Deck 27: Infants With Gestational Age-Related Problems

Question 1

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

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

Answer 1

Respiratory distress syndrome.

Question 2

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."

Answer 2

"Surfactant improves the ability of your baby's lungs to exchange oxygen and carbon dioxide."

Question 3

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

Answer 3

PaO₂ of 45

Question 4

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

Question 5

In appraising the growth and development potential of a preterm infant,nurses should:

A)Tell parents 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.

Question 6

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 7

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 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."

Question 8

In the continuing 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 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%. The nurse's most appropriate action would be to:

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.

Question 10

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 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 11

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 12

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 very tremulous. The tremors are most likely the result of:

A)Birth injury.
B)Hypocalcemia.
C)Hypoglycemia.
D)Seizures.

Question 13

For clinical purposes preterm and postterm infants are defined as:

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.

Question 14

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 15

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 16

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 17

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 18

With regard to small for gestational age (SGA) infants and intrauterine growth restrictions (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.

Question 19

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 20

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 female 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 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.

Question 21

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,there are known interventions that may decrease the risk of NEC. To develop an optimal plan of care for this infant,the nurse must understand that which intervention has the greatest effect on lowering the risk of NEC?

A)Early enteral feedings
B)Breastfeeding
C)Exchange transfusion
D)Prophylactic probiotics

Question 22

Risk factors associated with necrotizing enterocolitis (NEC) include (choose all that apply):

A)Polycythemia.
B)Anemia.
C)Congenital heart disease.
D)Bronchopulmonary dysphasia.
E)Retinopathy.

Question 23

The corrected age of an infant who was born at 25 1/7 weeks and is preparing for discharge 124 days past delivery is ____________________.

Question 24

As a result of large body surface in relation to weight,the preterm infant is at high risk for heat loss and cold stress. By understanding the four mechanisms of heat transfer (convection,conduction,radiation,and evaporation),the nurse can create an environment for the infant that prevents temperature instability. While evaluating the plan that has been implemented,the nurse knows that the infant is experiencing cold stress when he or she exhibits:

A)Decreased respiratory rate.
B)Bradycardia followed by an increased heart rate.
C)Mottled skin with acrocyanosis.
D)Increased physical activity.

Question 25

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

Question 26

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.