Chapter 24 Level 8 stuff

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? a). 41 weeks b). 44 weeks c). 40 weeks d). 42 weeks

42 weeks The nurse is most correct to state that mothers do not progress longer than 42 weeks gestation. At that point, either a cesarean section or an induction would be completed. Actual dates do vary depending on the status of the fetus.

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 stable body temperature. -Establish blood glucose stabilization. -Establish bonding with the parents. -Establish the cause of physical deformity. -Establish intactness of the lower spine.

Establish blood glucose stabilization. Establish stable body temperature. Establish bonding with the parents. At birth, establishing respirations, stabilization of blood glucose, and maintaining body temperature as well as bonding with the parents are the priorities. Determining the cause of the congenital amputation will come later or may never be known. Examining for intactness of the lower spine is part of a comprehensive newborn examination that occurs after the initial transition and stabilization process.

Which action would be most important to do for an infant following surgery for myelomeningocele? a). Assess a blink reflex hourly. b) Measure a daily head circumference. c). Measure total 24-hour urine output. d). Elicit a paracervical reflex daily.

Measure a daily head circumference. Because some meningocele absorbing surface is removed with surgery, cerebrospinal fluid can accumulate and lead to hydrocephalus.

At which time does the nurse obtain the Guthrie inhibition assay test to rule out phenylketonuria (PKU)? a). At the newborn's first checkup b). On the second day of life c). Immediately after birth d). On the infant's first birthday

On the second day of life The nurse is correct to obtain the Guthrie inhibition assay test on the second day of life. At this time, the newborn has ingested either breast milk or cow's milk and the test will be able to determine if the newborn has PKU. Immediately after birth, the newborn has not ingested any milk. It is too long to wait for the test in 3 to 4 weeks as permanent damage to the brain may be done. Deficits are seen by the first birthday.

A newborn is born diagnosed with an omphalocele. What will the nurse prioritize in the care plan during the preoperative period? a). Place the infant in a sterile bowel bag. b). Swaddle the infant in sterile newborn blankets. c). Care for the infant in a sterile isolette. d). Place the covered infant under the radiant warmer.

Place the infant in a sterile bowel bag. Nursing management of newborns with omphalocele must focus on preventing hypothermia, maintaining perfusion to the eviscerated abdominal contents by minimizing fluid loss, and protecting the exposed abdominal contents. This can be accomplished by placing the infant in a sterile bowel bag that maintains a sterile environment for the exposed contents, allows visualization, reduces heat and moisture loss. The infant may be cared for in an isolette, but a sterile bowel bag is the key to care. Blankets or covering the infant under a radiant warmer does not provide an appropriate environment in order to care for an omphalocele.

After teaching a group of new mothers about the physiologic jaundice in breastfed and bottle-fed newborns, the nurse determines that the teaching was successful when the mothers state which information? a). Jaundice associated with bottle feeding occurs in two distinct patterns. b). Breastfed newborns tend to have more frequent bowel movements. c). The decline in bilirubin levels occurs more quickly in bottle-fed newborns. d). Peak bilirubin levels occur earlier for bottle-fed newborns than for breastfed newborns.

The decline in bilirubin levels occurs more quickly in bottle-fed newborns. Breastfed newborns typically have peak bilirubin levels on the fourth day of life; bottle-fed newborns usually have peak bilirubin levels on the third day of life. The rate of bilirubin decline is less rapid in breastfed newborns compared with bottle-fed newborns. Jaundice associated with breastfeeding presents in two distinct patterns: early-onset and late-onset. Bottle-fed newborns have more frequent bowel movements, thus reducing the bilirubin levels more quickly than breast-fed newborns.

A newborn is born with a myelomeningocele. Which assessment data is most important to consider when managing care? a) The newborn drips urine throughout the shift. b). The newborn is able to lie on the back without pain. c). The newborn has a normal tonic-neck reflex. d). The newborn can follow a moving light across the midline of vision.

The newborn drips urine throughout the shift. Infants without innervation to the lower spinal cord do not have bladder control and thus void continually as the urine is made by the kidneys. Frequent diapering is needed. The newborn would not be placed on the back due to the myelomeningocele. Newborns have difficulty visualizing. It is appropriate to have a normal tonic-neck reflex.

When caring for parents whose neonate is newly diagnosed with a congenital disorder, which parents would be referred to pediatric hospice services? a). The parent with a neonate diagnosed with maple syrup urine disease b). The parent with a neonate diagnosed with spina bifida occulta c). The parent with a neonate diagnosed with Down syndrome d). The parent with a neonate diagnosed with hydrocephalus

The parent with a neonate diagnosed with maple syrup urine disease The parent with a neonate diagnosed with maple syrup urine disease (MSUD) would be referred to pediatric hospice services due to the prognosis of the disease. The disease is rapidly progressive and often fatal. The parents with a neonate diagnosed with Down syndrome and hydrocephalus will grieve the loss of the perfect child. The nurse must provide much education and support throughout the child's life. Most neonates with spina bifida occulta are asymptomatic. Instruction is needed for understanding the disease process.

The nurse is observing the perineal care of a 2-year-old in a hip spica cast. For which caregiver actions will the nurse provide additional instruction? Select all that apply. -Uses the tips of the fingers to handle the cast -Applies powder to the perineal area after a bowel movement -Cleanses the perineal area with each diaper change -Completes a skin assessment daily -Places a disposable diaper between the legs

Uses the tips of the fingers to handle the cast Applies powder to the perineal area after a bowel movement The nurse would provide additional instruction related to handling the cast with the palms of the hands instead of tips of the fingers. Also, the caregiver would be advised to refrain from using powders as powders can build up and irritate the skin. The other options demonstrate appropriate care.

A nurse is caring for a newborn who is approximately 13 hours old. On assessment, the nurse notes a yellow tint to the newborn's skin and sclera. What laboratory tests should the nurse anticipate? Select all that apply. -a hemoglobin test -a blood culture -a total bilirubin test -a direct Coombs test -a serum glucose test

a direct Coombs test a total bilirubin test a hemoglobin test A newborn with signs of jaundice who is less than 24 hours old often has Rh or ABO incompatibility. A test called a direct Coombs is ordered to see if maternal antibodies are circulating in the newborn's blood. A total bilirubin test helps determine the total amount of bilirubin in the blood to assess the risk of increased jaundice. A hemoglobin test will show if there is a decrease in red blood cells. A serum glucose test would be used in hypoglycemia of a newborn, and a blood culture would be used to detect sepsis of a newborn.

Bronchopulmonary dysplasia (BPD) is the result of lung injury in the preterm newborn. What can be done to reduce the incidence of BPD in the preterm newborn? a). mechanical ventilation of the newborn with 100% oxygen content b). antepartal administration of steroids to the mother c). exogenous surfactant given to the mother before the baby's birth d). steroid injection at birth to all infants at risk for BPD

antepartal administration of steroids to the mother BPD can be prevented by administering steroids to the mother in the antepartal period and exogenous surfactant to the newborn to aid in reducing the development of respiratory distress syndrome and its severity. A high oxygen content can cause damage to the neonatal lung. Steroid injections for newborns at risk for BPD do not help the lungs mature. Giving exogenous surfactant to the mother does not increase the level of surfactant in the infant.

A preterm newborn is being monitored for potential necrotizing enterocolitis. The nurse recognizes which factors as major pathologic mechanisms that could lead to this complication? Select all that apply. -bowel ischemia -formula feeding -perinatal stressors -uncontrolled diarrhea -maternal infection

bowel ischemia perinatal stressors formula feeding Current research points to these major pathologic mechanisms that lead to NEC: bowel hypoxic-ischemia events, perinatal stressors, an immature intestinal barrier, abnormal bacterial colonization, and formula feeding.

Which condition would place a neonate at the least risk for developing respiratory distress syndrome (RDS)? a). chronic maternal hypertension b). neonate of a diabetic mother c). neonate born at 34 weeks d). second born of twins

chronic maternal hypertension Chronic maternal hypertension is an unlikely factor because chronic fetal stress tends to increase lung maturity. Second twins may be prone to a greater risk of asphyxia. Premature neonates younger than 35 weeks are associated with RDS. Even with a mature lecithin to sphingomyelin ratio, neonates of diabetic mothers may still develop respiratory distress.

A nurse is performing a newborn assessment and notes the blood pressures in the upper extremities are higher than the lower extremities. The nurse should suspect which congenital newborn abnormality? a). coarctation of the aorta b). ventricular septal defect c). truncus arteriosus d). patent ductus arteriosus

coarctation of the aorta In congenital heart defects, coarctation of the aorta occurs when there is a narrow or constricted area of the aorta. This causes blood pressures to be higher in the upper extremities and lower in the lower extremities. Patent ductus arteriosus refers to an open patent foramen ovale after birth, and a ventricular septal defect is an opening in the ventricle. Both of these latter disorders cause increased pulmonary flow in the heart. Truncus arteriosus means there is one main branch for all vessels coming off the top of the heart.

An infant born with abdominal distention is diagnosed with meconium ileus. The nurse explains to the parents the baby will be examined for signs of which disorder? a). Crohn disease b). celiac disease c). Down syndrome d). cystic fibrosis

cystic fibrosis Meconium ileus is so strongly associated with cystic fibrosis that the infant needs close follow-up by an interprofessional cystic fibrosis team in the following months. Meconium ileus is not related to Down syndrome, celiac disease, or Crohn disease.

A nurse is making a home visit to a new mother who gave birth vaginally to a term newborn 4 days ago. The woman is enrolled in a methadone maintenance program. The woman reports that the newborn has been restless and irritable the last day or so. The nurse assesses the newborn. Which finding(s) from the nurse's assessment would lead the nurse to notify the health care provider that the newborn is experiencing withdrawal? Select all that apply. -vomiting with each feeding -reflexes 2+ -respiratory rate 65 breaths/min -frequent yawning -temperature 99.1°F (37.3°C)

frequent yawning vomiting with each feeding respiratory rate 65 breaths/min In addition to the mother's report of restlessness and irritability, the newborn's frequent yawning and vomiting with each feeding and tachypnea (respiratory rate greater than 60 breaths/min) would suggest withdrawal. Hyperactive reflexes and fever would be additional signs. However, this infant's reflexes are normal and fever is not present.

A nurse is assessing a newborn who was born to a woman with diabetes mellitus. The newborn is large-for-gestational age and has a ruddy skin color, short neck, buffalo hump, and distended upper abdomen. Laboratory testing has been completed and the results are as follows: Glucose: 30 mg/dL (1.67 mmol/L) Calcium: 7.2 mg/dL (1.80 mmol/L) Magnesium: 1.5 mg/dL (0.62 mmol/L) Bilirubin: 15 mg/dL (256.56 µmol/L) Hematocrit: 75% (0.75) Which result(s) would the nurse immediately report to the provider? Select all that apply. -calcium -magnesium -glucose -hematocrit -bilirubin

glucose bilirubin hematocrit The newborn's glucose level is low suggesting hypoglycemia, bilirubin level is high suggesting hyperbilirubinemia, and hematocrit is high suggesting polycythemia. These three results should be reported. The newborn's calcium and magnesium levels are within acceptable parameters and are not a cause for concern.

The nurse is caring for a pregnant woman who is struggling with controlling her gestational diabetes mellitus. What effect does the nurse predict this situation may have on the fetus? a). suffer from asymmetrical intrauterine growth restriction b). have a serious birth defect c) grow to an unusually large size d). suffer from symmetrical intrauterine growth restriction

grow to an unusually large size Maternal diabetes is the most widely known contributing factor to large-for-gestational-age newborns. LGA babies are frequently born to diabetic mothers with poor glucose control. Continued high blood glucose levels in the mother lead to an increase in insulin production in the fetus. Increased insulin levels act as a fetal growth hormone causing macrosomia, an unusually large newborn with a birth weight of greater than 4,500 grams (9 pounds, 14 ounces). The incidence of birth defects in the gestational diabetic is not greatly increased. IUGR is not a typical outcome of uncontrolled gestational diabetes. It is more likely that the baby will be large-for-gestational-age.

A nurse in a local health care facility is caring for a newborn with periventricular hemorrhage/intraventricular hemorrhage (PVH/IVH), who has recently been discharged from a local NICU. For which likely complications should the nurse assess? Select all that apply. -acid-base imbalances -pneumonitis -hydrocephalus -vision or hearing deficits -cerebral palsy

hydrocephalus vision or hearing deficits cerebral palsy A nurse should associate obstructive hydrocephalus, vision or hearing defects, and cerebral palsy with newborns who had a PVH/IVH. Acid-base imbalances are complications occurring during exchange transfusion for lowering serum bilirubin levels. Pneumonitis is a complication associated with esophageal atresia.

A nursing instructor is teaching students about cardiac congenital disorders in newborns and informs them that, like other diseases, risk factors increase the incidence of heart defects. Which of these are considered risk factors? Select all that apply. -maternal alcoholism -young maternal age (younger than 24 years) -maternal irradiation -advanced maternal age (older than 40 years) -ingestion of certain drugs during pregnancy -maternal diabetes

maternal alcoholism maternal irradiation ingestion of certain drugs during pregnancy maternal diabetes advanced maternal age (older than 40 years) Maternal alcoholism, maternal irradiation, ingestion of certain drugs during pregnancy, maternal diabetes, and advanced maternal age (older than 40 years) increase the incidence of heart defects in newborns. Young maternal age does not appear to be a factor.

A newborn is diagnosed with respiratory distress syndrome (RDS). While assessing the newborn, the nurse realizes that which maternal factor would most place the infant at risk for RDS? a) maternal opioid addiction b). maternal gestational diabetes c). prolonged rupture of membranes d). maternal smoking

maternal gestational diabetes Prolonged rupture of membranes, gestational or chronic maternal hypertension, maternal opioid addiction, and the use of prenatal corticosteroids reduces the newborn's risk for RDS because of the physiologic stress imposed on the fetus. Chronic stress experienced by the fetus in utero accelerates the production of surfactant before 35 weeks' gestation and thus reduces the incidence of RDS at birth. Maternal diabetes produces high levels of insulin that inhibits surfactant production thus placing the newborn more at risk for developing RDS.

A nurse recognizes that which sign is usually the first indication of esophageal atresia? a). maternal history of hydramnios b). newborn unable to feed properly c). maternal history of oligohydramnios d). newborn with rattling respirations

maternal history of hydramnios A maternal history of hydramnios is often the first sign of esophageal atresia because the fetus cannot swallow and absorb amniotic fluid in utero leading to accumulation. Esophageal atresia results in the newborn being unable to feed properly and may have rattling respirations due to aspiration of liquids.

When assessing a newborn for meconium aspiration syndrome, the nurse would most likely note which finding? a). Apgar of 8 b). polyhydramnios c) preterm birth d). maternal hypertension

maternal hypertension Predisposing factors for MAS include post-term pregnancy; breech presentation, forceps, or vacuum extraction births; nulliparity; ethnicity (Pacific Islander, Indigenous Australian, client of African descent); intrapartum fever; low Apgar score; prolonged or difficult labor associated with fetal distress in a term or post-term newborn; maternal drug abuse, especially of tobacco and cocaine; maternal infection/chorioamnionitis; maternal hypertension or diabetes; oligohydramnios; fetal growth restriction; prolapsed cord; or acute or chronic placental insufficiency (Kenner, et al., 2020).

A preterm newborn born at 30 weeks' gestation is in the NICU receiving supplemental oxygen. Based on the nurse's understanding of risk reduction for the severity of retinopathy of prematurity (ROP), the nurse monitors the oxygen saturation level, ensuring that the level is within which target range? a). mid-80s to mid-90s b). mid-80s to lower mid-90s c). lower mid-90s to upper mid-90s d). upper mid-80s to mid-90s

mid-80s to lower mid-90s Many NICUs have adopted lower oxygen saturations ranges for preterm infants. Oxygen saturation target ranges in the mid-80s to lower mid-90s are usually safe and can reduce the severity of ROP in newborns born at less than 32 weeks' gestation.

A client with diabetes presents to the emergency department in active labor. Assessment confirms placenta previa. The client was given oxytocin to stimulate the labor. The nurse should anticipate that the newborn will requiring monitoring for which condition? a) respiratory distress syndrome b). acidosis c). neonatal asphyxia d). transient tachypnea

neonatal asphyxia Early recognition and identification of newborns at risk is the key to successful treatment of newborn asphyxia. Some of these risks include trauma, intrauterine asphyxia, sepsis, malformation, hypovolemic shock secondary to placenta previa, and medication given during labor such as oxytocin. Acidosis may be a result of asphyxia.

The nurse should carefully monitor which neonate for hyperbilirubinemia? a). neonate of African descent b). neonate with Apgar scores 9 and 10 at 1 and 5 minutes c). neonate of an Rh-positive mother d). neonate with ABO incompatibility

neonate with ABO incompatibility The mother's blood type, which is different from the neonate's, has an impact on the neonate's bilirubin level due to the antigen antibody reaction. Neonates of African descent tend to have lower mean levels of bilirubin. Chinese, Japanese, Korean, and Greek neonates tend to have higher incidences of hyperbilirubinemia. Neonates of Rh-negative, not Rh-positive, mothers tend to have hyperbilirubinemia. Low Apgar scores may indicate a risk for hyperbilirubinemia; 9 and 10 associate with normal adjustment to extrauterine life.

The nurse is caring for a baby born to a mother with a history of alcohol use disorder. For what characteristics should the nurse observe to determine if the newborn has a fetal alcohol spectrum disorder? Select all that apply.

reduced ocular growth short palpebral fissures flattened nasal bridge The newborn withdrawing from alcohol typically is hyperactive and irritable, has trouble sleeping, and may have tremors or seizures. Characteristics of a fetal alcohol spectrum disorder include low birth weight, small height and head circumference, short palpebral fissures, reduced ocular growth, and a flattened nasal bridge.

Which sign appears early in a neonate with respiratory distress syndrome? a). pale gray skin color b). poor capillary filling time (3 to 4 seconds) c). bilateral crackles d) tachypnea more than 60 breaths/minute

tachypnea more than 60 breaths/minute Tachypnea and expiratory grunting occur early in respiratory distress syndrome to help improve oxygenation. Poor capillary filling time, a later manifestation, occurs if signs and symptoms aren't treated. Crackles occur as the respiratory distress progressively worsens. A pale gray skin color obscures earlier cyanosis as respiratory distress symptoms persist and worsen.

Which actions should nurses advocate to help the nation achieve the 2020 National Health Goals? Select all that apply. -teaching about folic acid supplementation prior to conception -encouraging sonograms at every prenatal visit -initiating oral iron supplementation at the time of conception -obtaining early prenatal care -providing support after the diagnosis of a fetal disorder

teaching about folic acid supplementation prior to conception obtaining early prenatal care providing support after the diagnosis of a fetal disorder Nurses can help achieve the 2020 National Health Goals by urging women to enter pregnancy with an adequate folic acid level, ensuring women obtain prenatal care, and receive comprehensive advice and support after diagnosis of a fetal or newborn disorder. Frequent sonograms are not necessary, and initiating oral iron supplementation at conception may worsen the nausea and vomiting of early pregnancy.

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? a) Surgery to correct the joint and muscle alignment b). Physical therapy to the joint and extremity c). Nothing but time and let nature take its course d). Immobilization of the shoulder and arm

torticollis Torticollis or wry neck may result when the sternocleidomastoid muscle is injured and bleeds during birth. This tends to occur in newborns with wide shoulders when pressure is exerted on the head to deliver the shoulder. Craniosynostosis is the premature closure of the sutures of the skull. Pectus excavatum, or "funnel chest," is an indentation of the lower portion of the sternum. Talipes deformities are ankle/foot disorders.