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Identify the potential long-term sequelae of a preterm infant delivered at 35 1/7 weeks gestation. A:Improved school performance at 6 years of age B:Increased risk for sudden infant death syndrome C:Increased risk for seizures D:Decreased health care utilization during the first 5 years of life
Correct:B At 35 1/7 weeks' gestation, this infant is a late preterm infant. The risk of sudden infant death syndrome can be 50% higher than in the term infant.
Signs of sensory overstimulation in neonates include finger and toe splaying, gaze aversion, and hiccups. The most appropriate nursing intervention to provide neurodevelopmental support to an infant exhibiting one or more of these behaviors during nursing care is to: A:swaddle the baby and provide a time-out for rest and recovery. B:dim the lights to decrease stimulation and continue with the care. C:play music during care to provide auditory distraction and calm the infant. D:hurry and finish the care being provided to shorten the noxious exposure.
Correct:A Swaddling the baby and implementing a time-out for rest and recovery provide neurodevelopmental support, promote self-regulatory behavior, and allow return to physiologic homeostasis.
The proteins whey and casein exist in a ratio of 80 (whey) to 20 (casein) in which of the following? A:Mature breast milk B:Colostrum C:Cow milk-based formula D:Soy-based formula
Correct:B Colostrum whey:casein ratio is 80:20.
Intravenous administration of medications is best in the neonatal population because: A:the ratio of body surface area in the neonate is higher than the body surface area of the adult. B:intravenously administered medications bypass all absorptive barriers. C:intramuscularly and subcutaneously administered medications are absorbed too rapidly. D:intravenously administered medications do not have to cross cell membranes to be absorbed.
Correct:B Intravenously administered medications bypass all absorptive barriers. It is the most effective method of medication administration because it is delivered directly into the bloodstream-circulating plasma volume.
The nurse is expecting the delivery of an infant at 24 weeks postconceptional age, with an estimated fetal weight of 800 g. Which of the following elements of the delivery room setup is most specifically geared toward the extremely low-birth-weight infant? A:Prewarmed radiant warmer B:Polyethylene wrap C:Prewarmed blankets D:Stockinet hat
Correct:B Polyethylene wrap is specifically indicated for the extremely low-birth-weight infant at delivery due to the potential for extreme evaporative thermal losses due to transdermal water loss.
The nurse recognizes that minimal enteral (trophic) feedings with expressed human milk should be initiated at a rate of: A:5 to 9 ml/kg/hr. B:10 to 20 ml/kg/hr. C:10 to 20 ml/kg/day. D:30 to 40 ml/kg/day.
Correct:C Minimal enteral feedings should be initiated at a rate of 10 to 20 ml/kg/day to facilitate postnatal gastrointestinal maturation and to minimize mucosal atrophy.
Contraindications to kangaroo care include: A:paternal hair on chest. B:mechanical ventilation. C:maternal preeclampsia requiring magnesium sulfate therapy. D:infection of the skin of the chest of the kangaroo care provider.
Correct:D Skin infection on the chest of the kangaroo care provider could potentially be transmitted to the infant, so kangaroo care should be avoided until the skin is clear.
Care in the NICU focuses on ways to foster the parent/family as the expert in the relationship with their infant. An example of this fostering would be the nurse: A:telling the parent how to feed their baby. B:having the mother watch the nurse give the first bath. C:making sure the parents are informed of the specific feeding times. D:identifying cues that the parent can use to calm the baby.
Correct:D To have the parent/family be a partner in the care, it is important to help them learn about their baby and how their baby reacts. Identifying cues and clues that they can use to care for their infant helps them gain competency and comfort with their care.
A preterm infant is receiving enteral feedings with iron supplementation of 2 mg/kg/day. Enteral feedings were resumed after a packed red blood cell transfusion. The nurse should be aware that iron supplementation was discontinued for which of the following reasons? A:Avoid excessive serum ferritin levels B:Provide for normalization of serum hemoglobin levels C:Permit normalization of serum sodium levels D:Avoid accumulation of methemoglobin in the blood
Correct:A Iron supplements were discontinued after the blood transfusion to minimize the risk of excessive serum ferritin levels. High ferritin levels can lead to an increased risk of infection, impaired growth, and formation of reactive oxygen species.
An infant needs to rapidly achieve a therapeutic plasma drug concentration of a medication. Rather than wait for a plateau level (steady state) to be achieved, the care provider will order a: A:loading dose. B:maintenance dose. C:medication with no first-pass effect D:medication with rapid cell entry properties.
Correct:A A loading or priming dose rapidly establishes a therapeutic plasma drug level. It is calculated by multiplying the volume of distribution by the desired plasma drug concentration. The loading dose establishes a desired level.
During a physical examination an infant's point of maximal impact is noted to be to the right of the mediastinum. The nurse should anticipate which of the following conditions? A:Left-sided pneumothorax B:Levocardia C:Right-sided pleural effusion D:Left-sided atelectasis
Correct:A A tension pneumothorax on the left will shift the mediastinum to the right, moving the point of maximal impulse (PMI) to the right.
A provider orders a trough level of a medication. The nurse knows to draw the specimen: A:just before a dose. B:an hour after administering the drug dose. C:at any time after a dose D:at the midpoint between two doses.
Correct:A A trough level represents the lowest concentration of a drug in the bloodstream and is obtained at the end of a dosing interval, that is, just before a dose.
Maturational hypotonia can lead to acquired positioning malformations in preterm infants, which include abnormal head molding, hip adduction, external rotation, and: A:arching posture. B:fixed neck flexion. C:wrist and ankle torsion. D:scapular abduction and shoulder extension.
Correct:A Abnormal head molding, hip adduction and external rotation, and arching posture are prevented by correct neurodevelopmental positioning.
An infant had a prenatal diagnosis of hydrops fetalis. An anteroposterior abdominal film is obtained at 4 hours of age and reveals a centralized bowel gas pattern. The nurse should anticipate that this finding is indicative of: A:ascites. B:bowel obstruction. C:ileus. D:Hirschsprung disease.
Correct:A Ascites is seen as a centralized bowel gas pattern on x-ray.
Feeding success has implications for mother-infant bonding, as well as decreasing length of NICU stay. Interventions that facilitate feeding success include: A:paced feeding, kangaroo care before feedings, and provision of nonnutritive sucking. B:continuous drip feedings, appropriate type of nipple, and increasing environmental stimuli at feeding time. C:appropriate temperature of feedings, vigorous patting to encourage adequate burping, and use of high-flow nipple. D:clustering of care, playing of music in the incubator for 6 to 12 hours a day, and use of a rocking mattress.
Correct:A Feeding success can be facilitated by decreasing environmental stimuli to allow the infant to focus on the feeding and avoid overstimulating and overwhelming the infant; reducing the stress of burping by positioning and gentle handling; using paced feedings to allow for reorganization of suck, swallowing, and breath coordination; providing kangaroo care before feedings; and providing nonnutritive sucking.
The potential adverse effect(s) of lipid emulsions for the preterm infant is (are): A:impaired pulmonary gas exchange and bilirubin toxicity. B:hypolipidemia. C:hypernatremia and hyperkalemia. D:hypoglycemia.
Correct:A High lipid infusion rates can be associated with decreases in oxygenation and the displacement of bilirubin from albumin-binding sites. Additional adverse effects include increased pulmonary vascular resistance, sepsis, and oxygen free-radical stress.
Which chest x-ray findings best represent primary surfactant deficiency? A:Hypoexpansion, air bronchograms, reticulogranular pattern B:Hyperexpansion, fluid in the fissure, air bronchograms C:Bilateral streakiness, hyperexpansion, reticulogranular pattern D:Hypoexpansion, sail sign, fluid in the fissure
Correct:A Hypoexpansion due to atelectasis, air bronchograms from atelectasis of the alveoli interspersed with open airways and a reticulogranular pattern, and open alveoli interspersed with atelectatic alveoli are the classic findings of surfactant deficiency.
Effects and benefits of kangaroo (skin-on-skin) care have been reported with as little as 10 minutes of kangaroo care. Which statement best describes the research findings on kangaroo care? A:Kangaroo care has positive effects on breast-feeding, sleep, and infection rates. B:Kangaroo care interval is best described as one sleep cycle—approximately 2 hours. C:Kangaroo care increases anxiety in parents due to worry about monitoring of their baby. D:Kangaroo care is embraced uniformly by all staff members, and there are no barriers to its use.
Correct:A Kangaroo care has been reported to enhance parental bonding and increase confidence. Other beneficial effects are improved breast-feeding, improved sleep patterns, and lower infection rates
Which of the following contributes to hyperbilirubinemia seen in late preterm infants? A:Poor coordination of sucking and swallowing B:Increase in hepatic update and conjugation C:Decrease in enterohepatic circulation D:Increased activity of hepatic uridine diphosphate glucuronyl transferase enzyme
Correct:A Late preterm infants have a decrease in oromotor tone, which leads to the inability to generate higher intraoral pressures during sucking and contributes to the incoordination of sucking and swallowing. Lack of such coordination can lead to poor feeding and dehydration, which in turn can lead to hyperbilirubinemia.
The nurse explains to the parents of a premature infant that maternal breast milk is the optimal primary nutritional source due to which of the following? A:Reduces the risk of necrotizing enterocolitis B:Meets nutritional requirements of premature infants C:Increases rate of growth compared with formula-fed infants D:Does not contain bacteria or viruses that could cause illness
Correct:A Maternal breast milk is the optimal primary nutritional source for premature neonates because evidence has shown that it reduces the incidence of necrotizing enterocolitis.
Repetitive noxious stimuli to the mouth, such as suctioning, can result in which developmental disorder? A:Oral aversion B:Feeding strike C:Feeding opposition D:Feeding intolerance
Correct:A Oral aversion can develop in response to repetitive invasive procedures, feeding on a schedule instead of on demand, and having multiple caregivers.
A nurse is teaching a mother to feed her preterm baby by keeping the nipple in the infant's mouth and regularly tilting the bottle slightly to stop the flow of expressed mother's milk. This method of shortened sucking bursts that lets the infant pause, swallow, and breathe is referred to as: A:paced feeding. B:synactive feeding. C:infant-driven feeding. D:interactive feeding.
Correct:A Paced feeding supports feeding success by coordinating sucking, promoting swallowing, regulating breathing breaks, and increasing stability.
A mother is caring for her infant daughter who is now 31 weeks adjusted age. The mother tells the nurse that she was reading about sleeping in preterm infants and would like to understand more about transitional sleep in preterms. The nurse would explain that transitional sleep: A:is the predominate sleep state for infants under 36 weeks' gestation. B:helps a preterm infant transition from rapid eye movement (REM) to non-REM sleep. C:is a more active form of quiet sleep. D:helps preterm infants learn to decrease their sleep time.
Correct:A Preterm infants do not have significant quiet sleep cycles until approximately 36 weeks' gestation; hence a third sleep state called transitional sleep is identified in preterm infants.
Which of the following element(s) may not be needed in the total parenteral nutrition solution for the first several days of life due to diuresis and the establishment of renal function in the extremely low-birth-weight infant? A:Sodium and potassium B:Magnesium C:Amino acids D:Calcium
Correct:A The addition of sodium and potassium to parenteral nutrition may not be needed for the first several days in extremely low-birth-weight infants because of the expected free water diuresis during the first week of life and their immature renal function. Fetal mineral stores of magnesium accumulate late in gestation.
The primary goal of delivering parenteral and enteral nutrition to the preterm infant is to: A:achieve the rate and composition of weight gain of a fetus at the same postmenstrual age. B:increase protein and energy deficits during the early neonatal period. C:enhance postnatal growth failure and suboptimal neurodevelopmental outcomes. D:meet total energy requirements for growing preterm infants of 80 kcal/kg/day.
Correct:A The current goal of parenteral and enteral nutrition is to attain approximately the same rate and composition of weight gain as a normal fetus at the same postmenstrual age.
A very-low-birth-weight infant has received several weeks of parenteral nutrition. Laboratory studies reveal a conjugated (direct) bilirubin level of 2 mg/dl. The infant should be evaluated for which of the following? A:Cholestatic jaundice B:Pneumatosis C:Glucose-6-phosphate dehydrogenase deficiency D:Intraventricular hemorrhage
Correct:A The primary complication of prolonged parenteral nutrition is cholestatic jaundice because total parental nutrition has been recognized as an important cause of intracellular and intracanalicular cholestasis. Conjugated hyperbilirubinemia is never normal and should always be evaluated.
Which of the following parameters post-hospital discharge of a former 28-week-gestation infant should be considered a high priority for the nurse? A:Body mass index for age B:Weight, length, and head circumference C:Weight for stature D:Weight for age
Correct:B According to the Centers for Disease Control and Prevention (CDC), body mass index, stature for age and weight for stature- are clinically indicated for children and adolescents 2 to 20 years of age.
An infant undergoes placement of an umbilical arterial catheter. The nurse should anticipate which of the following to reflect proper placement for a high-lying catheter per chest/abdominal x-ray? A:Thoracic vertebrae 3 to 5 B:Thoracic vertebrae 6 to 9 C:Lumbar vertebrae 1 to 3 D:Thoracic vertebrae 11 to 12
Correct:B Accurate high umbilical arterial catheter placement is between thoracic vertebrae 6 and 9.
Developmental care is in various stages of implementation in NICUs. An example of how an individual nurse may foster developmental care when doing direct care for an individual patient is: A:teaching the family the quickest way to complete a bath. B:alerting the infant to any care activity by speaking softly to him or her and making physical contact with them. C:allowing the infant to cry and learn self-consoling as he or she matures. D:educating the parents on the unit times for caregiving.
Correct:B Alerting the infant to changes has two goals: one is to allow the infant to have a smoother state transition and the other allows the caretaker to observe for subtle signs of discomfort or engagement.
A nurse is floating to the NICU and caring for infants in the feeder-grower area of the unit. After feeding she swaddles the infant tightly with the arms down at the sides and places the infant in a Back to Sleep position. Her NICU "buddy" discusses with her the NICU Back to Sleep program and some other elements of developmental care. One item the NICU buddy highlights is: A:Back to Sleep is only for babies who are going home in 2 days. B:babies need to have access to their hands for self-consoling behaviors. C:after feeding, the babies are placed prone for 30 minutes and then put on their back. D:swaddling a Back to Sleep infant helps them feel more secure when learning to sleep on the back.
Correct:B Back to Sleep "dressing" may include a sleep sac or blanket up to the nipple line. Infants should always have access to their hands for self-consoling behaviors.
The father of an infant in the NICU is worried because his baby's incubator is covered and is concerned that no one will notice if the baby's condition deteriorates or the baby needs attention. Which is the best explanation to provide? A:Looking at the fabric cover of the incubator stimulates the infant's retina to mature. B:Covered incubators allow decreased light so that the baby can rest but also immediate visualization if needed. C:NICU monitors detect adverse events and track the time of the event. D:Constant darkness will help the baby adjust to normal sleep patterns after discharge from the NICU.
Correct:B Bright light is detrimental to the developing brain due to overstimulation of the immature central nervous system and can lead to development of physiologic and behavioral defense mechanisms, maladaptions, and poor outcomes.
The purpose of adding carnitine to total parenteral nutrition solutions for preterm infants who are nothing-by-mouth and receiving intravenous lipids is to: A:facilitate digestion of lactose. B:transport long-chain fatty acids. C:synthesize bile acids. D:support gut integrity.
Correct:B Carnitine is a carrier molecule needed to transport long-chain fatty acids into mitochondria for oxidation. Preterm infants less than 34 weeks' gestation are usually dependent on lipids as an energy source and are at risk of not being able to appropriately store and synthesize carnitine, therefore, requiring supplementation in total parenteral nutrition solutions.
Digoxin (Lanoxin), a digitalis glycoside, exhibits which of the following actions? A:It increases plasma renin and aldosterone levels. B:It increases intracellular calcium, which produces a positive inotropic action. C:It has a positive dromotropic action, increasing sinoatrial and atrioventricular nodal conduction. D:It exhibits a positive chronotropic action secondary to increased vagal nerve tone.
Correct:B Digoxin inhibits sodium-potassium-adenosine triphosphatase; this results in calcium influx into the myocardial cells, which enhances contractility (inotropy).
A 36-week-gestation infant has been stable and cared for on the mother/baby unit. Discharge criteria of a late preterm infant includes which of the following? A:Weight loss not greater than 12% B:Twenty-four hours of successful feeding C:Follow-up appointments made for metabolic and hearing screening D:Older than 24 hours of age
Correct:B Discharge of the late preterm infant must take into consideration the potential physiological immaturity; therefore the infant must demonstrate the ability to successfully feed for at least 24 hours.
Implementing an evidence-based standardized feeding guideline by the nurse should lead to an: A:increased incidence of necrotizing enterocolitis. B:improved rates of growth. C:higher rates of practice variation within a facility. D:increase the amount of time to reach full enteral feeds.
Correct:B Implementing evidence-based standardized feeding guidelines can decrease rates of practice variation and lead to improved rates of growth velocity and improved clinical outcomes (ie, decreasing the duration of parenteral nutrition, decreasing the time to reach full enteral feeds, minimizing incidence of necrotizing enterocolitis).
An early cause of hypocalcemia in the neonate is: A:hypophosphatemia. B:maternal diabetes. C:calcium salt. D:thiazide diuretics.
Correct:B Infants of diabetic mothers are at risk of developing early hypocalcemia that can persist for several days due to maternal magnesium losses and can lead to fetal magnesium deficiency and secondary functional hypoparathyroidism in the newborn. The severity of the maternal diabetes is associated with the degree of hypocalcemia observed in the neonate.
Which of the following best describes neurodevelopmentally supportive positioning? A:Muscle tone and reflex development proceeds from upper to lower extremities. B:Intentional movement by newborns enhances neuromuscular development and stability. C:Pushing against boundaries should be avoided to prevent pressure on the developing joints. D:Any position that allows movement will increase physiologic stress and should be avoided.
Correct:B Intentional movement by newborns enhances neuromuscular development and stability. Regulatory efforts such as pushing against boundaries are an example of intentional movement.
The nurse is expecting the delivery of a 24-week postconceptional-age infant with an estimated fetal weight of 800 g. At delivery, the infant is noted to be apneic. The attending physician intubates and orders the nurse to deliver positive pressure ventilation with an inspired oxygen fraction (FiO2) of 0.40 while the respiratory therapist applies the oxygen saturation monitor. Based on the patient-specific data, which of the following is the most accurate interpretation of this order? A:This is an inappropriate order because blended oxygen is not available in the delivery room. B:This is an appropriate order because even brief hyperoxia can result in negative sequelae in the extremely low-birth-weight infant. C:This is an inappropriate order because apneic infants all require resuscitation with 100% oxygen until their condition is stabilized. D:This is an inappropriate order because apneic infants must be resuscitated with 100% oxygen until pulse oximetry indicates that their oxygen saturation is greater than 98%.
Correct:B It is expected that a newborn of this gestational age will need supplemental oxygen for resuscitation, but hyperoxia is to be avoided in order to avoid negative sequelae.
The predominant disaccharide in human milk is: A:sucrose. B:lactose. C:fructose. D:glucose.
Correct:B Lactose is the main disaccharide in human milk and is hydrolyzed into glucose and galactose in the small intestine by the enzyme lactase.
Which of the following is a benefit of minimal enteral (trophic) feedings in the preterm infant? A:Sufficient calories to sustain somatic growth B:Promote intestinal maturation with small volumes C:Enhance villous atrophy D:Replace the need for parenteral nutrition
Correct:B Minimal enteral or trophic feedings facilitate intestinal maturation with small volumes (typically less than 24 ml/kg/day).
An appropriate nursing intervention to provide developmental support to an infant during gavage feeding is to: A:feed on a strictly routine schedule. B:provide nonnutritive sucking before, during, and after the procedure. C:use a bright light to allow visualization of the correct placement of the tube. D:restrain the infant's body in an extended, supine posture with a soft fabric restraint to prevent the tube from being dislodged.
Correct:B Nonnutritive sucking accelerates maturation of the sucking reflex and improves weight gain. Consideration of what has been happening to the infant and readiness for care are always important.
A parent begins tapping on the incubator to wake up a sleeping infant for a visit. The most appropriate intervention at this time is to: A:suggest the parent wait until the infant is awake. B:identify a state-appropriate activity that the parent can do. C:encourage the parent's interactions with the infant. D:gently discourage the parent by stating, "The baby doesn't like that."
Correct:B Nurses should educate parents on their infant's behavioral states and cues. Because infants spend so much time asleep, parents need to be taught activities that they can do even while their infant is asleep. A goal of developmentally supportive care is to minimize external auditory stimuli.
An infant has an x-ray taken after intubation. The nurse should anticipate which of the following to reflect proper placement of the endotracheal tube? A:One cm below the carina B:Midway between thoracic inlet and carina C:At level of clavicles D:The fifth thoracic vertebrae
Correct:B Proper placement on an endotracheal tube is midway between the thoracic inlet and the carina.
The potassium-sparing diuretic spironolactone (Aldactone) is not useful in emergency situations such as florid pulmonary edema because: A:there is risk of an allergic reaction to the drug. B:the onset of action is approximately 60 hours. C:the intravenous form of the drug is highly caustic to veins. D:more than one dose results in hypokalemia and cardiac dysrhythmias.
Correct:B Spironolactone is an aldosterone antagonist and mild diuretic with a slow onset of action, taking up to 48 hours to take effect. This agent would be of limited value in acute pulmonary edema.
The nurse should explain to the parents that their premature infant needs to gain approximately how many grams per day to achieve adequate growth? A:5 B:15 C:80 D:100
Correct:B The infant needs to gain approximately 15 g/day for optimal weight gain. Infants that do not grow at intrauterine growth rates are vulnerable for energy and protein deficits in addition to postnatal growth restriction. Infants that grow in excess of intrauterine growth rates may be vulnerable to later risks of adult chronic diseases such as diabetes, hypertension, dyslipidemia, and cardiovascular disease.
A 35 3/7-week-gestational-age infant is placed on the mother's chest skin to skin after a vaginal delivery and covered with a warm blanket. Apgars are 8 at 1 minute and 9 at 5 minutes. Axillary skin temperature at 1 hour of age is 35.1° C (95.2° F). What is the most likely cause of hypothermia in the late preterm infant during the transition period? A:Low metabolic rate B:Large temperature gradient between the environment and the neonate C:Decreased surface area D:Decreased brown fat utilization
Correct:B The late preterm infant has an increased metabolic rate, thereby decreasing the ability to generate heat. The smaller size of late preterm infants leads to an increased ratio of surface area to body weight, causing the infant to lose heat easily to the environment. Late preterm infants are susceptible to the large temperature gradient between the infant and environment.
The RN is caring for a stable, 2-day-old infant born at 27 weeks postconceptional age. She identifies which of the following as the best approach to initiating feedings for most patients with this clinical profile? A:Starting feedings today with small volumes of probiotic supplements B:Start feedings today with small volumes of colostrum C:Maintaining nothing-by-mouth status for the first week of life D:Starting feedings today with full-strength premature formula
Correct:B The safety and efficacy of probiotic supplements are not yet fully established for this population.
An infant has liver disease and is receiving a drug that is highly metabolized by the liver. To achieve the desired pharmacodynamic response to the drug, the nurse would expect the drug's dose to be: A:higher than the standard dose. B:lower than the standard dose. C:the same as the standard dose. D:the same as the standard dose, but given more frequently.
Correct:B To prevent drug toxicity, a smaller-than-standard dose is expected.
An infant has been receiving an intravenous fentanyl infusion for 10 days, with the dose being the same for the past 7 days. The nurse notices a gradual increase in the infant's pain scores over the past 12 hours. Vital signs and physical examination remain stable. The nurse considers which of the following conditions has developed? A:Addiction B:Tolerance C:Withdrawal D:Dependence
Correct:B Tolerance is characterized by a diminished response to a medication that is given over a prolonged period. Tolerance exists when increasing doses and serum concentrations are needed to illicit the desired response.
Very-low-birth-weight infants present nutritional challenges related to their: A:low ratio of body surface area compared to weight. B:limited ability to digest and absorb fats, carbohydrates, and macro/micronutrients. C:decreased energy needs related to body composition. D:decreased water requirements.
Correct:B Very low-birth-weight (VLBW) infants have an immature gastrointestinal system, which limits their ability to digest and absorb fats, carbohydrates, macronutrients, and micronutrients.
The nurse should anticipate the tapering of parenteral amino acid intake in the extremely low-birth-weight infant when enteral nutrition reaches how many milliliters per kilogram per day? A:20 B:40 C:75 D:140
Correct:C A minimum of 75 ml/kg/day of enteral nutrition should be achieved before parenteral amino acids are tapered in extremely low-birth-weight and very low-birth-weight infants. Protein malnutrition can easily develop in this patient population during the transition from parenteral to enteral nutrition.
Methylxanthines, such as caffeine (Cafcit) and theophylline (Elixophyllin), are used in the treatment of apnea of prematurity. The infant receiving caffeine should be monitored for: A:hypocalcemia. B:hypersomnolence. C:feeding intolerance. D:temperature instability.
Correct:C Although cardiovascular symptoms such as tachycardia or dysrhythmias are most indicative of methylxanthine toxicity, gastrointestinal problems commonly occur.
The RN is caring for a stable, 2-day-old infant born at 27 weeks postconceptional age. The patient is receiving nasal continuous positive airway pressure and trophic feedings. The RN understands that which of the following represents appropriate, routine care for this patient? A:Use of an orogastric Replogle tube set to low, continuous suction B:Use of a vented indwelling orogastric feeding tube, capped between feedings C:Use of a vented indwelling orogastric feeding tube D:Use of an in-and-out orogastric feeding tube for feedings (no indwelling orogastric tube is maintained)
Correct:C Although the use of a vented orogastric tube in the setting of providing feedings is a challenge, it is crucial to provide venting of the air that enters the gastric space from nasal continuous positive airway pressure.
A 3-cm increase in abdominal girth, visible bowel loops, increased apnea episodes, and a 50% residual from the infant's last feed is noted upon clinical examination. The nurse should anticipate an order for which type of x-ray? A:Anterior/posterior chest B:Anterior/posterior abdomen C:Anterior/posterior abdomen and cross-table lateral D:Lateral decubitus and anterior/posterior chest
Correct:C Anterior posterior (AP) abdomen and cross-table lateral films will determine the presence of free air, given the concern for pneumoperitoneum per the clinical examination. Because free air rises, the cross-table lateral has the capability of showing free air positioned just under the abdominal wall.
Arachidonic acid and docosahexaenoic acid should be provided during enteral feedings for the preterm infant for which of the following purposes? A:Protein and nucleic acid synthesis B:Bone mineralization C:Neurological and visual development D:Hemoglobin synthesis
Correct:C Arachidonic acid and docosahexaenoic acid are considered conditional essential nutrients in preterm infants and should be provided during enteral feedings to improve neurologic and visual development and modulate immune functions.
Carbohydrates should supply what percent of an infant's total caloric intake? A:7 to 16 B:25 to 35 C:40 to 50 D:80 to 90
Correct:C Carbohydrates are the principal source of energy for the brain and heart and should supply 40% to 50% of an infant's total caloric intake. Values less than the recommended amount may result in hypoglycemia. Values higher than the recommended amount may lead to diarrhea and are associated with high-energy diets. Increasing evidence suggests that high-energy diets in the neonatal period have the potential to result in rapid adipose gains and may contribute to obesity, insulin resistance, and type 2 diabetes later in life.
The five constructs of developmental care are a method to operationalize developmental principles into practical applications for each individual infant. The constructs include cues, clues, consider, connect, and communicate. An example of consider would be to: A:observe the infant and determine whether the behaviors the nurse sees indicate stability or stress. B:check the situation and the environment for reasons for the observed behavior. C:decide what would be the best response based on the knowledge of the infant and the infant's reaction. D:see if it is possible to determine what events trigger infant stressors.
Correct:C Consider is deciding on the best response using the knowledge the nurse has gathered from the cues and clues.
The nurse admitting a 26-week infant who is on high-frequency ventilation and vasopressors is talking with the parents of the infant. The parents would like to start infant massage on their son now. The most appropriate response by the nurse to this request is: A:"Infant massage has shown to have positive effects for preterm infants." B:"Your son is too sick to be touched at this time." C:"Touch is important and your son needs you to make contact with him but massage may be too much stimulation for him at this time." D:"Massage can only be done by a certified infant massage therapist."
Correct:C Current research has shown that infant massage is best utilized for medically stable preterm infants at a variety of gestational ages. At this time their son may be too overstimulated by massage when he is dealing with respiratory and blood pressure problems. The nurse can guide the family to more appropriate types of touch such as facilitated tuck.
What are the common contributing factors that predispose a late preterm infant to hypoglycemia? A:Increased glycogen stores and increased glucose utilization B:Decreased glycogen stores and decreased glucose utilization C:Decreased glycogen stores and increased glucose utilization D:Increased glycogen stores and decreased glucose utilization
Correct:C Decreases in substrate availability to meet the metabolic demands place the late preterm infant at risk to develop hypoglycemia.
Which of the following is true of newborn sleep states? A:Oxygen consumption is lowest during rapid eye movement sleep. B:The best state for interaction with parents is the active alert state. C:Early dominant states are light sleep, quiet sleep, and active alert. D:As the infant matures, less time is spent in the quiet alert state
Correct:C Early dominant states influence the reaction of a newborn to stimuli and must be taken into account when providing developmentally supportive care.
A 35 2/7-week infant of a diabetic mother was delivered vaginally, weighing 3.5 kg. Premature rupture of membranes occurred 8 hours before delivery. Fluid was clear and nonodorous. Fetal monitoring strip revealed occasional variable decelerations with moderate variability. A cesarean section was performed, and immediately after birth, the infant displayed the following symptoms: tachypnea, grunting, retractions, and cyanosis. Continuous positive airway pressure was provided in the delivery room. Upon admission into the NICU, the initial arterial blood gas revealed a combined respiratory and metabolic acidosis with hypoxia. Initial chest x-ray revealed a reticulograndular pattern. Admission vital signs: heart rate 155; respiratory rate 68; peripheral blood pressure 62 systolic, 42 diastolic; oxygen saturation right hand 88%; oxygen saturation in left foot 88%. Given this information, which of the following differential diagnoses most likely correlates with this infant's presentation? A:Persistent pulmonary hypertension of the newborn B:Pneumonia C:Respiratory distress syndrome D:Transient tachypnea of the newborn
Correct:C Fetal hyperinsulinemia contributes to delayed maturation of the lungs, which inhibits the production of surfactant and increases the risk of surfactant deficiency related to respiratory distress syndrome. The reticulograndular pattern is suggestive of respiratory distress syndrome.
A side effect of anticholinergic ophthalmic medications used in neonates undergoing an examination for retinopathy of prematurity is: A:bradycardia. B:somnolence. C:respiratory distress. D:increased gastrointestinal transit time.
Correct:D Anticholinergic drugs block acetylcholine at parasympathetic muscarinic receptors. Their actions include increased heart rate, pupil relaxation, and decreased tone and motility of the gastrointestinal tract.\
A 30-week-gestation infant who is not physiologically stable will be undergoing a painful procedure. Which of the following techniques can be taught to parents so that they can provide developmental support to their baby to reduce pain response behaviors? A:Singing to the baby during the procedure B:Rapid stroking of the extremities C:Using their hands to provide flexed containment of the extremities D:Using a soft blanket to maintain gentle extension of the extremities
Correct:C Gentle human touch to provide flexion and containment has a soothing effect.
A late preterm infant is admitted from the labor and delivery department with grunting, flaring, retractions, and a maternal history of chorioamnionitis. An anteroposterior chest x-ray is immediately obtained and reveals generalized opacity. The nurse should anticipate that the infant is afflicted with which of the following conditions? A:Surfactant deficiency B:Congenital diaphragmatic hernia C:Pneumonia D:Bronchopulmonary dysplasia
Correct:C Given the history of maternal chorioamnionitis and the opacity of the film, pneumonia would be the most likely scenario.
Repeated exposure to painful stimuli has short- and long-term consequences. Which explanation best describes pain exposure in neonates? A:There are no appropriate pain assessment tools for preterm infants. B:Short-term effects of pain exposure include increases in oxygenation and heart rate. C:Long-term effects of pain exposure include increased somatic complaints and structural changes in the brain. D:The use of sucrose to reduce painful responses is mostly anecdotal and without supporting evidence.
Correct:C Long-term effects of pain include alterations in sensitivity to commonplace pain, somatic complaints, and structural changes in the brain.
Which of the following substrates is most influential to achieve optimal weight gain for the premature infant? A:Carbohydrate B:Fat C:Protein D:Sodium
Correct:C Proteins are the driving source for weight gain in the premature infant as the major functional and structural components of all human cells.
Als' synactive theory provides a framework for understanding preterm behavior. Als identified the autonomic, the motor, and the state systems of the preterm infant. An example of an intervention focused on the motor system is: A:reducing light and sound. B:providing paced feedings. C:providing boundaries or nesting. D:encouraging brief eye contact with family members at 30 weeks.
Correct:C Providing boundaries can assist with motoric stability such as posture and movement.
The RN is caring for a 630-g infant born at 27 weeks postconceptional age on day 3 of life. The RN chooses which of the following interventions as the best for balancing the needs of the parents to achieve parental role against the physiologic needs of the infant at this stage? A:Assuring the parents that their baby will be best served by delaying parental interaction until the baby reaches 2 weeks of age B:Assisting the parents to provide skin-to-skin care C:Assisting the parents to provide minimally stimulating, containing touch D:Encouraging the parents to determine whether or not to continue antibiotics beyond the third day of life
Correct:C Providing minimally stimulating, containing touch meets the needs of the extremely low-birth-weight infant in the initial stages of life by enhancing autonomic stability.
Which is true of noise exposure for premature infants in NICUs? A:A safe range to decrease physiologic stress is 100 to 110 dB. B:The human voice does not generally exceed the recommended decibel level. C:Increased environmental noise levels are a stressor to all infants, including preterm, term, ill, and well. D:Being inside an incubator sufficiently protects the infant from excessive decibel levels.
Correct:C Recommended noise levels are below 45 dB. Effects of loud noise affect all infants. Noise increases avoidance behaviors, disturbs sleep, increases cerebral blood flow and intraventricular hemorrhage, increases cardiorespiratory instability, and increases sensorineural hearing loss.
The nursing plan of care for the growing preterm infant includes approximately how many calories per kilogram per day to sustain adequate energy intake? A:40 B:80 C:120 D:150
Correct:C The average energy intake for preterm infants to support weight gain is 105 to 130 kcal/kg per day.
Which statement about the development of the human brain is the most accurate? A:The newborn brain is largely formed by term and is completely developed by 2 years of age. B:Developmental outcome is influenced almost entirely by genetic history, and environmental events have a minimal effect. C:The brain is a chain of communicating cells, and every touch, movement, and emotion affects its wiring and development. D:The brain of a preterm infant at 24 weeks' gestation has many cortical sulci, and these involutions can be harmed by inappropriate stimulation, excessive noise, and repetitive painful stimuli.
Correct:C The brain is a chain of communication cells, and every touch, movement, and emotion affect its wiring and development.
What is the preferred route of antibiotics for septic infants? A:Oral B:Topical C:Intravenous D:Intramuscular
Correct:C To minimize unpredictable pharmacokinetics and thus optimize the probability of a response to antibiotics, the intravenous route is the preferred route of administration when treating septic infants.
Sensory development proceeds in a specific order, and stimulation of one system influences other systems. The first sensory system group to develop is: A:auditory/visual. B:olfactory/gustatory. C:tactile/vestibular. D:temperature/pressure.
Correct:C Touch is the first sense to develop at approximately 7.5 weeks of age, and sensitivity to touch is very well developed in the face, lips, and hands.
The RN is using a hybrid warmer to manage the thermal needs of a 750-gram infant born yesterday at 24 weeks postconceptional age. When considering optimal thermal support for this infant, the RN understands that this is best accomplished by: A:using a humidity setting of greater than 70% while maintaining the device in the radiant warmer mode. B:using a humidity setting of greater than 50% while maintaining the device in the radiant warmer mode. C:using a humidity setting of greater than 70% while maintaining the device in the incubator mode. D:using a humidity setting of greater than 50% while maintaining the device in the incubator mode.
Correct:C Use of humidity greater than 70% is recommended for initial care of the extremely low-birth-weight infant.
Best practices for a developmentally supportive NICU environment include: A:windows that allow daylight in, use of auditory alarms, and cue-based nursing care. B:continuous fluorescent lighting, placement of pagers on vibrate mode, and provision of nonnutritive sucking. C:day-night cycling of light, avoidance of overhead paging, and rigid timing of nursing care. D:use of a procedure light, use of acoustical tile, and assessment of stress signals when providing nursing care.
Correct:D Best practices include use of a procedure light to allow for a focused source instead of overhead lighting, use of acoustical tile and visual alarms, avoidance of overhead paging to reduce ambient sound level, and assessment of stress signals when providing nursing care so that the nurse can determine when to stop providing care and let the baby recover, also known as cue-based care timing.
The factor that most determines drug distribution is: A:half-life. B:drug interactions. C:plateau (steady-state) drug level. D:vascular perfusion of the tissue or organ.
Correct:D Blood flow to tissues is the simplest factor determining drug distribution. Drugs are distributed via the circulatory system and reach tissues at a rate proportional to blood flow. The heart, liver, and kidneys receive a high percentage of the blood supply and thus highest exposure to drugs.
In extremely premature infants, initial enteral feedings of colostrum will result in which of the following? A:Delay induction of many digestive enzymes B:Prohibit the endocytosis of proteins C:Deliver low concentrations of secretory IgA D:Facilitate rapid growth of the intestinal mucosal surface
Correct:D Colostrum contains growth factors, and initial enteral feedings of colostrum in the premature infant stimulates rapid growth in the intestinal mucosal surface area and propagation of many digestive enzymes. It also promotes endocytosis of proteins and delivers high concentrations of secretory IgA.
An abdominal x-ray finding reveals a double bubble. The nurse should anticipate this finding to be indicative of which condition? A:Colonic obstruction B:Meconium ileus C:Pneumoperitoneum D:Duodenal atresia
Correct:D Duodenal atresia is classically seen radiologically as a double bubble as air in the stomach presents as the first bubble and the dilated duodenum filled with air is the second bubble.
Which of the following nutritional deficiencies is associated with poor weight gain, scalingrash, sparse hair growth, thrombocytopenia, and decreased platelet aggregation? A:Zinc deficiency B:Copper deficiency C:Iodine deficiency D:Essential fatty acid deficiency
Correct:D Essential fatty acid deficiency is associated with poor weight gain, scaling rash, sparse hair growth, thrombocytopenia, and decreased platelet aggregation and can be prevented by supplementing exogenous intravenous fat emulsions within 72 hours.
Developmental care supports sensory integration. Infants born preterm and/or critically ill are at high risk for sensory integration dysfunction due to the presence of sensory stimulation outside the normal sequence, brain injury, and environmental excesses. An example of appropriate sensory developmental care is: A:introduction of music at 28 weeks' gestation. B:mixing medications with a small amount of feedings before the main feeding. C:education and having parents implement infant massage as soon as possible in order to have them make a "connection" with their infant. D:using indirect lighting or eye covers to protect the infant's eyes if less than 32 weeks' gestation.
Correct:D External stimulation of the visual system should be kept to a minimum. Infants less than 35 weeks have an incompetent pupillary reflex and need their eyes protected from light.
Iron deficiency in preterm infants can lead to: A:poor bone mineralization. B:oxidative red blood cell injury and hemolysis. C:poor repair and growth of epithelial tissue D:anemia and adverse effects on brain development and function.
Correct:D If iron stores are depleted and not available from dietary sources, the infant's hemoglobin will decline and potentially lead to an anemic state. Iron deficiency in preterm infants can also lead to adverse effects on brain development and function.
The nurse should expect increased pulmonary vascular markings in an infant with which of the following conditions? A:Pneumo mediastinum B:Pleural effusion C:Pneumothorax D:Congestive heart failure
Correct:D Increased pulmonary venous engorgement is associated with congestive heart failure and will result in increased pulmonary vascular markings.
Which of the following is true regarding nonnutritive sucking (NNS)? A:NNS can lead to oral aversion. B:NNS can be used as a sign of readiness for nipple feeding. C:NNS is thought to impair sucking skills if overutilized before initiating bottle feeding. D:NNS is synergistic with a sweet taste, such as sucrose, on the tip of the tongue in decreasing pain responses.
Correct:D Nonnutritive sucking (NNS) is synergistic with a sweet taste on the tip of the tongue in decreasing pain responses. NNS is consoling.
Which of the following statements by the nurse would be most appropriate when educating the parents of a 26-week-gestation neonate about the advantages of parenteral nutrition infused through a central line? A:Promotes intestinal growth and maturation B:Decreases the risk of infection C:Minimizes risk of vessel perforation and infiltration D:Allows for delivery of higher concentrations of glucose
Correct:D One advantage of nutrition through a central line is that it permits higher concentrations of intravenous glucose, which may be required to maintain normal plasma glucose and meet glucose demands.
Core measures for developmental care have been identified and include (1) protected sleep, (2) pain and stress assessment and management, (3) developmental activities of daily living, (4) family-centered care, and (5) a healing environment. What is an example of a criterion for developmental activities of daily living? A:All caregiving activities are modified according to the infant's state. B:Physical and auditory privacy is offered at each patient bed space. C:Resources are available 24/7 to support implementation of developmental care. D:Skin assessment is done once per shift and documented.
Correct:D Skin assessment falls under the core measure of developmentally supportive activities of daily living, specifically under the attribute of skin care. Other attributes include positioning and feeding.
Which of the following is true of kangaroo care? A:Olfactory sensations occur with the rise and fall of the parent's chest. B:Documentation of length of kangaroo care time is not needed, because it is universally well tolerated. C:The practice of standing transfer may increase stress during movement from the incubator to the parent's chest. D:Skin-to-skin contact provides tactile stimulation, promotes physiologic stability, and improves maternal milk production.
Correct:D Skin-to-skin contact provides tactile stimulation, promotes physiologic stability, and improves maternal milk production.
The principal parenteral energy source for neural tissue and metabolic processes in an infant weighing less than 1000 grams is intravenous: A:fat emulsion. B:amino acids. C:sodium. D:glucose.
Correct:D The main intravenous energy source for neural tissue and metabolic processes is glucose. The rate of glucose production in neonates weighting less than 1000 grams is approximately 8 to 9 mg/kg/min.
What is the most common cause of rehospitalization of the late preterm infant between 6 and 12 months of life? A:Hyperbilirubinemia B:Early-onset sepsis C:Apnea D:Respiratory illnesses
Correct:D The most common cause of rehospitalization between 6 and 12 months of age is respiratory illnesses. The most common illness is respiratory syncytial virus.
The mother of an extremely low-birth-weight infant reports that she is pumping very small amounts of breast milk and asks the nurse about alternative options to maternal breast milk. Which of the following statements is most appropriate for the nurse to share with the mother? A:Human donor milk has the same nutritional properties as maternal breast milk. B:Formula is an option because donor human milk may put the infant at risk for HIV or cytomegalovirus. C:Formula is an option and may decrease the incidence of necrotizing enterocolitis (NEC). D:Donor human milk may decrease the incidence of NEC.
Correct:D The nurse instructs the parents that there is an important advantage to using donor human milk instead of formula, predominantly to decrease the incidence of necrotizing enterocolitis (NEC) in premature infants.
An intubated infant is given intravenous fentanyl (Sublimaze) postoperatively for pain control. Suddenly, the infant exhibits desaturation followed by decreasing heart rate. The infant remains intubated without an air leak. Which of the following is a possible cause of this infant's deteriorating condition? A:Hypertension B:Vagal response C:Anesthetic gases D:Chest wall rigidity
Correct:D The positive and negative effects of fentanyl occur rapidly. The infant receiving fentanyl should be monitored for chest wall rigidity and respiratory depression. Chest wall rigidity occurs most often when fentanyl is administered too rapidly.
Which of the following statements by the nurse to a parent most accurately describes the protein content of preterm human milk? A:Less than term human milk B:Equal to term human milk and increases over the first few weeks of lactation C:Equal to term human milk throughout lactation D:Greater than term human milk
Correct:D The protein content of preterm human milk is greater than term human milk; however, the protein content decreases over the first few weeks of lactation.
The optimal ratio of calcium to phosphorus to meet recommended dietary daily requirements and enhance growth for the premature infant is: A:1:1. B:1:2. C:1:4. D:2:1.
Correct:D The ratio of calcium to phosphorus should be approximately 2:1 to enhance growth and meet recommended daily requirements based upon rates of fetal accretion and an estimate of 50% to 70% intestinal absorption. In human milk the ratio of calcium to phosphorus is also 2:1. Ratios outside the recommended daily requirements may lead to inappropriate serum levels of calcium and phosphorus, and further lead to unsuitable accretion rates of minerals by the skeleton and absorption of minerals by the preterm intestine.