Question 1

An infant with severe meconium aspiration syndrome (MAS)is not responding to conventional treatment.Which treatment may be necessary for 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.The infant is most likely intubated and on a ventilator already.Laryngoscope insertion and tracheal suctioning are performed after birth before the infant takes the first breath.

Question 2

The goal of treatment of the infant with phenylketonuria (PKU)is to

Accepted Answer

CNS damage can occur as a result of toxic levels of phenylalanine.No cure exists for cognitive delays should they occur.Digestive problems are a clinical manifestation of PKU,but it is more important to prevent the CNS damage.PKU does not involve renal dysfunction.

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?

Accepted Answer

Infants of diabetic mothers may have hypertrophy of the islets of LangerhAnswer,which may cause them to produce more insulin than they need.The other statements are correct and show good understanding.

Question 4

The nurse learns that the most common cause of pathologic hyperbilirubinemia is which of the following?

Accepted Answer

Hemolytic disorders in the newborn are the most common cause of pathologic jaundice.Hepatic damage and prematurity may be causes of pathologic hyperbilirubinemia,but they are not the most common cause.Congenital heart defect is not a common cause of pathologic hyperbilirubinemia in neonates.

Question 5

An infant with hypocalcemia is receiving an intravenous bolus of calcium.The infant's heart rate changes from 144 beats/minute to 62 beats/minute.What action by the nurse is best?

Accepted Answer

IV calcium can lead to bradycardia.When this infant's heart rate drops to 60 beats/minute,the nurse stops the infusion.A stat ECG is not necessary unless policy requires it or the bradycardia does not resolve.Stimulating the infant will not increase the heart rate.Magnesium infusion will also not increase the heart rate.

Question 6

Transient 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 and hypoinflation of the lungs are not related to TTN.A slow vaginal delivery will help prevent TTN.

Question 7

What action by the nurse is the most important action in preventing neonatal infection?

Accepted Answer

Virtually all controlled clinical trials have demonstrated that effective handwashing is responsible for the prevention of nosocomial infection in nursery units.The other actions do reduce risk but not nearly to the degree that good hand hygiene does.

Question 8

A newborn has meconium aspiration at birth.The nurse notes increasing respiratory distress.What action takes priority?

Accepted Answer

This baby has a risk for,and signs of,persistent pulmonary hypertension.The nurse first checks an oxygen saturation then notifies the provider,or alternatively,gets the reading (and other assessments)while another nurse does the notification.This baby most likely has tachypnea so stimulation to increase respirations is not needed.ECMO may or may not be needed depending on whether or not other treatments work.

Question 9

The nurse is teaching the parents of a newborn who is going to receive phototherapy.What other measure does the nurse teach to help reduce the bilirubin?

Accepted Answer

Frequent feedings prevent hypoglycemia,provide protein to maintain albumin levels in the blood and promote gastrointestinal motility and removal of bilirubin in the stools.More frequent breastfeeding should be encouraged.Avoid offering water between feedings,because the infant may decrease his or her milk intake.Breast milk or formula is more effective at removing bilirubin from the intestines.Exchange trAnswerfusions are seldom necessary but may be performed when phototherapy cannot reduce high bilirubin levels quickly enough.Wrapping the infant in blankets will prevent the phototherapy from getting to the skin and being effective.The infant should be uncovered and unclothed.

Question 10

A neonate has white patches in her mouth that bled when the mother tried wiping them away.What action by the nurse is best?

Accepted Answer

These patches are characteristic of maternal infection with candidiasis or yeast.The nurse assesses the mother's perineal area for a rash.Telling the mother to leave the rash alone may be appropriate information but does not get to the bottom of the issue.The nurse should not provide medication without knowing what is being treated.The baby does not have toxoplasmosis.

Question 11

A nurse is participating in a neonatal resuscitation.What action by the nurse takes priority?

Accepted Answer

In a resuscitation situation,the nurse places the newborn in a preheated warmer immediately to reduce cold stress.Next position the infant in a "sniffing" position.Suctioning is the third step.Drying the infant is fourth,although if more than one health care provider is present,drying can occur simultaneously with the other actions.

Question 12

The difference between physiologic and nonphysiologic jaundice is that nonphysiologic 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.Both jaundices are the result of the breakdown of erythrocytes.Pathologic jaundice is due to a pathologic condition,such as Rh incompatibility.

Question 13

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

Accepted Answer

Breast milk is metabolized more slowly and provides longer normal glucose levels.Breast milk is best for nearly all babies.High levels of dextrose correct the hypoglycemia but will stimulate the production of more insulin.Oral feedings are tried first; intravenous lines should be a later choice if the hypoglycemia continues.Formula does provide longer normal glucose levels but would be administered via bottle,not by tube feeding unless the baby is unable to take oral feedings.

Question 14

Parents of a newborn with phenylketonuria are anxious to learn about the appropriate treatment for their infant.What topic does the nurse include in the teaching plan?

Accepted Answer

Phenylketonuria is treated with a special diet that restricts phenylalanine intake.Fluid and sodium restrictions are not included in this plan.Mobility and splinting are not included in the plan.A protein-rich diet is not in the plan.

Question 15

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

Accepted Answer

The prolonged rupture of membranes and the tachypnea (before and after birth)both suggest sepsis.There is no evidence of phrenic nerve damage or respiratory distress syndrome.Early signs of sepsis may be difficult to distinguish from other problems such as hypoglycemia,but the prolonged rupture of membranes puts this baby at high risk of sepsis.

Question 16

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?

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.Apgar scores are important but not directly related to meconium.There is no relationship between dehydration and meconium fluid.Bonding is an expected occurrence.

Question 17

Nursing care of the infant with neonatal abstinence syndrome should include

Accepted Answer

Placing the crib in a quiet corner helps avoid excessive stimulation of the infant.These infants have an increase calorie needs but poor suck and swallow coordination.Feeding should occur to meet these needs.Stimulation should be kept to a minimum.

Question 18

The nurse is caring for a neonate undergoing phototherapy.What action does the nurse include on the infant's care plan?

Accepted Answer

Retinal damage from phototherapy should be prevented by using eye shields on the infant under the light.To ensure total skin exposure,the infant's position is changed frequently.Special attention to increasing fluid intake ensures that the infant is well hydrated.To ensure total skin exposure,the infant is not dressed.

Question 19

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?

Accepted Answer

These are signs of hypoglycemia in the newborn.The nurse should test the infant's blood glucose level and then feed the infant if it is low.It is not common practice to give intravenous glucose to a newborn prior to feeding.Feeding the infant is preferable because the formula or breast milk will last longer.The provider needs to be notified after corrective action has been taken.Documentation should occur but is not the priority.

Question 20

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).What action by the nurse is most appropriate?

Accepted Answer

This infant is macrosomic (over 4000 g)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.The infant can stay with the mother,but this is not the best Answerwer since it does not include the close monitoring needed.Regardless of gestational age,this infant is macrosomic.

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

An infant with severe meconium aspiration syndrome (MAS) is not responding to conventional treatment.Which treatment may be necessary for this infant?

The goal of treatment of the infant with phenylketonuria (PKU) is to