Deck 37: Nursing Care of the High Risk Newborn

Question 1

A nurse practicing in the perinatal setting should promote kangaroo care regardless of an infant's gestational age.This intervention:

A)Is adopted from classical British nursing traditions
B)Helps infants with motor and central nervous system impairment
C)Helps infants to interact directly with their parents and enhances their temperature regulation
D)Gets infants ready for breastfeeding

Answer 1

Helps infants to interact directly with their parents and enhances their temperature regulation

Question 2

An infant at 36 weeks of gestation has increasing respirations (80 to 100 breaths/min with marked substernal retractions).The infant is given oxygen by continuous nasal positive airway pressure (CPAP).Which arterial oxygen level indicates hypoxia?

A)PaO2 of 67
B)PaO2 of 89
C)PaO2 of 45
D)PaO2 of 73

Answer 2

PaO2 of 45

Question 3

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.The nurse caring for the infant after birth anticipates:

A)Meconium aspiration,hypoglycemia,and dry,cracked skin
B)Excessive vernix caseosa covering the skin,lethargy,and respiratory distress syndrome
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

Answer 3

Meconium aspiration,hypoglycemia,and dry,cracked skin

Question 4

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 5

Insensible water loss (IWL)is an evaporative loss that occurs largely through the skin.The effects of radiant warmers,incubators,phototherapy,and other factors can augment the IWL.Increased stooling or voiding,increased evaporative losses,inadequate volume or incorrect fluid administration,and problems of malabsorption may cause weight loss.Calculate the weight loss for the following scenario.Is the infant's weight loss in an acceptable range?
Day 9 weight: 2340 g
Day 10 weight: 2299 g

Question 6

Risk factors associated with necrotizing enterocolitis (NEC)include (choose all that apply):

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

Question 7

For clinical purposes,preterm and postterm infants are defined as:

A)Preterm: Before 34 weeks if AGA;before 37 weeks if SGA
B)Postterm: After 40 weeks if LGA;beyond 42 weeks if AGA
C)Preterm: Before 37 weeks,postterm beyond 42 weeks;no matter the size for gestational age at birth
D)Preterm: SGA before 38 to 40 weeks;postterm,LGA beyond 40 to 42 weeks

Question 8

An infant is being discharged from the neonatal intensive care unit (NICU)after 70 days of hospitalization.The infant was born at 30 weeks of gestation with several conditions associated with prematurity,including respiratory distress syndrome,mild bronchopulmonary dysplasia,and retinopathy of prematurity 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.The nurse's most appropriate response is:

A)"Your baby will develop exactly like your first child did."
B)"Your baby does not appear to have any problems at this time."
C)"Your baby will need to be corrected for prematurity.Your baby is currently 40 weeks of postconceptional age and can be expected to be doing what a 40-week-old infant would be doing."
D)"Your baby will need to be followed very closely."

Question 9

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.Given that this newborn is physiologically stable,what response does the nurse give?

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,so the baby must be closely monitored.Therefore,I don't think you should hold the baby."
D)"You may hold your baby during the feeding."

Question 10

With regard to eventual discharge of the high risk newborn or transfer to a different facility,nurses and families should be aware that:

A)Infants stay in the neonatal intensive care unit (NICU)until they are ready to go home
B)Once discharged to 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 transfer to a specialized regional center,it is better to wait until after birth and the infant is stabilized

Question 11

There are numerous signs and symptoms of neonatal infection.Interestingly,the most common is ________________,whereas ________________ is rare.

A)Hyperthermia,hypothermia
B)Hypotension,hypothermia
C)Hypothermia,hyperthermia
D)Hypotension,hyperthermia

Question 12

In the continuing assessment of a preterm infant,the nurse notices continued respiratory distress even though oxygen and ventilation have been provided.The nurse should suspect:

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

Question 13

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

Question 14

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 female whose pregnancy was uncomplicated until 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.The nurse's most appropriate action is to:

A)Wait quietly at the newborn's bedside until the parents come closer
B)Go to the parents,introduce himself 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 can have some privacy
D)Tell the parents only about the newborn's physical condition and caution them to avoid touching their baby

Question 15

As a result of large body surface in relation to weight,the preterm infant is at high risk for heat loss and cold stress.In 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.While evaluating the plan that has been implemented,the nurse knows that the infant is experiencing cold stress when he or she exhibits:

A)Decreased respiratory rate
B)Bradycardia followed by an increased heart rate
C)Mottled skin with acrocyanosis
D)Increased physical activity

Question 16

An infant is to receive gastrostomy feedings.What 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

Question 17

In appraising the growth and development potential of a preterm infant,nurses should:

A)Tell parents their child won't catch up until about age 10 (girls)to 12 (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

Question 18

A premature infant never seems to sleep longer than an hour at a time.Each time a light is turned on,an incubator closes,or people talk near her crib,she wakes up and cries inconsolably until held.The correct nursing diagnosis is ineffective coping,related to:

A)Severe immaturity
B)Environmental stress
C)Physiologic distress
D)Behavioral responses

Question 19

Which combination of expressing pain could be demonstrated in a neonate?

A)Low-pitched crying,tachycardia,eyelids open wide
B)Cry face,flaccid limbs,closed mouth
C)High-pitched,shrill cry;withdrawal;change in heart rate
D)Cry face,eye squeeze,increase in blood pressure