Question 1

The labor and delivery nurse is present for the delivery of a premature neonate. Which action by the nurse is most important?

Accepted Answer

Maintaining a neutral temperature environment is crucial for a premature neonate to prevent hypothermia, which can lead to serious complications.

Question 2

The nurse is providing care for a premature neonate born at 28 weeks gestation who is experiencing respiratory distress syndrome (RDS). Which assessment finding indicates to the nurse that the neonate's respiratory status is deteriorating?

Accepted Answer

A Pao2 of 48 and Paco2 of 55 mm Hg on 90% oxygen indicates significant hypoxemia and hypercapnia, suggesting worsening respiratory status.

Question 3

The nurse notices that a neonate being treated for hyperbilirubinemia with phototherapy has had a daily increase of total bilirubin serum levels greater than 5 mg/dL for the past 2 days. The neonatal care provider prescribes an exchange transfusion. Which knowledge does the nurse apply to the procedure?

Accepted Answer

Approximately 85% of the neonate's RBCs are replaced.

Question 4

The nurse is providing support to a mother whose newborn is diagnosed with a life-threatening defect. The mother states, "I just want to go home and never come back." Which reaction by the mother does the nurse recognize?

Accepted Answer

The statement, "I just want to go home and never come back," suggests that the mother is experiencing emotional distancing, which is a common reaction in response to a distressing diagnosis or situation. The mother may be trying to emotionally protect herself from the pain and stress of the situation by withdrawing emotionally. Guilty feelings, delay of attachment process, and disruption of family life may also be present, but they are not the primary reaction that the mother is expressing in this statement.

Question 5

The nurse is present in the delivery room when a mother is told her neonate was stillborn. The mother begins to wail loudly and pull at her hair. Which action does the nurse take?

Accepted Answer

Allowing the mother to express her grief in her own way is the best option, as it is important for her to process her emotions and begin the grieving process. The nurse should provide a safe and supportive environment for the mother to do so. However, the nurse should also monitor the mother for any signs of self-harm and intervene if necessary. Asking for a sedative or delegating the task to a family member may not be appropriate or effective in this situation.

Question 6

The nurse is preparing for the discharge of a premature neonate to home with the parents. The nurse explains the neonate must be able to pass the infant car seat challenge before discharge. For which reason would the neonate be considered unsafe in a car seat?

Accepted Answer

The neonate must be able to maintain adequate oxygenation, heart rate, and respiratory rate during the car seat challenge. If the neonate is unable to maintain these vital signs during the trial, it would be considered unsafe for the neonate to travel in a car seat. The other options are not directly related to the safety of the neonate in a car seat.

Question 7

The nurse is preparing for the discharge of a neonate diagnosed with a congenital breathing disorder. Which health team members does the nurse include in discharge planning? Select all that apply.

Accepted Answer

The respiratory therapist can provide expertise on managing the breathing disorder. The social worker can assist with resources and support. The home health agency nurse can provide follow-up care at home. The case manager can coordinate the discharge plan and ensure continuity of care.

Question 8

The nurse is providing support for the parents of a neonate born with anencephaly. The parents repeatedly state, "I don't believe this is happening to us. We were so careful during pregnancy." The nurse associates the parents' comments with which stage of grief?

Accepted Answer

Disbelief is the first stage of grief, in which individuals have difficulty accepting the reality of a loss. The parents' repeated statements of disbelief indicate that they are struggling to come to terms with the diagnosis of their neonate's anencephaly.

Question 9

The nurse in NICU is assessing a neonate delivered at 32 weeks gestation. Which pathophysiological manifestation is the nurse's greatest concern?

Accepted Answer

Apnea 20 seconds or longer is the nurse's greatest concern as this can lead to hypoxia and bradycardia, which can be life-threatening for the neonate. As a result, prompt intervention and treatment are required.

Question 10

The nurse is providing care for a premature neonate in the NICU nursery. The neonate is diagnosed with bronchopulmonary dysplasia (BPD) and patent ductus arteriosus (PDA). Which specific intervention does the nurse expect for this neonate?

Accepted Answer

Bronchopulmonary dysplasia (BPD) and patent ductus arteriosus (PDA) both require careful management of fluid balance. Maintaining fluid restrictions will help prevent complications associated with these diagnoses. Monitoring hemoglobin and hematocrit levels, obtaining blood glucose levels, and administering enteral feedings may also be important for the neonate's care, but they are not specific to these diagnoses.

Question 11

A patient who is at 41 weeks gestation is concerned when the primary care provider decides to induce labor. Which reason does the nurse explain as the most important need for this procedure?

Accepted Answer

Risk for placental dysfunction increases after 40 weeks of gestation, which can lead to decreased oxygen supply to the fetus. Inducing labor can reduce the risk of complications for both the mother and the fetus.

Question 12

The nurses in a NICU are concerned about the appropriate levels of oxygen therapy during the care of premature neonates. The nurses referenced an article by Newman (2014) titled, "Oxygen Saturation Limits and Evidence supporting the Targets." On which evidence-based conclusion will the nurses develop guidelines?

Accepted Answer

According to Newman (2014), the appropriate oxygen saturation limits for premature neonates are between 87% to 94%. This is supported by evidence from multiple randomized controlled trials and systematic reviews. Therefore, the nurses should develop their guidelines based on this evidence-based conclusion.

Question 13

The postnatal nurse is providing care for a neonate being treated with phototherapy for hyperbilirubinemia. For which side effects of phototherapy will the nurse contact the neonatal care provider? Select all that apply.

Accepted Answer

The answer of The postnatal nurse is providing care for...

Question 14

A mother of a premature neonate in NICU asks the nurse when her baby will begin getting oral feedings. The nurse is aware that multiple conditions are desired. Which condition is most essential?

Accepted Answer

Cardiorespiratory regulation is the most essential condition for initiating oral feedings in premature neonates as they are at high risk of apnea, bradycardia, and desaturation during feedings. The neonate must be able to maintain stable vital signs during feedings before introducing oral feedings. While the other conditions are also desired, they are not as critical as ensuring stable cardiorespiratory function.

Question 15

The nurse is providing support to parents of a premature neonate in NICU. Which actions by the nurse will best provide psychosocial support to the parents? Select all that apply.

Accepted Answer

B) Asking the parents how they are coping with the experience allows the nurse to understand the parents' perception of the situation and provide appropriate support.
D) Encouraging parents to take photos to share with family and friends can help them feel involved in their neonate's care and provide a sense of normalcy.
E) Praising parents for their involvement in the care of their neonate can help them feel valued and supported in their role as parents. Assessing the parents' ability to care for their neonate and providing equipment for breast pumping and storage of milk are important actions but do not necessarily provide psychosocial support.

Question 16

The NICU nurse encourages the mother of a premature neonate to bring breast milk to the unit for enteral feedings to her baby. For which reason does the nurse make this suggestion?

Accepted Answer

Breast milk has been found to decrease the incidence of necrotizing enterocolitis (NEC) in premature neonates. Breast milk contains immunoglobulins and other protective factors that may help prevent this potentially fatal disease.

Question 17

The premature neonate is more susceptible to skin breakdown than a term neonate. Which skin care interventions will the nurse implement for the premature neonate? Select all that apply.

Accepted Answer

The answer of The premature neonate is more susceptible to...

Question 18

The nurse is providing care for a neonate born to a mother with preexisting diabetes mellitus. Which neonatal assessment findings do the nurse expect? Select all that apply.

Accepted Answer

Neonates born to mothers with diabetes are often macrosomic due to increased insulin production. They may experience hypocalcemia due to parathyroid hormone suppression, jaundice due to increased red blood cell breakdown, and respiratory issues like dyspnea due to delayed lung maturity. Hyperglycemia is not expected; rather, hypoglycemia is common due to high insulin levels.

Quiz 17: High-Risk Neonatal Nursing Care