone surgery for hydrocephalus has increased intracranial pressure and bulging fontanelles. Which intervention would the nurse provide? Select all that apply. 1. Placing the infant in the semi-Fowler's position. 2. Placing an internal flushing device in the shunt. 3. Administering intravenous fluids to the infant. 4. Changing the sleeping position every 5 hours. 5. Applying oil-based antimicrobial ointment on the sutures.

1 & 2 -Placing the infant in the semi-Fowler's position (to help promote the drainage of the CSF from the ventricles of the brain). -Placing an internal flushing device in the shunt (to help ensure patency of the shunt tube and enhances the elimination of CSF). --Hydrocephalus is caused by the accumulation of cerebrospinal fluid (CSF) in the brain. P. 331

A 3-day-old postterm infant has hypoxia and signs of cold stress. Which nursing interventions help prevent the infant from developing other complications resulting from hypoxia and cold stress? Select all that apply. 1. Placing the infant in an incubator 2. Feeding the infant glucose water 3. Providing supplemental oxygen to the infant 4. Administering intravenous infusion of lipids 5. Placing the infant in the supine position

1 & 3 -Placing the infant in an incubator (provides warmth and maintains the infant's body temperature). -Providing supplemental oxygen to the infant (helps prevent hypoxia and its resulting complications). --Cold stress occurs because the brown fat required for insulation is used up in utero for nourishment. P. 314

Which intervention by the nurse would be beneficial for an infant with Down syndrome? Select all that apply. 1. Feeding a high-fiber diet to the infant. 2. Providing bulb suction before feeding. 3. Wrapping the infant in a warm blanket 4. Placing the infant in the supine position 5. Providing large quantities of fluids to the infant

1, 2, 3 -Feeding a high-fiber diet to the infant -Providing bulb suction before feeding -Wrapping the infant in a warm blanket --Down syndrome is a chromosomal abnormality caused by trisomy 21. --Infant with Down syndrome has impaired physical and mental growth and hypotonicity of muscles, which may cause constipation. P. 343-344

The nurse caring for a preterm infant observes periods of apnea and measures the heart rate at 90 beats/minute. Rubbing the newborn's feet, ankles, and back has not improved the infant's status. Which interventions would the nurse add to the plan of care? Select all that apply. 1. Suctioning the newborn's nose and mouth. 2. Raising the newborn's head to the semi-Fowler position. 3. Connecting an Ambu bag to the newborn's mask. 4. Administering bevacizumab (Avastatin) to the newborn. 5. Administering intravenous calcium gluconate to the newborn.

1, 2, 3 -Suctioning the newborn's nose and mouth. -Raising the newborn's head to the semi-Fowler position. -Connecting an Ambu bag to the newborn's mask. --The nurse would provide resuscitation to the newborn. P.

Which nursing interventions are beneficial to the infant who has undergone cheiloplasty? Select all that apply. 1. Cleansing the suture line gently. 2. Applying elbow restraints to the infant. 3. Positioning the infant over the abdomen. 4. Preventing the infant from crying and sucking. 5. Placing the infant in the supine position after feeding.

1, 2, 4 -Cleansing the suture line gently (helps prevent the formation of crust, thereby preventing infection and scarring the surgical site). -Applying elbow restraints to the infant (helps prevent injury at the site of the surgery). -Preventing the infant from crying and sucking (may cause tension on the suture line). P. 335

A preterm infant has an increased respiratory rate and improper gag and cough reflexes. Which intervention should the nurse provide to ensure safety of the newborn? Select all that apply. 1. Keep the infant on mechanical ventilation 2. Administer warm and humid oxygen. 3. Place the infant in the supine position. 4. Administer betamethasone (Celestone). 5. Continuously monitor oxygen saturation.

1, 2, 5 -Keep the infant on mechanical ventilation (help increase the oxygen supply). -Administer warm and humid oxygen (avoid the drying of mucous membranes). -Continuously monitor oxygen saturation. --This indicates the patient has inadequate respiratory function. **Betamethasone (Celestone): A corticosteroid that helps reduce respiratory distress in the infant, it is administered to the mother 2 days before the delivery. P. 310-311

The nurse is caring for an infant with hydrocephalus who has an enlarged head, bulging fontanelles, and a shiny scalp. Which nursing interventions help provide safe and effective care to the infant? Select all that apply. 1. Changing the position of the infant frequently. 2. Keeping the creases of the neck moist. 3. Placing the infant in a side-lying position after feeding. 4. Placing a pad of lamb's wool under the infant's head. 5. Placing the infant in the prone position with a pad between the legs.

1, 3, 4 -Changing the position of the infant frequently (due to risk of hydrostatic hypostatic pneumonia and pressure sores). -Placing the infant in a side-lying position after feeding (to avoid the patient from regurgitating food substances). -Placing a pad of lamb's wool under the infant's head (to help decrease intracranial pressure). --Hydrocephalus: An accumulation of cerebrospinal fluid in the ventricles of the brain and associated with increase intracranial pressure, vomiting, anorexia, and impaired circulation of the brain. P. 330-331

Which findings in a child would cause the nurse to suspect developmental hip dysplasia? Select all that apply. 1. Unequal leg length 2. Inward-turned feet 3. Asymmetry of the skin folds 4. Presence of Ortolani's sign 5. Large space between the toes

1, 3, 4 -Unequal leg length (As the knee on the side of the dislocation is lowered, the infant has one leg that is shorter than the other). -Asymmetry of the skin folds (Due to improper positioning, the infant has uneven skin folds of the thigh and buttocks). -Presence of Ortolani's sign (A diagnostic tool used for developmental hip dysplasia that is indicated by a clicking sound). --Developmental hip dysplasia is characterized by either partial or complete dislocation of the hip. P. 337-338

A newborn's square window is 30°; arm recoil is 95°; and popliteal angle is 70°. The nurse gives a score of zero for posture, three for scarf sign, and one to the angle made from heel to ear. Which total neuromuscular maturity score is assigned to this newborn? Record your answer to the nearest whole number. ____________.

15. --The New Ballard Score helps determine the gestational age of a newborn by observing the score of neuromuscular maturity and physical maturity. --The total neuromuscular maturity is determined by adding: Score of posture, square window, arm recoil, popliteal angle, scarf sign, and the angle made from the heel to ear. --Square window: 30* = 3 --Recoils the arm: 95* = 3 --Popliteal angle: 70* = 5 --Posture: 0 --Scarf sign = 3 --Angle made from heel to ear = 1 --3+3+5+0+3+1 = 15 P. 309-310

Which conditions are the result of metabolic genetic disorders? Select all that apply. 1. Thalassemia 2. Cystic fibrosis 3. Phenylketonuria 4. Turner's syndrome 5. Klinefelter's syndrome

2 & 3 -Cystic fibrosis -Phenylketonuria --Metabolic genetic disorders: The deficiency of enzymes or substances that play a role in the metabolism of substances. --Cystic fibrosis: An inborn metabolic disorder, associated with impaired functioning of the lungs, pancreas, liver, and the intestine. --Phenylketonuria: An inborn metabolic genetic disorder associated with impaired metabolism of phenylalanine. **Thalassemia: An inherited genetic disorder associated with a decrease in the RBC count and hemoglobin levels. **Turner's syndrome & Klinefelter's syndrome: Chromosomal abnormalities that are characterized by improper physical and sexual development. P. 328

Which type of feeding would the nurse discuss with the parents of a 2-month-old infant with phenylketonuria (PKU)? Select all that apply. 1. Breast milk 2. Lofenalac 3. Phenex-1 4. Phenex-2 5. Phenyl-Free

2 & 3 -Lofenalac -Phenex-1 --PKU is a genetic disorder associated with impaired metabolism of an essential amino acid called phenylalanine. --An infant with PKU will need specific dietary management with frequent evaluation of the blood phenylalanine levels. --Lofenalac & Phenex-1 formula provides essential proteins and help support growth and development while maintaining phenylalanine blood levels within the limit. --Breast milk may worsen the symptoms of PKU as a result of the accumulation of phenylalanine in the blood. **Phenex-2: Can be administered to adolescents. **Phenyl-Free: Can be administered to children between ages 3 and 8. P. 341

An infant born at 28 weeks of gestation weighs 1400 grams (g). Which treatment strategies would be beneficial to the infant? Select all that apply. 1. Phototherapy 2. Retinal ablative therapy 3. Intravitreal injection of bevacizumab (Avastin) 4. Intravenous administration of antimicrobials 5. Intravenous administration of calcium gluconate.

2 & 3 -Retinal ablative therapy (using laser photocoagulation of the fibrous tissue). -Intravitreal injection of bevacizumab (Avastin) --Preterm infants and infants weighing less than 1500 g are at increased risk for retinopathy of prematurity (ROP), which can lead to blindness. --These are used to prevent blindness in preterm infants. **IV microbials: Used in the treatment of sepsis. **IV calcium gluconate: Used in the treatment of hypocalcemia. P. 315

The nurse is caring for a preterm infant who has apnea and a desaturated hemoglobin level of 5 g/dL. Which complication would the nurse assess for in the infant? Select all that apply. 1. Sepsis 2. Cyanosis 3. Tachypnea 4. Bradycardia 5. Hypoglycemia

2 & 4 -Cyanosis (due to a desaturated hemoglobin level of 5 g/dL). -Bradycardia (caused during the pause where the heart rate slows down). --Apnea: A pause in regular breathing for 20 seconds or longer. **Sepsis: An infection of the blood stream and occurs in preterm infants as a result of the immaturity of many body systems. P. 313

Which findings in an infant would cause the nurse to further assess for hip dysplasia? Select all that apply. 1. The infant's diaper is always wet. 2. The infant kicks with only one leg. 3. The infant has a tuft of hair at the lumbosacral region. 4. The infant has asymmetrical folds in the upper thighs. 5. The infant has swelling and numbness in the lower limbs.

2 & 4 -The infant kicks with only one leg (due to the hip malformation and joint laxity). -The infant has asymmetrical folds in the upper thighs (indicates the infant has unequal leg length). --Variations in buttock size and asymmetrical folds in the upper thighs are the characteristics of hip dysplasia. P. 338

An infant with hydrocephalus is found to have an enlarged head, poor muscle tone, setting-sun eyes, shrill cry, and vomiting. Which treatment strategy would be beneficial for this infant? Select all that apply. 1. Performing cheiloplasty 2. Administering furosemide (Lasix) 3. Administering acetazolamide (Diamox) 4. Performing a ventriculoperitoneal shunt 5. Administering oxybutynin chloride (Ditropan)

2, 3, 4 -Administering furosemide (Lasix) -Administering acetazolamide (Diamox) -Performing a ventriculoperitoneal shunt (a surgical procedure that drains the excess of CSF into the peritoneal cavity and provides relief to the child). --Hydrocephaly: A congenital anomaly caused by the accumulation of the cerebrospinal fluid in the ventricles of the brain. --Antidiuretic medications (Furosemide & Acetazolamide) decrease the production of cerebrospinal fluid, reducing intracranial pressure and alleviating the symptoms of hydrocephaly. **Cheiloplasty: A surgical procedure that helps repair the cleft lip in the infant. **Oxybutynin chloride: increases the uterine contraction and helps increase bladder storage. P. 329

Which nursing interventions are beneficial for an infant who has hyperbilirubinemia and is placed in an incubator for phototherapy? Select all that apply. 1. Placing a blanket over the infant. 2. Covering the eyes of the infant 3. Covering the genitals with a diaper. 4. Turning the infant every 2 hours 5. Removing eye patches only after therapy is complete

2, 3, 4 -Covering the eyes of the infant. -Covering the genitals with a diaper. -Turning the infant every 2 hours. --The patches on the infant's eyes should be removed at least once during the shift and determine whether the infant has conjunctivitis. P. 346

Which intervention would the nurse provide for an infant who has transient tachypnea (TTN)? Select all that apply. 1. Placing the infant in the supine position. 2. Covering the infant with a warm blanket. 3. Keeping the infant calm by swaddling. 4. Administering oxygen supplement to the infant. 5. Administering vitamin supplements to the infant.

2, 3, 4 -Covering the infant with a warm blanket (due to risk of hypothermia). -Keeping the infant calm by swaddling (to conserve energy in the infant). -Administering oxygen supplement to the infant (helps relieve respiratory distress in the infant). --An infant born via C-section has an increased risk for transient tachypnea. --> The infant would have chest retractions, grunting, and mild cyanosis. P. 350

An infant diagnosed with spina bifida cystica is at risk for which complication if treatment is not initiated immediately? Select all that apply. 1. Hip dysplasia 2. Hydrocephalus 3. Paralysis of the legs 4. Speech impairment 5. Poor bladder control

2, 3, 5 -Hydrocephalus (Due to accumulation of cerebrospinal fluid). -Paralysis of the legs (due to protruding membranes in the spinal cord leading to incomplete fusion of the spinal cord). -Poor bladder control (due to protruding membranes in the spinal cord leading to incomplete fusion of the spinal cord). --Spina bifida cystica: Presence of protruding membranes in the spinal cord and a cystic mass in the midline of the spine. P. 332

Which intervention would the nurse provide postoperatively for a 3-year-old child who has undergone cleft palate surgery? Select all that apply. 1. Encouraging the child to drink water with a straw. 2. Speaking slowly and distinctively with the child. 3. Using an antiseptic mouthwash to clean the mouth. 4. Providing pacifiers to soothe and calm the child. 5. Placing the spoon at the side of the mouth while feeding.

2, 3, 5 -Speaking slowly and distinctively with the child (helps the child understand the pronunciation of different words, which encourages the child to speak). -Using an antiseptic mouthwash to clean the mouth (prevents bacterial growth and helps maintain oral hygiene). -Placing the spoon at the side of the mouth while feeding (helps prevent injury to the palate). P. 336

Which complication is prevented with initiation of early feedings of expressed breast milk to a preterm infant in an incubator? Select all that apply. 1. Hypercalcemia 2. Dehydration 3. Polycythemia 4. Hypoglycemia 5. Hyperbilirubinemia

2, 4, 5 -Dehydration -Hypoglycemia -Hyperbilirubinemia --Expressed milk contains an adequate amount of calcium and prevents hypocalcemia in the infant. P. 317

A 2-day-old infant with anemia begins to experience seizure activity. Which additional complication would the nurse assess for in the infant? Select all that apply. 1. Kernicterus 2. Macrosomia 3. Tachypnea 4. Hyperglycemia 5. Hyperbilirubinemia

1 & 5 -Kernicterus -Hyperbilirubinemia --Anemia occurs as a result of the hemolysis of a large number of erythrocytes, leading to increased bilirubin levels in the blood. --Bilirubin toxicity indicates the presence of kernicterus. P. 346

Which anatomic findings are characteristic of Down syndrome? Select all that apply. 1. One shorter leg 2. Protruding tongue 3. Inward turned feet 4. Short and thick neck 5. Simian crease in the palm

2, 4, 5 -Protruding tongue (due to poor muscle tone). -Short and thick neck -Simian crease in the palm P. 343

A preterm infant who is at risk for cold stress is lethargic and bradycardic. Which nursing intervention addresses this infant's symptoms? 1. Monitoring the glucose levels frequently 2. Placing the infant under a radiant warmer. 3. Administering intravenous calcium gluconate. 4. Measuring abdominal girth and listening for bowel sounds.

Placing the infant under a radiant warmer. P. 314

Which symptoms in an infant may be indicative of kernicterus? Select all that apply. 1. Lipoma 2. Seizures 3. Lethargy 4. Sneezing 5. Opisthotonus position

2, 3, 5 -Seizures -Lethargy (resulting from reduced RBC count). -Opisthotonus position (arching of the back caused by muscle weakness). --Kernicterus is a complication of jaundice in the infant. **Lipoma: Caused by the accumulation of fat. **Sneezing: A symptom of neonatal abstinence syndrome. P. 346

Which findings in a preterm infant are associated with a diagnosis of sepsis? Select all that apply. 1. Bradycardia 2. Irritability 3. Convulsions 4. Poor feeding 5. Low body temperature

2, 4, 5 -Irritability -Poor feeding -Low body temperature --Microbial infection cause sepsis. P. 313-314

An infant suspected of having maple syrup urine disease (MSUD) has manifestations of hypotonia, convulsions, irregular respirations, and poor feeding. Which diagnostic test would the nurse expect to be ordered to aid in confirming a diagnosis? 1. Quad test 2. Amino acid blood test 3. Stool test 4. Coombs' test

Amino acid blood test. --MSUD: A genetic disorder, which is associated with an increase in serum leucine, isoleucine, and valine amino acid levels. --Blood test to measure these branched chain amino acids will help diagnose the infant's illness. **Quad test: A prenatal maternal screening test that determines the levels of alpha-fetoprotein and human chorionic gonadotropin in the blood. --> Also, helps identify whether the fetus has a risk for Down Syndrome. **Coombs' test: Measures the antibody coated Rh-positive red blood cells in the infant's blood. --> Prescribed to diagnose erythroblastosis fetalis. P. 342

A preterm infant with respiratory distress has a low body temperature, is lethargic, and has reduced feeding ability. Administration of which intravenous solution will alleviate these symptoms? 1. Crystalloid Fluids 2. Antimicrobials 3. Lipids 4. Calcium gluconate

Antimicrobials. --This indicates that the newborn has sepsis. --Sepsis: A microbial infection, which can be treated by administering IV antimicrobials. --> They destroy infection-causing microbes and alleviates the symptoms of sepsis. P. 314

Which assessment finding would the nurse anticipate when caring for a preterm infant who is experiencing cold stress? 1. Pallor 2. Shivering 3. Bradycardia 4. Hyperglycemia

Bradycardia. P. 314

The nurse is teaching the parents of a preterm infant about proper skin care. Which action by the parents indicates a need for additional teaching? 1. Checking the baby's skin for signs of infection. 2. Cleaning the baby with an alkaline soap. 3. Removing and dressings and tape gently. 4. Changing the baby's position frequently.

Cleaning the baby with an alkaline soap. --A preterm baby has delicate skin so proper skin care is required to maintain skin integrity. --Water should be used cleanse the baby's skin. --Using an alkaline soap may cause irritation due to its chemical composition. P. 320

A 2-year-old child who has a flexed ankle, a turned heel, and an adducted forefoot is observed by the nurse to walk on the toes and outer borders of the feet. Which condition would the nurse document in the electronic medical record (EMR)? 1. Clubfoot 2. Kernicterus 3. Hip dysplasia 4. Myelodysplasia

Clubfoot. --A skeletal deformity in which the child's foot is twisted either inward or outward. A child with clubfoot will also have a flexed ankle, turned heel, and adducted forefoot. --> If the foot turns in, the child with a clubfoot walks on the toes or the outer borders of the feet. P. 336

An infant with early jaundice is prescribed phototherapy using a biliblanket. Which nursing action maximizes the effectiveness of the treatment? 1. Exposing maximum skin surface to the light. 2. Placing the light source on a dark-colored carpet. 3. Setting the intensity of the light to the lowest level. 4. Covering the light source with a thin sheet of paper.

Exposing maximum skin surface to the light. --A biliblanket consists of a pad of woven fibers, permitting light to pass through. --> The light penetrates the biliblanket and reaches the infant's body where the skin and blood absorb the radiations. --> The radiations then convert bilirubin into its byproducts, thereby eliminating it from the body. -->Exposing the maximum surface of the skin to the light enhances light absorption and decreases bilirubin levels most effectively. P. 349 P. 349

The daily intake of which vitamin before conception can reduce the risk for neural tube defects such as spina bifida? 1. Folic acid 2. Vitamin C 3. Vitamin D 4. Vitamin E

Folic acid. --Neural tube defects such as spina bifida. P. 332

Which diagnostic tool is used to diagnose phenylketonuria (PKU)? 1. Guthrie test 2. Thyroid studies 3. Urinalysis 4. Radiography

Guthrie test. --A blood test that is widely used and is considered the most reliable test for phenylketonuria (PKU). P. 341

A preterm infant in the neonatal intensive care unit (NICU) is receiving calcium gluconate for hypoglycemia. Which assessment would the nurse complete first? 1. Skin color 2. Level of consciousness (LOC) 3. Body temperature 4. Heart rate

Heart rate. --IV calcium gluconate in an infant would have their heart rate closely monitored and the nurse would report bradycardia. P. 315

Which finding in a pregnant patient is associated with an increased risk for macrosomia in the neonate? 1. Increased bilirubin levels 2. Increased blood glucose levels 3. Discontinued of folic acid supplementation. 4. Amphetamine (Adderall) use on a daily basis.

Increased blood glucose levels. --Due to hyperglycemia the levels of insulin, proteins, and fatty acids increase in the fetus and cause excessive weight gain. P. 352

Which treatment would the nurse provide in the case where a patient who is Rh-negative gives birth to an Rh-positive infant? 1. Intramuscular RhoGAM to the patient. 2. Intravenous RhoGAM to the newborn. 3. Amnioinfusion to the patient 4 hours after delivery. 4. A biliblanket for 2 days for the newborn.

Intramuscular RhoGAM to the patient. --When a patient's blood group is Rh-negative and the newborn's blood group is Rh-positive, this may cause antigen-antibody reaction and increase the risk for erythroblastosis during the next pregnancy. **Amnioinfusion helps prevent meconium aspiration syndrome in the fetus. P. 345

Allergy to which substance commonly develops in infants diagnosed with spina bifida? 1. Penicillin 2. Latex 3. Peanuts 4. Sulfa

Latex. P. 334

Which terminology will the nurse use when considering how well developed an infant is at birth and the ability of the organs to function outside the uterus? 1. Level of growth 2. Level of development 3. Gestational level 4. Level of maturation

Level of maturation. P. 309

The nurse is caring for a preterm infant with a prothrombin deficiency. Which position would the nurse place the infant in? 1. Prone 2. Supine 3. Low Fowler's 4. Pillow under the legs

Low Fowler's. --Due to deficiency of clotting factors (prothrombin), preterm infants may have a high risk for bleeding and hemorrhage. --To reduce intracerebral pressure and minimize the risk for hemorrhage, the nurse would place the bed in a low Fowler's position. P. 315

A newborn is diagnosed with clubfoot caused by improper position in the uterus. Which intervention would be considered first line treatment for this type of clubfoot? 1. Immediate casting 2. Splinting as soon as possible 3. Surgery by age 3 years 4. Manipulative exercises

Manipulative exercises. P. 337

Which complication of gavage feeding would the nurse assess for in a preterm infant? 1. Kernicterus 2. Neonatal tetany 3. Neonatal hypoxia 4. Necrotizing enterocolitis

Necrotizing enterocolitis. --Milk formula or hypertonic gavage feeding is a source for bacterial overgrowth and infection of the GI tract. --These feedings can cause a decrease in the function of the protective mucus and result in bacterial invasion of the delicate tissues. P. 315

The nurse is caring for a postpartum patient who was on amphetamine drug therapy during pregnancy. Which complication does the nurse assess for in the newborn? 1. Macrosomia 2. Hydrocephalus 3. Neonatal abstinence syndrome 4. Meconium aspiration syndrome

Neonatal abstinence syndrome. --Amphetamine is a CNS stimulant that can alter CNS functioning and cause wakefulness, diarrhea, poor feeding, and sneezing in the newborn. **Diabetes during pregnancy may increase insulin levels in the fetus resulting in macrosomia in the newborn. **Hydrocephalus: A neural tube defect that is characterized by an accumulation of cerebrospinal fluid (CSF) in the ventricles of the brain. **Meconium aspiration syndrome: Caused by aspiration of meconium-stained amniotic fluid in the fetal lungs, occurs due to gasping movements of the fetus in utero as a result of asphyxia. P. 350

Which physical finding in a newborn is associated with postmaturity? 1. Abundant lanugo 2. Peeling skin 3. Abundant vernix caseosa 4. Thin, transparent skin

Peeling skin. --A postterm infant is long and thin and looks as though weight has been lost, the skin is loose (especially about the thighs and buttocks), there is little lanugo or vernix caseosa, the skin is dry, it cracks and peels and is almost like parchment in texture. P. 322

Which treatment strategy would be beneficial for the infant the maple syrup urine disease (MSUD)? 1. Phototherapy 2. Peritoneal dialysis 3. Acetazolamide (Diamox) 4. Sapropterin dihydrochloride (Kuvan)

Peritoneal dialysis. --To eliminate excess amino acids from the body, the PCP will prescribe peritoneal dialysis of the infant. P. 342

Which finding in an infant with a spica cast would cause the nurse to be concerned about the development of compartment syndrome? 1. Cyanosis 2. Persistent pain 3. Hyperglycemia 4. Hypotension

Persistent pain. --Spica cast helps treat hip dysplasia. --Compartment syndrome: Caused by reduced blood circulation to the hips, legs, and pelvis and increased pressure on the muscles of the hips and pelvis. P. 340

The nurse is caring for a preterm infant who has intracranial hemorrhage causing convulsions and twitching. Which medication would be beneficial to alleviate these symptoms? 1. Furosemide (Lasix) 2. Phenobarbital (Luminal) 3. Acetazolamide (Diamox) 4. Sapropterin dihydrochloride (Kuvan)

Phenobarbital (Luminal) --An anticonvulsant medication. **A preterm infant's blood vessels are fragile, resulting in injury or trauma such as intracranial hemorrhage during birth. P. 350

Which benefit does kangaroo care provide in addition to using skin-to-skin contact to warm and calm the child? 1. Promotes bonding. 2. Increases appetite 3. Stabilizes vital signs 4. Maintains skin integrity.

Promotes bonding. --A method of care for preterm infants that uses skin-to-skin contact, the skin warms and calms the child and the contact promotes bonding. P. 317

Which outcome in the infant is the nurse addressing when monitoring the infant's weight daily, checking for depressed fontanels, and keeping track of fluid intake? 1. Balanced nutrition 2. Proper skin turgor 3. Proper body temperature 4. Proper neurological development

Proper skin turgor. --An infant who is properly hydrated will have proper skin turgor. P. 347

Following phototherapy, an infant experiences lethargy and seizures and there is no decrease in the bilirubin levels. Which treatment strategy would benefit the infant in this scenario? 1. Administration of methadone 2. Administration of metalloporphyrins 3. Performing peritoneal dialysis 4. Providing an exchange transfusion

Providing an exchange transfusion. --The healthy RBCs are added to the infant's blood and antibodies are eliminated by transfusing Rh-negative blood to the infant. P. 346

Which condition would the nurse document in a child with impaired bladder sphincter functioning along with tufts of hair, lipoma, and discoloration at the lumbosacral region? 1. Hip dysplasia 2. Hydrocephalus 3. Spina bifida cystica 4. Spina bifida occulta

Spina bifida occulta. --A congenital abnormality characterized by the presence of a cleft in the spine, to include symptoms of impaired bladder sphincter functioning, presence of lipoma, tufts of hair, and discoloration at the lumbosacral region. P. 332

Which chemical is necessary for the absorption of oxygen by the lungs? 1. Surfactant 2. Actin 3. Myosin 4. Prostaglandin

Surfactant. --A chemical in the lungs that is high in lecithin, a fatty protein necessary for the absorption of oxygen by the lungs. P. 311

An infant with intracranial hemorrhage has severe bleeding. Which medication will be beneficial for the infant? 1. Vitamin K (Mephyton) 2. Phenobarbital (Luminal) 3. Acetazolamide (Diamox) 4. Oxybutynin chloride (Ditropan)

Vitamin K (Mephyton). --A coagulant that helps control bleeding in infants with intracranial hemorrhage. **Phenobarbital (Luminal): Helps treat twitching and convulsions. **Acetazolamide (Diamox): A diuretic drug that helps reduce cerebrospinal fluid. **Oxybutynin chloride (Ditropan): Helps increase bladder storage and treats urinary incontinence. P. 350

An infant with intracranial hemorrhage has severe bleeding. Which medication will be beneficial for the infant? 1. Vitamin K (Mephyton) 2. Phenobarbital (Luminal) 3. Acetazolamide (Diamox) 4. Oxybutynin chloride (Ditropan)

Vitamin K (Mephyton). --A coagulant that helps control bleeding in infants with intracranial hemorrhage. P. 350