Chapter 17 OB FA Davis

When caring for parents who are grieving after losing an infant, which of the following is the best action?

Remind them they can have another child.

Ensure that the hospital clergy comes to the room and prays for them.

Sit quietly with them and listen.

Take the baby to the morgue as soon as possible.

Sit quietly with them and listen.

When an infant is experiencing neonatal abstinence syndrome, what nursing action can help to minimize symptoms and complications?

Minimize stimulation to promote rest

Lay the infant on their abdomen to soothe gas pains

Make sure they are only wearing a diaper to prevent diaphoresis

Play music or the tv loudly to soothe them

Minimize stimulation to promote rest

Meconium aspiration syndrome is most likely to occur at which gestational age in the newborn?

29 weeks 4 days

42 weeks 2 days

38 weeks 3 days

32 weeks 6 days

42 weeks 2 days

One of the best ways to prevent necrotizing enterocolitis is _____________.

high flow oxygen therapy

nitric oxide therapy

delaying cord clamping

breastfeeding

breastfeeding

One of the most commonly occurring complications in infants under 28 weeks gestations is __________________.

Hyperbilirubinemia

sudden infant death syndrome

respiratory distress syndrome

meconium aspiration syndrome

respiratory distress syndrome

The nurse is planning to assess a neonate born at 25 weeks. Which would be an expected assessment finding? Select all that apply.

Hypotonic muscles

Creases on feet

Skin is pale

Lack of lanugo

Fused eyelids

Hypotonic muscles

Fused eyelids

Place the steps for neonatal gavage feedings in the correct order.

Measure the tube accurately

Assess the neonate for feeding intolerance

Check for residuals before starting feeding

Check for placement prior to feeding

Measure the tube accurately

Check for placement prior to feeding

Check for residuals before starting feeding

Assess the neonate for feeding intolerance

A neonate with respiratory distress syndrome is being prepared for intubation and surfactant administration. The mother refuses any animal products. What should the nurse anticipate the healthcare provider (HCP) will order?

Colfosceril (Exosurf)

Poractant (Curosurf )

Beractant (Survanta)

Calfactant (Infasurf)

Colfosceril (Exosurf)

Bronchopulmonary dysplasia (BPD) is a chronic lung problem associated w/neonates who have been treated with mechanical ventilation. Which assessment is consistent with BPD? Select all that apply.

Chest x-ray shows lung hyperinflation

ABG's pH 7.30, PCO2-60, HCO3 19, PO2-55

Intake matches output for at least 24 hours

Lung sounds clear throughout all fields

Increased pressure needed for ventilation

Chest x-ray shows lung hyperinflation

ABG's pH 7.30, PCO2-60, HCO3 19, PO2-55

Increased pressure needed for ventilation

The nurse is admitting a 28-week neonate to the NICU. Which assessment would indicate an intraventricular hemorrhage (IVH)?

Tachycardia

Hypoglycemia

Hypotonia

Hypertension

Hypotonia

The nurse is caring for a neonate with a grade II Intraventricular Hemorrhage (IVH). Routine nursing care can cause fluctuations in cerebral blood flow. What nursing strategies will decrease the worsening of this condition? Select all that apply.

Minimize crying

Minimize stimulation

Keep head of at 45 degrees

Keep temperature normal

Position infant prone

Minimize crying

Minimize stimulation

Keep temperature normal

What assessment does the nurse know indicates a high risk of retinopathy of prematurity (ROP)?

Advanced maternal age

Oxygenation of 87 to 94%

Intraventricular hemorrhage

Use of oxygen blenders

Intraventricular hemorrhage

Which risk factor for hyperbilirubinemia is modifiable? Select all that apply.

Mother is Native American

Delayed cord clamping

Infrequent feedings in first 24 hours

Bacterial infection at birth

Breast feeding only in first 24 hours

Delayed cord clamping

Infrequent feedings in first 24 hours

Bacterial infection at birth

Breast feeding only in first 24 hours

Which bilirubin level in a healthy term or near-term neonate would the nurse determine is concerning, but not critical, at 36 hours after birth?

1 to 3 mg/dL

4 to 5 mg/dL

10 to 14 mg/dL

15 to 20 mg/dL

10 to 14 mg/dL

The nurse is teaching parents about home use of the fiberoptic bili blanket. Which statement by the mother indicates effective teaching?

"I should dress my baby before wrapping him in the bili blanket."

"I should wrap my baby from neck to toe in the bili blanket."

"I can unwrap my baby for feedings."

"I should keep the bili blanket on 24 hours a day."

"I should keep the bili blanket on 24 hours a day."

A premature neonate with severe hyperbilirubinemia is starting phototherapy. What nursing intervention is the most important?

Bank of lights covered with plexiglass

Only diaper in place for maximum exposure

Feed neonate every 2 to 3 hours

Eye patches in place while under lights

Eye patches in place while under lights

Zika is an arbovirus that can infect the neonate in utero. What would the nurse explain as the method of transmission to the parents?

Trans-placental transfer

Ascending infection

Intrapartum exposure

Horizontal transmission

Trans-placental transfer

Abrupt discontinuation of intrauterine exposure to various substances, including heroin, nicotine, alcohol, cannabis, opiates, cocaine, and methamphetamines puts the neonate at risk for signs and symptoms of neonatal abstinence syndrome (NAS). The withdrawal of what substance can cause symptoms of NAS to start within 4 hours?

Cannabis

Alcohol

Narcotics

Barbiturates

Alcohol

The nurse knows that maternal alcohol, tobacco, cannabis, and cocaine abuse can all cause many long-term adverse effects. Which assessment findings can be attributed to all of these substances?

Lower IQ and language problems

Congenital infections and congenital anomalies

Low birth weight and attention deficit disorder

Mental retardation and aggressiveness

Low birth weight and attention deficit disorder

Fetal alcohol syndrome (FAS) can cause physical anomalies. What assessment would the nurse identify as consistent with FAS?

Heart defects

Increased cranial size

Amniotic bands

Congenital hip dysplasia

Heart defects

A nurse is caring for a 28-week gestation infant. What assessment finding would the nurse determine as being consistent with this gestational age?

Abundant lanugo

Hypertonia

Flexed posture

Descended testes

Abundant lanugo

During the cardiac assessment of a preterm neonate, the nurse is likely to identify what abnormality?

Hypertension

Heart murmur

Capillary refill less than 3 seconds

Increased hemoglobin and hematocrit

Heart murmur

A preterm infant needs approximately 105 to 130 kcal/kg/day. Calculate the lowest daily caloric need of an infant who weighs 2.18 kg. Round to the nearest whole number. Enter the numeral only.

229

A nasogastric tube has been ordered for an infant who is not tolerating oral feedings. How does the nurse measure the correct length to insert the tube?

Take the infant's length in centimeters and divide by 3

Measure from mouth, to ear, to lower sternum

Measure from nose, to ear, to lower sternum

Measure the distance from mouth to umbilicus

Measure from nose, to ear, to lower sternum

The nurse is caring for an infant with a nasogastric tube. Before starting a feeding, what does the nurse do to check for proper placement?

Obtain an abdominal x-ray.

Inject air into the tube while listening to the abdomen.

Inject air into the tube while listening to the lungs.

Measure the tubing length remaining outside the nares.

Inject air into the tube while listening to the abdomen.

A mother asks the nurse when her infant's nasogastric tube may be removed. What is the correct response by the nurse?

"Once he is eating at least 60 mL per feeding."

"When he reaches an adjusted gestational age of 34 weeks."

"When he demonstrates a coordinated suck, swallow, breathe pattern."

"Once he can maintain a blood glucose level above 50 mg/dL."

"When he demonstrates a coordinated suck, swallow, breathe pattern."

The nurse is teaching a father how to bottle feed his premature infant. What instructions should the nurse include in the teaching?

Pace the feeding to allow for breathing breaks.

Hold the baby in a supine position to prevent fatigue.

Use a high-flow nipple to make suckling easier.

A decrease in heart rate is expected and feeding can continue.

Pace the feeding to allow for breathing breaks.

A mother states to the nurse, "I want to breastfeed, but my baby is too fragile to hold." What can the nurse recommend to support breastfeeding by the mother?

Use donor breast milk to feed the infant.

Begin using a breast pump and storing milk for the infant.

Place cabbage on her breasts to prevent engorgement until the baby can nurse.

Use ice packs if breasts become firm and sore.

Begin using a breast pump and storing milk for the infant.

To prevent damage to the premature infant's skin, what interventions should the nurse perform? Select all that apply.

Bathe the infant with a mild, alkaline solution.

Use the minimum amount of tape needed to secure tubes or IV lines.

Avoid changing position and skin sheering.

Use water, air, or gel mattresses.

Assess skin at least once a shift for breakdown or infection.

Use the minimum amount of tape needed to secure tubes or IV lines.`

Use water, air, or gel mattresses.

Assess skin at least once a shift for breakdown or infection.

The nurse evaluates the gastric residual on an infant with a nasogastric tube and finds the volume to be high. In what position should the nurse place the infant to promote gastric emptying?

Supine

Prone

Head of bed elevated 30 degrees

Knees flexed to chest

Prone

A mother comes to visit her infant in the neonatal intensive care unit (NICU). She verbalizes anxiety regarding caring for the infant after discharge. What is the best response by the nurse?

"Being hands-on in your baby's care now will increase your confidence to handle things at home."

"Could you hire a home health nurse?"

"I understand your concern. You have a fragile newborn."

"We will write down all of your discharge instructions for you."

"Being hands-on in your baby's care now will increase your confidence to handle things at home."

A 30-week gestation infant has been born at a small rural hospital with no neonatal intensive care unit (NICU). The health care team has decided that the infant will be transferred via ambulance to a regional care center 45 minutes away. Place the following nursing interventions in the correct order in which they will need to be performed.

Call and report pertinent information regarding maternal and neonatal histories to the regional care center

Inform the parents of the infant's status upon arrival at the regional care center

Dispatch the appropriate healthcare team and equipment needed for the transport

Provide developmental care to the infant, including light and sound protection during transport

Call and report pertinent information regarding maternal and neonatal histories to the regional care center

Dispatch the appropriate healthcare team and equipment needed for the transport

Provide developmental care to the infant, including light and sound protection during transport

Inform the parents of the infant's status upon arrival at the regional care center

After birth, an infant received surfactant replacement therapy. The father questioned the nurse regarding the purpose of this therapy. What is the correct response by the nurse?

"It allows the infant to expand his lungs more easily."

"It prevents a lung infection."

"It causes bronchodilation so he can breathe better."

"It thins the mucus in the respiratory tract."

"It allows the infant to expand his lungs more easily."

The nurse is preparing a woman to have a lecithin/sphingomyelin (L/S) ratio performed. What education should the nurse provide to the client about the procedure?

"This blood sample will be taken from the baby's umbilical cord."

"Do not eat or drink anything 12 hours prior to the procedure."

"After the test, report any leaking of amniotic fluid to your provider."

"The results will let us know if there are any chromosomal abnormalities with your baby."

"After the test, report any leaking of amniotic fluid to your provider."

The nurse is caring for an infant with respiratory distress syndrome (RDS) who is intubated. What assessment does the nurse perform to ensure proper placement of the endotracheal tube (ET)?

Check arterial blood gas values (ABG).

Visually inspect the oropharynx.

Obtain a chest x-ray.

Auscultate bilateral breath sounds.

Auscultate bilateral breath sounds.

An infant has been diagnosed with bronchopulmonary dysplasia (BPD) following long term mechanical ventilation. What interventions should be included in the nursing care plan? Select all that apply.

Keep oxygen level at 100% at all times.

Gradually wean from mechanical ventilation per order.

Provide chest physiotherapy.

Restrict fluid intake.

Administer corticosteroids per order.

Gradually wean from mechanical ventilation per order.

Provide chest physiotherapy.

Restrict fluid intake.

Administer corticosteroids per order.

The parents of an infant diagnosed with patent ductus arteriosus (PDA) met with the cardiologist. What statement by the mother indicates to the nurse that she understands the teaching?

"My baby will need a heart transplant."

"There was an abnormal shunt that formed during pregnancy."

"The open shunt can be closed with a clip or suture."

"He will need extra fluids because his blood pressure will be lower."

"The open shunt can be closed with a clip or suture."

Changes in cerebral blood flow can increase the risk of intraventricular hemorrhage (IVH). What nursing interventions help maintain steady cerebral blood flow? Select all that apply.

Keep the head of the bed flat.

Avoid lifting hips with diaper changes.

Provide developmental stimulation, such as lights and sounds.

Minimize crying.

Avoid having the infant become too hot or cold.

Keep the head of the bed flat.

Avoid lifting hips with diaper changes.

Minimize crying.

Avoid having the infant become too hot or cold.

The nurse is teaching the parents of a preterm infant about necrotizing enterocolitis (NEC). What statement indicates to the nurse that teaching has been successful?

"This condition causes increased digestion and diarrhea."

"Full term infants are at the highest risk for developing NEC."

"The rotavirus vaccine will help protect my baby from NEC."

"Breastfeeding will help protect my baby's gut from NEC."

"Breastfeeding will help protect my baby's gut from NEC."

The nurse is caring for a preterm infant who has recently started enteral feedings. What assessment findings would the nurse associate with the possible development of necrotizing enterocolitis (NEC)? Select all that apply.

Blood in the stool

Vomiting

Distended abdomen

Decreased gastric residuals

Visible bowel loops

Blood in the stool

Vomiting

Distended abdomen

Visible bowel loops

The nurse is administering oxygen to a 29-week gestation infant. To decrease the risk of retinopathy of prematurity (ROP), what safety measure does the nurse utilize?

Use an oxygen blender to administer oxygen.

Never let the infant's oxygen saturation drop below 95%.

Rotate the pulse oximetry site daily.

Administer humidified oxygen via a nasal cannula.

Use an oxygen blender to administer oxygen.

The nurse is caring for an infant born at 42 weeks gestation. What assessment findings by the nurse are consistent with post-term infants? Select all that apply.

Abundant lanugo

Meconium staining

Vernix over back and face

Smooth skin with visible veins

Long fingernails

Meconium staining

Long fingernails

A client calls the nurse to her room and states, "The baby is really sleepy and hasn't been feeding well." The nurse notes the infant is jittery. What additional assessment should the nurse perform?

LATCH score

Urine output

Weight

Blood glucose

Blood glucose

During labor, the nurse notes the presence of meconium stained fluid. What does the nurse prepare for at the time of delivery?

Suctioning of the infant's mouth and trachea

Administration of antibiotics to the mother

Vigorous tactile stimulation of the infant

Culturing of the placenta for pathology

Suctioning of the infant's mouth and trachea

Despite maintaining a neutral thermal environment, a premature infant continues to have hypothermia. What intervention should the nurse perform next?

Check the infant's blood glucose.

Order an IV infusion of warmed saline.

Place the infant under double bili lights.

Continue to monitor and document findings.

Check the infant's blood glucose.

The nurse is caring for an infant born to a woman with diabetes. The nurse notes that the infant moves the left arm, but the right arm remains flaccid. What order does the nurse anticipate?

Head CT

Electroencephalogram

Chest X-ray

Electromyography

Chest X-ray

The neonatal nurse practitioner rounded on the unit and left new orders. After reviewing the following orders, the nurse prioritizes the infant's care. Place the interventions in the correct order in which they need to be completed.

Feed 15mL donor breastmilk every 3 hours

Heel stick blood glucose before each feeding

Administer 0.5mL Hepatitis B vaccine IM

Start single light phototherapy

Start single light phototherapy

Heel stick blood glucose before each feeding

Feed 15mL donor breastmilk every 3 hours

Administer 0.5mL Hepatitis B vaccine IM

The registered nurse (RN) is educating a mother whose infant is receiving phototherapy for hyperbilirubinemia. What statement by the mother does the RN identify as correct?

"I cannot hold my infant for feedings."

"My infant should wear a light shirt while under the lights."

"I should leave my infant in the same position under the lights."

"I will feed my baby frequently while on phototherapy."

"I will feed my baby frequently while on phototherapy."

The nurse is caring for a client with diabetes mellitus. She asks the nurse why strict blood glucose control is important. What is the correct response by the nurse? Select all that apply.

"High maternal blood glucose can cause hyperglycemia in the infant, as well."

"High maternal blood glucose can cause hypoglycemia in the infant."

"Congenital anomalies are more likely with uncontrolled diabetes."

"Precipitous births are more likely when blood glucose is uncontrolled."

"Your infant is more at risk for birth injuries, such as a broken collar bone, if your blood glucose is too high."

"High maternal blood glucose can cause hypoglycemia in the infant."

"Congenital anomalies are more likely with uncontrolled diabetes."

"Your infant is more at risk for birth injuries, such as a broken collar bone, if your blood glucose is too high."

The nurse is assessing a client during a prenatal visit. The client is at 30 weeks gestation. What assessment identifies a non-modifiable risk for preterm labor?

Placenta previa

Domestic violence

Periodontal disease

Incompetent cervix

Placenta previa

A nurse is assessing a 28-week neonate who is on 25% oxygen at 0.5 L/m via nasal cannula. The infant is pale with O2 saturation of 75%. What is the first intervention to perform?

Call the health care provider for orders.

Increase the oxygen percentage.

Increase the oxygen flow rate.

Assess the infant's airway.

Assess the infant's airway.

The nurse receives an order to begin trophic feeding at 2 ml/hour via nasogastric tube. The nurse recognizes what about trophic feedings?

Provides adequate nutrition

Enhances gastrointestinal functioning

Nasogastric feeding helps prevent choking

Allows continuous hydration

Enhances gastrointestinal functioning

The nurse is teaching parents of a preterm neonate about feedings in the newborn intensive care unit (NICU). What statement about nutrition indicates an understanding of the teaching?

"My baby can breastfeed right away."

"My baby can only have special formula."

"My baby will need breast milk only."

"My baby will need fortified breastmilk."

"My baby will need fortified breastmilk."

The nurse encourages parents of a stable neonate to start kangaroo care. The mother is hesitant. What should the nurse include when explaining the benefits of kangaroo care? Select all that apply

Decreases illness and infection

Prevents unstable temperature

Decreases excessive weight gain

Increases length of hospital stay

Decreases feeding intolerance

Decreases illness and infection

Prevents unstable temperature

Decreases feeding intolerance

The nurse is explaining necrotizing enterocolitis (NEC) to the student nurse. Which assessment findings are consistent with NEC? Select all that apply

Abdominal distention

Visible bowel loops

Normal vital signs

Abdominal discoloration

Decreased residuals prior to feeding

Abdominal distention

Visible bowel loops

Abdominal Discoloration

The nurse is assessing a preterm neonate immediately after delivery. Which assessment finding indicates respiratory distress? Select all that apply

Cyanosis of hands and feet

Low body temperature

Grunting on exhalation

Intercostal retractions

Slow capillary refill

Grunting on exhalation

Intercostal retractions

A nursing diagnosis for a very preterm neonate is ineffective thermos-regulation related to prematurity, lack of subcutaneous fat tissue, and environmental temperature. Which interventions would be the most important to perform immediately? Select all that apply.

Dry infant and discard wet linen

Place on pre-heated warmer

Keep head covered

Encourage kangaroo care

Place on mother's abdomen

Dry infant and discard wet linen

Place on pre-heated warmer

Keep head covered

The nurse is seeing a neonate for an immediate cardiac assessment. What will the nurse be looking for? Select all that apply.

Heart sounds

Peripheral pulses

Blood glucose level

Capillary refill

Body temperature

Heart sounds

Peripheral pulses

Capillary refill

To prevent heat loss from evaporation immediately after delivery, what is the most important nursing intervention?

Place the neonate on a chemical mattress.

Keep the neonate's head covered with a hat.

Dry the neonate gently and replace the wet linen.

Place the neonate in a double-walled incubator.

Dry the neonate gently and replace the wet linen.

Alcohol related birth defects (ARBD) affect the heart, skeleton, kidneys, and ears. The nurse is the most concerned about what assessment?

Facial anomalies

Cognitive problems

Brain abnormalities

Cardiac anomalies

Cardiac anomalies

The nurse is concerned that a newborn may be suffering from neonatal methamphetamine withdrawal. Which assessment finding is indicative of neonatal methamphetamine withdrawal?

Tachypnea and increased wakefulness

Poor weight gain and excoriated skin

Skin mottling and apnea

Hypotonia and high-pitched cry

Poor weight gain and excoriated skin

The student nurse asks about the use of surfactant. Which statement indicates to the nurse that the student understands the teaching?

"Surfactant increases surface tension of alveoli."

"Adverse effects include hypertension and hypotonia."

"Surfactant decreases risk of bronchopulmonary dysplasia."

"Surfactant reduces lung compliance and work of breathing."

Surfactant decreases risk of bronchopulmonary dysplasia."

The nurse is teaching parents to administer gavage feedings. Which statement made by the parents indicates to the nurse that further teaching is required?

"We should lay infant flat for feedings."

"We should use nonnutritive sucking during feeding."

"We should waken our infant for feeding tolerance."

"We should check the placement of the tube before each feeding."

"We should lay infant flat for feedings."

A neonate born at 28 weeks is 9 days old. During the nurse's assessment, symptoms of necrotizing enterocolitis (NEC) are noted. What is the highest priority symptom to address?

Unstable temperature

Bloody stools

Increased gastric residual

Abdominal distension

Unstable temperature

Infants with persistent pulmonary hypertension experience increased pulmonary vascular resistance. This impedes blood flow and causes hypertension inside the heart. Select which chamber of the heart experiences increased pressure.

Right ventricle