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OB Test 6 > Maternity Nursing Chap 24 > Flashcards

Maternity Nursing Chap 24 Flashcards

1
Q

True or False: An extremely low birth weight infant is one whose weight at birth is 2000 g or less.

A

False: <1000 g

  • low birth weight infant: weight is less than 2500 g regardless of gestational age
  • very low birth weight: weight is less than 1500 g
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2
Q

True or False: Eight months after birth an infant born at 30 weeks of gestation is considered to be the corrected age of 5.5 months.

A

True

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3
Q

True or False: The incidence of physical and emotional abuse is higher in infants who, because of preterm birth or illness, were separated from their parents for a time after birth.

A

True

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4
Q

True or False: Preterm infants are at risk for polycthemia.

A

False: The macrosomic infant is at risk for polycythemia

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5
Q

True or False: Surfactant is administered intravenously to a preterm infant.

A

False: administered as an adjunct to oxygen and ventilation therapy

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6
Q

True or False: Infants born before 36 weeks of gestation require exogenous surfactant administration to survive extrauterine life.

A

False: 32 weeks of gestation

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7
Q

True or False: Acrocyanosis is an assessment finding indicative of an underlying respiratory disorder.

A

False: normal finding in the neonate, but central cyanosis indicates poor oxygenation

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8
Q

True or False: A preterm newborn’s temperature should be monitored rectally to enhance accuracy.

A

False:

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9
Q

True or False: High risk infants usually have lower caloric, nutrient, and fluid requirements than those of the normal full term newborn.

A

False: higher

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10
Q

True or False: Sucking on a pacifier during gavage feedings can facilitate the preterm newborn’s transition to nipple feeding.

A

True

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11
Q

True or False: The weight of most postmature infants is appropriate for gestational age.

A

True

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12
Q

True or False: When meconium is present in the amniotic fluid at birth, the infant should be suctioned below the vocal cords before he or she takes his or her first breath.

A

False: close supervision of labor and monitoring of fetal well being, the presence of a team skilled in neonatal resuscitation is required, mouth and nares of the infant are no longer routinely suctioned on the perineum before the infant’s first breath, for the ones who are not vigorous endotracheal suctioning should be performed immediately

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13
Q

True or False: Preterm infants can better tolerate hypoglycemia than term infants.

A

False: There is no evidence to suggest that it will do better than term infants.

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14
Q

True or False: The presentation of the fetus can affect the type and location of birth injuries.

A

True

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15
Q

True or False: A common clinical manifestation of Erb-Duchenne paralysis in the newborn is absence of the Moro reflex on the affected side.

A

True

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16
Q

True or False: Neonatal spinal cord injuries are almost always a result of a birth complicated by shoulder dystocia.

A

False: causes breakage of clavicle

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17
Q

True or False: The woman infected with toxoplasmosis during pregnancy has a 90% chance of transmitting the infection to her fetus.

A

False:

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18
Q

True or False: Newborns infected with toxoplasmosis in utero are at risk for developing severe psychomotor problems or mental retardation.

A

True

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19
Q

True or False: A major mode of transmission of gonorrhea to the fetus or newborn is via passage from an infected mother through her placenta to the fetus.

A

False: acquired through ascending infection or during birth

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20
Q

True or False: Maternal infection with syphilis is most dangerous to the fetus during the first trimester, when organogenesis takes place.

A

False: between 16 and 18 weeks of gestation

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21
Q

True or False: Penicillin is the antibiotic of choice for treating syphilis.

A

True

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22
Q

True or False: Infants born to mothers who had chickenpox 5 days before birth should be given varicella-zoster immune globulin at birth.

A

True

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23
Q

True or False: Women positive for the hepatitis B virus should not breastfeed their newborns.

A

False: breastfeeding is permitted

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24
Q

True or False: Newborns infected with cytomegalovirus must being receiving penicillin therapy within 24 hours of birth.

A

False: Ganciclovir decreases viral replication and severity of neurologic and auditory damage

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25
Q

True or False: Snuffles is a common assessment finding exhibited by infants infected with herpes simplex virus (HSV).

A

False: oral lesions

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26
Q

True or False: The most common organism causing early onset neonatal sepsis is Escherichia coli.

A

True

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27
Q

True or False: Hepatitis B during pregnancy is associated with an increased risk for intrauterine growth retardation.

A

False: Acute heatitis, chronic hepatitis, cirrhosis of the liver, liver cancer years later

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28
Q

True or False: To prevent a chlamydial infection of the eyes, silver nitrate should be instilled over the cornea of the newborn’s eyes immediately after birth.

A

False: oral erythromycin or sulfonamide for 2-3 weeks

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29
Q

True or False: Infants diagnosed with fetal alcohol syndrome (FAS) might develop learning, speech, and behavioral problems.

A

True

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30
Q

True or False: Maternal heroin use, especially during the first trimester , results in a high rate of congenital anomalies.

A

False: increased rate of stillbirth, low birth weight, small for gestational age, meconium aspiration, microcephaly, neurobehavioral problems, irritability, tachypnea, feeding difficulties, vomiting, high pitched cry, seizures, 74 fold increase in SIDS, physical dependence

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31
Q

True or False: Marijuana use during pregnancy might result in a higher incidence of intrauterine growth restriction.

A

True

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32
Q

True or False: Newborns exposed to cocaine in utero begin a process of withdrawal within 24 hours of birth.

A

False: not addicted in a behavorial sense, experience mild to strong physiologic signs as a result of the exposure

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33
Q

True or False: ABO incompatibility is more common than Rh incompatibility but causes less severe problems in the affected infant.

A

True

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34
Q

True or False: At birth, an indirect Coombs’ test is performed on the newborn’s cord blood to determine if the fetus has produced antibodies to his or her mother’s blood.

A

False: weakly positive direct Coombs’ test

35
Q

True or False: Major congenital defects are the leading cause of death among infants in the US.

A

True

36
Q

True or False: The etiology for congenital heart defect is readily identified in the majority of diagnosed infants.

A

False:

37
Q

Purpose of exogenous surfactant administration:

A
  • preterm infants born before 32 weeks of gestation have difficulty producing enough surfactant to survive extrauterine life
  • exogenous surfactant will facilitate alveoli expansion and stability, easing respirations and enhancing gas exchange until the newborn can produce sufficient quantities on his or her own
  • administered via an endotracheal tube directly into the lungs
38
Q

Kangaroo care:

A

it uses skin to skin holding to help preterm newborns interact with parents

  • it benefits newborn and parents by increasing feeling of being in control and allowing better temperature and oxygen stability with fewer episodes of crying, apnea, and periodic respirations
  • the newborns is in the quiet, alert state longer, thereby enhancing attachment and development
39
Q

Classification according to gestational age:

A
  • late preterm (near term infant): born between 34 and 36 weeks of gestation regardless of weight
  • appropriate for gestational age (AGA): birth weight falls between the 10th and 90th percentiles on intrauterine growth curves
  • small for date or small for gestation age (SGA): infant whose rate of intrauterine growth was restricted and whose birth weight falls below the 10th percentile on intrauterine growth curves
  • large for gestation age (LGA): infant whose birth weight falls above the 90th percentile on intrauterine growth charts
40
Q

What does TORCH stand for?

A
  • T : toxoplasmosis
  • O : other; gonorrhea, syphilis, chicken pox, hepatitis B, Human parvovius B19, HiV
  • R : Rubella
  • C : CMV cytomegalovirus infection
  • H : Herpes simplex virus (HSV)
41
Q

Growth restriction:

A
  • Intrauterine growth restriction (IUGR): found in infants whose intrauterine growth is restricted (sometimes used as a more descriptive term for the SGA infant)
  • Symmetric IUGR: growth restriction in which the weight, length, and head circumference are all affected
  • asymmetric IUGR: growth restriction in which the head circumference remains within normal parameters while the birth weight falls below the 10th percentile
42
Q

physiologic basis for ABO incompatibility:

A
  • fetal blood is A, B, or AB
  • mother’s blood is type O
  • naturally occurring antibodies can cross the placenta, resulting in hemolysis of the fetus-newborn’s red blood cells
  • women with blood type O already have anti-A and anti-B antibodies in their blood
43
Q

Disorder of developing blood vessels in the eye often associated with oxygen tensions that are too high for the level of retinal maturity, resulting initially in vasoconstriction and continuing problems after the oxygen is discontinues:

A

retinopathy of prematurity

44
Q

Acute inflammatory disease of the gastrointestinal mucosa commonly complicated by perforation:

A

necrotizing enterocolitis

45
Q

Result of the fetal shunt between the pulmonary artery and the aorta failing to constrict after birth or reopening after constriction has occurred:

A

patent ductus arteriosus

46
Q

Chronic pulmonary iatrogenic condition caused by barotrauma from pressure ventilation oxygen toxicity:

A

chronic lung disease (formerly bronchopulmonary dysplasia)

47
Q

One of the most common types of brain injury encountered in the neonatal period and among the most severe in regard to both short term and long term outcomes

A

periventricular intraventricular

48
Q

Respiratory distress syndrome (RDS) is a lung disorder usually associated with preterm birth.

A. RDS is caused by lack of ________, which leads to progressive atelectasis, loss of functional residual capacity, and a ventilation-perfusion imbalance, with uneven distribution of ventilation.
B. Clinical signs of RDS include _______, _______, nasal flaring, retractions, hypercapnia, respiratory or mixed acidosis and hypotension, and shock. These respiratory symptoms usually occur immediately after birth. Physical examination reveals crackles, poor air exchange, pallor, and occasionally apnea.
C. RDS is usually self limiting, with respiratoy symptoms abating after 72 hours.
D. Treatment of RDS is supportive. It involves establishing and maintaining adequate _________ and ___________, administrating exogenous surfactant, and maintaining a neutral thermal environment.

A

a. pulmonary surfactant
b. tachypnea, grunting
c. 72
d. ventilation, oxygenation

49
Q

A small brain present in a normally formed head is termed __________.

A

-microcephaly

50
Q

_______ results when the urinary meatus opens below the glans penis or anywhere along the ventral surface of the penis, scrotum, or peritoneum. Epispadias results when the urethral meatus opens on the dorsal surface of the penis. Abnormal development of the bladder, abdominal wall, and pubic symphysis that causes the bladder, urethra, and ureteral orifices to be expose is called exstrophy of the bladder.

A

-hypospadias

51
Q

Enlargement of the ventricles of the brain, usually as a result of an imbalance between production and absorption of cerebrospinal fluid (CSF), characterized by a bulging anterior fontanel, an abnormal increase in the circumference of the head, and an increasing CSF pressure, is termed ____________.

A

-hydrocephalus

52
Q

__________, a type of congenital disorder, can result in ventricular septal defects and tetralogy of Fallot.

A

-congenital heart defect

53
Q

___________, a common form of clubfoot, is characterized by plantar flexion, in which the toes are lower than the heel.

A

-talipes equinovarus

54
Q

The most common congenital anomaly of the nose requiring emergency surgery after birth is ________. It consists of a bony or membranous septum between the nose and the pharynx.

A

-choanal atresia

55
Q

__________ is a form of spina bifida cystica (a neural tube defect) in which an external sac containing the meninges and spinal fluid protrudes through a defect in the vertebral column.

A

-meningocele

56
Q

_____________ is a covered defect of the umbilical ring into which varying amounts of the abdominal organs can herniate. It is covered with a peritoneal sac. Herniation of the bowel through a defect in the abdominal wall to the right of the umbilical cord is termed _________. No membrane covers the contents.

A
  • omphalocele

- gastroschisis

57
Q

_________ is the term denoting when the passageway from the mouth to the stomach ends in a blind pouch or narrows into a thick cord; thus a continuous passageway to the stomach is not present. An abnormal connection between this passageway and the trachea is called a __________________.

A
  • esophageal atresia

- tracheoesophageal fistula

58
Q

__________ is a type of neural tube defect characterized by teh absence of both cerebral hemispheres and the overlying skull. It is incompatible with life.

A

-anencephaly

59
Q

__________ is a disorder characterized by displacement of the abdominal organs into the thoracic cavity.

A

diaphragmatic hernia

60
Q

__________ is a form of spina bifida cystica (a neural tube defect) in which an external sac containing the meninges, spinal fluid, and nerves protrudes through a defect in the vertebral column.

A

-myelomeningocele

61
Q

Preterm infants are at increased risk for developing respiratory distress. The nurse should assess for signs that indicate that the newborn is having difficulty breathing. A sign of respiratory distress is:

a. use of abdominal muscles to breathe
b. respiratory rate of 40 breaths/min or higher
c. periodic breathing pattern
d. suprasternal retraction

A

d. suprasternal retraction

62
Q

When caring for a preterm infant at 30 weeks of gestation, the nurse should recognize that the newborn’s priority nursing diagnosis is:

a. risk for infection related to decreased immune response
b. impaired gas exchange related to deficiency of surfactant
c. ineffective thermoregulation related to immature thermoregulation center
d. imbalanced nutrition: less than body requirements related to ineffective suck and swallow

A

b. impaired gas exchange related to deficiency of surfactant

63
Q

A nurse is preparing to insert a gavage tube and feed a preterm newborn. As part of the protocol for this procedure, the nurse:

a. determines the length of tubing to be inserted by measuring from tip of nose to lobe of ear to midpoint between xiphoid process and umbilicus
b. coats the tube with water soluble lubricant to ease passage
c. inserts tube through the nose as the preferred route for most infants
d. checks placement of tube by injecting 2 to 3 ml of sterile water into the tube and listening for gurgling with a stethoscope

A

a. determines the length of tubing to be inserted by measuring from tip of nose to lobe of ear to midpoint between xiphoid process and umbilicus

64
Q

The care management of a newborn whose mother is human immunodeficiency virus (HIV) positive most likely includes:

a. isolating the newborn in a special nursey
b. cleansing of skin with soap, water, and alcohol before invasive procedures such as vitamin K administration
c. wearing gloves for routine care measures such as feeding
d. initiating zidovudine treatment once the newborn’s HIV status has been determined.

A

b. cleansing of skin with soap, water, and alcohol before invasive procedures such as vitamin K administration

65
Q

An Rh-negative woman (2-2-0-0-2) has just given birth to an Rh-positive baby boy. The direct and indirect Coombs’ test results are both negative. The nurse:

a. prepares to administer Rh(D) immunoglobulin (RhoGAM) to the newborn within 24 hours of his birth
b. observes the newborn closely for signs of pathologic jaundice
c. recognizes that RhoGAM is not needed because both Coombs’ test results are negative
d. administers RhoGAM intramuscularly to the mother within 72 hours of her baby’s birth

A

d. administers RhoGAM intramuscularly to the mother within 72 hours of her baby’s birth
- this is so the mother’s body does produce antibodies for the next birth of Rh positive baby.

66
Q

A newborn female has been diagnoses with myelomeningocele. Which of the following is an important nursing measure to protect the newborn from injury and further complications during the preoperative period?

a. maintaining the newborn in a lateral or prone position
b. telling the parents that they cannot hold their newborn
c. covering the sac with Vasline gauze to keep it moist and intact
d. placing a collection bag over the genitalia to collect urine

A

a. maintaining the newborn in a lateral or prone position

67
Q

Classification according to gestational age:

A
  • preterm before 37 weeks
  • full term between week 38 and week 42
  • postterm born after 42 weeks
68
Q

What is a hemolytic disease of the newborn usually caused by isoimmunization resulting from Rh incompatibility or ABO incompatibility?

A
  • erythroblastosis fetalis
  • fetal bilirubin levels increase
  • the infant compensates for the anemia by producing large numbers of immature erythrocytes to replace those hemolyzed
69
Q

The most severe form of this disease, the fetus has marked anemia, as well as cardiac decompensation, cardiomegaly, and hepatosplenomegaly:

A
  • hydrops fetalis
  • hypoxia results from the anemia
  • exhibit gross edema (anasarca)
  • profound pallor from anemia
70
Q

What is exchange transfusion?

A
  • accomplished by alternately removing a small amount of the infant’s blood and replacing it with an equal amount of donor blood
  • the purpose of which are to prevent an accumulation of bilirubin in the blood above a dangerous level
  • to prevent the accumulation of other by products of hemolysis in hemolytic disease
  • to correct anemia and acidosis
71
Q

Periodic breathing:

A
  • a respiratory pattern commonly seen in preterm infants
  • such infants exhibit 5- to 10-second respiratory pauses followed by 10 to 15 seconds of compensatory rapid respirations
  • do NOT confuse with apnea, which is a cessation of respirations of 20 seconds or more
72
Q

Normal Arterial Blood Gas Values for Neonates:

A
  • pH: 7.35-7.45
  • arterial oxygen pressure (PaO2): 60-80 mm Hg
  • carbon dioxide pressure (PaCO2): 35-45 mm Hg
  • bicarbonate (HCO3): 18-26 mEq/L
  • base excess: (-5) to (+5)
  • oxygen saturation: 92%-94%
73
Q

meconium aspiration syndrome:

A
  • meconium not removed from the airway at birth, it can migrate down to the terminal airways, causing mechanical obstruction
  • may have aspirated in utero
  • postterm infant
  • peeling of the skin
74
Q

What is the single most important factor influencing fetal well being?

A

-the euglycemic status of the mother

75
Q

Problems seen in infants of diabetic mothers (IDMs):

A
  • congenital anomalies (anencephaly, meningomyelocele, cardiac, CNS, musculoskeletal)
  • macrosomia
  • birth injuries (cephalhematoma, paralysis of the facial nerve, fracture of clavicle or humerus)
  • RDS
  • hypoglycemia: After constant exposure to high circulating levels of glucose, hyperplasia of the fetal pancreas occurs, resulting in hyperinsulinemia. With clamping of the umbilical cord, the fetal glucose supply is cut off.
  • cardiomyopathy
  • hyperbilirubinemia and polycythemia
76
Q

Skull birth injury:

A
  • linear fracture

- depressed fracture

77
Q

Treatment for Group B streptococcus?

A

-penicillin and an aminoglycoside

78
Q

Fetal alcohol syndrome:

A
  • short eyelid openings
  • black eyelids
  • flat midface
  • flat upper lip grove
  • thin upper lip
79
Q

Cocaine baby:

A
  • prune belly syndrome
  • SGA
  • preterm birth
80
Q

tobacco baby:

A
  • preterm birth
  • low birth weight
  • SIDS
81
Q

neonatal abstinence syndrome:

A

-the term used to describe the set of behaviors exhibited by the infant exposed to chemical substances in utero

82
Q

signs of neonatal abstinence syndrome:

A
  • gastrointestinal: poor feeding, vomiting, regurgitation, diarrhea, excessive sucking
  • central nervous: irritability, tremors, shrill cry, incessant crying, hyperactivity, little sleep, excoriations on face, convulsions
  • metabolic: nasal congestion, tachypnea, sweating, frequent yawning, increased respiratory rate >60 breaths/min, fever >37.2* C
83
Q

What do some grandparents experience during the death of an infant?

A

-survivors guilt because they feel teh death is out of order as they are alive and their grandchild has died

OB Test 6 (5 decks)

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