High-Risk Newborn: Acquired and Congenital Conditions chapter 24
In the child diagnosed with hydrocephalus, an obstruction occurs that blocks the normal process of which of the following? a) Cerebrospinal fluid b) Circulatory blood flow c) Lymphatic system d) Genitourinary tract
Cerebrospinal fluid
Periventricular hemorrhage is suspected in a newborn of 30 weeks' gestation. The nurse would anticipate preparing the newborn for which of the following to confirm the diagnosis? a) Cranial ultrasound b) Blood glucose level c) Chest x-ray d) Arterial blood gases
Cranial ultrasound
Nursing assessment of the infant should include what important information that might indicate heart failure? a) Blood glucose level b) Color of hands and feet c) Diminished peripheral pulses d) Capillary refill time
Diminished peripheral pulses
After teaching a group of students about the physiologic jaundice in breast-fed and bottle-fed newborns, the instructor determines that the teaching was successful when the students state which of the following? a) Jaundice associated with bottle feeding occurs in two distinct patterns. b) Peak bilirubin levels occur earlier for bottle-fed newborns than for breast-fed newborns. c) The decline in bilirubin levels occurs more quickly in bottle-fed newborns. d) Breast-fed newborns tend to have more frequent bowel movements.
The decline in bilirubin levels occurs more quickly in bottle-fed newborns.
The nurse is caring for a newborn with retinopathy of prematurity (ROP). Which of the following is the best explanation of this disorder? a) The infant has a degenerative disease of the retina b) The infant's lungs are immature and deficient in surfactant c) The infant has bleeding into the ventricles of the brain d) The infant's liver is unable to manage the bilirubin produced by hemolysis
The infant has a degenerative disease of the retina
The nurse is caring for a newborn with hyaline membrane disease. Which of the following is the best explanation of this disorder? a) The infant's lungs are immature and deficient in surfactant b) The infant's liver is unable to manage the bilirubin produced by hemolysis c) The infant has bleeding into the ventricles of the brain d) The infant has a degenerative disease of the retina
The infant's lungs are immature and deficient in surfactant
The nurse is caring for a newborn with retinopathy of prematurity (ROP). Which of the following is the best explanation of this disorder? a) The infant has bleeding into the ventricles of the brain b) The infant's liver is unable to manage the bilirubin produced by hemolysis c) The infant's lungs are immature and deficient in surfactant d) The infant has a degenerative disease of the retina
The infant's lungs are immature and deficient in surfactant
A nurse is assigned to care for a newborn with hyperbilirubinemia. The newborn is relatively large in size and shows signs of listlessness. What would have most likely happened to have caused these conditions to occur in the infant? a) The infant's mother must have had a long labor. b) The infant's mother probably used alcohol. c) The infant's mother probably had diabetes. d) The infant may have experienced birth trauma.
The infant's mother probably had diabetes.
A newborn is suspected of having gastroschisis at birth. How would the nurse differentiate this problem from other congenital defects? a) The umbilical cord comes out of middle of the defect b) The intestines appear reddened and swollen and have no sac around them c) The abdominal contents are contained within a thin, transparent sac d) The skin over the abdomen is wrinkled and looks like a prune
The intestines appear reddened and swollen and have no sac around them
The nurse is caring for a newborn who was small for gestational age and has been determined to have the condition intrauterine growth restriction (IUGR). Which of the following factors would most likely have contributed to this condition? a) The mother of this newborn smoked until 4 years ago b) The mother of this newborn has been pregnant 3 previous times c) The mother of this newborn has a history of abnormal blood glucose levels d) The mother of this newborn was on a food stamp program during pregnancy
The mother of this newborn has a history of abnormal blood glucose levels
The nurse is caring for a newborn of a substance abusing mother who is withdrawing from alcohol. Which of the following would the nurse likely see in this newborn? a) The newborn has a large head circumference b) The newborn is lethargic and sleepy c) The newborn is hyperactive and irritable d) The newborn is above average birth weight
The newborn is hyperactive and irritable
The nurse is caring for a newborn with hemolytic disease of the newborn who is receiving phototherapy. Which of the following nursing interventions would be most appropriate for the nurse to do? a) The nurse dresses the newborn in a lightweight gown at night b) The nurse leaves the light off for one hour 6 times a day c) The nurse turns the newborn every 3 or 4 hours d) The nurse removes and changes the eye patches every hour
The nurse turns the newborn every 3 or 4 hours
The nurse is reinforcing discharge teaching with the mother of an infant who is being discharged prior to having a required blood test done. The nurse explains to this mother that she needs to bring the newborn back to check the infant's phenylalanine level. Which of the following is most accurate related to this blood test? a) It is common to perform this test after the newborn is five days old. b) The test is done after the newborn has ingested protein. c) If the test is not done the newborn could be mentally retarded. d) The test is done by drawing blood from the infant's umbilical cord.
The test is done after the newborn has ingested protein.
The nurse is caring for a newborn who has transient tachypnea of the newborn. In discussing the contributing factors for this disorder which of the following statements is most accurate? a) This disorder is associated with fetal distress during labor b) This disorder is often seen in newborns born by cesarean delivery c) This disorder usually occurs when the mother has a history of hypertension d) This disorder may be seen with advanced gestational age
This disorder is often seen in newborns born by cesarean delivery
A nurse is caring for a newborn with asphyxia. What nursing management is involved when treating a newborn with asphyxia? a) Administer surfactant as ordere b) Ensure effective resuscitation measures c) Ensure adequate tissue perfusion d) Administer IV fluids
Ensure effective resuscitation measures
A woman with hydramnios has just given birth. The nurse recognizes that the infant must be assessed for which of the following conditions? a) Torticollis b) Esophageal atresia c) Talipes d) Ankyloglossia
Esophageal atresia
The nurse is assessing a newborn suspected of having meconium aspiration syndrome. What sign or symptom would be most suggestive of this condition? a) Intermittent tachypnea b) Expiratory grunting c) Bile-stained emesis d) High-pitched shrill cry
Expiratory grunting
Since the inclusion of calcium in prenatal vitamins and all cereal and grain products, the incidence of neural tube disorders has fallen dramatically in the United States. a) True b) False
False
You care for a child born with a tracheoesophageal fistula. Which finding during pregnancy would have caused you to suspect this might be present? a) Oligohydramnios b) Bleeding at 32 weeks of pregnancy c) A difficult second stage of labor d) Hydramnios
Hydramnios
For which of the following would you commonly assess in an infant following surgery for a myelomeningocele? a) Dehydration b) Cerebrovascular accident c) Hydrocephalus d) Urinary tract infection
Hydrocephalus
In addition to newborns of diabetic mothers being at risk for hypoglycemia, these newborns are also at risk for which of the following? a) Hypermagnesemia b) Hypobilirubinemia c) Hypocalcemia d) Hyperkalemia
Hypocalcemia
A newborn has not passed any stools in the first 24 hours after birth, and his abdomen is becoming distended. The nurse recognizes that which of the following conditions could explain such findings? a) Imperforate anus b) Esophageal atresia c) Ankyloglossia d) Cleft palate
Imperforate anus
Over the course of an eight hour shift of postoperative care for a child who has had ventriculoatrial shunt placement, the nurse notes that the child's cry has become increasingly shrill and the child has projectile vomiting. The nurse would notify the physician immediately because of the possibility that the child might be experiencing a) A sudden increase in pain b) Increased intracranial pressure c) Infection at the surgical site d) Rejection of the shunt
Increased intracranial pressure
The nurse who is caring for newborn Andrew notices that although he has seemed healthy at 18 hours of age, Andrew's abdomen is now distended. By 24 hours he has passed no stool. The nurse will a) Inform the caregivers that Andrew might need surgery b) Schedule radiography to diagnose the problem c) Inform the physician of the findings d) Attempt to take a rectal temperature
Inform the physician of the findings
A pre-term newborn is noted to have hypotonia, apnea, bradycardia, a bulging fontanelle, cyanosis, and increased head circumference. These signs indicate the newborn most likely has which of the following complications? a) Cold stress b) Intraventricular hemorrhage (IVH) c) Respiratory distress syndrome d) Retinopathy of prematurity (ROP)
Intraventricular hemorrhage (IVH)
While the nurse is weighing and measuring a toddler during his annual checkup, the toddler's mother mentions that she is thinking of having another child. The toddler is small in stature and seems mildly developmentally delayed. His eyelid folds are short and his nose is flat. What do the toddler's characteristics suggest is the best advice the nurse can give this mother about pregnancy? a) It's a good idea to stop drinking alcohol 3 months before trying to get pregnant b) It's important to keep insulin levels controlled during pregnancy c) It would be good to stop smoking before getting pregnant d) It's important to add iron and vitamin B supplements to your diet
It's a good idea to stop drinking alcohol 3 months before trying to get pregnant
Which of the following is a common finding in the child who has a ventricular septal defect? a) Bounding pulse b) Delayed growth and development c) Fatigue and dyspnea d) Loud, harsh murmur
Loud, harsh murmur
Which of the following is a common finding in the child who has a ventricular septal defect? a) Delayed growth and development b) Loud, harsh murmur c) Bounding pulse d) Fatigue and dyspnea
Loud, harsh murmur
In the infant born with a cleft lip and a cleft palate, the highest priority of the nurse is related to which of the following? a) Maintaining the nutritional needs if the infant b) Promoting coping skills in the family caregivers c) Reducing family anxiety related to the treatment d) Managing the pain level of the infant
Maintaining the nutritional needs if the infant
A nurse is caring for a newborn whose chest x-ray reveals marked hyperaeration mixed with areas of atelectasis. The infant's arterial blood gas analysis indicates metabolic acidosis. The nurse should prepare for the management of which dangerous conditions when providing care to this newborn? a) Choanal atresia b) Diaphragmatic hernia c) Pneumonia d) Meconium aspiration syndrome
Meconium aspiration syndrome
The hereditary defect known as Phenylketonuria (PKU) will cause which of the following if left untreated? a) Strangulated intestine b) Congenital heart defects c) Increased intracranial pressure d) Mental retardation
Mental retardation
It would be best to place an infant with a myelomeningocele in which position prior to surgery? a) Supine with the head elevated b) On the stomach (prone) c) Semi-Fowler's in an infant chair d) On the left side with the head dependent
On the stomach (prone)
The nurse is assessing for developmental dysplasia of the hip in the newborn. The dislocated hip elicits a characteristic clunk as the femoral head slides over the posterior rim of the acetabulum and the dislocation feels reduced. Which maneuver did the nurse perform? a) Pavlik b) Gower c) Barlow d) Ortolani
Ortolani
The nurse is changing the diaper on a newborn and notices that there is a musty smell to the infant's urine. This finding is a characteristic sign of which of the following disorders? a) Turner syndrome b) Phenylketonuria c) Congenital hypothyroidism d) Galactosemia
Phenylketonuria
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? a) Place a wedge under the child's crib. b) Place the child on the abdomen. c) Place the child on the back. d) Position the child on the side.
Position the child on the side.
A nurse is assigned to care for a newborn with esophageal atresia. What priority preoperative nursing care is the priority for this newborn? a) Prevent aspiration by elevating the head of the bed and insert an NG tube to low suction b) Administer antibiotics and total parenteral nutrition as ordered c) Provide NG feedings only d) Document the amount and color of esophageal drainage
Prevent aspiration by elevating the head of the bed and insert an NG tube to low suction
The nurse cares for a newborn with a congenital cardiac anomaly. What component of nursing care is the priority for the newborn? a) Accompany the newborn to all radiologic examinations b) Teach the parents to take pulse and blood pressure measurements c) Prevent pain as much as possible d) Maintain oxygen saturation at 95% or above
Prevent pain as much as possible
A nurse is working with a child who has spina bifida. The highest priority nursing goal for this child would be which of the following? a) Providing caregiver teaching b) Reducing family anxiety c) Promoting comfort measures d) Preventing infection
Preventing infection
An infant born is suspected of having persistent pulmonary hypertension of the newborn (PPHM). What intervention implemented by the nurse would be most beneficial in treating this client? a) Provide oxygen by oxygen hood or ventilator b) Encourage the parents to hold the infant for bonding c) Administer anticonvulsants as ordered d) Place the infant in a cool environment to prevent overheating
Provide oxygen by oxygen hood or ventilator
In the pre-term newborn, which of the following body systems are the most critical complications related to? a) Integumentary b) Immune c) Respiratory d) Digestive
Respiratory
In caring for the child with esophageal atresia the nurse recognizes the highest concern for this child is the possibility of which of the following? a) Respiratory distress b) Cardiac anomalies c) Excess bleeding d) Feeding difficulty
Respiratory distress
An infant has just been born with a cleft lip and palate. The birthing room suddenly becomes very quiet, and the birth team seem somber. The physician is busy examining the newborn, but the mother is obviously aware that something is not right. Which of the following should the nurse do? a) Say to the parents, "I'm very sorry. There appears to be a problem with your son. The doctor will be over shortly to talk to you about it." b) Say to the parents, "Your son has been born with a cleft lip and palate. This condition is highly treatable by surgery, however, and he is otherwise in excellent health." c) Wait until the physician has finished examining the baby, and allow her to tell the parents. d) When the physician has finished examining the baby, take the baby over to the mother and let her hold him and bond with him before discussing the condition.
Say to the parents, "Your son has been born with a cleft lip and palate. This condition is highly treatable by surgery, however, and he is otherwise in excellent health."
When assessing a newborn, the nurse determines that the newborn is most likely experiencing respiratory distress syndrome (RDS) based on which of the following? a) Peripheral cyanosis b) Slightly diminished breath sounds c) See-saw respirations d) Respiratory distress occurring by 6 hours of age
See-saw respirations
The parents of an infant with congenital club foot question the nurse about what the treatment will be to address this problem. What initial treatment plan would the nurse explain to the parents? a) Serial casting b) Application of bilateral braces c) Initiation of physical therapy d) Immediate surgery to straighten the ankle
Serial casting
What treatment can the nurse anticipate assisting with for a newborn with congenital talipes equinovarus? a) Serial casting b) Open reduction with internal fixation c) Pavlik harness d) Closed reduction
Serial casting
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? a) "Intravenous fluids are going to be needed so that the baby won't get dehydrated." b) "After this surgery is done tomorrow, my baby will be able to eat and drink." c) "They will be placing a tube in the stomach during surgery." d) "The baby will have tubes in the chest to drain chest fluids."
"After this surgery is done tomorrow, my baby will be able to eat and drink."
A nurse is caring for a newborn with jaundice undergoing phototherapy. What intervention is appropriate when caring for the newborn? a) Shield the newborn's eyes b) Expose the newborn's skin minimally c) Discourage feeding the newborn d) Discontinue therapy if stools are loose, green, and frequent
Shield the newborn's eyes
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) Spina bifida with menigocele b) Spina bifida occulta c) A normal spinal closure d) Spina bifida with myelomeningocele
Spina bifida occulta
Four weeks before the birth of her already large child, the physician has told the pregnant woman that if the baby gets bigger and his lungs are ready, the physician would like to perform a cesarean to deliver the baby. The woman asks the nurse what the downside is to having a cesarean rather than a vaginal delivery. What is an appropriate response by the nurse? a) "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." b) "If the physician has recommended the procedure, it's likely that the benefits outweigh the risks." c) "The procedure isn't risky for the baby, but your healing takes longer and you'll have a scar." d) "Some women don't have any problem delivering 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."
The nurse is doing teaching with the caregivers of an infant diagnosed with hypospadias. Which of the following statements made by the caregivers is accurate regarding hypospadias? a) "It is upsetting to me that he is in pain when he urinates." b) "We hadn't decided about circumcision, but he will have to be circumcised before they do the surgery." c) "At least he won't have to have surgery until he is almost ready to start school." d) "Being able to most likely correct this in one stage rather than several is reassuring."
"Being able to most likely correct this in one stage rather than several is reassuring."
A meconium plug is an extremely hard portion of meconium that has completely blocked the intestinal lumen, causing bowel obstruction. a) True b) False
True
In working with the child or family of a child with a congenital disorder, the most effective nursing intervention for this child or family would be for the nurse to a) Keep the family informed about new and effective treatments b) Use reflective listening and offer nonjudgmental support c) Help the child to understand his or her limitations d) Model good medical practices for the child's family
Use reflective listening and offer nonjudgmental support
In working with the child or family of a child with a congenital disorder, the most effective nursing intervention for this child or family would be for the nurse to a) Model good medical practices for the child's family b) Keep the family informed about new and effective treatments c) Help the child to understand his or her limitations d) Use reflective listening and offer nonjudgmental support
Use reflective listening and offer nonjudgmental support
In examining her newborn son, a mother becomes concerned that the frenulum, under his tongue, is too short. She points it out to the nurse. Which of the following should the nurse say in response to this mother's concern? a) "In most cases, a short frenulum does not cause problems and does not need to be corrected." b) "The child will most likely develop speech problems and will require speech therapy." c) "It is likely that the child will need to have surgery in the coming weeks to prevent developmental problems." d) "This condition can be corrected by passive stretching exercises of the tongue."
"In most cases, a short frenulum does not cause problems and does not need to be corrected."
A woman with a history of PKU tells the nurse that she has decided to try to become pregnant. Her serum phenylalanine level is 10 mg/dL. Which of the following is an appropriate response for the nurse to make? a) "It will be best if you cut back on vegetables and fruit before you become pregnant to get your serum phenylalanine level down under 8 mg." b) "It will be best if you cut back on meat, fish, and dairy products before you become pregnant to get your serum phenylalanine level down under 8 mg." c) "The baby won't be able to breast feed. You know breast feeding is really the best way to care for a newborn." d) "Think carefully about the decision. The child might be mentally retarded if she inherits your PKU, especially if your levels stay that high."
"It will be best if you cut back on meat, fish, and dairy products before you become pregnant to get your serum phenylalanine level down under 8 mg."
The nurse is working with a group of parents of children who have congenital heart disorders. Which of the following statements made by the parents would most likely be an indication the child is showing signs of congestive heart failure. a) "They say he has a heart murmur but it may go away." b) "She gets so tired when she is eating." c) "His chest measurement is the same as his head." d) "When I move her legs up toward her chest I hear a click."
"She gets so tired when she is eating."
A group of nursing students is discussing hydrocephalus. The students make the following statements related to the noncommunicating type of congenital hydrocephalus. Which statement is the most accurate? a) "There is defective absorption of cerebrospinal fluid." b) "There is an obstruction that keeps cerebrospinal fluid from passing between the ventricles and the spinal cord." c) "There is an opening between the ventricles and the spinal cord that usually closes at birth." d) "There is a decreased production of cerebrospinal fluid."
"There is an obstruction that keeps cerebrospinal fluid from passing between the ventricles and the spinal cord."
A group of nursing students is discussing hydrocephalus. The students make the following statements related to the noncommunicating type of congenital hydrocephalus. Which statement is the most accurate? a) "There is an opening between the ventricles and the spinal cord that usually closes at birth." b) "There is an obstruction that keeps cerebrospinal fluid from passing between the ventricles and the spinal cord." c) "There is a decreased production of cerebrospinal fluid." d) "There is defective absorption of cerebrospinal fluid."
"We can probably start feeding him with the bottle about a day after the surgery."
The nurse teaches the parents of a newborn with hyperbilirubinemia about home phototherapy using bilirubin lights. Which statement indicates that the teaching was successful? a) "We will turn him every ½ hour to make sure that his whole body is exposed." b) "We should see reddened areas on his skin, which mean the treatment is working." c) "We'll place the lights so that they are about 5 inches above our baby at all times." d) "We'll take off the patches on his eyes when we're feeding him so he can look at us."
"We'll take off the patches on his eyes when we're feeding him so he can look at us."
An infant was born with a severely deformed hand. He is now 6 months old. The nurse informs the parents that the orthopedic surgeon has recommended amputation of the hand and fitting of a prosthesis. The mother objects and tells the nurse that they would like to wait and see how the hand develops. Which of the following should the nurse say in response? a) "An alternative to amputation and prosthesis is administration of a new drug that can help regenerate the hand." b) "With a deformity such as this, the hand is highly unlikely to improve." c) "If we perform the amputation and you change your mind later, the hand can always be surgically reattached." d) "I agree. You should wait until your son is older and let him decide whether he would like to have it done."
"With a deformity such as this, the hand is highly unlikely to improve."
Which of the following instructions would the nurse include in the teaching plan for a mother of a substance-exposed newborn? a) "Let your newborn sleep in his stomach for naps but not at night." b) "Place your newborn on his side when you feed him." c) "Wrap him snugly in a blanket and gently rock him if he's fussy." d) "Avoid using a pacifier because it can damage his teeth in the future."
"Wrap him snugly in a blanket and gently rock him if he's fussy."
An older infant is scheduled to have a cleft palate repair. The mother asks if she will still be able to breastfeed the baby during the postoperative phase. What is the best response by the nurse? a) "You will not be able to breastfeed but immediately after, but you can pump and feed the child with a cup." b) "Yes, the surgery will not interfere with breastfeeding your child." c) "No, you will have to put the baby on regular formula." d) "Yes, you will be able to breastfeed but will have to interrupt the feedings frequently."
"You will not be able to breastfeed but immediately after, but you can pump and feed the child with a cup."
In the infant diagnosed with spina bifida with myelomeningocele, the infant will likely have which of the following? a) A protruding sac that contains abdominal contents b) A membrane between the rectum and the anus c) An extremely large and rapidly growing head d) A partial to complete paralysis in the lower extremities
A partial to complete paralysis in the lower extremities
An infant with severe meconium aspiration syndrome (MAS) is not responding to conventional treatment. Which highly technical method of treatment may be necessary for an infant who does not respond to conventional treatment? a.Extracorporeal membrane oxygenation b.Respiratory support with ventilator c.Insertion of laryngoscope and suctioning of the trachea d.Insertion of an endotracheal tube
ANS: A
In conjunction with phototherapy, which intervention is most effective in reducing the indirect bilirubin in an affected newborn? a.Increase the frequency of feedings. b.Increase oral intake of water between feedings. c.Offer an exchange transfusion. d.Wrap the infant in triple blankets to prevent cold stress.
ANS: A
Nursing care of the infant with neonatal abstinence syndrome should include a.Positioning the infant's crib in a quiet corner of the nursery b.Feeding the infant on a 2-hour schedule c.Placing stuffed animals and mobiles in the crib to provide visual stimulation d.Spending extra time holding and rocking the infant
ANS: A
Nursing care of the neonate undergoing jaundice phototherapy includes a. Keeping the infant's eyes covered under the light b.Keeping the infant supine at all times c. Restricting parenteral and oral fluids d.Keeping the infant dressed in only a T-shirt and diaper
ANS: A
The most important nursing action in preventing neonatal infection is a.Good handwashing b.Isolation of infected infants c.Separate gown technique d. Standard Precautions
ANS: A
The nurse must continually assess the infant who has meconium aspiration syndrome (MAS) for the complication of a.Persistent pulmonary hypertension b. Bronchopulmonary dysplasia c.Transitory tachypnea of the newborn d.Left-to-right shunting of blood through the foramen ovale
ANS: A
Which infant is most likely to have Rh incompatibility?a.Infant of an Rh-negative mother and a father who is Rh positive and homozygous for the Rh factor b.Infant who is Rh negative and whose mother is Rh negative c.Infant of an Rh-negative mother and a father who is Rh positive and heterozygous for the Rh factor d.Infant who is Rh positive and whose mother is Rh positive
ANS: A
An infant with hypocalcemia is receiving an intravenous bolus of calcium. Which sign signals the nurse to stop the administration of this medication? a.Tachypnea of the newborn b.Bradycardia c.Decrease of acrocyanosis d.Gastric irritation (diarrhea)
ANS: B
Newborns whose mothers are substance abusers frequently have what behavior? a. Circumoral cyanosis, hyperactive Babinski reflex, and constipation b.Decreased amounts of sleep, hyperactive Moro (startle) reflex, and difficulty feeding c. Hypothermia, decreased muscle tone, and weak sucking reflex d.Excessive sleep, weak cry, and diminished grasp reflex
ANS: B
Parents of a newborn with phenylketonuria are anxious to learn about the appropriate treatment for their infant. The nurse should explain that treatment of PKU involves _____ diet. a.Sodium restrictions in the b.A phenylalanine-free c.A phenylalanine-enriched d.A protein-rich
ANS: B
The difference between physiologic and nonphysiologic jaundice is that nonphysiologic jaundice a.Usually results in kernicterus b.Appears during the first 24 hours of life c.Results from breakdown of excessive erythrocytes not needed after birth d.Begins on the head and progresses down the body
ANS: B
The goal of treatment of the infant with phenylketonuria (PKU) is to a.Cure mental retardation. b.Prevent central nervous system (CNS) damage, which leads to mental retardation. c.Prevent gastrointestinal symptoms. d.Cure the urinary tract infection.
ANS: B
The most common cause of pathologic hyperbilirubinemia is a.Hepatic disease b.Hemolytic disorders in the newborn c. Postmaturity d.Congenital heart defect
ANS: B
A plan of care for an infant experiencing symptoms of drug withdrawal should include a.Administering chloral hydrate for sedation b.Feeding every 4 to 6 hours to allow extra rest c.Swaddling the infant snugly and holding the baby tightly d.Playing soft music during feeding
ANS: C
A primigravida has just delivered a healthy infant girl. The nurse is about to administer erythromycin ointment in the infant's eyes when the mother asks, "What is that medicine for?" The nurse responds a."It is an eye ointment to help your baby see you better."b."It is to protect your baby from contracting herpes from your vaginal tract." c."Erythromycin is given prophylactically to prevent a gonorrheal infection." d."This medicine will protect your baby's eyes from drying out over the next few days."
ANS: C
Near the end of the first week of life, an infant who has not been treated for any infection develops a copper-colored, maculopapular rash on the palms and around the mouth and anus. The newborn is showing signs of a.Gonorrhea b.Herpes simplex virus infection c.Congenital syphilis d.HIV
ANS: C
Providing care for the neonate born to a mother who abuses substances can present a challenge for the health care team. Nursing care for this infant requires a multisystem approach. The first step in the provision of this care is a. Pharmacologic treatment b.Reduction of environmental stimuli c.Neonatal abstinence syndrome scoring d.Adequate nutrition and maintenance of fluid and electrolyte balance
ANS: C
The nurse present at the delivery is reporting to the nurse who will be caring for the neonate after birth. What information might be included for an infant who had thick meconium in the amniotic fluid? a.The infant needed vigorous stimulation immediately after birth to initiate crying. b.An IV was started immediately after birth to treat dehydration.c.No meconium was found below the vocal cords when they were examined. d.The parents spent an hour bonding with the baby after birth.
ANS: C
Transitory tachypnea of the newborn (TTN) is thought to occur as a result of a.A lack of surfactant b.Hypoinflation of the lungs c.Delayed absorption of fetal lung fluid d.A slow vaginal delivery associated with meconium-stained fluid
ANS: C
A macrosomic infant is born after a difficult, forceps-assisted delivery. After stabilization, the infant is weighed, and the birth weight is 4550 g (9 pounds, 6 ounces). The nurse's most appropriate action is to a.Leave the infant in the room with the mother.b.Take the infant immediately to the nursery. c.Perform a gestational age assessment to determine whether the infant is large for gestational age. d.Monitor blood glucose levels frequently and observe closely for signs of hypoglycemia.
ANS: D
A pregnant woman at 37 weeks of gestation has had ruptured membranes for 26 hours. A cesarean section is performed for failure to progress. The fetal heart rate before birth is 180 beats/min with limited variability. At birth, the newborn has Apgar scores of 6 and 7 at 1 and 5 minutes and is noted to be pale and tachypneic. Based on the maternal history, the cause of this newborn's distress is most likely a.Hypoglycemia b.Phrenic nerve injury c.Respiratory distress syndrome d.Sepsis
ANS: D
HIV may be perinatally transmitted a.Only in the third trimester from the maternal circulation b.From the use of unsterile instruments c.Only through the ingestion of amniotic fluid d.Through the ingestion of breast milk from an infected mother
ANS: D
It is important for the nurse to remember that when performing neonatal resuscitation, the priority action should be to a.Suction the mouth and nose. b.Stimulate the infant by rubbing the back. c.Perform the Apgar test. d.Dry the infant and position the head.
ANS: D
The infant of a mother with diabetes is hypoglycemic. What type of feeding should be instituted first? a.Glucose water in a bottle b.D5W intravenously c.Formula via nasogastric tube d.Breast milk
ANS: D
When providing care to a newborn with necrotizing enterocolitis (NEC), which of the following would the nurse need to report immediately? a) Stools negative for blood b) Abdomen appearing red and shiny c) Decrease in abdominal girth d) Bowel sounds in all four quadrants
Abdomen appearing red and shiny
When examining a newborn for developmental hip dysplasia, which of the following motions would the newborn's hip be unable to accomplish? a) Extension b) Abduction c) Adduction d) Rotation
Abduction
A nurse is caring for a newborn with transient tachypnea. Which is the priority nursing intervention? a) Administer IV fluids; gavage feedings b) Perform gentle suctioning c) Monitor for signs of hypotonia d) Maintain adequate hydration
Administer IV fluids; gavage feedings
Which of the following would the nurse expect to be included in the plan of care for an infant of a diabetic mother who has a serum calcium level of 6.2 mg/dL? a) Administration of calcium gluconate b) Infusions of intravenous glucose c) Initiation of phototherapy d) Initiation of oral feedings
Administration of calcium gluconate
A nursing instructor is teaching about newborn congenital disorders and realizes that the student needs further instruction upon making which of the following statements? a) All congenital disorders can be diagnosed at birth. b) Congenital defects may be caused by genetic or environmental factors. c) Hydrocephalus may not be diagnosed until after a few weeks or months of life. d) Hydrocephalus may be recognized at birth.
All congenital disorders can be diagnosed at birth.
One of the clinical manifestations seen in the child with hydrocephalus is which of the following? a) A partial to complete paralysis in the lower extremities b) An extremely large and rapidly growing head c) A membrane between the rectum and the anus d) Aprotruding sac that contains abdominal contents
An extremely large and rapidly growing head
After delivery, an infant experiences meconium aspiration. What does the nurse anticipate the physician ordering prophylactically to prevent pneumonia? a) Intubation b) Antibiotics c) Inhaled surfactant d) Suction of the oropharynx
Antibiotics
The nurse is caring for a newborn diagnosed with congenital talipes equinovarus. Which of the following treatments would the nurse most likely expect for this newborn? a) Placing the child in special shoes b) Doing passive range of motion c) Application of a cast d) Putting the child in Bryant's traction
Application of a cast
Immediately after delivery, the nurse is caring for a newborn with a myeolomeningocele. What intervention should the nurse provide to prevent drying out of the sac to avoid damage? a) Cover the sac with petroleum jelly and a dry sterile dressing. b) Apply a sterile dressing moistened in a warm sterile saline solution. c) Cover the sac with a water-soluble lubricant and a dry sterile dressing. d) Allow the sac to dry out to "toughen" it.
Apply a sterile dressing moistened in a warm sterile saline solution.
Following birth the newborn's independent circulatory system is established. If there is an abnormal opening between the chambers in the heart, which of the following cardiac defects may occur? a) Patent ductus arteriosus b) Transposition of the great vessels c) Coarctation of the aorta d) Ventricular septal defect
Ventricular septal defect
A procedure used in the treatment of the child with hydrocephalus is to surgically insert a shunt that drains cerebrospinal fluid into a chamber in the heart. This type of shunt procedure is referred to as which of the following? a) Ventricular septal b) Ventriculoatrial c) Atrial septal d) Ventriculoperitoneal
Ventriculoatrial
An infant develops hydrocephalus at 2 weeks of age. Which of the following would you expect to assess? a) Hypothermia in the late afternoon b) White sclera showing above the pupils c) A soft, fretful cry d) Excessive thirst
White sclera showing above the pupils
A nursing student has read that cleft lip is diagnosed at birth based on inspection of physical appearance, and that cleft palate is diagnosed in which of the following ways? a) ultrasound b) X-ray c) blood work d) feeling the palate with a gloved finger or using a tongue blade
feeling the palate with a gloved finger or using a tongue blade
When planning preoperative care for a newborn with a cleft lip and palate, a major need for which you would plan interventions is a) visual stimulation. b) prevention of pneumonia. c) nutrition. d) prevention of oral infection.
nutrition
What are the causes of retinopathy of the preterm newborn? Select all that apply. a) Assistive ventilation with high oxygen content b) Insufficient oxygenation in an Isolette c) Shock d) Alkalosis e) Fragility of blood vessels in the eyes in response to changes on oxygenation.
• Assistive ventilation with high oxygen content • Fragility of blood vessels in the eyes in response to changes on oxygenation. • Shock
A mother brings her 1-month-old daughter in for a visit to the doctor's office and mentions that her daughter tends to tilt her head to one side and rotates her chin to the opposite side. The nurse explains that this is a condition called torticollis and explains the interventions that are commonly used to correct this condition. Which of the following should she mention to the mother? (Select all that apply.) a) Administering botulism injections b) Feeding the child in such a way as to cause her to look toward the affected shoulder c) Placing a mobile on the child's crib on the affected side d) Applying an ice pack to the shoulder on the affected side 15 minutes daily e) Speaking to the child from the unaffected side f) Performing passive stretching exercises
• Performing passive stretching exercises • Feeding the child in such a way as to cause her to look toward the affected shoulder • Placing a mobile on the child's crib on the affected side
A woman who has a history of cocaine abuse gives birth to a newborn. Which of the following would the nurse expect to assess in the newborn? Select all that apply. a) Prolonged periods of sleeping b) Inconsolable c) Flaccid positioning d) Poor sucking e) Piercing cry
• Piercing cry • Poor sucking • Inconsolable
