Core Curriculum - Ch 17 The Infant at Risk

True or false: Acidosis and hypothermia may lead to decreased pulmonary blood flow, which perpetuates decreased production of surfactant and may cause RDS.

True

A term infant develops severe respiratory distress immediately after birth. On physical examination, the chest is hyperexpanded, and the point of maximal impulse (PMI) is shifted to the right. What is the most likely cause for this infant's respiratory distress? a. Diaphragmatic hernia b. Right pneumothorax c. Transposition of the great arteries

a

All of the following factors indicate that Baby M. is at greater risk for hyperbilirubinemia except: a. Gestational age of 40 6/7 weeks b. Mother taking aspirin for her headaches c. Respirations having to be stimulated and oxygen administered

a

Baby L. was born to a 21-year-old gravida 1, para 1 (G1, P1) Vietnamese mother. He was born vaginally after a difficult delivery due to shoulder dystocia. At admission, his weight was 4400 g (9 pounds, 11.5 ounces). Physical and neurologic examination placed him at 40 weeks of gestation. His physical examination revealed an unequal Moro reflex with decreased movement of the left arm and crepitus at the left neck area. Bluish marking was also noted across the lower back. What is the correct gestational classification for Baby L.? a. LGA with risk for hypoglycemia b. AGA with risk for hypothermia c. SGA with risk for hypoglycemia

a

In actuality, the nurse finds the infant has a fractured clavicle, which is confirmed by x-ray. What may have led the nurse to this conclusion? a. Asymmetric startle reflex b. Extreme jitteriness c. History of forceps delivery

a

Ms. J., a gravida 2, para 1 (G2, P1) woman, delivered an infant boy vaginally at 35 weeks' gestation. The infant weighed 2500 g (5 pounds, 8 ounces); the fetal heart rate appeared fine during labor, although an L/S ratio was reported at 1.8:1. Ms. J. has gestational diabetes. What is a characteristic of a neonate with RDS? a. Has a deficiency of pulmonary surfactant b. Is postmature c. Has sternal excursions

a

What might the nurse expect to find in the mother's history? a. Premature labor treated with tocolytics b. Gestational diabetes c. Exposure to rubella in the first trimester

a

Why is hyperbilirubinemia of special concern in preterm infants? a. Immature liver function b. Poor vascular system c. Immature endocrine function

a

A 2300-g (5-pound, 1.5-ounce) infant girl is born to a 25-year-old gravida 1, now para 1 (G1, P1) woman by spontaneous vaginal delivery. The infant's length is 44 cm (17.5 inches), and her head circumference is 30.5 cm (12 inches). No abnormalities are noted on physical examination. Maternal history and a gestational age assessment reveal the neonate to be at approximately 38 weeks' gestation and that she is SGA. What might you expect to find in the mother's history? a. Weight gain of 15.9 kg (35 pounds) b. A history of smoking one pack of cigarettes per day c. Documented class A diabetes

b

A 32-year-old gravida 3, now para 3 (G3, P3) woman delivered a 3250-g (7-pound, 3-ounce) girl through meconium-stained fluid at 42 weeks' gestation. The infant's initial presentation is that she is limp, cyanotic, has minimal respirations, and has a heart rate less than 100 bpm. She was intubated and suctioned by the neonatal team. Although she was suctioned through the endotracheal tube (ETT), no meconium was seen below the cords. With oxygen and stimulation, her Apgar scores at 1 and 5 minutes were 7 and 9, respectively. What is the most serious consequence that might result from this delivery? a. Patent ductus arteriosus (PDA) b. Meconium aspiration c. Hyaline membrane disease

b

A 4100-g (9-pound, 1.5-ounce) boy is born after a difficult forceps delivery. The prenatal history reveals an uncomplicated pregnancy of 40 weeks' gestation. The infant's length is 53.3 cm (21 inches), and his head circumference is 37 cm (14.6 inches). Gestational age assessment reveals the infant to be LGA. On physical examination, what might you expect to find with this infant? a. Clubfoot b. Brachial plexus injury c. Diminished Babinski reflex

b

Baby R. is a 6-hour-old female born to a 28-year-old mother with a history of preeclampsia. Baby R. was born 5 weeks premature and has a birthweight of 1450 g (3 pounds, 3 ounces). On admission to the newborn nursery, the infant's respiratory rate was 74, and she was noted to have mild intercostal and substernal retractions with adequate air entry on auscultation. Auscultation of her heart revealed a harsh murmur that was best heard in the area of the left upper sternal border. Baby R.'s history and presentation are most indicative of: a. Coarctation of the aorta b. Atrial septal defect c. Patent ductus arteriosus (PDA)

b

A 42-week postterm neonate was born with greenish discoloration of the nails and skin and greenish secretions in the nasal passages. Why might the infant be transferred to a level 3 nursery? 412 a. To determine the reason for the postmaturity b. To observe more closely for skin color changes c. To manage severe respiratory problems that develop

c

An 18-year-old G1, P1 woman delivered a 2000-g (4-pound, 6.5-ounce) boy by cesarean section. The infant is assessed to be AGA of 34 weeks. No abnormalities are noted on physical examination. This infant is at risk for what condition? a. Hyperglycemia b. Premature closure of the ductus arteriosus c. Respiratory distress syndrome (RDS)

c

Baby M.'s mother is crying, expresses fear about her infant's health, and does not want to leave. Which intervention would be the least effective? a. Encourage the mother to come in to feed her infant as often as possible. b. Emphasize the temporary nature of hyperbilirubinemia, and explain the monitoring of Baby M.'s bilirubin levels. c. Remind the mother that newborns require demanding care, which is very fatiguing to a new mother, and that she should take this added opportunity to rest and recover.

c

On her second day of life, Baby M. required phototherapy treatment. Her mother was being discharged from the hospital and came to the nursery to breastfeed her infant before leaving. Baby M.'s mother was crying and did not want to go home without her infant. Baby M.'s father was trying to comfort his wife. While Baby M. is under the phototherapy lights, it is important to: a. Keep the infant under the lights at all times so that there will be maximal effectiveness in the shortest period. b. Discontinue Baby M.'s breastfeeding because the fluid content of breast milk is deficient for a neonate undergoing phototherapy. c. Prevent hypothermia, hyperthermia, or both in Baby M.

c

The historical and physical findings for Baby L. might suggest: a. Torticollis b. Fractured clavicle c. Duchenne-Erb's palsy

c

To what should the nurse be alert when caring for this infant? a. Possible skull fracture b. Positive drug screen c. Hypothermia

c

What physiologic factor contributes to greater risk for alterations in skin integrity in preterm infants? a. Immature immunologic system b. Malfunctioning of regulatory organs, such as the kidneys and respiratory tract c. Decreased cohesion between the dermis and epidermis

c

Which prenatal factor is most likely to predispose the neonate to develop respiratory distress? a. Maternal diabetes b. Gestation of 34 weeks c. Fetal scalp pH of 7.20

b

You are preparing to care for several recently born infants. Which infant is at greatest risk for TTN? a. Spontaneous vaginal delivery; 40 weeks' gestation b. Cesarean birth; 41 weeks' gestation c. Vaginal delivery with maternal anesthesia; 38 weeks' gestation

b

Baby M. was delivered after a 16-hour induced labor. Maternal membranes were artificially ruptured, fluid was clear, and an oxytocin (Pitocin) infusion was initiated. The mother was afebrile throughout the labor. The second stage of labor was 2 hours, 45 minutes. Review of the mother's prenatal and labor history yielded the following information: Blood type is A +. Venereal Disease Research Laboratory (VDRL) is nonreactive. Alpha-fetoprotein is normal. Average blood pressure is 116 to 124/76 to 82. Total weight gain was 12.25 kg (27 pounds). Medications are prenatal vitamins, iron, and aspirin for stress headaches. Gestational age is 40 6/7 weeks. Nonstress test is reactive. Baby M. had the umbilical cord wrapped twice around her neck and required stimulation to initiate breathing and administration of oxygen by face mask. Apgar scores were 7 at 1 minute and 8 at 5 minutes. From this information, which factor places Baby M. at increased risk for hyperbilirubinemia? a. Ruptured membranes for 16 hours b. Postmaturity c. Labor induced with Pitocin

c

In RDS, blood may not be well oxygenated because of all of the following except: a. A patent ductus arteriosus (PDA) b. Decreased pulmonary resistance c. Atelectasis of the alveoli

c

What problem may the LGA infant experience? a. PDA b. Facial nerve damage c. Poor suck, swallow, and breathing coordination

c

What would the nurse expect to see on examination of this infant? a. Abundant lanugo b. Absence of sole creases c. Leathery, cracked, and wrinkled skin

c