Maternity Chapter 24

A preterm newborn in the neonatal intensive care unit (NICU) has been diagnosed with periventricular-intraventricular hemorrhage (PVH-IVH). Which nursing action would be a priority in the plan of care for this newborn? Supervise the newborn with the mother at feedings. Avoiding lifting the lower extremities above the midline. Encourage frequent parental stimulation of the newborn in the NICU. Provide routine newborn care in the NICU at frequent intervals.

B Nursing management for an infant with PVH-IVH includes minimal handling of the newborn by clustering nursing care, and limit stimulation in the newborn's environment to reduce stress. Reduce the newborn's exposure to noxious stimuli to avoid a fluctuation in blood pressure and energy expenditure. Developmental care principles include avoiding lifting the lower extremities above the midline with diaper changes, as this can increase the chance of more cranial hemorrhage.

The use of breast milk for premature neonates helps prevent which condition? Turner syndrome Down syndrome necrotizing enterocolitis infantile respiratory distress syndrome

C Components specific to breast milk have been shown to lower the incidence of necrotizing enterocolitis in premature neonates. Infantile respiratory distress syndrome isn't directly influenced by breast milk or breastfeeding. Down syndrome and Turner syndrome are genetic defects and aren't influenced by breast milk.

Which intervention is helpful for the neonate experiencing drug withdrawal? 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. Dress the neonate in loose clothing so the infant will not feel restricted.

C 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.

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? vigorous cry respiratory rate 50 breaths/min heart rate of 70 beats/min pink tongue

C 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.

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 cephalohematoma vernix caseosa

C Vernix caseosa is a thick white substance found on a newborn. Erythema toxicum is a newborn rash. Caput succedaneum is molding or edema.

When attempting to interact with a neonate experiencing drug withdrawal, which behavior would indicate that the neonate is willing to interact? gaze aversion hiccups quiet, alert state yawning

C When caring for neonates experiencing drug withdrawal, the nurse must be alert for distress signals from the neonate. Stimuli should be introduced one at a time when the neonate is in a quiet, alert state. Gaze aversion, yawning, sneezing, hiccups, and body arching are distress signals that the neonate can't handle stimuli at that time.

The nurse is examining a newborn and notes that there is bruising and swelling on the newborn's head, limited to the right side of the scalp and does not cross the suture lines. How will the nurse interpret this finding? The newborn has caput succedaneum that will go away within the first week of life. This is concerning because the swelling does not cross the newborn's suture lines. This newborn has a subarachnoid hemorrhage requiring surgical intervention. This is a cephalohematoma that typically spontaneously resolves without interventions.

D The newborn is exhibiting signs of a cephalohematoma, a collection of blood under the periosteum of the skull. It is caused by birth trauma and should resolve spontaneously. If the swelling crosses the suture line, caput succedaneum is suspected. A subarachnoid hemorrhage in a newborn usually results in symptoms such as seizures, apnea, and bradycardia

A newborn admitted to the neonatal intensive care unit is diagnosed with persistent pulmonary hypertension of the newborn (PPHN). What findings in the mother's prenatal history would best correlate with this diagnosis? fluoxetine use during last trimester of pregnancy maternal diagnosis of anorexia nervosa poorly controlled myasthenia gravis maternal diagnosis of alcoholism during pregnancy

A Current research links increased risk of developing PPHN to exposure to selective serotonin reuptake inhibitors (SSRIs) (antidepressants) such as fluoxetine in late pregnancy. Treatment of depression with antidepressants is complicated by the mother's needs. Careful consideration must be given to the risks, benefits, and alternatives of utero medication exposure. PPHN can also occur as a complication of maternal smoking, maternal obesity, and maternal asthma. Alcohol use during pregnancy causes other birth defects not PPHN. Myasthenia gravis and anorexia are not associated with PPHN.

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? Spinach, oranges, and beans Milk, yogurt, and cheese Bananas, avocados, and coconut Pork, beans, and poultry

A 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.

Which nursing action is required when caring for the post-term infant? Serial blood glucose levels temperature checks every 2 hours Echocardiogram at the end of pregnancy IV initiation

A Of the options provided, the one that is required is serial blood glucose levels. The newborn may require IV glucose infusion to stabilize glucose level. The rest of the options are on an as-needed basis.

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? intraventricular hemorrhage (IVH) cold stress respiratory distress syndrome retinopathy of prematurity (ROP)

A Signs that may accompany IVH include hypotonia, apnea, bradycardia, a full or bulging fontanel (fontanelle), cyanosis, and increased head circumference.

The nurse is teaching the parents of a newborn who was born with a high type of imperforate anus the care the newborn will need at home after surgery. The parents need to be aware that the newborn will require which measure temporarily? colostomy intravenous fluids nasal cannula for oxygen nasogastric tube

A Surgical intervention is needed for both high and low types of imperforated anus. Surgery for a high type of defect involves a colostomy in the newborn period, with corrective surgery performed in stages to allow for growth. The newborn will require intravenous fluids, nasogastric tube attached to low suction, and oxygen in the immediate postoperative period. Once bowel function has become established, these should no longer be needed.

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? Moro Babinski rooting stepping

A 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.

A nurse caring for a client in premature labor knows that the best indicator of fetal lung maturity is which data? meconium in the amniotic fluid lecithin to sphingomyelin ratio of more than 2:1 Absence of phosphatidylglycerol in amniotic fluid glucocorticoid treatment just before delivery

B Lecithin and sphingomyelin are phospholipids that help compose surfactant in the lungs; lecithin peaks at 36 weeks, and sphingomyelin concentrations remain stable. Meconium is released due to fetal stress before delivery, but it's chronic fetal stress that matures lungs. Glucocorticoids must be given at least 48 hours before delivery. The presence of phosphatidylglycerol indicates lung maturity.

A nursing instructor is teaching about newborn congenital disorders and realizes that the student needs further instruction after making which statement? "All congenital disorders can be diagnosed at birth." "Hydrocephalus may be recognized at birth." "Hydrocephalus may not be diagnosed until after a few weeks or months of life." "Congenital defects may be caused by genetic or environmental factors."

A All congenital disorders are not diagnosed at birth. Hydrocephalus is one such disorder that may be diagnosed at birth but also may not be diagnosed until after a few weeks or months. It is also true that congenital defects may be caused by both genetics and environmental factors.

In completing the newborn assessment checklist, the nurse documents a meconium stool. This documentation rules out which condition? Imperforate anus Epispadias Spina bifida occulta Hiatal hernia

A 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.

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 a good idea to stop drinking alcohol 3 months before trying to get pregnant." "It would be good to stop smoking before getting pregnant." "It's important to keep insulin levels controlled during pregnancy." "It's important to add iron and vitamin B supplements to your diet."

A Fetal alcohol syndrome (FAS) is caused by intake of alcohol by the pregnant parent during pregnancy; alcohol consumption may be periodic or chronic. Newborns born with FAS have characteristic facial features, are more susceptible to congenital defects, and often have developmental delays. Newborns with FAS have a high-pitched and shrill cry and are generally jittery. Newborns with FAS have a flat midface and a thin upper lip. Newborns with FAS have small and wide-spaced eyes not large narrow-spaced eyes. Newborns with FAS are not easily consoled and have a poor, not an increased appetite.

A newborn is found to have hemolytic disease. Which combination would be found related to the blood types of this newborn and the parents of the newborn? newborn who is type A, mother who is type O newborn who is type O, father who is type A newborn who is type A, father who is type O newborn who is type O, mother who is type O

A Hemolytic disease of the newborn may develop when a mother and the unborn fetus have different blood types. The disease occurs when the immune system of the mother sees the fetus's red blood cells as foreign. Antibodies then develop against the fetus's red blood cells. These antibodies attack the red blood cells beginning at birth, causing them to break down too early. There is more than one way in which the fetus's blood type may not match the mother's. Commonly, it is the result of ABO incompatibility. It also occurs with Rh factor incompatibility. Of the options provided, the newborn with type A and the mother with type O will result in hemolytic disease of the newborn.

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? necrotizing enterocolitis respiratory distress syndrome garamycin-resistant bacteria rotavirus infection

A 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.

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? Provide oxygen by oxygen hood or ventilator. Place the infant in a cool environment to prevent overheating. Administer anticonvulsants as prescribed. Encourage the parents to hold the infant for bonding.

A 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.

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. For which dangerous condition should the nurse prepare when providing care to this newborn? meconium aspiration syndrome pneumonia diaphragmatic hernia choanal atresia

A The nurse should assess for meconium aspiration syndrome in the newborn. Meconium aspiration involves patchy, fluffy infiltrates unevenly distributed throughout the lungs and marked hyperaeration mixed with areas of atelectasis that can be seen through chest X-rays. Direct visualization of the vocal cords for meconium staining using a laryngoscope can confirm aspiration. Lung auscultation typically reveals coarse crackles and rhonchi. Arterial blood gas analysis will indicate metabolic acidosis with a low blood pH, decreased PaO2, and increased PaCO2. Newborns with choanal atresia, diaphragmatic hernia, and pneumonia do not exhibit these manifestations.

A nurse is caring for a 25-year-old G1P0 at 37 weeks' gestation. The client's history indicates that the client has had alcohol abuse disorder throughout their pregnancy. What signs and symptoms does the nurse expect the newborn to exhibit? Drag words from the choices below to fill in each blank in the following sentence. The nurse recognizes the newborn is exhibiting signs and symptoms of fetal alcohol syndrome, which include: A) thin upper lip B)easily consoled C)jitteriness D)increased appetite E)high-pitched, shrill cry F)large, narrow-spaced eyes G)flat midface

A, C, E, G Fetal alcohol syndrome (FAS) is caused by intake of alcohol by the pregnant parent during pregnancy; alcohol consumption may be periodic or chronic. Newborns born with FAS have characteristic facial features, are more susceptible to congenital defects, and often have developmental delays. Newborns with FAS have a high-pitched and shrill cry and are generally jittery. Newborns with FAS have a flat midface and a thin upper lip. Newborns with FAS have small and wide-spaced eyes not large narrow-spaced eyes. Newborns with FAS are not easily consoled and have a poor, not an increased appetite.

Which nursing interventions are essential when caring for a newborn with macrosomia born to a mother with diabetes? Select all that apply. Obtain IV glucose for potential infusion. Keep the newborn NPO. Obtain blood glucose reading. Anticipate supplemental oxygen. Assess for respiratory distress.

ACDE Newborns of mothers with diabetes require careful observation. Frequent blood glucose checks begin after birth. Administering feeding early maintains the blood glucose level. If the newborn cannot tolerate feedings, obtain IV glucose for infusion. Monitor for respiratory distress and anticipate supplemental oxygen therapy and surfactant therapy.

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? chest x-rays arterial blood gases angiography echocardiogram

B 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.

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? Aspirin Morphine Ibuprofen Acetaminophen

B 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.

The nurse suspects a preterm newborn receiving enteral feedings of having necrotizing enterocolitis (NEC). What assessment finding best correlates with this diagnosis? poor suck reflex bloody stools high-pitched cry meconium stools

B NEC assessment includes assessing the newborn's health history and physical examination as well as laboratory and diagnostic testing. The onset of NEC is demonstrated by the development of feeding intolerance, abdominal distention, and bloody stools in a preterm infant receiving enteral feedings. As the disease worsens, the infant develops signs and symptoms of septic shock with RDS, temperature instability, lethargy, hypotension, and oliguria.

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? "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." "The head of his bed will be elevated to prevent him from aspirating." "We can give him a pacifier to help satisfy his need to suck."

B 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.

A nurse is assigned to care for a newborn with hyperbilirubinemia. The newborn is relatively large in size and shows signs of listlessness. What most likely occurred? The infant may have been exposed to alcohol during pregnancy. The infant's mother probably had diabetes. The infant's mother must have had a long labor. The infant may have experienced birth trauma.

B The nurse should know that the infant's mother more than likely had/has diabetes. The large size of the infant born to a mother with diabetes is secondary to exposure to high levels of maternal glucose crossing the placenta into the fetal circulation. Common problems among infants of mothers with diabetes include macrosomia, respiratory distress syndrome, birth trauma, hypoglycemia, hypocalcemia and hypomagnesemia, polycythemia, hyperbilirubinemia, and congenital anomalies. Listlessness is also a common symptom noted in these infants. Infants born to clients who use alcohol during pregnancy, infants who have experienced birth traumas, or infants whose mothers have had long labors are not known to exhibit these particular characteristics, although these conditions do not produce very positive pregnancy outcomes. Infants with fetal alcohol spectrum disorder or alcohol exposure during pregnancy do not usually have hypoglycemia problems.

Which respiratory disorder in a neonate is usually mild and runs a self-limited course? Persistent pulmonary hypertension transient tachypnea of the newborn meconium aspiration syndrome pneumonia

B Transient tachypnea of the newborn (TTN) has an invariably favorable outcome after several hours to several days. The outcome of pneumonia depends on the causative agent involved and may have complications. Meconium aspiration, depending on severity, may have long-term adverse effects. In persistent pulmonary hypertension, mortality is more than 50%.

Which nursing actions limit overstimulation of the preterm infant? Select all that apply. Tap on the isolette before opening the door. Speak softly to the infant. Keep lights low in the nursery. Frequently open the isolette portholes. Coordinate nursing care.

BCE It is noted that excessive noise can overstimulate the preterm infant. It is up to the nurse to protect the neurologic status of the infant. Minimize overstimulation by speaking softly to the infant and keeping the lights in the nursery low. Also, coordinate nursing care to minimize interruptions. Tapping and opening the isolette portholes can startle the infant.

A client who gave birth 2 hours ago expresses concern about her baby developing jaundice. Which response from the nurse would be best? "If you are concerned about your baby developing jaundice, don't breastfeed your baby until you get home." "You don't need to worry about your baby developing jaundice because you are both fine." "I understand your concern because as many as 50% of babies can develop jaundice." "We will monitor the baby now, and your baby will not develop jaundice after the first 24 hours of life."

C 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 teaching gavage feedings to the mother of a preterm infant. Which instruction is most important? Amount of feeding Quantity of bowel movement Gastric residual present Expelling of gas

C Check prefeed gastric residual before infusing the next feeding. If the stomach is not empty by the next feeding, allow more time between feedings or give smaller feedings. The other options are important but not the most important.

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? "You must have had some problems during labor with keeping your blood pressure under control. Your newborn will need to be handled gently." "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." "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." "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."

D 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 with high serum bilirubin is receiving phototherapy. Which nursing intervention is the most appropriate for this client? delay of feeding until bilirubin levels are normal gentle shaking of the baby placing light 6 inches above the newborn's bassinet application of eye dressings to the infant

D Continuous exposure to bright lights by phototherapy may be harmful to a newborn's retina, so the infant's eyes must always be covered while under bilirubin lights. Eye dressings or cotton balls can be firmly secured in place by an infant mask. The lights are placed 12 to 30 inches above the newborn's bassinet or incubator. Bilirubin is removed from the body by being incorporated into feces. Therefore, the sooner bowel elimination begins, the sooner bilirubin removal begins. Early feeding by either breast milk or formula, therefore, stimulates bowel peristalsis and helps to accomplish this. Gently shaking the infant is a method of stimulating breathing in an infant experiencing apnea.

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? "We will care for the bladder with frequent sterile tub baths to keep it moist." "Disturbances to the bladder with diaper changes will be kept to a minimum." "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."

D 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.

While caring for a neonate born of a mother with diabetes, the nurse should monitor the neonate for which complication? atelectasis microcephaly pneumothorax macrosomia

D Neonates born of mothers with diabetes are at increased risk for macrosomia (excessive fetal growth) due to the increased supply of maternal glucose combined with an increase in fetal insulin. Along with macrosomia, neonates of mothers with diabetes are at risk for respiratory distress syndrome, hypoglycemia, hypocalcemia, hyperbilirubinemia, and congenital anomalies. They are not at greater risk for atelectasis or pneumothorax. Microcephaly is usually the result of cytomegalovirus or rubella virus infection.

When providing postpartum teaching to a couple, the nurse correctly identifies what time as when pathologic jaundice may be found in the newborn? often with formula-fed babies between 2 and 4 days of life after 5 days postpartum during the first 24 hours of life

D 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.

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

D 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.

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

D 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.

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? "They will be placing a tube in the stomach during surgery." "The baby will have tubes in the chest to drain chest fluids." "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."

D 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.