Ch. 69 The High-Risk Newborn

Question 1

The virus that causes German measles is called

Answer 1

Rubella

Question 2

__________ is a catarrhal discharge from the nasal mucous membrane of newborn infants with syphilis.

Answer 2

Snuffles

Question 3

The “C” in torch stands for ________.

Answer 3

Cytomegalovirus

Question 4

When the urethra opens on the bottom side of the penis, the condition is called?

Answer 4

Hypospadias

Question 5

________ is a genetic disorder in which the
newborn is incapable of metabolizing galactose.

Answer 5

Galactosemia

Question 6

Hemolytic disease of the newborn caused by Rh sensitization

Answer 6

Erythroblastosis fetalis

Question 7

Increase in size of the musculature at the junction of the stomach and small intestine

Answer 7

Pyloric stenosis

Question 8

Neural tube defect in which the vertebral spaces fail to close

Answer 8

Spina Bifida

Question 9

Obstruction/ closure of the nostrils at the entrance to the throat

Answer 9

Choanal atresia

Question 10

Write the correct sequence that needs to occur during the treatment for dehvdration in newborn with diarrhea.
1. Obtain stool cultures.
2. Give intravenous fluids.
3. Replace lost electrolytes.
4. Administer antibiotics (if necessary)

Answer 10

2 Give intravenous fluids.
3 Replace lost electrolytes.
1 Obtain stool cultures.
4 Administer antibiotics (if necessary)

Question 11

What is respiratory distress syndrome?

Answer 11

-Respiratory distress syndrome (RDS) is a developmental disorder in newborns that occurs due to deficiency of a substance called pulmonary surfactant, which results in incomplete lung expansion.
-The newborn’s lungs cannot expand normally, and the newborn therefore does not receive enough air for proper oxygenation. It can cause death, especially in the preterm newborn.
-Onset of RDS is prevented by administration of betamethasone, glucocorticosteroid, to the mother 12 to 24 hours before the preterm birth.
-The newborn with RDS demonstrates dyspnea and cyanosis.
-The infant may exhibit an increase in respiratory rate, flaring of the nares (nostrils), retraction of the chest muscles during inspiration, tachycardia, and an expiratory grunt during breathing.
-If the newborn survives the first few days of life, however, recovery is usually complete

Question 12

What is phototherapy? Explain the procedure.

Answer 12

Phototherapy is the use of fluorescent lights to alleviate jaundice in newborns. The ultraviolet (UV) light of sunshine or intense fluorescent light accelerates the elimination of bilirubin in the skin (photo-oxidation).
To provide maximum skin exposure, the newborn is kept naked except for a small diaper.
The eyes are closed with dressings to protect the retinas.
The newborn is placed under the lights.
During the procedure, care is taken to monitor the infant’s vital signs, especially temperature.
The baby is placed on a 3-hour feeding schedule.
Frequent feedings help to speed the excretion of bilirubin.
Water is provided, if necessary, to prevent dehydration.
The newborn is removed from the lights for feeding, obtaining vital signs, and bonding

Question 13

What are the risk factors for hypoglycemia in the newborn? What are its signs and symptoms?

Answer 13

Hypoglycemia or decreased blood sugar is a prominent feature in all neonates after birth.
However, newborns who are large for gestational age; newborns of diabetic mothers; and newborns with erythroblastosis fetalis, heart disease, and galactosemia are at the greatest risk of developing this condition.
Hypoglycemia occurs when the blood glucose level is less than 40 mg/dL.
Signs of hypoglycemia normally relate to the central nervous system and include tremors, irritability, jitteriness, a high-pitched or weak cry, and eye rolling.
Observable changes in vital signs, such as apnea and tachycardia, may appear.
The newborn may be cyanotic or pale, may eat poorly, and may have seizures

Question 14

What is Down syndrome?

Answer 14

Down syndrome is a genetic disorder often associated with mothers who give birth after 40 years of age. It is commonly identified in the newborn nursery by typical physical features, although only chromosomal analysis can make a final diagnosis.
Physical and mental manifestations may range from mild to severe.
The features of Down syndrome include a single deep crease running horizontally across the hands.
Eyes are slanted, and the tongue is large and protruding.
The infant is flaccid. Usually, accompanying mental retardation and heart defects exist, and cataracts and gastrointestinal disorders may be present

Question 15

An 18-year-old client has just delivered a preterm baby. When assessing the condition of the baby, the nurse notices that the neonate is gradually losing body temperature.

a. What interventions should the nurse take to ensure that the body temperature returns to normal? Explain with rationales.

Answer 15

The nurse should perform the following interventions to ensure that the body temperature returns
to normal:
• Dry the newborn thoroughly, and place the newborn in an isolette or under a radiant warmer.
•. Keep handling of the neonate to a minimum. Refrain from bathing the neonate until the temperature has stabilized between 97.6°F and 98.6°F (36.5°C to 37°C). Consolidate procedures and treatments to avoid tiring the neonate.
• Cover the neonate’s head.
• Cover any surface that the neonate is to lie on and position the neonate away from doors, windows, or other areas that could cause drafts

Question 16

An 18-year-old client has just delivered a preterm baby. When assessing the condition of the baby, the nurse notices that the neonate is gradually losing body temperature.

b. How is the return of body temperature in newborns evaluated?

Answer 16

The return of body temperature in newborns is evaluated as follows:
• Observe whether the neonate is warm, the color is pale pink, and the head is covered. The axillary temperature of the infant should be at 97.6°F (36.5°C) when in an isolette. The infant should not show any evidence of cold stress.
• The neonate’s temperature should range between 97.6°F and 98.6°F (36.5°C to 37°C) for 4 hours.
• Weigh the neonate daily and report any significant decreases.
• The neonate’s temperature should range between 97.6°F and 98.6°F (36.5°C to 37°C); heart rate is usually between 120 and 130 beats per minute, and respirations are 56 to 60 breaths per minute within age-acceptable parameters. The neonate is kept out of the isolette for 10 minutes three times a day, with temperature maintained at 97.6°F (36.5°C).

Question 17

As a part of client teaching, a nurse instructs a pregnant client to avoid alcohol, nicotine, and other drugs completely.

A. Why should a pregnant client avoid these substances?

Answer 17

a. The nurse should instruct the pregnant client to avoid use of alcohol, nicotine, and other drugs because these substances could reach the fetus through the placenta, leading to withdrawal symptoms in the neonate after birth. Other complications likely to develop include the following:
• Preterm delivery
• Low-birth-weight neonate
• Intellectual impairments in the infant
• Spontaneous abortion
• Abruptio placentae
• Stillbirth

Question 18

As a part of client teaching, a nurse instructs a pregnant client to avoid alcohol, nicotine, and other drugs completely.

What suggestions should a nurse provide for handling an addicted newborn?

Answer 18

The addicted newborn is usually hypersensitive.
The nervous system and the gastrointestinal systems are most commonly affected. The nurse’s suggestions when handling an addicted newborn should include providing eye contact, touching gently, and rocking the baby up and down rather than side to side.

Question 19

A 19-year-old client gave birth to a postterm newborn at the healthcare facility. The baby’s weight is below the 10th percentile for gestational age. How should this newborn be classified?
A. Very-low-birth-weight infant
B. Small-for-gestational age infant
C. Normal-birth-weight infant
D. Large-for-gestational age infant

Answer 19

B. Small-for-gestational age infant

• RATIONALE: Small for gestational age (SGA) indicates an infant whose birth weight is below the 10th percentile expected for that gestational age. Very low-birth-weight (VLBW) infants are those weighing between 1 and 3.5 lb (500 to 1,499 g). Normal-birth-weight infants are usually born between the 37th and 41st week of gestation. Macrosomic neonates, or large-for-gestational-age (LGA) neonates, are those newborns whose birth weight exceeds the 90th percentile of newborns of the same gestational age

Question 20

A client who recently gave birth to a low birth weight newborn rushes her child to the healthcare facility with frequent vomiting and diarrhea. Which should the nurse monitor in this case?

A. Dehydration
B. Jaundice
C. Necrotizing enterocolitis
D. Hypoglycemia

Answer 20

A. Dehydration

RATIONALE: In a newborn who has frequent vomiting and diarrhea, the nurse should monitor for the presence of dehydration. Dehydration rapidly develops because the baby has very little reserve fluid in the body, and this reserve is depleted quickly if the newborn is losing water from the body at such a high rate. Symptoms of necrotizing enterocolitis include lethargy, abdominal distention, hypothermia, apnea, and irritability. Signs of hypoglycemia normally relate to the central nervous system and include tremors, irritability, jitteriness, a high-pitched or weak cry, and eye rolling. Jaundice results from the inability of the newborn’s immature liver to handle bilirubin. Excess bilirubin appears in the bloodstream, causing the skin to appear yellow

Question 21

A 35-year-old client is overdue for delivery by
3 weeks. Which assessment does the nurse expect to find in the postterm newborn?
A. The infant’s skin may appear wet and smooth.
B. Excess vernix caseosa may be seen on the skin.
C. The infant may have aspirated meconium into the lungs.
D. The neonate may appear large-for-gestational age.

Answer 21

C. The infant may have aspirated meconium into the lungs.

RATIONALE: Postterm newborns are at a higher risk of swallowing meconium or aspirating it into their lungs in utero or at birth. This occurs if the first breath is taken before suctioning; the newborn may aspirate meconium and amniotic fluid into the lungs. Postterm newborns are not necessarily in better condition than full-term newborns. They often have long fingernails and hair, and dry, parched skin, not wet, smooth skin. There is usually no vernix caseosa. These babies look wrinkled and old at birth. Postterm babies often have respiratory or nutritional problems because the placenta is unable to provide adequately for them after the normal gestation period. As a result, they may be small and not large for gestational age

Question 22

A nurse is caring for a newborn with signs of fussiness, weight loss, and dehydration. The infant first vomited a milky substance after an initial feed, and then the vomiting was projectile. Which condition do these symptoms indicate?

A. Pyloric stenosis
B. Tracheoesophageal fistula
C. Imperforate anus
D. Cleft palate

Answer 22

A. Pyloric stenosis

Answer: a

RATIONALE: The symptoms are indicative of pyloric stenosis. The pyloric opening of the stomach is constricted, leading to restriction of the food passage. When a tracheal fistula accompanies esophageal atresia, it is referred to as a tracheoesophageal fistula. The situation is life-threatening because the esophagus channels food and mucus directly into the lungs. In an imperforate anus, the baby’s rectum ends in a blind pouch, causing an obstruction to the normal passage of feces. Imperforate anus is suspected if the newborn does not pass a stool within 24 hours after delivery. Cleft lip is a vertical opening in the upper lip. It may appear as a notch in the lip or extend upward into the nose. Cleft lip and palate cause feeding difficulties because the newborn is unable to suck effectively. In addition, milk that goes into the mouth may be expelled through the nose.

Question 23

When caring for a preterm newborn, the nurse notices milk-like spots or monilial infection in the newborn’s mouth. Which nursing consideration should the nurse employ when caring for the newborn?

A. Use an antibiotic solution to swab the affected area.
B. Administer humidified oxygen to the newborn.
C. Maintain the newborn on parenteral nutrition.
D. Isolate the newborn and treat with nystatin.

Answer 23

D. Isolate the newborn and treat with nystatin.

RATIONALE: The newborn with a monilial infection is isolated and treated with nystatin, because the infection can spread through contact. Administering humidified oxygen is not necessary in the newborn, because thrush is a localized condition that does not affect the respiratory system of the newborn or alter breathing. Swabbing of the infant’s mouth with an antibiotic agent does not help in the treatment of the condition, because thrush is a fungal infection caused by yeast, and the antibiotic agent will not have any effect on the condition. Parenteral feeding of the newborn is unnecessary because the condition is not so severe that it affects feeding or alters other functions in the newborn

Question 24

A client with a previous history of syphilis infection recently gave birth. The newborn has acquired syphilis infection and has rose spots, blebs (blisters) on the soles and palms, and catarrhal discharge from the nasal mucous membrane. Which intervention should the nurse implement when caring for the newborn?

A. Isolate the newborn and begin treatment with antibiotics as ordered.
B. Treat the newborn with 1%-2% aqueous solution of gentian violet.
C. Wipe the newborn’s mouth with a sterile gauze sponge after each feeding.
D. Administer oxygen, vitamin K, anticonvul-sive medications, and sedatives as required.

Answer 24

A. Isolate the newborn and begin treatment with antibiotics as ordered.

RATIONALE: Isolating the newborn and beginning treatment with antibiotics is necessary to help control the infection and prevent harmful effects on the newborn. Treating the newborn with 1% to 2% aqueous solution of gentian violet does not help in treating syphilis; this treatment is sometimes used in newborns with monilial infection. Wiping the newborn’s mouth with a sterile gauze sponge after each feeding does not make much of a difference to a newborn with syphilis; this procedure is, however, beneficial in newborns with monilial infection. Administering oxygen, vitamin K, anticonvulsive medications, and sedatives does not help in the management and treatment of syphilis; this is often necessary in newborns with intracranial hemorrhage

Question 25

A nurse is assessing a 26-year-old pregnant client with a history of marijuana and alcohol misuse. Which complication of such abuse should the nurse warn the client about?

A. Postterm birth
B. Hypoglycemia
C. Low birth weight
D. Prolonged labor

Answer 25

C. Low birth weight

RATIONALE: The nurse should warn the client that marijuana and alcohol abuse increases the risk of giving birth to a low-birth-weight child. Marijuana abuse does not prolong labor; using marijuana during pregnancy can actually precipitate labor of fewer than 3 hours. Marijuana abuse does not lead to postterm birth because marijuana use during pregnancy can actually shorten the gestation period, thereby leading to a preterm birth. Hypoglycemia does not usually develop in the newborn of the client with a history of marijuana and alcohol abuse; hypoglycemia is an important finding in large-for-gestational-age infants, who are most often born to mothers with diabetes

Question 26

When assessing the condition of a preterm baby, the nurse notices a deep crease that runs horizontally across the infant’s hands.
The baby has slanted eyes and a large protruding tongue. Which condition should the nurse suspect in such a child?

A. Anencephaly
B. Down syndrome
C. Spina bifida
D. Hydrocephalus

Answer 26

B. Down syndrome

RATIONALE: Infants with Down syndrome may show a single deep crease running horizontally across the hands. Their eyes are slanted, and their tongue is large and protruding. The infant is flaccid and usually exhibits signs of mental retardation, heart defects, cataracts, and gastrointestinal disorders. In children with anencephaly, part or all of the brain is missing. The skull is flat, and these newborns live for only a short time, if at all. Spina bifida is a congenital neural tube defect in which the vertebral spaces fail to close, allowing a herniation (bulging) of the spinal contents into a sac. Hydrocephalus is an excess of cerebrospinal fluid (CSF) in the ventricles and subarachnoid spaces of the brain, which leads to bulging fontanels and nervous irritability

Question 27

A nurse is caring for a 2-day-old infant with signs of seizures, respiratory distress, cyanosis, a shrill cry, and muscle weakness.
The child is diagnosed with intracranial hemorrhage. Which procedure must the nurse employ when caring for the child?
A. Position the head of the bed slightly lowered.
B. Administer vitamin K immediately.
C. Subject the newborn to phototherapy.
D. Avoid using a gavage tube for feeding.

Answer 27

B. Administer vitamin K immediately.

RATIONALE: Newborns with intracranial hemorrhage are administered vitamin K intramuscularly immediately after birth to control the bleeding by enhancing clot formation. The newborn should not be positioned with the head of the bed lowered, because doing so increases the intracranial pressure due to the intracranial hemorrhage. Instead, the newborn with intracranial hemorrhage should be positioned with the head of the bed slightly elevated. The infant may require administration of oxygen, vitamin K, antibiotics, anti convulsive medications, and sedatives as ordered. Feeding in newborns with intracranial hemorrhage is usually through a gavage tube. Phototherapy is the use of ultraviolet light to treat conditions such as jaundice in newborns; it is not used for management of intracranial hemorrhage.

Question 28

A nurse caring for a newborn notices an abnormal breathing pattern. The newborn shows signs of dyspnea and cyanosis along with tachycardia and an expiratory grunt.
What does the nurse suspect is the condition for this newborn?
A. Fetal alcohol syndrome
B. Respiratory distress syndrome
C. Down syndrome
D. Congenital rubella syndrome

Answer 28

B. Respiratory distress syndrome

RATIONALE: The characteristics are suggestive of respiratory distress syndrome (RDS) caused due to deficiency of a pulmonary surfactant in the lungs. Infants with RDS exhibit signs of abnormal breathing, dyspnea, cyanosis, increased respiratory rate, and flaring of the nares (nostrils). The chest muscles retract during inspiration, and the condition is accompanied by tachycardia and an expiratory grunts. Fetal alcohol syndrome is characterized by growth deficiency, microcephaly, facial abnormalities, cardiac anomalies, and mental retardation. Congenital rubella syndrome is caused by rubella virus in newborns. It can cause cataracts, deafness, congenital heart defects, cardiac disease, and mental retardation. Down syndrome is characterized by a single deep crease running horizontally across the hands, slanted eyes, a large and protruding tongue, mental retardation, heart defects, cataracts, and gastrointestinal disorders