Upgrade to remove ads
OB Ch 30: The High-Risk Newborn: Acquired and Congenital Conditions
Terms in this set (30)
1. 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
A High levels of dextrose correct the hypoglycemia but will stimulate the production of more insulin.
B Oral feedings are tried first; intravenous lines should be a later choice if the hypoglycemia continues.
C Formula does provide longer normal glucose levels but would be administered via bottle, not by tube feeding.
D Breast milk is metabolized more slowly and provides longer normal glucose levels.
2. The most common cause of pathologic hyperbilirubinemia is
a. Hepatic disease
b. Hemolytic disorders in the newborn
d. Congenital heart defect
A Hepatic damage may be a cause of pathologic hyperbilirubinemia, but it is not the most common cause.
B Hemolytic disorders in the newborn are the most common cause of pathologic jaundice.
C Prematurity is a potential cause of pathologic hyperbilirubinemia in neonates, but it is not the most common cause.
D Congenital heart defect is not a common cause of pathologic hyperbilirubinemia in neonates.
3. 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
A 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.
B The infant is likely to have been first connected to a ventilator.
C Laryngoscope insertion and tracheal suctioning are performed after birth before the infant takes the first breath.
D An endotracheal tube will be in place to facilitate deep tracheal suctioning and ventilation.
4. 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.
A 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.
B Test blood glucose level according to agency policy, treat symptoms with standing orders protocol, and notify the physician with the results.
C Documentation can wait until the infant has been tested and treated if a problem is present.
D 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.
5. 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.
A The neonate is not breathing, so drying the neonate to prevent heat loss and positioning the neonate takes priority over the suctioning.
B Stimulating the infant is a step in the process, but not the first action.
C The Apgar can be delayed until steps have been taken to initiate breathing. By assessing the lack of breathing, some of the Apgar has already been completed.
D Drying the infant to prevent heat loss is the first action. It is followed by positioning to open the airway.
6. 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
A If the mother is Rh negative and the father is Rh positive and homozygous for the Rh factor, all the offspring will be Rh positive. Only Rh-positive offspring of an Rh-negative mother are at risk for Rh incompatibility.
B Only the Rh-positive offspring of an Rh-negative mother are at risk.
C If the mother is Rh negative and the father is Rh positive and heterozygous for the factor, there is a 50% chance that each infant born of the union will be Rh positive and a 50% chance that each will be born Rh negative.
D There is no risk for incompatibility with this scenario.
7. 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
A Lack of surfactant causes respiratory distress syndrome.
B TTN is caused by delayed absorption of fetal lung fluid.
C Delayed absorption of fetal lung fluid is thought to be the reason for TTN.
D A slow vaginal delivery will help prevent TTN.
8. 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
A Persistent pulmonary hypertension can result from the aspiration of meconium.
B Bronchopulmonary dysplasia is due to the use of positive pressure oxygenation that stretches the immature lung membranes.
C Transitory tachypnea of the newborn is due to delayed absorption of fetal lung fluid.
D This is a congenital defect that can be caused by atrial septal defects, ventricular septal defects, patent ductus arteriosus, or atrioventricular canal defects.
9. 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.
A Vigorous stimulation in the presence of meconium fluid is contraindicated to prevent aspiration.
B There is no relationship between dehydration and meconium fluid.
C 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.
D This is an expected occurrence.
10. 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.
A 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.
B Avoid offering water between feedings, because the infant may decrease their milk intake. Breast milk or formula is more effective at removing bilirubin from the intestines.
C Exchange transfusions are seldom necessary; but, may be performed when phototherapy cannot reduce high bilirubin levels quickly enough.
D Wrapping the infant in blankets will prevent the phototherapy from getting to the skin and being effective. The infant should be uncovered and unclothed.
11. 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."
A This is a correct statement.
B Neonates of diabetic mothers are prone to hypoglycemia.
C High hematocrits in neonates of diabetic mothers have a ruddy look.
D Infants of diabetic mothers may have hypertrophy of the islets of Langerhans, which may cause them to produce more insulin than they need.
12. 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
A They will have diarrhea and increased muscle tone.
B The infant exposed to drugs in utero often has poor sleeping patterns, hyperactive reflexes, and uncoordinated sucking and swallowing behavior.
C They will have an uncoordinated sucking and swallowing reflex and decreased muscle tone.
D They will have poor sleeping patterns, increased reflexes, and a high-pitched cry.
13. 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
A Placing the crib in a quiet corner helps avoid excessive stimulation of the infant.
B These infants have an increase calorie needs, but poor suck and swallow coordination. Feeding should occur to meet these needs.
C Stimulation should be kept to a minimum.
D The neonate needs to have reduced handling and disturbances.
14. 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
A Pathologic jaundice may lead to kernicterus, but it needs to be stopped before that occurs.
B Nonphysiologic jaundice appears during the first 24 hours of life, whereas physiologic jaundice appears after the first 24 hours of life.
C Both jaundices are the result of the breakdown of erythrocytes. Pathologic jaundice is due to a pathologic condition, such as Rh incompatibility.
D Jaundice proceeds from the head down.
15. 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.
A No known cure exists for mental retardation.
B CNS damage can occur as a result of toxic levels of phenylalanine.
C Digestive problems are a clinical manifestation of PKU.
D PKU does not involve any urinary problems.
16. 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
A Sodium restriction is not an issue in phenylketonuria.
B Phenylketonuria is treated with a special diet that restricts phenylalanine intake.
C Phenylalanine is eliminated from the diet to prevent CNS damage.
D A specially prepared milk substitute is used to control the amount of protein in the infant's diet, thereby decreasing the amount of phenylalanine.
17. 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
A Retinal damage from phototherapy should be prevented by using eye shields on the infant under the light.
B To ensure total skin exposure, the infant's position is changed frequently.
C Special attention to increasing fluid intake ensures that the infant is well hydrated.
D To ensure total skin exposure, the infant is not dressed.
18. 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
c. Decrease of acrocyanosis
d. Gastric irritation (diarrhea)
A Tachypnea is seen in many neonates delivered by cesarean section, but it is not associated with the administration of calcium.
B If bradycardia or dysrhythmias occur during administration, stop the drug infusion immediately.
C Acrocyanosis is not a major problem of calcium administration.
D Gastric irritation is usually seen with administration of oral calcium.
19. 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.
A Macrosomic infants are at high risk for hypoglycemia after birth and need to be observed closely. This can be achieved in the mother's room with nursing interventions, depending on the condition of the fetus. It may be more appropriate for observation to occur in the nursery.
B Macrosomic infants are at high risk for hypoglycemia after birth and need to be observed closely. Observation may occur in the nursery or in the mother's room, depending on the condition of the fetus.
C Regardless of gestational age, this infant is macrosomic. Macrosomia is defined as fetal weight over 4000 g. Hypoglycemia affects many macrosomic infants. Blood glucose levels should be observed closely.
D 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.
20. 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
b. Phrenic nerve injury
c. Respiratory distress syndrome
A A differential diagnosis can be difficult because signs of sepsis are similar to noninfectious problems such as anemia and hypoglycemia.
B Phrenic nerve injury is usually the result of traction on the neck and arm during birth and is not applicable to this situation.
C The earliest signs of sepsis are characterized by lack of specificity—i.e., lethargy, poor feeding, and irritability—not respiratory distress syndrome.
D The prolonged rupture of membranes and the tachypnea (before and after birth) both suggest sepsis.
21. 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
A Virtually all controlled clinical trials have demonstrated that effective handwashing is responsible for the prevention of nosocomial infection in nursery units.
B Overcrowding must be avoided in nurseries and infants with infectious processes should be isolated; however, the most important nursing action for preventing neonatal infection is effective handwashing.
C Separate gowns should be worn in caring for each individual infant. Soiled linens should be disposed of in an appropriate manner; however, the most important nursing action for preventing neonatal infection is effective handwashing.
D Measures to be taken include Standard Precautions, careful and thorough cleaning, frequent replacement of used equipment, and disposal of excrement and linens in an appropriate manner. The most important nursing action for preventing neonatal infection is effective handwashing.
22. 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
A Phenobarbital or diazepam may be administered to decrease CNS irritability.
B The infant should be fed in small, frequent amounts and burped well to diminish aspiration and maintain hydration.
C The infant should be wrapped snugly to reduce self-stimulation behaviors and protect the skin from abrasions.
D The infant should not be stimulated (such as with music), because this will increase activity and potentially increase CNS irritability.
23. 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
A Transmission of HIV from the mother to the infant may occur transplacentally at various gestational ages.
B This is highly unlikely as most health care facilities must meet sterility standards for all instrumentation.
C Transmission of HIV may occur during birth from blood or secretions.
D Postnatal transmission of HIV through breastfeeding may occur.
24. 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."
A Erythromycin has no bearing on enhancing vision.
B Erythromycin is used to prevent an infection caused by gonorrhea, not herpes.
C With the prophylactic use of erythromycin, the incidence of gonococcal conjunctivitis has declined to less than 0.5%. Eye prophylaxis is administered at or shortly after birth to prevent ophthalmia neonatorum.
D Erythromycin is given to prevent infection, not for lubrication.
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
b. Herpes simplex virus infection
c. Congenital syphilis
A This rash is not an indication that the neonate has contracted gonorrhea. The neonate with gonorrheal infection might present with septicemia, meningitis, conjunctivitis and scalp abscesses.
B Infants affected with HSV will display growth restriction, skin lesions, microcephaly, hypertonicity and seizures.
C This rash is indicative of congenital syphilis. The lesions may extend over the trunk and extremities.
D Typically the HIV infected neonate is asymptomatic at birth. Most often the infant will develop an opportunistic infection and rapid progression of immunodeficiency.
26. 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
A Pharmacologic treatment is based on the severity of withdrawal symptoms. Symptoms are determined by using a standard assessment tool. Medications of choice are morphine, phenobarbital, diazepam, or diluted tincture of opium.
B Swaddling, holding, and reducing environmental stimuli are essential in providing care to the infant who is experiencing withdrawal. These nursing interventions are appropriate for the infant who displays central nervous system disturbances.
C Neonatal abstinence syndrome (NAS) is the term used to describe the cohort of symptoms associated with drug withdrawal in the neonate. The Neonatal Abstinence Scoring System evaluates CNS, metabolic, vasomotor, respiratory, and gastrointestinal disturbances. This evaluation tool enables the care team to develop an appropriate plan of care. The infant is scored throughout the length of stay and the treatment plan is adjusted accordingly.
D Poor feeding is one of the GI symptoms common to this patient population. Fluid and electrolyte balance must be maintained and adequate nutrition provided. These infants often have a poor suck reflex and may need to be fed via gavage.
1. 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.
ANS: B, C, D
Correct These criteria are all correct.
Incorrect The infant must be at least 36 weeks of gestation to meet the criteria for therapeutic hypothermia. Treatment should be initiated within the first 6 hours of life, ideally at a tertiary care center.
1. 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?
Other probable causes of PPHN include abnormal lung development, the use of aspirin, or reasons unknown. PPHN is often associated with meconium aspiration, sepsis, asphyxia, polycythemia, diaphragmatic hernia, diabetes, and respiratory distress syndrome. Nursing care is similar to that of other infants with severe respiratory disease.
1. A lack of O2 and an increase in CO2 in the blood is known as __________. This condition in the neonate may occur while in utero, at birth, or later.
Complications during pregnancy, labor, or birth increase the infant's risk for asphyxia. If the mother receives narcotics shortly before birth, the infant may be too physiologically depressed to breathe spontaneously. Resuscitative measures must be initiated immediately to prevent permanent brain damage or death.
2. ______________, a synthetic opiate, has been the therapy of choice for heroin addiction. It crosses the placenta, leading to significant neonatal abstinence syndrome after birth.
Methadone withdrawal is more severe and prolonged than withdrawal from heroin. Signs of withdrawal include tremors, irritability, hypertonicity, vomiting, nasal stuffiness and disturbed sleep patterns. This infant is also at increased risk for SIDS.
Sets found in the same folder
PEDS: Chapter 6: Health Promotion for the Infant
PEDS: Chapter 5: Health Promotion for the Developi…
Chapter 25: The High Risk Newborn
Chapter 7: Health Promotion during Early Childhood
Sets with similar terms
Ch 25 Maternal
Chapter 25: The High Risk Newborn NCLEX
Other sets by this creator
OB Ch 27: The Woman with an Intrapartum Complicati…
OB Ch 28: The Woman with a Postpartum Complication
OB Ch 29: The High-Risk Newborn: Problems Related…
OB Ch 25: Pregnancy-Related Complications