Chapter 29: The Newborn at Risk: Acquired and Congenital Problems
MULTIPLE CHOICE
1. A pregnant woman at 37 weeks of gestation has had ruptured membranes for 26 hours. A
Caesarean birth 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 at 1 minute
and 7 at 5 minutes and is noted to be pale and tachypneic. On the basis of the maternal history,
which is the most likely cause of this newborn’s distress?
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.
DIF: Cognitive Level: Analysis REF: p. 793 | Table 29-3 | Table 29-4 OBJ:
Nursing Process: Assessment
2. 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.
DIF: Cognitive Level: Comprehension REF: p. 794
OBJ: Nursing Process: Implementation
3. 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.
DIF: Cognitive Level: ComprehensionREF: p. 803 | Table 29-6 OBJ:
Nursing Process: Assessment
4. 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 him or
her 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.
DIF: Cognitive Level: Application REF: p. 808 |Patient Teaching OBJ:
Nursing Process: Implementation
5. 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.
DIF: Cognitive Level: ComprehensionREF: p. 796 | Table 29-5 OBJ:
Nursing Process: Planning
6. 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 abuse during pregnancy is recognized as one of the leading causes of cognitive
impairment in newborns.
DIF: Cognitive Level: Knowledge REF: p. 804
OBJ: Nursing Process: Assessment
7. 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, what is the basis for the nurse’s response?
MULTIPLE CHOICE
1. A pregnant woman at 37 weeks of gestation has had ruptured membranes for 26 hours. A
Caesarean birth 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 at 1 minute
and 7 at 5 minutes and is noted to be pale and tachypneic. On the basis of the maternal history,
which is the most likely cause of this newborn’s distress?
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.
DIF: Cognitive Level: Analysis REF: p. 793 | Table 29-3 | Table 29-4 OBJ:
Nursing Process: Assessment
2. 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.
DIF: Cognitive Level: Comprehension REF: p. 794
OBJ: Nursing Process: Implementation
3. 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.
DIF: Cognitive Level: ComprehensionREF: p. 803 | Table 29-6 OBJ:
Nursing Process: Assessment
4. 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 him or
her 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.
DIF: Cognitive Level: Application REF: p. 808 |Patient Teaching OBJ:
Nursing Process: Implementation
5. 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.
DIF: Cognitive Level: ComprehensionREF: p. 796 | Table 29-5 OBJ:
Nursing Process: Planning
6. 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 abuse during pregnancy is recognized as one of the leading causes of cognitive
impairment in newborns.
DIF: Cognitive Level: Knowledge REF: p. 804
OBJ: Nursing Process: Assessment
7. 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, what is the basis for the nurse’s response?
