Question 1

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.Which is the nurse's most appropriate response?
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 corrected 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."

Accepted Answer

The age of a preterm newborn is corrected by adding the gestational age and the postnatal age.The infant's responses are evaluated accordingly against the norm expected for the corrected age of the infant.Although it is impossible to predict with complete accuracy the growth and development potential of each preterm infant,certain measurable factors predict normal growth and development.The preterm infant experiences catch-up body growth during the first 2 to 3 years of life.The growth and developmental milestones are corrected for gestational age until the child is approximately 2.5 years old.Stating that the baby doesn't appear to have any problems at the present time is inaccurate.Development will need to be evaluated over time.

Question 2

What is the weight designation of an extremely low birth weight (ELBW)infant?
A) Less than 1500 g
B) Less than 1000 g
C) Less than 2000 g
D) Dependent on the gestational age

Accepted Answer

At a weight of less than 1000 g,problems are so numerous that ethical issues regarding when to treat arise.The designation for very low birth rate is less than 1500 g; ELBW is less than 1000 g.A weight of less than 2000 g is less than low but too high for extremely low,which is less than 1000 g.Gestational age is a factor with weight in the condition of the preterm birth,but it is not part of the birth weight categorization.

Question 3

A pregnant woman was admitted for induction of labour 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.What should the nurse caring for the infant after birth 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

Accepted Answer

Meconium aspiration,hypoglycemia,and dry,cracked skin are consistent with a postmature infant.Excessive vernix caseosa covering the skin,lethargy,and respiratory distress syndrome would be consistent with a very premature infant.The skin may be meconium stained,but the infant would most likely have longer hair and decreased amounts of subcutaneous fat.Postmaturity with a nonreactive NST would indicate hypoxia.Signs and symptoms associated with fetal hypoxia are hypoglycemia,temperature instability,and lethargy.

Question 4

An infant was born 2 hours ago at 37 weeks of gestation,weighing 4.1 kg.The infant appears chubby with a flushed complexion and is jittery.What would the nurse suspect is occurring with this infant?
A) Birth injury
B) Hypocalcemia
C) Hypoglycemia
D) Seizures

Accepted Answer

Hypoglycemia is common in the macrosomic infant.Signs of hypoglycemia include jitteriness,apnea,tachypnea,and cyanosis.

Question 5

What should the nurse know with regard to appraising the growth and development potential of a preterm infant?
A) Tell the parents that their child won't catch up until about age 10 (girls) to 12 (boys).
B) Correct for milestones such as motor competencies and vocalizations until the child is approximately 3 years of age.
C) Know that the greatest catch-up period is between 9 and 15 months postconceptual age.
D) Know that the length and breadth of the trunk is the first part of the infant to experience catch-up growth.

Accepted Answer

Corrections are made with a formula that adds gestational age and postnatal age.The infant,girl or boy,experiences catch-up body growth during the first 2 to 3 years of life.Maximum catch-up growth occurs between 36 and 40 weeks postconceptual age.The head is the first to experience catch-up growth.

Question 6

An infant at 26 weeks of gestation arrives from the delivery room intubated.The nurse weighs the infant,places him under the radiant warmer,and attaches him to the ventilator at the prescribed settings.A pulse oximeter and cardiorespiratory monitor are placed.The pulse oximeter is recording oxygen saturations of 80%.The prescribed saturations are 92%.What is the nurse's most appropriate action?
A) Listen to breath sounds and ensure the patency of the endotracheal tube, increase oxygen, and notify a physician.
B) Continue to observe and make no changes until the saturations are 75%.
C) Continue with the admission process to ensure that a thorough assessment is completed.
D) Notify the parents that their infant is not doing well.

Accepted Answer

Listening to breath sounds and ensuring the patency of the endotracheal tube,increasing oxygen,and notifying a physician are appropriate nursing interventions to ensure optimal oxygen saturation of the infant.Oxygenation of the infant is crucial.O₂ saturation should be maintained above 92 to 94%.The nurse should delay other tasks to stabilize the infant.Notifying the parents that the infant is not doing well is not an appropriate action.Further assessment and intervention are warranted before determination of fetal status.

Question 7

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,white female whose pregnancy was uncomplicated until premature rupture of membranes and preterm birth occurred.The newborn's parents arrive for their first visit after the birth.The parents walk toward the bedside but remain approximately 3 metres away from the bed.What is the nurse's most appropriate action?
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 them 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.

Accepted Answer

The nurse is instrumental in the initial interactions with the infant.The nurse can help the parents "see" the infant rather than focus on the equipment.The importance and purpose of the apparatus that surrounds their infant also should be explained to them.Parents often need encouragement and recognition from the nurse to acknowledge the reality of the infant's condition.Parents need to see and touch their infant as soon as possible to acknowledge the reality of the birth and the infant's appearance and condition.Encouragement from the nurse is instrumental in this process.Telling the parents only about the newborn's physical condition and cautioning them to avoid touching their baby is an inappropriate action.

Question 8

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

Accepted Answer

Feedings by gravity are done slowly over 20- to 30-minute periods to prevent adverse reactions.Rapid bolusing of the entire amount in 15 minutes would most likely lead to the adverse reactions listed.Temperature stability in the newborn is critical.This type of warming would not be appropriate because it is not a thermoregulated environment.Additionally,abdominal warming is not indicated with feedings of any kind.Small feedings at room temperature are recommended to prevent adverse reactions.

Question 9

Which of the following is reflected when premature infants exhibit 5 to 10 seconds of respiratory pauses,followed by 10 to 15 seconds of compensatory rapid respirations?
A) They are suffering from sleep or wakeful apnea.
B) They are experiencing severe swings in blood pressure.
C) They are trying to maintain a neutral thermal environment.
D) They are breathing in a respiratory pattern common to premature infants.

Accepted Answer

This pattern is called periodic breathing and is common to premature infants.It may still require nursing intervention of oxygen and/or ventilation.Apnea is a cessation of respirations for 20 seconds or longer.It should not be confused with periodic breathing.

Question 10

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

Accepted Answer

Documentation of a gavage feeding should include the size of the feeding tube,the amount and quality of the residual from the previous feeding,the type and quantity of the fluid instilled,and the infant's response to the procedure.Abdominal circumference is not measured after a gavage feeding.Vital signs may be obtained before feeding.However,the infant's response to the feeding is more important.Some older infants may be learning to suck,but the important factor to document would be the infant's response to the feeding (including attempts to suck).

Question 11

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

Accepted Answer

A PaO₂ of 45 is below the normal range for a normal neonate.The normal range for arterial oxygen pressure is 50 to 80 mm Hg.The laboratory value of PaO₂ of 45 indicates hypoxia in this infant.

Question 12

What should nurses be aware of with regard to small-for-gestational-age ( SGA )infants and intrauterine growth restrictions ( IUGR )?
A) In the first trimester, diseases or abnormalities result in asymmetrical IUGR.
B) Infants with asymmetrical IUGR have the potential for normal growth and development.
C) In asymmetrical IUGR weight will be slightly more than SGA, whereas length and head circumference will be somewhat less than SGA.
D) Symmetrical IUGR occurs in the later stages of pregnancy.

Accepted Answer

IUGR is either symmetrical or asymmetrical.The symmetrical form occurs in the first trimester; SGA infants have reduced brain capacity.The asymmetrical form occurs in the later stages of pregnancy.Weight is less than the tenth percentile; head circumference is greater than the tenth percentile.Infants with asymmetrical IUGR have the potential for normal growth and development.

Question 13

The nurse practising in the perinatal setting should promote kangaroo care,regardless of an infant's gestational age.What should the nurse know about this intervention?
A) It is adopted from classical British nursing traditions.
B) It helps infants with motor and central nervous system impairment.
C) It enhances their temperature regulation.
D) It gets infants ready for breastfeeding.

Accepted Answer

Kangaroo care is skin-to-skin holding in which the infant,dressed only in a diaper,is placed directly on the parent's bare chest and then covered.The procedure helps infants interact with their parents and regulates their temperature,among other developmental benefits.

Question 14

A macrosomic infant is born after a difficult forceps-assisted delivery.After stabilization the infant is weighed,and the birth weight is 455 g.What is the nurse's most appropriate action?
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.

Accepted Answer

This infant is macrosomic (over 4000 g is above the ninetieth percentile)and is at high risk for hypoglycemia.Blood glucose levels should be monitored frequently,and the infant should be observed closely for signs of hypoglycemia.Observation may occur in the nursery or in the mother's room,depending on the condition of the fetus.Regardless of gestational age,this infant is macrosomic.

Question 15

In the continuing assessment of a preterm infant,the nurse notices continued respiratory distress even though oxygen and ventilation have been provided.What should the nurse suspect?
A) Hypovolemia and/or shock
B) A non-neutral thermal environment
C) Central nervous system injury
D) Pending renal failure

Accepted Answer

The nurse should suspect hypovolemia and/or shock.Other symptoms might include hypotension,prolonged capillary refill,and tachycardia followed by bradycardia.Intervention is necessary.

Question 16

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

Accepted Answer

Preterm and postterm are strictly measures of time-before completion of 37 weeks and beyond 42 completed weeks,respectively-regardless of size for gestational age.

Question 17

Necrotizing enterocolitis ( NEC )is an inflammatory disease of the gastrointestinal mucosa.What are some of the generalized signs associated with NEC?
A) Hypertonia, tachycardia, and metabolic alkalosis
B) Abdominal distension, temperature instability, and grossly bloody stools
C) Hypertension, absence of apnea, and ruddy skin colour
D) Scaphoid abdomen, no residual with feedings, and increased urinary output

Accepted Answer

Some generalized signs of NEC include decreased activity,hypotonia,pallor,recurrent apnea and bradycardia,decreased oxygen saturation values,respiratory distress,metabolic acidosis,oliguria,hypotension,decreased perfusion,temperature instability,cyanosis,abdominal distension,residual gastric aspirates,vomiting,grossly bloody stools,abdominal tenderness,and erythema of the abdominal wall.The infant may display hypotonia,bradycardia,and metabolic acidosis.Hypotension,apnea,and pallor are signs of NEC,as are abdominal distension,residual gastric aspirates,and oliguria.

Question 18

The nurse knows that infants of mothers with diabetes (IDMs)are at higher risk for developing which of the following?
A) Anemia
B) Hyponatremia
C) Respiratory distress syndrome
D) Sepsis

Accepted Answer

IDMs are at risk for macrosomia,birth trauma,perinatal asphyxia,respiratory distress syndrome,hypoglycemia,hypocalcemia,hypomagnesemia,cardiomyopathy,hyperbilirubinemia,and polycythemia.They are not at risk for anemia,hyponatremia,or sepsis.

Question 19

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."

Accepted Answer

Surfactant can be administered as an adjunct to oxygen and ventilation therapy.With administration of artificial surfactant,respiratory compliance is improved until the infant can generate enough surfactant on his or her own.Surfactant has no bearing on the sedation needs of the infant.Surfactant is used to improve respiratory compliance,including the exchange of oxygen and carbon dioxide.The goal of surfactant therapy in an infant with respiratory distress syndrome (RDS)is to stimulate production of surfactant in the type 2 cells of the alveoli.The clinical presentation of RDS and neonatal pneumonia may be similar.The infant may be started on broad-spectrum antibiotics to treat infection.

Question 20

On day 3 of life,a newborn continues to require 100% oxygen by nasal cannula.The parents ask if 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 only hold your baby's hand during the feeding."
C) "Feedings cause more physiological 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."

Accepted Answer

"You may hold your baby during the feeding" is an accurate statement.Parental interaction via holding is encouraged during gavage feedings so that the infant will associate the feeding with positive interactions.Nasal cannula oxygen therapy allows for easier feedings and psychosocial interactions.The parent can swaddle the infant during gavage feedings to help the infant associate the feeding with positive interactions.Some parents like to do kangaroo care while gavage feeding their infant.Swaddling or kangaroo care during feedings provides positive interactions for the infant.

Quiz 27: Infants With Gestational Age-Related Problems

What is the weight designation of an extremely low birth weight (ELBW) infant?

An infant was born 2 hours ago at 37 weeks of gestation,weighing 4.1 kg.The infant appears chubby with a flushed complexion and is jittery.What would the nurse suspect is occurring with this infant?

What should the nurse know with regard to appraising the growth and development potential of a preterm infant?

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?

Which of the following is reflected when premature infants exhibit 5 to 10 seconds of respiratory pauses,followed by 10 to 15 seconds of compensatory rapid respirations?

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

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?

What should nurses be aware of with regard to small-for-gestational-age ( SGA ) infants and intrauterine growth restrictions ( IUGR ) ?

The nurse practising in the perinatal setting should promote kangaroo care,regardless of an infant's gestational age.What should the nurse know about this intervention?

A macrosomic infant is born after a difficult forceps-assisted delivery.After stabilization the infant is weighed,and the birth weight is 455 g.What is the nurse's most appropriate action?

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

How are preterm and postterm infants defined?

Necrotizing enterocolitis ( NEC ) is an inflammatory disease of the gastrointestinal mucosa.What are some of the generalized signs associated with NEC?

The nurse knows that infants of mothers with diabetes (IDMs) are at higher risk for developing which of the following?

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

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