(Mod 14; CH 23)
A nursing student, observing care of a 30-week-gestation infant in the neonatal intensive care unit, asks the nurse, "Are premature infants more susceptible to infection as I have to wash my hands so often in this department?" What is the nurse's best response?
"That is correct; a 30-week-gestation infant lacks the protective antibody called IgG."
When discussing heat loss in newborns, placing a newborn on a cold scale would be an example of what type of heat loss?
conduction
A nurse is assessing the fluid status of a preterm newborn. Which parameter would be most appropriate for the nurse to assess?
fontanels (fontanelles)
Which maternal factors should the nurse consider contributory to a newborn being large for gestational age? Select all that apply.
diabetes postdates gestation prepregnancy obesity
A nurse is caring for a preterm newborn who has developed rapid, irregular respirations with periods of apnea. Which additional assessment finding should the nurse identify as an indication of respiratory distress syndrome (RDS)?
Sternal retraction
What action by the nurse provides the neonate with sensory stimulation of a human face?
assisting the mother to position the infant in an en face position
A newborn does not breathe spontaneously at birth. The nurse administers oxygen by bag and mask. If oxygen is entering the lungs, the nurse should notice that the:
chest rises with each bag compression.
A client asks the nurse what surfactant is. Which explanation would the nurse give as the main role of surfactant in the neonate?
helps the lungs remain expanded after the initiation of breathing
A nurse completes the initial assessment of a newborn. According to the due date on the antenatal record, the baby is 12 days' postmature. Which physical finding does not confirm that this newborn is 12 days' postmature?
increased amounts of vernix
When reviewing the medical record of a newborn who is large-for-gestational-age (LGA), which factor would the nurse identify as having increased the newborn's risk of being LGA?
maternal pregravid obesity
A 35-year-old client has just given birth to a healthy newborn during her 43rd week of gestation. What should the nurse expect when assessing the condition of the newborn?
meconium aspiration in utero or at birth
The nurse assesses a post-term newborn. What finding corresponds with this gestational age diagnosis?
meconium-stained skin and fingernails
After a gavage feeding of a preterm neonate, the nurse aspirates 4 ml of undigested formula. This finding may indicate the development of which complication?
necrotizing enterocolitis
How does the nurse position the infant experiencing respiratory difficulty?
on the back with the head elevated 15 degrees
The nurse is assessing a small-for-gestational age (SGA) newborn, 12 hours of age, and notes the newborn is lethargic with cyanosis of the extremities, jittery with handling, and a jaundiced, ruddy skin color. The nurse expects which diagnosis as a result of the findings?
polycythemia
At birth, the infant has dry, cracked skin, absence of vernix, lack of subcutaneous fat, fingernail extending beyond the fingertips, and poor skin turgor. Based on these findings, how would the nurse would classify this neonate?
postterm
A nurse is assisting with the resuscitation of a preterm newborn. Which assessment would help assist the team in determining that the resuscitation efforts have been successful?
pulse rate of 110 beats per minute
Which finding would lead the nurse to suspect that a large-for-gestational-age newborn is developing hyperbilirubinemia?
tea-colored urine
A premature infant develops respiratory distress syndrome. With this condition, circulatory impairment is likely to occur because, with increased lung tension,:
the ductus arteriosus remains open.
A nurse initiates bag and mask ventilation with an anesthesia bag on a newborn with no spontaneous respiratory effort. What controls the pressure of breaths delivered by an anesthesia bag?
the pressure the nurse uses when the hand squeezes against the bag
A cesarean birth results in an infant weighing 4,990 g (11 lb). The nurse assesses the infant for which complication?
transient lung fluid
The nurse is admitting a newborn male for observation with the diagnosis of preterm. What assessment finding corresponds with this gestational age diagnosis?
undescended testes
A client gives birth to a newborn baby at term. The nurse records the weight of the baby as 1,200 g, interpreting this to indicate that the newborn is of:
very low birth weight.
The nurse determines a newborn is small-for-gestational-age based on which characteristics?
wasted appearance of extremities, thin umbilical cord, and reduced subcutaneous fat stores
After completing an assessment of a newborn, the nurse determines that the newborn is small-for-gestational-age based on which weight assessment?
weight of 2,400 g
The nurse is teaching nursing students about the risks that late preterm infants may experience. The nurse feels confident learning has taken place when the students make which statement?
"A late preterm newborn may have more clinical problems compared with full-term newborns."
The nurse is weighing a newborn and documents AGA (appropriate for gestational age) on the newborn record. Which weight percentile is anticipated?
20th
The obstetrics nurse has admitted a large-for-gestational-age infant, 1-hour old, for observation. The initial blood glucose level is 44 mg/dl (2.44 mmol). What is the nurse's priority action?
Begin supervised feedings for the newborn.
At birth, a term infant has irregular respirations and a weak cry. What is the sequence of events initiated by the nurse when caring for this infant?
Dry the infant, stimulate the infant, and keep the infant warm.
A preterm infant has an umbilical vessel catheter inserted so that blood can be drawn readily. Which would be most important to implement during this procedure?
Ensure that the infant is kept warm.
A preterm infant is receiving indomethacin. What is a priority assessment following administration of indomethacin? Select all that apply.
Monitor urine output. Observe for bleeding.
The nurse is caring for a preterm neonate on an apnea monitor. When the monitor alarms, what action does the nurse take? Select all that apply.
Performs a focused assessment of the neonate Silences the alarm Counts the respiratory rate for a full minute
At birth, the newborn was at the 8th percentile with a weight of 2350 g and born at 36 weeks' gestation. Which documentation is most accurate?
The infant was a preterm, low-birth-weight and small-for-gestational-age
A 20-year-old client gave birth to a baby boy at 43 weeks' gestation. What might the nurse observe in the newborn during routine assessment?
The newborn may look wrinkled and old at birth.
The nurse observes a neonate born at 28 weeks' gestation. Which finding would the nurse expect to see?
The pinna of the ear is soft and flat and stays folded.
The mother of a preterm infant tells her nurse that she would like to visit her newborn in the neonatal intensive care unit (NICU). Which response by the nurse would be most appropriate?
"Certainly. You will need to wash your hands and gown before you can hold him, however."
A premature infant is admitted to the neonatal intensive care unit with respiratory distress syndrome and requires assisted ventilation. The parents asks the nurse, "Why won't our baby breath on its own?" What is the nurse's best response?
"Your infant cannot sustain respirations yet due to the lack of assistance from surfactant."
The nurse is concerned that a newborn is hypoglycemic. Which blood glucose level would support the nurse's intervention?
30 mg/dl (1.67 mmol/l)
Hypoglycemia in a mature infant is defined as a blood glucose level below which amount?
45 mg/100 ml whole blood
A set of newborn twins has been admitted to the neonatal intensive care unit with the diagnosis of fetal growth restriction (FGR). Which maternal factors would predispose the newborn to this diagnosis? Select all that apply.
A1C levels of 8% (0.08) heroin use disorder blood pressure baseline of 170/90 mm Hg age 39 years multiple gestation
A nurse is caring for a preterm infant. Which intervention will prepare the newborn's gastrointestinal tract to better tolerate feedings when initiated?
Administer 0.5 ml/kg/hr of breast milk enterally.
A nurse is caring for an infant. A serum blood sugar of 40 was noted at birth. What care should the nurse provide to this newborn?
Begin early feedings either by the breast or bottle.
The nurse has admitted a small-for-gestational-age infant (SGA) to the observation nursery from the birth room. Which action would the nurse prioritize in the newborn's care plan?
Closely monitor temperature.
The nurse in the NICU is caring for preterm newborns. Which guidelines are recommended for care of these newborns? Select all that apply.
Dress the newborn in ways to preserve warmth. Take the newborn's temperature often. Supply oxygen for the newborn, if necessary.
A full-term infant with spontaneous respiration at birth begins exhibiting signs of respiratory distress syndrome (RDS) at 22 hours of age. Which condition would the nurse assess for in this infant?
Group B streptococcus (GBS) infection
A preterm infant will be hospitalized for an extended time. Assuming the infant's condition is improving, which environment would the nurse feel is most suitable for the child?
Provide a mobile the child can see no matter how he or she is turned.
Which symptom would most accurately indicate that a newborn has experienced meconium aspiration during the birth process?
meconium stained fluids followed by tachypnea
The newborn nursery nurse is admitting a small-for-gestational-age (SGA) infant and is reviewing the maternal history. What factor in the maternal history would the nurse correlate as a risk factor for an SGA infant?
placental factors
The nurse notices while holding a 1-day-old infant upright that the baby has a significantly indented anterior fontanel (fontanelle). She immediately brings it to the attention of the health care provider. What does this finding indicate?
dehydration
A preterm infant of 32 weeks' gestation is admitted from the birth suite to the neonatal intensive care unit with symptoms of respiratory distress. What would the nurse expect to see during assessments? Select all that apply.
pH 7 PaCO2 54 mm Hg PaO2 35
A newborn girl who was born at 38 weeks' gestation weighs 2000 g and is below the 10th percentile in weight. The nurse recognizes that this girl will be placed in which classification?
term, small-for-gestational-age, and low-birth-weight infant