Deck 25: The High-Risk Newborn

Question 1

Necrotizing enterocolitis (NEC)is an acute inflammatory disease of the gastrointestinal mucosa that can progress to perforation of the bowel.Approximately 2% to 5% of premature infants succumb to this fatal disease.Care is supportive; however,known interventions may decrease the risk of NEC.To develop an optimal plan of care for this infant,the nurse must understand which intervention has the greatest effect on lowering the risk of NEC:

A) early enteral feedings.
B) breastfeeding.
C) exchange transfusion.
D) prophylactic probiotics.

Answer 1

breastfeeding.

Question 2

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 whether her baby will meet developmental milestones on time,as did her son who was born at term.The nurse's most appropriate response is:

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."

Answer 2

"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."

Question 3

When assessing the preterm infant the nurse understands that compared with the term infant,the preterm infant has:

A) few blood vessels visible through the skin.
B) more subcutaneous fat.
C) well-developed flexor muscles.
D) greater surface area in proportion to weight.

Answer 3

greater surface area in proportion to weight.

Question 4

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 5

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 6

Because of the premature infant's decreased immune functioning,what nursing diagnosis should the nurse include in a plan of care for a premature infant?

A) Delayed growth and development
B) Ineffective thermoregulation
C) Ineffective infant feeding pattern
D) Risk for infection

Question 7

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 30 minutes.
D) Cold, medium bolus feedings over 20 minutes.

Question 8

In the assessment of a preterm infant,the nurse notices continued respiratory distress even though oxygen and ventilation have been provided.The nurse should suspect:

A) hypovolemia and/or shock.
B) a nonneutral thermal environment.
C) central nervous system injury.
D) pending renal failure.

Question 9

An infant was born 2 hours ago at 37 weeks of gestation and weighing 4.1 kg.The infant appears chubby with a flushed complexion and is very tremulous.The tremors are most likely the result of:

A) birth injury.
B) hypocalcemia.
C) hypoglycemia.
D) seizures.

Question 10

A newborn was admitted to the neonatal intensive care unit after being delivered at 29 weeks of gestation to a 28-year-old multiparous,married,Caucasian woman whose pregnancy was uncomplicated until premature rupture of membranes and preterm birth.The newborn's parents arrive for their first visit after the birth.The parents walk toward the bedside but remain approximately 5 feet away from the bed.The nurse's most appropriate action would be to:

A) wait quietly at the newborn's bedside until the parents come closer.
B) go to the parents, introduce himself or herself, and gently encourage the parents to come meet their infant; explain the equipment first, and then focus on the newborn.
C) leave the parents at the bedside while they are visiting so they can have some privacy.
D) tell the parents only about the newborn's physical condition, and caution them to avoid touching their baby.

Question 11

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 12

As related to the 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 13

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

A) anemia.
B) hyponatremia.
C) respiratory distress syndrome.
D) sepsis.

Question 14

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 15

On day 3 of life,a newborn continues to require 100% oxygen by nasal cannula.The parents ask whether they can hold their infant during his next gavage feeding.Given that this newborn is physiologically stable,what response would the nurse give?

A) "Parents are not allowed to hold infants who depend on oxygen."
B) "You may hold only your baby's hand during the feeding."
C) "Feedings cause more physiologic stress, so the baby must be closely monitored. Therefore, I don't think you should hold the baby."
D) "You may hold your baby during the feeding."

Question 16

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 17

When providing an infant with a gavage feeding,which of the following should be documented each time?

A) The infant's abdominal circumference after the feeding.
B) The infant's heart rate and respirations.
C) The infant's suck and swallow coordination.
D) The infant's response to the feeding.

Question 18

In caring for the preterm infant,what complication is thought to be a result of high arterial blood oxygen level?

A) Necrotizing enterocolitis (NEC)
B) Retinopathy of prematurity (ROP)
C) Bronchopulmonary dysplasia (BPD)
D) Intraventricular hemorrhage (IVH)

Question 19

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 lbs,6 ounces).The nurse's most appropriate action is to:

A) leave the infant in the room with the mother.
B) take the infant immediately to the nursery.
C) perform a gestational age assessment to determine whether the infant is large for gestational age.
D) monitor blood glucose levels frequently and observe closely for signs of hypoglycemia.

Question 20

For clinical purposes,preterm and postterm infants are defined as:

A) preterm before 34 weeks if appropriate for gestational age (AGA) and before 37 weeks if small for gestational age (SGA).
B) Postterm after 40 weeks if large for gestational age (LGA) and beyond 42 weeks if AGA.
C) Preterm before 37 weeks, and postterm beyond 42 weeks, no matter the size for gestational age at birth.
D) Preterm, SGA before 38 to 40 weeks, and postterm, LGA beyond 40 to 42 weeks.

Question 21

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

A) Rh incompatibility matters only when an Rh-negative child 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

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 prophylactically to prevent a gonorrheal infection."
D) "This medicine will protect your baby's eyes from drying out over the next few days."

Question 23

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 24

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 25

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 (FHR)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.On the basis of the maternal history,the cause of this newborn's distress is most likely to be:

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

Question 26

To care adequately for infants at risk for neonatal bacterial infection,nurses should be aware that:

A) congenital infection progresses more slowly than does nosocomial infection.
B) nosocomial infection can be prevented by effective hand washing; early-onset infections cannot.
C) infections occur with about the same frequency in boy and girl infants, although female mortality is higher.
D) the clinical sign of a rapid, high fever makes infection easier to diagnose.

Question 27

With regard to injuries to the infant's plexus during labor and birth,nurses should be aware that:

A) if the nerves are stretched with no avulsion, they should recover completely in 3 to 6 months.
B) Erb palsy is damage to the lower plexus.
C) parents of children with brachial palsy are taught to pick up the child from under the axillae.
D) breastfeeding is not recommended for infants with facial nerve paralysis until the condition resolves.

Question 28

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 29

The abuse of which of the following substances during pregnancy is the leading cause of cognitive impairment in the United States?

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

Question 30

The most common cause of pathologic hyperbilirubinemia is:

A) hepatic disease.
B) hemolytic disorders in the newborn.
C) postmaturity.
D) congenital heart defect.

Question 31

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 32

Human immunodeficiency virus (HIV)may be perinatally transmitted:

A) only in the third trimester from the maternal circulation.
B) by a needlestick injury at birth from unsterile instruments.
C) only through the ingestion of amniotic fluid.
D) through the ingestion of breast milk from an infected mother.

Question 33

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 34

Which infant would be more likely to have Rh incompatibility?

A) Infant of an Rh-negative mother and a father who is Rh positive and homozygous for the Rh factor.
B) Infant who is Rh negative and whose mother is Rh negative.
C) Infant of an Rh-negative mother and a father who is Rh positive and heterozygous for the Rh factor.
D) Infant who is Rh positive and whose mother is Rh positive.

Question 35

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 36

A plan of care for an infant experiencing symptoms of drug withdrawal should include:

A) administering chloral hydrate for sedation.
B) feeding every 4 to 6 hours to allow extra rest.
C) swaddling the infant snugly and holding the baby tightly.
D) playing soft music during feeding.

Question 37

In caring for the mother who has abused (or is abusing)alcohol and for her infant,nurses should be aware that:

A) the pattern of growth restriction of the fetus begun in prenatal life is halted after birth, and normal growth takes over.
B) two-thirds of newborns with fetal alcohol syndrome (FAS) are boys.
C) alcohol-related neurodevelopmental disorders not sufficient to meet FAS criteria (learning disabilities, speech, and language problems) are often not detected until the child goes to school.
D) both the distinctive facial features of the FAS infant and the diminished mental capacities tend toward normal over time.

Question 38

An infant with severe meconium aspiration syndrome (MAS)is not responding to conventional treatment.Which highly technical method of treatment may be necessary for an infant who does not respond to conventional treatment?

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

Question 39

The most important nursing action in preventing neonatal infection is:

A) good hand washing.
B) isolation of infected infants.
C) separate gown technique.
D) Standard Precautions.

Question 40

A careful review of the literature on the various recreational and illicit drugs reveals that:

A) more longer-term studies are needed to assess the lasting effects on infants when mothers have taken or are taking illegal drugs.
B) heroin and methadone cross the placenta; marijuana, cocaine, and phencyclidine (PCP) do not.
C) mothers should discontinue heroin use (detox) any time they can during pregnancy.
D) methadone withdrawal for infants is less severe and shorter than heroin withdrawal.

Question 41

HIV may be perinatally transmitted:

A) only in the third trimester from the maternal circulation.
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 42

MATCHING
Car seat safety is an essential part of discharge planning, and infants younger than 37 weeks of gestation should have a period of observation in an appropriate car seat to monitor for possible apnea, bradycardia, and decreased SaO₂. The nurse who is about to perform a car seat evaluation on a late-preterm infant will perform the sequence of the test in which order?

Step 7

A)Secure the infant in the car seat per guidelines using blanket rolls on the side.
B)Leave the infant undisturbed for 90 to 120 minutes.
C)Set the heart rate alarm at 80 beats/min and the apnea alarm at 20 seconds.
D)Document the infant's tolerance to the test.
E)Perform the evaluation 1 to 7 days before discharge.
F)Use the parent's car seat.
G)Set the pulse oximeter low alarm at 88%.

Question 43

MATCHING
Car seat safety is an essential part of discharge planning, and infants younger than 37 weeks of gestation should have a period of observation in an appropriate car seat to monitor for possible apnea, bradycardia, and decreased SaO₂. The nurse who is about to perform a car seat evaluation on a late-preterm infant will perform the sequence of the test in which order?

Step 5

A)Secure the infant in the car seat per guidelines using blanket rolls on the side.
B)Leave the infant undisturbed for 90 to 120 minutes.
C)Set the heart rate alarm at 80 beats/min and the apnea alarm at 20 seconds.
D)Document the infant's tolerance to the test.
E)Perform the evaluation 1 to 7 days before discharge.
F)Use the parent's car seat.
G)Set the pulse oximeter low alarm at 88%.

Question 44

MATCHING
Car seat safety is an essential part of discharge planning, and infants younger than 37 weeks of gestation should have a period of observation in an appropriate car seat to monitor for possible apnea, bradycardia, and decreased SaO₂. The nurse who is about to perform a car seat evaluation on a late-preterm infant will perform the sequence of the test in which order?

Step 1

A)Secure the infant in the car seat per guidelines using blanket rolls on the side.
B)Leave the infant undisturbed for 90 to 120 minutes.
C)Set the heart rate alarm at 80 beats/min and the apnea alarm at 20 seconds.
D)Document the infant's tolerance to the test.
E)Perform the evaluation 1 to 7 days before discharge.
F)Use the parent's car seat.
G)Set the pulse oximeter low alarm at 88%.

Question 45

MATCHING
Car seat safety is an essential part of discharge planning, and infants younger than 37 weeks of gestation should have a period of observation in an appropriate car seat to monitor for possible apnea, bradycardia, and decreased SaO₂. The nurse who is about to perform a car seat evaluation on a late-preterm infant will perform the sequence of the test in which order?

Step 4

A)Secure the infant in the car seat per guidelines using blanket rolls on the side.
B)Leave the infant undisturbed for 90 to 120 minutes.
C)Set the heart rate alarm at 80 beats/min and the apnea alarm at 20 seconds.
D)Document the infant's tolerance to the test.
E)Perform the evaluation 1 to 7 days before discharge.
F)Use the parent's car seat.
G)Set the pulse oximeter low alarm at 88%.

Question 46

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

A) cure mental retardation.
B) prevent central nervous system (CNS) damage, which leads to mental retardation.
C) prevent gastrointestinal symptoms.
D) cure the urinary tract infection.

Question 47

Infants born between 34 0/7 and 36 6/7 weeks of gestation are called late-preterm infants because they have many needs similar to those of preterm infants.Because they are more stable than early-preterm infants,they may receive care that is much like that of a full-term baby.The mother-baby or nursery nurse knows that these babies are at increased risk for: (Select all that apply.)

A) problems with thermoregulation.
B) cardiac distress.
C) hyperbilirubinemia.
D) sepsis.
E) hyperglycemia.

Question 48

MATCHING
Car seat safety is an essential part of discharge planning, and infants younger than 37 weeks of gestation should have a period of observation in an appropriate car seat to monitor for possible apnea, bradycardia, and decreased SaO₂. The nurse who is about to perform a car seat evaluation on a late-preterm infant will perform the sequence of the test in which order?

Step 6

A)Secure the infant in the car seat per guidelines using blanket rolls on the side.
B)Leave the infant undisturbed for 90 to 120 minutes.
C)Set the heart rate alarm at 80 beats/min and the apnea alarm at 20 seconds.
D)Document the infant's tolerance to the test.
E)Perform the evaluation 1 to 7 days before discharge.
F)Use the parent's car seat.
G)Set the pulse oximeter low alarm at 88%.

Question 49

MATCHING
Car seat safety is an essential part of discharge planning, and infants younger than 37 weeks of gestation should have a period of observation in an appropriate car seat to monitor for possible apnea, bradycardia, and decreased SaO₂. The nurse who is about to perform a car seat evaluation on a late-preterm infant will perform the sequence of the test in which order?

Step 3

A)Secure the infant in the car seat per guidelines using blanket rolls on the side.
B)Leave the infant undisturbed for 90 to 120 minutes.
C)Set the heart rate alarm at 80 beats/min and the apnea alarm at 20 seconds.
D)Document the infant's tolerance to the test.
E)Perform the evaluation 1 to 7 days before discharge.
F)Use the parent's car seat.
G)Set the pulse oximeter low alarm at 88%.

Question 50

MATCHING
Car seat safety is an essential part of discharge planning, and infants younger than 37 weeks of gestation should have a period of observation in an appropriate car seat to monitor for possible apnea, bradycardia, and decreased SaO₂. The nurse who is about to perform a car seat evaluation on a late-preterm infant will perform the sequence of the test in which order?

Step 2

A)Secure the infant in the car seat per guidelines using blanket rolls on the side.
B)Leave the infant undisturbed for 90 to 120 minutes.
C)Set the heart rate alarm at 80 beats/min and the apnea alarm at 20 seconds.
D)Document the infant's tolerance to the test.
E)Perform the evaluation 1 to 7 days before discharge.
F)Use the parent's car seat.
G)Set the pulse oximeter low alarm at 88%.