Deck 9: Health Problems of Newborns

Question 1

The nurse is caring for a 3-week-old boy born at 29 weeks' gestation. While taking vital signs and changing his diaper after stooling, the nurse observes: his color is pink but slightly mottled; his arms and legs are limp and extended; he has the hiccoughs; there are respiratory pauses and gasping; his heart rate is regular and rapid. The nurse should recognize these behaviors as manifestations of which of the following?

A)Stress
B)Subtle seizures
C)Preterm behavior
D)Onset of respiratory distress

Answer 1

Stress

Question 2

The parents of a neonate ask the nurse what caused the baby's facial nerve paralysis. The nurse's response is based on knowledge that this is caused by which of the following?

A)Genetic defect
B)Birth injury
C)Spinal cord injury
D)Inborn error of metabolism

Answer 2

Birth injury

Question 3

Which of the following is the most appropriate way for the nurse to obtain an occasional urine sample from a neonate?

A)Apply a plastic collecting device.
B)Obtain suprapubic urine specimen.
C)Weigh diaper before and after urinating.
D)Aspirate small amount of urine from cotton balls placed in the diaper

Answer 3

Aspirate small amount of urine from cotton balls placed in the diaper

Question 4

The parents of a newborn with a strawberry hemangioma ask the nurse what the treatment will be. The nurse's response should be based on knowledge that:

A)Excision of the lesion will be necessary.
B)Injections of prednisone into the lesion will reduce it.
C)No treatment is usually necessary because of the high rate of spontaneous involution.
D)Pulsed dye laser treatments will be necessary immediately to prevent permanent disability.

Question 5

A healthy, stable, preterm infant will soon be discharged. The nurse should recommend which of the following positions for sleep?

A)Prone
B)Non-prone
C)Side-lying
D)Position of comfort

Question 6

The nurse is caring for a very-low-birth-weight (VLBW) infant with a peripheral intravenous infusion. Nursing considerations regarding infiltration include which of the following?

A)Infiltration occurs infrequently because VLBW infants are inactive.
B)Continuous infusion pumps stop automatically when infiltration occurs.
C)Hypertonic solutions can cause severe tissue damage if infiltration occurs.
D)Infusion site should be checked for infiltration at least once per 8-hour shift.

Question 7

The mother of a preterm neonate asks the nurse when she can start breast-feeding. The nurse should explain that breast-feeding can be initiated when her infant:

A)Achieves a weight of at least 3 lbs.
B)Indicates an interest in breast-feeding.
C)Does not require supplemental oxygen.
D)Has adequate sucking and swallowing reflexes.

Question 8

Which of the following is defined as a vaguely outlined area of edematous tissue situated over the portion of the scalp that presents in a vertex delivery?

A)Caput succedaneum
B)Hydrocephalus
C)Cephalhematoma
D)Subdural hematoma

Question 9

A mother is upset because her newborn has erythema toxicum neonatorum. The nurse should reassure her that this is which of the following?

A)Easily treated
B)Benign and transient
C)Usually not contagious
D)Usually not disfiguring

Question 10

Which of the following is a bright red, rubbery nodule with a rough surface and a well-defined margin that may be present at birth?

A)Port-wine stain
B)Juvenile melanoma
C)Cavernous hemangioma
D)Strawberry hemangioma

Question 11

Why is a neutral thermal environment essential for the high-risk neonate?

A)Metabolism slows dramatically in the neonate experiencing cold stress.
B)The neonate produces heat by increasing activity and shivering.
C)It permits the neonate to maintain a normal core temperature with minimal oxygen consumption.
D)It permits the neonate to maintain a normal core temperature with increased caloric consumption.

Question 12

Nursing care of the newborn with oral candidiasis (thrush) includes which of the following?

A)Avoid use of pacifier.
B)Remove characteristic white patches with a soft cloth.
C)Continue medication for prescribed number of days.
D)Apply medication to oral mucosa, being careful that none is ingested.

Question 13

Oral candidiasis (thrush) in the neonate is which of the following?

A)Bacterial infection that is life threatening in the neonatal period
B)Bacterial infection of mucous membranes that responds readily to treatment
C)Yeastlike fungal infection of mucous membranes that is relatively common
D)Benign disorder that is transmitted from mother to infant only during the birth process.

Question 14

Which of the following interventions should the nurse implement to maintain the skin integrity of the premature infant?

A)Cleanse skin with a gentle alkaline-based soap and water.
B)Cleanse skin with a neutral pH solution only when necessary.
C)Thoroughly rinse skin with plain water after bathing in a mild hexachlorophene solution.
D)Avoid cleaning skin.

Question 15

Which of the following terms refers to an infant born before completion of the week 37 of gestation, regardless of birth weight?

A)Postterm
B)Premature
C)Low-birth-weight
D)Small-for-gestational-age

Question 16

Which of the following findings on a newborn assessment should the nurse recognize as suggestive of a clavicle fracture?

A)Negative scarf sign
B)Asymmetrical Moro reflex
C)Swelling of fingers on affected side
D)Paralysis of affected extremity and muscles

Question 17

The nurse is caring for a high-risk neonate in a radiant warmer who has an umbilical catheter. The nurse notes blanching of the feet. Which of the following is the most appropriate nursing action?

A)Elevate feet 15 degrees.
B)Place socks on infant.
C)Wrap feet loosely in prewarmed blanket.
D)Report findings immediately to the practitioner.

Question 18

Which of the following is the most appropriate nursing action when intermittently gavage-feeding a preterm infant?

A)Allow formula to flow by gravity.
B)Insert tube through nares rather than mouth.
C)Avoid letting infant suck on tube.
D)Apply steady pressure to syringe to deliver formula to stomach in a timely manner.

Question 19

Which of the following is an important nursing action related to the use of tape and/or adhesives on premature neonates?

A)Avoid using tape and adhesives until skin is more mature.
B)Use solvents to remove tape and adhesives instead of pulling on skin.
C)Remove adhesives with warm water or mineral oil.
D)Use scissors carefully to remove tape instead of pulling tape off.

Question 20

Which of the following refers to an infant whose rate of intrauterine growth was slowed and whose birth weight falls below the 10th percentile on intrauterine growth charts?

A)Postterm
B)Postmature
C)Low-birth-weight
D)Small-for-gestational-age

Question 21

When is the best time for the neonatal intensive care unit (ICU) nurse to initiate an individualized stimulation program for the preterm infant?

A)As soon as possible after infant is born
B)As soon as parent is available to provide stimulation
C)When infant is over 38 weeks' gestation
D)When developmental organization and stability is sufficient

Question 22

The nurse is preparing the parents of a newborn for home phototherapy. Instructions should include which of the following?

A)Maintain infant in prone position.
B)Dress infant in light-weight clothing.
C)Make sure eyelids are open before applying patches.
D)Remove patches during feedings and other care-giving activities.

Question 23

The parents of a preterm infant in neonatal ICU (NICU) are concerned about their infant experiencing pain from so many procedures. The nurse's response should be based on the knowledge that preterm infants:

A)May react to painful stimuli but are unable to remember the pain experience.
B)Perceive and react to pain in much the same manner as children and adults.
C)Do not have the cortical and subcortical centers that are needed for pain perception.
D)Lack neurochemical systems associated with pain transmission and modulation.

Question 24

Hemolytic disease is suspected in a mother's second baby, a son. Which of the following factors is important in understanding how this could develop?

A)Her first child was Rh positive.
B)Her first child was a girl.
C)Both parents have type O blood.
D)She was not immunized against hemolysis.

Question 25

Which of the following is a clinical manifestation of postmaturity in the neonate?

A)Excessive lanugo
B)Increased subcutaneous fat
C)Absence of scalp hair
D)Parchment-like skin

Question 26

After 8 weeks in the NICU, Chris will soon be discharged. His parents seem very apprehensive and worry that he may still be in danger. The nurse should recognize that this is which of the following?

A)Normal
B)A reason to postpone discharge
C)Suggestive of maladaptation
D)Suggestive of inadequate bonding

Question 27

When should the nurse expect breast-feeding-associated jaundice to first appear in a normal newborn?

A)0 to 12 hours
B)12 to 24 hours
C)2 to 4 days
D)4 to 5 days

Question 28

A preterm neonate has been receiving orogastric feedings of breast milk. The nurse initiates nipple feedings, but the infant tires easily and has weak sucking and swallowing reflexes. The most appropriate nursing intervention is to:

A)Encourage mother to breast-feed.
B)Try nipple-feeding preterm infant formula.
C)Resume orogastric feedings of breast milk.
D)Resume orogastric feedings of formula.

Question 29

The parents of a neonate who has just died decide, after their infant has gone to the morgue, that they want to hold their infant. The most appropriate nursing intervention at this time is to:

A)Explain gently that this is no longer possible.
B)Encourage parents to accept the loss of their infant.
C)Offer to take a photograph of their infant because they can't hold infant.
D)Get the infant, wrap in a blanket, and rewarm in a radiant warmer so they can hold their infant.

Question 30

Early clinical manifestations of bilirubin encephalopathy in the neonate include which of the following?

A)Mental retardation
B)Absence of stooling
C)Lethargy or irritability
D)Increased or decreased temperature

Question 31

A preterm infant has just been admitted to the NICU. The infant's parents ask the nurse about anesthesia and analgesia when painful procedures are necessary. The nurse's explanation should be based on knowledge that:

A)Nerve pathways of neonates are not sufficiently myelinated to transmit painful stimuli.
B)Risk of anesthesia and analgesia is too great to justify any possible benefit of pain relief.
C)Neonates do not possess sufficiently integrated cortical function to interpret or recall pain experiences.
D)Pain pathways and neurochemical systems associated with pain transmission are intact and functional in neonates.

Question 32

The newborn with severe jaundice is at risk for developing which of the following?

A)Encephalopathy
B)Bullous impetigo
C)Respiratory distress
D)Blood incompatibility

Question 33

A blood sample for measurement of bilirubin is required from a neonate receiving phototherapy. In what environment should this blood sample be drawn?

A)While phototherapy lights are turned off
B)While infant remains under phototherapy lights
C)When infant is covered with a blanket
D)When infant has been off phototherapy for 30 to 60 minutes

Question 34

The nurse is planning care for a family expecting their newborn infant to die. The nurse's interventions should be based on knowledge of which of the following?

A)Tangible remembrances of the infant (e.g., lock of hair, picture) prolong grief.
B)Photographs of infants should not be taken after the death has occurred.
C)Funerals are not recommended, because mother is still recovering from childbirth.
D)Parents should be encouraged to name their infant if they have not done so already.

Question 35

Physiologic jaundice in a neonate can be caused by which of the following?

A)Fetal-maternal blood incompatibility
B)Destruction of red blood cells as a result of antibody reaction
C)Liver's inability to bind bilirubin adequately for excretion
D)Immature kidneys' inability to hydrolyze and excrete bilirubin

Question 36

The nurse is planning care for a low-birth-weight neonate. Which of the following is an appropriate nursing intervention to promote adequate oxygenation?

A)Place in Trendelenburg position periodically.
B)Suction at least every 2 to 3 hours.
C)Maintain neutral thermal environment.
D)Hyperextend neck with nose pointing to ceiling.

Question 37

The nurse has been caring for a neonate who has just died. The parents are present but say they are "afraid" to hold the dead infant. The most appropriate nursing intervention is which of the following?

A)Tell them there is nothing to fear.
B)Insist that they hold infant "one last time."
C)Respect their wishes and release body to morgue.
D)Keep infant's body available for a few hours in case they change their minds.

Question 38

Which of the following statements best describes the clinical manifestations of the preterm infant?

A)Head is proportionately small in relation to the body.
B)Sucking reflex is absent, weak, or ineffectual.
C)Thermostability is well established.
D)Extremities remain in attitude of flexion.

Question 39

The nurse is caring for an infant with hyperbilirubinemia who is receiving phototherapy. Which of the following is an appropriate nursing intervention for this infant?

A)Apply lotion as prescribed to moisturize skin.
B)Maintain nothing-by-mouth (NPO) status to prevent nausea and vomiting.
C)Monitor temperature to prevent hypothermia or hyperthermia.
D)Keep eye patches on for at least 8-12 hours of every 24 hours.

Question 40

Where is the best place to observe for jaundice in dark-skinned infants?

A)Buttocks
B)Tip of nose and sclera
C)Sclera, conjunctiva, and oral mucosa
D)Palms of hands and soles of feet

Question 41

Which of the following is the most appropriate nursing intervention for the neonate who is jittery and twitching and has a high-pitched cry?

A)Monitor blood pressure closely.
B)Obtain urine sample to detect glycosuria.
C)Obtain serum glucose and serum calcium levels.
D)Administer oral glucose or, if infant refuses to suck, IV dextrose.

Question 42

When should the nurse expect jaundice to be present in a newborn with hemolytic disease?

A)At birth
B)During first 24 hours after birth 3.24 to 48 hours after birth
C)48 to 72 hours after birth

Question 43

A woman who is 18 weeks pregnant is diagnosed with isoimmunization. The nurse should know that:

A)No treatment is necessary.
B)No treatment is available until the infant is born.
C)Fetal transfusion may be required.
D)Administration of Rho immune globulin is indicated.

Question 44

Which of the following is the most common cause of anemia in preterm infants?

A)Frequent blood sampling
B)Respiratory distress syndrome
C)Meconium aspiration syndrome
D)Persistent pulmonary hypertension

Question 45

To prevent Rh isoimmunization, Rho immune globulin (such as RhoGAM) is administered to all:

A)Rh-negative women who deliver an Rh-positive infant
B)Rh-positive women who deliver an Rh-negative infant
C)Rh-negative infants whose mothers are Rh positive
D)Rh-positive fathers before conception of second infant when first infant was Rh positive

Question 46

Meconium aspiration syndrome is caused by which of the following?

A)Hypoglycemia
B)Carbon dioxide retention
C)Bowel obstruction with meconium
D)Aspiration of meconium in utero or at birth

Question 47

Which of the following is the central factor responsible for respiratory distress syndrome?

A)Deficient surfactant production
B)Overproduction of surfactant
C)Overdeveloped alveoli
D)Absence of alveoli

Question 48

Which of the following is the primary treatment for hypoglycemia in neonates?

A)Oral glucose feedings
B)Intravenous (IV) infusion of glucose
C)Short-term insulin therapy
D)Feedings (formula or breast milk) at least every 2 hours

Question 49

Several types of seizures can occur in the neonate. Which of the following is characteristic of clonic seizures?

A)Apnea
B)Tremors
C)Rhythmic jerking movements
D)Extensions of all four limbs

Question 50

The nurse is caring for a male infant who was born 24 hours ago to a mother who received no prenatal care. The infant is a poor feeder but sucks avidly on his hands. Clinical manifestations also include loose stools, tachycardia, fever, projectile vomiting, sneezing, and generalized sweating. The nurse should suspect which of the following?

A)Seizure disorder
B)Narcotic withdrawal
C)Placental insufficiency
D)Meconium aspiration syndrome

Question 51

A preterm infant of 36 weeks' gestation is admitted to the NICU. Approximately 2 hours after birth, the neonate begins having difficulty breathing with grunting, tachypnea, and nasal flaring. The nurse should recognize that:

A)This is a normal finding.
B)This is not significant unless cyanosis is present.
C)Improvement should occur within 24 hours.
D)Further evaluation is needed.

Question 52

The nurse is planning care for a newborn receiving IV calcium gluconate for treatment of hypocalcemia. Which of the following interventions is the most appropriate during the acute phase?

A)Allow infant to sleep with pacifier to decrease stimuli.
B)Keep infant awake to monitor central nervous system changes.
C)Encourage parents to hold and feed infant to facilitate attachment during illness.
D)Awaken infant periodically to assess level of consciousness.

Question 53

The nurse is caring for a neonate with respiratory distress syndrome. The infant has an endotracheal tube. Nursing considerations related to suctioning should include which of the following?

A)Suctioning should not be carried out routinely.
B)Infant should be in Trendelenburg position for suctioning.
C)Routine suctioning, usually every 15 minutes, is necessary.
D)Frequent suctioning is necessary to maintain patency of bronchi.

Question 54

Neonates are highly susceptible to infection as a result of which of the following?

A)Excessive levels of immunoglobulin A (IgA) and IgM
B)Diminished nonspecific and specific immunity
C)Increased humoral immunity
D)Overwhelming anti-inflammatory response

Question 55

The nurse is caring for a neonate receiving an exchange transfusion for hemolytic disease. Assessment of the infant reveals slight respiratory distress and tachycardia. The nurse's first action should be which of the following?

A)Notify practitioner.
B)Stop the transfusion.
C)Administer calcium gluconate.
D)Monitor vital signs electronically.

Question 56

The nurse is caring for a neonate whose mother is diabetic. Which of the following clinical manifestations would the nurse expect to see?

A)Hypoglycemic, large-for-gestational-age
B)Hyperglycemic, large-for-gestational-age
C)Hypoglycemic, small-for-gestational-age
D)Hyperglycemic, small-for-gestational-age

Question 57

A newborn is diagnosed with retinopathy of prematurity. The nurse should know that:

A)Blindness cannot be prevented.
B)No treatment is currently available.
C)Cryotherapy and laser therapy are effective treatments.
D)Long-term administration of oxygen will be necessary.

Question 58

The nurse is caring for a preterm neonate who requires mechanical ventilation for treatment of respiratory distress syndrome. The nurse should recognize that, because of the mechanical ventilation, there is an increased risk of which of the following?

A)Alveolar rupture
B)Meconium aspiration
C)Transient tachypnea
D)Retractions and nasal flaring

Question 59

Which of the following are possible complications of the oxygen therapy and mechanical ventilation a premature infant often requires?

A)Bronchopulmonary dysplasia
B)Anemia, necrotizing enterocolitis
C)Cerebral palsy, persistent patent ductus
D)Congestive heart failure, cerebral edema

Question 60

Which of the following is the most descriptive of the clinical manifestations observed in neonatal sepsis?

A)Seizures
B)Sudden hyperthermia
C)Decreased urine output
D)Subtle, vague, and nonspecific physical signs

Question 61

Which of the following is an important nursing consideration in preventing the complications of congenital hypothyroidism (CH)?

A)Assess for family history of CH.
B)Assess mother for signs of hypothyroidism.
C)Be sure appropriate screening is done prenatally.
D)Be sure appropriate screening is done on newborn.

Question 62

Which of the following is an important nursing consideration in the care of the infant with PKU?

A)Suggest ways to make formula more palatable.
B)Teach proper administration of phenylalanine hydroxylase.
C)Encourage breast-feeding mother to adhere to low-phenylalanine diet.
D)Give reassurance that dietary restrictions are a temporary inconvenience.

Question 63

Which of the following is characteristic of infants whose mothers smoked during pregnancy?

A)Large for gestational age
B)Preterm, but size appropriate for gestational age
C)Growth retardation in weight only
D)Growth retardation in weight, length, and head circumference

Question 64

Trisomy 13, trisomy 18, and trisomy 21 have which of the following in common?

A)Viability is rare.
B)They are considered deletion syndromes.
C)Diagnosis is difficult, time-consuming, and expensive.
D)Diagnosis can be made early, based on physical characteristics.

Question 65

The commonly used Guthrie blood test is performed on newborns to diagnose:

A)Down syndrome.
B)Isoimmunization.
C)PKU.
D)Congenital hypothyroidism (CH).

Question 66

Which of the following should the nurse anticipate in the infant whose mother used cocaine during pregnancy?

A)Seizures
B)Hyperglycemia
C)Cardiac/respiratory problems
D)Neurobehavioral depression or excitability

Question 67

The screening test for PKU is most reliable if the blood sample is:

A)From cord blood.
B)Taken 14 days after birth.
C)Taken before oral feedings are initiated.
D)Fresh blood from the heel.

Question 68

Which of the following genetic terms refers to the transfer of all or part of a chromosome to a different chromosome after chromosome breakage?

A)Trisomy
B)Monosomy
C)Translocation
D)Nondisjunction

Question 69

Phenylketonuria is a genetic disease that results in the body's inability correctly to metabolize:

A)Glucose.
B)Phenylalanine.
C)Phenylketones.
D)Thyroxin.

Question 70

The nurse needs to do obtain blood for ongoing assessment of a high-risk newborn's progress. Select all the tests that the nurse would likely be monitoring.

A)Blood glucose
B)Complete blood count (CBC)
C)Calcium
D)Serum electrolytes
E)Neonatal prothrombin time (PTT)