Question 1

A primigravida has just delivered a healthy infant girl.The nurse is about to administer erythromycin ointment in the infant's eyes when the mother asks,"What is that medicine for?" The nurse responds:

Accepted Answer

With the prophylactic use of erythromycin,the incidence of gonococcal conjunctivitis has declined to less than 0.5%.Eye prophylaxis is administered at or shortly after birth to prevent ophthalmia neonatorum.Erythromycin has no bearing on enhancing vision.Erythromycin is used to prevent an infection caused by gonorrhea,not herpes.Erythromycin is given to prevent infection,not for lubrication.

Question 2

Many common drugs of abuse cause significant physiologic and behavioral problems in infants who are breastfed by mothers currently using (choose all that apply):

Accepted Answer

Use of amphetamines,heroin,nicotine,and PDP is contraindicated during breastfeeding because of the reported effects on the infant.Morphine is a medication often used to treat neonatal abstinence syndrome.

Question 3

Infants of mothers with diabetes are at higher risk for developing:

Accepted Answer

IDMs are at risk for macrosomia,birth trauma,perinatal asphyxia,respiratory distress syndrome,hypoglycemia,hypocalcemia,hypomagnesemia,cardiomyopathy,hyperbilirubinemia,and polycythemia.Infants of diabetic mothers (IDMs)are not at risk for anemia.They are at risk for polycythemia.IDMs are not at risk for hyponatremia.They are at risk for hypocalcemia and hypomagnesemia.IDMs are not at risk for sepsis.

Question 4

During a prenatal examination a woman reports having two cats at home.The nurse informs her that she should not be cleaning the litter box while she is pregnant.When the woman questions the nurse as to why,the nurse's best response is:

Accepted Answer

Toxoplasmosis is a multisystem disease caused by the protozoal Toxoplasma gondii parasite,commonly found in cats,dogs,pigs,sheep,and cattle.About 30% of women who contract toxoplasmosis during gestation transmit the disease to their offspring.Clinical features ascribed to toxoplasmosis include hydrocephalus or microcephaly,chorioretinitis,seizures,or cerebral calcifications.Human immunodeficiency virus (HIV)is not transmitted by cats.Although this may be a valid statement,it is not appropriate,does not answer the client's question,and is not the nurse's best response.E.coli is found in normal human fecal flora.It is not transmitted by cats.

Question 5

When planning care for an infant with a fractured clavicle,the nurse should recognize that in addition to gentle handling:

Accepted Answer

Fractures in newborns generally heal rapidly.Except for gentle handling,no accepted treatment for a fractured clavicle exists.Fractures in newborns generally heal rapidly.Except for gentle handling,no accepted treatment for a fractured clavicle exists.Movement should be limited,and the infant should be gently handled.It is not necessary to perform range of motion exercises on the infant.A fractured clavicle does not require immobilization with a splint.

Question 6

The most important nursing action in preventing neonatal infection is:

Accepted Answer

Virtually all controlled clinical trials have demonstrated that effective handwashing is responsible for the prevention of health care-associated infection in nursery units.Overcrowding must be avoided in nurseries,and infants with infectious processes should be isolated;however,the most important nursing action for preventing neonatal infection is effective handwashing.Separate gowns should be worn in caring for each infant.Soiled linens should be disposed of in an appropriate manner;however,the most important nursing action for preventing neonatal infection is effective handwashing.Measures to be taken include Standard Precautions,careful and thorough cleaning,frequent replacement of used equipment,and disposal of excrement and linens in an appropriate manner.The most important nursing action for preventing neonatal infection is effective handwashing.

Question 7

A pregnant woman at 37 weeks of gestation has had ruptured membranes for 26 hours.A cesarean section is performed for failure to progress.The fetal heart rate before birth is 180 beats/min with limited variability.At birth the newborn has Apgar scores of 6 and 7 at 1 and 5 minutes and is noted to be pale and tachypneic.Based on the maternal history,the cause of this newborn's distress is most likely:

Accepted Answer

The prolonged rupture of membranes and the tachypnea (before and after birth)suggest sepsis.A differential diagnosis can be difficult because signs of sepsis are similar to noninfectious problems such as anemia and hypoglycemia.Phrenic nerve injury is usually the result of traction on the neck and arm during birth and is not applicable to this situation.The earliest signs of sepsis are characterized by lack of specificity (i.e.,lethargy,poor feeding,and irritability),not respiratory distress syndrome.

Question 8

A careful review of the literature on the various recreational and illicit drugs reveals that:

Accepted Answer

Studies on the effects of marijuana and cocaine use by mothers are somewhat contradictory.More,longer-range studies are needed.Just about all of these drugs cross the placenta,including marijuana,cocaine,and PCP.Drug withdrawal is accompanied by fetal withdrawal,which can lead to fetal death.Therefore,detoxification from heroin is not recommended,particularly later,in pregnancy.Methadone withdrawal is more severe and more prolonged than heroin withdrawal.

Question 9

With regard to skeletal injuries sustained by a neonate during labor or birth,nurses should be aware that:

Accepted Answer

About 70% of neonatal skull fractures are linear.Because the newborn skull is flexible,considerable force is required to fracture it.Clavicle fractures need no special treatment.The clavicle is the bone most often fractured during birth.

Question 10

A macrosomic infant is born after a difficult forceps-assisted delivery.After stabilization,the infant is weighed,and the birth weight is 4550 g (9 lb,6 oz).The nurse's most appropriate action is to:

Accepted Answer

This infant is macrosomic (more than 4000 g)and is at high risk for hypoglycemia.Blood glucose levels should be monitored frequently,and the infant should be observed closely for signs of hypoglycemia.Macrosomic infants need to be observed closely.This can be achieved in the mother's room with nursing interventions,depending on the condition of the infant.It may be more appropriate for observation to occur in the nursery.Observation of the macrosomic infant may occur in the nursery or in the mother's room,depending on the condition of the infant.Regardless of gestational age,this infant is macrosomic.Macrosomia is defined as fetal weight over 4000 g.Hypoglycemia affects many macrosomic infants.Blood glucose levels should be observed closely.

Question 11

Near the end of the first week of life,an infant who has not been treated for any infection develops a copper-colored maculopapular rash on the palms and around the mouth and anus.The newborn is showing signs of:

Accepted Answer

This rash is indicative of congenital syphilis.The lesions may extend over the trunk and extremities.This rash is not an indication that the neonate has contracted gonorrhea.The neonate with gonorrheal infection might present with septicemia,meningitis,conjunctivitis,and scalp abscesses.Infants affected with HSV display growth restriction,skin lesions,microcephaly,hypertonicity,and seizures.Typically the HIV-infected neonate is asymptomatic at birth.Most often the infant develops an opportunistic infection and rapid progression of immunodeficiency.

Question 12

A plan of care for an infant experiencing symptoms of drug withdrawal should include:

Accepted Answer

The infant should be wrapped snugly to reduce self-stimulation behaviors and protect the skin from abrasions.Phenobarbital or diazepam may be administered to decrease central nervous system (CNS)irritability.The infant should be fed in small,frequent amounts and burped well to diminish aspiration and maintain hydration.The infant should not be stimulated (such as with music),because this will increase activity and potentially increase CNS irritability.

Question 13

Human immunodeficiency virus (HIV)may be perinatally transmitted:

Accepted Answer

Postnatal transmission of HIV through breastfeeding may occur.Transmission of HIV from the mother to the infant may occur transplacentally at various gestational ages.Transmission close to or at the time of birth is thought to account for 50% to 80% of cases.This is highly unlikely because most health care facilities must meet sterility standards for all instrumentation.Transmission of HIV may occur through the placenta from the mother to the fetus or through breast milk postnatally.

Question 14

With regard to the understanding and treatment of infants born to mothers who are substance abusers,nurses should be aware that:

Accepted Answer

Multiple substance use (even alcohol and tobacco)makes it difficult to assess the problems of the exposed infant,particularly with regard to withdrawal manifestations.Infants of substance-abusing mothers may have some of the physiologic signs but are not addicted in the behavioral sense."Drug-exposed newborn" is a more accurate description than "addict."
The NNNS is designed to assess the neurologic,behavioral,and stress/abstinence function of the neonate.Newborn urine,hair,or meconium sampling may be used to identify an infant's intrauterine drug exposure.

Question 15

The abuse of which substance during pregnancy is a significant cause of mental retardation in the United States?

Accepted Answer

Alcohol abuse during pregnancy is recognized as one of the leading causes of mental retardation in the United States.Alcohol is a teratogen;maternal ethanol abuse during gestation can lead to identifiable fetal alcohol spectrum disorders that include alcohol-related neurodevelopmental disorders.Cigarette smoking is linked to adverse pregnancy outcomes.The risk for placenta previa,abruption,and premature rupture of membranes is twice that of nonsmokers.Marijuana is the most common illicit drug used by pregnant women.Marijuana crosses the placenta,and its use during pregnancy can result in shortened gestation and a higher incidence of intrauterine growth restriction (IUGR).Heroin crosses the placenta and often results in IUGR,stillbirth,and congenital anomalies.

Question 16

A 3.8-kg infant was delivered vaginally at 39 weeks after a 30-minute second stage.There was a nuchal cord.After birth the infant is noted to have petechiae over the face and upper back.Information given to the infant's parents should be based on the knowledge that petechiae:

Accepted Answer

Petechiae,or pinpoint hemorrhagic areas,acquired during birth may extend over the upper portion of the trunk and face.These lesions are benign if they disappear within 2 days of birth and no new lesions appear.Petechiae may result from decreased platelet formation.In this situation,the presence of petechiae is most likely a soft-tissue injury resulting from the nuchal cord at birth.Unless they do not dissipate in 2 days,there is no reason to alarm the family.Petechiae usually occur with a breech presentation vaginal birth.

Question 17

A pregnant woman presents in labor at term,having had no prenatal care.After birth her infant is noted to be small for gestational age with small eyes and a thin upper lip.The infant also is microcephalic.Based on her infant's physical findings,this woman should be questioned about her use of which substance during pregnancy?

Accepted Answer

The description of the infant suggests fetal alcohol syndrome,which is consistent with maternal alcohol consumption during pregnancy.Fetal brain,kidney,and urogenital system malformations have been associated with maternal cocaine ingestions.Heroin use in pregnancy frequently results in intrauterine growth restriction (IUGR).The infant may have a shrill cry and sleep cycle disturbances and may present with poor feeding,tachypnea,vomiting,diarrhea,hypothermia or hyperthermia,and sweating.Studies have found a higher incidence of meconium staining in infants born of mothers who used marijuana during pregnancy.

Question 18

What bacterial infection is definitely decreasing because of effective drug treatment?

Accepted Answer

Penicillin has significantly decreased the incidence of GBS infection.E.coli may be increasing,perhaps because of the increasing use of ampicillin (resulting in a more virulent E.coli resistant to the drug).Tuberculosis is increasing in the United States and in Canada.Candidiasis is a fairly benign fungal infection.

Question 19

Providing care for the neonate born to a mother who abuses substances can present a challenge for the health care team.Nursing care for this infant requires a multisystem approach.The first step in the provision of this care is:

Accepted Answer

Neonatal abstinence syndrome (NAS)describes the cohort of symptoms associated with drug withdrawal in the neonate.The Neonatal Abstinence Scoring System evaluates central nervous system (CNS),metabolic,vasomotor,respiratory,and gastrointestinal (GI)disturbances.This evaluation tool enables the health care team to develop an appropriate plan of care.The infant is scored throughout the length of stay and the treatment plan is adjusted accordingly.Pharmacologic treatment is based on the severity of withdrawal symptoms.Symptoms are determined by using a standard assessment tool.Medications of choice are morphine,phenobarbital,diazepam,or diluted tincture of opium.Swaddling,holding,and reducing environmental stimuli are essential in providing care to the infant who is experiencing withdrawal.These nursing interventions are appropriate for the infant who displays central nervous system disturbances.Poor feeding is one of the GI symptoms common to this client population.Fluid and electrolyte balance must be maintained and adequate nutrition provided.These infants often have a poor suck reflex and may need to be fed via gavage.

Question 20

With regard to central nervous system injuries to the infant during labor and birth,nurses should be aware that:

Accepted Answer

Abnormalities in lumbar punctures or red blood cell counts,for instance,or in visuals on computed tomography (CT)scan might reveal a hemorrhage.ICH as a result of birth trauma is more likely to occur in the full-term,large infant.Subarachnoid hemorrhage in term infants is a result of trauma;in preterm infants,it is a result of hypoxia.Spinal cord injuries are almost always from breech births;they are rare today because cesarean birth often is used for breech presentation.

Quiz 35: Acquired Problems of the Newborn