Chapter 14: The Newborn With a Congenital Malformation My Nursing Test Banks

Chapter 14: The Newborn With a Congenital Malformation

Elsevier items and derived items 2007 by Saunders, an imprint of Elsevier Inc.

MULTIPLE CHOICE

1. Obstruction within the ventricles of the brain or inadequate reabsorption of cerebrospinal fluid may be responsible for the occurrence of:

a.

Meningitis

b.

Meningocele

c.

Spina bifida occulta

d.

Hydrocephalus

ANS: D

Hydrocephalus is characterized by an increase in cerebrospinal fluid in the ventricles of the brain.

DIF: Cognitive Level: Knowledge REF: Text Reference: 320

OBJ: Objective: 4 TOP: Topic: Hydrocephalus

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

2. The nurse caring for an infant with hydrocephalus would take special precaution to:

a.

Align the limbs

b.

Support the head

c.

Keep the head lower than the hips

d.

Check intake and output

ANS: B

The child with hydrocephalus has a heavy head on a small body with poor muscle tone; the head must be supported when feeding and moving the child to prevent injury to the neck.

DIF: Cognitive Level: Comprehension REF: Text Reference: 321

OBJ: Objective: 4 TOP: Topic: Hydrocephalus

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Reduction of Risk

3. The nurse observes that the infants anterior fontanelle is bulging after placement of a ventriculoperitoneal shunt. The nurse positions this infant:

a.

Prone, with the head of the bed elevated

b.

Supine, with the head flat

c.

Side-lying on the operative side

d.

In the semi-Fowlers position

ANS: D

If the fontanels are bulging, the child would be positioned in a semi-Fowlers position to promote drainage from the ventricles through the shunt.

DIF: Cognitive Level: Application REF: Text Reference: 322

OBJ: Objective: 4 TOP: Topic: Hydrocephalus

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

4. After feeding a baby with hydrocephalus, the nurse will take special care to:

a.

Sit the baby upright in an infant seat

b.

Place the baby over the shoulder to burp

c.

Leave the baby in a side-lying position

d.

Stimulate the baby by rubbing its feet

ANS: C

Because children with hydrocephalus are prone to vomiting, the child is fed and then positioned in the side-lying position in a quiet atmosphere to reduce the incidence of vomiting.

DIF: Cognitive Level: Application REF: Text Reference: 322

OBJ: Objective: 4 TOP: Topic: Feeding a Hydrocephalic Child

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

5. A newborn was just admitted to the NICU with a meningomyelocele. The priority for preoperative nursing care of this newborn is to protect the sac by:

a.

Keeping the sac dry

b.

Diapering snugly

c.

Positioning prone in an incubator

d.

Moving from side to side every hour

ANS: C

The infant is placed prone in a humidified incubator, and the sac is covered with dressings of sterile saline. The babys hips are kept lower than the lesion, and the baby is usually not in diapers.

DIF: Cognitive Level: Analysis REF: Text Reference: 324

OBJ: Objective: 6 TOP: Topic: Myelodysplasia and Spina Bifida

KEY: Nursing Process Step: Planning

MSC: NCLEX: Physiological Integrity: Reduction of Risk

6. The nurse caring for the child who has had a ventriculoperitoneal shunt for hydrocephalus observes an increasing abdominal girth. The most appropriate response would be to:

a.

Elevate the childs head

b.

Check bowel sounds

c.

Record retention of feeding

d.

Notify charge nurse of possible malabsorption

ANS: D

An increasing abdominal girth in a child with a VP shunt may be indicative of malabsorption of the CSF that is being shunted to the peritoneum.

DIF: Cognitive Level: Application REF: Text Reference: 322

OBJ: Objective: 5 TOP: Topic: V-P Shunt

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

7. The nurse counsels the parents of a child with a cleft palate that they should be alert for signs of:

a.

Facial paralysis

b.

Ear infections

c.

Increasing ICP

d.

Drooling

ANS: B

Children with cleft palate are at risk of ear infections and dental disorders.

DIF: Cognitive Level: Application REF: Text Reference: 328

OBJ: Objective: 2 TOP: Topic: Complication of Cleft Palate

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

8. Postoperative nursing care of the infant following surgical repair of a cleft lip would include:

a.

Feeding the infant with a spoon to avoid sucking

b.

Positioning the infant on the abdomen to facilitate drainage

c.

Applying elbow restraints to protect the surgical area

d.

Providing minimal stimulation to prevent injury to the incision

ANS: C

Elbow restraints are used postoperatively to prevent the infant from damaging the operative area.

DIF: Cognitive Level: Application REF: Text Reference: 326

OBJ: Objective: 9 TOP: Topic: Cleft Lip and Palate

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

9. The statement that indicates parents understand how to feed their infant who had surgical repair of a cleft lip is:

a.

We are feeding the baby with a dropper for two weeks.

b.

We resumed bottle feeding after discharge.

c.

We started the baby on solid food yesterday.

d.

The baby is drinking well from a straw.

ANS: A

The infant is fed with a dropper until the incision is completely healed, about 1 to 2 weeks after surgery.

DIF: Cognitive Level: Application REF: Text Reference: 327

OBJ: Objective: 9 TOP: Topic: Cleft Lip and Palate

KEY: Nursing Process Step: Evaluation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

10. An 18-month-old child who has had a surgical repair of a cleft palate is now allowed to eat a regular diet. The adjustment the nurse would make in feeding is:

a.

Feed solid foods with the spoon at the side of the mouth.

b.

Puree foods and offer them through a straw.

c.

Place small bites of food in the mouth with a tongue blade.

d.

Offer small, frequent meals of finger foods.

ANS: A

The primary concern with feeding is to protect the operative site. The child can be fed with a spoon, but only the side of the spoon is placed into the mouth at the side of the mouth. The spoon must not touch the roof of the mouth.

DIF: Cognitive Level: Application REF: Text Reference: 327

OBJ: Objective: 9 TOP: Topic: Cleft Lip and Palate

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Basic Care and Comfort

11. The nurse bathing an infant would recognize a sign of developmental hip dysplasia, which is:

a.

Hypotonicity of the leg muscles

b.

One leg is shorter than the other

c.

Broadening and flattening of the buttocks

d.

Two skin folds on the back of each thigh

ANS: B

When developmental hip dysplasia is present, the leg on the affected side will appear shorter than the leg on the unaffected side.

DIF: Cognitive Level: Application REF: Text Reference: 329

OBJ: Objective: 10 TOP: Topic: Developmental Hip Dysplasia

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

12. A 3-month-old infant is diagnosed with developmental hip dysplasia. The nurse explains that the usual treatment for this infant would be:

a.

A Pavlik harness

b.

A body spica cast

c.

Traction

d.

Triple-diapering

ANS: A

In infants more than 2 months of age, longer-term immobilization with a Pavlik harness is required.

DIF: Cognitive Level: Comprehension REF: Text Reference: 330

OBJ: Objective: 10 TOP: Topic: Developmental Hip Dysplasia

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

13. Following delivery, a mother asks the nurse about newborn screening tests. The nurse explains that the optimal time for testing for phenylketonuria is:

a.

In the first 24 hours of life

b.

After 2 to 3 days

c.

At 4 to 6 weeks of age

d.

At 2 months of age

ANS: B

Blood tests for phenylketonuria should be obtained 48 to 72 hours after birth. The newborn will have had enough time to ingest protein through feedings and the chance of false-negative results will be reduced.

DIF: Cognitive Level: Application REF: Text Reference: 332

OBJ: Objective: 7 TOP: Topic: Metabolic Defects

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Prevention and Early Detection of Disease

14. The nurse advising parents about feeding their infant who has phenylketonuria, would include the information to:

a.

Provide a life-long high-protein diet.

b.

Use a formula that is low in the amino acid leucine.

c.

Feed the baby a soy-based formula.

d.

Substitute Lofenalac for some protein foods.

ANS: D

A synthetic food providing enough protein for growth and tissue repair, but little phenylalanine, is substituted for natural protein foods.

DIF: Cognitive Level: Application REF: Text Reference: 333

OBJ: Objective: 7 TOP: Topic: Metabolic Defects

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

15. Parents of a 2-month-old Down syndrome infant should be instructed, because of the generalized hypotonicity of the child, that special attention should be given to:

a.

Careful feeding

b.

Respiratory care

c.

Range of motion

d.

Incontinent care

ANS: B

The child with Down syndrome has generalized hypotonicity, which caused mucus accumulation and respiratory problems

DIF: Cognitive Level: Application REF: Text Reference: 334

OBJ: Objective: 11 TOP: Topic: Down Syndrome

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Reduction of Risk

16. The nurse instructing parents about positioning their toddler who has just had a body spica cast applied would include to:

a.

Prop the child upright with pillows for meals.

b.

Use the bar between the legs to turn the child.

c.

Put the child on her abdomen to sleep.

d.

Change the childs position frequently.

ANS: D

The childs position must be changed frequently to relieve pressure on body points and promote circulation.

DIF: Cognitive Level: Application REF: Text Reference: 332

OBJ: Objective: 10 TOP: Topic: Developmental Hip Dysplasia

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity

17. The nurse explains that the Rh-negative mother who should receive RhoGAM is the mother who:

a.

Has had one Rh-negative child and is pregnant with an Rh-negative child

b.

Had an Rh-positive baby and is pregnant with an Rh-positive baby

c.

Has had an O-negative child and is pregnant with a B-negative child

d.

Is a primipara with an O-negative child

ANS: B

The only woman with antibodies against the Rh-positive baby is the Rh-negative woman who has had one Rh-positive child and is now pregnant with another.

DIF: Cognitive Level: Analysis REF: Text Reference: 337

OBJ: Objective: 12 TOP: Topic: Rh Concerns

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Reduction of Risk

18. When the parents ask what the light does for their jaundiced baby, the nurse responds that the light:

a.

Increases the babys metabolism

b.

Stimulates liver function

c.

Dilates blood vessels

d.

Breaks down bilirubin

ANS: D

Severe jaundice can cause kernicterus, an accumulation of bilirubin in the brain tissue, which can lead to serious brain damage. The light breaks down excess bilirubin so that it can be excreted.

DIF: Cognitive Level: Application REF: Text Reference: 338

OBJ: Objective: 12

TOP: Topic: Hemolytic Disease of the Newborn

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Physiological Adaptation

19. Parents of a newborn with a unilateral cleft lip are concerned about having the defect repaired. The nurse explains that a child with a cleft lip usually undergoes surgical repair:

a.

Immediately after birth

b.

By 3 months of age

c.

After 12 months of age

d.

Varies in every case

ANS: B

A cleft lip is repaired by 3 months of age when weight gain is established and the infant is free of infection.

DIF: Cognitive Level: Application REF: Text Reference: 327

OBJ: Objective: 9 TOP: Topic: Cleft Lip

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Growth and Development

20. Phototherapy is instituted for an infant with jaundice. An appropriate nursing action for the infant with jaundice is to:

a.

Cover the infants head with a hat.

b.

Dress the infant lightly in a T-shirt.

c.

Keep the infants eyes covered.

d.

Reposition at least every 4 to 8 hours.

ANS: C

The infants eyes are protected with patches to prevent damage from the high-intensity lights.

DIF: Cognitive Level: Application REF: Text Reference: 338

OBJ: Objective: 12

TOP: Topic: Hemolytic Disease of the Newborn

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Physiological Integrity: Reduction of Risk

21. The nurse is caring for a newborn whose mother has diabetes. The nurse would assess the neonate for:

a.

Hypoglycemia

b.

Erythroblastosis fetalis

c.

Intracranial hemorrhage

d.

Pancreatic failure

ANS: A

The newborn of a mother with diabetes is prone to hypoglycemia.

DIF: Cognitive Level: Analysis REF: Text Reference: 343

OBJ: Objective: N/A TOP: Topic: Infant of a Diabetic Mother

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Reduction of Risk

MULTIPLE RESPONSE

1. The nurse in the newborn nursery is watchful for neonatal abstinence syndrome in the newborn of a crack-addicted mother, which would be manifested by:

Select all that apply.

a.

Body tremors

b.

Excessive sneezing

c.

Hyperirritability

d.

Drowsiness

e.

Excessive appetite

ANS: A, B, C

The neonate with abstinence syndrome will be hyperirritable and wakeful, have excessive sneezing or yawning, and have no appetite.

DIF: Cognitive Level: Application REF: Text Reference: 242-243

OBJ: Objective: 2 TOP: Topic: Neonatal Abstinence

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Reduction of Risk

2. The nurse assesses the hydrocephalic child for increasing ICP, which would be manifested by:

Select all that apply.

a.

High-pitched cry

b.

Inequality of pupils

c.

Bulging fontanelles

d.

Diarrhea

e.

Strabismus

ANS: A, B, C

Increased ICP is manifested by high-pitched cry, inequality of pupils, and bulging fontanelles.

DIF: Cognitive Level: Application REF: Text Reference: 322

OBJ: Objective: 4 TOP: Topic: Signs of ICP

KEY: Nursing Process Step: Assessment

MSC: NCLEX: Physiological Integrity: Reduction of Risk

COMPLETION

1. The nurse uses a diagram to show that when the CSF is obstructed in the subarachnoid space rather than in the ventricles, the resulting hydrocephalus is diagnosed as ____________________ hydrocephalus.

ANS: communicating

DIF: Cognitive Level: Comprehension REF: Text Reference: 321

OBJ: Objective: 2 TOP: Topic: Communicating Hydrocephalus

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Growth and Development

NOT: Rationale: Communicating hydrocephalus occurs when the CFS is obstructed in the subarachnoid space rather than in the ventricles.

2. The nurse clarifies to the parents of a child with spina bifida that their child has a portion of the spinal cord in the sac, in addition to the meninges, which makes this defect a ____________________.

ANS: meningomyelocele

DIF: Cognitive Level: Application REF: Text Reference: 223

OBJ: Objective: 2 TOP: Topic: Meningomyelocele

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Growth and Development

NOT: Rationale: A spina bifida that includes a portion of the cord in the sac in addition to the meninges is classified as a meningomyelocele.

3. The nurse demonstrates how to flush the ventriculoperitoneal shunt by the use of the ____________________ that is in place behind the babys ear.

ANS: pump

DIF: Cognitive Level: Comprehension REF: Text Reference: 322

OBJ: Objective: 6 TOP: Topic: Pumping the Shunt

KEY: Nursing Process Step: Implementation

MSC: NCLEX: Health Promotion and Maintenance: Growth and Development

NOT: Rationale: A small pump is part of the VP shunt. The pump is in place behind the childs ear. The shunt can be pumped according to the physicians instructions in order to maintain flow from the ventricles to the peritoneum.

Leave a Reply