Chapter 34: Nursing Care of the High Risk Newborn ( Test Questions ) Flashcards
An infant at 36 weeks of gestation has increasing respirations (80 to 100 breaths per minute with significant substernal retractions). The infant is given oxygen by continuous nasal positive airway pressure (CPAP). What level of partial pressure of arterial oxygen (PaO2) indicates hypoxia?
45 mm Hg
On day 3 of life, a newborn continues to require 100% oxygen by nasal cannula. The parents ask if they may hold their infant during his next gavage feeding. Considering that this newborn is physiologically stable, what response should the nurse provide?
You may hold your baby during the feeding.”
A premature infant with respiratory distress syndrome (RDS) receives artificial surfactant. How does the nurse explain surfactant therapy to the parents?
“Surfactant improves the ability of your baby’s lungs to exchange oxygen and carbon dioxide.”
An infant is to receive gastrostomy feedings. Which intervention should the nurse institute to prevent bloating, gastrointestinal reflux into the esophagus, vomiting, and respiratory compromise?
Slow, small, warm bolus feedings over 30 minutes
A premature infant never seems to sleep longer than an hour at a time. Each time a light is turned on, an incubator closes, or people talk near her crib, she wakes up and inconsolably cries until held. What is the correct nursing diagnosis beginning with “ineffective coping, related to”?
Environmental stress
Which clinical findings would alert the nurse that the neonate is expressing pain?
Cry face; eyes squeezed; increase in blood pressure
A newborn was admitted to the neonatal intensive care unit (NICU) after being delivered at 29 weeks of gestation to a 28-year-old multiparous, married, Caucasian woman whose pregnancy was uncomplicated until the 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. What is the nurse’s most appropriate action?
Go to the parents, introduce him or herself, and gently encourage them to meet their infant. Explain the equipment first, and then focus on the newborn.
An infant is being discharged from the NICU after 70 days of hospitalization. The infant was born at 30 weeks of gestation with several conditions associated with prematurity, including RDS, mild bronchopulmonary dysplasia (BPD), and retinopathy of prematurity (ROP), 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. What is the nurse’smost appropriate response?
Your baby will need to be corrected for prematurity.”
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. What should the nurse caring for the infant after birth anticipate?
Meconium aspiration, hypoglycemia, and dry, cracked skin
During the assessment of a preterm infant, the nurse notices continued respiratory distress even though oxygen and ventilation have been provided. In this situation, which condition should the nurse suspect?
Hypovolemia and/or shock
For clinical purposes, the most accurate definition of preterm and postterm infants is defined as what?
Preterm: Before 37 weeks of gestation and postterm beyond 42 weeks of gestation; no matter the size for gestational age at birth
In appraising the growth and development potential of a preterm infant, the nurse should be cognizant of the information that is best described in which statement?
Correct for milestones, such as motor competencies and vocalizations, until the child is approximately 2 years of age.
A nurse practicing in the perinatal setting should promote kangaroo care regardless of an infant’s gestational age. Which statement regarding this intervention is most appropriate?
Kangaroo care helps infants interact directly with their parents and enhances their temperature regulation.
With regard to an eventual discharge of the high-risk newborn or the transfer of the newborn to a different facility, which information is essential to provide to the parents?
Parents of high-risk infants need special support and detailed contact information
When providing an infant with a gavage feeding, which infant assessment should be documented each time?
Response to the feeding
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. Which significant symptoms will the infant display when experiencing cold stress?
Mottled skin with acrocyanosis
When evaluating the preterm infant, the nurse understands that compared with the term infant, what information is important for the nurse to understand?
Greater surface area in proportion to weight
Necrotizing enterocolitis (NEC) is an inflammatory disease of the gastrointestinal mucosa. The signs of NEC are nonspecific. What are generalized signs and symptoms of this condition?
Abdominal distention, temperature instability, and grossly bloody stools
An infant at 26 weeks of gestation arrives intubated from the delivery room. 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%. What is the nurse’s most appropriate action at this time?
Listening to breath sounds, and ensuring the patency of the endotracheal tube, increasing oxygen, and notifying a physician
In caring for the preterm infant, what complication is thought to be a result of high arterial blood oxygen level?
ROP
Which condition might premature infants who exhibit 5 to 10 seconds of respiratory pauses, followed by 10 to 15 seconds of compensatory rapid respiration, be experiencing?
Breathing in a respiratory pattern common to premature infants
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, known interventions may decrease the risk of NEC. Which intervention has the greatest effect on lowering the risk of NEC?
Breastfeeding
With regard to infants who are SGA and intrauterine growth restriction (IUGR), the nurse should be aware of which information?
Infants with asymmetric IUGR have the potential for normal growth and development.
Because of the premature infant’s decreased immune functioning, what nursing diagnosis should the nurse include in a plan of care for a premature infant?
Risk for infection
