Chapter 21: The Newborn at Risk: Congenital Disorders

A newborn boy is diagnosed with esophageal atresia and tracheoesophageal fistula. After the nurse provides preoperative teaching, which statement indicates that the parents need additional teaching? "He'll need antibiotics for a bit after the surgery to prevent infection." "We can probably start feeding him with the bottle about a day after the surgery." "The head of his bed will be elevated to prevent him from aspirating." "We can give him a pacifier to help satisfy his need to suck."

"We can probably start feeding him with the bottle about a day after the surgery."

Immediately after birth, the nurse is caring for a newborn with a myelomeningocele. What intervention should the nurse provide to prevent drying out of the sac to avoid damage? Cover the sac with petroleum jelly and a dry sterile dressing. Cover the sac with a water-soluble lubricant and a dry sterile dressing. Apply a sterile dressing moistened in a warm, sterile saline solution. Allow the sac to dry out to "toughen" it.

Apply a sterile dressing moistened in a warm, sterile saline solution.

When planning preoperative care for a newborn with a cleft lip and palate, the nurse would plan interventions for which major need? prevention of pneumonia prevention of oral infection nutrition visual stimulation

Nutrition

When examining a newborn for developmental dysplasia of the hip (DDH), which motion would the newborn's hip be unable to accomplish? abduction adduction rotation extension

abduction

Which diagnostic procedure is anticipated prior to heart surgery in an infant with a congenital heart defect? Magnetic resonance imaging (MRI) Computed tomography (CT) of the chest Cardiac catheterization A chest x-ray

Cardiac catheterization

Which nursing suggestion is most helpful in preventing symptoms from a 3-month-old's hiatal hernia? Increase the amount of feeding Feed in an upright position Add cereal to the feeding Use a hypoallergenic formula

Feed in an upright position

A nurse is caring for a child with complex esophageal atresia who will be undergoing surgery for repair. What comment by the parents indicates further teaching is required? "They will be placing a tube in the stomach during surgery." "The baby will have tubes in the chest to drain chest fluids." "Intravenous fluids are going to be needed so that the baby won't get dehydrated." "After this surgery is done tomorrow, my baby will be able to eat and drink."

"After this surgery is done tomorrow, my baby will be able to eat and drink."

The nurse is caring for a newborn client newly diagnosed with developmental dysplasia of the hip (DDH). Which response by the nurse educates the parents on the correct plan of treatment for this diagnosis? "Treatment will start once your child can bear weight." "Treatment will begin immediately." "Treatment will consist of surgery when your child weighs about 10 pounds." "Treatment will include bilateral casts at 1 month of age."

"Treatment will begin immediately."

The nurse is caring for an infant diagnosed with a ventricular septal defect. Which assessment findings does the nurse anticipate? Cyanosis A harsh murmur Fatigue Slow weight gain

A harsh murmur

A pediatric nurse who cares for newborns with congenital heart defects informs the precepting student nurse that cyanotic heart disease implies an oxygen saturation of the peripheral arterial blood of: 90% or less. 85% or less. 95% or less. 92% or less.

85% or less.

A new mother is concerned because she fears that her infant's head is larger than normal. What would be the nurse's best response? A large head at birth suggests hydrocephalus. A large head at birth in itself is not indicative of hydrocephalus, but we will keep a check on it. It will become even larger as the baby grows. If we do not drain the excessive fluid building up the child will have a problem raising the head when older.

A large head at birth in itself is not indicative of hydrocephalus, but we will keep a check on it.

In the infant diagnosed with spina bifida with myelomeningocele, the infant will likely have: a partial to complete paralysis in the lower extremities. a protruding sac that contains abdominal contents. a membrane between the rectum and the anus. an extremely large and rapidly growing head.

A partial to complete paralysis in the lower extermities

A newborn was diagnosed as having hypothyroidism at birth. The parent asks the nurse how the disease could be discovered this early. Which is the nurse's best answer? Hypothyroidism is usually detected at birth by the newborn's physical appearance. A newborn has a typical rash at birth that suggests the diagnosis. A simple blood test to diagnose hypothyroidism is required in most states. The newborn is already severely impaired at birth, and this suggests the diagnosis.

A simple blood test to diagnose hypothyroidism is required in most states

The nurse is reviewing the medical record of the antepartum client with an abnormal alpha-fetoprotein test. The mother is distraught and states, "How bad can it be?" The nurse is correct to describe which? A cardiac deficit A type of spina bifida A cleft lip and palate The absence of a kidney

A type of spina bifida

Which clinical manifestation is seen in the child with hydrocephalus? An extremely large and rapidly growing head A protruding sac that contains abdominal contents A membrane between the rectum and the anus Partial to complete paralysis in the lower extremities

An extremely large and rapidly growing head

Which health care provider assessment technique does the nurse anticipate being used to determine developmental dysplasia of the hip (DDH) on a newborn? Full range of motion of the hip Barlow sign and Ortolani click Assessing leg kicks for extension Visual inspection of the hip

Barlow sign and Ortolani click

A dietitian is consulted to assist with the planning of meals for a family that must follow a low phenylalanine diet since their child is now 2 years old and eating more table foods. Which instruction is anticipated? Select all that apply. This is an easy diet, just stay away from milk. Common foods must be eliminated. The child must remain on the diet until early adulthood. Formulas low in phenylalanine are available. Meats and fish must be eliminated. Care must be provided when eating out

Common foods must be eliminated. The child must remain on the diet until early adulthood. Meats and fish must be eliminated. Care must be provided when eating out

From which pair of metabolic disorders must the nurse instruct the parents to eliminate breast and cow's milk from the diet? Maple syrup urine disease and galactosemia Congenital hypothyroidism and phenylketonuria Galactosemia and phenylketonuria Turner syndrome and maple syrup urine disease

Congenital hypothyroidism and phenylketonuria

A nurse is caring for a newborn client who is diagnosed with myelomeningocele. Which nursing intervention would protect the newborn from injury? Place the newborn in a prone or lateral position. Delay the parents from holding the newborn. Place petroleum jelly gauze on the spinal sac to keep it moist. Place a urine collection bag on newborn for the continuous leakage.

Place the newborn in a prone or lateral position.

The parent has brought a 2-year-old to the public clinic for immunizations. The nurse documents the following characteristics: A duck waddle gait Shortened extremity Asymmetry of the gluteal folds Protruding abdomen The nurse then refers the toddler to the health care provider for potential diagnosis of which? clubfoot (congenital talipes equinovarus) Muscular dystrophy Scoliosis Developmental dysplasia of the hip (DDH)

Developmental dysplasia of the hip (DDH)

The nurse is assessing a neonate brought into the newborn nursery. The nurse notes a dimple on the lower back with a tuft of hair over the site. Which nursing intervention is most appropriate? Document the assessment finding and report in shift handoff. Place the neonate on the left or right lateral side for sleep. Notify the health care provider immediately. Place an absorbent, sterile dressing over the site.

Document the assessment finding and report in shift handoff.

Which assessment findings are most prominent in the infant with Tetralogy of Fallot and significant pulmonary stenosis? Irregular heart rate, fatigue, pink tinged skin Dry mucous membranes, poor urine output Poor weight gain, nausea, decreased muscle tone Dyspnea on limited exertion, fatigue, cyanosis

Dyspnea on limited exertion, fatigue, cyanosis

In completing the newborn assessment checklist, the nurse documents a meconium stool. This documentation rules out which condition? Hiatal hernia Imperforate anus Spina bifida occulta Epispadias

Imperforate anus

An infant is born with congenital amputation of the lower left leg. Which actions taken by the nurse are the priority in the first hours after birth? Select all that apply. Establish intactness of the lower spine. Establish blood glucose stabilization. Establish stable body temperature. Establish the cause of physical deformity. Establish bonding with the parents.

Establish blood glucose stabilization. Establish stable body temperature. Establish bonding with the parents.

The nurse is caring for an infant after repair of a cleft lip. The nurse expects which of the following to be included in the plan of care? Select all that apply. Position the infant on the abdomen to facilitate drainage of secretions. Give parenteral fluids to maintain hydration in the immediate postoperative period. Use a special feeder to prevent tension on the suture line. Use elbow restraints to prevent fingers in the mouth. Clean the suture line with tepid water after feedings.

Give parenteral fluids to maintain hydration in the immediate postoperative period. Use a special feeder to prevent tension on the suture line. Use elbow restraints to prevent fingers in the mouth. Clean the suture line with tepid water after feedings.

The nurse is caring for a neonate in the newborn nursery with clubfoot (congenital talipes equinovarus). If nonsurgical treatment is chosen, which nursing action is anticipated? Assisting in applying an ace wrap Passive range of motion of ankles Instruction on corrective shoes Holding feet/ankles in position for casting

Holding feet/ankles in position for casting

During cardiac surgery, the surgeon reduces the child's body temperature to decrease the effects of the surgery on the brain and other body organs. This process is referred to as inducing which of the following? Hypothermia Hypotension Hypokalemia Hypoactivity

Hypothermia

The parent reports that the health care provider said that the infant had a hernia but she can't remember which type. When recalling what the health care provider said, the parent said that a surgeon will repair it soon and there is no problem with the testes. Which hernia type is anticipated? Diaphragmatic hernia Umbilical hernia Inguinal hernia Hiatal hernia

Inguinal hernia

The nurse is reviewing a chart for a male client with Klinefelter syndrome. Which physical characteristics does the nurse anticipate? No development of secondary sex characteristics An enlarged heart with arrhythmias The client has a small stature and features Cognitive deficits with emotional outbursts

No development of secondary sex characteristics

The nurse is caring for a neonate with epispadias. In which location will the nurse assess the anomaly? At the distal end of the testes On the dorsal end of the penis On the anterior scrotum On the ventral surface near the chordee

On the dorsal end of the penis

A 5-month-old is having a cleft lip/palate repair. What games could the nurse play with the child to provide comfort and diversion postoperatively while the baby is in elbow restraints? Arts and crafts Blowing a pinwheel Peek-a-boo A board game

Peek-a-boo

A nurse is caring for a newborn with a repaired cleft lip. What intervention can the nurse provide to facilitate drainage of mucus and secretions to prevent aspiration? Place a wedge under the child's crib. Place the child on the abdomen. Place the child on the back. Position the child on the side

Position the child on the side

The nurse is caring for a neonate with an exstrophy of the bladder. When the nurse is planning care, which client goal is the priority? The client will be free from infection. The client will exhibit signs of bonding with parents. The client will urinate 2 to 3 ml/kg/hour The client will not cry during diapering.

The client will be free from infection.

The nurse is educating the parents of a neonate with Down syndrome regarding nutrition. Which provides the biggest challenge in feeding the neonate? Cognitive ability Brachycephaly Thick, fissured tongue Decreased gastric motility

Thick, fissured tongue

Which congenital condition is an immediate emergency requiring notification of the health care provider? Hypospadias Cleft palate Tracheoesophageal fistula Atrial septal defect

Tracheoesophageal fistula

The nurse is preparing an infant with a myelomeningocele for surgery. Which environment does the nurse select to best meet the infant's needs? an incubator a radiant warmer swaddled in an open crib skin-to-skin (kangaroo) care with parent

an incubator

In the hour immediately following the birth of an infant with a physical challenge, what is a nursing care priority? Select all that apply. determining the infant's immediate physiologic needs promoting bonding between parents and the newborn outlining the long-term implications of the conditions referring the parents to a geneticist to understand the cause exploring maternal behavior during pregnancy

determining the infant's immediate physiologic needs promoting bonding between parents and the newborn

A nurse in the newborn nursery has noticed that an infant is frothing and appears to have excessive drooling. Further assessment reveals that the baby has episodes of respiratory distress with choking and cyanosis. What disorder should the nurse suspect based on these findings? cleft palate esophageal atresia cleft lip coarctation of the aorta

esophageal atresia

A nursing student has read that cleft lip is diagnosed at birth based on inspection of physical appearance and that cleft palate is diagnosed by which method? X-ray blood work feeling the palate with a gloved finger or using a tongue blade ultrasound

feeling the palate with a gloved finger or using a tongue blade

Congenital myelomeningocele is commonly associated with which condition? hydrocephalus microcephaly cranial suture overlap absence of the cranial vault

hydrocephalus

A newborn is diagnosed with congenital hypothyroidism prior to discharge from the hospital. What medication does the nurse anticipate administering to the newborn? inderal tapazole radioactive iodine levothyroxine

levothyroxine

In the infant born with a cleft lip and a cleft palate, the highest priority of the nurse is related to which intervention? maintaining the nutritional needs of the infant managing the pain level of the infant promoting coping skills in the family caregivers reducing family anxiety related to the treatment

maintaining the nutritional needs of the infant

A new mother brings her 6-month-old to the clinic and informs the nurse that her son has what she thinks is an umbilical hernia. Upon examination the diagnosis of umbilical hernia is confirmed. What should the treatment be for this child? immediate surgery surgery within 2 to 3 months nothing taping of a coin to the hernia to reduce it

nothing

It would be best to place an infant with a myelomeningocele in which position prior to surgery? semi-Fowler in an infant chair on the left side with the head dependent on the stomach (prone) supine with the head elevated

on the stomach (prone)

A mother is inspecting her newborn and notices the baby has a sixth finger. The nurse would explain that this condition is called: polydactyly. syndactyly. webbing. genu varum.

polydactyly.

A nurse is providing preoperative care to a female newborn client with the congenital abnormality myelomeningocele. Which intervention is the priority? preventing infection promoting newborn nutrition preserving newborn GI function maximizing newborn motor function

preventing infection

A nursing student is caring for a newborn with a defect in the neural arch where the posterior laminae of the vertebrae have failed to close. The nurse knows that this infant is suffering from which disorder? hydrocephalus spina bifida cleft palate esophageal atresia

spina bifida

A nurse is performing a newborn assessment and notices a small dimple on the sacral area. The infant has a normal neurological assessment and moves all extremities well. What does the nurse suspect that the dimple indicates? a normal spinal closure spina bifida with meningocele spina bifida occulta spina bifida with myelomeningocele

spina bifida occulta

The nurse is providing education to the parents of an infant who was just diagnosed with transposition of the great arteries. The parents ask, "Which vessels were involved?" The nurse is correct to educate about: the superior and inferior vena cava. the aorta and pulmonary artery. the pulmonary vein and pulmonary artery. the inferior vena cava and pulmonary vein.

the aorta and pulmonary artery.

The nurse is caring for a newborn with hydrocephalus. To protect the newborn from injury in the postoperative period, the nurse should position the head: in Trendelenburg position. turned away from the operative site. supported on a pillow. turned toward the operative site.

turned away from the operative site.

A student nurse is learning about congenital heart defects in newborns and correctly identifies which of the following to be the most common intracardiac defect? atrial septal defect ventricular septal defect patent ductus arteriosus coarctation of the aorta

ventricular septal defect