Deck 17: High-Risk Neonatal Nursing Care

Question 1

The labor and delivery nurse is present for the delivery of a premature neonate. Which action by the nurse is most important?

A)Stabilize and transfer neonate to NICU.
B)Review pregnancy history for risk factors.
C)Maintain fluid and electrolyte balance.
D)Provide a neutral temperature environment.

Answer 1

Provide a neutral temperature environment.

Question 2

The nurse is providing care for a premature neonate born at 28 weeks gestation who is experiencing respiratory distress syndrome (RDS). Which assessment finding indicates to the nurse that the neonate's respiratory status is deteriorating?

A)Pao₂ is 48 and Paco₂ is 55 mm Hg on 90% oxygen.
B)Respiratory rate is 58 breaths per minute.
C)Breath sounds on auscultation are decreased.
D)Heart rate is 162 beats per minute.

Answer 2

Pao₂ is 48 and Paco₂ is 55 mm Hg on 90% oxygen.

Question 3

The nurse notices that a neonate being treated for hyperbilirubinemia with phototherapy has had a daily increase of total bilirubin serum levels greater than 5 mg/dL for the past 2 days. The neonatal care provider prescribes an exchange transfusion. Which knowledge does the nurse apply to the procedure?

A)The bilirubin indicates a severe hemolytic disease.
B)Approximately 85% of the neonate's RBCs are replaced.
C)Donor RBCs are obtained from the neonate's mother.
D)The procedure is exclusive to pathological jaundice.

Answer 3

Approximately 85% of the neonate's RBCs are replaced.

Question 4

The nurse is providing support to a mother whose newborn is diagnosed with a life-threatening defect. The mother states, "I just want to go home and never come back." Which reaction by the mother does the nurse recognize?

A)Guilty feelings by the mother
B)Delay of attachment process
C)Maternal emotional distancing
D)Disruption of family life

Question 5

The nurse is present in the delivery room when a mother is told her neonate was stillborn. The mother begins to wail loudly and pull at her hair. Which action does the nurse take?

A)Allow the mother to express grief in her own way.
B)Attempt to calm the mother and prevent self-harm.
C)Ask for a sedative to calm the mother's reaction.
D)Ask a family member to comfort the mother.

Question 6

The nurse is preparing for the discharge of a premature neonate to home with the parents. The nurse explains the neonate must be able to pass the infant car seat challenge before discharge. For which reason would the neonate be considered unsafe in a car seat?

A)Inability to remain at a 45-degree angle for a period of 1 hour
B)Reluctance of parents to use the car seat because of the small size of the baby
C)Inability to maintain adequate oxygenation, heart rate, and respiratory rate during trial
D)Inability to continue prescribed oxygen therapy for the neonate while in a car seat

Question 7

The nurse is preparing for the discharge of a neonate diagnosed with a congenital breathing disorder. Which health team members does the nurse include in discharge planning? Select all that apply.

A)Respiratory therapist
B)Community agency manager
C)Social worker
D)Home health agency nurse
E)Case manager

Question 8

The nurse is providing support for the parents of a neonate born with anencephaly. The parents repeatedly state, "I don't believe this is happening to us. We were so careful during pregnancy." The nurse associates the parents' comments with which stage of grief?

A)Disbelief
B)Depression
C)Denial of reality
D)Anger with each other

Question 9

The nurse in NICU is assessing a neonate delivered at 32 weeks gestation. Which pathophysiological manifestation is the nurse's greatest concern?

A)Absent or weak reflexes
B)Presence of a heart murmur
C)Apnea 20 seconds or longer
D)Low hemoglobin lab level

Question 10

The nurse is providing care for a premature neonate in the NICU nursery. The neonate is diagnosed with bronchopulmonary dysplasia (BPD) and patent ductus arteriosus (PDA). Which specific intervention does the nurse expect for this neonate?

A)Monitor of hemoglobin and hematocrit levels.
B)Obtain blood glucose levels.
C)Maintain fluid restrictions.
D)Administer enteral feedings.

Question 11

A patient who is at 41 weeks gestation is concerned when the primary care provider decides to induce labor. Which reason does the nurse explain as the most important need for this procedure?

A)Increasing size of the neonate
B)Ability to deliver vaginally
C)Risk for placental dysfunction
D)Likelihood of meconium aspiration

Question 12

The nurses in a NICU are concerned about the appropriate levels of oxygen therapy during the care of premature neonates. The nurses referenced an article by Newman (2014) titled, "Oxygen Saturation Limits and Evidence supporting the Targets." On which evidence-based conclusion will the nurses develop guidelines?

A)Oxygen saturation limits of 85% to 89% are effective.
B)Oxygen saturation rates of 91% to 95% are effective.
C)Infants are within saturation limits about 75% of the time.
D)Oxygen saturation limits need to be between 87% to 94%.

Question 13

The postnatal nurse is providing care for a neonate being treated with phototherapy for hyperbilirubinemia. For which side effects of phototherapy will the nurse contact the neonatal care provider? Select all that apply.

A)Hyperthermia
B)Lethargy
C)Hypocalcemia
D)Thrombocytopenia
E)Bronze baby syndrome

Question 14

A mother of a premature neonate in NICU asks the nurse when her baby will begin getting oral feedings. The nurse is aware that multiple conditions are desired. Which condition is most essential?

A)The neonate demonstrates proper feeding actions.
B)The neonate exhibits cardiorespiratory regulation.
C)The neonate is able to demonstrate hunger cues.
D)The neonate is able to maintain a quiet alert state.

Question 15

The nurse is providing support to parents of a premature neonate in NICU. Which actions by the nurse will best provide psychosocial support to the parents? Select all that apply.

A)Assess the parents' ability to care for their neonate.
B)Ask the parents how they are coping with the experience.
C)Provide equipment for breast pumping and storage of milk.
D)Encourage parents to take photos to share with family and friends.
E)Praise parents for their involvement in the care of their neonate.

Question 16

The NICU nurse encourages the mother of a premature neonate to bring breast milk to the unit for enteral feedings to her baby. For which reason does the nurse make this suggestion?

A)The baby will be more likely to breastfeed later.
B)The mother will feel more involved with the baby.
C)The neonate will gain weight faster on breast milk.
D)Breast milk helps prevent necrotizing enterocolitis.

Question 17

The premature neonate is more susceptible to skin breakdown than a term neonate. Which skin care interventions will the nurse implement for the premature neonate? Select all that apply.

A)Use a neutral pH cleanser and sterile water for bathing.
B)Gently apply emollients to avoid unnecessary friction.
C)Perform daily skin assessment to identify problems early.
D)Use water, air, or gel mattresses.
E)Provide a full bath every other day.

Question 18

The nurse is providing care for a neonate born to a mother with preexisting diabetes mellitus. Which neonatal assessment findings do the nurse expect? Select all that apply.

A)Macrosomia
B)Hyperglycemia
C)Hypocalcemia
D)Jaundice
E)Dyspnea