Deck 24: The Newborn at Risk

Question 1

An infant is to receive gastrostomy feedings. What intervention should the nurse institute to prevent bloating, gastrointestinal reflux into the esophagus, vomiting, and respiratory compromise?

A) Rapid bolusing of the entire amount in 15 minutes
B) Warm cloths to the abdomen for the first 10 minutes
C) Slow, small, warm bolus feedings over 20 to 30 minutes
D) Cold, medium bolus feedings over 20 minutes

Answer 1

Slow, small, warm bolus feedings over 20 to 30 minutes

Question 2

For diagnostic and treatment purposes, nurses should know the birth weight classifications of high risk infants. For example, extremely low birth weight (ELBW) is the designation for an infant whose weight is:

A) Less than 1500 g.
B) Less than 1000 g.
C) Less than 2000 g.
D) Dependent on the gestational age.

Answer 2

Less than 1000 g.

Question 3

In helping bereaved parents cope and move on, nurses should keep in mind that:

A) A perinatal or parental grief support group is more likely to be helpful if the needs of the parents are matched with the focus of the group.
B) When pictures of the infant are taken for keepsakes, no close-ups should be taken of any congenital anomalies.
C) No significant differences exist in grieving individuals from various cultures, ethnic groups, and religions.
D) In emergency situations, nurses who are so disposed must resist the temptation to baptize the infant in the absence of a priest or minister.

Answer 3

A perinatal or parental grief support group is more likely to be helpful if the needs of the parents are matched with the focus of the group.

Question 4

A pregnant woman was admitted for induction of labor at 43 weeks of gestation with sure dates. A nonstress test (NST) in the obstetrician's office revealed a nonreactive tracing. On artificial rupture of membranes, thick, meconium-stained fluid was noted. The nurse caring for the infant after birth should anticipate:

A) Meconium aspiration, hypoglycemia, and dry, cracked skin.
B) Excessive vernix caseosa covering the skin, lethargy, and respiratory distress syndrome.
C) Golden yellow- to green-stained skin and nails, absence of scalp hair, and an increased amount of subcutaneous fat.
D) Hyperglycemia, hyperthermia, and an alert, wide-eyed appearance.

Question 5

While completing a newborn assessment, the nurse should be aware that the most common birth injury is:

A) To the soft tissues.
B) Caused by forceps gripping the head on delivery.
C) Fracture of the humerus and femur.
D) Fracture of the clavicle.

Question 6

An infant at 36 weeks of gestation has increasing respirations (80 to 100 breaths/min with marked substernal retractions). The infant is given oxygen by continuous nasal positive airway pressure. Which arterial oxygen level would indicate hypoxia?

A) PaO₂ of 67
B) PaO₂ of 89
C) PaO₂ of 45
D) PaO₂ of 73

Question 7

The nurse practicing in the perinatal setting should promote kangaroo care regardless of an infant's gestational age. This intervention:

A) Is adopted from classical British nursing traditions.
B) Helps infants with motor and central nervous system impairment.
C) Helps infants to interact directly with their parents and enhances their temperature regulation.
D) Gets infants ready for breastfeeding.

Question 8

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. On the basis of her infant's physical findings, this woman should be questioned about her use of which substance during pregnancy?

A) Alcohol
B) Cocaine
C) Heroin
D) Marijuana

Question 9

The nurse caring for a family during a loss might notice that survival guilt sometimes is felt at the death of an infant by the child's:

A) Siblings.
B) Mother.
C) Father.
D) Grandparents.

Question 10

The most appropriate statement that the nurse can make to bereaved parents is:

A) "You have an angel in heaven."
B) "I understand how you must feel."
C) "You're young and can have other children."
D) "I'm sorry."

Question 11

What options for saying goodbye would the nurse want to discuss with a woman who is diagnosed with having a stillborn girl?

A) The nurse shouldn't discuss any options at this time; there is plenty of time after the baby is born.
B) "Would you like a picture taken of your baby after birth?"
C) "When your baby is born, would you like to see and hold her?"
D) "What funeral home do you want notified after the baby is born?"

Question 12

During a prenatal examination, the 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 asks why, the nurse's best response would be:

A) "Your cats could be carrying toxoplasmosis. This is a zoonotic parasite that can infect you and have severe effects on your unborn child."
B) "You and your baby can be exposed to the human immunodeficiency virus (HIV) in your cats' feces."
C) "It's just gross. You should make your husband clean the litter boxes."
D) "Cat feces are known to carry Escherichia coli, which can cause a severe infection in both you and your baby."

Question 13

Necrotizing enterocolitis (NEC) is an inflammatory disease of the gastrointestinal mucosa. The signs of NEC are nonspecific. Some generalized signs include:

A) Hypertonia, tachycardia, and metabolic alkalosis.
B) Abdominal distention, temperature instability, and grossly bloody stools.
C) Hypertension, absence of apnea, and ruddy skin color.
D) Scaphoid abdomen, no residual with feedings, and increased urinary output.

Question 14

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) Human immunodeficiency virus.

Question 15

Premature infants who exhibit 5 to 10 seconds of respiratory pauses followed by 10 to 15 seconds of compensatory rapid respiration are:

A) Suffering from sleep or wakeful apnea.
B) Experiencing severe swings in blood pressure.
C) Trying to maintain a neutral thermal environment.
D) Breathing in a respiratory pattern common to premature infants.

Question 16

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

A) A newborn's skull is still forming and fractures fairly easily.
B) Unless a blood vessel is involved, linear skull fractures heal without special treatment.
C) Clavicle fractures often need to be set with an inserted pin for stability.
D) Other than the skull, the most common skeletal injuries are to leg bones.

Question 17

After giving birth to a stillborn infant, the woman turns to the nurse and says, "I just finished painting the baby's room. Do you think that caused my baby to die?" The nurse's best response to this woman is:

A) "That's an old wives' tale; lots of women are around paint during pregnancy, and this doesn't happen to them."
B) "That's not likely. Paint is associated with elevated pediatric lead levels."
C) Silence.
D) "I can understand your need to find an answer to what caused this. What else are you thinking about?"

Question 18

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

A) Anemia.
B) Hyponatremia.
C) Respiratory distress syndrome.
D) Sepsis.

Question 19

When attempting to diagnose and treat developmental dysplasia of the hip (DDH), the nurse should:

A) Be able to perform the Ortolani and Barlow tests.
B) Teach double or triple diapering for added support.
C) Explain to the parents the need for serial casting.
D) Carefully monitor infants for DDH at follow-up visits.

Question 20

With regard to eventual discharge of the high risk newborn or transfer to a different facility, nurses and families should be aware that:

A) Infants will stay in the neonatal intensive care unit (NICU) until they are ready to go home.
B) Once discharged to home, the high risk infant should be treated like any healthy term newborn.
C) Parents of high risk infants need special support and detailed contact information.
D) If a high risk infant and mother need transfer to a specialized regional center, it is better to wait until after birth and the infant is stabilized.

Question 21

With regard to hemolytic diseases of the newborn, nurses should be aware that:

A) Rh incompatibility matters only when an Rh-negative offspring is born to an Rh-positive mother.
B) ABO incompatibility is more likely than Rh incompatibility to precipitate significant anemia.
C) Exchange transfusions frequently are required in the treatment of hemolytic disorders.
D) The indirect Coombs' test is performed on the mother before birth; the direct Coombs' test is performed on the cord blood after birth.

Question 22

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

A) Escherichia coli infection
B) Tuberculosis
C) Candidiasis
D) Group B streptococcal infection

Question 23

As with all aspects of care, strict handwashing is the single most important measure to prevent nosocomial infections.

Question 24

When helping the mother, father, and other family members actualize the loss of the infant, nurses should:

A) Use the words lost or gone rather than dead or died.
B) Make sure that the family understands that it is important to name the baby.
C) If the parents choose to visit with the baby, apply powder and lotion to the baby and wrap the infant in a pretty blanket.
D) Set a firm time for ending the visit with the baby so the parents know when to let go.

Question 25

A major nursing intervention for an infant born with myelomeningocele is to:

A) Protect the sac from injury.
B) Prepare the parents for the child's paralysis from the waist down.
C) Prepare the parents for closure of the sac at around 2 years of age.
D) Assess for cyanosis.

Question 26

_____________________, a synthetic opiate, has been the therapy of choice for heroin addiction. It crosses the placenta, leading to significant neonatal abstinence syndrome after birth.

Question 27

A premature infant with respiratory distress syndrome receives artificial surfactant. How would the nurse explain surfactant therapy to the parents?

A) "Surfactant improves the ability of your baby's lungs to exchange oxygen and carbon dioxide."
B) "The drug keeps your baby from requiring too much sedation."
C) "Surfactant is used to reduce episodes of periodic apnea."
D) "Your baby needs this medication to fight a possible respiratory tract infection."

Question 28

____________________ is a condition in which the ventricles of the brain are enlarged as a result of an imbalance between the production and absorption of the cerebrospinal fluid (CSF). An infant with this condition initially has a bulging anterior fontanel and a head circumference that increases at an abnormal rate, resulting from the increase in CSF pressure.

Question 29

An infant is being discharged from the neonatal intensive care unit after 70 days of hospitalization. The infant was born at 30 weeks of gestation with several conditions associated with prematurity, including respiratory distress syndrome, mild bronchopulmonary dysplasia, and retinopathy of prematurity requiring surgical treatment. During discharge teaching the infant's mother asks the nurse if her baby will meet developmental milestones on time, as did her son who was born at term. The nurse's most appropriate response would be:

A) "Your baby will develop exactly like your first child did."
B) "Your baby does not appear to have any problems at the present time."
C) "Your baby will need to be corrected for prematurity. Your baby is currently 40 weeks of postconceptional age and can be expected to be doing what a 40-week-old infant would be doing."
D) "Your baby will need to be followed very closely."

Question 30

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 31

With regard to small for gestational age (SGA) infants and intrauterine growth restriction (IUGR), nurses should be aware that:

A) In the first trimester diseases or abnormalities result in asymmetric IUGR.
B) Infants with asymmetric IUGR have the potential for normal growth and development.
C) In asymmetric IUGR, weight will be slightly more than SGA, whereas length and head circumference will be somewhat less than SGA.
D) Symmetric IUGR occurs in the later stages of pregnancy.