Deck 30: The High Risk Newborn: Acquired and Congenital Conditions

Question 1

Four hours after delivery of a healthy neonate of an insulin-dependent diabetic woman,the baby appears jittery,irritable,and has a high-pitched cry.Which nursing action has top priority?

A) Start an intravenous line with D5W.
B) Notify the clinician stat.
C) Document the event in the nurses' notes.
D) Test for blood glucose level.

Answer 1

Test for blood glucose level.

Question 2

The nurse present at the delivery is reporting to the nurse who will be caring for the neonate after birth.What information might be included for an infant who had thick meconium in the amniotic fluid?

A) The infant needed vigorous stimulation immediately after birth to initiate crying.
B) An IV was started immediately after birth to treat dehydration.
C) No meconium was found below the vocal cords when they were examined.
D) The parents spent an hour bonding with the baby after birth.

Answer 2

No meconium was found below the vocal cords when they were examined.

Question 3

A mother with diabetes has done some reading about the effects of the condition on her newborn.Which statement shows a misunderstanding that should be clarified by the nurse?

A) "Although my baby is large, some women with diabetes have very small babies because the blood flow through the placenta may not be as good as it should be."
B) "My baby will be watched closely for signs of low blood sugar, especially during the early days after birth."
C) "The red appearance of my baby's skin is due to an excessive number of red blood cells."
D) "My baby's pancreas may not produce enough insulin because the cells became smaller than normal during my pregnancy."

Answer 3

"My baby's pancreas may not produce enough insulin because the cells became smaller than normal during my pregnancy."

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 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.Based on the maternal history,the cause of this newborn's distress is most likely

A) Hypoglycemia
B) Phrenic nerve injury
C) Respiratory distress syndrome
D) Sepsis

Question 5

Nursing care of the neonate undergoing jaundice phototherapy includes

A) Keeping the infant's eyes covered under the light
B) Keeping the infant supine at all times
C) Restricting parenteral and oral fluids
D) Keeping the infant dressed in only a T-shirt and diaper

Question 6

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 ventilator
C) Insertion of laryngoscope and suctioning of the trachea
D) Insertion of an endotracheal tube

Question 7

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 8

Nursing care of the infant with neonatal abstinence syndrome should include

A) Positioning the infant's crib in a quiet corner of the nursery
B) Feeding the infant on a 2-hour schedule
C) Placing stuffed animals and mobiles in the crib to provide visual stimulation
D) Spending extra time holding and rocking the infant

Question 9

The infant of a mother with diabetes is hypoglycemic.What type of feeding should be instituted first?

A) Glucose water in a bottle
B) D5W intravenously
C) Formula via nasogastric tube
D) Breast milk

Question 10

Which infant is most 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 11

The most common cause of pathologic hyperbilirubinemia is

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

Question 12

The nurse must continually assess the infant who has meconium aspiration syndrome (MAS)for the complication of

A) Persistent pulmonary hypertension
B) Bronchopulmonary dysplasia
C) Transitory tachypnea of the newborn
D) Left-to-right shunting of blood through the foramen ovale

Question 13

An infant with hypocalcemia is receiving an intravenous bolus of calcium.Which sign signals the nurse to stop the administration of this medication?

A) Tachypnea of the newborn
B) Bradycardia
C) Decrease of acrocyanosis
D) Gastric irritation (diarrhea)

Question 14

Newborns whose mothers are substance abusers frequently have what behavior?

A) Circumoral cyanosis, hyperactive Babinski reflex, and constipation
B) Decreased amounts of sleep, hyperactive Moro (startle) reflex, and difficulty feeding
C) Hypothermia, decreased muscle tone, and weak sucking reflex
D) Excessive sleep, weak cry, and diminished grasp reflex

Question 15

Transitory tachypnea of the newborn (TTN)is thought to occur as a result of

A) A lack of surfactant
B) Hypoinflation of the lungs
C) Delayed absorption of fetal lung fluid
D) A slow vaginal delivery associated with meconium-stained fluid

Question 16

It is important for the nurse to remember that when performing neonatal resuscitation,the priority action should be to

A) Suction the mouth and nose.
B) Stimulate the infant by rubbing the back.
C) Perform the Apgar test.
D) Dry the infant and position the head.

Question 17

The difference between physiologic and nonphysiologic jaundice is that nonphysiologic jaundice

A) Usually results in kernicterus
B) Appears during the first 24 hours of life
C) Results from breakdown of excessive erythrocytes not needed after birth
D) Begins on the head and progresses down the body

Question 18

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 pounds,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 19

In conjunction with phototherapy,which intervention is most effective in reducing the indirect bilirubin in an affected newborn?

A) Increase the frequency of feedings.
B) Increase oral intake of water between feedings.
C) Offer an exchange transfusion.
D) Wrap the infant in triple blankets to prevent cold stress.

Question 20

Parents of a newborn with phenylketonuria are anxious to learn about the appropriate treatment for their infant.The nurse should explain that treatment of PKU involves _____ diet.

A) Sodium restrictions in the
B) A phenylalanine-free
C) A phenylalanine-enriched
D) A protein-rich

Question 21

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 22

A lack of O? and an increase in CO? in the blood is known as __________.This condition in the neonate may occur while in utero,at birth,or later.

Question 23

______________,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 24

Some infants develop hypoxic-ischemic encephalopathy after asphyxia.Therapeutic hypothermia has been used to improve neurologic outcomes for these infants.Criteria for the use of this modality include (select all that apply)

A) The infant must be 28 weeks gestation or greater.
B) Have evidence of an acute hypoxic event.
C) Be in a facility they can initiate treatment within 6 hours.
D) The infant must be 36 or more weeks gestation.
E) The treatment must be initiated within the first 12 hours of life.

Question 25

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) HIV

Question 26

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 27

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 28

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 29

Persistent pulmonary hypertension of the newborn (PPHN)is a condition in which the vascular resistance of the lungs does not decrease after birth and consequently normal changes to neonatal circulation are impaired.The neonatal nurse knows that there are numerous underlying causes for this condition,one of which is maternal use of nonsteroidal antiinflammatory drugs (NSAIDs).Is this statement true or false?

Question 30

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."