Ch 25 High Risk Newborn EAQ quizzes PDF

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Practice quizzes.
Conditions or circumstances superimposed on the normal course of events associated with birth and adjustment to extrauterine existence....

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73% 11 out of 15 questions answered correctly

Completed on Nov 23, 2021 6:15 pm

Incorrect (4)

Which condition in a preterm infant in the neonatal period can increase the risk for respiratory distress? Jaundice Pneumonia Galactosemia Fluid imbalance

Rationale Pneumonia in a preterm infant causes respiratory distress due to bacterial or viral agents. Galactosemia is an autosomal recessive disorder that indicates a deficiency of galactose 1-phosphate uridyltransferase (GALT) and causes hepatic dysfunction. As a result the infant is more susceptible to jaundice, not respiratory distress. Fluid imbalance does not cause respiratory distress; it may cause dehydration in an infant. Jaundice is caused by an increase in bilirubin levels due to a hemolytic disease. It does not increase the risk for respiratory distress. p. 659

Which skeletal injuries does the nurse assess for in an infant after a difficult birth? Select all that apply. Anencephaly Macrosomia Galactosemia Skull fractures Clavicle fracture

Rationale The infant may have a linear or depressed skull fracture from a difficult birth as a result of the pressure of the head on the bony pelvis. A clavicle fracture is sometimes seen in a difficult birth. There may be limited arm motion and an absence of the Moro reflex on the affected side. Anencephaly is a central nervous system anomaly seen in an infant of a diabetic mother. Macrosomia refers to excessive weight gain in the infant after birth, seen in the infants of diabetic mothers. Galactosemia is an autosomal recessive disorder. p. 637

Two thirds of newborns with fetal alcohol syndrome (FAS) are boys. The pattern of growth restriction of the fetus begun in prenatal life is halted after birth, and normal growth takes over. Both the distinctive facial features of the FAS infant and the diminished mental capacities tend toward normal over time. Alcohol-related neurodevelopmental disorders (ARNDs) not sufficient to meet FAS criteria (learning disabilities, speech and language problems) often are not detected until the child goes to school.

Rationale Some learning problems do not become evident until the child is in school. The pattern of growth restriction persists after birth. Two thirds of newborns with FAS are girls. Although the distinctive facial features of the FAS infant tend to become less evident, the mental capacities never become normal. Test-Taking Tip: Many times the correct answer is the longest alternative given, but do not count on it. NCLEX item writers (those who write the questions) are also aware of this and attempt to avoid offering you such "helpful hints." p. 651

Which statement by the student nurse about a diabetic pregnancy and the fetal side effects indicates effective learning? "The infant is likely to have diabetes after birth." "The euglycemic status will influence fetal well-being." "The infant will be born with congenital malformations." "Hyperglycemia is the only reason for fetal macrosomia."

Rationale The euglycemic status will influence fetal well-being, because a decrease or increase in the blood glucose levels enhances the risks for complications in the fetus. Congenital malformations are more likely to be seen in infants exposed to alcohol, not as a result of diabetes. The infant is not likely to have diabetes after birth but may have hypoglycemia, because the infant's glucose supply is removed abruptly at the time of birth. Hyperglycemia is not the only reason for fetal macrosomia. Macrosomia is caused by maternal hyperlipidemia and increased lipid transfer to the fetus. p. 656

Correct (11)

Hypertonia, tachycardia, and metabolic alkalosis Hypertension, absence of apnea, and ruddy skin color Abdominal distention, temperature instability, and grossly bloody stools Scaphoid abdomen, no residual with feedings, and increased urinary output

Rationale Some generalized signs of NEC include

The infant may display hypotonia, bradycardia, and metabolic

acidosis. Hypotension, apnea, and pallor are signs of NEC. Abdominal distention, residual gastric aspirates, and oliguria are signs of NEC. pp. 668-669

Which statement by the nursing student about the prevention of health care–associated infections (HAIs) in a nursery unit indicates effective learning? "Nursery visitors are allowed if they wear masks." "Changing used equipment often may cause HAIs." "Hand washing helps prevent HAIs in a nursery unit." "Soiled diapers are kept far from the children's beds."

Rationale Infants in the nursery unit are at a high risk for infections. Hence, the most effective way to prevent infection is effective hand washing. The equipment used for the infants, such as nasogastric and intravenous tubing, needs to be changed frequently because it may become contaminated and cause infections. Visitors should be instructed not to overcrowd the nursery and to wash their hands before entering. Keeping soiled diapers away from the children is not enough; only proper disposal will help prevent infections. p. 643

Which infant is a likely candidate for receiving exogenous surfactant? An infant with hypoglycemia born to a diabetic mother A preterm infant with respiratory distress syndrome at birth A preterm infant with a soft cranium who is at risk for cranial molding

An infant at risk for inborn errors of metabolism, such as galactosemia

Rationale Exogenous surfactant helps maintain lung expansion in infants with respiratory distress syndrome. Oral glucose is used for an infant with hypoglycemia at birth. A preterm infant is placed on a waterbed or a gel mattress to minimize the risk of cranial molding. Galactosemia is managed by eliminating lactose-containing food and milk from the infant's diet. p. 661

The nurse finds poor feeding, lethargy, and constipation in an infant. In reviewing the maternal history, the nurse finds that the infant's mother was treated for Graves' disease during pregnancy. Which condition does the nurse suspect in the infant? Facial paralysis Neonatal syphilis lesions Cytomegalovirus infection Congenital hypothyroidism

Rationale A pregnant patient with Graves' disease is treated with antithyroid drugs, which may cause congenital hypothyroidism in the infant due to thyroid dysgenesis. Facial paralysis is a birth trauma seen in an infant as a result of a difficult birth. Cytomegalovirus infection is a rash on the infant's body caused by fetal exposure to drugs. Neonatal syphilis lesions are seen in an infant born to a mother with secondary syphilis. p. 680

Which condition may be seen in an infant born to a patient who consumed excessive alcohol during pregnancy? Skull fractures Hypothyroidism Respiratory distress Congenital abnormalities

Rationale Infants born to mothers who are heavy alcohol drinkers are at risk for congenital abnormalities. Respiratory distress is not usually seen in an infant exposed to alcohol. Hypothyroidism is a genetic disorder not related to alcohol consumption. Skull fractures are sometimes caused during a difficult birth as a result of the pressure of the fetal skull against the maternal pelvis. pp. 650-651

With regard to the classification of neonatal bacterial infection, nurses should be aware of what? The clinical sign of a rapid, high fever makes infection easier to diagnose. Congenital infection progresses slower than health care–associated infection. Health care–associated infection can be prevented by effective hand washing. Infections occur with about the same frequency in boy and girl infants, although female mortality is higher.

Rationale Hand washing is an effective preventive measure for health care–associated

infections because these infections come from the environment around the infant. Congenital (early onset) infections progress more rapidly than health care– associated (late onset) infections. Infection occurs about twice as often in boys and results in higher mortality. Clinical signs of neonatal infection are nonspecific and similar to noninfectious problems, making diagnosis difficult. Test-Taking Tip: Avoid looking for an answer pattern or code. There may be times when four or five consecutive questions have the same letter or number for the correct answer. p. 643

An infant weighing 4.1 kg was born 2 hours ago at 37 weeks of gestation. The infant appears chubby with a flushed complexion and is very tremulous. What are the tremors most likely the result of? Seizures Birth injury Hypocalcemia Hypoglycemia

Rationale This infant is macrosomic and at risk for hypoglycemia. The tremors are jitteriness that is associated with hypoglycemia. Signs of hypoglycemia include jitteriness, apnea, tachypnea, and cyanosis. Tremors are not associated with seizures, birth injury, or hypocalcemia. p. 657

Rubella Toxoplasmosis Varicella-zoster Parvovirus B19

Rationale Cats that eat birds infected with the Toxoplasma gondii protozoan excrete infective oocysts. Humans (including pregnant women) can become infected if they fail to wash their hands after cleaning the litter box. The infection is passed through the placenta. The varicella-zoster virus is responsible for chickenpox and shingles. Approximately 90% of childbearing women are immune. This virus cannot be contracted from a cat. During pregnancy infection with parvovirus can result in abortion, fetal anemia, hydrops, intrauterine growth restriction (IUGR), and stillbirth. This virus is spread by vertical transmission, not by felines. Since vaccination for rubella was begun in 1969, cases of congenital rubella infection have been reduced significantly. Vaccination failures, lack of compliance, and the migration of nonimmunized persons result in periodic outbreaks of rubella (German measles). pp. 644-645

Which is a priority nursing action while assessing an infant with rubella infection? Evaluating the infant's urine reports Washing the infant with warm water Evaluating the infant's blood reports Wearing gloves before touching the infant

Rationale Rubella infection may easily transmit from one infant to the other if proper caution is not taken. Therefore the nurse wears gloves before touching the infant to avoid contact and prevent the risk of cross-contamination. The nurse evaluates the infant's blood and urine reports as a part of the assessment process. However, it is not a priority in this case. The nurse washes the infant with warm water after birth to remove the blood and meconium from the infant's body. p. 645

What instruction does the nurse provide to parents of a preterm infant who has "The child will have irreparable physiologic deformities." "The child may be vulnerable to fluid and electrolyte imbalances later." "The infant will have attention deficit hyperactivity disorder (ADHD)." "The infant may need neurologic and developmental interventions later."

Rationale A preterm infant may have neurologic impairment after birth, which may result in behavioral and developmental problems later in life. Therefore the nurse instructs the parents that the infant may need neurologic and developmental interventions later. Telling the parents that the infant will have irreparable physiologic deformities will make the parents anxious. There may or may not be any deformities depending on the size and gestational age of infants at birth. Fluid and electrolyte imbalances are caused by fluid overload or dehydration and are treated with appropriate fluid replacement. The child may have ADHD or other neurologic problems depending on the degree of immaturity at birth. p. 675

which behaviors? Excessive sleep, weak cry, and diminished grasp reflex Hypothermia, decreased muscle tone, and weak sucking reflex Circumoral cyanosis, hyperactive Babinski reflex, and constipation Decreased amounts of sleep, hyperactive Moro reflex, and difficulty feeding

Test-Taking Tip: Key words or phrases in the stem of the question such as first, primary, early, or best are important. Similarly, words such as only, always, never, and all in the alternatives are frequently evidence of a wrong response. As in life, no real absolutes exist in nursing; however, every rule has its exceptions, so answer with care. p. 652

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Chapter 25, The High-Risk Newborn Perry 6e Chapter

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