Chapter 36 Hemolytic Disorders and Congenital Anomalies

Chapter 36  Hemolytic Disorders and Congenital Anomalies

Complete Chapter Questions And Answers
 

Sample Questions

MULTIPLE CHOICE

1. To explain hemolytic disorders in the newborn to new parents, the nurse who cares for the newborn population must be aware of the physiologic characteristics related to these conditions. What is the most common cause of pathologic hyperbilirubinemia?
a.
Hepatic disease
b.
Hemolytic disorders
c.
Postmaturity
d.
Congenital heart defect

ANS: B
Hemolytic disorders in the newborn are the most common cause of pathologic hyperbilirubinemia (jaundice). Although hepatic damage, prematurity, and congenital heart defects may cause pathologic hyperbilirubinemia, they are not the most common causes.

DIF: Cognitive Level: Apply REF: p. 882 TOP: Nursing Process: Diagnosis
MSC: Client Needs: Physiologic Integrity

2. Which infant is most likely to express 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 a mother who 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 a mother who is Rh positive

ANS: A
If the mother is Rh negative and the father is Rh positive and homozygous for the Rh factor, then all the offspring of this union 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, a 50% chance exists that each infant born of this union will be Rh positive, and a 50% chance exists that each will be born Rh negative. No risk for incompatibility exists if both the mother and the infant are Rh positive.

DIF: Cognitive Level: Understand REF: p. 883 TOP: Nursing Process: Planning
MSC: Client Needs: Health Promotion and Maintenance

3. What is the highest priority nursing intervention for an infant born with myelomeningocele?
a.
Protect the sac from injury.
b.
Prepare the parents for the child’s paralysis from the waist down.
c.
Prepare the parents for closure of the sac when the child is approximately 2 years of age.
d.
Assess for cyanosis.

ANS: A
A major preoperative nursing intervention for a neonate with a myelomeningocele is the 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: Understand REF: p. 892
TOP: Nursing Process: Planning | Nursing Process: Implementation
MSC: Client Needs: Physiologic Integrity

4. Which nursing diagnosis is most appropriate for a newborn diagnosed with a diaphragmatic hernia?
a.
Risk for impaired parent-infant attachment
b.
Imbalanced nutrition, related to 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 imbalanced nutrition, related to less than body requirements, 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 the 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: Apply REF: p. 894 TOP: Nursing Process: Diagnosis
MSC: Client Needs: Physiologic Integrity

5. What is the clinical finding most likely to be exhibited in an infant diagnosed with erythroblastosis fetalis?
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, as well as demonstrate signs of ascites.

DIF: Cognitive Level: Understand REF: p. 883
TOP: Nursing Process: Assessment MSC: Client Needs: Physiologic Integrity