Download NURS368 Final Exam Questions and Answers: Neonatal Intensive Care and more Exams Nursing in PDF only on Docsity!
NURS368 Final Exam Questions With 100%
Accurate Answers
Surfactant replacement therapy is used in the medical management of:
A: Bronchopulmonary dysplasia (BPD)
B: Patent ductus arteriosus (PDA)
C: Respiratory distress syndrome (RDS)
D: Necrotizing enterocolitis (NEC) - ANSWER C: Respiratory distress syndrome (RDS)
Which intervention is the most important to prevent necrotizing enterocolitis?
A: Exclusive human milk feeding
B: Surfactant
C: Oxygen
D: Ventilator support - ANSWER A: Exclusive human milk feeding
Which type of IUGR has better developmental outcomes?
A: Asymmetric
B: Symmetric - ANSWER A: Asymmetric
Weight is the only abnormal measurement
A macrosomic infant is born after a difficult forceps-assisted delivery. After stabilization the infant is weighed, and the birth weight is 4550 g (9 pounds, 6 ounces). The nurse's most appropriate action is to:
a. Leave the infant in the room with the mother.
b. Take the infant immediately to the nursery.
c. Perform a gestational age assessment to determine whether the infant is large for gestational age.
d. Monitor blood glucose levels frequently and observe closely for signs of hypoglycemia. - ANSWER d. Monitor blood glucose levels frequently and observe closely for signs of hypoglycemia.
(This infant is macrosomic (more than 4000 g) and is at high risk for hypoglycemia.
Blood glucose levels should be monitored frequently, and the infant should be observed closely for signs of hypoglycemia. Observation may occur in the nursery or in the mother's room, depending on the condition of the fetus. Regardless of gestational age, this infant is macrosomic.)
Infants of mothers with diabetes (IDMs) are at higher risk for developing:
a. Anemia.
b. Hyponatremia.
c. Respiratory distress syndrome.
d. Sepsis. - ANSWER c. Respiratory distress syndrome.
(IDMs are at risk for macrosomia, birth injury, perinatal asphyxia, respiratory distress syndrome, hypoglycemia, hypocalcemia, hypomagnesemia, cardiomyopathy, hyperbilirubinemia, and polycythemia. They are not at risk for anemia, hyponatremia, or sepsis.)
An infant was born 2 hours ago at 37 weeks of gestation and 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. Hypocalcemia.
c. Hypoglycemia
d. Seizures. - ANSWER c. Hypoglycemia
(Hypoglycemia is common in the macrosomic infant. Signs of hypoglycemia include jitteriness, apnea, tachypnea, and cyanosis.)
When assessing the preterm infant the nurse understands that compared with the term infant, the preterm infant has:
a. Few blood vessels visible through the skin.
b. More subcutaneous fat.
c. Well-developed flexor muscles.
d. Greater surface area in proportion to weight. - ANSWER d. Greater surface area in proportion to weight.
(Preterm infants have greater surface area in proportion to their weight. More subcutaneous fat and well-developed muscles are indications of a more mature infant.)
sedation needs of the infant. Surfactant is used to improve respiratory compliance, including the exchange of oxygen and carbon dioxide. The goal of surfactant therapy in an infant with respiratory distress syndrome (RDS) is to stimulate production of surfactant in the type 2 cells of the alveoli. The clinical presentation of RDS and neonatal pneumonia may be similar. The infant may be started on broad-spectrum antibiotics to treat infection.)
When providing an infant with a gavage feeding, which of the following should be documented each time?
a. The infant's abdominal circumference after the feeding
b. The infant's heart rate and respirations
c. The infant's suck and swallow coordination
d. The infant's response to the feeding - ANSWER d. The infant's response to the feeding
(Documentation of a gavage feeding should include the size of the feeding tube, the amount and quality of the residual from the previous feeding, the type and quantity of the fluid instilled, and the infant's response to the procedure. Abdominal circumference is not measured after a gavage feeding. Vital signs may be obtained before feeding. However, the infant's response to the feeding is more important. Some older infants may be learning to suck, but the important factor to document would be the infant's response to the feeding (including attempts to suck).)
An infant is to receive gastrostomy feedings. What intervention should the nurse institute to prevent bloating, gastrointestinal reflux into the esophagus, vomiting, and respiratory compromise?
a. Rapid bolusing of the entire amount in 15 minutes
b. Warm cloths to the abdomen for the first 10 minutes
c. Slow, small, warm bolus feedings over 30 minutes
d. Cold, medium bolus feedings over 20 minutes - ANSWER c. Slow, small, warm bolus feedings over 30 minutes
(Feedings by gravity are done slowly over 20- to 30-minute periods to prevent adverse reactions. Rapid bolusing of the entire amount in 15 minutes would most likely lead to the adverse reactions listed. Temperature stability in the newborn is critical. Warm cloths to the abdomen for the first 10 minutes would not be appropriate because it is not a thermoregulated environment. Additionally, abdominal warming is not indicated with feedings of any kind. Small feedings at room temperature are recommended to prevent adverse reactions.)
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%. The nurse's most appropriate action would be to:
a. Listen to breath sounds and ensure the patency of the endotracheal tube, increase oxygen, and notify a physician.
b. Continue to observe and make no changes until the saturations are 75%.
c. Continue with the admission process to ensure that a thorough assessment is completed.
d. Notify the parents that their infant is not doing well. - ANSWER a. Listen to breath sounds and ensure the patency of the endotracheal tube, increase oxygen, and notify a physician.
(Listening to breath sounds and ensuring the patency of the endotracheal tube, increasing oxygen, and notifying a physician are appropriate nursing interventions to assist in optimal oxygen saturation of the infant. Oxygenation of the infant is crucial. O saturation should be maintained above 92%. Oxygenation status of the infant is crucial. The nurse should delay other tasks to stabilize the infant. Notifying the parents that the infant is not doing well is not an appropriate action. Further assessment and intervention are warranted before determination of fetal status.)
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 woman 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:
display hypotonia, bradycardia, and metabolic acidosis.)
An infant is being discharged from the neonatal intensive care unit after 70 days of hospitalization. The infant was born at 30 weeks of gestation with several conditions associated with prematurity, including respiratory distress syndrome, mild bronchopulmonary dysplasia, and retinopathy of prematurity requiring surgical treatment. During discharge teaching the infant's mother asks the nurse whether her baby will meet developmental milestones on time, as did her son who was born at term. The nurse's most appropriate response is:
a. "Your baby will develop exactly like your first child did."
b. "Your baby does not appear to have any problems at the present time."
c. "Your baby will need to be corrected for prematurity. Your baby is currently 40 weeks of postconceptional age and can be expected to be doing what a 40-week-old infant would be doing."
d. "Your baby will need to be followed very closely." - ANSWER c. "Your baby will need to be corrected for prematurity. Your baby is currently 40 weeks of postconceptional age and can be expected to be doing what a 40-week-old infant would be doing."
(The age of a preterm newborn is corrected by adding the gestational age and the postnatal age. The infant's responses are evaluated accordingly against the norm expected for the corrected age of the infant. Although it is impossible to predict with complete accuracy the growth and development potential of each preterm infant, certain measurable factors predict normal growth and development. The preterm infant experiences catch-up body growth during the first 2 to 3 years of life. The growth and developmental milestones are corrected for gestational age until the child is approximately 2.5 years old. Stating that the baby does not appear to have any problems at the present time is inaccurate. Development will need to be evaluated over time.)
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. The nurse caring for the infant after birth should anticipate:
a. Meconium aspiration, hypoglycemia, and dry, cracked skin.
b. Excessive vernix caseosa covering the skin, lethargy, and respiratory distress syndrome.
c. Golden yellow- to green stained-skin and nails, absence of scalp hair, and an increased amount of subcutaneous fat.
d. Hyperglycemia, hyperthermia, and an alert, wide-eyed appearance. - ANSWER a. Meconium aspiration, hypoglycemia, and dry, cracked skin.
(Meconium aspiration, hypoglycemia, and dry, cracked skin are consistent with a postmature infant. Excessive vernix caseosa covering the skin, lethargy, and respiratory distress syndrome would be consistent with a very premature infant. The skin may be meconium stained, but the infant would most likely have longer hair and decreased amounts of subcutaneous fat. Postmaturity with a nonreactive NST would indicate hypoxia. Signs and symptoms associated with fetal hypoxia are hypoglycemia, temperature instability, and lethargy.)
In caring for the preterm infant, what complication is thought to be a result of high arterial blood oxygen level?
a. Necrotizing enterocolitis (NEC)
b. Retinopathy of prematurity (ROP)
c. Bronchopulmonary dysplasia (BPD)
d. Intraventricular hemorrhage (IVH) - ANSWER b. Retinopathy of prematurity (ROP)
(ROP is thought to occur as a result of high levels of oxygen in the blood. NEC is caused by the interference of blood supply to the intestinal mucosa. Necrotic lesions occur at that site. BPD is caused by the use of positive pressure ventilation against the immature lung tissue. IVH results from rupture of the fragile blood vessels in the ventricles of the brain. It is most often associated with hypoxic injury, increased blood pressure, and fluctuating cerebral blood flow.)
In the assessment of a preterm infant, the nurse notices continued respiratory distress even though oxygen and ventilation have been provided. The nurse should suspect:
with their parents and enhances their temperature regulation.
(Kangaroo care is skin-to-skin holding in which the infant, dressed only in a diaper, is placed directly on the parent's bare chest and then covered. The procedure helps infants interact with their parents and regulates their temperature, among other developmental benefits.)
For clinical purposes, preterm and post-term infants are defined as:
a. Preterm before 34 weeks if appropriate for gestational age (AGA) and before 37 weeks if small for gestational age (SGA).
b. Post-term after 40 weeks if large for gestational age (LGA) and beyond 42 weeks if AGA.
c. Preterm before 37 weeks, and post-term beyond 42 weeks, no matter the size for gestational age at birth.
d. Preterm, SGA before 38 to 40 weeks, and post-term, LGA beyond 40 to 42 weeks. - ANSWER c. Preterm before 37 weeks, and post-term beyond 42 weeks, no matter the size for gestational age at birth.
(Preterm and post-term are strictly measures of time — before 37 weeks and beyond 42 weeks, respectively — regardless of size for gestational age.)
With regard to small for gestational age (SGA) infants and intrauterine growth restrictions (IUGR), nurses should be aware that:
a. In the first trimester diseases or abnormalities result in asymmetric IUGR.
b. Infants with asymmetric IUGR have the potential for normal growth and development.
c. In asymmetric IUGR weight is slightly more than SGA, whereas length and head circumference are somewhat less than SGA.
d. Symmetric IUGR occurs in the later stages of pregnancy. - ANSWER b. Infants with asymmetric IUGR have the potential for normal growth and development.
(IUGR is either symmetric or asymmetric. The symmetric form occurs in the first trimester; SGA infants have reduced brain capacity. The asymmetric form occurs in the later stages of pregnancy. Weight is less than the 10th percentile; head circumference is greater than the 10th percentile. Infants with asymmetric IUGR have the potential for normal growth and development.)
As related to the eventual discharge of the high risk newborn or transfer to a different facility, nurses and families should be aware that:
a. Infants will stay in the neonatal intensive care unit (NICU) until they are ready to go home.
b. Once discharged to home, the high risk infant should be treated like any healthy term newborn.
c. Parents of high risk infants need special support and detailed contact information.
d. If a high risk infant and mother need transfer to a specialized regional center, it is better to wait until after birth and the infant is stabilized. - ANSWER c. Parents of high risk infants need special support and detailed contact information.
(High risk infants can cause profound parental stress and emotional turmoil. Parents need support, special teaching, and quick access to various resources available to help them care for their baby. Parents and their high risk infant should spend a night or two in a predischarge room, where care for the infant is provided away from the NICU. Just because high risk infants are discharged does not mean that they are normal, healthy babies. Follow-up by specialized practitioners is essential. Ideally, the mother and baby are transported with the fetus in utero; this reduces neonatal morbidity and mortality.)
Necrotizing enterocolitis (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. To develop an optimal plan of care for this infant, the nurse must understand which intervention has the greatest effect on lowering the risk of NEC:
a. Early enteral feedings
b. Breastfeeding
followed by periods of bradycardia. 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.)
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?
a. Delayed growth and development
b. Ineffective thermoregulation
c. Ineffective infant feeding pattern
d. Risk for infection - ANSWER d. Risk for infection
(The nurse needs to understand that decreased immune functioning increases the risk for infection. Growth and development, thermoregulation, and feeding may be affected, although only indirectly.)
A pregnant woman at 37 weeks of gestation has had ruptured membranes for 26 hours. A cesarean section is performed for failure to progress. The fetal heart rate (FHR) before birth is 180 beats/min with limited 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. - ANSWER d. Sepsis.
(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.)
The most important nursing action in preventing neonatal infection is:
a. Good handwashing.
b. Isolation of infected infants.
c. Separate gown protocol
d. Standard Precautions. - ANSWER a. Good handwashing.
(Virtually all controlled clinical trials have demonstrated that effective handwashing is responsible for the prevention of nosocomial infection in nursery units. Measures to be taken include Standard Precautions, 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 handwashing.)
A pregnant woman presents in labor 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 - ANSWER a. Alcohol
(The description of the infant suggests fetal alcohol syndrome, which is consistent with maternal alcohol consumption during pregnancy. Fetal brain, kidney, and urogenital system malformations have been associated with maternal cocaine ingestions. 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.)
a. Alcohol
b. Tobacco
c. Marijuana
d. Heroin - ANSWER a. Alcohol
During a prenatal examination, the woman reports having two cats at home. The nurse informs her that she should not be cleaning the litter box while she is pregnant. When the woman asks why, the nurse's best response would be:
a. "Your cats could be carrying toxoplasmosis. This is a zoonotic parasite that can infect you and have severe effects on your unborn child."
b. "You and your baby can be exposed to the human immunodeficiency virus (HIV) in your cats' feces."
c. "It's just gross. You should make your husband clean the litter boxes."
d. "Cat feces are known to carry Escherichia coli, which can cause a severe infection in both you and your baby." - ANSWER a. "Your cats could be carrying toxoplasmosis. This is a zoonotic parasite that can infect you and have severe effects on your unborn child."
(Toxoplasmosis is a multisystem disease caused by the protozoal Toxoplasma gondii parasite, commonly found in cats, dogs, pigs, sheep, and cattle. About 30% of women who contract toxoplasmosis during gestation transmit the disease to their children. Clinical features ascribed to toxoplasmosis include hydrocephalus or microcephaly, chorioretinitis, seizures, or cerebral calcifications. HIV is not transmitted by cats. Although suggesting that the woman's husband 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 delivered a healthy infant girl. The nurse is about to administer erythromycin ointment in the infant's eyes when the mother asks, "What is that medicine for?" The nurse responds:
a. "It is an eye ointment to help your baby see you better."
b. "It is to protect your baby from contracting herpes from your vaginal tract."
c. "Erythromycin is given prophylactically to prevent a gonorrheal infection."
d. "This medicine will protect your baby's eyes from drying out over the next few days." - ANSWER c. "Erythromycin is given prophylactically to prevent a gonorrheal infection."
(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 an infection caused by gonorrhea, not herpes, and is not used for eye lubrication.)
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. - ANSWER a. If the nerves are stretched with no avulsion, they should recover completely in 3 to 6 months.
(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 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 the mother and infant will need help from the nurse at the start.)
As related to central nervous system injuries that could occur to the infant during labor and birth, nurses should be aware that:
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-colored, maculopapular rash on the palms and around the mouth and anus. The newborn is showing signs of:
a. Gonorrhea.
b. Herpes simplex virus infection.
c. Congenital syphilis.
d. Human immunodeficiency virus. - ANSWER c. Congenital syphilis.
(The rash is indicative of congenital syphilis. The lesions may extend over the trunk and extremities.)
What bacterial infection is definitely decreasing because of effective drug treatment?
a. Escherichia coli infection
b. Tuberculosis
c. Candidiasis
d. Group B streptococcal infection - ANSWER d. Group B streptococcal infection
(Penicillin has significantly decreased the incidence of group B streptococcal infection. E. coli may be increasing, perhaps because of the increasing use of ampicillin (resulting in a more virulent E. coli resistant to the drug). Tuberculosis is increasing in the United States and Canada. Candidiasis is a fairly benign fungal infection.)
In caring for the mother who has abused (or is abusing) alcohol and for her infant, nurses should be aware that:
a. The pattern of growth restriction of the fetus begun in prenatal life is halted after
birth, and normal growth takes over.
b. Two thirds of newborns with fetal alcohol syndrome (FAS) are boys.
c. Alcohol-related neurodevelopmental disorders not sufficient to meet FAS criteria (learning disabilities, speech and language problems) 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. - ANSWER c. Alcohol-related neurodevelopmental disorders not sufficient to meet FAS criteria (learning disabilities, speech and language problems) are often not detected until the child goes to school.
(Some learning problems do not become evident until the child is at school. The pattern of growth restriction persists after birth. Two thirds of newborns with FAS are girls. Although the distinctive facial features of the FAS infant tend to become less evident, the mental capacities never become normal.)
A careful review of the literature on the various recreational and illicit drugs reveals that:
a. More longer-term studies are needed to assess the lasting effects on infants when mothers have taken or are taking illegal drugs.
b. Heroin and methadone cross the placenta; marijuana, cocaine, and phencyclidine (PCP) do not.
c. Mothers should discontinue heroin use (detox) any time they can during pregnancy.
d. Methadone withdrawal for infants is less severe and shorter than heroin withdrawal. - ANSWER a. More longer-term studies are needed to assess the lasting effects on infants when mothers have taken or are taking illegal drugs.
(Studies on the effects of marijuana and cocaine use by mothers are somewhat contradictory. More long-range studies are needed. Just about all these drugs cross the placenta, including marijuana, cocaine, and PCP. Drug withdrawal is accompanied by fetal withdrawal, which can lead to fetal death. Therefore, detoxification from heroin is not recommended, particularly later in pregnancy. Methadone withdrawal is more severe and more prolonged than heroin withdrawal.)
