Chapter 30 The High-Risk Newborn: Acquired and Congenital Conditions

Chapter 30  The High-Risk Newborn: Acquired and Congenital Conditions

Complete Chapter Questions And Answers
 

Sample Questions

MULTIPLE CHOICE

1. The infant of a mother with diabetes is hypoglycemic. What type of feeding should be

instituted first?
a. Glucose water in a bottle
b. D5W intravenously
c. Formula via nasogastric tube
d. Breast milk

ANS: D
Breast milk is metabolized more slowly and provides longer normal glucose levels. Breast
milk is best for nearly all babies. High levels of dextrose correct the hypoglycemia but will
stimulate the production of more insulin. Oral feedings are tried first; intravenous lines
should be a later choice if the hypoglycemia continues. Formula does provide longer normal
glucose levels but would be administered via bottle, not by tube feeding unless the baby is
unable to take oral feedings.

PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
REF: p. 652 OBJ: Nursing Process: Implementation
MSC: Client Needs: Physiologic Integrity

2. The nurse learns that the most common cause of pathologic hyperbilirubinemia is which of

the following?
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 and prematurity may be causes of pathologic hyperbilirubinemia, but they
are not the most common cause. Congenital heart defect is not a common cause of
pathologic hyperbilirubinemia in neonates.

PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
REF: p. 645 OBJ: Integrated Process: Teaching-Learning
MSC: Client Needs: Physiologic Integrity

3. An infant with severe meconium aspiration syndrome (MAS) is not responding to

conventional treatment. Which treatment may be necessary for this infant?
a. Extracorporeal membrane oxygenation
b. Respiratory support with ventilator
c. Insertion of laryngoscope and suctioning of the trachea
d. Insertion of an endotracheal tube

ANS: A

Extracorporeal membrane oxygenation is a highly technical method that oxygenates the
blood while bypassing the lungs, allowing the infant’s lungs to rest and recover. The infant
is most likely intubated and on a ventilator already. Laryngoscope insertion and tracheal
suctioning are performed after birth before the infant takes the first breath.

PTS: 1 DIF: Cognitive Level: Knowledge/Remembering
REF: p. 644 OBJ: Nursing Process: Planning
MSC: Client Needs: Physiologic Integrity

4. Four hours after delivery of a healthy neonate of an insulin-dependent diabetic woman, the

baby appears jittery, irritable, and has a high-pitched cry. Which nursing action has top
priority?
a. Start an intravenous line with D5W.
b. Notify the clinician stat.
c. Document the event in the nurses’ notes.
d. Test for blood glucose level.

ANS: D
These are signs of hypoglycemia in the newborn. The nurse should test the infant’s blood
glucose level and then feed the infant if it is low. It is not common practice to give
intravenous glucose to a newborn prior to feeding. Feeding the infant is preferable because
the formula or breast milk will last longer. The provider needs to be notified after corrective
action has been taken. Documentation should occur but is not the priority.

PTS: 1 DIF: Cognitive Level: Application/Applying
REF: p. 652 OBJ: Nursing Process: Implementation
MSC: Client Needs: Safe and Effective Care Environment

5. A nurse is participating in a neonatal resuscitation. What action by the nurse takes priority?

a. Suction the mouth and nose.
b. Stimulate the infant by rubbing the back.
c. Perform the Apgar test.
d. Place the infant in a preheated warmer.

ANS: D
In a resuscitation situation, the nurse places the newborn in a preheated warmer immediately
to reduce cold stress. Next position the infant in a “sniffing” position. Suctioning is the third
step. Drying the infant is fourth, although if more than one health care provider is present,
drying can occur simultaneously with the other actions.

PTS: 1 DIF: Cognitive Level: Application/Applying
REF: p. 643 OBJ: Nursing Process: Implementation
MSC: Client Needs: Physiologic Integrity