Question 1

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

Accepted Answer

The best time to initiate an individualized stimulation program for a preterm infant in the neonatal ICU is when the infant demonstrates developmental organization and stability. This ensures that the infant is ready to benefit from the stimulation without being overwhelmed or stressed, which could lead to adverse outcomes.

Question 2

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

Accepted Answer

Removing the eye patches during feedings and caregiving activities allows for bonding and visual stimulation, which is important for the infant's development.

Question 3

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:

Accepted Answer

Preterm infants perceive and react to pain similarly to older children and adults. They have the necessary neurological pathways to experience pain, including the cortical and subcortical centers required for pain perception, as well as the neurochemical systems associated with pain transmission and modulation. This understanding is crucial for ensuring they receive appropriate pain management in the NICU.

Question 4

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?

Accepted Answer

Hemolytic disease of the newborn can occur when an Rh-negative mother becomes sensitized to Rh-positive blood, often from a previous pregnancy with an Rh-positive child. If the mother's immune system produces antibodies against the Rh factor, these can cross the placenta and attack the red blood cells of an Rh-positive fetus in a subsequent pregnancy.

Question 5

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

Accepted Answer

Postmaturity in neonates can lead to a decrease in subcutaneous fat, making the skin appear thin, dry, and wrinkled, similar to parchment. This is in contrast to the other options, which are not typical signs of postmaturity.

Question 6

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?

Accepted Answer

This reaction is normal for parents who have experienced the stress and uncertainty of having a child in the NICU. It reflects their concern and care for their child's well-being as they transition from a highly monitored environment to home care.

Question 7

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

Accepted Answer

Breast-feeding-associated jaundice typically first appears 2 to 4 days after birth, as it is related to the newborn's feeding practices and the mother's milk supply.

Question 8

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:

Accepted Answer

Resuming orogastric feedings of breast milk is the most appropriate intervention because it ensures the infant continues to receive nutrition in a manner that does not exhaust them, while still providing the benefits of breast milk. Weak sucking and swallowing reflexes indicate the infant is not yet ready for nipple feeding.

Question 9

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:

Accepted Answer

The most appropriate nursing intervention is to respect the parents' wishes to hold their infant, even after death. This can be facilitated by retrieving the infant from the morgue, wrapping them in a blanket, and gently rewarming them in a radiant warmer to make the experience as comforting as possible for the grieving parents. This approach supports the parents' need for closure and bonding, even after the infant's death, and is considered a compassionate and supportive action in the context of neonatal loss.

Question 10

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

Accepted Answer

Lethargy or irritability are early clinical manifestations of bilirubin encephalopathy in neonates, indicating acute neurological dysfunction due to elevated bilirubin levels.

Question 11

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:

Accepted Answer

Pain pathways and the neurochemical systems associated with pain transmission are indeed intact and functional in neonates, meaning they can experience pain. This understanding is crucial for providing appropriate care and pain management for neonates undergoing painful procedures.

Question 12

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

Accepted Answer

Severe jaundice in newborns can lead to a condition called kernicterus, a form of brain damage (encephalopathy) caused by excessive bilirubin in the blood.

Question 13

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

Accepted Answer

Drawing a blood sample for bilirubin measurement while phototherapy lights are turned off is necessary to avoid the potential breakdown of bilirubin in the sample due to the light exposure, which could lead to inaccurately low bilirubin levels being reported.

Question 14

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?

Accepted Answer

Encouraging parents to name their infant can help in the grieving process by acknowledging the baby's importance and individuality. Tangible remembrances, photographs, and funerals can actually support the grieving process rather than prolong or negatively impact it.

Question 15

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

Accepted Answer

Physiologic jaundice in neonates is primarily due to the immature liver's inability to conjugate (bind) and thus adequately excrete bilirubin. This is a normal developmental process as the neonatal liver matures in the first few days to weeks of life.

Question 16

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

Accepted Answer

Maintaining a neutral thermal environment is crucial for promoting adequate oxygenation in low-birth-weight neonates. It helps prevent hypothermia, which can lead to increased oxygen demand and respiratory distress. The other options could potentially compromise the neonate's airway and breathing.

Question 17

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?

Accepted Answer

Keeping the infant's body available for a few hours allows the parents time to process their grief and decide if they wish to hold their infant, respecting their initial fear and giving them space to change their minds.

Question 18

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

Accepted Answer

Preterm infants often have an absent, weak, or ineffectual sucking reflex due to their underdeveloped neurologic system, making feeding a challenge.

Question 19

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?

Accepted Answer

Phototherapy can affect the infant's temperature regulation, so it's important to monitor the temperature to prevent hypothermia or hyperthermia.

Question 20

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

Accepted Answer

Jaundice in dark-skinned infants is best observed in areas where the skin is thinnest and least pigmented, such as the sclera, conjunctiva, and oral mucosa, allowing for easier detection of the yellowish discoloration caused by elevated bilirubin levels.

Quiz 9: Health Problems of Newborns