Chapter 29:The Newborn at Risk: Acquired and Congenital Conditions Flashcards
- A pregnant patient at 37 weeks of gestation has had ruptured membranes for 26 hours. A Caesarean birth is done for labour dystocia. The fetal heart rate (FHR) before birth is 180 beats/min with minimal variability. At birth the newborn has Apgar scores of 6 and 7 at 1 and 5 minutes and is noted to be pale and tachypneic. On the basis of the maternal history, the cause of this newborn’s distress is most likely to be
a. hypoglycemia.
b. phrenic nerve injury.
c. respiratory distress syndrome.
d. sepsis.
ANS: D
The prolonged rupture of membranes and the tachypnea (before and after birth) both suggest sepsis. An FHR of 180 beats/min is also indicative. This infant is at high risk for sepsis.
- What is the most important nursing action for preventing neonatal infection?
a. Good hand hygiene
b. Isolation of infected infants
c. Separate gown technique
d. Standard precautions
ANS: A
Virtually all controlled clinical trials have demonstrated that effective hand hygiene is responsible for the prevention of hospital-acquired infection in nursery units. Measures to be taken include standard precautions/routine practices, careful and thorough cleaning, frequent replacement of used equipment, and disposal of excrement and linens in an appropriate manner. Overcrowding must be avoided in nurseries. However, the most important nursing action for preventing neonatal infection is effective hand hygiene
- A pregnant woman presents in labour 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?
a. Alcohol
b. Cocaine
c. Heroin
d. Marijuana
ANS: A
The description of the infant suggests fetal alcohol syndrome (FAS), which is consistent with maternal alcohol consumption during pregnancy. Fetal brain, kidney, and urogenital system malformations have been associated with maternal cocaine ingestion. Heroin use in pregnancy frequently results in intrauterine growth restriction. The infant may have a shrill cry and sleep cycle disturbances and present with poor feeding, tachypnea, vomiting, diarrhea, hypothermia or hyperthermia, and sweating. Studies have found a higher incidence of meconium staining in infants born of mothers who used marijuana during pregnancy.
- What should be included in a plan of care for an infant experiencing symptoms of drug withdrawal?
a. Administer chloral hydrate for sedation.
b. Feed every 4 to 6 hours to allow extra rest.
c. Swaddle the infant snugly and hold them tightly.
d. Play soft music during feeding.
ANS: C
The infant should be wrapped snugly to reduce self-stimulation behaviours and protect the skin from abrasions. Phenobarbital or diazepam may be administered to decrease central nervous system (CNS) irritability. The infant should be fed in small, frequent amounts and burped well to diminish aspiration and maintain hydration. The infant should not be stimulated (such as with music) because this will increase activity and potentially increase CNS irritability.
- How can human immunodeficiency virus (HIV) be transmitted from mother to infant?
a. Only in the third trimester from the maternal circulation
b. From a needlestick injury at birth from unsterile instruments
c. Only through the infant’s ingestion of amniotic fluid
d. Through the ingestion of breast milk from an infected mother
ANS: D
Postnatal transmission of HIV through breastfeeding may occur. Transmission of HIV from mother to infant may occur transplacentally at various gestational ages. Transmission close to or at the time of birth is thought to account for 50% to 80% of cases.
- The use of which substance during pregnancy is the leading cause of cognitive impairment?
a. Alcohol
b. Tobacco
c. Marijuana
d. Heroin
ANS: A
Alcohol use during pregnancy is recognized as one of the leading causes of cognitive impairment in newborns.
- During a prenatal examination, the woman reports having two cats at home. The nurse teaches the patient they should not be cleaning the litter box while they are pregnant. When the woman asks why, what is the basis for the nurse’s response?
a. Cats could be carrying toxoplasmosis which is a parasite that can infect the
mother and unborn child.
b. The mother and fetus can be exposed to the human immunodeficiency virus
(HIV) in cats’ feces.
c. Inform her that it is not a clean task and the father of the baby should clean the litter box.
d. Cat feces are known to carry Escherichia coli, which can cause severe infections in both mother and baby.
ANS: A
Toxoplasmosis is a multisystem disease caused by the protozoal Toxoplasma gondii parasite commonly found in cats. Clinical features ascribed to toxoplasmosis include hydrocephalus or microcephaly, chorioretinitis, seizures, or encephalitis, among other features. HIV is not transmitted by cats. Although suggesting that the baby’s father clean the litter boxes may be a valid statement, it is not appropriate, does not answer the client’s question, and is not the nurse’s best response. E. coli is found in normal human fecal flora. It is not transmitted by cats.
- A primigravida has just given birth to a healthy newborn. The nurse is about to administer erythromycin ointment to the newborn’s eyes when the mother asks, “What is that medicine for?” What is the basis for the nurse’s response?
a. It is an eye ointment to help newborns see clearer.
b. It is to protect newborns from contracting maternal herpes.
c. Erythromycin is given prophylactically to newborns to prevent a gonorrheal infection.
d. This medicine will protect newborn’s eyes from drying out over the next few days.
ANS: C
With the prophylactic use of erythromycin, the incidence of gonococcal conjunctivitis has declined to less than 0.5%. Eye prophylaxis is administered at or shortly after birth to prevent ophthalmia neonatorum. Erythromycin has no bearing on enhancing vision, is used to prevent infections caused by gonorrhea, not herpes, and is not used for eye lubrication.
- What should nurses be aware of with regard to skeletal injuries sustained by a newborn during labour or birth?
a. A newborn’s skull is still forming and fractures fairly easily.
b. Unless a blood vessel is involved, linear skull fractures heal without special
treatment.
c. Clavicle fractures often need to be set with an inserted pin for stability.
d. Other than the skull, the most common skeletal injuries are to leg bones.
ANS: B
About 70% of newborn skull fractures are linear. Because the newborn skull is flexible, considerable force is required to fracture it. Clavicle fractures need no special treatment. The clavicle is the bone most often fractured during birth, not the leg bones.
- Which should nurses be aware of with regard to injuries to the infant’s plexus during labour and birth?
a. If the nerves are stretched with no avulsion, they should recover completely in 3
to 6 months.
b. Erb palsy is caused by 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.
ANS: 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. Erb palsy is caused by damage to the upper plexus and is less serious than brachial palsy. Parents of children with brachial palsy are taught to avoid picking up the child under the axillae or by pulling on the arms. Breastfeeding is not contraindicated, but both mother and infant will need help from the nurse at the start.
- What should the nurse be aware of with regard to the classification of a neonatal bacterial infection?
a. Congenital infection progresses more slowly than health care associated infection.
b. Health care associated infection can be prevented by effective hand hygiene;
early-onset infections cannot.
c. Infections occur with about the same frequency in boy and girl infants, although
female mortality is higher.
d. The clinical sign of a rapid, high fever makes infection easier to diagnose.
ANS: B
Hand hygiene is an effective preventive measure for health care associated infections because these come from the infant’s environment. Early-onset or congenital infections are caused by the normal flora of the maternal vaginal tract and progress more rapidly than health care associated infections. Infection occurs about twice as often in boys and results in higher mortality for them. Clinical signs of neonatal infection are nonspecific and similar to non-infectious problems, making diagnosis difficult.
- Near the end of the first week of life, an infant who has not been treated for any infection develops a copper-coloured, maculopapular rash on the palms and around the mouth and anus. What is the newborn showing signs of?
a. Gonorrhea
b. Herpes simplex virus
c. Congenital syphilis
d. Human immunodeficiency virus (HIV)
NS: C
The rash is indicative of congenital syphilis. The lesions may extend over the trunk and extremities.
- Which bacterial infection is decreasing because of effective medication treatment?
a. Escherichia coli infection
b. Tuberculosis
c. Candidiasis
d. Group B streptococcal infection
ANS: D
Penicillin has significantly decreased the incidence of group B streptococcal infections. E. coli may be increasing, perhaps because of the increased use of ampicillin (resulting in a more virulent E. coli strain resistant to the drug). Tuberculosis is increasing in Canada and the United States. Candidiasis is a fairly benign fungal infection.
- Which should the nurse be aware of when caring for a mother who has used alcohol during their pregnancy, and for their infant?
a. The pattern of growth restriction of the fetus begun in prenatal life is halted after
birth, and normal growth takes over.
b. Newborns with fetal alcohol syndrome (FAS) are below the twenty-fifth
percentile for weight and height.
c. Alcohol-related neurodevelopmental disorders that do not meet FAS criteria are
often not detected until the child goes to school.
d. Both the distinctive facial features of the FAS infant and the diminished mental
capacities tend toward normal over time.
ANS: C
Some learning problems do not become evident until the child is at school. The pattern of growth restriction persists after birth. Newborns with FAS are below the tenth percentile for weight and height. Although the distinctive facial features of the FAS infant tend to become less evident, mental capacities never become normal.
- For infants of mothers who used heroin during their pregnancy, which statement is true?
a. They are usually small for gestational age.
b. They have a higher-than-average birth weight.
c. They have more risk of congenital anomalies.
d. They have a decreased risk of sudden infant death syndrome (SIDS).
ANS: A
Heroin crosses the placenta and often results in a growth reduction and a baby that is small for gestational age. Infants usually have a lower-than-average birth weight. There is less of a risk of congenital anomalies. There is an increased risk of SIDS.
