Chapter 24 The Newborn at Risk

Chapter 24  The Newborn at Risk

Complete Chapter Questions And Answers
 

Sample Questions

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: Comprehension REF: 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: Comprehension REF: 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.
“You’re young and can have other children.”
d.
“I’m sorry.”

ANS: D

Feedback
A
The initial impulse may be to reduce one’s 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 clichés when offering support to the bereaved.
C
This is not a therapeutic response for the nurse to make.
D
One of the nurse’s 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, “I’m sorry.”

DIF: Cognitive Level: Application REF: 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: Analysis REF: 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: Application REF: 766
OBJ: Client Needs: Physiologic Integrity
TOP: Nursing Process: Implementation