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

Question 1

An infant with severe meconium aspiration syndrome (MAS)is not responding to conventional treatment.Which treatment may be necessary for this infant?

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

Answer 1

Extracorporeal membrane oxygenation

Question 2

The goal of treatment of the infant with phenylketonuria (PKU)is to

A) cure cognitive delays.
B) prevent central nervous system (CNS) damage.
C) prevent gastrointestinal symptoms.
D) prevent the renal system damage.

Answer 2

prevent central nervous system (CNS) damage.

Question 3

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

A) "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."
B) "My baby will be watched closely for signs of low blood sugar, especially during the early days after birth."
C) "The red appearance of my baby's skin is due to an excessive number of red blood cells."
D) "My baby's pancreas may not produce enough insulin because the cells became smaller than normal during my pregnancy."

Answer 3

"My baby's pancreas may not produce enough insulin because the cells became smaller than normal during my pregnancy."

Question 4

The nurse learns that the most common cause of pathologic hyperbilirubinemia is which of the following?

A) Hepatic disease
B) Hemolytic disorders in the newborn
C) Postmaturity
D) Congenital heart defect

Question 5

An infant with hypocalcemia is receiving an intravenous bolus of calcium.The infant's heart rate changes from 144 beats/minute to 62 beats/minute.What action by the nurse is best?

A) Call for a stat EGG.
B) Stop the infusion.
C) Stimulate the infant.
D) Administer magnesium.

Question 6

Transient 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 delivery associated with meconium-stained fluid.

Question 7

What action by the nurse is the most important action in preventing neonatal infection?

A) Good hand hygiene
B) Isolation of infected infants
C) Separate gown technique
D) Standard Precautions

Question 8

A newborn has meconium aspiration at birth.The nurse notes increasing respiratory distress.What action takes priority?

A) Obtain an oxygen saturation.
B) Notify the provider at once.
C) Stimulate the baby to increase respirations.
D) Prepare to initiate ECMO.

Question 9

The nurse is teaching the parents of a newborn who is going to receive phototherapy.What other measure does the nurse teach to help reduce the bilirubin?

A) Increase the frequency of feedings.
B) Increase oral intake of water between feedings.
C) How to prepare the newborn for an exchange transfusion
D) Wrap the infant in triple blankets to prevent cold stress during phototherapy.

Question 10

A neonate has white patches in her mouth that bled when the mother tried wiping them away.What action by the nurse is best?

A) Tell the mother to leave the patches alone.
B) Assess the mother for a perineal rash.
C) Give the infant medicated pacifiers.
D) Test the infant for toxoplasmosis.

Question 11

A nurse is participating in a neonatal resuscitation.What action by the nurse takes priority?

A) Suction the mouth and nose.
B) Stimulate the infant by rubbing the back.
C) Perform the Apgar test.
D) Place the infant in a preheated warmer.

Question 12

The difference between physiologic and nonphysiologic jaundice is that nonphysiologic jaundice

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

Question 13

The infant of a mother with diabetes is hypoglycemic.What type of feeding should be instituted first?

A) Glucose water in a bottle
B) D5W intravenously
C) Formula via nasogastric tube
D) Breast milk

Question 14

Parents of a newborn with phenylketonuria are anxious to learn about the appropriate treatment for their infant.What topic does the nurse include in the teaching plan?

A) Fluid and sodium restrictions
B) A phenylalanine-free diet
C) Progressive mobility and splinting
D) A protein-rich diet

Question 15

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

A) hypoglycemia.
B) phrenic nerve injury.
C) respiratory distress syndrome.
D) sepsis.

Question 16

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

A) The infant had Apgar scores of 6 and 8.
B) An IV was started immediately after birth to treat dehydration.
C) No meconium was found below the vocal cords when they were examined.
D) The parents spent an hour bonding with the baby after birth.

Question 17

Nursing care of the infant with neonatal abstinence syndrome should include

A) Positioning the infant's crib in a quiet corner of the nursery
B) Feeding the infant on a 2-hour schedule
C) Placing stuffed animals and mobiles in the crib to provide visual stimulation
D) Spending extra time holding and rocking the infant

Question 18

The nurse is caring for a neonate undergoing phototherapy.What action does the nurse include on the infant's care plan?

A) Keep the infant's eyes covered under the light.
B) Keep the infant supine at all times.
C) Restrict parenteral and oral fluids.
D) Dress the infant in only a T-shirt and diaper.

Question 19

Four hours after delivery of a healthy neonate of an insulin-dependent diabetic woman,the baby appears jittery,irritable,and has a high-pitched cry.Which nursing action has top priority?

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

Question 20

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 pounds,6 ounces).What action by the nurse is most appropriate?

A) Leave the infant in the room with the mother.
B) Take the infant immediately to the nursery.
C) Perform a gestational age assessment.
D) Monitor blood glucose levels frequently.

Question 21

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

A) pharmacologic treatment.
B) reduction of environmental stimuli.
C) neonatal abstinence syndrome scoring.
D) adequate nutrition and maintenance of fluid and electrolyte balance.

Question 22

A woman who has had no prenatal care enters the labor and delivery unit in advanced labor.She has chickenpox.What action by the nurse is best?

A) Place the woman in isolation.
B) Give the woman immune globulin before delivery.
C) Treat the woman with acyclovir.
D) Administer antibiotics to the infant after birth.

Question 23

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

A) "It is an eye ointment to help your baby see you better."
B) "It is to protect your baby from contracting herpes from your vaginal tract."
C) "Erythromycin is given to prevent a gonorrheal infection."
D) "This medicine will protect your baby's eyes from drying out."

Question 24

A woman who has a history of frequent substance abuse is close to delivering.What action by the nurse is best?

A) Notify social services of the situation prior to the birth.
B) Draw up and label a syringe of naloxone.
C) Administer naloxone if the baby shows signs of withdrawal.
D) Prepare to administer naloxone to the mother.

Question 25

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

A) gonorrhea.
B) herpes simplex virus infection.
C) congenital syphilis.
D) HIV.

Question 26

Newborns whose mothers are substance abusers frequently have what behaviors? (Select all that apply.)

A) Circumoral cyanosis
B) Decreased amounts of sleep
C) Hyperactive Moro (startle) reflex
D) Difficulty feeding
E) Weak cry

Question 27

The nursing student learns that transmission of HIV from mother to baby occurs in which fashion?

A) From the maternal circulation only in the third trimester
B) From the use of unsterile instruments
C) Only through the ingestion of amniotic fluid
D) Through the ingestion of breast milk from an infected mother

Question 28

Some infants develop hypoxic-ischemic encephalopathy after asphyxia.Therapeutic hypothermia has been used to improve neurologic outcomes for these infants.Criteria for the use of this modality include (Select all that apply.)

A) The infant must be 28 weeks gestation or greater.
B) Have evidence of an acute hypoxic event.
C) Be in a facility they can initiate treatment within 6 hours.
D) The infant must be 36 or more weeks' gestation.
E) The treatment must be initiated within the first 12 hours of life.

Question 29

The nurse is preparing a dose of naloxone for a newborn who weighs 6.9 pounds.How much naloxone does the nurse administer? ______ mg

Question 30

What action does the nurse add to the plan of care for an infant experiencing symptoms of drug withdrawal?

A) Keeping the newborn sedated
B) Feeding every 4 to 6 hours to allow extra rest
C) Swaddling the infant snugly
D) Playing soft music during feeding