Deck 34: Nursing Care of the High Risk Newborn

Question 1

By understanding the four mechanisms of heat transfer (convection,conduction,radiation,and evaporation),the nurse can create an environment for the infant that prevents temperature instability.Which significant symptoms will the infant display when experiencing cold stress?

A) Decreased respiratory rate
B) Bradycardia,followed by an increased heart rate
C) Irritability with central cyanosis
D) Increased physical activity

Answer 1

Irritability with central cyanosis

Question 2

In appraising the growth and development potential of a preterm infant,the nurse should be cognizant of the information that is best described in which statement?

A) Tell the parents that their child will not catch up until approximately age 10 years (for girls)to age 12 years (for boys).
B) Correct for milestones,such as motor competencies and vocalizations,until the child is approximately 2 years of age.
C) Know that the greatest catch-up period is between 9 and 15 months postconceptual age.
D) Know that the length and breadth of the trunk is the first part of the infant to experience catch-up growth.

Answer 2

Correct for milestones,such as motor competencies and vocalizations,until the child is approximately 2 years of age.

Question 3

An infant is to receive gastrostomy feedings.Which intervention should the nurse institute to prevent bloating,gastrointestinal reflux into the esophagus,vomiting,and respiratory compromise?

A) Rapid bolusing of the entire amount in 15 minutes
B) Warm cloths to the abdomen for the first 10 minutes
C) Slow,small,warm bolus feedings over 30 minutes
D) Cold,medium bolus feedings over 20 minutes

Answer 3

Slow,small,warm bolus feedings over 30 minutes

Question 4

When providing an infant with a gavage feeding,which infant assessment should be documented each time?

A) Abdominal circumference after the feeding
B) Heart rate and respirations before feeding
C) Suck and swallow coordination
D) Response to the feeding

Question 5

A pregnant woman was admitted for induction of labor at 43 weeks of gestation with sure dates.A nonstress test (NST)in the obstetrician's office revealed a nonreactive tracing.On artificial rupture of membranes,thick meconium-stained fluid was noted.What should the nurse caring for the infant after birth anticipate?

A) Meconium aspiration,hypoglycemia,and dry,cracked skin
B) Excessive vernix caseosa covering the skin,lethargy,and RDS
C) Golden yellow to green-stained skin and nails,absence of scalp hair,and an increased amount of subcutaneous fat
D) Hyperglycemia,hyperthermia,and an alert,wide-eyed appearance

Question 6

In caring for the preterm infant,what complication is thought to be a result of high arterial blood oxygen level?

A) Necrotizing enterocolitis (NEC)
B) Retinopathy of prematurity (ROP)
C) Bronchopulmonary dysplasia (BPD).
D) Intraventricular hemorrhage (IVH)

Question 7

A premature infant with respiratory distress syndrome (RDS)receives artificial surfactant.How does the nurse explain surfactant therapy to the parents?

A) "Surfactant improves the ability of your baby's lungs to exchange oxygen and carbon dioxide."
B) "The drug keeps your baby from requiring too much sedation."
C) "Surfactant is used to reduce episodes of periodic apnea."
D) "Your baby needs this medication to fight a possible respiratory tract infection."

Question 8

A nurse practicing in the perinatal setting should promote kangaroo care regardless of an infant's gestational age.Which statement regarding this intervention is most appropriate?

A) Kangaroo care was adopted from classical British nursing traditions.
B) This intervention helps infants with motor and CNS impairments.
C) Kangaroo care helps infants interact directly with their parents and enhances their temperature regulation.
D) This intervention gets infants ready for breastfeeding.

Question 9

When evaluating the preterm infant,the nurse understands that compared with the term infant,what information is important for the nurse to understand?

A) Few blood vessels visible through the skin
B) More subcutaneous fat
C) Well-developed flexor muscles
D) Greater surface area in proportion to weight

Question 10

Which condition might premature infants who exhibit 5 to 10 seconds of respiratory pauses,followed by 10 to 15 seconds of compensatory rapid respiration,be experiencing?

A) Suffering from sleep or wakeful apnea
B) Experiencing severe swings in blood pressure
C) Trying to maintain a neutral thermal environment
D) Breathing in a respiratory pattern common to premature infants

Question 11

An infant is being discharged from the NICU after 70 days of hospitalization.The infant was born at 30 weeks of gestation with several conditions associated with prematurity,including RDS,mild bronchopulmonary dysplasia (BPD),and retinopathy of prematurity (ROP),requiring surgical treatment.During discharge teaching,the infant's mother asks the nurse if her baby will meet developmental milestones on time,as did her son who was born at term.What is the nurse's most appropriate response?

A) "Your baby will develop exactly like your first child."
B) "Your baby does not appear to have any problems at this time."
C) "Your baby will need to be corrected for prematurity."
D) "Your baby will need to be followed very closely."

Question 12

For clinical purposes,the most accurate definition of preterm and postterm infants is defined as what?

A) Preterm: Before 34 weeks of gestation if the infant is appropriate for gestational age (AGA);before 37 weeks if the infant is small for gestational age (SGA)
B) Postterm: After 40 weeks of gestation if the infant is large for gestational age (LGA);beyond 42 weeks if the infant is AGA
C) Preterm: Before 37 weeks of gestation and postterm beyond 42 weeks of gestation;no matter the size for gestational age at birth
D) Preterm: Before 38 to 40 weeks of gestation if the infant is SGA;postterm,beyond 40 to 42 weeks gestation if the infant is LGA

Question 13

On day 3 of life,a newborn continues to require 100% oxygen by nasal cannula.The parents ask if they may hold their infant during his next gavage feeding.Considering that this newborn is physiologically stable,what response should the nurse provide?

A) "Parents are not allowed to hold their infants who are dependent on oxygen."
B) "You may only hold your baby's hand during the feeding."
C) "Feedings cause more physiologic stress;therefore,the baby must be closely monitored.I don't think you should hold the baby."
D) "You may hold your baby during the feeding."

Question 14

With regard to an eventual discharge of the high-risk newborn or the transfer of the newborn to a different facility,which information is essential to provide to the parents?

A) Infants stay in the NICU until they are ready to go home.
B) Once discharged to go home,the high-risk infant should be treated like any healthy term newborn.
C) Parents of high-risk infants need special support and detailed contact information.
D) If a high-risk infant and mother need to be transferred to a specialized regional center,then waiting until after the birth and until the infant is stabilized is best.

Question 15

With regard to infants who are diagnosed with both small gestational age (SGA)and intrauterine growth restriction (IUGR),the nurse should be aware of which information?

A) In the first trimester,diseases or abnormalities result in asymmetric IUGR.
B) Infants with asymmetric IUGR have the potential for normal growth and development.
C) In asymmetric IUGR,weight is slightly larger than SGA,whereas length and head circumference are somewhat less than SGA.
D) Symmetric IUGR occurs in the later stages of pregnancy.

Question 16

An infant at 36 weeks of gestation has increasing respirations (80 to 100 breaths per minute with significant substernal retractions).The infant is given oxygen by continuous nasal positive airway pressure (CPAP).What level of partial pressure of arterial oxygen (PaO₂)indicates hypoxia?

A) 67 mm Hg
B) 89 mm Hg
C) 45 mm Hg
D) 73 mm Hg

Question 17

Necrotizing enterocolitis (NEC)is an inflammatory disease of the gastrointestinal mucosa.The signs of NEC are nonspecific.What are generalized signs and symptoms of this condition?

A) Hypertonia,tachycardia,and metabolic alkalosis
B) Abdominal distention,temperature instability,and grossly bloody stools
C) Hypertension,absence of apnea,and ruddy skin color
D) Scaphoid abdomen,no residual with feedings,and increased urinary output

Question 18

An infant at 26 weeks of gestation arrives intubated from the delivery room.The nurse weighs the infant,places him under the radiant warmer,and attaches him to the ventilator at the prescribed settings.A pulse oximeter and cardiorespiratory monitor are placed.The pulse oximeter is recording oxygen saturations of 80%.The prescribed saturations are 92%.What is the nurse's most appropriate action at this time?

A) Listening to breath sounds,and ensuring the patency of the endotracheal tube,increasing oxygen,and notifying a physician
B) Continuing to observe and making no changes until the saturations are 75%
C) Continuing with the admission process to ensure that a thorough assessment is completed
D) Notifying the parents that their infant is not doing well

Question 19

A newborn was admitted to the neonatal intensive care unit (NICU)after being delivered at 29 weeks of gestation to a 28-year-old multiparous,married,Caucasian woman whose pregnancy was uncomplicated until the premature rupture of membranes and preterm birth.The newborn's parents arrive for their first visit after the birth.The parents walk toward the bedside but remain approximately 5 feet away from the bed.What is the nurse's most appropriate action?

A) Wait quietly at the newborn's bedside until the parents come closer.
B) Go to the parents,introduce him or herself,and gently encourage them to meet their infant.Explain the equipment first,and then focus on the newborn.
C) Leave the parents at the bedside while they are visiting so that they have some privacy.
D) Tell the parents only about the newborn's physical condition and caution them to avoid touching their baby.

Question 20

During the assessment of a preterm infant,the nurse notices continued respiratory distress even though oxygen and ventilation have been provided.In this situation,which condition should the nurse suspect?

A) Hypovolemia and/or shock
B) Excessively cool environment
C) Central nervous system (CNS)injury
D) Pending renal failure

Question 21

Infants born between 34 0/7 and 36 6/7 weeks of gestation are called late-preterm infants because they have many needs similar to those of preterm infants.Because they are more stable than early-preterm infants,they may receive care that is similar to that of a full-term baby.These infants are at increased risk for which conditions? (Select all that apply. )

A) Problems with thermoregulation
B) Cardiac distress
C) Hyperbilirubinemia
D) Sepsis
E) Hyperglycemia

Question 22

The corrected age of an infant who was born at 25 1/7 weeks and is preparing for discharge 124 days past delivery is ______________.

Question 23

Which risk factors are associated with necrotizing enterocolitis (NEC)? (Select all that apply. )

A) Polycythemia
B) Anemia
C) Congenital heart disease
D) Bronchopulmonary dysphasia
E) Retinopathy

Question 24

Because of the premature infant's decreased immune functioning,what nursing diagnosis should the nurse include in a plan of care for a premature infant?

A) Delayed growth and development
B) Ineffective thermoregulation
C) Ineffective infant feeding pattern
D) Risk for infection