Question 1

Which of the following lab values indicates that an infant may have polycythemia?

Accepted Answer

The presence of polycythemia in an infant is characterized by a hemoglobin level greater than 22 g/dL and a hematocrit value greater than 65%.

Question 2

An infant with severe meconium aspiration syndrome is not responding to conventional treatment. Which method of treatment may be available at a level III facility for use with this infant?

Accepted Answer

Extracorporeal membrane oxygenation is a highly technical method that oxygenates the blood while bypassing the lungs, allowing the infant's lungs to rest and recover. An endotracheal tube will be in place to facilitate deep tracheal suctioning and ventilation. The infant is likely to have been first connected to a ventilator. Laryngoscope insertion and tracheal suctioning are performed after birth, before the infant takes the first breath.

Question 3

Newborns whose mothers are substance abusers frequently have which behaviors?

Accepted Answer

Infants exposed to drugs in utero often have poor sleeping patterns, hyperactive reflexes, and uncoordinated sucking and swallowing behaviors. They will have hyperactive muscle tone, a high-pitched cry, and diarrhea, not constipation.

Question 4

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

Accepted Answer

Delayed absorption of fetal lung fluid is thought to be the reason for TTN. Lack of surfactant causes respiratory distress syndrome. A slow vaginal birth will help prevent TTN.

Question 5

Which intervention should make phototherapy most effective in reducing the indirect bilirubin in an affected newborn?

Accepted Answer

Exposure of all parts of the skin increases the effectiveness of phototherapy. Placing eye patches is important to protect the eyes; however, this is not what affects the bilirubin levels. Wrapping the infant in blankets will prevent the phototherapy from getting to the skin and being effective. The infant should be uncovered and unclothed. It is important to increase oral feedings, but water should not necessarily be given, which would not reduce the bilirubin.

Question 6

In an infant with cyanotic cardiac anomaly, the nurse should expect to see:

Accepted Answer

With a cyanotic cardiac defect, the shunting of blood is right to left, so there is little if any improvement in the oxygenation of the blood with the administration of oxygen. Infants with cardiac anomalies are usually difficult feeders, have difficulty gaining weight, and have an increase in the heart rate with activity.

Question 7

Which diagnostic test is used to help confirmation of hyperbilirubinemia in an infant?

Accepted Answer

The direct Coombs test is based on cord blood drawn from the infant, whereas the indirect Coombs test is based on maternal blood samples. Although maternal blood type is important in determining whether there is a potential ABO incompatibility, the infant's bilirubin level provides the best evidence of whether the infant has hyperbilirubinemia or pathologic jaundice.

Question 8

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

Accepted Answer

A laryngoscope is inserted to examine the vocal cords. If no meconium is below the cords, probably no meconium is present in the lower air passages, and the infant will not develop meconium aspiration syndrome. Bonding after birth is an expected occurrence. There is no relationship between dehydration and meconium fluid. Vigorous stimulation in the presence of meconium fluid is contraindicated to prevent aspiration.

Question 9

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

Accepted Answer

Infants of diabetic mothers may have hypertrophy of the islets of Langerhans, which may cause them to produce more insulin than they need. High hematocrit values in neonates of diabetic mothers cause them to have a have a ruddy look. Neonates of diabetic mothers are prone to hypoglycemia. It is correct that some women with diabetes have very small babies because of poor blood flow through the placenta.

Question 10

When a cardiac defect causes the mixing of arterial and venous blood in the right side of the heart, the nurse might expect to find:

Accepted Answer

Mixing of the blood in the right side of the heart will cause excessive blood flow to the lungs and pulmonary congestion. Cyanosis is seen more frequently with right-to-left shunts. Diuresis is not a common finding with cardiac defects. Increased oxygenation of the tissues is not seen with this type of cardiac defect.

Question 11

Four hours after the birth of a healthy neonate of an insulin-dependent (type 1) diabetic mother, the baby appears jittery and irritable and has a high-pitched cry. Which nursing action has top priority?

Accepted Answer

These symptoms are signs of hypoglycemia in the newborn. Permanent damage can occur if glucose is not constantly available to the brain, but it is not common practice to give intravenous glucose to a newborn. Feeding the infant is preferable because the formula or breast milk will last longer. Determine the blood glucose level according to agency policy, treat symptoms with standing orders protocol, and notify the physician with the results. Documentation can wait until the infant has been tested and treated if a problem is present.

Question 12

The nurse is responsible for monitoring the feedings of the infant with hyperbilirubinemia every 2 to 3 hours around the clock. The purpose of these formula feedings or breastfeedings is to:

Accepted Answer

Proteins help maintain the albumin level in the blood, and the extra fluids help eliminate the excess bilirubin from the infant's system. Feedings every 2 hours will help prevent hypoglycemia. Increased gastrointestinal motility can facilitate the prompt emptying of the bilirubin from the bowel. The feedings stimulate bowel movements and emptying of the bilirubin from the bowel.

Question 13

Which newborn should the nurse recognize as being most at risk for developing respiratory distress syndrome?

Accepted Answer

Infants of mothers with diabetes have delayed production of surfactant, thus placing the infant at risk for respiratory distress syndrome. A 35-week-gestation male baby born vaginally to a mother addicted to heroin is at risk for withdrawal. A 35-week-gestation female baby born vaginally 72 hours after the rupture of membranes is at risk for infection because of the prolonged rupture of membranes. A 35-week-gestation female baby born vaginally to a mother who has pregnancy-induced hypertension is at risk for hypoxia.

Question 14

The nurse must continually assess the infant who has meconium aspiration syndrome for the complication of:

Accepted Answer

Persistent pulmonary hypertension can result from the aspiration of meconium. Bronchopulmonary dysplasia is caused by the use of positive-pressure oxygenation, which stretches the immature lung membranes. Transitory tachypnea of the newborn is caused by delayed absorption of fetal lung fluid. Left-to-right shunting of blood through the foramen ovale is a congenital defect that can be caused by atrial septal defects, ventricular septal defects, patent ductus arteriosus, or atrioventricular canal defects.

Question 15

While in utero, the fetus passes meconium. Based on this assessment, which nursing diagnosis takes priority for the newborn at birth?

Accepted Answer

Because the fetus has already passed meconium in utero, the labor and birth take on a high-risk management perspective. The likelihood that the infant will develop meconium aspiration syndrome (MAS) is increased, so airway abnormalities take precedence in terms of nursing diagnosis and medical management.

Question 16

Which defect is present with tetralogy of Fallot?

Accepted Answer

Tetralogy of Fallot has four characteristics-ventricular septal defect, positioning of the aorta over the defect, pulmonary stenosis, and hypertrophy of the right ventricle. Patent ductus arteriosus is a result of the failure of the ductus arteriosus to close after birth. Blood flow is impeded, though this constricted area of the aorta is not a characteristic of tetralogy of Fallot. In transposition of the great arteries, the positions of the aorta and pulmonary artery are reversed.

Question 17

The difference between pathologic jaundice and physiologic jaundice is that pathologic jaundice:

Accepted Answer

Nonphysiologic jaundice appears during the first 24 hours of life, whereas physiologic jaundice appears after the first 24 hours of life. Pathologic jaundice may lead to kernicterus, but it needs to be stopped before that occurs. Jaundice proceeds from the head down. Both jaundices are the result of the breakdown of erythrocytes. Pathologic jaundice is caused by a pathologic condition, such as Rh incompatibility.

Question 18

The infant of a diabetic mother is hypoglycemic. Which type of feeding should be instituted first?

Accepted Answer

Glucose followed by formula or breast milk is metabolized more slowly and results in longer normal glucose levels. High levels of dextrose correct the hypoglycemia but will stimulate the production of more insulin. Oral feedings are tried first; intravenous lines would be a later choice if the hypoglycemia continues. Formula results in longer normal glucose levels but would be administered via bottle, not by tube feeding.

Question 19

While caring for a post-term infant, the nurse recognizes that the elevated hematocrit level most likely results from:

Accepted Answer

While in utero, the infant who is hypoxic will compensate by producing more red blood cells. An elevated hematocrit results from an overproduction of red blood cells. It would be seen with a decreased breakdown of red blood cells and is not a normal shift from fetal hemoglobin to normal hemoglobin.

Question 20

Shortly after a cesarean birth, a newborn begins to exhibit difficulty breathing. Nasal flaring and slight retractions are noted. The newborn is admitted to the neonatal intensive care unit (NICU) for closer observation, with a diagnosis of transient tachypnea (TTN). The parents are notified and become anxious because they have no idea what this means in terms of medical condition. The best action that the nurse can take at this time is to:

Accepted Answer

The clinical diagnosis of TTN has been established, and the nurse should provide factual information relative to the clinical condition. The RN should be able to provide information to clarify the parents' concern. Telling someone not to worry usually has the opposite effect in terms of a medical crisis. Facilitating an interaction with the newborn and parents may help ease anxiety but does not address the parents' knowledge deficit.

Quiz 30: High-Risk Newborn: Acquired and Congenital Conditions