Chapter 20: The Newborn at Risk: Gestational and Acquired Disorders

A late preterm newborn is born at: Between 32 and 34 weeks Between 32 and 36 weeks Between 34 and 36 weeks Between 34 and 37 weeks

Between 34 and 37 weeks

Which environmental consideration is most helpful to promoting comfort when the neonate is withdrawing from alcohol and drugs? Offer tactile stimulation Provide a dark, quiet environment Play soothing music Incorporate a massage

Provide a dark, quiet environment

Which assessment finding within the first 24 hours of birth requires immediate health care provider notification? The skin is jaundiced. Milia is noted on the nose. The neonate slept for 18 hours. The neonate ate 1 to 2 oz of formula.

The skin is jaundiced

What is the most common reason why an infant will be small for gestational age (SGA)? Intrauterine growth restriction Oligohydramnios Placenta previa Hyperemesis gravidarum

Intrauterine growth restriction

Which nursing action is required when caring for the post-term infant? Echocardiogram at the end of pregnancy Serial blood glucose levels temperature checks every 2 hours IV initiation

Serial blood glucose levels

Which classification for gestational age is correct? Preterm is a newborn born before 37 weeks. Post-term is a newborn born after 42 weeks. Preterm is a newborn born before 36 weeks. Post-term is a newborn born after 42 weeks. Preterm is a newborn born before 36 weeks. Post-term is a newborn born after 40 weeks. Preterm is a newborn born before 37 weeks. Post-term is a newborn born after 40 weeks.

Preterm is a newborn born before 37 weeks. Post-term is a newborn born after 42 weeks.

The nurse is caring for a post-term neonate. Which assessment findings are congruent with the age determination? Select all that apply. Hyperalert expression Dry, cracked and peeling skin Little vernix remains Dense lanugo Little subcutaneous fat Long fingernails

Hyperalert expression Dry, cracked and peeling skin Little vernix remains Little subcutaneous fat Long fingernails

A newborn has been diagnosed recently with transient tachypnea of the newborn. How should the nurse counsel the parents? "I know it's scary now, but this condition most likely will resolve on its own without affecting your baby in the long run." "Although this condition is very treatable, it is most likely caused by an infection, and we will need to start him on antibiotics." "This is happening because your baby was born via cesarean. If you had had a vaginal delivery, this wouldn't be happening." "Unfortunately, there isn't any treatment for this condition. We will need to show you how to monitor your baby at home, particularly for blueness around the mouth."

"I know it's scary now, but this condition most likely will resolve on its own without affecting your baby in the long run.

The pregnant woman with diabetes asks the nurse why her last baby weighed 11 pounds. What is the best response by the nurse? "Your baby weighed so much because of how you were eating. You must eat less with this child." "The fetus increases insulin production in response to elevated glucose levels of the mother, which acts as a fetal growth hormone." "The fetus maintains elevated levels of glucose in response to the mother's eating patterns and gains too much weight." "There is no way to control the amount of glucose the mother is producing, because she can't take insulin while she is pregnant and the baby gains too much weight."

"The fetus increases insulin production in response to elevated glucose levels of the mother, which acts as a fetal growth hormone."

A woman gave birth to a healthy term newborn about 2 hours ago. She asks the nurse about the appearance of her newborn's head. Assessment reveals swelling of the head that extends across the midline. Which response by the nurse would be appropriate? "The swelling in your newborn's head is due to the head pressing against your cervix during labor and birth. It will go away on its own in a few days." "The tiny blood vessels under your newborn's skull broke during labor and caused the swelling. It will get better in about 2 to 3 weeks." "You must have had some problems during labor with keeping your blood pressure under control. Your newborn will need to be handled gently." "Your newborn has a collection of blood that was caused by tearing of the veins and is pushing on the brain. This collection of blood will need to be drained."

"The swelling in your newborn's head is due to the head pressing against your cervix during labor and birth. It will go away on its own in a few days."

A newborn has been diagnosed with retinopathy of prematurity. The nurse is teaching the parents about this condition. Which statement would the nurse most likely include in the teaching? "You'll need to schedule follow-up eye examinations with the pediatric ophthalmologist." "Let's talk about the surgery that will be needed." "You'll need to give the eye drops each day for the next few weeks." "It's difficult now, but rest assured that your baby will grow out of it."

"You'll need to schedule follow-up eye examinations with the pediatric ophthalmologist."

The nurse is caring for a client who is at her due date. The client asks. "How long is the health care provider going to let me go?" The nurse is correct to state that typical a mother should not pass how many weeks' gestation? 40 weeks 41 weeks 42 weeks 44 weeks

42 weeks

What is the responsibility of the registered nurse (RN) after the delivery of the newborn? Select all that apply. Assessing the gestational age. Identifying potential complications. Intubating the infant if there is respiratory compromise. Initiating the plan of care. Ordering a prophylactic antibiotic for possible meconium aspiration.

Assessing the gestational age. Identifying potential complications. Initiating the plan of care.

The nurse is preparing to administer a tube feeding to a preterm infant. When checking for residual prior to the feeding, there is a residual of 3 mL. What action should the nurse take? Administer the tube feeding. Take the tube out. Reduce the amount of the tube feeding by half. Call the physician.

Call the physician

A nurse is caring for a newborn who was diagnosed with an imperforate anus. Assessment reveals drooling, copious bubbles of mucus in mouth, rattling respirations, and abdominal distention. During feeding, the newborn coughs and becomes cyanotic. Which action by the nurse would be appropriate? give gavage feedings clear the airway suction the throat prepare for endotracheal intubation

Clear the airway

The nurse is assessing the plantar creases on the newborns for documentation on the Ballard Scale. Which documentation is interpreted as evidence of a full-term infant? Middle crease across the palm of the hand No deep creases on the newborn's body Creases covering two-thirds of the anterior foot Creases extending across the brow

Creases covering two-thirds of the anterior foot

What intervention can the nurse provide to reduce pain and stress in the preterm infant? Speak clearly and loudly around the infant. Touch the infant frequently to provide stimulation. Create minimal stimulation and reduce procedures that cause pain. Give pain medication hourly.

Create minimal stimulation and reduce procedures that cause pain.

At which point is the treatment (RhoGAM) for the hemolytic disease of the newborn finished? During the prenatal period Immediately before delivery During the postpartum period It is no longer needed after the first pregnancy.

During the postpartum period

Newborns born to a mother with diabetes are at risk for which of the following? Hypoglycemia, delayed fetal lung maturity, respiratory distress, and shoulder dystocia Hyperglycemia, meconium aspiration syndrome, cerebral ischemia, and polycythemia Hypoglycemia, polycythemia, respiratory distress, and hyperviscosity of the blood Hyperglycemia, intrauterine hypoxia, hemolytic disease of the newborn, and hyperviscosity of the blood

Hypoglycemia, delayed fetal lung maturity, respiratory distress, and shoulder dystocia

A neonate is diagnosed with Erb's palsy after birth. The parents are concerned about their neonate's limp arm. The nurse explains the neonate will be scheduled to receive what recommended treatment for this condition first? Physical therapy to the joint and extremity Nothing but time and let nature take its course Surgery to correct the joint and muscle alignment Immobilization of the shoulder and arm

Immobilization of the shoulder and arm

A nurse is caring for a preterm newborn born at 29 weeks' gestation. Which nursing diagnosis would have the highest priority? Grieving related to the loss of "a healthy full-term newborn" Ineffective thermoregulation related to decreased amount of subcutaneous fat Risk for injury related to the very thin epidermis layer of skin Imbalanced nutrition: Less than body requirements related to the premature digestive system

Ineffective thermoregulation related to decreased amount of subcutaneous fat

A newborn admitted to the nursery weighs 2,000 grams. This newborn is classified as which of the following? Low birth weight Very low birth weight Normal birth weight High birth weight

Low birth weight

The nursing students describe the infant they are caring for as weighing 2000 g. The instructor knows that effective communication among staff members suggests that what term be used to describe the infant? Low birth weight (LBW) Very low birth weight (VLBW) Large for gestational age (LGA) Extremely low birth weight (ELBW) Appropriate for gestational age (AGA)

Low birth weight (LBW)

A newborn is exhibiting symptoms of withdrawal and toxicology test have been prescribed. Which type of specimen should the nurse collect to obtain the most accurate results? Meconium Blood Urine Sputum

Meconium

At birth, a neonate is diagnosed with brachial plexus palsy. The parent asks how the nurse knows the baby's positioning of the arm is a result of the palsy and not just a preferred position. The nurse would show the parent that the neonate has asymmetry of which neonatal reflex? Moro reflex Stepping reflex Rooting reflex Babinski reflex

Moro reflex

When providing care to the newborn withdrawing from a drug such as cocaine or heroin, which drug is given to ease the symptoms and prevent complications? Acetaminophen Ibuprofen Morphine Aspirin

Morphine

What would the nurse suspect in a premature newborn who has difficulty feeding and maintaining a stable temperature and is vomiting bile? Necrotizing enterocolitis Meconium aspiration syndrome Intraventricular hemorrhage Respiratory distress syndrome

Necrotizing enterocolitis

The nurse in the newborn nursery has used the Ballard scoring system to assess the newborn. This gestational assessment evaluation includes which of the following categories of maturity of the newborn? Neuromuscular and physical Cardiac and psychological Genitourinary and hearing Respiratory and vision

Neuromuscular and physical

The nurse is providing care to a large-for-gestational age newborn whose mother has diabetes. The mother is breastfeeding the newborn approximately every 2 to 3 hours. The nurse is monitoring the newborn's blood glucose levels. Previous blood glucose levels were as follows: 0900: 44 mg/dL (2.44 mmol/L) 1200: 50 mg/dL (2.77 mmol/L) It is now 1500 and the newborn's blood glucose level is 33 mg/dL (1.83 mmol/L). Which action would the nurse do next? Continue to encourage the mother to breastfeed every 2 to 3 hours. Supplement the mother's breastfeeding with 2 ounces of glucose water. Prepare to initiate an intravenous infusion of glucose after reporting the result. Reduce environmental stimuli to minimize stress on the newborn.

Prepare to initiate an intravenous infusion of glucose after reporting the result.

The nurse is caring for an intrapartum mother whose fetus has asymmetrical intrauterine growth restriction (IUGR) after the 24th week of gestation. Which nursing action is best? Provide emotional support to the mother and support person as the neonate has anomalies. Regular assessment of the fetal monitor tracings and preparation for a cesarean birth, if needed. Anticipate a precipitous delivery since the neonate is small-for-gestational-age. Use regular assessment techniques as an uncomplicated delivery is anticipated.

Regular assessment of the fetal monitor tracings and preparation for a cesarean birth, if needed.

A nurse observes in a preterm newborn a respiratory rate of 60, nasal flaring, and retractions. What do these clinical manifestations indicate to the nurse? Polycythemia Neonatal jaundice Respiratory distress syndrome Rh incompatibility

Respiratory distress syndrome

Upon shift handoff the nurse reports meconium staining of the amniotic fluid. Which neonatal system requires close monitoring by the incoming nurse? Gastrointestinal system Cardiovascular system Endocrine system Respiratory system

Respiratory system

The student nurse is performing a Ballard scale on a newborn. The instructor assesses that the student understands methods to check neuromuscular maturity when she gently pulls the newborn's arm in front of and across the top portion of the body until resistance is met and identifies this action as: Square window. Arm recoil. Scarf sign. Popliteal angle. Posture.

Scarf sign.

Which preventable cause of intrauterine growth restriction (IUGR) is most common? Smoking Alcohol use Gestational diabetes Hypertension

Smoking

Which nursing actions limit overstimulation of the preterm infant? Select all that apply. Tap on the isolette before opening the door. Speak softly to the infant. Keep lights low in the nursery. Frequently open the isolette portholes. Coordinate nursing care.

Speak softly to the infant. Keep lights low in the nursery. Coordinate nursing care.

The nurse is working in the special care nursery caring for a newborn withdrawing from alcohol. Which nursing intervention promotes client comfort? Administer benzodiazepines Provide 1 ounce of formula Swaddle and decrease stimulation Promote parental bonding

Swaddle and decrease stimulation

The client brings her infant daughter to the pediatrician's office for her first visit since hospital discharge. At birth, the newborn was at the 8th percentile with a weight of 2,350 g. She was born at 36 weeks' gestation. Which documentation is most accurate? The infant was a preterm, low birth weight and small for gestational age neonate. The infant was born at term but at a low birth weight and small for gestational age. The infant was born at term but a very low birth weight and small for gestational age. The infant was a preterm, very low birth weight and small for gestational age.

The infant was a preterm, very low birth weight and small for gestational age.

In doing the Ballard assessment of gestational age, which of the following is done to assess what is called the scarf sign? The infant's arm is pulled gently in front of and across the top portion of the body until resistance is met. It is the measurement of the wrist angle with flexion toward the forearm until resistance is met. The infant's foot is moved to as close to the head as possible without forcing the foot. It is the measurement of the knee angle when the thigh is flexed and the lower leg extended until resistance is met.

The infant's arm is pulled gently in front of and across the top portion of the body until resistance is met.

The nurse is caring for a newborn who is large-for-gestational-age (LGA). Which characteristics are documented as a contributing factor? Select all that apply. The mother has had previous large-for-gestational-age neonates. The mother has poorly controlled diabetes. Both parents are of a larger stature and size. The father is obese but mother is of normal weight. The neonate is a female.

The mother has had previous large-for-gestational-age neonates. The mother has poorly controlled diabetes. Both parents are of a larger stature and size.

The nurse is assessing a male neonate using the Ballard gestational age assessment tool. The neonate has the following characteristics: Deep cracking skin, no vessels Thinning lanugo Creases on the plantar surface Raised areola Formed ear, instant recoil Testes down, good rugae From the above characteristics, which can the nurse determine? The neonate has intrauterine growth restriction. The neonate is a term newborn. The neonate has been born preterm. The neonate has post-term characteristics.

The neonate is a term newborn.

The nurse is caring for a preterm neonate and has chosen the following goal: improvement of the neonate's respiratory function. Which expected outcome is most appropriate for the first week? The neonate will not use accessory muscles when breathing. The neonate will have 99% oxygen saturation. The neonate will sleep without apnea periods. The neonate will maintain a temperature under 99.5°F (37.5°C).

The neonate will not use accessory muscles when breathing.

The NICU nurse is caring for a preterm neonate with respiratory distress syndrome on mechanical ventilation. Which assessment data would alert the nurse that a pneumothorax might have developed? Select all that apply. Neonate's blood pressure is 80/50. The neonate's respiratory rate is 68. Oxygen saturation is 92% and heart rate is 130. Neonate is exhibiting nasal flaring and grunting. Chest radiography reveals low lung volume and a ground glass appearance. The neonate's chest is asymmetrical with decreased breath sounds on one side.

The neonate's respiratory rate is 68. Neonate is exhibiting nasal flaring and grunting. The neonate's chest is asymmetrical with decreased breath sounds on one side.

A nurse is caring for a neonate of 25 weeks' gestation who is at risk for intraventricular hemorrhage (IVH). Which assessment finding should be reported immediately? a sudden drop in hematocrit soft, flat anterior fontanels (fontanelles) pink skin with noted blue extremities intake and output for 8 hours

a sudden drop in hematocrit

A preterm newborn is noted to have hypotonia, apnea, bradycardia, a bulging fontanel (fontanelle), cyanosis, and increased head circumference. These signs indicate the newborn has which complication? intraventricular hemorrhage (IVH) cold stress respiratory distress syndrome retinopathy of prematurity (ROP)

intraventricular hemorrhage (IVH)

A newborn is found to have hemolytic disease. Which combination would be found related to the blood types of this newborn and the parents of the newborn? newborn who is type A, mother who is type O newborn who is type A, father who is type O newborn who is type O, mother who is type O newborn who is type O, father who is type A

newborn who is type A, mother who is type O

The parents of an 8-month-old tell the nurse that they have a fear that the infant will develop sudden infant death syndrome (SIDS). What is the best response by the nurse? "There is no need to worry about it, because it is unexpected and cannot be prevented." "I don't blame you. I worried about it when I had my children." "Infants who die from SIDS are usually 2 to 4 months old, but I understand your concern." "Be sure you place the infant on the abdomen while sleeping."

"Infants who die from SIDS are usually 2 to 4 months old, but I understand your concern."

What percentage of newborns are born with a complication or develop one shortly after birth? 1% 5% 10% 18%

10%

Extremely low birth weight, or ELBW, describes a newborn who weighs less than _______ g.

1000

The incidence of sudden infant death syndrome (SIDS) peaks at what age? During the neonatal period 1 to 2 months 2 to 4 months 4 to 6 months

2 to 4 months

Why is thermoregulation a problem for the preterm newborn? A preterm infant is not born with brown fat. A decrease in skin surface to body mass is noted. Water cannot escape easily through the skin. The CNS is overactive, leading to excessive shivering and use of glucose stores.

A preterm infant is not born with brown fat.

A nurse makes a home visit to a new mother and her 5-day-old newborn. Assessment of the newborn reveals slight yellowing of the skin on the face and forehead and slowed skin turgor. The mother tells the nurse that she's been having trouble breastfeeding the newborn. "My baby's been feeding about every 4 to 5 hours." Additional assessment reveals about 3 wet diapers per day and 1 to 2 stools per day. Which action by the nurse would be the priority? Call the provider to obtain a prescription for a bilirubin level. Arrange for home phototherapy. Evaluate the mother's technique for breastfeeding. Measure the newborn's abdominal girth.

Call the provider to obtain a prescription for a bilirubin level.

For which potential neonatal infection does the nurse anticipate using ophthalmic erythromycin? Chlamydia trachomatis Group B streptococcus (GBS) Human immunodeficiency virus (HIV) Herpes simplex type 1

Chlamydia trachomatis

Which of the following best describes the time between fertilization of the egg and birth? Gestational age Intrauterine growth Signs of pregnancy Trimesters

Gestational age

All of the following complications are more likely to develop in a large for gestational age (LGA) newborn as opposed to an appropriate for gestational age (AGA) newborn except: Polycythemia Cesarean delivery Breech presentation Shoulder dystocia

Polycythemia

The nurse is most correct to assess for transient tachypnea of the newborn (TTN) in which neonate? The large-for-gestational-age neonate The neonate delivered by cesarean section The neonate whose mother received limited prenatal care The neonate born at 41 weeks' gestation

The neonate delivered by cesarean section

The nurse is providing care to a newborn with macrosomia who has sustained a midclavicular fracture. When reviewing the mother's labor and birth record, the nurse notes the following information: Breech birth Amniotomy APGAR score: 7 at 1 minute; 8 at 5 minutes Oxytocin augmentation Which information would the nurse correlate with the newborn's current injury? breech birth amniotomy APGAR score: 7 at 1 minute; 8 at 5 minutes oxytocin augmentation

breech birth

The nurse is caring for an infant born to a mother with cocaine use disorder during her pregnancy. The nurse would likely notice that this infant: cries when touched. sleeps for long periods of time. weighed above average when born. has facial deformities.

cries when touched.

When providing postpartum teaching to a couple, the nurse correctly identifies what time as when pathologic jaundice may be found in the newborn? during the first 24 hours of life between 2 and 4 days of life after 5 days postpartum often with formula-fed babies

during the first 24 hours of life

A newborn requires resuscitation secondary to asphyxia. The resuscitation team frequently assesses the newborn's response and continues resuscitation efforts based on which assessment finding? vigorous cry heart rate of 70 beats/min respiratory rate 50 breaths/min pink tongue

heart rate of 70 beats/min

If a newborn whose weight, length, and head circumference falls into the 15th percentile for gestational age, the newborn would be said to be which of the following? Appropriate for gestational age Small for gestational age Preterm for gestational age Post-term for gestational age

Appropriate for gestational age

Which physical features are characteristic in a neonate born with fetal alcohol spectrum disorder? Select all that apply. flattened nasal bridge small ears eyelid folds small height and head circumference low birth weight hearing deficits

flattened nasal bridge eyelid folds small height and head circumference low birth weight

The nurse is caring for a newborn with fetal alcohol syndrome. The nurse knows that the newborn will demonstrate: Jitteriness. lethargy. a large head circumference. hyperactivity. hyperglycemia.

hyperactivity.

The nurse is caring for a neonate that is small for gestational age due to intrauterine growth restriction. Which is the most common cause? genetic characteristics oxygen and nutrient deficiency prior to birth mother with diabetes chromosomal abnormalities

oxygen and nutrient deficiency prior to birth

The nurse is providing care to a newborn with severe meconium aspiration syndrome (MAS). The nurse is reviewing the newborn's diagnostic test results. Which finding would the nurse expect? patchy, fluffy infiltrates on chest X-ray vocal cords negative for meconium elevated blood pH increased PaO2

patchy, fluffy infiltrates on chest X-ray

All of the following are characteristics of a preterm newborn except: the head is disproportionately small. an excessive amount of lanugo is present on the back and shoulders. undescended testes are present in the male, and a prominent clitoris is noted in the female. reflexes are weak or absent.

the head is disproportionately small.