Deck 28: The Newborn at Risk: Acquired and Congenital Problems

Question 1

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.

Answer 1

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.

Question 2

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

Answer 2

Alcohol

Question 3

With regard to the classification of neonatal bacterial infection,nurses should be aware that:

A)Congenital infection progresses slower than nosocomial infection.
B)Nosocomial infection can be prevented by effective handwashing;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.

Answer 3

Nosocomial infection can be prevented by effective handwashing;early-onset infections cannot.

Question 4

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 5

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 6

The most important nursing action in preventing neonatal infection is:

A)Good handwashing.
B)Isolation of infected infants.
C)Separate gown technique.
D)Standard Precautions.

Question 7

The most common cause of pathologic hyperbilirubinemia is:

A)Hepatic disease.
B)Hemolytic disorders in the newborn.
C)Postmaturity.
D)Congenital heart defect.

Question 8

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 get off heroin (detox) any time they can during pregnancy.
D)Methadone withdrawal for infants is less severe and shorter than heroin withdrawal.

Question 9

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 10

With regard to central nervous system injuries to the infant during labor and birth,nurses should be aware that:

A)Intracranial hemorrhage (ICH) as a result of birth trauma is more likely to occur in the preterm,low-birth-weight infant.
B)Subarachnoid hemorrhage (the most common form of ICH) occurs in term infants as a result of hypoxia.
C)In many infants signs of hemorrhage in a full-term infant are absent and diagnosed only through laboratory tests.
D)Spinal cord injuries almost always result from forceps-assisted deliveries.

Question 11

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 12

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 13

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 14

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 15

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 16

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 17

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 18

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 19

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 20

With regard to the understanding and treatment of infants born to mothers who are substance abusers,nurses should be aware that:

A)Infants born to addicted mothers are also addicted.
B)Mothers who abuse one substance likely will use or abuse another,compounding the infant's difficulties.
C)The NICU Network Neurobehavioral Scale (NNNS) is designed to assess the damage the mother has done to herself.
D)No laboratory procedures are available that can identify the intrauterine drug exposure of the infant.

Question 21

An infant diagnosed with erythroblastosis fetalis would characteristically exhibit:

A)Edema.
B)Immature red blood cells.
C)Enlargement of the heart.
D)Ascites.

Question 22

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 23

The priority nursing diagnosis for a newborn diagnosed with a diaphragmatic hernia would be:

A)Risk for impaired parent-infant attachment.
B)Imbalanced nutrition: less than body requirements.
C)Risk for infection.
D)Impaired gas exchange.

Question 24

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 25

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 26

With regard to congenital anomalies of the cardiovascular and respiratory systems,nurses should be aware that:

A)Cardiac disease may be manifested by respiratory signs and symptoms.
B)Screening for congenital anomalies of the respiratory system need only be done for infants having respiratory distress.
C)Choanal atresia can be corrected by a suction catheter.
D)Congenital diaphragmatic hernias are diagnosed and treated after birth.

Question 27

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 28

Cleft lip or palate is a common congenital midline fissure,or opening,in the lip or palate resulting from failure of the primary palate to fuse. Multiple genetic and to a lesser extent environmental factors may lead to the development of a cleft lip or palate. Such factors include (choose all that apply):

A)Alcohol consumption.
B)Female gender.
C)Use of some antiepileptics.
D)Maternal cigarette smoking.
E)Antibiotic use in pregnancy.

Question 29

_____________________,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 30

Many common drugs of abuse cause significant physiologic and behavioral problems in infants who are breastfed by mothers currently using (choose all that apply):

A)Amphetamine.
B)Heroin.
C)Nicotine.
D)PCP.
E)Morphine.

Question 31

____________________ 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.