Chapter 24: The Newborn at Risk My Nursing Test Banks

Lowdermilk: Maternity Nursing, 8th Edition

Chapter 24: The Newborn at Risk

Test Bank 

MULTIPLE CHOICE

1. Infants of mothers with diabetes are at higher risk for developing:

a. Anemia.
b. Hyponatremia.
c. Respiratory distress syndrome.
d. Sepsis.

ANS: C

Feedback
A Infants of diabetic mothers (IDMs) are not at risk for anemia. They are at risk for polycythemia.
B  IDMs are not at risk for hyponatremia. They are at risk for hypocalcemia and hypomagnesemia.
C IDMs are at risk for macrosomia, birth trauma, perinatal asphyxia, respiratory distress syndrome, hypoglycemia, hypocalcemia, hypomagnesemia, cardiomyopathy, hyperbilirubinemia, and polycythemia.
D  IDMs are not at risk for sepsis.

DIF:Cognitive Level: ComprehensionREF:774

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning

2. An infant at 36 weeks of gestation has increasing respirations (80 to 100 breaths/min with marked substernal retractions). The infant is given oxygen by continuous nasal positive airway pressure. Which arterial oxygen level would indicate hypoxia?

a. PaO2 of 67
b. PaO2 of 89
c. PaO2 of 45
d. PaO2 of 73

ANS: C

Feedback
A The normal range for PaO2 for the neonate is 60 to 80 mm Hg. A laboratory value below this range would indicate hypoxia.
B The normal range for PaO2 for the neonate is 60 to 80 mm Hg. A laboratory value below this range would indicate hypoxia.
C A PaO2 of 45 is below the normal range for a normal neonate. The range for arterial oxygen pressure is 60 to 80 mm Hg. The laboratory value of PaO2 of 45 indicates hypoxia in this infant.
D The normal range for PaO2 for the neonate is 60 to 80 mm Hg. A laboratory value below this range would indicate hypoxia.

DIF:Cognitive Level: ComprehensionREF:768

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment

3. The most appropriate statement that the nurse can make to bereaved parents is:

a. You have an angel in heaven.
b. I understand how you must feel.
c. Youre young and can have other children.
d. Im sorry.

ANS: D

Feedback
A The initial impulse may be to reduce ones sense of helplessness and say or do something that you think will reduce their pain. Although such a response may seem supportive at the time, it can stifle the further expression of emotion.
B The nurse should resist the temptation to give advice or to use clichs when offering support to the bereaved.
C This is not a therapeutic response for the nurse to make.
D One of the nurses most important goals is to validate the experience and feelings of the parents by encouraging them to tell their stories and listening with care. At the very least, the nurse should acknowledge the loss with a simple but sincere comment such as, Im sorry.

DIF:Cognitive Level: ApplicationREF:806

OBJ:Client Needs: Psychosocial Integrity

TOP: Nursing Process: Implementation

4. 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:

a. Gonorrhea.
b. Herpes simplex virus infection.
c. Congenital syphilis.
d. Human immunodeficiency virus.

ANS: C

Feedback
A The rash is indicative of congenital syphilis. The lesions may extend over the trunk and extremities.
B The rash is indicative of congenital syphilis. The lesions may extend over the trunk and extremities.
C The rash is indicative of congenital syphilis. The lesions may extend over the trunk and extremities.
D The rash is indicative of congenital syphilis. The lesions may extend over the trunk and extremities.

DIF:Cognitive Level: AnalysisREF:780

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Diagnosis

5. An infant is to receive gastrostomy feedings. What intervention should the nurse institute to prevent bloating, gastrointestinal reflux into the esophagus, vomiting, and respiratory compromise?

a. Rapid bolusing of the entire amount in 15 minutes
b. Warm cloths to the abdomen for the first 10 minutes
c. Slow, small, warm bolus feedings over 20 to 30 minutes
d. Cold, medium bolus feedings over 20 minutes

ANS: C

Feedback
A This would most likely lead to the adverse reactions listed.
B Temperature stability in the newborn is critical. This type of warming would not be appropriate because it is not a thermoregulated environment. Additionally, abdominal warming is not indicated with feedings of any kind.
C Feedings by gravity are done slowly over 20- to 30-minute periods to prevent adverse reactions.
D Small feedings at room temperature are recommended to prevent adverse reactions.

DIF:Cognitive Level: ApplicationREF:766

OBJ:Client Needs: Physiologic Integrity

TOP: Nursing Process: Implementation

6. After giving birth to a stillborn infant, the woman turns to the nurse and says, I just finished painting the babys room. Do you think that caused my baby to die? The nurses best response to this woman is:

a. Thats an old wives tale; lots of women are around paint during pregnancy, and this doesnt happen to them.
b. Thats not likely. Paint is associated with elevated pediatric lead levels.
c. Silence.
d. I can understand your need to find an answer to what caused this. What else are you thinking about?

ANS: D

Feedback
A The nurse should resist the temptation to give advice or to use clichs in offering support to the bereaved. In addition, trying to give bereaved parents answers when no clear answers exist or trying to squelch their guilt feeling does not help the process of grief.
B Trying to give bereaved parents answers when no clear answers exist does not help the grief process. In addition, this response probably would increase the mothers feelings of guilt.
C One of the most important goals of the nurse is to validate the experience and feelings of the parents by encouraging them to tell their stories and listening with care. The nurse should encourage the mother to express her ideas.
D This statement is very appropriate for the nurse. It demonstrates caring and compassion and allows the mother to vent her thoughts and feelings, which is therapeutic in the process of grieving.

DIF:Cognitive Level: ApplicationREF:806

OBJ:Client Needs: Psychosocial Integrity

TOP: Nursing Process: Implementation

7. Necrotizing enterocolitis (NEC) is an inflammatory disease of the gastrointestinal mucosa. The signs of NEC are nonspecific. Some generalized signs include:

a. Hypertonia, tachycardia, and metabolic alkalosis.
b. Abdominal distention, temperature instability, and grossly bloody stools.
c. Hypertension, absence of apnea, and ruddy skin color.
d. Scaphoid abdomen, no residual with feedings, and increased urinary output.

ANS: B

Feedback
A The infant may display hypotonia, bradycardia, and metabolic acidosis.
B Some generalized signs of NEC include decreased activity, hypotonia, pallor, recurrent apnea and bradycardia, decreased oxygen saturation values, respiratory distress, metabolic acidosis, oliguria, hypotension, decreased perfusion, temperature instability, cyanosis, abdominal distention, residual gastric aspirates, vomiting, grossly bloody stools, abdominal tenderness, and erythema of the abdominal wall.
C Hypotension, apnea, and pallor are signs of NEC.
D Abdominal distention, residual gastric aspirates, and oliguria are signs of NEC.

DIF:Cognitive Level: ComprehensionREF:763

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment

8. When attempting to diagnose and treat developmental dysplasia of the hip (DDH), the nurse should:

a. Be able to perform the Ortolani and Barlow tests.
b. Teach double or triple diapering for added support.
c. Explain to the parents the need for serial casting.
d. Carefully monitor infants for DDH at follow-up visits.

ANS: D

Feedback
A The Ortolani and Barlow tests must be performed by experienced clinicians to prevent fracture or other damage to the hip.
B Double or triple diapering is not recommended because it promotes hip extension, thus worsening the problem.
C Serial casting is done for clubfeet, not DDH.
D Because DDH often is not detected at birth, infants should be monitored carefully at follow-up visits.

DIF:Cognitive Level: ComprehensionREF:796

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Planning

9. A pregnant woman was admitted for induction of labor at 43 weeks of gestation with sure dates. A nonstress test (NST) in the obstetricians office revealed a nonreactive tracing. On artificial rupture of membranes, thick, meconium-stained fluid was noted. The nurse caring for the infant after birth should anticipate:

a. Meconium aspiration, hypoglycemia, and dry, cracked skin.
b. Excessive vernix caseosa covering the skin, lethargy, and respiratory distress syndrome.
c. Golden yellow- to green-stained skin and nails, absence of scalp hair, and an increased amount of subcutaneous fat.
d. Hyperglycemia, hyperthermia, and an alert, wide-eyed appearance.

ANS: A

Feedback
A These infant findings are consistent with a postmature infant.
B These findings would be consistent with a very premature infant.
C The skin may be meconium stained, but the infant would most likely have longer hair and decreased amounts of subcutaneous fat.
D Postmaturity with a nonreactive NST would indicate hypoxia. Signs and symptoms associated with fetal hypoxia are hypoglycemia, temperature instability, and lethargy.

DIF:Cognitive Level: AnalysisREF:770

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning

10. During a prenatal examination, the woman reports having two cats at home. The nurse informs her that she should not be cleaning the litter box while she is pregnant. When the woman asks why, the nurses best response would be:

a. Your cats could be carrying toxoplasmosis. This is a zoonotic parasite that can infect you and have severe effects on your unborn child.
b. You and your baby can be exposed to the human immunodeficiency virus (HIV) in your cats feces.
c. Its just gross. You should make your husband clean the litter boxes.
d. Cat feces are known to carry Escherichia coli, which can cause a severe infection in both you and your baby.

ANS: A

Feedback
A Toxoplasmosis is a multisystem disease caused by the protozoal Toxoplasma gondii parasite, commonly found in cats, dogs, pigs, sheep, and cattle. About 30% of women who contract toxoplasmosis during gestation transmit the disease to their offspring. Clinical features ascribed to toxoplasmosis include hydrocephalus or microcephaly, chorioretinitis, seizures, or cerebral calcifications.
B HIV is not transmitted by cats.
C Although this may be a valid statement, it is not appropriate, does not answer the patients question, and is not the nurses best response.
D E. coli is found in normal human fecal flora. It is not transmitted by cats.

DIF:Cognitive Level: ApplicationREF:780

OBJ: Client Needs: Safe and Effective Care Environment TOP: Nursing Process: Planning

11. Premature infants who exhibit 5 to 10 seconds of respiratory pauses followed by 10 to 15 seconds of compensatory rapid respiration are:

a. Suffering from sleep or wakeful apnea.
b. Experiencing severe swings in blood pressure.
c. Trying to maintain a neutral thermal environment.
d. Breathing in a respiratory pattern common to premature infants.

ANS: D

Feedback
A Apnea is a cessation of respirations for 20 seconds or longer. It should not be confused with periodic breathing, which still may need a nursing intervention of oxygen and/or ventilation.
B This is a respiratory pattern called periodic breathing, which is common to premature infants. It may still require a nursing intervention of oxygen and/or ventilation.
C This is a respiratory pattern called periodic breathing, which is common to premature infants. It may still require a nursing intervention of oxygen and/or ventilation.
D This pattern is called periodic breathing, and it may still require nursing intervention of oxygen and/or ventilation.

DIF:Cognitive Level: ComprehensionREF:754

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Assessment

12. What options for saying goodbye would the nurse want to discuss with a woman who is diagnosed with having a stillborn girl?

a. The nurse shouldnt discuss any options at this time; there is plenty of time after the baby is born.
b. Would you like a picture taken of your baby after birth?
c. When your baby is born, would you like to see and hold her?
d. What funeral home do you want notified after the baby is born?

ANS: C

Feedback
A Interventions and support from the nursing and medical staff after a prenatal loss are extremely important in the healing of the parents.
B Although this may be an intervention, the initial intervention should be related directly to the parents wishes with regard to seeing or holding their dead infant.
C Mothers and fathers may find it helpful to see the infant after delivery. The parents wishes should be respected.
D Although this information may be relevant, it is not the most appropriate option at this time. Burial arrangements can be discussed after the infant is born.

DIF:Cognitive Level: ApplicationREF:803

OBJ: Client Needs: Psychosocial Integrity TOP: Nursing Process: Planning

13. The nurse practicing in the perinatal setting should promote kangaroo care regardless of an infants gestational age. This intervention:

a. Is adopted from classical British nursing traditions.
b. Helps infants with motor and central nervous system impairment.
c. Helps infants to interact directly with their parents and enhances their temperature regulation.
d. Gets infants ready for breastfeeding.

ANS: C

Feedback
A Kangaroo care is skin-to-skin holding in which the infant, dressed only in a diaper, is placed directly on the parents bare chest and then covered. The procedure helps infants interact with their parents and regulates their temperature, among other developmental benefits.
B Kangaroo care is skin-to-skin holding in which the infant, dressed only in a diaper, is placed directly on the parents bare chest and then covered. The procedure helps infants interact with their parents and regulates their temperature, among other developmental benefits.
C Kangaroo care is skin-to-skin holding in which the infant, dressed only in a diaper, is placed directly on the parents bare chest and then covered. The procedure helps infants interact with their parents and regulates their temperature, among other developmental benefits.
D Kangaroo care is skin-to-skin holding in which the infant, dressed only in a diaper, is placed directly on the parents bare chest and then covered. The procedure helps infants interact with their parents and regulates their temperature, among other developmental benefits.

DIF:Cognitive Level: KnowledgeREF:768

OBJ:Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Implementation

14. While completing a newborn assessment, the nurse should be aware that the most common birth injury is:

a. To the soft tissues.
b. Caused by forceps gripping the head on delivery.
c. Fracture of the humerus and femur.
d. Fracture of the clavicle.

ANS: D

Feedback
A The most common birth injury is fracture of the clavicle (collarbone). It usually heals without treatment, although the arm and shoulder may be immobilized for comfort.
B The most common birth injury is fracture of the clavicle (collarbone). It usually heals without treatment, although the arm and shoulder may be immobilized for comfort.
C The most common birth injury is fracture of the clavicle (collarbone). It usually heals without treatment, although the arm and shoulder may be immobilized for comfort.
D The most common birth injury is fracture of the clavicle (collarbone). It usually heals without treatment, although the arm and shoulder may be immobilized for comfort.

DIF:Cognitive Level: KnowledgeREF:777

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment

15. With regard to eventual discharge of the high risk newborn or transfer to a different facility, nurses and families should be aware that:

a. Infants will stay in the neonatal intensive care unit (NICU) until they are ready to go home.
b. Once discharged to home, the high risk infant should be treated like any healthy term newborn.
c. Parents of high risk infants need special support and detailed contact information.
d. If a high risk infant and mother need transfer to a specialized regional center, it is better to wait until after birth and the infant is stabilized.

ANS: C

Feedback
A Parents and their high risk infant should get to spend a night or two in a predischarge room, where care for the infant is provided away from the NICU.
B Just because high risk infants are discharged does not mean that they are normal, healthy babies. Follow-up by specialized practitioners is essential.
C High risk infants can cause profound parental stress and emotional turmoil. Parents need support, special teaching, and quick access to various resources available to help them care for their baby.
D Ideally the mother and baby are transported with the fetus in utero; this reduces neonatal morbidity and mortality.

DIF:Cognitive Level: ComprehensionREF:800

OBJ: Client Needs: Psychosocial Integrity TOP: Nursing Process: Planning

16. In helping bereaved parents cope and move on, nurses should keep in mind that:

a. A perinatal or parental grief support group is more likely to be helpful if the needs of the parents are matched with the focus of the group.
b. When pictures of the infant are taken for keepsakes, no close-ups should be taken of any congenital anomalies.
c. No significant differences exist in grieving individuals from various cultures, ethnic groups, and religions.
d. In emergency situations, nurses who are so disposed must resist the temptation to baptize the infant in the absence of a priest or minister.

ANS: A

Feedback
A For example, a religious-based group may not work for nonreligious parents.
B Close-up pictures of the baby must be taken as the infant was, congenital anomalies and all.
C Although death and grieving are events shared by all people, mourning rituals, traditions, and taboos vary by culture, ethnicity, and religion. Differences must be respected.
D Baptism for some religious groups can be performed by a layperson such as a nurse in an emergency situation when a priest is not available.

DIF:Cognitive Level: ComprehensionREF:808

OBJ: Client Needs: Psychosocial Integrity TOP: Nursing Process: Planning

17. A pregnant woman presents in labor at term, having had no prenatal care. After birth her infant is noted to be small for gestational age with small eyes and a thin upper lip. The infant also is microcephalic. On the basis of her infants physical findings, this woman should be questioned about her use of which substance during pregnancy?

a. Alcohol
b. Cocaine
c. Heroin
d. Marijuana

ANS: A

Feedback
A The description of the infant suggests fetal alcohol syndrome, which is consistent with maternal alcohol consumption during pregnancy.
B Fetal brain, kidney, and urogenital system malformations have been associated with maternal cocaine ingestions.
C Heroin use in pregnancy frequently results in intrauterine growth restriction. The infant may have a shrill cry and sleep cycle disturbances and present with poor feeding, tachypnea, vomiting, diarrhea, hypothermia or hyperthermia, and sweating.
D Studies have found a higher incidence of meconium staining in infants born of mothers who used marijuana during pregnancy.

DIF:Cognitive Level: ComprehensionREF:785

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment

18. For diagnostic and treatment purposes, nurses should know the birth weight classifications of high risk infants. For example, extremely low birth weight (ELBW) is the designation for an infant whose weight is:

a. Less than 1500 g.
b. Less than 1000 g.
c. Less than 2000 g.
d. Dependent on the gestational age.

ANS: B

Feedback
A This is the designation for very low birth rate; ELBW is less than 1000 g.
B At this weight, problems are so numerous that ethical issues regarding when to treat arise.
C This weight is less than low but too high for extremely low, which is less than 1000 g.
D Gestational age is a factor related to weight and the condition of the preterm birth, but it is not part of the birth weight categorization.

DIF:Cognitive Level: KnowledgeREF:753

OBJ:Client Needs: Physiologic Integrity

TOP:Nursing Process: Planning, Implementation

19. With regard to skeletal injuries sustained by a neonate during labor or birth, nurses should be aware that:

a. A newborns skull is still forming and fractures fairly easily.
b. Unless a blood vessel is involved, linear skull fractures heal without special treatment.
c. Clavicle fractures often need to be set with an inserted pin for stability.
d. Other than the skull, the most common skeletal injuries are to leg bones.

ANS: B

Feedback
A Because the newborn skull is flexible, considerable force is required to fracture it.
B About 70% of neonatal skull fractures are linear.
C Clavicle fractures need no special treatment.
D The clavicle is the bone most often fractured during birth.

DIF:Cognitive Level: ComprehensionREF:776

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning

20. The nurse caring for a family during a loss might notice that survival guilt sometimes is felt at the death of an infant by the childs:

a. Siblings.
b. Mother.
c. Father.
d. Grandparents.

ANS: D

Feedback
A Survival guilt is most often felt by grandparents, not siblings, because they believe that the death upsets the natural order of things. They are angry that they are alive and their grandchild is not.
B Survival guilt sometimes is most often felt by grandparents, not the mother, because they believe that the death upsets the natural order of things. They are angry that they are alive and their grandchild is not.
C Survival guilt sometimes is most often felt by grandparents, rather than the father, because they believe that the death upsets the natural order of things. They are angry that they are alive and their grandchild is not.
D Survival guilt sometimes is felt by grandparents, because they believe that the death upsets the natural order of things. They are angry that they are alive and their grandchild is not.

DIF:Cognitive Level: ComprehensionREF:803

OBJ: Client Needs: Psychosocial Integrity TOP: Nursing Process: Evaluation

21. A premature infant with respiratory distress syndrome receives artificial surfactant. How would the nurse explain surfactant therapy to the parents?

a. Surfactant improves the ability of your babys lungs to exchange oxygen and carbon dioxide.
b. The drug keeps your baby from requiring too much sedation.
c. Surfactant is used to reduce episodes of periodic apnea.
d. Your baby needs this medication to fight a possible respiratory tract infection.

ANS: A

Feedback
A Surfactant can be administered as an adjunct to oxygen and ventilation therapy. With administration of artificial surfactant, respiratory compliance is improved until the infant can generate enough surfactant on his or her own.
B Surfactant has no bearing on the sedation needs of the infant.
C Surfactant is used to improve respiratory compliance, including the exchange of oxygen and carbon dioxide. The goal of surfactant therapy in an infant with respiratory distress syndrome (RDS) is to stimulate production of surfactant in the type 2 cells of the alveoli.
D The clinical presentation of RDS and neonatal pneumonia may be similar. The infant may be started on broad-spectrum antibiotics to treat infection.

DIF:Cognitive Level: ApplicationREF:759

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Planning

22. What bacterial infection is definitely decreasing because of effective drug treatment?

a. Escherichia coli infection
b. Tuberculosis
c. Candidiasis
d. Group B streptococcal infection

ANS: D

Feedback
A E. coli may be increasing, perhaps because of the increasing use of ampicillin (resulting in a more virulent E. coli resistant to the drug). Group B streptococcus has been beaten back by penicillin.
B Tuberculosis is increasing in the United States and Canada. Group B streptococcus has been beaten back by penicillin.
C Candidiasis is a fairly benign fungal infection. Group B streptococcus has been beaten back by penicillin.
D Penicillin has significantly decreased the incidence of group B streptococcal infection.

DIF:Cognitive Level: ComprehensionREF:775

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Evaluation

23. 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.

ANS: C

Feedback
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 (CNS) 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 gastrointestinal 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.

DIF:Cognitive Level: ApplicationREF:787

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment

24. With regard to small for gestational age (SGA) infants and intrauterine growth restriction (IUGR), nurses should be aware that:

a. In the first trimester diseases or abnormalities result in asymmetric IUGR.
b. Infants with asymmetric IUGR have the potential for normal growth and development.
c. In asymmetric IUGR, weight will be slightly more than SGA, whereas length and head circumference will be somewhat less than SGA.
d. Symmetric IUGR occurs in the later stages of pregnancy.

ANS: B

Feedback
A IUGR is either symmetric or asymmetric. The symmetric form occurs in the first trimester; SGA infants have reduced brain capacity. The asymmetric form occurs in the later stages of pregnancy. Weight is less than the 10th percentile; head circumference is greater than the 10th percentile. Infants with asymmetric IUGR have the potential for normal growth and development.
B IUGR is either symmetric or asymmetric. The symmetric form occurs in the first trimester; SGA infants have reduced brain capacity. The asymmetric form occurs in the later stages of pregnancy. Weight is less than the 10th percentile; head circumference is greater than the 10th percentile. Infants with asymmetric IUGR have the potential for normal growth and development.
C IUGR is either symmetric or asymmetric. The symmetric form occurs in the first trimester; SGA infants have reduced brain capacity. The asymmetric form occurs in the later stages of pregnancy. Weight is less than the 10th percentile; head circumference is greater than the 10th percentile. Infants with asymmetric IUGR have the potential for normal growth and development.
D IUGR is either symmetric or asymmetric. The symmetric form occurs in the first trimester; SGA infants have reduced brain capacity. The asymmetric form occurs in the later stages of pregnancy. Weight is less than the 10th percentile; head circumference is greater than the 10th percentile. Infants with asymmetric IUGR have the potential for normal growth and development.

DIF:Cognitive Level: ComprehensionREF:772

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Planning

25. A major nursing intervention for an infant born with myelomeningocele is to:

a. Protect the sac from injury.
b. Prepare the parents for the childs paralysis from the waist down.
c. Prepare the parents for closure of the sac at around 2 years of age.
d. Assess for cyanosis.

ANS: A

Feedback
A A major preoperative nursing intervention for a neonate with a myelomeningocele is protection of the protruding sac from injury to prevent its rupture and the resultant risk of central nervous system infection.
B The long-term prognosis in an affected infant can be determined to a large extent at birth with the degree of neurologic dysfunction related to the level of the lesion, which determines the nerves involved.
C A myelomeningocele should be surgically closed within 24 hours.
D Although the nurse would assess for multiple potential problems in this infant, the major nursing intervention would be to protect the sac from injury.

DIF:Cognitive Level: ComprehensionREF:791

OBJ:Client Needs: Physiologic Integrity

TOP:Nursing Process: Planning, Implementation

26. With regard to hemolytic diseases of the newborn, nurses should be aware that:

a. Rh incompatibility matters only when an Rh-negative offspring is born to an Rh-positive mother.
b. ABO incompatibility is more likely than Rh incompatibility to precipitate significant anemia.
c. Exchange transfusions frequently are required in the treatment of hemolytic disorders.
d. The indirect Coombs test is performed on the mother before birth; the direct Coombs test is performed on the cord blood after birth.

ANS: D

Feedback
A Only the Rh-positive offspring of an Rh-negative mother is at risk.
B ABO incompatibility is more common than Rh incompatibility but causes less severe problems; significant anemia, for instance, is rare with ABO.
C Exchange transfers are needed infrequently because of the decrease in the incidence of severe hemolytic disease in newborns from Rh incompatibility.
D An indirect Coombs test may be performed on the mother a few times during pregnancy.

DIF:Cognitive Level: ComprehensionREF:789

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Planning

27. An infant is being discharged from the neonatal intensive care unit after 70 days of hospitalization. The infant was born at 30 weeks of gestation with several conditions associated with prematurity, including respiratory distress syndrome, mild bronchopulmonary dysplasia, and retinopathy of prematurity requiring surgical treatment. During discharge teaching the infants mother asks the nurse if her baby will meet developmental milestones on time, as did her son who was born at term. The nurses most appropriate response would be:

a. Your baby will develop exactly like your first child did.
b. Your baby does not appear to have any problems at the present time.
c. Your baby will need to be corrected for prematurity. Your baby is currently 40 weeks of postconceptional age and can be expected to be doing what a 40-week-old infant would be doing.
d. Your baby will need to be followed very closely.

ANS: C

Feedback
A Although it is impossible to predict with complete accuracy the growth and development potential of each preterm infant, certain measurable factors predict normal growth and development. The preterm infant experiences catch-up body growth during the first 2 to 3 years of life. The growth and developmental milestones are corrected for gestational age until the child is approximately 2 years old.
B This statement is inaccurate. Development will need to be evaluated over time.
C The age of a preterm newborn is corrected by adding the gestational age and the postnatal age. The infants responses are evaluated accordingly against the norm expected for the corrected age of the infant.
D The growth and developmental milestones are corrected for gestational age until the child is approximately 2 years old.

DIF:Cognitive Level: ApplicationREF:769

OBJ: Client Needs: Health Promotion and Maintenance TOP: Nursing Process: Planning

28. When helping the mother, father, and other family members actualize the loss of the infant, nurses should:

a. Use the words lost or gone rather than dead or died.
b. Make sure that the family understands that it is important to name the baby.
c. If the parents choose to visit with the baby, apply powder and lotion to the baby and wrap the infant in a pretty blanket.
d. Set a firm time for ending the visit with the baby so the parents know when to let go.

ANS: C

Feedback
A Nurses must use dead and died to assist the bereaved in accepting reality.
B Although naming the baby can be helpful, it is important not to create the sense that parents have to name the baby. In fact, some cultural taboos and religious rules prohibit the naming of an infant who has died.
C Presenting the baby in a nice way stimulates the parents senses and provides pleasant memories of their baby.
D Parents need different time periods with their baby to say goodbye. Nurses need to be careful not to rush the process.

DIF:Cognitive Level: ComprehensionREF:803

OBJ: Client Needs: Psychosocial Integrity TOP: Nursing Process: Planning

COMPLETION

1. ____________________ is a condition in which the ventricles of the brain are enlarged as a result of an imbalance between the production and absorption of the cerebrospinal fluid (CSF). An infant with this condition initially has a bulging anterior fontanel and a head circumference that increases at an abnormal rate, resulting from the increase in CSF pressure.

ANS:

Hydrocephalus

Surgical shunting is necessary shortly after birth. Nursing care is similar to that of any high risk newborn.

DIF:Cognitive Level: ComprehensionREF:792

OBJ: Client Needs: Physiologic Integrity TOP: Nursing Process: Assessment

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.

ANS:

Methadone

Methadone withdrawal is more severe and prolonged than withdrawal from heroin. Signs of withdrawal include tremors, irritability, hypertonicity, vomiting, mottling, nasal stuffiness, and disturbed sleep patterns. This infant is also at an increased risk for SIDS.

DIF:Cognitive Level: ComprehensionREF:785

OBJ:Client Needs: Physiologic Integrity

TOP:Nursing Process: Implementation, Planning

TRUE/FALSE

1. As with all aspects of care, strict handwashing is the single most important measure to prevent nosocomial infections.

ANS: T

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Correct Strict handwashing is the single most important measure to prevent nosocomial infections.
Incorrect Even though protection from infection is an integral part of all newborn care, preterm and sick infants are particularly susceptible to infectious organisms.

DIF:Cognitive Level: KnowledgeREF:757

OBJ:Client Needs: Safe and Effective Care Environment

TOP: Nursing Process: Implementation

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