Maternal Child Nursing Care–] ] ]
(Chp 25) The High- ] ] ]
Risk Newborn Study Questions and Cor
] ] ] ] ]
rect Answers
] ]
A ]macrocosmic ]infant ]is ]born ]after ]a ]difficult ]forceps-
assisted ]delivery. ]After ]stabilization ]the ]infant ]is ]weighed, ]and ]the ]birth ]weight ]is ]4550 ]g ](9 ]lbs., ]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. ]- ]corre
ct ]answer: ]ANS: ]D
This ]infant ]is ]macrocosmic ]
(more ]than ]4000 ]g) ]and ]is ]at ]high ]risk ]for ]hypoglycemia. ]Blood ]glucose ]levels ]should ]be ]monitore
d ]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. ]Rega
rdless ]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. ]- ]correct ]answer: ]ANS: ]C
,IDMs ]are ]at ]risk ]for ]macrosomia, ]birth ]injury, ]perinatal ]asphyxia, ]respiratory ]distress ]syndrome, ]
hypoglycemia, ]hypocalcemia, ]hypomagnesemia, ]cardiomyopathy, ]hyperbilirubinemia, ]and ]polyc
ythemia. ]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. ]- ]correct ]answer: ]ANS: ]C
Hypoglycemia ]is ]common ]in ]the ]macrosomic ]infant. ]Signs ]of ]hypoglycemia ]include ]jitteriness, ]ap
nea, ]tachypnea, ]and ]cyanosis.
When ]assessing ]the ]preterm ]infant ]the ]nurse ]understands ]that ]compared ]with ]the ]term ]infant, ]t
he ]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. ]- ]correct ]answer: ]ANS: ]D
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.
On ]day ]3 ]of ]life, ]a ]newborn ]continues ]to ]require ]100% ]oxygen ]by ]nasal ]cannula. ]The ]parents ]ask ]
whether ]they ]can ]hold ]their ]infant ]during ]his ]next ]gavage ]feeding. ]Given ]that ]this ]newborn ]is ]ph
ysiologically ]stable, ]what ]response ]would ]the ]nurse ]give?
, a. ]"Parents ]are ]not ]allowed ]to ]hold ]infants ]who ]depend ]on ]oxygen."
b. ]"You ]may ]hold ]only ]your ]baby's ]hand ]during ]the ]feeding."
c. ]"Feedings ]cause ]more ]physiologic ]stress, ]so ]the ]baby ]must ]be ]closely ]monitored. ]Therefore, ]I ]
don't ]think ]you ]should ]hold ]the ]baby."
d. ]"You ]may ]hold ]your ]baby ]during ]the ]feeding." ]- ]correct ]answer: ]ANS: ]D
"You ]may ]hold ]your ]baby ]during ]the ]feeding" ]is ]an ]accurate ]statement. ]Parental ]interaction ]via ]h
olding ]is ]encouraged ]during ]gavage ]feedings ]so ]that ]the ]infant ]will ]associate ]the ]feeding ]with ]po
sitive ]interactions. ]Nasal ]cannula ]oxygen ]therapy ]allows ]for ]easier ]feedings ]and ]psychosocial ]inte
ractions. ]The ]parent ]can ]swaddle ]the ]infant ]during ]gavage ]feedings ]to ]help ]the ]infant ]associate ]t
he ]feeding ]with ]positive ]interactions. ]Some ]parents ]like ]to ]do ]kangaroo ]care ]while ]gavage ]feedin
g ]their ]infant. ]Swaddling ]or ]kangaroo ]care ]during ]feedings ]provides ]positive ]interactions ]for ]the ]i
nfant.
A ]premature ]infant ]with ]respiratory ]distress ]syndrome ]receives ]artificial ]surfactant. ]How ]would ]t
he ]nurse ]explain ]surfactant ]therapy ]to ]the ]parents?
a. ]"Surfactant ]improves ]the ]ability ]of ]your ]baby's ]lungs ]to ]exchange ]oxygen ]and ]carbon ]dioxide."
b. ]"The ]drug ]keeps ]your ]baby ]from ]requiring ]too ]much ]sedation."
c. ]"Surfactant ]is ]used ]to ]reduce ]episodes ]of ]periodic ]apnea."
d. ]"Your ]baby ]needs ]this ]medication ]to ]fight ]a ]possible ]respiratory ]tract ]infection." ]- ]correct ]ans
wer: ]ANS: ]A
Surfactant ]can ]be ]administered ]as ]an ]adjunct ]to ]oxygen ]and ]ventilation ]therapy. ]With ]administra
tion ]of ]artificial ]surfactant, ]respiratory ]compliance ]is ]improved ]until ]the ]infant ]can ]generate ]eno
ugh ]surfactant ]on ]his ]or ]her ]own. ]Surfactant ]has ]no ]bearing ]on ]the ]sedation ]needs ]of ]the ]infant. ]
Surfactant ]is ]used ]to ]improve ]respiratory ]compliance, ]including ]the ]exchange ]of ]oxygen ]and ]carb
on ]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 ]presen
tation ]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?
(Chp 25) The High- ] ] ]
Risk Newborn Study Questions and Cor
] ] ] ] ]
rect Answers
] ]
A ]macrocosmic ]infant ]is ]born ]after ]a ]difficult ]forceps-
assisted ]delivery. ]After ]stabilization ]the ]infant ]is ]weighed, ]and ]the ]birth ]weight ]is ]4550 ]g ](9 ]lbs., ]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. ]- ]corre
ct ]answer: ]ANS: ]D
This ]infant ]is ]macrocosmic ]
(more ]than ]4000 ]g) ]and ]is ]at ]high ]risk ]for ]hypoglycemia. ]Blood ]glucose ]levels ]should ]be ]monitore
d ]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. ]Rega
rdless ]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. ]- ]correct ]answer: ]ANS: ]C
,IDMs ]are ]at ]risk ]for ]macrosomia, ]birth ]injury, ]perinatal ]asphyxia, ]respiratory ]distress ]syndrome, ]
hypoglycemia, ]hypocalcemia, ]hypomagnesemia, ]cardiomyopathy, ]hyperbilirubinemia, ]and ]polyc
ythemia. ]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. ]- ]correct ]answer: ]ANS: ]C
Hypoglycemia ]is ]common ]in ]the ]macrosomic ]infant. ]Signs ]of ]hypoglycemia ]include ]jitteriness, ]ap
nea, ]tachypnea, ]and ]cyanosis.
When ]assessing ]the ]preterm ]infant ]the ]nurse ]understands ]that ]compared ]with ]the ]term ]infant, ]t
he ]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. ]- ]correct ]answer: ]ANS: ]D
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.
On ]day ]3 ]of ]life, ]a ]newborn ]continues ]to ]require ]100% ]oxygen ]by ]nasal ]cannula. ]The ]parents ]ask ]
whether ]they ]can ]hold ]their ]infant ]during ]his ]next ]gavage ]feeding. ]Given ]that ]this ]newborn ]is ]ph
ysiologically ]stable, ]what ]response ]would ]the ]nurse ]give?
, a. ]"Parents ]are ]not ]allowed ]to ]hold ]infants ]who ]depend ]on ]oxygen."
b. ]"You ]may ]hold ]only ]your ]baby's ]hand ]during ]the ]feeding."
c. ]"Feedings ]cause ]more ]physiologic ]stress, ]so ]the ]baby ]must ]be ]closely ]monitored. ]Therefore, ]I ]
don't ]think ]you ]should ]hold ]the ]baby."
d. ]"You ]may ]hold ]your ]baby ]during ]the ]feeding." ]- ]correct ]answer: ]ANS: ]D
"You ]may ]hold ]your ]baby ]during ]the ]feeding" ]is ]an ]accurate ]statement. ]Parental ]interaction ]via ]h
olding ]is ]encouraged ]during ]gavage ]feedings ]so ]that ]the ]infant ]will ]associate ]the ]feeding ]with ]po
sitive ]interactions. ]Nasal ]cannula ]oxygen ]therapy ]allows ]for ]easier ]feedings ]and ]psychosocial ]inte
ractions. ]The ]parent ]can ]swaddle ]the ]infant ]during ]gavage ]feedings ]to ]help ]the ]infant ]associate ]t
he ]feeding ]with ]positive ]interactions. ]Some ]parents ]like ]to ]do ]kangaroo ]care ]while ]gavage ]feedin
g ]their ]infant. ]Swaddling ]or ]kangaroo ]care ]during ]feedings ]provides ]positive ]interactions ]for ]the ]i
nfant.
A ]premature ]infant ]with ]respiratory ]distress ]syndrome ]receives ]artificial ]surfactant. ]How ]would ]t
he ]nurse ]explain ]surfactant ]therapy ]to ]the ]parents?
a. ]"Surfactant ]improves ]the ]ability ]of ]your ]baby's ]lungs ]to ]exchange ]oxygen ]and ]carbon ]dioxide."
b. ]"The ]drug ]keeps ]your ]baby ]from ]requiring ]too ]much ]sedation."
c. ]"Surfactant ]is ]used ]to ]reduce ]episodes ]of ]periodic ]apnea."
d. ]"Your ]baby ]needs ]this ]medication ]to ]fight ]a ]possible ]respiratory ]tract ]infection." ]- ]correct ]ans
wer: ]ANS: ]A
Surfactant ]can ]be ]administered ]as ]an ]adjunct ]to ]oxygen ]and ]ventilation ]therapy. ]With ]administra
tion ]of ]artificial ]surfactant, ]respiratory ]compliance ]is ]improved ]until ]the ]infant ]can ]generate ]eno
ugh ]surfactant ]on ]his ]or ]her ]own. ]Surfactant ]has ]no ]bearing ]on ]the ]sedation ]needs ]of ]the ]infant. ]
Surfactant ]is ]used ]to ]improve ]respiratory ]compliance, ]including ]the ]exchange ]of ]oxygen ]and ]carb
on ]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 ]presen
tation ]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?
