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Chapter 5: The High-Risk Neonate
MULTIPLE CHOICE
- The nurse weighs a neonate just after birth. The weight of the baby was 2475 grams. The neonate would be classified as:
| a. | Normal birth weight |
| b. | Low birth weight |
| c. | Very low birth weight |
| d. | Extremely low birth weight |
ANS: B
Low birth weight is classified as under 2500 grams. Very low birth weight is less than 1500 grams. Extremely low birth weight is less than 1000 grams.
DIF: Cognitive Level: Application REF: Page 71 OBJ: 2
TOP: The Preterm Infant KEY: Nursing Process Step: Assessment
MSC: NCLEX: Health Promotion and Maintenance
- A school nurse is counseling a group of teenage mothers. The nurse explains to the expectant mothers that having a low–birth weight baby could increase the risk for complications. A factor(s) that could increase the risk of low–birth weight infants with this group of mothers is(are):
| a. | Increased potential for lack of prenatal care |
| b. | Maternal age below 16 |
| c. | Physical or psychological stress |
| d. | All of the above |
ANS: D
These factors are commonly found among teenage mothers.
DIF: Cognitive Level: Application REF: Page 72 OBJ: 3
TOP: Risks Related to Prematurity KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
- A mother gives birth to a preterm infant. When inspecting the baby after birth, the nurse would expect to find:
| a. | The skin is firm and opaque |
| b. | Superficial veins may be seen beneath the abdomen and scalp |
| c. | Vernix caseosa |
| d. | Abdomen is flat or inverted |
ANS: B
The skin is transparent and loose. The baby is covered in lanugo. The vernix caseosa is absent. The abdomen protrudes. Superficial veins are visible on abdomen and scalp.
DIF: Cognitive Level: Application REF: Page 73 OBJ: 2
TOP: Risks Related to Prematurity KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
- During assessment of a newborn, the nurse notes the following symptoms: irregular, rapid respirations accompanied by respiratory grunting, flaring of the nostrils, tachycardia, and cyanosis. The nurse suspects the following problem:
| a. | No problem: these are normal findings |
| b. | Apnea |
| c. | Atelectasis |
| d. | Hemorrhagic disease |
ANS: C
The findings are not normal for an infant. Apnea is the cessation of breathing for 20 seconds or more. These symptoms are not consistent with hemorrhagic disease.
DIF: Cognitive Level: Analysis REF: Page 73 OBJ: 4
TOP: Risks Related to Prematurity KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
- Nursing care for the patient with atelectasis would include:
| a. | Placing baby in semi-Fowler’s |
| b. | Placing baby flat on back |
| c. | Placing baby on abdomen |
| d. | None of the above |
ANS: A
Placing the baby in semi-Fowler’s would allow optimal air exchange. Placing baby on the back or on the abdomen makes breathing much more difficult. Babies are usually abdominal breathers.
DIF: Cognitive Level: Application REF: Page 73 OBJ: 5
TOP: Atelectasis KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
- A physician anticipates that a mother may deliver her baby preterm. What test might be ordered to determine if the baby is at risk for the development of respiratory distress syndrome?
| a. | Alpha-fetoprotein |
| b. | L/S ratio |
| c. | PKU |
| d. | CBC |
ANS: B
Alpha-fetoprotein tests for congenital defects. The L/S ratio is used to detect insufficient amounts of surfactant. PKU tests for phenylketonuria. The CBC is not used to test for surfactant.
DIF: Cognitive Level: Analysis REF: Page 75 OBJ: 5
TOP: Respiratory Distress Syndrome KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
- The physician finds that the baby has insufficient amounts of surfactant. Replacement of surfactant:
| a. | Is not possible |
| b. | Can be given 1 to 2 days before delivery |
| c. | Is administered to the infant IV |
| d. | Is administered to the infant directly into the endotracheal tube |
ANS: D
Surfactant replacement is possible. It is administered directly into the endotracheal tube. It is not given IV. An injection of corticosteroid given to the mother 1 to 2 days before delivery may help reduce the risk of RDS.
DIF: Cognitive Level: Application REF: Page 75 OBJ: 5
TOP: Respiratory Distress Syndrome KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
- A nurse observes a neonate with an irregular breathing pattern. The infant has an episode of rapid breathing, then has very slow breathing, and then has no noticeable breathing. Staining of the amniotic fluid was noted at birth. The nurse suspects:
| a. | Necrotizing enterocolitis |
| b. | Apnea |
| c. | Meconium aspiration syndrome |
| d. | Atelectasis |
ANS: C
Meconium aspiration syndrome is suspected because of the stained amniotic fluid.
DIF: Cognitive Level: Analysis REF: Page 73 OBJ: 5
TOP: Meconium Aspiration Syndrome KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
- A preterm infant’s risk for infection is:
| a. | The same as that of a term infant |
| b. | Greater than that of a term infant |
| c. | The same as that of a fetus |
| d. | The same as that of a 3-month-old infant |
ANS: B
The risk for infection is greater than a term infant. The preterm infant has diminished immunity, and there is often a lack of inflammatory response at the site of infection.
DIF: Cognitive Level: Comprehension REF: Page 76 OBJ: 4
TOP: Sepsis KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
- A nurse is caring for a preterm infant that has been diagnosed with an infection. The nurse understands that:
| a. | The special precautions taken for all newborns are sufficient to care for this baby |
| b. | Neonates with sepsis are placed in an isolette to prevent infection spreading to the other neonates |
| c. | Spread of infection is not a problem because of the presence of maternal antibodies |
| d. | The site of infection will be obvious owing to specific signs and symptoms |
ANS: B
A preterm infant is at higher risk, and the normal precautions for all newborns are not sufficient. Neonates with an infection are placed in an isolette to prevent the spread of infection. Maternal antibodies cannot be relied on to combat all infections. The site of infection may not be obvious.
DIF: Cognitive Level: Synthesis REF: Page 76 OBJ: 5
TOP: Sepsis KEY: Nursing Process Step: Implementation
MSC: NCLEX: Infection Control
- A neonate in the NICU is unable to tolerate oral feedings. What are the possible methods of feeding this baby?
| a. | Gavage |
| b. | Parenteral feeding |
| c. | TPN |
| d. | All of the above |
ANS: D
All of these methods are alternatives for an infant that cannot tolerate oral feeding.
DIF: Cognitive Level: Application REF: Page 80 OBJ: 6
TOP: Nutrition KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
- The infant has improved. Which of the following findings would indicate to the nurse that the infant may be ready to try oral feedings?
| a. | Sucking and swallowing reflexes |
| b. | Weight loss |
| c. | Increased respiratory distress |
| d. | Bonding and attachment |
ANS: A
The sucking and swallowing reflexes must be intact before the baby can resume oral feedings. If the baby is experiencing weight loss, the baby will not likely be able to consume sufficient nutrition by mouth alone. Increased respiratory distress would be worsened by introducing oral feedings. Bonding and attachment are important, but do not help determine if a baby is ready for oral feeding.
DIF: Cognitive Level: Analysis REF: Page 81 OBJ: 6
TOP: Nutrition KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
- A preterm infant is critically ill. She is on a ventilator and is receiving TPN. The new mother wants to help with her baby’s care. The nurse tells her:
| a. | “You cannot touch your baby until she is off the ventilator” |
| b. | “You can change your baby’s diaper and bathe her” |
| c. | “You cannot touch your baby because of the risk of infection” |
| d. | “You can talk to your baby while she is awake” |
ANS: B
Both the baby and the mother need the opportunity for physical contact. Although talking to the baby would offer some comfort, babies need to be touched as well. The mother also needs to participate in the care of the baby.
DIF: Cognitive Level: Analysis REF: Page 82 OBJ: 7
TOP: Family Reaction to the Preterm Infant
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychological Integrity
- A preterm infant in the NICU has two older siblings. The parents are concerned that the siblings have not accepted the new baby. In order to facilitate acceptance, the nurse can:
| a. | Encourage the siblings to send drawings to the infant |
| b. | Avoid allowing the siblings to see the baby while the baby is so ill |
| c. | Encourage the parents to not address the baby by name in case the baby dies |
| d. | Tell the siblings that that the baby will be fine |
ANS: A
Encouraging the siblings to send drawings will help the children accept the infant. Not allowing the children to see their sibling will not help acceptance. The baby should be addressed by his or her name. The siblings should not be told the baby will be fine, in case the baby is not! This will cause problems with trust.
DIF: Cognitive Level: Application REF: Page 82 OBJ: 7
TOP: Family Reaction to the Preterm Infant
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychological Integrity
- A baby was delivered at 42 weeks’ gestation. The nurse begins to assess the neonate. The nurse should expect to see which of the following observations:
| a. | Prolific lanugo |
| b. | Large amounts of vernix caseosa |
| c. | Dry, peeling, cracked skin |
| d. | Firm skin around the thighs and buttocks |
ANS: C
Lanugo is seen in preterm infants. Vernix caseosa is seen among term infants. Dry, peeling, cracked skin is seen with postterm infants. The skin around the thighs and buttocks will be loose.
DIF: Cognitive Level: Application REF: Page 83 OBJ: 8
TOP: The Postterm Infant KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
- An expectant mother has reached 41 weeks’ gestation. She is anxious and upset because her baby has not been delivered. The nurse reassures her and explains:
| a. | There are no risks to the baby because it is late |
| b. | Both she and the baby will be monitored closely |
| c. | The baby will be healthier because is it was in utero longer |
| d. | Her baby will not need to be monitored as closely as term babies |
ANS: B
There are risks for postterm infants. Both the baby and the mother are watched closely. The baby may not be healthier because it was in utero longer. The baby will be monitored more closely than a term baby.
DIF: Cognitive Level: Analysis REF: Page 83 OBJ: 8
TOP: The Postterm Infant KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychological Integrity
- A neonate was born with stained amniotic fluid. The nurse suspects that the neonate may have aspirated meconium. What signs and symptoms would confirm her suspicions?
| a. | Tachypnea |
| b. | Hypoxia |
| c. | Cyanosis |
| d. | All of the above |
ANS: D
All of these symptoms can be present when meconium is aspirated.
DIF: Cognitive Level: Application REF: Page 73 OBJ: 4
TOP: Meconium Aspiration Syndrome KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
- The nurse’s suspicions were confirmed, and the baby was diagnosed with meconium aspiration syndrome. The nurse would expect the neonate to receive which of the following treatments:
| a. | Placement in the regular nursery |
| b. | Possible ventilator support |
| c. | Suctioning only if secretions are obstructing airway |
| d. | Oral fluids only |
ANS: B
The infant is placed in the NICU. Ventilator support may be needed. The airway is suctioned immediately. IV fluids are also administered.
DIF: Cognitive Level: Application REF: Page 73 OBJ: 4
TOP: Meconium Aspiration Syndrome KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
- A neonate is born to a diabetic mother. The baby is very large, weighing 10 lb. The nurse plans care of the neonate accordingly. Nursing care will include:
| a. | Holding feedings to help reduce blood glucose |
| b. | Monitoring blood glucose levels carefully |
| c. | Checking vital signs each shift |
| d. | None of the above |
ANS: B
Feedings are initiated early after birth. Blood glucose levels are monitored closely. The vital signs and condition of the infant are monitored closely, more than once per shift.
DIF: Cognitive Level: Analysis REF: Page 83 OBJ: 5
TOP: Infants of Mothers with Diabetes KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
- A woman is diagnosed with diabetes. She is concerned about the impact this will have on her ability to have children. The nurse tells her:
| a. | Women with diabetes cannot have children |
| b. | She should have been more careful about her diet and exercise |
| c. | Successful regulation of blood glucose has allowed increasing numbers of women to bear children |
| d. | If she has a baby, it will be critically ill for many weeks |
ANS: C
Women with diabetes can have children. Her diabetes may or may not have been caused by her diet and exercise. Careful monitoring and regulation of blood glucose is allowing women to successfully bear children. The baby is not necessarily doomed to being critically ill.
DIF: Cognitive Level: Application REF: Page 83 OBJ: 4
TOP: Infants of Mothers with Diabetes KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance
MATCHING
Match the following terms with their definitions:
| a. | Apnea |
| b. | Primary atelectasis |
| c. | Secondary atelectasis |
| d. | Respiratory distress syndrome |
- Failure of lungs to expand after birth
- Periods of rapid respirations, slow breathing, then cessation of breathing for 20 or more seconds
- Also known as hyaline membrane disease
- The lungs collapse after they have once inflated
- ANS: B DIF: Cognitive Level: Comprehension REF: Pages 73-75
OBJ: 1 TOP: Risks Related to Prematurity
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity
- ANS: A DIF: Cognitive Level: Comprehension REF: Pages 73-75
OBJ: 1 TOP: Risks Related to Prematurity
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity
- ANS: D DIF: Cognitive Level: Comprehension REF: Pages 73-75
OBJ: 1 TOP: Risks Related to Prematurity
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity
- ANS: C DIF: Cognitive Level: Comprehension REF: Pages 73-75
OBJ: 1 TOP: Risks Related to Prematurity
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity
Match the following terms to their definitions:
| a. | Previability |
| b. | Kernicterus |
| c. | Macrosomia |
- A syndrome of severe brain damage
- Often seen in babies of mothers with diabetes
- Before life
- ANS: B DIF: Cognitive Level: Comprehension REF: Pages 73, 78, 83
OBJ: 1
TOP: Risks Related to Immaturity, Jaundice, Infants of Mothers with Diabetes
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity
- ANS: C DIF: Cognitive Level: Comprehension REF: Pages 73, 78, 83
OBJ: 1
TOP: Risks Related to Immaturity, Jaundice, Infants of Mothers with Diabetes
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity
- ANS: A DIF: Cognitive Level: Comprehension REF: Pages 73, 78, 83
OBJ: 1
TOP: Risks Related to Immaturity, Jaundice, Infants of Mothers with Diabetes
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity
Match the condition with its definition:
| a. | Meconium aspiration syndrome |
| b. | Necrotizing enterocolitis |
| c. | Sepsis |
| d. | Hypoglycemia |
| e. | Hypocalcemia |
| f. | Retinopathy of prematurity |
- Acute inflammatory disease of the bowel
- Low blood glucose level
- The fetus releases meconium into the amniotic fluid and then aspirates, often with the first breath, resulting in respiratory distress
- Generalized infection in the bloodstream
- May cause blindness in preterm infants
- Low calcium in the blood
- ANS: B DIF: Cognitive Level: Comprehension REF: Pages 73, 76-77
OBJ: 4 TOP: Risks Related to Prematurity
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity
- ANS: D DIF: Cognitive Level: Comprehension REF: Pages 73, 76-77
OBJ: 4 TOP: Risks Related to Prematurity
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity
- ANS: A DIF: Cognitive Level: Comprehension REF: Pages 73, 76-77
OBJ: 4 TOP: Risks Related to Prematurity
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity
- ANS: C DIF: Cognitive Level: Comprehension REF: Pages 73, 76-77
OBJ: 4 TOP: Risks Related to Prematurity
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity
- ANS: F DIF: Cognitive Level: Comprehension REF: Pages 73, 76-77
OBJ: 4 TOP: Risks Related to Prematurity
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity
- ANS: E DIF: Cognitive Level: Comprehension REF: Pages 73, 76-77
OBJ: 4 TOP: Risks Related to Prematurity
KEY: Nursing Process Step: Assessment MSC: NCLEX: Physiological Integrity
SHORT ANSWER
- Any infant at risk for having medical, developmental, or psychological problems is considered to be a:
ANS:
High-risk infant
DIF: Cognitive Level: Comprehension REF: Page 71 OBJ: 1
TOP: The Preterm Infant KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
- The length of time from conception to birth that the fetus remains in the uterus is called the:
ANS:
Gestational age
DIF: Cognitive Level: Knowledge REF: Page 71 OBJ: 1
TOP: The Preterm Infant KEY: Nursing Process Step: N/A
MSC: NCLEX: Health Promotion and Maintenance
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