San Jacinto College - RNSG 2201

Chapter 08: Health Problems of Newborns

Hockenberry: Wong’s Essentials of Pediatric Nursing, 10th Edition

MULTIPLE CHOICE

1)Which is defined as a vaguely outlined area of edematous tissue situated over the portion of the scalp that presents in a vertex delivery?

1. 1. Caput succedaneum
   2. Hydrocephalus
   3. Cephalhematoma
   4. Subdural hematoma

2. Which finding on a newborn assessment should the nurse recognize as suggestive of a clavicle fracture?
   1. Negative scarf sign
   2. Asymmetric Moro reflex
   3. Swelling of fingers on affected side
   4. Paralysis of affected extremity and muscles

3. The parents of a newborn ask the nurse what caused the baby’s facial nerve paralysis. What knowledge should the nurse’s response be based on?
   1. Genetic defect
   2. Birth injury

1. 3. Spinal cord injury
   4. Inborn error of metabolism

4. A mother is upset because her newborn has erythema toxicum neonatorum. What information should the nurse base the response to the mother?
   1. Easily treated
   2. Benign and transient
   3. Usually not contagious
   4. Usually not disfiguring

5. What is oral candidiasis (thrush) in the newborn?
   1. Bacterial infection that is life threatening in the neonatal period
   2. Bacterial infection of mucous membranes that responds readily to treatment
   3. Yeastlike fungal infection of mucous membranes that is relatively common
   4. Benign disorder that is transmitted from mother to newborn during the birth process only

6. What does nursing care of the newborn with oral candidiasis (thrush) include?
   1. Avoiding use of pacifier
   2. Removing characteristic white patches with a soft cloth

1. 3. Continuing medication for a prescribed number of days
   4. Applying medication to oral mucosa, being careful that none is ingested

7. Which is a bright red, rubbery nodule with a rough surface and a well-defined margin that may be present at birth?
   1. Port-wine stain
   2. Juvenile melanoma
   3. Cavernous hemangioma
   4. Strawberry hemangioma

8. The parents of a newborn with a strawberry hemangioma ask the nurse what the treatment will be. What information does the nurse need to include in the response?
   1. Excision of the lesion will be necessary.
   2. Injections of prednisone into the lesion will reduce it.
   3. No treatment is usually necessary because of the high rate of spontaneous involution.
   4. Pulsed dye laser treatments will be necessary immediately to prevent permanent disability.

9. Which term refers to a newborn born before completion of week 37 of gestation, regardless of birth weight?
   1. Postterm
   2. Preterm
   3. Low birth weight
   4. Small for gestational age

10. Which refers to a newborn whose rate of intrauterine growth was slowed and whose birth weight falls below the 10th percentile on intrauterine growth charts?
    1. Postterm
    2. Postmature
    3. Low birth weight

1. 4. Small for gestational age

11. The nurse is caring for a very low birth weight (VLBW) newborn with a peripheral intravenous infusion. Which statement describes nursing considerations regarding infiltration?
    1. Infiltration occurs infrequently because VLBW newborns are inactive.
    2. Continuous infusion pumps stop automatically when infiltration occurs.
    3. Hypertonic solutions can cause severe tissue damage if infiltration occurs.
    4. Infusion site should be checked for infiltration at least once per 8-hour shift.

12. The nurse is caring for a high-risk newborn with an umbilical catheter in a radiant warmer. The nurse notes blanching of the feet. Which is the most appropriate nursing action?
    1. Elevate feet 15 degrees.
    2. Place socks on newborn.
    3. Wrap feet loosely in prewarmed blanket.
    4. Report findings immediately to the practitioner.

13. The mother of a preterm new born ask when she can start breastfeeding. The nurse should explain that breastfeeding can be initiated when her newborn:
    1. achieves a weight of at least 3 pounds.
    2. indicates an interest in breastfeeding.
    3. does not require supplemental oxygen.
    4. has adequate sucking and swallowing reflexes.

14. Which is the most appropriate nursing action when intermittently gavage-feeding a preterm newborn?
    1. Allow formula to flow by gravity.
    2. Insert tube through nares rather than mouth.

1. 3. Avoid letting newborn suck on tube.
   4. Apply steady pressure to syringe to deliver formula to stomach in a timely manner.

15. A healthy, stable, preterm newborn will soon be discharged. The nurse should recommend which position for sleep?
    1. Prone
    2. Supine
    3. Side lying
    4. Position of comfort

16. Which intervention should the nurse implement to maintain the skin integrity of the preterm newborn?
    1. Cleanse skin with a gentle alkaline-based soap and water.
    2. Cleanse skin with a neutral pH solution only when necessary.
    3. Thoroughly rinse skin with plain water after bathing in a mild hexachlorophene solution.
    4. Avoid cleaning skin.

17. Which is an important nursing action related to the use of tape and/or adhesives on preterm newborns?
    1. Avoid using tape and adhesives until skin is more mature.
    2. Use solvents to remove tape and adhesives instead of pulling on skin.
    3. Remove adhesives with warm water or mineral oil.
    4. Use scissors carefully to remove tape instead of pulling tape off.

18. The nurse is caring for a 3-week-old preterm newborn born at 29 weeks of gestation. While taking vital signs and changing the newborn’s diaper, the nurse observes the newborn’s color is pink but slightly mottled, arms and legs are limp and extended, hiccups are present, and heart rate is regular and rapid. The nurse should recognize these behaviors as manifestations of:
    1. stress.
    2. subtle seizures.

1. 3. preterm behavior.
   4. onset of respiratory distress.

19. When is the best time for the neonatal intensive care unit (NICU) nurse to initiate an individualized stimulation program for the preterm newborn?
    1. As soon as possible after newborn is born
    2. As soon as parent is available to provide stimulation
    3. When newborn is over 38 weeks of gestation
    4. When developmental organization and stability are sufficient

20. A preterm newborn, after spending 8 weeks in the NICU, is being discharged. The parents of the newborn express apprehension and worry that the newborn may still be in danger. How should the nurse interpret these statements?
    1. Normal
    2. A reason to postpone discharge
    3. Suggestive of maladaptation
    4. Suggestive of inadequate bonding

21. The nurse is planning care for a family expecting their newborn to die. The nurse’s interventions should be based on which statement?
    1. Tangible remembrances of the newborn (e.g., lock of hair, picture) prolong grief.
    2. Photographs of newborns should not be taken after the death has occurred.
    3. Funerals are not recommended because mother is still recovering from childbirth.
    4. Parents should be encouraged to name their newborn if they have not done so already.

22. The nurse has been caring for a newborn who just died. The parents are present but say they are “afraid” to hold the dead newborn. Which is the most appropriate nursing intervention?
    1. Tell them there is nothing to fear.
    2. Insist that they hold newborn “one last time.”
    3. Respect their wishes and release body to morgue.
    4. Keep newborn’s body available for a few hours in case they change their minds.

23. The nurse is planning care for a low birth weight newborn. Which is an appropriate nursing intervention to promote adequate oxygenation?
    1. Place in Trendelenburg position periodically.
    2. Suction at least every 2 to 3 hours.
    3. Maintain neutral thermal environment.
    4. Hyperextend neck with nose pointing to ceiling.

24. A preterm newborn has been receiving orogastric feedings of breast milk. The nurse initiates nipple feedings, but the newborn tires easily and has weak sucking and swallowing reflexes. What is the most appropriate nursing intervention?
    1. Encourage mother to breastfeed.
    2. Try nipple-feeding preterm newborn formula.
    3. Resume orogastric feedings of breast milk.
    4. Resume orogastric feedings of formula.

25. The parents of a newborn who has just died decide they want to hold their deceased infant. What is the most appropriate nursing intervention?
    1. Explain gently that this is no longer possible.
    2. Encourage parents to accept the loss of their newborn.
    3. Offer to take a photograph of their newborn because they cannot hold newborn.
    4. Get the newborn, wrap in a blanket, and rewarm in a radiant warmer so parents can hold their deceased infant.

26. Which statement best describes the clinical manifestations of the preterm newborn?
    1. Head is proportionately small in relation to the body.
    2. Sucking reflex is absent, weak, or ineffectual.
    3. Thermostability is well established.
    4. Extremities remain in attitude of flexion.

27. Physiologic jaundice in a newborn can be caused by:
    1. fetal-maternal blood incompatibility.
    2. destruction of red blood cells as a result of antibody reaction.
    3. liver’s inability to bind bilirubin adequately for excretion.
    4. immature kidneys’ inability to hydrolyze and excrete bilirubin.

28. When should the nurse expect breastfeeding-associated jaundice to first appear in a normal newborn?
    1. 0 to 12 hours
    2. 12 to 24 hours
    3. 2 to 4 days
    4. 4 to 5 days

29. The newborn with severe jaundice is at risk for developing:
    1. encephalopathy.
    2. bullous impetigo.
    3. respiratory distress.
    4. blood incompatibility.

30. What is an early clinical manifestation of bilirubin encephalopathy in the newborn?
    1. Cognitive impairment
    2. Absence of stooling
    3. Lethargy or irritability
    4. Increased or decreased temperature

31. A nurse is assessing for jaundice in a dark-skinned newborn. Where is the best place to assess for jaundice in this newborn?
    1. Buttocks
    2. Tip of nose and sclera
    3. Sclera, conjunctiva, and oral mucosa
    4. Palms of hands and soles of feet

32. A blood sample for measurement of bilirubin is required from a newborn receiving phototherapy. In what environment should this blood sample be drawn?
    1. While phototherapy lights are turned off
    2. While newborn remains under phototherapy lights
    3. When newborn is covered with a blanket
    4. When newborn has been off phototherapy for 30 to 60 minutes

33. The nurse is preparing a parent of a newborn for home phototherapy. Which statement made by the parent would indicate a need for further teaching?
    1. “I should change the baby’s position many times during the day.”
    2. “I can dress the baby in lightweight clothing while under phototherapy.”

1. 3. “I should be sure that the baby’s eyelids are closed before applying patches.”
   4. “I can take the patches off the baby during feedings and other caregiving activities.”

34. The nurse is caring for a newborn with hyperbilirubinemia who is receiving phototherapy. Which is an appropriate nursing intervention for this newborn?
    1. Apply lotion as prescribed to moisturize skin.
    2. Maintain nothing-by-mouth (NPO) status to prevent nausea and vomiting.
    3. Monitor temperature to prevent hypothermia or hyperthermia.
    4. Keep eye patches on for at least 8 to 12 of every 24 hours.

35. Hemolytic disease is suspected in a mother’s second newborn. Which factor is important in understanding how this could develop?
    1. The mother’s first child was Rh positive.
    2. The mother is Rh positive.
    3. Both parents have type O blood.
    4. RhIG (RhoGAM) was given to the mother during her first pregnancy.

36. When should the nurse expect jaundice to be present in a newborn with hemolytic disease?
    1. At birth
    2. During first 24 hours after birth
    3. 24 to 48 hours after birth
    4. 48 to 72 hours after birth

37. To whom is RhIG (RhoGAM) administered to prevent Rh isoimmunization?
    1. Rh-negative women who deliver an Rh-positive newborn
    2. Rh-positive women who deliver an Rh-negative newborn
    3. Rh-negative newborns whose mothers are Rh positive
    4. Rh-positive fathers before conception of second newborn when first newborn was Rh positive

38. The nurse is caring for a newborn receiving an exchange transfusion for hemolytic disease. Assessment of the newborn reveals slight respiratory distress and tachycardia. Which should the nurse’s first action be?
    1. Notify practitioner.
    2. Stop the transfusion.
    3. Administer calcium gluconate.
    4. Monitor vital signs electronically.

39. Which is the primary treatment for hypoglycemia in newborns with feeding intolerance?
    1. Oral glucose feedings
    2. Intravenous (IV) infusion of glucose
    3. Short-term insulin therapy
    4. Feedings (formula or breast milk) at least every 2 hours

40. Which is the most appropriate nursing intervention for the newborn who is jittery and twitching and has a high-pitched cry?
    1. Monitor blood pressure closely.
    2. Obtain urine sample to detect glycosuria.
    3. Obtain serum glucose and serum calcium levels.
    4. Administer oral glucose or, if newborn refuses to suck, IV dextrose.

41. The nurse is planning care for a newborn receiving IV calcium gluconate for treatment of hypocalcemia. Which intervention is the most appropriate during the acute phase?
    1. Allow newborn to sleep with pacifier to decrease stimuli.
    2. Keep newborn awake to monitor central nervous system changes.
    3. Encourage parents to hold and feed newborn to facilitate attachment during illness.
    4. Awaken newborn periodically to assess level of consciousness.

42. Which is the central factor responsible for respiratory distress syndrome?
    1. Deficient surfactant production
    2. Overproduction of surfactant
    3. Overdeveloped alveoli
    4. Absence of alveoli

43. A preterm newborn of 36 weeks of gestation is admitted to the NICU. Approximately 2 hours after birth, the newborn begins having difficulty breathing, with grunting, tachypnea, and nasal flaring. Which is important for the nurse to recognize?

1. 1. This is a normal finding.
   2. This is not significant unless cyanosis is present.
   3. Improvement should occur within 24 hours.
   4. Further evaluation is needed.

44. The nurse is caring for a preterm newborn who requires mechanical ventilation for the treatment of respiratory distress syndrome. What is the preterm newborn at increased risk of due to the mechanical ventilation?
    1. Alveolar rupture
    2. Meconium aspiration
    3. Transient tachypnea
    4. Retractions and nasal flaring

45. The nurse is caring for a newborn with respiratory distress syndrome. The newborn has an endotracheal tube. Which statement describes nursing considerations related to suctioning?
    1. Suctioning should not be carried out routinely.
    2. Newborn should be in Trendelenburg position for suctioning.
    3. Routine suctioning, usually every 15 minutes, is necessary.
    4. Frequent suctioning is necessary to maintain patency of bronchi.

46. A preterm newborn requires oxygen and mechanical ventilation. Which complications should the nurse assess for?
    1. Bronchopulmonary dysplasia, pneumothorax
    2. Anemia, necrotizing enterocolitis
    3. Cerebral palsy, persistent patent ductus
    4. Congestive heart failure, cerebral edema

47. What causes meconium aspiration syndrome?
    1. Hypoglycemia
    2. Carbon dioxide retention
    3. Bowel obstruction with meconium
    4. Aspiration of meconium in utero or at birth

48. Which is the most common cause of anemia in preterm newborns?
    1. Frequent blood sampling
    2. Respiratory distress syndrome
    3. Meconium aspiration syndrome
    4. Persistent pulmonary hypertension

49. A newborn is diagnosed with retinopathy of prematurity. What should the nurse know about this diagnosis?
    1. Blindness cannot be prevented.
    2. No treatment is currently available.
    3. Cryotherapy and laser therapy are effective treatments.
    4. Long-term administration of oxygen will be necessary.

50. Several types of seizures can occur in the newborn. Which is characteristic of clonic seizures?
    1. Apnea
    2. Tremors
    3. Rhythmic jerking movements
    4. Extensions of all four limbs

51. Newborns are highly susceptible to infection as a result of:
    1. excessive levels of immunoglobulin A (IgA) and immunoglobulin M (IgM).
    2. diminished nonspecific and specific immunity.
    3. increased humoral immunity.
    4. overwhelming anti-inflammatory response.

52. Which is most descriptive of the clinical manifestations observed in neonatal sepsis?
    1. Seizures and sunken fontanels
    2. Sudden hyperthermia and profuse sweating
    3. Decreased urinary output and frequent stools
    4. Nonspecific physical signs with hypothermia

53. The nurse is caring for a newborn whose mother is diabetic. Which clinical manifestations should the nurse expect to see?
    1. Hypoglycemic, large for gestational age
    2. Hyperglycemic, large for gestational age
    3. Hypoglycemic, small for gestational age
    4. Hyperglycemic, small for gestational age

54. The nurse is caring for a newborn who was born 24 hours ago to a mother who received no prenatal care. The newborn is a poor feeder but sucks avidly on his hands. Clinical manifestations also include loose stools, tachycardia, fever, projectile vomiting, sneezing, and generalized sweating. Which should the nurse suspect?
    1. Seizure disorder
    2. Narcotic withdrawal
    3. Placental insufficiency
    4. Meconium aspiration syndrome

55. Which should the nurse anticipate in the newborn whose mother used cocaine during pregnancy?
    1. Seizures
    2. Hyperglycemia
    3. Cardiac and respiratory problems
    4. Neurobehavioral depression or excitability

56. Which is characteristic of newborns whose mothers smoked during pregnancy?
    1. Large for gestational age
    2. Preterm, but size appropriate for gestational age
    3. Growth retardation in weight only
    4. Growth retardation in weight, length, and head circumference

57. Which is an important nursing consideration in preventing the complications of congenital hypothyroidism (CH)?
    1. Assess for family history of CH.
    2. Assess mother for signs of hypothyroidism.

1. 3. Be certain appropriate screening is done prenatally.
   4. Be certain appropriate screening is done on newborn.

58. Phenylketonuria (PKU) is a genetic disease that results in the body’s inability to correctly metabolize:
    1. glucose.
    2. phenylalanine.
    3. phenylketones.
    4. thyroxine.

59. What is the Guthrie blood test use to diagnose in the newborn?
    1. Down syndrome
    2. Isoimmunization
    3. PKU
    4. Congenital hypothyroidism (CH)

60. The screening test for PKU is most reliable if the blood sample is:
    1. from cord blood.
    2. taken 14 days after birth.

1. 3. taken before oral feedings are initiated.
   4. fresh blood from the heel.

61. Which is an important nursing consideration in the care of the newborn with PKU?
    1. Suggest ways to make formula more palatable.
    2. Teach proper administration of phenylalanine hydroxylase.
    3. Encourage the breastfeeding mother to adhere to a low-phenylalanine diet.
    4. Give reassurance that dietary restrictions are a temporary inconvenience.

MULTIPLE RESPONSE

1. The nurse needs to obtain blood for ongoing assessment of a high-risk newborn’s progress. Which tests should the nurse monitor?
   1. Blood glucose
   2. Complete blood count (CBC)
   3. Calcium
   4. Serum electrolytes
   5. Neonatal prothrombin time (PTT)

2. Which are clinical manifestations of the postterm newborn?
   1. Excessive lanugo
   2. Increased subcutaneous fat
   3. Absence of scalp hair
   4. Parchment-like skin
   5. Minimal vernix caseosa
   6. Long fingernails

3. The nurse is preparing to care for a newborn receiving phototherapy. Which interventions are appropriate?
   1. Avoid stimulation.
   2. Decrease fluid intake.
   3. Expose all the newborn’s skin.
   4. Monitor skin temperature closely.
   5. Reposition the newborn every 2 hours.
   6. Cover the newborn’s eyes with eye shield patches.

4. A nurse is planning care for a preterm newborn. Which interventions should the nurse implement for skin care?
   1. Use cleaning agents with neutral pH.
   2. Rub skin during drying.
   3. Use adhesive remover solvent when removing tape.
   4. Avoid removing adhesives for at least 24 hours.
   5. Consider pectin barriers beneath adhesives.

5. A nurse is assessing a preterm newborn for the possibility of necrotizing enterocolitis (NEC). Which assessment findings should the nurse expect to find if NEC is confirmed?
   1. Minimal gastric residual
   2. Abdominal distention
   3. Apnea
   4. Urinary output at 2 ml/kg/hr
   5. Unstable temperature

6. A nurse is admitting a preterm newborn to the NICU. Which interventions should the nurse implement to prevent retinopathy?
   1. Place on pulse oximetry.
   2. Decrease exposure to bright, direct lighting.
   3. Place on a cardiac monitor.
   4. Cover eyes with an eye shield at night.
   5. Use supplemental oxygen only when needed.

7. A nurse is assessing a preterm newborn. Which assessment findings are consistent with prematurity?
   1. Abundant lanugo over the body
   2. Ear cartilage soft and pliable
   3. Flexed body posture
   4. Deep creases on the sole of the foot
   5. Skin is bright pink, smooth, and shiny.

8. A nurse is reviewing acid-base laboratory data on a newborn admitted to the NICU for meconium aspiration. Which laboratory value should  the nurse report to the physician?

a.   pH: 7.35

2. PCO2: 49
3. HCO3-: 30
4. PaO2: 96