Chapter 29: The High-Risk Newborn: Problems Related to Gestational Age and Development My Nursing Test Banks

Chapter 29: The High-Risk Newborn: Problems Related to Gestational Age and Development

Test Bank

MULTIPLE CHOICE

1. What is most helpful in preventing premature birth?

a.

High socioeconomic status

b.

Adequate prenatal care

c.

Transitional Assistance to Needy Families

d.

Women, Infants, and Children nutritional program

ANS: B

Feedback

A

People with higher socioeconomic status are more likely to seek adequate prenatal care. The care is the most helpful in prevention.

B

Prenatal care is vital in identifying possible problems.

C

Lower socioeconomic groups do not seek out health care, and that puts them at risk for preterm labor.

D

This aids in the nutritional status of the pregnant woman, but the most helpful aid in prevention of premature births is adequate prenatal care.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 692

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

2. Compared to the term infant, the preterm infant has

a.

Few blood vessels visible though the skin

b.

More subcutaneous fat

c.

Well-developed flexor muscles

d.

Greater surface area in proportion to weight

ANS: D

Feedback

A

Preterm infants have greater surface area in proportion to their weight.

B

This is an indication of a more mature infant.

C

This is an indication of a more mature infant.

D

Preterm infants have greater surface area in proportion to their weight.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 693

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

3. Decreased surfactant production in the preterm lung is a problem because surfactant

a.

Causes increased permeability of the alveoli

b.

Provides transportation for oxygen to enter the blood supply

c.

Keeps the alveoli open during expiration

d.

Dilates the bronchioles, decreasing airway resistance

ANS: C

Feedback

A

Surfactant prevents the alveoli from collapsing.

B

By keeping the alveoli open, it permits better oxygen exchange, but that is not its main purpose.

C

Surfactant prevents the alveoli from collapsing each time the infant exhales, thus reducing the work of breathing.

D

It does not affect the bronchioles.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 692

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

4. An infant girl is preterm and on a respirator with intravenous lines and much equipment around her when her parents come to visit for the first time. It is important for the nurse to

a.

Suggest that the parents visit for only a short time to reduce their anxieties.

b.

Reassure the parents that the baby is progressing well.

c.

Encourage the parents to touch her.

d.

Discuss the care they will give her when she goes home.

ANS: C

Feedback

A

Bonding needs to occur, and this can be fostered by encouraging the parents to spend time with the infant.

B

It is important to keep the parents informed about the infants progression, but the nurse needs to be honest with the explanations.

C

Physical contact with the infant is important to establish early bonding. The nurse as the support person and teacher is responsible for shaping the environment and making the care giving responsive to the needs of both the parents and the infant. This is the most appropriate response by the nurse.

D

This is an important part of parent teaching, but it is not the most important priority during the first visit.

PTS: 1 DIF: Cognitive Level: Application REF: p. 705

OBJ: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

5. Late preterm infants need closer monitoring during her hospital stay than term infants. In order to prevent unrecognized cold-stress the nurse should perform all except

a.

Wean the infant to an open crib.

b.

Check temperature every 3 to 4 hours.

c.

Encourage kangaroo care.

d.

Place infant on a radiant warmer.

ANS: A

Feedback

A

The infant can be placed in an open bassinet after the nurse is assured that the baby is not experiencing cold stress and can maintain his or her body temperature.

B

LPI infants should have their temperature checked every 3 to 4 hours, depending on need and agency policy.

C

Kangaroo care (a method of providing skin to skin contact between infants and their parents) should be encouraged.

D

If the infant cannot maintain normal temperature they should be placed on a radiant warmer or in an incubator.

PTS: 1 DIF: Cognitive Level: Application REF: p. 691, 694

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

6. The preterm infant who should receive gavage feedings instead of a bottle is the one who

a.

Sometimes gags when a feeding tube is inserted

b.

Is unable to coordinate sucking and swallowing

c.

Sucks on a pacifier during gavage feedings

d.

Has an axillary temperature of 98.4 F, an apical pulse of 149 beats/min, and respirations of 54 breaths/min

ANS: B

Feedback

A

The presence of the gag reflex is important before initiating bottle-feeding.

B

Infants less than 34 weeks of gestation or who weigh less than 1500 g generally have difficulty with bottle-feeding.

C

Providing a pacifier during gavage feedings gives positive oral stimulation and helps associate the comfortable feeling of fullness with sucking.

D

These vital signs are within expected limits and an indication that the infant is not having respiratory problems at that time.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 700

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

7. Overstimulation may cause increased oxygen use in a preterm infant. Which nursing intervention helps to avoid this problem?

a.

Group all care activities together to provide long periods of rest.

b.

While giving your report to the next nurse, stand in front of the incubator and talk softly about how the infant responds to stimulation.

c.

Teach the parents signs of overstimulation, such as turning the face away or stiffening and extending the extremities and fingers.

d.

Keep charts on top of the incubator so the nurses can write on them there.

ANS: C

Feedback

A

This may understimulate the infant during those long periods and overtire the infant during the procedures.

B

This may cause overstimulation.

C

Parents should be taught these signs of overstimulation so they will learn to adapt their care to the needs of their infant.

D

Placing objects on top of the incubator or using it as a writing surface increases the noise inside.

PTS: 1 DIF: Cognitive Level: Application REF: p. 698

OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

8. A premature infant never seems to sleep longer than an hour at a time. Each time a light is turned on, an incubator closes, or people talk near her crib, she wakes up and cries inconsolably until held. The correct nursing diagnosis is ineffective coping related to

a.

Severe immaturity

b.

Environmental stress

c.

Physiologic distress

d.

Behavioral responses

ANS: B

Feedback

A

Although the infant may be severely immature in this case she is responding to environmental stress.

B

This nursing diagnosis is the most appropriate for this infant. Light and sound are known adverse stimuli that add to an already stressed premature infant. The nurse must monitor the environment closely for sources of overstimulation.

C

Physiologic distress is the response to environmental stress. The result is stress cues such as increased metabolic rate, increased oxygen and caloric use and depression of the immune system.

D

The infants behavioral response in the case is crying. The nursing diagnosis should reflect the cause of this response, which is environmental stress.

PTS: 1 DIF: Cognitive Level: Application REF: pp. 698-699

OBJ: Nursing Process: Diagnosis

MSC: Client Needs: Safe and Effective Care Environment

9. In caring for the preterm infant, what complication is thought to be a result of high arterial blood oxygen level?

a.

Necrotizing enterocolitis (NEC)

b.

Retinopathy of prematurity (ROP)

c.

Bronchopulmonary dysplasia (BPD)

d.

Intraventricular hemorrhage (IVH)

ANS: B

Feedback

A

NEC is due to the interference of blood supply to the intestinal mucosa. Necrotic lesions occur at that site.

B

ROP is thought to occur as a result of high levels of oxygen in the blood.

C

BPD is caused by the use of positive pressure ventilation against the immature lung tissue.

D

IVH is due to rupture of the fragile blood vessels in the ventricles of the brain. It is most often associated with hypoxic injury, increased blood pressure, and fluctuating cerebral blood flow.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 709

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

10. 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 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 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.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 707

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

11. Which combination of expressing pain could be demonstrated in a neonate?

a.

Low-pitched crying, tachycardia, eyelids open wide

b.

Cry face, flaccid limbs, closed mouth

c.

High-pitched, shrill cry, withdrawal, change in heart rate

d.

Cry face, eye squeeze, increase in blood pressure

ANS: D

Feedback

A

Cry and an increased heart rate are manifestations of neonatal pain. Typically, infants will close their eyes tightly when in pain, not open them wide.

B

Infants may cry in response to pain. Additionally, they may display a rigid posture with the mouth open.

C

A high-pitched, shrill cry is associated with genetic/neurologic anomalies. The infant may cry, withdraw limbs, and become tachycardic with pain.

D

These manifestations are indicative of pain in the neonate.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 697

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

12. Which is true about newborns classified as small for gestational age (SGA)?

a.

They weigh less than 2500 g.

b.

They are born before 38 weeks of gestation.

c.

Placental malfunction is the only recognized cause of this condition.

d.

They are below the 10th percentile on gestational growth charts.

ANS: D

Feedback

A

SGA infants are defined as below the 10th percentile in growth when compared to other infants of the same gestational age. SGA is not defined by weight.

B

Infants born before 38 weeks are defined as preterm.

C

There are many causes of SGA babies.

D

SGA infants are defined as below the 10th percentile in growth when compared with other infants of the same gestational age.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 711

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

13. What nursing action is especially important for the SGA newborn?

a.

Observe for respiratory distress syndrome.

b.

Observe for and prevent dehydration.

c.

Promote bonding.

d.

Prevent hypoglycemia by early and frequent feedings.

ANS: D

Feedback

A

Respiratory distress syndrome is seen in preterm infants.

B

Dehydration is a concern for all infants and is not specific for SGA infants.

C

Promoting bonding is a concern for all infants and is not specific for SGA infants.

D

The SGA infant has poor glycogen stores and is subject to hypoglycemia.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 712

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

14. What will the nurse note when assessing an SGA infant with asymmetric intrauterine growth restriction?

a.

One side of the body appears slightly smaller than the other.

b.

All body parts appear proportionate.

c.

The head seems large compared with the rest of the body.

d.

The extremities are disproportionate to the trunk.

ANS: C

Feedback

A

The left and right side growth should be symmetric. With asymmetric intrauterine growth restrictions, the body appears smaller than normal compared to the head.

B

The body parts are out of proportion, with the body looking smaller than expected due to the lack of subcutaneous fat.

C

In asymmetric intrauterine growth restriction, the head is normal in size but appears large because the infants body is long and thin due to lack of subcutaneous fat.

D

The body, arms, and legs have lost subcutaneous fat so they will look small compared to the head.

PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 711

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

15. Which statement is true about large for gestational age (LGA) infants?

a.

They weigh more than 3500 g.

b.

They are above the 80th percentile on gestational growth charts.

c.

They are prone to hypoglycemia, polycythemia, and birth injuries.

d.

Postmaturity syndrome and fractured clavicles are the most common complications.

ANS: C

Feedback

A

LGA infants are determined by their weight compared to their age.

B

They are above the 90th percentile on the gestational growth charts.

C

All three of these complications are common in LGA infants.

D

Birth injuries are a problem, but postmaturity syndrome is not an expected complication with LGA infants.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 712

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

16. Of all the signs seen in infants with respiratory distress syndrome, which sign is especially indicative of the syndrome?

a.

Pulse more than 160 beats/min

b.

Circumoral cyanosis

c.

Grunting

d.

Substernal retractions

ANS: C

Feedback

A

Grunting is more indicative of respiratory distress syndrome.

B

Grunting is more indicative of respiratory distress syndrome.

C

Grunting increases the pressure inside the alveoli to keep them open when surfactant is insufficient.

D

Grunting is more indicative of this syndrome.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 708

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

17. While caring for the postterm infant, the nurse recognizes that the fetus may have passed meconium prior to birth as a result of

a.

Hypoxia in utero

b.

NEC

c.

Placental insufficiency

d.

Rapid use of glycogen stores

ANS: A

Feedback

A

When labor begins, poor oxygen reserves may cause fetal compromise. The fetus may passed meconium as a result of hypoxia before or during labor increasing the risk of meconium aspiration.

B

Necrotizing enterocolitis (NEC) is a serious inflammatory condition of the intestinal tract that may lead to death of areas of the mucosa of the intestines. SGA infants are at increased risk for NEC.

C

If placental insufficiency is present, decreased amniotic fluid volume and umbilical cord compression is likely to occur. This resulted in both hypoxia and malnourishment of the fetus.

D

Postterm infants should be assessed for hypoglycemia because of the rapid use of glycogen stores.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 710

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

18. Which data should alert the nurse that the neonate is postmature?

a.

Cracked, peeling skin

b.

Short, chubby arms and legs

c.

Presence of vernix caseosa

d.

Presence of lanugo

ANS: A

Feedback

A

Loss of vernix caseosa, which protects the fetal skin in utero, may leave the skin macerated.

B

Postmature infants usually have long, thin arms and legs.

C

Vernix caseosa decreases in the postmature infant.

D

Absence of lanugo is common in postmature infants.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 711

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

19. Because of the premature infants decreased immune functioning, what nursing diagnosis should the nurse include in a plan of care for a premature infant?

a.

Delayed growth and development

b.

Ineffective thermoregulation

c.

Ineffective infant feeding pattern

d.

Risk for infection

ANS: D

Feedback

A

Growth and development may be affected, but only indirectly.

B

Thermoregulation may be affected, but only indirectly.

C

Feeding may be affected, but only indirectly.

D

The nurse needs to know that decreased immune functioning increases the risk for infection.

PTS: 1 DIF: Cognitive Level: Application REF: p. 696

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

20. To maintain optimal thermoregulation for the premature infant, the nurse should

a.

Bathe the infant once a day.

b.

Put an undershirt on the infant in the incubator.

c.

Assess the infants hydration status.

d.

Lightly clothe the infant under the radiant warmer.

ANS: B

Feedback

A

Bathing causes evaporative heat loss.

B

Air currents around an unclothed infant will result in heat loss.

C

This is an important assessment but will not maintain thermoregulation.

D

Clothing is not worn when the infant is under a radiant warmer.

PTS: 1 DIF: Cognitive Level: Application REF: p. 694

OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

MULTIPLE RESPONSE

1. Infants born between 34 0/7 and 36 6/7 weeks of gestation are called late preterm infants because they have many needs similar to those of preterm infants. Because they are more stable than early preterm infants, they may receive care that is much like that of a full-term baby. The mother-baby or nursery nurse knows that these babies are at increased risk for (select all that apply)

a.

Problems with thermoregulation

b.

Cardiac distress

c.

Hyperbilirubinemia

d.

Sepsis

e.

Hyperglycemia

ANS: A, C, D

Feedback

Correct

All of these conditions are related to immaturity and warrant close observation. After discharge the infant is at risk for rehospitalization related to these problems. AWHONN has recently launched the Near-Term Infant Initiative to study the problem and ways to ensure that these infants receive adequate care. The nurse should ensure that this infant is feeding adequately before discharge and that parents are taught the signs and symptoms of these complications.

Incorrect

These infants are at risk for respiratory distress and hypoglycemia.

PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 690

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

2. An important nursing factor during the care of the infant in the NICU is assessment for signs of adequate parental attachment. The nurse must observe for signs that bonding is not occurring as expected. These include (select all that apply)

a.

Using positive terms to describe the infant

b.

Showing interest in other infants equal to that of their own

c.

Naming the infant

d.

Decreasing the number and length of visits

e.

Refusing offers to hold and care for the infant

ANS: B, D, E

Feedback

Correct

These are all indications that parental attachment may be delayed. The parent may also show a decrease in or lack of eye contact and spend last time talking to or smiling at their infant.

Incorrect

Failing to give the infant a name or use their name is a sign that bonding may be delayed. Refusing offers to hold their infant or learn how to care for them may initially be an expression of fear; however, over time this may indicate delayed bonding.

PTS: 1 DIF: Cognitive Level: Analysis REF: p. 704

OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

COMPLETION

1. The NICU nurse begins her shift by assessing one of the preterm infants assigned to her care. The infants color is pale, his O2 saturation has decreased, and he is grimacing. This infant is displaying common signs of ________.

ANS:

pain

These are all nonverbal cues to newborn pain. Other signs include moaning, whimpering, tense rigid muscles, increased or decreased heart rate, apnea, increased blood pressure, sleep-wake pattern changes, or display of a cry face. The nurse should discuss the infants response to pain with his provider to ensure that appropriate medications are available. Ordered medications should always be given before any painful procedure.

PTS: 1 DIF: Cognitive Level: Application REF: p. 697

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

2. Approximately 30% of preterm infants weighing less than 1500 g develop bleeding around and into the ventricles of the brain. This condition is known as _______________.

ANS:

intraventricular hemorrhage

Rupture of the fragile blood vessels in the germinal matrix, located around the ventricles of the brain results in germinal matrix bleeding or intraventricular hemorrhage. It is associated with increased or decreased blood pressure, asphyxia, mechanical ventilation, and increased or fluctuating cerebral blood flow.

PTS: 1 DIF: Cognitive Level: Application REF: p. 709

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

TRUE/FALSE

1. Breast milk is best source of food almost all infants and especially for preterm infants. Breast-feeding has numerous benefits for the preterm infant. One of the most important of these benefits is reducing the incidence of necrotizing enterocolitis (NEC). Is this statement true or false?

ANS: T

Is important for the nurse to explain to parents that the immunologic benefits of breast milk are particularly important to the preterm infant who did not receive passive immunity during fetal life. Human milk may stimulate the immune system and promotes gastrointestinal maturation. Breast milk provides protection against infection and decreases the incidence of NEC in the premature infant.

PTS: 1 DIF: Cognitive Level: Application REF: p. 701

OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

Leave a Reply