prepU ch 23 Nursing Care of the Newborn with Special Needs

The nurse is teaching nursing students about the risks that late preterm infants may experience. The nurse feels confident learning has taken place when the students make which statement?

"A late preterm newborn may have more clinical problems compared with full-term newborns."

An infant born 10 minutes prior was brought into the nursery for an examination. The nurse notices the infant's lip and palate are malformed. The parent comes up to door and asks if the infant seems okay. What is the appropriate response by the nurse?

"Come on over and I will explain your infant's exam and findings."

At a prenatal class the nurse describes the various birth weight terms that may be used to describe a newborn at birth. The nurse feels confident learning has occurred when a participant makes which statement?

"Newborns who are appropriate-for-gestational-age at birth have lower chance of complications than others."

A nursing student, observing care of a 30-week-gestation infant in the neonatal intensive care unit, asks the nurse, "Are premature infants more susceptible to infection as I have to wash my hands so often in this department?" What is the nurse's best response?

"That is correct; a 30-week-gestation infant lacks the protective antibody called IgG."

The nurse weighs the new infant and calculates the child's measurements. The new mom asks, "Did my baby grow well? The doctor said he was LGA. What does that mean?"What is the nurse's best response?

"That means your baby is over the 90th percentile for weight."

A newborn has scheduled heel sticks for bilirubin checks every 4 hours. The mother asks the nurse "what can be done to calm my baby after those heel pricks?" What is the nurse's mostappropriate response?

"You can give your baby a sucrose solution by bottle for pain relief."

A newborn with high serum bilirubin is receiving phototherapy. Which is the most appropriate nursing intervention for this client?

Application of eye dressings to the infant

A nurse is caring for an infant. A serum blood sugar of 40 was noted at birth. What care should the nurse provide to this newborn?

Begin early feedings either by the breast or bottle

The nurse has admitted a small-for-gestational-age infant (SGA) to the observation nursery from the birth room. Which action would the nurse prioritize in the newborn's care plan?

Closely monitor temperature.

When discussing heat loss in newborns, placing a newborn on a cold scale would be an example of what type of heat loss?

Conduction

A 33-week-gestation infant has just been born. The child's heartbeat is not audible. What is the priority nursing intervention?

Depression of the sternum with both thumbs 1 to 2 cm at a rate of 100 times per minute

Which maternal factors should the nurse consider contributory to a newborn being large for gestational age? Select all that apply.

Diabetes mellitus Postdates gestation Prepregnancy obesity

Which maternal factors should the nurse consider contributory to a newborn being large for gestational age? Select all that apply.

Diabetes mellitusPostdates gestationPrepregnancy obesity

The nurse in the NICU is caring for preterm newborns. Which guidelines are recommended for care of these newborns? Select all that apply.

Dress the newborn in ways to preserve warmth. Take the newborn's temperature often. Supply oxygen for the newborn, if necessary.

A nurse is caring for an infant born with polycythemia. Which intervention is most appropriate when caring for this infant?

Focus on decreasing blood viscosity by increasing fluid volume.

A client asks the nurse what surfactant is. Which explanation would the nurse give as the main role of surfactant in the neonate?

Helps the lungs remain expanded after the initiation of breathing

A neonate born at 40 weeks' gestation, weighing 2300 grams (5 lb, 1 oz) is admitted to the newborn nursery for observation only. What is the nurse's first observation about the infant?

The neonate is small for its gestational age.

A 20-year-old client gave birth to a baby boy at 43 weeks' gestation. What might the nurse observe in the newborn during routine assessment?

The newborn may look wrinkled and old at birth.

The nurse observes a neonate born at 28 weeks' gestation. Which finding would the nurse expect to see?

The pinna of the ear is soft and flat and stays folded.

When documenting the newborn's weight on a growth chart, the nurse recognizes the newborn is large-for-gestational-size based on which percentile on growth charts?

above 90th percentile

The nurse examines a 26-week-old premature neonate. The skin temperature is lowered. What could be a consequence of the infant being cold?

apnea

Which factors in a maternal birth record are risks for fetal growth restriction?

congenital malformations, infections, or placental insufficiency

A common symptom that would alert the nurse that a preterm infant is developing respiratory distress syndrome is:

expiratory grunting.

A nurse is assessing the fluid status of a preterm newborn. Which parameter would be mostappropriate for the nurse to assess?

fontanels

A newborn that has a surfactant deficiency will have which assessment noted on a physical exam?

grunting

A client has given birth to a small-for-gestational-age (SGA) newborn. Which finding would the nurse expect to assess?

head larger than body

A nurse is assessing a preterm newborn. The nurse determines that the newborn is comfortable and without pain based on which finding?

lack of body posturing

The nurse is reviewing the medical record of a newborn born 2 hours ago. The nurse notes that the newborn was born at 35 weeks' gestation. How would the nurse classify this newborn?

late preterm

A 35-year-old client has just given birth to a healthy newborn during her 43rd week of gestation. What should the nurse expect when assessing the condition of the newborn?

meconium aspiration in utero or at birth

Which symptom would most accurately indicate that a newborn has experienced meconium aspiration during the birth process?

meconium stained fluids followed by tachypnea

A nurse is working in the newborn observational unit and is assigned four newborns. In which newborn will the nurse suspect difficulties with thermal regulation?

newly born preterm newborn

The nurse needs to conduct a procedure on a preterm newborn. Which measures would be most effective in reducing pain? Select all that apply.

offering a pacifier prior to a procedure swaddling the newborn closely encouraging kangaroo care during procedures

At birth, the infant has dry, cracked skin, absence of vernix, lack of subcutaneous fat, fingernail extending beyond the fingertips, and poor skin turgor. Based on these findings, how would the nurse would classify this neonate?

postterm

Which finding would lead the nurse to suspect that a large-for-gestational-age newborn is developing hyperbilirubinemia?

tea-colored urine

A newborn girl who was born at 38 weeks' gestation weighs 2000 g and is below the 10th percentile in weight. The nurse recognizes that this girl will be placed in which classification?

term, small-for-gestational-age, and low-birth-weight infant

A premature infant develops respiratory distress syndrome. With this condition, circulatory impairment is likely to occur because, with increased lung tension,:

the ductus arteriosus remains open.

A nurse initiates bag and mask ventilation with an anesthesia bag on a newborn with no spontaneous respiratory effort. What controls the pressure of breaths delivered by an anesthesia bag?

the pressure the nurse uses when the hand squeezes against the bag

The nurse determines a newborn is small-for-gestational-age based on which characteristics?

wasted appearance of extremities, thin umbilical cord, and reduced subcutaneous fat stores

After completing an assessment of a newborn, the nurse determines that the newborn is small-for-gestational-age based on which weight assessment?

weight of 2,400 g