Pre-Term Practice Questions (Test #3, Fall 2020)

Which of the following would the nurse most expect to assess in a neonate born at 28 weeks' gestation who is diagnosed with intraventricular hemorrhage (IVH)? 1.Increased muscle tone. 2.Hyperbilirubinemia. 3.Bulging fontanels. 4.Hyperactivity.

3 A common finding of IVH is a bulging fontanel. The most common site of hemorrhage is the periventricular subependymal germinal matrix, where there is a rich blood supply and where the capillary walls are thin and fragile. Rapid volume expansion, hypercarbia, and hypoglycemia contribute to the development of IVH. Other common manifestations include neurologic signs such as hypotonia, lethargy, temperature instability, nystagmus, apnea, bradycardia, decreased hematocrit, and increasing hypoxia. Seizures also may occur. Hyperbilirubinemia refers to an increase in bilirubin in the blood and may be seen if bleeding was severe.

Two hours ago, a neonate at 38 weeks' gestation and weighing 3,175 g (7 lb) was born to a primiparous client who tested positive for beta-hemolytic Streptococcus. Which of the following would alert the nurse to notify the primary health care provider? 1.Alkalosis. 2.Increased muscle tone. 3.Temperature instability. 4.Positive Babinski's reflex.

3 The neonate is at high risk for sepsis due to exposure to the mother's infection. Temperature instability in a neonate at 38 weeks' gestation is an early sign of sepsis. Other signs include tachycardia, decreased muscle tone, acidosis, apnea, respiratory distress, hypotension, poor feeding behaviors, vomiting, and diarrhea. Late signs of infection include jaundice, seizures, enlarged liver and spleen, respiratory failure, and shock. Alkalosis is not typically seen in neonates who develop sepsis. Acidosis and respiratory distress may develop unless treatment such as antibiotics is started. A positive Babinski reflex is a normal finding and does not need to be reported.

After a vaginal birth, a preterm neonate is to receive oxygen via mask. While administering the oxygen, the nurse would place the neonate in which of the following positions? 1.Left side, with the neck slightly flexed. 2.Back, with the head turned to the left side. 3.Abdomen, with the head down. 4.Back, with the neck slightly extended.

4 When receiving oxygen by mask, the neonate is placed on the back with the neck slightly extended, in the "sniffing" or neutral position. This position optimizes lung expansion and places the upper respiratory tract in the best position for receiving oxygen. Placing a small rolled towel under the neonate's shoulders helps to extend the neck properly without overextending it. Once stabilized and transferred to an isolette in the intensive care unit, the neonate can be positioned in the prone position, which allows for lung expansion in the oxygenated environment. Placing the neonate on the left side does not allow for maximum lung expansion. Also, slightly flexing the neck interferes with opening the airway. Placing the neonate on the back with the head turned to the left side does not allow for lung expansion. Placing the neonate on the abdomen interferes with proper positioning of the oxygen mask.

Which of the following would alert the nurse to suspect that a neonate born at 34 weeks' gestation who is currently in an isolette with humidified oxygen and receiving intravenous fluids has developed overhydration? 1.Hypernatremia. 2.Polycythemia. 3.Hypoproteinemia. 4.Increased urine specific gravity.

3 Decreased protein or hypoproteinemia is a sign of overhydration, which can lead to patent ductus arteriosus or congestive heart failure. Bulging fontanels, decreased serum sodium, decreased urine specific gravity, and decreased hematocrit are other signs of overhydration. Hypernatremia (increased serum sodium concentration) or increased urine specific gravity would suggest dehydration, not overhydration. Polycythemia evidenced by an elevated hematocrit would suggest hypoxia or congenital heart disorder

Which of the following subjects should the nurse include when teaching the mother of a neonate diagnosed with retinopathy of prematurity (ROP) about possible treatment for complications? 1.Laser therapy. 2.Cromolyn sodium eye drops. 3.Frequent testing for glaucoma. 4.Corneal transplants.

1 Because the retina may become detached with ROP, laser therapy has been used successfully in some medical centers to treat ROP. Cromolyn sodium is used to treat seasonal allergies. ROP is not associated with glaucoma, so frequent testing is not necessary. Because the vessels of the eye are affected, not the corneas, corneal transplantation is not used.

Which of the following actions should the nurse take when performing external chest compressions on a neonate born at 28 weeks' gestation? 1.Maintain a compression to ventilation ratio of 3:1. 2.Compress the sternum with the palm of the hand. 3.Compress the chest 70 to 80 times/min. 4.Displace the chest wall half the depth of the anterior-posterior diameter of the chest.

1 Chest compressions should be alternated with ventilation to ensure breathing and circulation. Two fingers or two thumbs encirciling hands, not the palm of the hand, are used to compress a neonate's sternum. The chest is compressed 100 to 120 times/min. The proper technique recommended by the Neonatal Resuscitation Program is to use enough pressure to depress the sternum to a depth of approximately one-third of the anterior-posterior diameter of the chest.

Three days after admission of a neonate born at 30 weeks' gestation, the neonatologist plans to assess the neonate for intraventricular hemorrhage (IVH). The nurse should plan to assist the neonatologist by preparing the neonate for which of the following? 1.Cranial ultrasonography. 2.Arterial blood specimen collection. 3.Radiographs of the skull. 4.Complete blood count specimen collection.

1 Neonates who weigh less than 1,500 g or are born at less than 34 weeks' gestation are susceptible to IVH. Cranial ultrasound scanning can confirm the diagnosis. The spinal fluid will show an increased number of red blood cells. Arterial blood gas specimen collection is done to evaluate the neonate's oxygen saturation level. Skull radiographs are not commonly used because of the danger of radiation. Additionally, computed tomography scans have replaced the use of skull x-ray films because they can provide more definitive results. Complete blood count specimen collection is usually performed to determine the hemoglobin, hematocrit, and white blood cell count. The results are not specific for PIVH.

Which of the following best identifies the reason for assessing a neonate weighing 1,500 g at 32 weeks' gestation for retinopathy of prematurity (ROP)? 1.The neonate is at risk because of multiple factors. 2.Oxygen is being administered at a level of 21%. 3.The neonate was alkalotic immediately after birth. 4.Phototherapy is likely to be prescribed by the primary health care provider.

1 ROP, previously called retrolental fibroplasia, is associated with multiple risk factors, including high arterial blood oxygen levels, prematurity, and very low birth weight (less than 1,500 g). In the early acute stages of ROP, the neonate's immature retinal vessels constrict. If vasoconstriction is sustained, vascular closure follows, and irreversible capillary endothelial damage occurs. Normal room air is at 21%. Acidosis, not alkalosis, is commonly seen in preterm neonates, but this is not related to the development of ROP. Phototherapy is not related to the development of ROP. However, during phototherapy, the neonate's eyes should be constantly covered to prevent damage from the lights.

A preterm neonate who has been stabilized is placed in a radiant warmer and is receiving oxygen via an oxygen hood. While administering oxygen in this manner, the nurse should do which of the following? 1.Humidify the air being delivered. 2.Cover the neonate's scalp with a warm cap. 3.Record the neonate's temperature every 3 to 4 minutes. 4.Assess the neonate's blood glucose level.

1 Whenever oxygen is administered, it should be humidified to prevent drying of the nasal passages and mucous membranes. Because the neonate is under a radiant warmer, a stocking cap is not necessary. Temperature, continuously monitored by a skin probe attached to the radiant warmer, is recorded every 30 to 60 minutes initially. Although the oxygen concentration in the hood requires close monitoring and measurement of blood gases, checking the blood glucose level is not necessary.

Assessment of a 2-day-old neonate born at 34 weeks' gestation reveals absent apical pulse left of the midclavicular line, cyanosis, grunting, and diminished breath sounds. The priority intervention is to: 1.Obtain a prescription for a stat chest x-ray. 2.Reposition the neonate and then assess if the grunting and cyanosis resolve. 3.Begin oxygen administration at 6 to 8 L via mask. 4.Obtain a complete blood count to determine infection.

1 With an absent apical pulse left of the midclavicular line accompanied by cyanosis, grunting, and diminished breath sounds, the neonate is most likely experiencing pneumothorax. Pneumothorax occurs when alveoli are overdistended and subsequently the lung collapses, compressing the heart and lung and compromising the venous return to the right side of the heart. This condition can be confirmed by x-ray or ultrasound studies. Repositioning the infant may open the airway, administering oxygen will improve oxygen saturation levels, and obtaining blood studies for infection will rule that out, but until pneumothorax is resolved, the other symptoms will continue

The nurse is discussing kangaroo care with the parents of a premature neonate. The nurse should tell the parents that the advantages of kangaroo care include which of the following? Select all that apply. 1.Enhanced bonding. 2.Increased IQ. 3.Improved physiologic stability. 4.Decreased length of stay in the neonatal intensive care unit. 5.Improved breast-feeding

1,3,4,5 Kangaroo care is skin-to-skin holding of a neonate by one of the parents. Research has shown increased bonding, physiologic stability, decreased length of stay, and improved breast-feeding for neonates who experience this method of holding. Research has not shown an increase in IQ as a developmental outcome. The experience is usually limited to 1 to 2 hours, 2 to 3 times/day.

Which of the following statements by the mother of a neonate diagnosed with bronchopulmonary dysplasia (BPD) indicates effective teaching? 1."BPD is an acute disease that can be treated with antibiotics." 2."My baby may require long-term respiratory support." 3."Bronchodilators can cure my baby's condition." 4."My baby may have seizures later on in life because of this condition."

2 BPD is a chronic illness that may require prolonged hospitalization and permanent assisted ventilation. The disease typically occurs in compromised very-low-birth-weight neonates who require oxygen therapy and assisted ventilation for treatment of respiratory distress syndrome. The cause is multifactorial, and the disease has four stages. The neonate's activities may be limited by the disease. Antibiotics may be prescribed, and bronchodilators may be used, but these medications will not cure the chronic disease state. Seizure activity is associated with periventricular-intraventricular hemorrhage, not BPD.

A viable male neonate born to a 28-year-old multiparous client by cesarean section because of placenta previa is diagnosed with respiratory distress syndrome (RDS). Which of the following would the nurse explain as the factor placing the neonate at the greatest risk for this syndrome? 1.Mother's development of placenta previa. 2.Neonate born preterm. 3.Mother receiving analgesia 4 hours before birth. 4.Neonate with sluggish respiratory efforts after birth.

2 RDS is a developmental condition that primarily affects preterm infants before 35 weeks' gestation because of inadequate lung development from deficient surfactant production. The development of placenta previa has little correlation with the development of RDS. Although excessive analgesia can depress the neonate's respiratory condition if it is given shortly before birth, the scenario presents no information that this has occurred. The neonate's sluggish respiratory activity postpartum is not the likely cause of RDS but may be a sign that the neonate has the condition

Twenty-four hours after cesarean birth, a neonate at 30 weeks' gestation is diagnosed with respiratory distress syndrome (RDS). When explaining to the parents about the cause of this syndrome, the nurse should include a discussion about an alteration in the body's secretion of which of the following? 1.Somatotropin. 2.Surfactant. 3.Testosterone. 4.Progesterone.

2 RDS, previously called hyaline membrane disease, is a developmental condition involving a decrease in lung surfactant leading to improper expansion of the lung alveoli. Surfactant contains a group of surface-active phospholipids, of which one component—lecithin—is the most critical for alveolar stability. Surfactant production peaks at about 35 weeks' gestation. This syndrome primarily attacks preterm neonates, although it can also affect term and postterm neonates. Altered somatotropin secretion is associated with growth disorders such as gigantism or dwarfism. Altered testosterone secretion is associated with masculinization. Altered progesterone secretion is associated with spontaneous abortion during pregnancy.

An infant born premature at 34 weeks is receiving gavage feedings. The client holding her infant asks why the nurse places a pacifier in the infant's mouth during these feedings. The nurse replies that the pacifier helps in what ways? Select all that apply. 1.Teaches the infant to coordinate the swallow. 2.Provides oral stimulation. 3.Keeps oral mucous membranes moist while the tube is in place. 4.Reminds the infant how to suck. 5.Stimulates secretions that help gastric emptying.

2,4,5 Nonnutritive sucking has been seen in infants as early as 28 weeks and ultrasound examinations have shown thumb sucking in utero even earlier. Nonnutritive sucking provides oral stimulation and allows the baby to maintain the sucking reflex needed for breast- or bottle-feedings later. It does not teach the infant how to suck and swallow. Sucking is thought to help with gastric emptying by stimulating secretions of GI peptides. Moisture of the mucous membranes is an indication of adequate hydration, and nonnutritive sucking will not have an effect

While the nurse is caring for a neonate at 32 weeks' gestation in an isolette with continuous oxygen administration, the neonate's mother asks why the neonate's oxygen is humidified. The nurse should tell the mother: 1."The humidity promotes expansion of the neonate's immature lungs." 2."The humidity helps to prevent viral or bacterial pneumonia." 3."Oxygen is drying to the mucous membranes unless it is humidified." 4."Circulation to the baby's heart is improved with humidified oxygen."

3 Oxygen should be humidified before administration to help prevent drying of the mucous membranes in the respiratory tract. Drying impedes the normal functioning of cilia in the respiratory tract and predisposes to mucous membrane irritation. Humidification of oxygen does not promote expansion of the immature lungs. Expansion is promoted by placing the infant in a prone position or providing the preterm infant with surfactant medication. Humidified oxygen does not prevent viral or bacterial pneumonia. In fact, in some nurseries, Staphylococcus aureus has been detected in moist environments and on the hands and nails of staff members, predisposing the neonate to pneumonia. Humidified oxygen does not improve blood circulation in the cardiac system.

While caring for a neonate born at 32 weeks' gestation, the nurse assesses the neonate daily for symptoms of necrotizing enterocolitis (NEC). Which of the following would alert the nurse to notify the neonatologist? 1.The presence of 1 mL of gastric residual before a gavage feeding. 2.Jaundice appearing on the face and chest. 3.An increase in bowel peristalsis. 4.Abdominal distention.

4 Indications of NEC include abdominal distention with gastric retention and vomiting. Other signs may include lethargy, irritability, positive blood culture in stool, absent or diminished bowel sounds, apnea, diarrhea, metabolic acidosis, and unstable temperature. A gastric residual of 1 mL is not significant. Jaundice of the face and chest is associated with the neonate's immature liver function and increased bilirubin, not NEC. Typically with NEC, the neonate would exhibit absent or diminished bowel sounds, not increased peristalsis.

A preterm neonate admitted to the neonatal intensive care unit at about 30 weeks' gestation is placed in an oxygenated isolette. The neonate's mother tells the nurse that she was planning to breast-feed the neonate. Which of the following instructions about breast-feeding would be most appropriate? 1.Breast-feeding is not recommended because the neonate needs increased fat in the diet. 2.Once the neonate no longer needs oxygen and continuous monitoring, breast-feeding can be done. 3.Breast-feeding is contraindicated because the neonate needs a high-calorie formula every 2 hours. 4.Gavage feedings using breast milk can be given until the neonate can coordinate sucking and swallowing.

4 Many intensive care units that care for high-risk neonates recommend that the mother pump her breasts, store the milk, and bring it to the unit so the neonate can be fed with it, even if the neonate is being fed by gavage. As soon as the neonate has developed a coordinated suck-and-swallow reflex, breast-feeding can begin. Secretory immunoglobulin A, found in breast milk, is an important immunoglobulin that can provide immunity to the mucosal surfaces of the gastrointestinal tract. It can protect the neonate from enteric infections, such as those caused by Escherichia coli and Shigella species. Some studies have also shown that breast-fed preterm neonates maintain transcutaneous oxygen pressure and body temperature better than bottle-fed neonates. There is some evidence that breast milk can decrease the incidence of necrotizing enterocolitis. The preterm neonate does not need additional fat in the diet. However, some neonates may need an increased caloric intake. In such cases, breast milk can be fortified with an additive to provide additional calories. Neonates who are receiving oxygen can breast-feed. During feedings, supplemental oxygen can be delivered by nasal cannula.

A preterm infant born 2 hours ago at 34 weeks' gestation is experiencing rapid respirations, grunting, no breath sounds on one side, and a shift in location of heart sounds. The nurse should prepare to assist with which of the following? 1.Placement of the neonate on a ventilator. 2.Administration of bronchodilators through the nares. 3.Suctioning of the neonate's nares with wall suction. 4.Insertion of a chest tube into the neonate.

4. The client data support the diagnosis of pneumothorax, which would be confirmed with a chest x-ray. Pneumothorax is an accumulation of air in the thoracic cavity between the parietal and visceral pleurae and requires immediate removal of the accumulated air. Resolution is initiated with insertion of a chest tube connected to continuous negative pressure. The neonate does not need to be placed on a ventilator unless there is evidence of severe respiratory distress. The goal of treatment is to re-inflate the collapsed lung. Administering bronchodilators through the nares or suctioning the neonate's nares would do nothing to aid in lung re-inflation.