Chapter 35: Acquired Problems of the Newborn My Nursing Test Banks

Lowdermilk: Maternity & Womens Health Care, 10th Edition

Chapter 35: Acquired Problems of the Newborn

Test Bank

MULTIPLE CHOICE

1. 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 lb, 6 oz). The nurses 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

ANS: D

This infant is macrosomic (more than 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.

Macrosomic infants need to be observed closely. This can be achieved in the mothers room with nursing interventions, depending on the condition of the infant. It may be more appropriate for observation to occur in the nursery.

Observation of the macrosomic infant may occur in the nursery or in the mothers room, depending on the condition of the infant.

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.

DIF: Cognitive Level: Application REF: 843

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Implementation

2. A 3.8-kg infant was delivered vaginally at 39 weeks after a 30-minute second stage. There was a nuchal cord. After birth the infant is noted to have petechiae over the face and upper back. Information given to the infants parents should be based on the knowledge that petechiae:

a.

Are benign if they disappear within 48 hours of birth

b.

Result from increased blood volume

c.

Should always be further investigated

d.

Usually occur with forceps delivery

ANS: A

Petechiae, or pinpoint hemorrhagic areas, acquired during birth may extend over the upper portion of the trunk and face. These lesions are benign if they disappear within 2 days of birth and no new lesions appear.

Petechiae may result from decreased platelet formation.

In this situation, the presence of petechiae is most likely a soft-tissue injury resulting from the nuchal cord at birth. Unless they do not dissipate in 2 days, there is no reason to alarm the family.

Petechiae usually occur with a breech presentation vaginal birth.

DIF: Cognitive Level: Application REF: 838

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

3. When planning care for an infant with a fractured clavicle, the nurse should recognize that in addition to gentle handling:

a.

Prone positioning facilitates bone alignment

b.

No special treatment is necessary

c.

Parents should be taught range-of-motion exercises

d.

The shoulder should be immobilized with a splint

ANS: B

Fractures in newborns generally heal rapidly. Except for gentle handling, no accepted treatment for a fractured clavicle exists.

Fractures in newborns generally heal rapidly. Except for gentle handling, no accepted treatment for a fractured clavicle exists.

Movement should be limited, and the infant should be gently handled. It is not necessary to perform range of motion exercises on the infant.

A fractured clavicle does not require immobilization with a splint.

DIF: Cognitive Level: Application REF: 839

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Implementation

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

a.

Anemia

b.

Hyponatremia

c.

Respiratory distress syndrome

d.

Sepsis

ANS: C

IDMs are at risk for macrosomia, birth trauma, perinatal asphyxia, respiratory distress syndrome, hypoglycemia, hypocalcemia, hypomagnesemia, cardiomyopathy, hyperbilirubinemia, and polycythemia.

Infants of diabetic mothers (IDMs) are not at risk for anemia. They are at risk for polycythemia.

IDMs are not at risk for hyponatremia. They are at risk for hypocalcemia and hypomagnesemia.

IDMs are not at risk for sepsis.

DIF: Cognitive Level: Comprehension REF: 841

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Planning

5. 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 newborns distress is most likely:

a.

Hypoglycemia

b.

Phrenic nerve injury

c.

Respiratory distress syndrome

d.

Sepsis

ANS: D

The prolonged rupture of membranes and the tachypnea (before and after birth) suggest sepsis.

A differential diagnosis can be difficult because signs of sepsis are similar to noninfectious problems such as anemia and hypoglycemia.

Phrenic nerve injury is usually the result of traction on the neck and arm during birth and is not applicable to this situation.

The earliest signs of sepsis are characterized by lack of specificity (i.e., lethargy, poor feeding, and irritability), not respiratory distress syndrome.

DIF: Cognitive Level: Comprehension REF: 845

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Assessment

6. 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

ANS: A

Virtually all controlled clinical trials have demonstrated that effective handwashing is responsible for the prevention of health careassociated infection in nursery units.

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.

Separate gowns should be worn in caring for each infant. Soiled linens should be disposed of in an appropriate manner; however, the most important nursing action for preventing neonatal infection is effective handwashing.

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.

DIF: Cognitive Level: Comprehension REF: 847

OBJ: Client Needs: Safe and Effective Care Environment

TOP: Nursing Process: Implementation

7. 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. Based on 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

The description of the infant suggests fetal alcohol syndrome, which is consistent with maternal alcohol consumption during pregnancy.

Fetal brain, kidney, and urogenital system malformations have been associated with maternal cocaine ingestions.

Heroin use in pregnancy frequently results in intrauterine growth restriction (IUGR). The infant may have a shrill cry and sleep cycle disturbances and may present with poor feeding, tachypnea, vomiting, diarrhea, hypothermia or hyperthermia, and sweating.

Studies have found a higher incidence of meconium staining in infants born of mothers who used marijuana during pregnancy.

DIF: Cognitive Level: Comprehension REF: 857

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Assessment

8. 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

ANS: C

The infant should be wrapped snugly to reduce self-stimulation behaviors and protect the skin from abrasions.

Phenobarbital or diazepam may be administered to decrease central nervous system (CNS) irritability.

The infant should be fed in small, frequent amounts and burped well to diminish aspiration and maintain hydration.

The infant should not be stimulated (such as with music), because this will increase activity and potentially increase CNS irritability.

DIF: Cognitive Level: Application REF: 863

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Implementation

9. Human immunodeficiency virus (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

ANS: D

Postnatal transmission of HIV through breastfeeding may occur.

Transmission of HIV from the mother to the infant may occur transplacentally at various gestational ages. Transmission close to or at the time of birth is thought to account for 50% to 80% of cases.

This is highly unlikely because most health care facilities must meet sterility standards for all instrumentation.

Transmission of HIV may occur through the placenta from the mother to the fetus or through breast milk postnatally.

DIF: Cognitive Level: Comprehension REF: 851

OBJ: Client Needs: Physiologic Integrity, Reduction of Risk Potential

TOP: Nursing Process: Planning

10. The abuse of which substance during pregnancy is a significant cause of mental retardation in the United States?

a.

Alcohol

b.

Tobacco

c.

Marijuana

d.

Heroin

ANS: A

Alcohol abuse during pregnancy is recognized as one of the leading causes of mental retardation in the United States. Alcohol is a teratogen; maternal ethanol abuse during gestation can lead to identifiable fetal alcohol spectrum disorders that include alcohol-related neurodevelopmental disorders.

Cigarette smoking is linked to adverse pregnancy outcomes. The risk for placenta previa, abruption, and premature rupture of membranes is twice that of nonsmokers.

Marijuana is the most common illicit drug used by pregnant women. Marijuana crosses the placenta, and its use during pregnancy can result in shortened gestation and a higher incidence of intrauterine growth restriction (IUGR).

Heroin crosses the placenta and often results in IUGR, stillbirth, and congenital anomalies.

DIF: Cognitive Level: Knowledge REF: 857

OBJ: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Assessment

11. During a prenatal examination a 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 questions the nurse as to why, the nurses best response is:

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 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 you and your baby.

ANS: 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.

Human immunodeficiency virus (HIV) is not transmitted by cats.

Although this may be a valid statement, it is not appropriate, does not answer the clients question, and is not the nurses best response.

E. coli is found in normal human fecal flora. It is not transmitted by cats.

DIF: Cognitive Level: Application REF: 848

OBJ: Client Needs: Safe and Effective Care Environment

TOP: Nursing Process: Planning

12. A primigravida has just delivered a healthy infant girl. The nurse is about to administer erythromycin ointment in the infants 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 babys eyes from drying out over the next few days.

ANS: 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.

Erythromycin has no bearing on enhancing vision.

Erythromycin is used to prevent an infection caused by gonorrhea, not herpes.

Erythromycin is given to prevent infection, not for lubrication.

DIF: Cognitive Level: Application REF: 848

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

13. 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

About 70% of neonatal skull fractures are linear.

Because the newborn skull is flexible, considerable force is required to fracture it.

Clavicle fractures need no special treatment.

The clavicle is the bone most often fractured during birth.

DIF: Cognitive Level: Comprehension REF: 839

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Planning

14. With regard to central nervous system injuries to the infant during labor and birth, nurses should be aware that:

a.

Intracranial hemorrhage (ICH) as a result of birth trauma is more likely to occur in the preterm, low-birth-weight infant

b.

Subarachnoid hemorrhage (the most common form of ICH) occurs in term infants as a result of hypoxia

c.

In many infants, signs of hemorrhage in a full-term infant are absent and diagnosed only through laboratory tests

d.

Spinal cord injuries almost always result from forceps-assisted deliveries

ANS: C

Abnormalities in lumbar punctures or red blood cell counts, for instance, or in visuals on computed tomography (CT) scan might reveal a hemorrhage.

ICH as a result of birth trauma is more likely to occur in the full-term, large infant.

Subarachnoid hemorrhage in term infants is a result of trauma; in preterm infants, it is a result of hypoxia.

Spinal cord injuries are almost always from breech births; they are rare today because cesarean birth often is used for breech presentation.

DIF: Cognitive Level: Comprehension REF: 841

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Planning

15. 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 (HSV) infection

c.

Congenital syphilis

d.

Human immunodeficiency virus (HIV)

ANS: C

This rash is indicative of congenital syphilis. The lesions may extend over the trunk and extremities.

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.

Infants affected with HSV display growth restriction, skin lesions, microcephaly, hypertonicity, and seizures.

Typically the HIV-infected neonate is asymptomatic at birth. Most often the infant develops an opportunistic infection and rapid progression of immunodeficiency.

DIF: Cognitive Level: Analysis REF: 849

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Diagnosis

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

a.

Escherichia coli infection

b.

Tuberculosis

c.

Candidiasis

d.

Group B streptococci (GBS) infection

ANS: D

Penicillin has significantly decreased the incidence of GBS infection.

E. coli may be increasing, perhaps because of the increasing use of ampicillin (resulting in a more virulent E. coli resistant to the drug).

Tuberculosis is increasing in the United States and in Canada.

Candidiasis is a fairly benign fungal infection.

DIF: Cognitive Level: Comprehension REF: 853, 854

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Evaluation

17. A careful review of the literature on the various recreational and illicit drugs reveals that:

a.

More, longer-term studies are needed to assess the lasting effects on infants when mothers have taken or are taking illegal drugs

b.

Heroin and methadone cross the placenta; marijuana, cocaine, and PCP do not

c.

Mothers should get off heroin (detoxification) any time they can during pregnancy

d.

Methadone withdrawal for infants is less severe and shorter than heroin withdrawal

ANS: A

Studies on the effects of marijuana and cocaine use by mothers are somewhat contradictory. More, longer-range studies are needed.

Just about all of these drugs cross the placenta, including marijuana, cocaine, and PCP.

Drug withdrawal is accompanied by fetal withdrawal, which can lead to fetal death. Therefore, detoxification from heroin is not recommended, particularly later, in pregnancy.

Methadone withdrawal is more severe and more prolonged than heroin withdrawal.

DIF: Cognitive Level: Analysis REF: 860

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Evaluation

18. With regard to the understanding and treatment of infants born to mothers who are substance abusers, nurses should be aware that:

a.

Infants born to addicted mothers are also addicted

b.

Mothers who abuse one substance likely will use or abuse another, compounding the infants difficulties

c.

The NICU Network Neurobehavioral Scale (NNNS) is designed to assess the damage the mother has done to herself

d.

No laboratory procedures can identify the intrauterine drug exposure of the infant

ANS: B

Multiple substance use (even alcohol and tobacco) makes it difficult to assess the problems of the exposed infant, particularly with regard to withdrawal manifestations.

Infants of substance-abusing mothers may have some of the physiologic signs but are not addicted in the behavioral sense. Drug-exposed newborn is a more accurate description than addict.

The NNNS is designed to assess the neurologic, behavioral, and stress/abstinence function of the neonate.

Newborn urine, hair, or meconium sampling may be used to identify an infants intrauterine drug exposure.

DIF: Cognitive Level: Comprehension REF: 856

OBJ: Client Needs: Psychosocial Integrity

TOP: Nursing Process: Evaluation

19. 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

Neonatal abstinence syndrome (NAS) describes the cohort of symptoms associated with drug withdrawal in the neonate. The Neonatal Abstinence Scoring System evaluates central nervous system (CNS), metabolic, vasomotor, respiratory, and gastrointestinal (GI) disturbances. This evaluation tool enables the health 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.

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.

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.

Poor feeding is one of the GI symptoms common to this client 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: Application REF: 862

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Assessment

MULTIPLE RESPONSE

1. Many common drugs of abuse cause significant physiologic and behavioral problems in infants who are breastfed by mothers currently using (choose all that apply):

a.

Amphetamine

b.

Heroin

c.

Nicotine

d.

PCP

e.

Morphine

ANS: A, B, C, D

Use of amphetamines, heroin, nicotine, and PDP is contraindicated during breastfeeding because of the reported effects on the infant.

Morphine is a medication often used to treat neonatal abstinence syndrome.

DIF: Cognitive Level: Comprehension REF: 862

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Assessment

COMPLETION

1. ____________________, 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, nasal stuffiness, and disturbed sleep patterns. This infant is also at increased risk for sudden infant death syndrome (SIDS).

DIF: Cognitive Level: Comprehension REF: 859

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Implementation, Planning

TRUE/FALSE

1. In the neonatal intensive care unit (NICU) setting, artificial and long fingernails worn by nurses have been associated with serious neonatal infection and morbidity. Is this statement true or false?

ANS: T

Organisms such as Pseudomonas aeruginosa and Klebsiella have been transmitted to neonates in the NICU setting by the nursing staff. Institutional policies should guide the appropriate attire of the nursing staff.

DIF: Cognitive Level: Application REF: 848

OBJ: Client Needs: Safe and Effective Care Environment

TOP: Nursing Process: Implementation

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