NURS 320 Exam 3 Questions with
Complete Answers
Small for gestational age (SGA): - ANSWER-- Birth weight less than 10th percentile
- The infant who is small for gestational age (SGA) can be presumed to have grown
at a restricted rate during intrauterine life
Classification by Gestational Age:
- Preterm/Premature
- Late preterm
- Early term
- Full term
- Late term
- Postterm
- Postmature - ANSWER-- Preterm/Premature: Born before 37 0/7 weeks of
gestation, regardless of birth weight
- Late preterm: 34 0/7 through 36 6/7 weeks
- Early term: 37 0/7 through 38 6/7 weeks
- Full term: 39 0/7 through 40 6/7 weeks
- Late term: 41 0/7 through 41 6/7 weeks
- Postterm: 42 0/7 weeks and beyond
- Postmature: Born after completion of week 42 of gestation and showing the effects
of progressive placental insufficiency
Late preterm:
- Complications - ANSWER-- Respiratory distress
- Temperature instability
- Hypoglycemia
- Apnea
- Feeding difficulties
- Hyperbilirubinemia
Postmature:
- Characteristics - ANSWER-- Skin is cracked, parchment-like, and peeling
,- Little if any vernix caseosa
- Long fingernails
- Absence of lanugo
- Abundant scalp hair
- Wasted physical appearance
Neonate:
- Airway Maintenance - ANSWER-- Healthy term infants born vaginally have little
difficulty clearing the airway
- Most secretions are moved by gravity and brought by the cough reflex to the
oropharynx to be drained, swallowed, or wiped away
*Secretions from the lungs being coughed upwards
- If the airway is obstructed, then the mouth and nasal passages can be gently
suctioned with a bulb syringe
- Vigorous suctioning should be avoided; it can cause trauma to fragile tissues
- Routine chest percussion and suctioning of healthy term or late-preterm infants
should be avoided; evidence is insufficient to support anything other than gentle
nasopharyngeal and oropharyngeal suctioning to clear secretions from an obstructed
airway
- The nurse should auscultate the infant's chest with a stethoscope to assess for
abnormal breath sounds or inspiratory stridor
- Fine crackles may be auscultated for several hours after birth, especially in
neonates born by cesarean
- If the bulb syringe does not clear mucus interfering with respiratory effort, deeper
mechanical suction may be needed to remove mucus from the newborn's
nasopharynx or posterior oropharynx
- If the newborn has an obstruction that is not cleared with suctioning, the neonatal
or pediatric care provider should be notified.
Suctioning with a Bulb Syringe: - ANSWER-- Keep the bulb syringe easily accessible
and visible. It is to be used when there is concern that the airway is obstructed. This
suctioning can cause swelling and trauma to the nasal mucosa.
- Suction the mouth before the nose to prevent the infant from inhaling pharyngeal
secretions by gasping as the nares are touched.
,- Compress the bulb, and insert the tip into one side of the mouth. Avoid the center
of the infant's mouth because the gag reflex can be stimulated.
- Gently suction nasal passages one nostril at a time.
- When the airway is no longer obstructed, suctioning should be stopped.
- After each use, clean bulb syringe with warm soapy water and rinse thoroughly.
Intrauterine Growth Restriction (IUGR):
- Causes - ANSWER-- Preeclampsia
- Maternal malnourishment during pregnancy
- Chronic hypoxia
*Tobacco smoker/use
Growth-restricted Infants:
- Characteristics - ANSWER-- Reduced subcutaneous fat stores
- Loose and dry skin
- Diminished muscle mass, especially over the buttocks and cheeks
- Sunken abdomen (scaphoid) as opposed to the well-rounded abdomen seen in
normal infants
- Thin, yellowish, dry umbilical cord (normal color is gray, glistening, round, and
moist)
- Wide skull sutures (inadequate bone growth)
- Large head in relation to the body
- Long fingernails
- Thin extremities and trunk
- Loose skin due to lack of subcutaneous fat
- Decreased amount of Wharton's jelly in the umbilical cord
Small for Gestational Age (SGA):
- Problems - ANSWER-- Perinatal asphyxia
- Hypoglycemia
- Heat loss
- Polycythemia
, Small for Gestational Age (SGA):
- Perinatal asphyxia - ANSWER-- Chronic hypoxia for varying periods before labor
and birth
- Labor is a stressor to the normal fetus, but it is even greater stressor for the growth-
restricted fetus
- The chronically hypoxic infant is severely compromised even by a normal labor and
has difficulty compensating after birth
- Appropriate management and resuscitation are essential for these depressed
infants
- The birth of growth-restricted infants with perinatal asphyxia can be associated
with:
*Maternal history or heavy cigarette smoking
*Preeclampsia
*Low socioeconomic status
*Multifetal gestation
*Gestational infections
*Advanced diabetes mellitus (DM)
*Cardiac problems
- RDS may occur in SGA infants who are born prematurely or aspirated meconium-
stained amniotic fluid - chronic hypoxia in utero.
Small for Gestational Age (SGA):
- Hypoglycemia - ANSWER-- Plasma glucose: <40 mg/dL
- Results from:
*Decreased glycogen supply
*Inadequate gluconeogenesis
*Overuse of glycogen stored during fetal and postnatal life
- Preterm infants may become hypoglycemic because of inadequate intake and
increased metabolic demands as a result of illness
- Manifestations:
*Poor feeding
*Hypothermia
*Diaphoresis
*Tremors and jitteriness
*Weak cry
*Lethargy
*Floppy posture
*Profound hypoglycemia: Seizures or coma
Small for Gestational Age (SGA):
Complete Answers
Small for gestational age (SGA): - ANSWER-- Birth weight less than 10th percentile
- The infant who is small for gestational age (SGA) can be presumed to have grown
at a restricted rate during intrauterine life
Classification by Gestational Age:
- Preterm/Premature
- Late preterm
- Early term
- Full term
- Late term
- Postterm
- Postmature - ANSWER-- Preterm/Premature: Born before 37 0/7 weeks of
gestation, regardless of birth weight
- Late preterm: 34 0/7 through 36 6/7 weeks
- Early term: 37 0/7 through 38 6/7 weeks
- Full term: 39 0/7 through 40 6/7 weeks
- Late term: 41 0/7 through 41 6/7 weeks
- Postterm: 42 0/7 weeks and beyond
- Postmature: Born after completion of week 42 of gestation and showing the effects
of progressive placental insufficiency
Late preterm:
- Complications - ANSWER-- Respiratory distress
- Temperature instability
- Hypoglycemia
- Apnea
- Feeding difficulties
- Hyperbilirubinemia
Postmature:
- Characteristics - ANSWER-- Skin is cracked, parchment-like, and peeling
,- Little if any vernix caseosa
- Long fingernails
- Absence of lanugo
- Abundant scalp hair
- Wasted physical appearance
Neonate:
- Airway Maintenance - ANSWER-- Healthy term infants born vaginally have little
difficulty clearing the airway
- Most secretions are moved by gravity and brought by the cough reflex to the
oropharynx to be drained, swallowed, or wiped away
*Secretions from the lungs being coughed upwards
- If the airway is obstructed, then the mouth and nasal passages can be gently
suctioned with a bulb syringe
- Vigorous suctioning should be avoided; it can cause trauma to fragile tissues
- Routine chest percussion and suctioning of healthy term or late-preterm infants
should be avoided; evidence is insufficient to support anything other than gentle
nasopharyngeal and oropharyngeal suctioning to clear secretions from an obstructed
airway
- The nurse should auscultate the infant's chest with a stethoscope to assess for
abnormal breath sounds or inspiratory stridor
- Fine crackles may be auscultated for several hours after birth, especially in
neonates born by cesarean
- If the bulb syringe does not clear mucus interfering with respiratory effort, deeper
mechanical suction may be needed to remove mucus from the newborn's
nasopharynx or posterior oropharynx
- If the newborn has an obstruction that is not cleared with suctioning, the neonatal
or pediatric care provider should be notified.
Suctioning with a Bulb Syringe: - ANSWER-- Keep the bulb syringe easily accessible
and visible. It is to be used when there is concern that the airway is obstructed. This
suctioning can cause swelling and trauma to the nasal mucosa.
- Suction the mouth before the nose to prevent the infant from inhaling pharyngeal
secretions by gasping as the nares are touched.
,- Compress the bulb, and insert the tip into one side of the mouth. Avoid the center
of the infant's mouth because the gag reflex can be stimulated.
- Gently suction nasal passages one nostril at a time.
- When the airway is no longer obstructed, suctioning should be stopped.
- After each use, clean bulb syringe with warm soapy water and rinse thoroughly.
Intrauterine Growth Restriction (IUGR):
- Causes - ANSWER-- Preeclampsia
- Maternal malnourishment during pregnancy
- Chronic hypoxia
*Tobacco smoker/use
Growth-restricted Infants:
- Characteristics - ANSWER-- Reduced subcutaneous fat stores
- Loose and dry skin
- Diminished muscle mass, especially over the buttocks and cheeks
- Sunken abdomen (scaphoid) as opposed to the well-rounded abdomen seen in
normal infants
- Thin, yellowish, dry umbilical cord (normal color is gray, glistening, round, and
moist)
- Wide skull sutures (inadequate bone growth)
- Large head in relation to the body
- Long fingernails
- Thin extremities and trunk
- Loose skin due to lack of subcutaneous fat
- Decreased amount of Wharton's jelly in the umbilical cord
Small for Gestational Age (SGA):
- Problems - ANSWER-- Perinatal asphyxia
- Hypoglycemia
- Heat loss
- Polycythemia
, Small for Gestational Age (SGA):
- Perinatal asphyxia - ANSWER-- Chronic hypoxia for varying periods before labor
and birth
- Labor is a stressor to the normal fetus, but it is even greater stressor for the growth-
restricted fetus
- The chronically hypoxic infant is severely compromised even by a normal labor and
has difficulty compensating after birth
- Appropriate management and resuscitation are essential for these depressed
infants
- The birth of growth-restricted infants with perinatal asphyxia can be associated
with:
*Maternal history or heavy cigarette smoking
*Preeclampsia
*Low socioeconomic status
*Multifetal gestation
*Gestational infections
*Advanced diabetes mellitus (DM)
*Cardiac problems
- RDS may occur in SGA infants who are born prematurely or aspirated meconium-
stained amniotic fluid - chronic hypoxia in utero.
Small for Gestational Age (SGA):
- Hypoglycemia - ANSWER-- Plasma glucose: <40 mg/dL
- Results from:
*Decreased glycogen supply
*Inadequate gluconeogenesis
*Overuse of glycogen stored during fetal and postnatal life
- Preterm infants may become hypoglycemic because of inadequate intake and
increased metabolic demands as a result of illness
- Manifestations:
*Poor feeding
*Hypothermia
*Diaphoresis
*Tremors and jitteriness
*Weak cry
*Lethargy
*Floppy posture
*Profound hypoglycemia: Seizures or coma
Small for Gestational Age (SGA):
