Deck 14: The Newborn with a Perinatal Injury or Congenital Malformation

Question 1

The nurse is caring for a child who has had a ventriculoperitoneal shunt (VP)for hydrocephalus and observes an increasing abdominal girth.What is the most appropriate response?

A) Elevate the child's head.
B) Check bowel sounds.
C) Record retention of feeding.
D) Notify the charge nurse of possible malabsorption.

Answer 1

Notify the charge nurse of possible malabsorption.

Question 2

An 18-month-old child had a surgical repair of a cleft palate and is now allowed to eat a regular diet.What nursing action is the most appropriate?

A) Feed solid foods with the spoon at the side of the mouth.
B) Puree foods and offer them through a straw.
C) Place small bites of food in the mouth with a tongue blade.
D) Offer small, frequent meals of finger foods.

Answer 2

Feed solid foods with the spoon at the side of the mouth.

Question 3

The nurse is advising parents about feeding their infant with phenylketonuria.What formula and/or diet should the nurse suggest?

A) Lifelong high-protein diet
B) A formula that is low in the amino acid leucine
C) A soy-based formula
D) Substitute Lofenalac for some protein foods

Answer 3

Substitute Lofenalac for some protein foods

Question 4

A newborn was just admitted to the neonatal intensive care unit with a meningomyelocele.What is the priority preoperative nursing care of this newborn?

A) Keep the sac dry.
B) Diaper snugly.
C) Position prone in an incubator.
D) Move from side to side every hour.

Question 5

What occurrence results from obstruction within the ventricles of the brain or inadequate reabsorption of cerebrospinal fluid?

A) Meningitis
B) Meningocele
C) Spina bifida occulta
D) Hydrocephalus

Question 6

What would the nurse include when instructing parents about positioning their toddler who has just had a body spica cast applied?

A) Prop the child upright with pillows for meals.
B) Use the bar between the legs to turn the child.
C) Put the child on her abdomen to sleep.
D) Change the child's position frequently.

Question 7

When bathing an infant,what sign does the nurse recognize as a sign of developmental hip dysplasia?

A) Hypotonicity of the leg muscles
B) One leg is shorter than the other
C) Broadening and flattening of the buttocks
D) Two skinfolds on the back of each thigh

Question 8

Parents ask the nursery staff what the light does for their jaundiced infant.What is the nurse's best response?

A) "The light increases the infant's metabolism."
B) "The light stimulates liver function."
C) "The light dilates blood vessels."
D) "The light breaks down bilirubin."

Question 9

The nurse is caring for an Rh-negative mother on the postpartum unit.What scenario indicates the need to administer RhoGAM to this patient?

A) She has had one Rh-negative child and is pregnant with an Rh-negative child.
B) She has had an Rh-positive infant and is pregnant with an Rh-positive fetus.
C) She has had an O-negative child and is pregnant with a B-negative child.
D) She is a primipara with an O-negative child.

Question 10

After delivery,a mother asks the nurse about newborn screening tests.The nurse explains that what is the optimal time for testing for phenylketonuria?

A) In the first 24 hours of life
B) After 2 to 3 days
C) At 4 to 6 weeks of age
D) At 2 months of age

Question 11

Parents of a newborn with a unilateral cleft lip are concerned about having the defect repaired.The nurse explains that a child with a cleft lip usually undergoes surgical repair at which time?

A) Immediately after birth
B) By 3 months of age
C) After 12 months of age
D) Varies in every case

Question 12

The nurse is providing education to parents of a child with cleft palate.What will the nurse instruct the parents to report immediately?

A) Facial paralysis
B) Ear infections
C) Increasing intracranial pressure (ICP)
D) Drooling

Question 13

The nurse is caring for an infant with hydrocephalus.What nursing action is most important for this nurse to implement?

A) Align the limbs.
B) Support the head.
C) Keep the head lower than the hip.
D) Check intake and output.

Question 14

The nurse observes that the infant's anterior fontanelle is bulging after placement of a ventriculoperitoneal shunt.How should the nurse position this infant?

A) Prone, with the head of the bed elevated
B) Supine, with the head flat
C) Side-lying on the operative side
D) In a semi-Fowler's position

Question 15

A 3-month-old infant is diagnosed with developmental hip dysplasia.The nurse knows that what is the usual treatment for an infant with this diagnosis?

A) A Pavlik harness
B) A body spica cast
C) Traction
D) Triple-diapering

Question 16

Parents of a 2-month-old infant with Down syndrome are attending a well visit at the pediatric clinic.What should they be instructed to provide special attention to in regard to the generalized hypotonicity of the child?

A) Preventing hyperthermia
B) Respiratory care
C) Prevention of diarrhea
D) Incontinence care

Question 17

Which statement indicates that parents understand how to feed their infant who had a surgical repair for a cleft lip?

A) "We are feeding the baby with a dropper for 2 weeks."
B) "We resumed bottle feeding after discharge."
C) "We started the baby on solid food yesterday."
D) "The baby is drinking well from a straw."

Question 18

Postoperative nursing care of the infant following surgical repair of a cleft lip would include:

A) Feeding the infant with a spoon to avoid sucking
B) Positioning the infant on the abdomen to facilitate drainage
C) Applying elbow restraints to protect the surgical area
D) Providing minimal stimulation to prevent injury to the incision

Question 19

What nursing action will the nurse implement after feeding an infant with hydrocephalus?

A) Position the infant sitting upright in an infant seat.
B) Place the infant over the shoulder to burp.
C) Leave the infant in a side-lying position.
D) Stimulate the infant by rubbing its feet.

Question 20

Phototherapy is instituted for an infant.What is the most appropriate nursing action for the infant having phototherapy?

A) Cover the infant's head with a hat.
B) Dress the infant lightly in a T-shirt.
C) Keep the infant's eyes covered.
D) Reposition the infant at least every 4 to 8 hours.

Question 21

The home health nurse is educating parents on home phototherapy.What will the nurse include when providing information to these parents?

A) Cover the infant's eyes when under the light.
B) Use a three-prong plug.
C) Keep a diaper in place.
D) Place the light source on an absorbent surface.
E) Expose as much skin as possible.

Question 22

What characteristics are typical in a child diagnosed with Down syndrome?

A) Close-set eyes
B) Simian creases
C) Wide-spaced front teeth
D) Protruding tongue
E) Curved, small fingers

Question 23

The nurse in the newborn nursery is watchful for neonatal abstinence syndrome in the newborn of a crack-addicted mother.What would be the manifestations of this syndrome?

A) Body tremors
B) Excessive sneezing
C) Hyperirritability
D) Drowsiness
E) Excessive appetite

Question 24

The parents of a child diagnosed with cystic fibrosis ask the nurse what caused this disorder.What is the most appropriate response?

A) "Cystic fibrosis is a chromosomal defect."
B) "Cystic fibrosis is a metabolic defect."
C) "Cystic fibrosis is a malformation present at birth."
D) "Cystic fibrosis is a blood disorder."

Question 25

What would be included in the plan of care for a child just returned to the floor from surgery in which a clubfoot was repaired?

A) Keep cast uncovered to allow drying.
B) Check toes for capillary refill.
C) Circle with a pen any area of bleeding on the cast.
D) Keep casted leg lowered.
E) Observe for skin irritation.

Question 26

When the CSF is obstructed in the subarachnoid space rather than in the ventricles,the resulting hydrocephalus is diagnosed as ____________________ hydrocephalus.

Question 27

What will the nurse include in the plan of care when caring for an infant with an intracranial hemorrhage?

A) Keep positioned with head elevated.
B) Feed slowly to reduce possibility of vomiting.
C) Stimulate often to maintain level of consciousness.
D) Hold and coddle frequently to stimulate.
E) Observe for increased intracranial pressure.

Question 28

What manifestations of increasing ICP in the hydrocephalic child should the nurse be aware of?

A) High-pitched cry
B) Inequality of pupils
C) Bulging fontanelles
D) Diarrhea
E) Hiccups

Question 29

The initial treatment for cleft lip is a surgical repair known as ______________.

Question 30

The nurse demonstrates how to flush the ventriculoperitoneal shunt by the use of the ____________________ that is in place behind the infant's ear.

Question 31

What assessment made by the nurse would lead the nurse to suspect hip dysplasia?

A) Asymmetrical gluteal folds
B) Limited adduction of the affected side
C) Foot turned inward
D) Deep inguinal creases

Question 32

The nurse clarifies to the parents of a child with spina bifida that their child has a portion of the spinal cord in the sac in addition to the meninges.This type of spina bifida is known as a(n)____________________.

Question 33

The nurse is providing care to a child with Down syndrome.What body system has the highest risk of congenital anomaly in a child with Down syndrome?

A) Reproductive system
B) Genitourinary system
C) Cardiovascular system
D) Gastrointestinal system

Question 34

The nurse is obtaining intake information on a new patient being seen for preconception care and notes a family history of neural tube defects.What interventions can the nurse suggest to this woman to help prevent neural tube anomalies in a developing fetus?

A) Avoid drug use.
B) Follow a low-calorie, low-protein diet.
C) Take a folic acid supplement every day.
D) Exercise daily.
E) Maintain bed rest during the first trimester.

Question 35

The nurse is caring for a macrosomic newborn of a woman diagnosed with gestational diabetes immediately after birth.What assessment findings can the nurse anticipate?

A) High blood glucose levels
B) Weight of 9 pounds or more
C) Decreased subcutaneous fat
D) Hypocalcemia
E) Hyperbilirubinemia

Question 36

The nurse is caring for a macrosomic newborn whose mother has diabetes.What should the nurse assess for with this neonate?

A) Hypoglycemia
B) Erythroblastosis fetalis
C) Intracranial hemorrhage
D) Pancreatic failure