Chapter 24 PrepU
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? "The baby will have tubes in the chest to drain chest fluids." "They will be placing a tube in the stomach during surgery." "After this surgery is done tomorrow, my baby will be able to eat and drink." "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." Explanation: The newborn will need IV fluids to maintain optimal hydration. The first stage of surgery may involve a gastrostomy and a method of draining the proximal esophageal pouch. A chest tube is inserted to drain chest fluids. If the repair is complex, surgery may need to be done in stages.
Four weeks before the birth of a client's already large child, the health care provider has told the client that if the baby gets bigger and the baby's lungs are ready, a cesarean birth is preferred. The woman asks the nurse what the downside is to having a cesarean rather than a vaginal birth. What is an appropriate response by the nurse? "The procedure isn't risky for the baby, but your healing takes longer, and you'll have a scar." "Some women don't have any problem giving birth to large babies. You might want to get a second opinion." "As the baby passes through the birth canal some of the excess fluid is expelled from the lungs; if that doesn't happen there's a higher risk of respiratory distress." "If the health care provider has recommended the procedure, it's likely that the benefits outweigh the risks."
"As the baby passes through the birth canal some of the excess fluid is expelled from the lungs; if that doesn't happen there's a higher risk of respiratory distress." Explanation: Transient tachypnea of the newborn (TTN) involves the development of mild respiratory distress in a newborn. TTN results from a delay in absorption of fetal lung fluid after birth. As the fetus passes through the birth canal during birth, some of the fluid is expelled as the thoracic area is compressed. TTN is commonly seen in newborns born by cesarean birth. It typically occurs after birth with the greatest degree of distress occurring approximately 36 hours after birth. TTN commonly disappears spontaneously around the third day.
A client who gave birth 2 hours ago expresses concern about her baby developing jaundice. Which response from the nurse would be best? "You don't need to worry about your baby developing jaundice because you are both fine." "If you are concerned about your baby developing jaundice, don't breastfeed your baby until you get home." "We will monitor the baby now, and your baby will not develop jaundice after the first 24 hours of life." "I understand your concern because as many as 50% of babies can develop jaundice."
"I understand your concern because as many as 50% of babies can develop jaundice." Explanation: As many as 50% of term newborns will develop physiologic jaundice. Physiologic jaundice occurs after the first 24 hours of life and is not pathologic. Pathologic jaundice will develop within the first 24 hours of life.
The nurse is assessing a toddler at a well-child visit and notes the following: small in stature, appears mildly developmentally delayed; short eyelid folds; and the nose is flat. Which advice should the nurse prioritize to the mother in response to her questions about having another baby? "It's important to add iron and vitamin B supplements to your diet." "It would be good to stop smoking before getting pregnant." "It's a good idea to stop drinking alcohol 3 months before trying to get pregnant." "It's important to keep insulin levels controlled during pregnancy."
"It's a good idea to stop drinking alcohol 3 months before trying to get pregnant." Explanation: Alcohol is one of the many teratogenic substances that cross the placenta to the fetus. Fetal alcohol spectrum disorder is often apparent in newborns of mothers with chronic alcoholism and sometimes appears in newborns whose mothers consume low-to-moderate amounts of alcohol. No amount of alcohol is believed to be safe, and women should stop drinking at least 3 months before they plan to become pregnant. The ability of the mother's liver to detoxify the alcohol is apparently of greater importance than the actual amount consumed. Fetal alcohol spectrum disorder is characterized by low birth weight, smaller height and head circumference, short palpebral fissures (eyelid folds), reduced ocular growth, and a flattened nasal bridge. These newborns are prone to respiratory difficulties, hypoglycemia, hypocalcemia, and hyperbilirubinemia. Their growth continues to be slow, and their mental development is delayed despite expert care and nutrition. Smoking is related to respiratory issues. Proper nutrition and glucose control are also important but do not result in fetal alcohol spectrum disorder.
A nurse is explaining to the parents the preoperative care for their infant born with bladder exstrophy. The parents ask, "What will happen to the bladder while waiting for the surgery?" What is the nurse's best response? "Your baby will be cared for in the prone position with a cover over the bladder." "The bladder will be covered in a sterile plastic bag to keep it moist." "Disturbances to the bladder with diaper changes will be kept to a minimum." "We will care for the bladder with frequent sterile tub baths to keep it moist."
"The bladder will be covered in a sterile plastic bag to keep it moist." Explanation: In the preoperative period, infant care is focused on protecting the exstrophied bladder and preventing infection. The infant is kept in a supine position, and the bladder is kept moist and covered with a sterile plastic bag. Change soiled diapers immediately to prevent contamination of the bladder with feces. Sponge-bathe the infant only (rather than immersing him or her in water) to prevent pathogens in the bath water from entering the bladder. Consult the ostomy nurse if necessary.
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? "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." "You must have had some problems during labor with keeping your blood pressure under control. Your newborn will need to be handled gently." "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."
"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." Explanation: Assessment indicates that the newborn has caput succedaneum. This is soft tissue swelling caused by edema of the head against the dilating cervix during the birth process. In caput succedaneum, swelling is not limited by suture lines; it extends across the midline and is associated with head molding. It does not usually cause complications other than a misshapen head and usually resolves over the first few days without treatment. Cephalohematoma is the subperiosteal collection of blood secondary to the rupture of blood vessels between the skull and periosteum. Suture lines delineate its extent and it is usually located on one side, over the parietal bone. Cephalohematoma resolves gradually over 2 to 3 weeks without treatment. Subarachnoid hemorrhage (one of the most common types of intracranial trauma) may be due to hypoxia/ischemia, variations in blood pressure, and the pressure exerted on the head during labor. Bleeding is of venous origin, and underlying contusions also may occur. Subarachnoid hemorrhage requires minimal handling to reduce stress. Subdural hemorrhage (hematomas) involves tears of the major veins or venous sinuses overlying the cerebral hemispheres or cerebellum. Increased pressure on the blood vessels inside the skull leads to tears. Subdural hematoma requires aspiration; can be life-threatening if it is in an inaccessible location and cannot be aspirated.
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? "We can give him a pacifier to help satisfy his need to suck." "The head of his bed will be elevated to prevent him from aspirating." "We can probably start feeding him with the bottle about a day after the surgery." "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." Explanation: Preoperatively, the newborn is at risk for pneumonitis due to aspiration of food and secretions. Antibiotics are typically given until the anastomosis is proven intact and patent. Oral feedings are usually started within a week after surgery once the esophageal anastomosis is proven to be intact and patent. Proper position with elevation of the head is important for the newborn with esophageal atresia and tracheoesophageal fistula because he is at risk for aspiration of food and secretions. Using a pacifier to provide nonnutritive sucking helps to meet the newborn's need to suck.
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? 42 weeks 41 weeks 40 weeks 44 weeks
42 weeks Explanation: 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.
The nurse is instructing a mother with diabetes on the complications associated with uncontrolled blood glucose levels. Which complication is most concerning? Macrosomia Hyperbilirubinemia Hypoglycemia after birth Delayed lung maturity
Delayed lung maturity Explanation: High insulin levels can delay fetal lung maturity resulting in respiratory distress. Surfactant therapy may be needed. Hypoglycemia can be avoided by beginning feeding soon after birth or using IV glucose. Hyperbilirubinemia can be corrected with fluids or phototherapy. Reducing macrosomia and the build-up of fat deposits will occur over time.
In completing the newborn assessment checklist, the nurse documents a meconium stool. This documentation rules out which condition? Epispadias Hiatal hernia Imperforate anus Spina bifida occulta
Imperforate anus Explanation: Clinical manifestations of an imperforate anus include not having a meconium stool within the first 24 hours of birth. A hiatal hernia can cause esophageal reflux. Spina bifida occulta is caused by a neural tube defect and is typically asymptomatic, causing no problems. Epispadias is when the opening of the urethra is on the dorsal aspect of the penis.
At birth, a neonate is diagnosed with brachial plexus palsy. The parent asks how the nurse knows the neonate'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? stepping Moro rooting Babinski
Moro Explanation: When a neonate has a brachial plexus palsy, there will be asymmetry of the Moro reflex. The stepping reflex assesses movement of the legs. The rooting reflex is used to stimulate sucking and feeding. A positive Babinski sign indicates neurologic immaturity.
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? Morphine Aspirin Ibuprofen Acetaminophen
Morphine Explanation: Care of the newborn experiencing substance withdrawal focuses on providing physical and emotional support and also medication administration to ease withdrawal symptoms. Morphine, an opioid, is given to the client to ease the withdrawal symptoms and also gradually remove opioids from the system. The other options do not ease withdrawal symptoms.
Which intervention is helpful for the neonate experiencing drug withdrawal? Dress the neonate in loose clothing so the infant will not feel restricted. Place the isolette near the nurses' station for frequent contact with health care workers. Withhold all medication to help the liver metabolize drugs. Place the isolette in a quiet area of the nursery.
Place the isolette in a quiet area of the nursery. Explanation: Neonates experiencing drug withdrawal commonly have sleep disturbance. The neonate should be moved to a quiet area of the nursery to minimize environmental stimuli. Medications such as phenobarbital and paregoric should be given as needed. The neonate should be swaddled to prevent him from flailing and stimulating himself.
The nurse is caring for a neonate. Which is the most important step the nurse can take to prevent and control infection? Wear gloves at all times. Use sterile technique for all caregiving. Check frequently for signs of infection. Practice meticulous handwashing.
Practice meticulous handwashing. Explanation: To prevent and control infection, the nurse should practice meticulous handwashing, scrubbing for 3 minutes before entering the nursery, washing frequently during caregiving activities, and scrubbing for 1 minute after providing care. Checking for signs of infection can detect, not prevent, infection. The nurse should use sterile technique for invasive procedures, not all caregiving. The nurse should wear gloves whenever contact with blood or body fluids is possible.
An infant is suspected of having persistent pulmonary hypertension of the newborn (PPHN). What intervention implemented by the nurse would be appropriate for treating this client? Encourage the parents to hold the infant for bonding. Place the infant in a cool environment to prevent overheating. Administer anticonvulsants as prescribed. Provide oxygen by oxygen hood or ventilator.
Provide oxygen by oxygen hood or ventilator. Explanation: The nurse should administer oxygen to the infant in whatever manner needed to help maintain the infant's oxygen levels. Anticonvulsants are not necessary in treating this disorder. The infant's physical environment should be warm, not cool, and stimulation should be limited for these clients.
Upon shift handoff the nurse reports meconium staining of the amniotic fluid. Which neonatal system requires close monitoring by the incoming nurse? Cardiovascular system Respiratory system Gastrointestinal system Endocrine system
Respiratory system Explanation: If the incoming nurse is told that the neonate had meconium staining of the amniotic fluid, the nurse realizes that the respiratory system can be affected. Meconium is the thick, pasty, greenish-black substance that is present in the fetal bowel. When the fetus releases the meconium in utero, the fetus can inhale the meconium into the lungs causing respiratory distress. This is called meconium aspiration syndrome.
A client at 6 weeks' gestation asks the nurse what foods she should eat to help prevent neural tube disorders in her growing baby. The nurse would recommend which foods? Pork, beans, and poultry Milk, yogurt, and cheese Spinach, oranges, and beans Bananas, avocados, and coconut
Spinach, oranges, and beans Explanation: Folic acid assists in preventing the incidence of neural tube disorders. These foods include green, leafy vegetables; citrus fruits, beans, and fortified breads; cereals, rice, and pasta. Milk, yogurt, and cheese are high in calcium. Bananas, avocados, and coconut are high in potassium. Pork, beans, and poultry are high in iron.
The nurse teaches a postpartum client that her neonate's first stool will be meconium, which consists of intestinal secretions and cells. Which colors and consistencies should the nurse use to best describe the typical appearance of meconium? Sticky, greenish black Loose, golden yellow Hard, pale brown Soft, pale yellow
Sticky, greenish black Explanation: Meconium collects in the GI tract during gestation and is initially sterile. Meconium is greenish-black because of occult blood and is viscous. The stools of formula-fed babies are typically soft and pale yellow after feeding is well established. The stools of breast-fed neonates are loose and golden yellow after the transition to extrauterine life.
he nurse teaches a postpartum client that her neonate's first stool will be meconium, which consists of intestinal secretions and cells. Which colors and consistencies should the nurse use to best describe the typical appearance of meconium? Loose, golden yellow Sticky, greenish black Soft, pale yellow Hard, pale brown
Sticky, greenish black Explanation: Meconium collects in the GI tract during gestation and is initially sterile. Meconium is greenish-black because of occult blood and is viscous. The stools of formula-fed babies are typically soft and pale yellow after feeding is well established. The stools of breast-fed neonates are loose and golden yellow after the transition to extrauterine life.
The nurse is completing gavage feedings for the preterm neonate every 2 hours. Which rationale is most correct? The neonate requires food in the gut to avoid atrophy of the mucosa. The neonate needs to gain weight and muscle strength. The neonate gulps if fed orally, which creates indigestion. The neonate can only absorb minimal feedings.
The neonate requires food in the gut to avoid atrophy of the mucosa. Explanation: Frequent, small amounts of feeding are necessary to keep the gastrointestinal system functioning normally. Lack of food in the gut leads to atrophy of the mucosa. At that point it becomes more difficult to initiate feedings. Absorption of the nutrients and gaining weight and strength are not the rationale but a secondary benefit for the feedings. It is true that neonates have difficulty coordinating breathing and sucking oral fluids but it is not the most correct rationale for gavage feedings.
When providing care to a newborn with necrotizing enterocolitis (NEC), the nurse would need to report which finding immediately? decrease in abdominal girth stools negative for blood bowel sounds in all four quadrants abdomen appearing red and shiny
abdomen appearing red and shiny Explanation: An abdomen that appears red and shiny in a newborn with NEC indicates peritonitis and must be reported immediately. A decrease in abdominal girth, stools negative for blood, and active bowel sounds suggest that the condition is resolving.
A nurse is reading a journal article about birth defects and finds that some birth defects are preventable. Which risk factor would the nurse expect to find as being cited as the current leading preventable cause of birth defects? recreational drugs alcohol smoking obesity
alcohol Explanation: Alcohol is now recognized as the leading preventable cause of birth defects and developmental disorders in the United States. Smoking, recreational drugs, and obesity are also contributing factors.
A preterm newborn is noted to be cyanotic. Which laboratory test will the nurse prepare the infant for to determine if the cyanosis is due to respiratory or circulatory problems? arterial blood gases chest x-rays echocardiogram angiography
arterial blood gases Explanation: Arterial blood gases are obtained to determine the oxygenation levels and to help differentiate lung disease from heart disease. Chest x-rays will help identify cardiac size, shape, and position. An echocardiogram will evaluate the heart anatomy and flow defects. An angiography will be conducted to prepare the client for cardiac surgery, if needed.
The priority for the nurse caring for a newborn with esophageal atresia is to observe for which finding? constipation bleeding aspiration vomiting
aspiration Explanation: In the newborn with esophageal atresia, any mucus or fluid that the newborn swallows enters the blind pouch of the esophagus. This pouch soon fills and overflows, usually resulting in aspiration into the trachea.
What is the term for a small collection of blood that forms underneath the skull as a result of birth trauma? erythema toxicum caput succedaneum vernix caseosa cephalohematoma
cephalohematoma Explanation: Vernix caseosa is a thick white substance found on a newborn. Erythema toxicum is a newborn rash. Caput succedaneum is molding or edema.
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. Explanation: Developmental delays occur in young children of mothers with a substance use disorder. Infants of mothers with cocaine use disorder do not like to be touched or held and avoid the caregiver's gaze, which contributes to bonding delays. Infants of mothers with cocaine use disorder are often restless and below average weight when born.
When providing postpartum teaching to a couple, the nurse correctly identifies what time as when pathologic jaundice may be found in the newborn? between 2 and 4 days of life during the first 24 hours of life often with formula-fed babies after 5 days postpartum
during the first 24 hours of life Explanation: Pathologic jaundice occurs within the first 24 hours of life and is often related to blood incompatibility. Conversely, physiologic jaundice occurs 48 hours or more after birth, peaks at the 5th to 7th day, and disappears between the 7th and 10th day postpartum. Physiologic jaundice is caused by the normal reduction of red blood cells and occurs in both breastfed and bottle-fed babies.
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 lip cleft palate esophageal atresia coarctation of the aorta
esophageal atresia Explanation: Any swallowed mucus or fluid enters the blind pouch of the esophagus when a newborn suffers from esophageal atresia. The newborn with this disorder will have frothing, excessive drooling, and periods of respiratory distress with choking and cyanosis. If this happens, no feedings should be given until the newborn has been examined.
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? heart rate of 70 beats/min pink tongue respiratory rate 50 breaths/min vigorous cry
heart rate of 70 beats/min Explanation: Resuscitation is continued until the newborn has a heart rate higher than 100 beats/min, a good healthy cry, or good breathing efforts and a pink tongue. This last sign indicates a good oxygen supply to the brain.
A nurse is assigned to care for a high-risk newborn with a periventricular-intraventricular hemorrhage (PVH-IVH) in the home environment after discharge. For which condition should the nurse monitor the infant? formula intolerance urinary tract infection spina bifida hydrocephalus
hydrocephalus Explanation: A significant number of newborns with PVH-INH will incur brain injury, leading to complications that may include hydrocephalus. The nurse should monitor for the incidence of hydrocephalus in this high-risk newborn. Urinary tract infection is not a condition that persists after discharge. Spina bifida is most often noted at birth and would not need to be assessed by the nurse. Formula intolerance is not specific to high-risk newborns.
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? respiratory distress syndrome intraventricular hemorrhage (IVH) cold stress retinopathy of prematurity (ROP)
intraventricular hemorrhage (IVH) Explanation: Signs that may accompany IVH include hypotonia, apnea, bradycardia, a full or bulging fontanel (fontanelle), cyanosis, and increased head circumference.
When caring for a neonate of a mother with diabetes, which physiologic finding is most indicative of a hypoglycemic episode? excessive crying jitteriness hyperalert state serum glucose level of 60 mg/dl
jitteriness Explanation: Hypoglycemia in a neonate is expressed as jitteriness, lethargy, diaphoresis, and a serum glucose level below 40 mg/dl. A hyperalert state in a neonate is more suggestive of neuralgic irritability and has no correlation to blood glucose levels. Excessive crying isn't found in hypoglycemia. A serum glucose level of 60 mg/dl is a normal level.
When assessing a newborn for meconium aspiration syndrome, the nurse would most likely note which finding? preterm birth polyhydramnios maternal hypertension Apgar of 8
maternal hypertension Explanation: 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 premature infant in the neonatal intensive care unit exhibits worsening respiratory distress and is noted to have abdominal distention, absent bowel sounds, and frequent diarrhea stools that are positive for hemoccult. What diagnosis would be most likely to correlate with the symptoms? respiratory distress syndrome garamycin-resistant bacteria rotavirus infection necrotizing enterocolitis
necrotizing enterocolitis Explanation: Observations for the development of NEC in the premature newborn may include feeding intolerance with abdominal distention, abdominal tenderness, and bloody or hemoccult-positive stools. Diarrhea is present with NEC and worsening of respiratory distress. Decreased or absent bowel sounds are noted. Rotavirus causes inflammation of a child's stomach and digestive tract, usually triggering vomiting, diarrhea, and fever and not seen in a preterm infant. Garamycin-resistant bacteria is usually seen in older adults.
When caring for a neonate receiving phototherapy, the nurse should remember to: massage the neonate's skin with lotion. reposition the neonate frequently. dress the neonate warmly. decrease the amount of formula.
reposition the neonate frequently. Explanation: Phototherapy works by the chemical interaction between a light source and the bilirubin in the neonate's skin. Therefore, the larger the skin area exposed to light, the more effective the treatment. Changing the neonate's position frequently ensures maximum exposure. Because the neonate will lose water through the skin as a result of evaporation, the amount of formula or water may need to be increased. The neonate is typically undressed to ensure maximum skin exposure. The eyes are covered to protect them from light, and an abbreviated diaper is used to prevent soiling. The skin should be clean and patted dry. Use of lotions would interfere with phototherapy.
Which newborn would the nurse suspect to be most at risk for intellectual disability due to the mother's actions during pregnancy? the child of a teenage client who used marijuana through her pregnancy to cope with stress the child of a client who admits to drinking a liter of alcohol daily during the pregnancy the newborn of a client who used cocaine occasionally during her pregnancy the newborn of a client addicted to heroin and in the methadone maintenance program
the child of a client who admits to drinking a liter of alcohol daily during the pregnancy Explanation: Fetal alcohol spectrum disorder is one of the most common known causes of intellectual disability. The newborn is also at risk for fetal alcohol spectrum disorder and other alcohol-related birth defects. The other illicit drugs are not linked to intellectual disability but have many other teratogenic effects on the fetus/newborn. Marijuana has not shown to have teratogenic effects on the fetus.
