Deck 30: High-Risk Newborn: Acquired and Congenital Conditions

Question 1

Which of the following lab values indicates that an infant may have polycythemia?

A) Hb 18 g/dL, Hct 50%
B) Hb 25/dL, Hct 55%
C) Hb 20/dL, Hct 65%
D) Hb 30 g/dL, Hct 70%

Answer 1

Hb 30 g/dL, Hct 70%

Question 2

An infant with severe meconium aspiration syndrome is not responding to conventional treatment. Which method of treatment may be available at a level III facility for use with this infant?

A) Insertion of an endotracheal tube
B) Respiratory support with a ventilator
C) Extracorporeal membrane oxygenation
D) Insertion of a laryngoscope and suctioning of the trachea

Answer 2

Extracorporeal membrane oxygenation

Question 3

Newborns whose mothers are substance abusers frequently have which behaviors?

A) Hypothermia, decreased muscle tone, and weak sucking reflex
B) Excessive sleep, weak cry, and diminished grasp reflex
C) Circumoral cyanosis, hyperactive Babinski reflex, and constipation
D) Decreased amounts of sleep, hyperactive Moro reflex, and difficulty feeding

Answer 3

Decreased amounts of sleep, hyperactive Moro reflex, and difficulty feeding

Question 4

Transitory tachypnea of the newborn (TTN) is thought to occur as a result of:

A) a lack of surfactant.
B) hypoinflation of the lungs.
C) delayed absorption of fetal lung fluid.
D) a slow vaginal birth associated with meconium-stained fluid.

Question 5

Which intervention should make phototherapy most effective in reducing the indirect bilirubin in an affected newborn?

A) Turn the infant every 2 hours.
B) Place eye patches on the newborn.
C) Wrap the infant in triple blankets to prevent cold stress.
D) Increase the oral intake of water between and before feedings.

Question 6

In an infant with cyanotic cardiac anomaly, the nurse should expect to see:

A) feedings taken eagerly.
B) a consistent and rapid weight gain.
C) a decrease in the heart rate with activity.
D) little to no improvement in color with oxygen administration.

Question 7

Which diagnostic test is used to help confirmation of hyperbilirubinemia in an infant?

A) Direct Coombs test based on maternal blood sample
B) Indirect Coombs test based on infant cord blood sample
C) Infant bilirubin level
D) Maternal blood type

Question 8

The nurse present at the birth is reporting to the nurse who will be caring for the neonate after birth. Which information should be included for an infant who had thick meconium in the amniotic fluid?

A) The parents spent an hour bonding with the baby after birth.
B) An IV was started immediately after birth to treat dehydration.
C) There was no meconium below the vocal cords when they were visualized.
D) The infant needed vigorous stimulation immediately after birth to initiate crying.

Question 9

A mother with diabetes has done some reading about the effects of her condition on a newborn. Which statement shows a misunderstanding that should be clarified by the nurse?

A) "The red appearance of my baby's skin is due to an excessive number of red blood cells."
B) "My baby will be watched closely for signs of low blood sugar, especially during the early days after birth."
C) "My baby's pancreas may not produce enough insulin because the cells became smaller than normal during my pregnancy."
D) "Although my baby is large, some women with diabetes have very small babies because the blood flow through the placenta may not be as good as it should be."

Question 10

When a cardiac defect causes the mixing of arterial and venous blood in the right side of the heart, the nurse might expect to find:

A) cyanosis.
B) diuresis.
C) signs of pulmonary congestion.
D) increased oxygenation of the tissues.

Question 11

Four hours after the birth of a healthy neonate of an insulin-dependent (type 1) diabetic mother, the baby appears jittery and irritable and has a high-pitched cry. Which nursing action has top priority?

A) Notify the clinician stat.
B) Test for the blood glucose level.
C) Start an intravenous line with D5W.
D) Document the event in the nurses' notes.

Question 12

The nurse is responsible for monitoring the feedings of the infant with hyperbilirubinemia every 2 to 3 hours around the clock. The purpose of these formula feedings or breastfeedings is to:

A) prevent hyperglycemia.
B) provide fluids and protein.
C) decrease gastrointestinal motility.
D) prevent rapid emptying of the bilirubin from the bowel.

Question 13

Which newborn should the nurse recognize as being most at risk for developing respiratory distress syndrome?

A) A 35-week-gestation male baby born vaginally to a mother addicted to heroin
B) A 35-week-gestation female baby born vaginally 72 hours after the rupture of membranes
C) A 36-week-gestation male baby born by cesarean birth to a mother with insulin-dependent diabetes
D) A 35-week-gestation female baby born vaginally to a mother who has pregnancy-induced hypertension

Question 14

The nurse must continually assess the infant who has meconium aspiration syndrome for the complication of:

A) persistent pulmonary hypertension.
B) bronchopulmonary dysplasia.
C) transitory tachypnea of the newborn.
D) left-to-right shunting of blood through the foramen ovale.

Question 15

While in utero, the fetus passes meconium. Based on this assessment, which nursing diagnosis takes priority for the newborn at birth?

A) Risk for infection related to release of meconium
B) Risk for injury related to high-risk birth interventions, such as amino infusion
C) Risk for aspiration related to retained secretions
D) Risk for thermoregulation because of high-risk labor status

Question 16

Which defect is present with tetralogy of Fallot?

A) Patent ductus arteriosus
B) Coarctation of the aorta
C) Hypertrophy of the right ventricle
D) Transposition of the great arteries

Question 17

The difference between pathologic jaundice and physiologic jaundice is that pathologic jaundice:

A) usually results in kernicterus.
B) appears during the first 24 hours of life.
C) begins on the head and progresses down the body.
D) results from the breakdown of excessive erythrocytes not needed after birth.

Question 18

The infant of a diabetic mother is hypoglycemic. Which type of feeding should be instituted first?

A) Glucose water
B) D5W intravenously
C) Formula via nasogastric tube
D) Small amount of glucose water followed by formula or breast milk

Question 19

While caring for a post-term infant, the nurse recognizes that the elevated hematocrit level most likely results from:

A) hypoxia in utero.
B) underproduction of red blood cells.
C) increased breakdown of red blood cells.
D) the normal expected shift from fetal hemoglobin to normal hemoglobin.

Question 20

Shortly after a cesarean birth, a newborn begins to exhibit difficulty breathing. Nasal flaring and slight retractions are noted. The newborn is admitted to the neonatal intensive care unit (NICU) for closer observation, with a diagnosis of transient tachypnea (TTN). The parents are notified and become anxious because they have no idea what this means in terms of medical condition. The best action that the nurse can take at this time is to:

A) refer them to the neonatologist for more information.
B) tell them not to worry because their infant will be monitored closely by trained staff.
C) explain to them that this often occurs following a birth but it will most likely resolve in the next 24 to 48 hours.
D) tell them that they will be able to come and see their baby, which will help make them feel better.

Question 21

The nurse should be alert to a blood group incompatibility if:

A) both mother and infant are O-positive.
B) mother is A-positive and infant is A-negative.
C) mother is O-positive and infant is B-negative.
D) mother is B-positive and infant is O-negative.

Question 22

The nurse notes that the infant has been feeding poorly over the last 24 hours. She should immediately assess for other signs of:

A) hyperglycemia.
B) neonatal infection.
C) hemolytic anemia.
D) increased bilirubin levels.

Question 23

The nurse's immediate action after the birth of a post-term infant with meconium stained amniotic fluid is to:

A) stimulate the infant to cry.
B) suction the infant's airways.
C) complete the 1- and 5-minute Apgars.
D) vigorously dry the infant's head and trunk.

Question 24

The priority assessment for the Rh-positive infant whose mother's indirect Coombs test was positive at 36 weeks is:

A) skin color.
B) temperature.
C) respiratory rate.
D) blood glucose level.