Chapter 36: Hemolytic Disorders and Congenital Anomalies My Nursing Test Banks

Lowdermilk: Maternity & Womens Health Care, 10th Edition

Chapter 36: Hemolytic Disorders and Congenital Anomalies

Test Bank

MULTIPLE CHOICE

1. The most common cause of pathologic hyperbilirubinemia is:

a.

Hepatic disease

b.

Hemolytic disorders in the newborn

c.

Postmaturity

d.

Congenital heart defect

ANS: B

Hemolytic disorders in the newborn are the most common cause of pathologic jaundice.

Hepatic damage may be a cause of pathologic hyperbilirubinemia, but it is not the most common cause.

Prematurity is a cause of pathologic hyperbilirubinemia in neonates, but it is not the most common cause.

Congenital heart defect is not a common cause of pathologic hyperbilirubinemia in neonates.

DIF: Cognitive Level: Knowledge REF: 868

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Diagnosis

2. Which infant is more likely to have Rh incompatibility?

a.

Infant of an Rh-negative mother and a father who is Rh positive and homozygous for the Rh factor

b.

Infant who is Rh negative and whose mother is Rh negative

c.

Infant of an Rh-negative mother and a father who is Rh positive and heterozygous for the Rh factor

d.

Infant who is Rh positive and whose mother is Rh positive

ANS: A

If the mother is Rh negative and the father is Rh positive and homozygous for the Rh factor, all the offspring will be Rh positive. Only Rh-positive offspring of an Rh-negative mother are at risk for Rh incompatibility.

Only the Rh-positive offspring of an Rh-negative mother are at risk.

If the mother is Rh negative and the father is Rh positive and heterozygous for the factor, there is a 50% chance that each infant born of the union will be Rh positive and a 50% chance that each will be born Rh negative.

There is no risk for incompatibility if both the mother and infant are Rh positive.

DIF: Cognitive Level: Comprehension REF: 869

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

3. 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

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 (CNS) infection.

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.

A myelomeningocele should be surgically closed within 24 hours.

Although the nurse should assess for multiple potential problems in this infant, the major nursing intervention is to protect the sac from injury.

DIF: Cognitive Level: Comprehension REF: 877

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Planning, Implementation

4. The priority nursing diagnosis for a newborn diagnosed with a diaphragmatic hernia is:

a.

Risk for impaired parent-infant attachment

b.

Imbalanced nutrition: less than body requirements

c.

Risk for infection

d.

Impaired gas exchange

ANS: D

Herniation of the abdominal viscera into the thoracic cavity may cause severe respiratory distress and represent a neonatal emergency. Oxygen therapy, mechanical ventilation, and the correction of acidosis are necessary in infants with large defects.

Although this issue may be a factor in providing care to a newborn with a diaphragmatic hernia, the priority nursing diagnosis relates to the oxygenation issues arising from the lung hypoplasia that occurs with diaphragmatic hernia.

The nutritional needs of this infant may be a clearly identified need; however, at this time the nurse should be most concerned about impaired gas exchange.

This infant is at risk for infection especially once surgical repair has been performed. The extent of the herniation may have hindered normal development of the lungs in utero resulting in respiratory distress.

DIF: Cognitive Level: Application REF: 879

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Diagnosis

5. An infant diagnosed with erythroblastosis fetalis characteristically exhibits:

a.

Edema

b.

Immature red blood cells

c.

Enlargement of the heart

d.

Ascites

ANS: B

Erythroblastosis fetalis occurs when the fetus compensates for the anemia associated with Rh incompatibility by producing large numbers of immature erythrocytes to replace those hemolyzed.

Edema occurs with hydrops fetalis, a more severe form of erythroblastosis fetalis.

The fetus with hydrops fetalis may exhibit effusions into the peritoneal, pericardial, and pleural spaces.

The infant with hydrops fetalis displays signs of ascites.

DIF: Cognitive Level: Comprehension REF: 869

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Assessment

6. With regard to congenital anomalies of the cardiovascular and respiratory systems, nurses should be aware that:

a.

Cardiac disease may be manifested by respiratory signs and symptoms

b.

Screening for congenital anomalies of the respiratory system need only be done for infants having respiratory distress

c.

Choanal atresia can be corrected by a suction catheter

d.

Congenital diaphragmatic hernias are diagnosed and treated after birth

ANS: A

The cardiac and respiratory systems function together.

Screening for congenital respiratory system anomalies is necessary even for infants who appear normal at birth.

Choanal atresia requires emergency surgery.

Congenital diaphragmatic hernias are discovered prenatally on ultrasound.

DIF: Cognitive Level: Comprehension REF: 875

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Assessment

7. 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

Because DDH often is not detected at birth, infants should be carefully monitored at follow-up visits.

The Ortolani and Barlow tests must be performed by experienced clinicians to prevent fracture or other damage to the hip.

Double or triple diapering is not recommended because it promotes hip extension, thus worsening the problem.

Serial casting is done for clubfoot, not DDH.

DIF: Cognitive Level: Comprehension REF: 885

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

8. As a home care nurse, you are visiting a 5-day-old male infant for a scheduled follow-up appointment to ensure that he is responding to home phototherapy for treatment of jaundice. Based on the diagnosis of hyperbilirubinemia, you are aware that the development of acute bilirubin encephalopathy is a risk for this infant. This disease process occurs after the bilirubin level has peaked. After completing a thorough assessment and obtaining a history from the parents, you recognize that this infant is in the first phase of encephalopathy when he exhibits:

a.

A high-pitched cry

b.

Severe muscle spasms (opisthotonos)

c.

Fever and seizures

d.

Hypotonia, lethargy, and poor suck

ANS: D

The early and most subtle symptoms of bilirubin encephalopathy include hypotonia, lethargy, poor suck, and depressed or absent Moro reflex.

Should the infant display symptoms such as a high-pitched cry, severe muscle spasms, hyperreflexia, or arching of the back, the nurse should be aware that the baby has progressed beyond the more subtle signs of the first phase. Medical attention is necessary immediately.

Should the infant display symptoms such as a high-pitched cry, severe muscle spasms, hyperreflexia, or arching of the back, the nurse should be aware that the baby has progressed beyond the more subtle signs of the first phase. Medical attention is necessary immediately.

Symptoms may progress from the subtle indications of the first phase to fever and seizures in as little as 24 hours. Only about half of these infants survive and will have permanent sequelae including auditory deficiencies, intellectual deficits, and movement abnormalities.

DIF: Cognitive Level: Analysis REF: 870

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

9. The most widespread use of postnatal testing for genetic disease is the routine screening of newborns for inborn errors of metabolism (IEM). Which condition is not an IEM?

a.

Phenylketonuria (PKU)

b.

Galactosemia

c.

Hemoglobinopathy

d.

Cytomegalovirus (CMV)

ANS: D

CMV is not a metabolic disorder. Rather it is a virus contracted by the fetus. CMV cannot be detected by newborn screening.

PKU is an IEM that can be diagnosed with newborn screening.

Galactosemia is a metabolic defect that falls under the category of IEM.

Sickle cell disease and thalassemia are hemoglobinopathies that can be detected by newborn screening.

DIF: Cognitive Level: Comprehension REF: 889

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning

MULTIPLE RESPONSE

1. Cleft lip or palate is a common congenital midline fissure, or opening, in the lip or palate resulting from failure of the primary palate to fuse. Multiple genetic and, to a lesser extent, environmental factors may lead to the development of a cleft lip or palate. Such factors include (choose all that apply):

a.

Alcohol consumption

b.

Female gender

c.

Use of some anticonvulsant medications

d.

Maternal cigarette smoking

e.

Antibiotic use in pregnancy

ANS: A, C, D

Factors associated with the potential development of cleft lip or palate are maternal infections, radiation exposure, corticosteroids, anticonvulsants, male gender, Native-American or Asian descent, and smoking during pregnancy.

Cleft lip is more common in male infants. Antibiotic use in pregnancy is not associated with the development of cleft lip or palate.

DIF: Cognitive Level: Comprehension REF: 880

OBJ: Client Needs: Physiologic 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

If the surgical shunting of excess CSF from the brain is not done soon after birth, the resulting intracranial pressure will lead to irreversible neurologic damage.

DIF: Cognitive Level: Comprehension REF: 878

OBJ: Client Needs: Physiologic Integrity

TOP: Nursing Process: Assessment

TRUE/FALSE

1. Maternal obesity can increase the risk of congenital heart anomalies. Is this statement true or false?

ANS: T

An above-normal body mass index (BMI) has been associated with an increased risk for all congenital heart defects, and specifically conotruncal defects, tetralogy of Fallot, total anomalous pulmonary venous return, hypoplastic left heart syndrome, right ventricular outflow tract defects, and septal defects.

DIF: Cognitive Level: Comprehension REF: 874

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Assessment

2. Research has shown that maternal folic acid deficit has no bearing on failure of the neural tube defects to close. Is this statement true or false?

ANS: F

Maternal folic acid deficit has a direct bearing on failure of the neural tube to close; therefore, folic acid supplementation is recommended for all women of childbearing age.

DIF: Cognitive Level: Knowledge REF: 876

OBJ: Client Needs: Health Promotion and Maintenance

TOP: Nursing Process: Planning and Implementation

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