Chapter 24, High-Risk Newborn

What is the most common defect of the central nervous system (CNS) that results from failure of the neural tube to close at some point? 1 Spina bifida 2 Anencephaly 3 Encephalocele 4 Hydrocephalus

1 The most common defect of the CNS that results from failure of the neural tube to close at some point is spina bifida. Anencephaly is the absence of both cerebral hemispheres and of the overlying skull. An encephalocele is a herniation of the brain and meninges through a skull defect, usually in the occipital area. Hydrocephalus is a condition in which there is excess cerebrospinal fluid (CSF) in the ventricles of the brain due to overproduction (rare) or a decrease in reabsorption.

Which conditions are risk factors for meconium aspiration syndrome (MAS) in the newborn? Select all that apply. 1 Preterm 2 Postterm 3 Cord compression 4 Low amniotic fluid 5 Small for gestational age 6 Large for gestational age

2,3,4,5 Risk factors for MAS include postterm, cord compression, low amniotic fluid, and being small for gestational age. Preterm and large for gestational age are not risk factors for MAS.

Which condition may be seen in an infant born to a patient who consumed excessive alcohol during pregnancy? 1 Respiratory distress 2 Hypothyroidism 3 Congenital abnormalities 4 Skull fractures

3 Infants born to parents who are heavy alcohol drinkers are at risk for congenital abnormalities. Respiratory distress is not usually seen in an infant exposed to alcohol. Hypothyroidism is a genetic disorder not related to alcohol consumption. Skull fractures are sometimes caused during a difficult birth due to the pressure of the fetal skull against the maternal pelvis.

Which prescription will be included in an infant's plan of care to decrease the withdrawal effects of heroin in an infant? 1 Levothyroxine sodium (Synthroid) 2 Sildenafil (Revatio) 3 Phenobarbital (Luminal) 4 Digoxin (Lanoxin)

3 Phenobarbital (Luminal) is used in drug-exposed infants to decrease withdrawal effects. Levothyroxine sodium (Synthroid) is used in the treatment of thyroid conditions. Sildenafil (Revatio) is more effective in infants with persistent pulmonary hypertension. Digoxin (Lanoxin) is used for maternal and fetal arrhythmias and heart failure.

What electrolyte imbalance can a neonate have due to maternal diabetes? 1 Decreased sodium levels 2 Decreased potassium levels 3 Decreased phosphate levels 4 Decreased magnesium levels

4 Maternal diabetes affects the neonatal electrolyte balance. The neonate is at risk for hypomagnesemia related to increased maternal magnesium loss due to diabetes. Maternal diabetes does not affect the sodium, potassium, or phosphate levels of the neonate. Therefore, there is no reduction in the neonatal sodium, potassium, or phosphate levels.

Which instruction does the nurse include in the teaching plan for a new mother who has a history of cocaine use during pregnancy? 1 "Let the infant sleep on the stomach during naps." 2 "Place the infant in the head lifting position while breastfeeding." 3 "Avoid using a pacifier, because it damages the infant's teeth." 4 "Wrap the infant snugly in a blanket and rock gently."

4 The newborn of a substance-abusing mother may have neonatal abstinence syndrome, characterized by irritability of the central nervous system and respiratory distress. Hence, the nurse should instruct the mother to snugly wrap the neonate in a blanket and gently rock the baby when the newborn looks distressed. This intervention decreases the irritable behavior of the newborn. Neonates should be allowed to sleep on their backs to support breathing. Neonates should be placed in cross-cradle position or cradle position while breastfeeding to provide comfort and to prevent choking. Pacifiers should be used, because the newborn of a substance-abusing mother has difficulty sucking.

A newborn is born with gastroschisis. Which other condition may be found in the newborn? 1 Trisomy 12 2 Heart defect 3 Choanal atresia 4 Intestinal atresia

4 The presence of a hole in the abdominal wall, and protrusion of intestine and abdominal organs through the hole, indicates that the newborn has gastroschisis. Gastroschisis is characterized by the absence of the membrane on the intestine and abdominal organ. This condition is usually associated with intestinal atresia or malformation of the intestine, and the newborn should be assessed for its presence. Trisomy 12, a chromosomal abnormality, and heart defects are not associated with gastroschisis, and are usually associated with omphalocele. Choanal atresia is the congenital anomaly of the nose characterized by the blockage of the posterior nares by a bony or soft-tissue obstruction. It is not associated with gastroschisis.

The nurse is caring for an infant with a cleft lip and palate. What nursing interventions should be implemented for the infant and parent(s)? Select all that apply. 1 Provide support for parent(s) of the child. 2 Provide information on support groups for parents of children with orofacial clefts. 3 Explain that repair of the defects will involve only one surgical procedure to allow the child to have a near-normal appearance and function. 4 Recognize that the normal parent-infant bonding in the neonatal period can be disrupted because of the orofacial cleft, and the nurse must assess for this and intervene appropriately. 5 A multidisciplinary health care team that includes pediatrics, plastic surgery, orthodontics, otolaryngology, speech/language pathology, audiology, nursing, and social work should be involved.

1,2,4,5 Nursing interventions that should be implemented for the infant and parent(s) include: provide support for parent(s) of the child; provide information on support groups for parents of children with orofacial clefts; explain that repair of the defects will involve a series of surgical procedures (not just one surgical procedure) to allow the child to have a near-normal appearance and function; recognize that the normal parent-infant bonding in the neonatal period can be disrupted because of the orofacial cleft, and the nurse must assess for this and intervene appropriately; and a multidisciplinary health care team that includes pediatrics, plastic surgery, orthodontics, otolaryngology, speech/language pathology, audiology, nursing, and social work should be involved.

Asphyxia in the newborn causes vasoconstriction that decreases blood flow to the organs. Blood flow to which organs is maintained? Select all that apply. 1 Brain 2 Liver 3 Kidney 4 Thyroid 5 Myocardium 6 Adrenal glands

1,5,6 Vasoconstriction caused by low oxygen decreases blood flow to all organs except the brain, myocardium, and adrenal glands. Blood flow to liver, kidney, and thyroid is decreased.

With regard to the classification of neonatal bacterial infection, what should the nurses be aware of? 1 Congenital infection progresses slower than health care-associated infection. 2 Health care-associated infection can be prevented by effective handwashing; early onset cannot. 3 Infections occur with about the same frequency in boy and girl infants, although female mortality is higher. 4 The clinical sign of a rapid, high fever makes infection easier to diagnose.

2 Handwashing is an effective preventative measure for late-onset (health care-associated infections), because these infections come from the environment around the infant. Early-onset, or congenital, infections are caused by the normal flora of the maternal vaginal tract. Congenital (early onset) infections progress more rapidly than health care-associated (late onset) infections. Infection occurs about twice as often in boys and results in higher mortality. Clinical signs of neonatal infection are nonspecific and similar to noninfectious problems, making diagnosis difficult.

Nurses should be aware of what with regard to the classification of neonatal bacterial infection? 1 Congenital infection progresses slower than health care-associated infection. 2 Health care-associated infection can be prevented by effective handwashing. 3 Infections occur with about the same frequency in male and female infants, although female mortality is higher. 4 The clinical sign of a rapid, high fever makes infection easier to diagnose.

2 Handwashing is an effective preventive measure for late-onset (health care-associated) infections because these infections come from the environment around the infant. Early-onset, or congenital, infections are caused by the normal flora at the maternal vaginal tract. Congenital (early-onset) infections progress more rapidly than health care-associated (late-onset) infections. Infection occurs about twice as often in males and results in higher mortality. Clinical signs of neonatal infection are nonspecific and similar to noninfectious problems, making diagnosis difficult.

The home care nurse is providing postnatal care for an infant who is prescribed phototherapy for jaundice. The nurse explains the use of the equipment and other care processes to the family during the home visit. What is the priority information that needs to be included in the teaching? 1 How to talk to the infant during the therapy 2 What action to take in an emergency situation 3 When the nurse will be providing home care next 4 Which books to consult for additional information

2 Phototherapy usually increases the infant's fluid requirements and may cause dehydration if the fluids are not adjusted accordingly. Therefore, the nurse needs to inform the family about any emergency situation that may arise with the use of the equipment. Informing the family about how to talk to the infant or what toys to bring is a general care process, which is secondary in this case. Providing information about the next home care visit is not a priority in this case, because it can be arranged at any time. Asking the family to refer to books will help increase their knowledge about the disease, but it may not help them to take appropriate action during emergencies.