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An infant at 36 weeks of gestation has increasing respirations (80 to 100 breaths/min with marked substernal retractions). The infant is given oxygen by continuous nasal positive airway pressure. Which arterial oxygen level would indicate hypoxia?
a) PaO2 of 89
b) PaO2 of 45
c) PaO2 of 73
d) PaO2 of 67
An infant is being discharged from the neonatal intensive care unit after 70 days of hospitalization. The infant was born at 30 weeks of gestation with several conditions associated with prematurity, including respiratory distress syndrome, mild bronchopulmonary dysplasia, and retinopathy of prematurity requiring surgical treatment. During discharge teaching the infant’s mother asks the nurse if her baby will meet developmental milestones on time, as did her son who was born at term. The nurse’s most appropriate response is:
a) Your baby does not appear to have any problems at the present time.”
b) Your baby will need to be followed very closely.”
c) “Your baby will need to be corrected for prematurity. Your baby is currently 40 weeks of postconceptional age and can be expected to be doing what a 40-week-old infant would be doing.”
d) Your baby will develop exactly like your first child did.”
“Your baby will need to be corrected for prematurity. Your baby is currently 40 weeks of postconceptional age and can be expected to be doing what a 40-week-old infant would be doing.”
For diagnostic and treatment purposes nurses should know the birth weight classifications of high risk infants. For example, extremely low birth weight (ELBW) is the designation for an infant whose weight is:
a) Less than 2000 g.
b) Less than 1500 g
c) Dependent on the gestational age.
d) Less than 1000 g.
An infant is to receive gastrostomy feedings. What intervention should the nurse institute to prevent bloating, gastrointestinal reflux into the esophagus, vomiting, and respiratory compromise?
a) Rapid bolusing of the entire amount in 15 minutes
b) Slow, small, warm bolus feedings over 30 minutes
c) Cold, medium bolus feedings over 20 minutes
d) Warm cloths to the abdomen for the first 10 minutes
When providing an infant with a gavage feeding, which of the following should be documented each time?
a) The infant’s heart rate and respirations
b) The infant’s abdominal circumference after the feeding
c) The infant’s response to the feeding
d) The infant’s suck and swallow coordination
An infant at 26 weeks of gestation arrives from the delivery room intubated. The nurse weighs the infant, places him under the radiant warmer, and attaches him to the ventilator at the prescribed settings. A pulse oximeter and cardiorespiratory monitor are placed. The pulse oximeter is recording oxygen saturations of 80%. The prescribed saturations are 92%. The nurse’s most appropriate action would be to:
a) Continue to observe and make no changes until the saturations are 75%.
b) Listen to breath sounds and ensure the patency of the endotracheal tube, increase oxygen, and notify a physician.
c) Continue with the admission process to ensure that a thorough assessment is completed.
d) Notify the parents that their infant is not doing well.
The nurse practicing in the perinatal setting should promote kangaroo care regardless of an infant’s gestational age. This intervention:
a) Helps infants to interact directly with their parents and enhances their temperature regulation.
b) Helps infants with motor and central nervous system impairment
c) Is adopted from classical British nursing traditions
d) Gets infants ready for breastfeeding
In appraising the growth and development potential of a preterm infant, nurses should:
a) Know that the greatest catch-up period is between 9 and 15 months postconceptual age.
b) Correct for milestones such as motor competencies and vocalizations until the child is approximately 3 years of age
c) Tell parents their child won’t catch up until about age 10 (girls) to 12 (boys).
d) Know that the length and breadth of the trunk is the first part of the infant to experience catch-up growth.
Necrotizing enterocolitis (NEC) is an inflammatory disease of the gastrointestinal mucosa. The signs of NEC are nonspecific. Some generalized signs include:
a) Abdominal distention, temperature instability, and grossly bloody stools.
b) Hypertension, absence of apnea, and ruddy skin color
c) Scaphoid abdomen, no residual with feedings, and increased urinary output
d) Hypertonia, tachycardia, and metabolic alkalosis
Necrotizing enterocolitis (NEC) is an acute inflammatory disease of the gastrointestinal mucosa that can progress to perforation of the bowel. Approximately 2% to 5% of premature infants succumb to this fatal disease. Care is supportive; however, there are known interventions that may decrease the risk of NEC. To develop an optimal plan of care for this infant, the nurse must understand that which intervention has the greatest effect on lowering the risk of NEC?
a) Prophylactic probiotics
b) Exchange transfusion
c) Early enteral feedingsd) Breastfeeding
A macrosomic infant is born after a difficult forceps-assisted delivery. After stabilization the infant is weighed, and the birth weight is 4550 g (9 pounds, 6 ounces). The nurse’s most appropriate action is to:
a) Take the infant immediately to the nursery.
b) Monitor blood glucose levels and observe closely for signs of hypoglycemia
c) Leave the infant in the room with the mother
d) Perform a gestational age assessment to determine whether the infant is large for gestational age.
On day 3 of life, a newborn continues to require 100% oxygen by nasal cannula. The parents ask if they can hold their infant during his next gavage feeding. Given that this newborn is physiologically stable, what response would the nurse give?
a) “Feedings cause more physiologic stress, so the baby must be closely monitored. Therefore, I don’t think you should hold the baby.”
b) “You may only hold your baby’s hand during the feeding.”
c) “Parents are not allowed to hold infants who depend on oxygen.”
d) “You may hold your baby during the feeding.”
“You may hold your baby during the feeding.”
A newborn was admitted to the neonatal intensive care unit after being delivered at 29 weeks of gestation to a 28-year-old multiparous, married, Caucasian female whose pregnancy was uncomplicated until premature rupture of membranes and preterm birth. The newborn’s parents arrive for their first visit after the birth. The parents walk toward the bedside but remain approximately 5 feet away from the bed. The nurse’s most appropriate action would be to:
a) Go to the parents, introduce himself or herself, and gently encourage them to come meet their infant; explain the equipment first, and then focus on the newborn.
b) Tell the parents only about the newborn’s physical condition and caution them to avoid touching their baby.
c) Leave the parents at the bedside while they are visiting so they can have some privacy.
d) Wait quietly at the newborn’s bedside until the parents come closer.
A pregnant woman was admitted for induction of labor at 43 weeks of gestation with sure dates. A nonstress test (NST) in the obstetrician’s office revealed a nonreactive tracing. On artificial rupture of membranes, thick, meconium-stained fluid was noted. The nurse caring for the infant after birth should anticipate thse possibilities:
a) Golden yellow- to green stained–skin and nails, absence of scalp hair, and an increased amount of subcutaneous fat.
b) Hyperglycemia, hyperthermia, and an alert, wide-eyed appearance
c) Excessive vernix caseosa covering the skin, lethargy, and respiratory distress syndrome.
d) Meconium aspiration, hypoglycemia, and dry, cracked skin.
Meconium aspiration, hypoglycemia, and dry, cracked skin.
For clinical purposes preterm and postterm infants are defined as:
a) Postterm after 40 weeks if large for gestational age (LGA); beyond 42 weeks if AGA.
b) Preterm before 34 weeks if appropriate for gestational age (AGA); before 37 weeks if small for gestational age (SGA).
c) Preterm, SGA before 38 to 40 weeks; postterm, LGA beyond 40 to 42 weeks
d) Preterm before 37 weeks, postterm beyond 42 weeks, no matter the size for gestational age at birth.
Preterm before 37 weeks, postterm beyond 42 weeks, no matter the size for gestational age at birth.
Premature infants who exhibit 5 to 10 seconds of respiratory pauses followed by 10 to 15 seconds of compensatory rapid respiration are:
a) Breathing in a respiratory pattern common to premature infants.
b) Trying to maintain a neutral thermal environment
c) Experiencing severe swings in blood pressure
d) Suffering from sleep or wakeful apnea.
Premature Infants of mothers with diabetes are at higher risk for developing:
c) Respiratory distress syndrome.
With regard to small for gestational age (SGA) infants and intrauterine growth restrictions (IUGR), nurses should be aware that:
a) Symmetric IUGR occurs in the later stages of pregnancy
b) In the first trimester diseases or abnormalities result in asymmetric IUGR
c) In asymmetric IUGR weight will be slightly more than SGA, whereas length and head circumference will be somewhat less than SGA.
d) Infants with asymmetric IUGR have the potential for normal growth and development.
As a result of large body surface in relation to weight, the preterm infant is at high risk for heat loss and cold stress. By understanding the four mechanisms of heat transfer (convection, conduction, radiation, and evaporation), the nurse can create an environment for the infant that prevents temperature instability. While evaluating the plan that has been implemented, the nurse knows that the infant is experiencing cold stress when he or she exhibits:
a) Mottled skin with acrocyanosis.
b) Bradycardia followed by an increased heart rate.
c) Decreased respiratory rated) Increased physical activity
A premature infant with respiratory distress syndrome receives artificial surfactant. How would the nurse explain surfactant therapy to the parents?
a) Your baby needs this medication to fight a possible respiratory tract infection
b) “Surfactant improves the ability of your baby’s lungs to open more easily and exchange oxygen and carbon dioxide.”
c) Surfactant is used to reduce episodes of periodic apnea.”
d) The drug keeps your baby from requiring too much sedation.
An infant was born 2 hours ago at 37 weeks of gestation, weighing 4.1 kg. The infant appears chubby with a flushed complexion and is very tremulous. The tremors are most likely the result of:
a) Birth injury.
What bacterial infection is definitely decreasing because of effective drug treatment?
b) Escherichia coli infection
d) Group B streptococcal infection
With regard to congenital anomalies of the cardiovascular and respiratory systems, nurses should be aware that:
a) Choanal atresia can be corrected by a suction catheter
b) Cardiac disease may be manifested by respiratory signs and symptoms.
c) Screening for congenital anomalies of the respiratory system need only be done for infants having respiratory distress.
d) Congenital diaphragmatic hernias are diagnosed and treated after birth
During a prenatal examination, the woman reports having two cats at home. The nurse informs her that she should not be cleaning the litter box while she is pregnant. When the woman asks why, the nurse’s best response would be:
a) It’s just gross. You should make your husband clean the litter boxes.”
b) “Cat feces are known to carry Escherichia coli, which can cause a severe infection in both you and your baby.”
c) Your cats could be carrying toxoplasmosis. This is a zoonotic parasite that can infect you and have severe effects on your unborn child.”
d) You and your baby can be exposed to the human immunodeficiency virus (HIV) in your cats’ feces.”
Your cats could be carrying toxoplasmosis. This is a zoonotic parasite that can infect you and have severe effects on your unborn child.”
Near the end of the first week of life an infant who has not been treated for any infection develops a copper-colored, maculopapular rash on the palms and around the mouth and anus. The newborn is showing signs of:
b) Congenital syphilis.
c) Human immunodeficiency virus
d) Herpes simplex virus infection.
A primigravida has just delivered a healthy infant girl. The nurse is about to administer erythromycin ointment in the infant’s eyes when the mother asks, “What is that medicine for?” The nurse responds:
a) This medicine will protect your baby’s eyes from drying out over the next few days.”
b) “It is to protect your baby from contracting herpes from your vaginal tract
c) It is an eye ointment to help your baby see you better.”
d) Erythromycin is given prophylactically to prevent a gonorrheal infection.”
Human immunodeficiency virus (HIV) may be perinatally transmitted
a) Only in the third trimester from the maternal circulation
b) Only through the ingestion of amniotic fluid.
c) By a needlestick injury at birth from unsterile instruments
d) Through the ingestion of breast milk from an infected mother
A careful review of the literature on the various recreational and illicit drugs reveals that:
a) More longer-term studies are needed to assess the lasting effects on infants when mothers have taken or are taking illegal drugs
b) Mothers should get off heroin (detox) any time they can during pregnancy
c) Heroin and methadone cross the placenta; marijuana, cocaine, and phencyclidine (PCP) do not.
d) Methadone withdrawal for infants is less severe and shorter than heroin withdrawal.
The abuse of which of the following substances during pregnancy is the leading cause of cognitive impairment in the United States?
While completing a newborn assessment, the nurse should be aware that the most common birth injury is:
a) Broken Rib
b) Fracture of the humerus and femur.
c) Caused by forceps gripping the head on delivery.
d) Fracture of the clavicle.
With regard to the classification of neonatal bacterial infection, nurses should be aware that:
a) Nosocomial infection can be prevented by effective handwashing; early-onset infections cannot.
b) The clinical sign of a rapid, high fever makes infection easier to diagnose
c) Congenital infection progresses slower than nosocomial infection.
d) Infections occur with about the same frequency in boy and girl infants, although female mortality is higher.
A pregnant woman presents in labor at term, having had no prenatal care. After birth her infant is noted to be small for gestational age with small eyes and a thin upper lip. The infant also is microcephalic. On the basis of her infant’s physical findings, this woman should be questioned about her use of which substance during pregnancy?
The most important nursing action in preventing neonatal infection is:
a) Isolation of infected infants.
b) Standard Precautions.
c) Separate gown technique.
d) Good handwashing.
Providing care for the neonate born to a mother who abuses substances can present a challenge for the health care team. Nursing care for this infant requires a multisystem approach. The first step in the provision of this care is:
a) Pharmacologic treatment.
b) Neonatal abstinence syndrome scoring.
c) Reduction of environmental stimuli.
d) Adequate nutrition and maintenance of fluid and electrolyte balance.
Which infant would be more likely to have Rh incompatibility
a) Infant who is Rh positive and whose mother is Rh positive
b) Infant of an Rh-negative mother and a father who is Rh negative.
c) Infant of an Rh-negative mother and a father who is Rh positive and homozygous for the Rh factor
With regard to the understanding and treatment of infants born to mothers who are substance abusers, nurses should be aware that:
a) Mothers who abuse one substance likely will use or abuse another, compounding the infant’s difficulties
b) A baby that crys a lot, is irritable, and has tremors is all you need to know to diagnose drug withdrawal.
c) No laboratory procedures are available that can identify the intrauterine drug exposure of the infant
d) The NICU Network Neurobehavioral Scale (NNNS) is designed to assess the damage the mother has done to herself.
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