NSG2400 Cleft Lip/Palette & Spina Bifida

A newborn with a cleft lip and palate is born to a mother who has a history of epilepsy. Which drug might be responsible for this malformation? 1 Phenytoin 2 Topiramate 3 Valproic acid 4 Carbamazepine

2 Used to treat epilepsy, topiramate may have teratogenic effects that cause a newborn to develop a cleft lip with cleft palate. Carbamazepine and valproic acid may cause fetal neural tube defects. Phenytoin may cause fetal central nervous system defects.

During which period of pregnancy may drug exposure cause meromelia, cleft lip, and enamel hypoplasia? 1 Fetal period 2 Embryonic period 3 Presomite period 4 Preimplantation period

2

The parents of an infant born with a unilateral cleft lip and palate are upset about the defect and ask the nurse, "What caused our baby to be born deformed?" What is the most therapeutic response? 1 "You're feeling guilty about what happened." 2 "I'm glad you're able to ask these kinds of questions." 3 "You don't need to worry, because surgery can correct it." 4 "It sounds like you're concerned that you may have caused this situation."

4

At 18 months of age a child born with a cleft lip and palate is readmitted for palate surgery. Why does the nurse teach the parents not to brush their child's teeth immediately after the surgery? 1 The suture line might be injured. 2 A toothbrush might be frightening. 3 The child will probably have no teeth. 4 A toothbrush has not been used before.

1

An infant is born with a cleft lip. What nursing intervention is unique to infants with cleft lip? 1 Changing the infant's position often 2 Using modified techniques for feeding 3 Monitoring the infant's daily intake and output 4 Keeping the infant's head elevated during feedings

2

An infant with a cleft lip is fed with a special nipple. What should the nurse teach the parents about feeding their infant to minimize regurgitation? 1 Offer a thickened formula. 2 Burp frequently during a feeding. 3 Place the child in an infant seat during feedings. 4 Position the child on the side with the bottle propped.

2

After a cleft lip repair a nurse places elbow restraints on the infant. The parents ask the nurse, "Why does our child have to have restraints?" How should the nurse respond? 1 "They're used routinely on infants who have had lip surgery." 2 "Legally we're required to put them on infants after lip surgery." 3 "The staff can't be with your baby continuously to prevent touching of the mouth." 4 "Because we're keeping the arms straight, your baby won't be able to touch the mouth."

4

Which item should a nurse use to feed an infant born with a unilateral cleft lip and palate? 1 Plastic spoon 2 Cross-cut nipple 3 Parenteral infusion 4 Rubber-tipped syringe

4 Because the infant with a cleft lip and palate is unable to form the vacuum needed for sucking, a rubber-tipped syringe or dropper is used. This allows formula to flow along the sides to the back of the mouth, minimizing the danger of aspiration. A spoon is ineffective because the infant's extrusion reflex will prevent fluid from entering the mouth. A cross-cut nipple may be used with some infants, but rapid flow is dangerous because it can cause aspiration. Feeding can be accomplished with the use of special equipment; intravenous fluids are not necessary.

A newborn with a severe bilateral cleft lip and palate is shown to the father. The father says, "How could this happen to us? What's my wife going to do? It would've been better if she'd never gotten pregnant." How should the nurse respond? 1 "This must be very hard on you. I can go with you when your wife sees the baby." 2 "You have a healthy baby, and the clefts can be closed so they won't be noticeable." 3 "This feeling won't last. Soon you'll love your baby so much that you won't even notice the clefts." 4 "I know this is difficult for you, but you can't think of yourself now, because your wife needs you to be strong."

1

A 4-day-old infant is admitted to the pediatric unit with a cleft lip and palate. Surgery to repair the lip is scheduled for later in the week. Which assessment finding requires notification of the surgeon and will probably result in cancellation of the surgery? 1 Hypotonia 2 rrectOral candidiasis 3 Facial paralysis 4 Cephalohematoma

2

What is the priority nursing intervention for an infant during the immediate postoperative period after surgical repair of a cleft lip? 1 Minimize crying. 2 Restrain continuously. 3 Oxygenate frequently.

1

At the age of 3 weeks an infant undergoes surgery to repair a cleft lip. What should postoperative nursing care include? 1 Using a spoon to administer oral feedings 2 Cleansing the suture line to prevent infection 3 Offering a pacifier for sucking to prevent crying 4 Using wrist restraints to keep the infant's hands away from the face

2

What intrauterine medication exposure may lead to the child being born with a cleft lip? 1 The mother was on phenytoin therapy. 2 The mother was on multivitamin therapy. 3 The mother was taking methotrexate. 4 The mother was on nitrofurantoin therapy.

4

An adolescent gives birth to an infant with a severe cleft lip and palate who is immediately placed on the radiant warmer. After ensuring that there is an adequate airway, the nurse gives the newborn to the mother. Which response to the infant would the nurse anticipate? 1 "Oh no! This is the wrong baby!" 2 "I'm so sad. Do you think I'm being punished?" 3 "My parents will be so upset. What could have happened?" 4 "I shouldn't have had this baby! Now my boyfriend won't marry me.

1 Denial or disbelief and shock are considered initial grieving responses. There is a feeling of guilt and inadequacy when an infant is born with a defect. It is unusual for a client to initially verbalize feelings of punishment or guilt so directly. A sense of shame and guilt is voiced later, after denial, disbelief, and shock have occurred. It is unusual for a client to use rationalization and voice it so obviously.

A nurse is caring for an infant who just underwent surgery for a cleft lip. In which position should the nurse place the infant? 1 Prone 2 Low Fowler 3 Left side-lying 4 Caregiver's shoulder

2

A nurse is feeding an infant who recently underwent surgical repair of a cleft lip. What does the nurse plan to do for the infant just after each feeding? 1 Burp several times. 2 Rinse the suture line. 3 Place on the abdomen. 4 Hold for several minutes.

2 Meticulous care of the suture line is necessary, because inflammation and sloughing of tissue disrupt healing. Burping should be done throughout the feeding. Placing the infant on the abdomen is contraindicated, not only because the infant may rub the face on the sheet and irritate the suture line but also because this position has been linked to sudden infant death syndrome. The infant may be held at any time.

A mother asks why her 2-year-old toddler's cleft palate was not repaired at the same time that the cleft lip was repaired. What is the best response by the nurse? 1 "Waiting leaves time for other birth defects to be detected and corrected." 2 "The cleft lip was so disfiguring that surgery was done as quickly as possible." 3 "Your surgeon prefers to separate the operations to minimize the potential for complications." 4 "The palate usually is repaired before a child starts to speak. Some surgeons prefer to wait up to 2 years."

4

A nurse is caring for an infant with a cleft lip and palate. What information should the nurse include when teaching the parents about this diagnosis? 1 Anticipation that these children will have psychological problems 2 Emphasis that the two defects follow the laws of Mendelian genetics 3 Assurance that the defect is rare and probably will not occur twice in the same family 4 Expectation that these children will have no other defect and otherwise will be healthy

4

A nurse is teaching the parents of an infant with a cleft lip and palate how to prevent infection. What information should the nurse include about why the infant is predisposed to infection? 1 Waste products accumulate along the defect. 2 Circulation to the defective area is insufficient. 3 Inefficient feeding behaviors result in inadequate nutrition. 4 Mouth breathing dries the oropharyngeal mucous membranes.

4

During discharge planning the parents of an infant with spina bifida express concern about skin care and ask the nurse what can be done to avoid problems. What is the best response by the nurse? 1 Diapers should be changed at least every 4 hours. 2 Frequent diaper changes with cleansing are needed. 3 Medicated ointment should be applied six times a day. 4 Powder may be used in the perineal area when it becomes wet

2

What is the priority of preoperative nursing care for an infant with a cleft lip? 1 Preventing crying 2 Modifying feeding 3 Preventing infection 4 Minimizing handling

2

A nurse confers with the nutritionist about the diet of a 4-year-old child with spina bifida who spends many hours in a wheelchair. What should the nurse encourage the mother to increase in her child's diet? Select all that apply. 1 Fat 2 Fiber 3 Protein 4 Calories 5 Carbohydrates

2 3 Extra fiber is needed to combat constipation resulting from immobility. Extra protein is needed for maintaining muscle mass and to help prevent pressure ulcers. Of this child's dietary intake, 25% should consist of fat; this is the lowest recommended daily intake for fat. It should not be increased because more fat calories may lead to obesity in an immobilized child. Calories should be limited because energy needs are less for immobile children than for children who are active. Carbohydrates, especially simple sugars, should be limited to help prevent obesity.

The mother of an infant who just underwent cleft lip repair tells the nurse, "He seems restless. May I hold him?" What information influences the nurse's response? 1 Holding may meet needs and reduce tension on the suture line. 2 Sedation limits activity and decreases tension on the suture line. 3 Handling may increase irritability, causing tension on the suture line. 4 Arm movements cannot be controlled, placing tension on the suture line.

1 Touching and cuddling provide a sense of well-being and relieve strain on the suture line that results from restlessness and crying. It is inappropriate to sedate an infant for its calming effect or to decrease activity. Careful handling will not damage the suture line. Arm movement can be controlled by applying elbow restraints to prevent the infant's hands from touching the suture line.