Deck 30: The Newborn at Risk: Conditions Present at Birth

Question 1

Benefits of skin-to-skin care as a developmental intervention include which of the following?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.

A) Routine discharge
B) Stabilization of vital signs
C) Increased periods of awake-alert state
D) Decline in episodes of apnea and bradycardia
E) Increased growth parameters

Answer 1

B, D, E

Question 2

The mother of a premature newborn questions why a gavage feeding catheter is placed in the mouth of the newborn and not in the nose. What is the nurse's best response?

A) "Most newborns are nose breathers."
B) "The tube will elicit the sucking reflex."
C) "A smaller catheter is preferred for feedings."
D) "Most newborns are mouth breathers."

Answer 2

A

Question 3

The nurse is caring for the newborn of a diabetic mother. Which of the following should be included in the nurse's plan of care for this newborn?

A) Offer early feedings.
B) Administer an intravenous infusion of glucose.
C) Assess for hypercalcemia.
D) Assess for hyperbilirubinemia immediately after birth.

Answer 3

A

Question 4

The nurse is caring for an infant born at 37 weeks that weighs 1750 g (3 pounds 10 ounces). The head circumference and length are in the 25th percentile. What statement would the nurse expect to find in the chart?

A) Preterm appropriate for gestational age, symmetrical I U G R
B) Term small for gestational age, symmetrical I U G R
C) Preterm small for gestational age, asymmetrical I U G R
D) Preterm appropriate for gestational age, asymmetrical I U G R

Question 5

A 38-week newborn is found to be small for gestational age (S G A). Which nursing intervention should be included in the care of this newborn?

A) Monitor for feeding difficulties.
B) Assess for facial paralysis.
C) Monitor for signs of hyperglycemia.
D) Maintain a warm environment.

Question 6

The nurse assesses the gestational age of a newborn and informs the parents that the newborn is premature. Which of the following assessment findings is not congruent with prematurity?

A) Cry is weak and feeble
B) Clitoris and labia minora are prominent
C) Strong sucking reflex
D) Lanugo is plentiful

Question 7

The nurse caring for a postterm newborn would not perform what intervention?

A) Providing warmth
B) Frequently monitoring blood glucose
C) Observing respiratory status
D) Restricting breastfeeding

Question 8

The nurse is caring for several pregnant clients. Which client should the nurse anticipate is most likely to have a newborn at risk for mortality or morbidity?

A) 37-year-old, with a history of multiple births and preterm deliveries who works in a chemical factory
B) 23-year-old of low socioeconomic status, unmarried
C) 16-year-old who began prenatal care at 30 weeks
D) 28-year-old with a history of gestational diabetes

Question 9

The nurse is caring for a 2-hour-old newborn whose mother is diabetic. The nurse assesses that the newborn is experiencing tremors. Which nursing action has the highest priority?

A) Obtain a blood calcium level.
B) Take the newborn's temperature.
C) Obtain a bilirubin level.
D) Place a pulse oximeter on the newborn.

Question 10

A 3-month-old baby who was born at 25 weeks has been exposed to prolonged oxygen therapy. The nurse explains to the parents that due to oxygen therapy, their infant is at a greater risk for which of the following?

A) Visual impairment
B) Hyperthermia
C) Central cyanosis
D) Sensitive gag reflex

Question 11

The nurse is teaching the parents of an infant with an inborn error of metabolism how to care for the infant at home. What information does teaching include?

A) Specially prepared formulas
B) Cataract problems
C) Low glucose concentrations
D) Administration of thyroid medication

Question 12

The neonatal special care unit nurse is overseeing the care provided by a nurse new to the unit. Which action requires immediate intervention?

A) The new nurse holds the infant after giving a gavage feeding.
B) The new nurse provides skin-to-skin care.
C) The new nurse provides care when the baby is awake.
D) The new nurse gives the feeding with room-temperature formula.

Question 13

The nurse is caring for a newborn in the special care nursery. The infant has hydrocephalus, and is positioned in a prone position. The nurse is especially careful to cleanse all stool after bowel movements. This care is most appropriate for an infant born with which of the following?

A) Omphalocele
B) Gastroschisis
C) Diaphragmatic hernia
D) Myelomeningocele

Question 14

The pregnant client at 41 weeks is scheduled for labor induction. She asks the nurse whether induction is really necessary. What response by the nurse is best?

A) "Babies can develop postmaturity syndrome, which refers to a number of complications that can occur after 42 weeks of pregnancy."
B) "When infants are born 2 or more weeks after their due date, they have meconium in the amniotic fluid."
C) "Sometimes the placenta ages excessively, and we want to take care of that problem before it happens."
D) "The doctor wants to be proactive in preventing any problems with your baby if he gets any bigger."

Question 15

The nurse is working with parents who have just experienced the birth of their first child at 34 weeks. Which statement(s) by the parents indicate that additional teaching is needed?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.

A) "Our baby will be in an incubator to keep him warm."
B) "Breathing might be harder for our baby because he is early."
C) "The growth of our baby will be faster than if he were term."
D) "Tube feedings will be required because his stomach is small."
E) "Because he came early, he will not produce urine for 2 days."

Question 16

In caring for the premature newborn, the nurse must assess hydration status continually. Assessment parameters should include which of the following?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.

A) Volume of urine output
B) Weight
C) Blood p H
D) Head circumference
E) Bowel sounds

Question 17

A 7 pound 14 ounce girl was born to an insulin-dependent type Ⅱ diabetic mother 2 hours ago. The infant's blood sugar is 47 m g/d L. What is the best nursing action?

A) To recheck the blood sugar in 6 hours
B) To begin an I V of 10% dextrose
C) To feed the baby 1 ounce of formula
D) To document the findings in the chart

Question 18

The nurse is caring for the newborn of a diabetic mother whose blood glucose level is 39 m g/d L. What should the nurse include in the plan of care for this newborn?

A) Offer early feedings with formula or breast milk.
B) Provide glucose water exclusively.
C) Evaluate blood glucose levels at 12 hours after birth.
D) Assess for hyperthermia.

Question 19

The nurse is planning care for a preterm newborn. Which nursing diagnosis has the highest priority?

A) Tissue Integrity, Impaired
B) Infection, Risk for
C) Gas Exchange, Impaired
D) Family Processes, Dysfunctional

Question 20

A N I C U nurse plans care for a preterm newborn that will provide opportunities for development. Which interventions support development in a preterm newborn in a N I C U?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.

A) Schedule care throughout the day.
B) Silence alarms quickly.
C) Place a blanket over the top portion of the incubator.
D) Do not offer a pacifier.
E) Dim the lights.

Question 21

An H I V-positive mother delivered 2 days ago. The infant will be placed in foster care. The nurse is planning discharge teaching for the foster parents on how to care for the newborn at home. Which instructions should the nurse include?

A) Do not add food supplements to the baby's diet.
B) Place soiled diapers in a sealed plastic bag.
C) Wash soiled linens in cool water with bleach.
D) Shield the baby's eyes from bright lights.

Question 22

The nurse is assessing a drug-dependent newborn. Which symptom would require further assessment by the nurse?

A) Occasional watery stools
B) Spitting up after feeding
C) Jitteriness and irritability
D) Nasal stuffiness

Question 23

The nurse is preparing an educational session on phenylketonuria for a family whose neonate has been diagnosed with the condition. Which statement by a parent indicates that teaching was effective?

A) "This condition occurs more frequently among Japanese people."
B) "We must be very careful to avoid most proteins to prevent brain damage."
C) "Carbohydrates can cause our baby to develop cataracts and liver damage."
D) "Our baby's thyroid gland isn't functioning properly."

Question 24

The nurse is caring for the newborn of a drug-addicted mother. Which assessment findings would be typical for this newborn?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.

A) Hyperirritability
B) Decreased muscle tone
C) Exaggerated reflexes
D) Low pitched cry
E) Transient tachypnea

Question 25

Parents have been told their child has fetal alcohol syndrome (F A S). Which statement by a parent indicates that additional teaching is required?

A) "Our baby's heart murmur is from this syndrome."
B) "He might be a fussy baby because of this."
C) "His face looks like it does due to this problem."
D) "Cuddling and rocking will help him stay calm."

Question 26

During discharge planning for a drug-dependent newborn, the nurse explains to the mother how to do which of the following?

A) Place the newborn in a prone position.
B) Limit feedings to three a day to decrease diarrhea.
C) Place the infant supine and operate a home apnea-monitoring system.
D) Wean the newborn off the pacifier.

Question 27

The parents of a newborn have just been told their infant has tetralogy of Fallot. The parents do not seem to understand the explanation given by the physician. What statement by the nurse is best?

A) "With this defect, not enough of the blood circulates through the lungs, leading to a lack of oxygen in the baby's body."
B) "The baby's aorta has a narrowing in a section near the heart that makes the left side of the heart work harder."
C) "The blood vessels that attach to the ventricles of the heart are positioned on the wrong sides of the heart."
D) "Your baby's heart doesn't circulate blood well because the left ventricle is smaller and thinner than normal."

Question 28

Many newborns exposed to H I V/A I D S show signs and symptoms of disease within days of birth that include which of the following?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.

A) Swollen glands
B) Hard stools
C) Smaller than average spleen and liver
D) Rhinorrhea
E) Interstitial pneumonia

Question 29

The nurse is preparing teaching material for the parents of a newborn with tracheoesophageal fistula. Where on the diagram should the nurse identify the location of this disorder?

A) A
B) B
C) C
D) D

Question 30

The nurse is teaching the parents of a newborn who has been exposed to H I V how to care for the newborn at home. Which instructions should the nurse emphasize?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.

A) Use proper hand-washing technique.
B) Provide three feedings per day.
C) Place soiled diapers in a sealed plastic bag.
D) Cleanse the diaper changing area with a 1:10 bleach solution after each diaper change.
E) Take the temperature rectally.

Question 31

The nurse is observed conducting the following measurement. For what will this measurement be used?

A) Determine fetal length
B) Gauge stomach contents
C) Placement of gavage tube
D) Estimate chest circumference

Question 32

An infant is diagnosed with an atrial-septal defect. When teaching the parents of this infant about the disorder, which diagram should the nurse use?

A)

B)

C)

D)

Question 33

The nurse is analyzing assessment findings on four newborns. Which finding might suggest a congenital heart defect?

A) Apical heart rate of 140 beats per minute
B) Respiratory rate of 40
C) Temperature of 36.5°C
D) Visible, blue discoloration of the skin

Question 34

The nurse is preparing teaching material for the parents of a newborn. For which health problem should the nurse select the following diagram to be used for teaching?

A) Gastroschisis
B) Omphalocele
C) Diaphragmatic hernia
D) Prune belly syndrome

Question 35

In planning care for the fetal alcohol syndrome (F A S) newborn, which intervention would the nurse include?

A) Allow extra time with feedings.
B) Assign different personnel to the newborn each day.
C) Place the newborn in a well-lit room.
D) Monitor for hyperthermia.

Question 36

The nurse is preparing to gavage-feed a preterm infant. Put the steps in the order in which the nurse should provide this feeding.
1. Check p H of the gastric aspirate
2. Elevate the syringe 6-8 inches above the infant's head
3. Measure from the tip of the nose to the earlobe to the xiphoid process
4. Clear the tubing with 2-3 m L of air
5. Lubricate the tube by dipping it into sterile water

Question 37

The nurse is caring for a newborn with the following anomaly. What actions should the nurse take when caring for this infant?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
1. Burp frequently
2. Assess patency of nares
3. Assist with parental coping
4. Clean the area with sterile water
5. Feed with a special nipple and bottle

Question 38

A mother who is H I V-positive has given birth to a term female. What plan of care is most appropriate for this infant?

A) Test with an H I V serologic test at 8 months.
B) Begin prophylactic A Z T (Zidovudine) administration.
C) Provide 4 to 5 large feedings throughout the day.
D) Encourage the mother to breastfeed the child.