NUR114 CH24

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Author:
TomWruble
ID:
186825
Filename:
NUR114 CH24
Updated:
2012-12-04 21:47:58
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nur114f Newborn Risk
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The Newborn at Risk
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  1. High risk infants are classified by ___, ___, and ___.
    • birth weight, e.g. LBW < 2500g
    • gestational age, e.g. Preterm: before 37 weeks
    • predominant pathophysiologic problems
  2. Late preterm infants who make an effective transition to extrauterine life remain at risk for problems with ___, ___, ___, ___, and ___.
    • thermoregulation
    • hypoglycemia
    • hyperbilirubinemia
    • sepsis
    • respiratory function
  3. The goals of oxygen therapy are to ___, ___, and ___.  
    • provide adequate oxygen to the tissues
    • prevent lactic acid accumulation
    • avoid the effects of hyperoxia and free radicals
  4. Evidence supports the use of ___ nutrition within hours of a preterm birth and minimal ___ feedings within the first ___ of life.
    • parenteral
    • enteral
    • 5 days
  5. ___ feeding provides breast milk or formula through a nasogastric or orogastric tube to the preterm infant.
    Gavage
  6. An infant whose gestation is prolonged beyond ___ is considered a ___ infant.
    • 42 weeks
    • postmature
  7. Health problems that occur in infants of mothers with diabetes include ___, ___, birth injury, ___, ___, ___, ___, and ___.
    • congenital anomalies
    • macrosomia - large for gestational age
    • respiratory distress syndrome
    • hypoglycemia
    • cardiomyopathy
    • hyperbilirubinemia
    • polycythemia
  8. ___ is one of the most significant causes of neonatal morbidity and mortality.
    Sepsis
  9. Rh incompatibility occurs when an ___ mother has an ___ fetus who inherits the dominant ___ gene from the father.
    • RhD-negative
    • RhD-positive
    • Rh-positive
  10. In the United States, ___ are the leading cause of death in infants underage 1.
    major congenital defects
  11. 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.
    B. Hypoglycemia.
    C. Seizures.
    D. Hypocalcemia.
    B. Hypoglycemia.

    Hypoglycemia is common in the macrosomic infant. Signs of hypoglycemia include jitteriness, apnea, tachypnea, and cyanosis.
    (this multiple choice question has been scrambled)
  12. Hypoglycemia is common in the ___ infant. Signs of hypoglycemia include ___, ___, ___, and ___.
    • macrosomic
    • jitteriness
    • apnea
    • tachypnea
    • cyanosis
  13. The abuse of which of the following substances during pregnancy is the leading cause of cognitive impairment in the United States?

    A. Alcohol
    B. Tobacco
    C. Marijuana
    D. Heroin
    A. Alcohol

    Alcohol abuse during pregnancy is recognized as one of the leading causes of cognitive impairment in the United States.
    (this multiple choice question has been scrambled)
  14. 3.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. Tell the parents only about the newborn’s physical condition and caution them to avoid touching their baby.
    B. Leave the parents at the bedside while they are visiting so they can have some privacy.
    C. Wait quietly at the newborn’s bedside until the parents come closer.
    D. 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.
    D. 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.
    (this multiple choice question has been scrambled)
  15. With regard to injuries to the infant’s plexus during labor and birth, nurses should be aware that:

    A. If the nerves are stretched with no avulsion, they should recover completely in 3 to 6 months.
    B. Erb palsy is damage to the lower plexus.
    C. Parents of children with brachial palsy are taught to pick up the child from under the axillae.
    D. Breastfeeding is not recommended for infants with facial nerve paralysis until the condition resolves.
    A. If the nerves are stretched with no avulsion, they should recover completely in 3 to 6 months.

    However, if the ganglia are disconnected completely from the spinal cord, the damage is permanent.

    A branching network of axons located out side of the CNS (Central Nervous System) is termed a(n) Plexus. The four primary nerve plexi are the cervical plexus, brachial plexus, lumbar plexus, and the sacral plexus.
    (this multiple choice question has been scrambled)
  16. Erb palsy is damage to the ___ plexus and is less serious than brachial palsy.
    upper
  17. T/F: Parents of children with brachial palsy are taught to avoid picking up the child under the axillae or by pulling on the arms.
    True
  18. T/F: Breastfeeding is not recommended for infants with facial nerve paralysis until the condition resolves.
    False: Breastfeeding is not contraindicated, but both the mother and infant will need help from the nurse at the start.
  19. 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. Tell parents their child won’t catch up until about age 10 (girls) to 12 (boys).
    C. Correct for milestones such as motor competencies and vocalizations until the child is approximately 3 years of age.
    D. Know that the length and breadth of the trunk is the first part of the infant to experience catch-up growth.
    C. Correct for milestones such as motor competencies and vocalizations until the child is approximately 3 years of age.

    Corrections are made with a formula that adds gestational age and postnatal age.
    (this multiple choice question has been scrambled)
  20. T/F: In appraising the growth and development potential of a preterm infant catch-up body growth occurs during the first 2 to 3 years of life.
    True
  21. Sequelae
    is a pathological condition resulting from a disease, injury, or other trauma. Typically, a sequela is a chronic condition that is a complication of an acute condition that begins during the acute condition. Chronic kidney disease, for example, is sometimes a sequela of diabetes.
  22. During the initial acute distress phase of grieving, parents still must make unexpected and unwanted decisions about funeral arrangements and even naming the baby. The nurse’s role should be to:

    A. Encourage grandparents to take over.
    B. Let them alone to work things out.
    C. Take over as much as possible to relieve the pressure.
    D. Make sure the parents themselves approve the final decisions.
    D. Make sure the parents themselves approve the final decisions.
    (this multiple choice question has been scrambled)
  23. Preterm and postterm are strictly measures of time—before ___ weeks and beyond ___ weeks respectively—regardless of size for gestational age.
    • 37
    • 42
  24. A plan of care for an infant experiencing symptoms of drug withdrawal should include:

    A. Swaddling the infant snugly and holding the baby tightly.
    B.Administering chloral hydrate for sedation.
    C. Feeding every 4 to 6 hours to allow extra rest.
    D. Playing soft music during feeding.
    A. Swaddling the infant snugly and holding the baby tightly.

    The infant should be wrapped snugly to reduce self-stimulation behaviors and protect the skin from abrasions.
    (this multiple choice question has been scrambled)
  25. T/F: A plan of care for an infant experiencing symptoms of drug withdrawal should include administering chloral hydrate for sedation.
    False: Chloral hydrate is an unapproved, Schedule IV sedative and hypnotic drug. Phenobarbital or diazepam may be administered to decrease central nervous system (CNS) irritability.
  26. With regard to the classification of neonatal bacterial infection, nurses should be aware that:

    A. The clinical sign of a rapid, high fever makes infection easier to diagnose.
    B. Infections occur with about the same frequency in boy and girl infants, although female mortality is higher.
    C. Congenital infection progresses slower than nosocomial infection.
    D. Nosocomial infection can be prevented by effective handwashing; early-onset infections cannot.
    D. Nosocomial infection can be prevented by effective handwashing; early-onset infections cannot.

    Handwashing is an effective preventive measure for late-onset (nosocomial) infections because these infections come from the environment around the infant. Early-onset, or congenital, infections are caused by the normal flora at the maternal vaginal tract. Congenital (early-onset) infections progress more rapidly than nosocomial (late-onset) infections.
    (this multiple choice question has been scrambled)
  27. Congenital (early-onset) infections progress more OR less rapidly than nosocomial (late-onset) infections.
    more
  28. T/F: With regard to the classification of neonatal bacterial infection, nurses should be aware that infections occur with about the same frequency in boy and girl infants, although female mortality is higher.
    False: Infection occurs about twice as often in boys and results in higher mortality.
  29. T/F  Re: neonatal bacterial infection, the clinical sign of a rapid, high fever makes infection easier to diagnose.
    False: Clinical signs of neonatal infection are nonspecific and similar to noninfectious problems, making diagnosis difficult.
  30. Which infant would be more likely to have Rh incompatibility?

    A. Infant who is Rh negative and whose mother is Rh negative
    B. Infant of an Rh-negative mother and a father who is Rh positive and homozygous for the Rh factor
    C. Infant who is Rh positive and whose mother is Rh positive
    D. Infant of an Rh-negative mother and a father who is Rh positive and heterozygous for the Rh factor
    B. Infant of an Rh-negative mother and a father who is Rh positive and homozygous for the Rh factor

    Note: homozygous, NOT heterozygous, which would make the probably of each ofspring being Rh-positive only 50% as opposed to the 100& certatin of a homozygous Rj-positive father
    (this multiple choice question has been scrambled)
  31. 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. Decreased respiratory rate.
    B. Mottled skin with acrocyanosis.
    C. Bradycardia followed by an increased heart rate.
    D. Increased physical activity.
    B. Mottled skin with acrocyanosis.
    (this multiple choice question has been scrambled)
  32. In the preterm infant experiencing heat loss, the heart rate initially ___ followed by periods of ___.
    • increases
    • bradycardia
  33. In the term infant, the natural response to heat loss is increased physical activity. However, ___
    in a term infant experiencing respiratory distress or in a preterm infant, physical activity is decreased.
  34. Meconium aspiration syndrome occurss in ___ to ___% of all births, and primarily in ___ and ___ babies, especially those presenting ___ , i.e. cephalic.
    • 10%-15%
    • term and postterm
    • vertext
  35. Complications of postmaturity:
    • Polycythemia
    • Meconium aspiration syndrome
    • Persistent pulmonary hypertension
  36. Common complications with preterm infants:
    • Respiratory distress syndrome
    • Periventricular hemorrhage
    • Patent ductus arteriosus
  37. ABO incompatibility
    • Mother type O, newborn: A, B, or AB
    • Common cause of hyperbillirubinemia
    • Rarely precipitates significant anemia resulting from hemolysis of RBCs
  38. Coombs test
    • Indirect: determiation of Rh-positive antibodies in maternal blood
    • Direct: determiation of maternal Rh-positive antibodies in fetal cord blood

    Positive result indicates presense of antibodoes or titer
  39. erythroblastosis fetalis
    Hemolytic disease of the newbornusually caused by isoimmunization resulting from Rh or ABO incompatibility
  40. hydrops fetalis
    Most severe expression of fetal hemolytic disorder with high mortality , a possible sequela to maternal Rh isoimmunization; infant displays gross edema (nasarca) cardiac decompensation and profound pallor from anemia

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