CHAPTER 26: NURSING CARE OF A
FAMILY WITH A HIGH-RISK NEWBORN
QUESTIONS AND ANSWERS
TheunurseuisuweighinguaunewbornuandudocumentsuAGAu(appropriateuforugestati
onaluage)uonutheunewbornurecord.uWhichuweightupercentileuisuanticipated?
a.u20th
b.u9th
c.u5th
d.u95thu-uans-a.u20th
Appropriateuforugestationuageuinfantsufallubetweenutheu10thuandu90thupercentileu
foruweight.
Whatuisuauconsequenceuofuhypothermiauinuaunewborn?
a.urespirationsuofu46
b.uhearturateuofu126
c.uholdsubreathu25useconds
d.uskinupinkuanduwarmu-uans-c.uholdsubreathu25useconds
Apneauisutheucessationuofubreathinguforuauspecificuamountuofutime,uanduinunew
bornsuituusuallyuoccursuwhenutheubreathuisuhelduforu15useconds.uApnea,ucyano
sis,urespiratoryudistress,uanduincreaseduoxygenudemanduareualluconsequencesuof
uhypothermia.
Aunurseuisuprovidingucareutouaularge-for-gestational-
ageunewborn.uTheunewborn'sublooduglucoseuleveluwasu32umg/
dluoneuhouruago.uBreastfeedinguwasuinitiated.uTheunurseuchecksutheunewborn'su
blooduglucoseuleveluandufindsuitutoubeu23umg/
dl.uWhichuactionuwouldutheunurseudounext?
a.uAdministeruintravenousuglucose.
b.uFeedutheunewbornu2uouncesuofuformula.
c.uInitiateublow-byuoxygenutherapy.
d.uPlaceutheunewbornuunderuauradiantuwarmer.u-uans-
a.uAdministeruintravenousuglucose
,Supervisedubreastfeedinguoruformulaufeedingumayubeutheuinitialutreatmentuoption
suinuasymptomaticuhypoglycemia.uHowever,usymptomaticuhypoglycemiaushouldual
waysubeutreateduwithufrequentubreastuoruformulaufeedingsuorudextroseugelumass
ageduintoutheubuccalumucosa.uIfuhypoglycemiaupersists,uthenuintravenousudextro
seumayubeuneeded.uOralufeedingsuwouldubeuusedutoumaintainutheunewborn'sugl
ucoseuleveluaboveu40umg/dl.uBlow-
byuoxygenuwoulduhaveunoueffectuonuglucoseulevels;uitumayubeuhelpfuluinupromo
tinguoxygenation.uPlacingutheunewbornuunderuauradiantuwarmeruwouldubeuaumor
euappropriateumeasureuforucoldustress.
Aunurseuisucaringuforuaupretermunewbornuwhouhasudevelopedurapid,uirregularure
spirationsuwithuperiodsuofuapnea.uWhichuadditionaluassessmentufindingushoulduth
eunurseuidentifyuasuanuindicationuofurespiratoryudistressusyndromeu(RDS)?
a.uDeepuinspiration
b.uExpiratoryulag
c.uSternaluretraction
d.uInspiratoryugruntu-uans-c.uSternaluretraction
Theunurseushoulduidentifyusternaluretractionuasuausignuofurespiratoryudistressusy
ndromeuinutheupretermunewborn.uDeepuinspirationuisunotuseenuduringurespiratory
udistress;urather,uaushallowuandurapidurespirationuisuseen.uThereuisuanuinspirato
ryulag,uinsteaduofuanuexpiratoryulag,uduringurespiratoryudistress.uThereuisuaugrun
tinguhearduwhenutheuairuisubreatheduout,uwhichuisuduringuexpirationuandunotudu
ringuinspiration.
Au35-year-
olduclientuhasujustugivenubirthutouauhealthyunewbornuduringuheru43rduweekuofu
gestation.uWhatushouldutheunurseuexpectuwhenuassessingutheuconditionuofutheu
newborn?
a.umeconiumuaspirationuinuuterouoruatubirth
b.useizures,urespiratoryudistress,ucyanosis,uandushrillucry
c.uyellowuappearanceuofutheunewborn'suskin
d.utremors,uirritability,uanduhigh-pitcheducryu-uans-
a.umeconiumuaspirationuinuuterouoruatubirth
Infantsubornuafteru42uweeksuofupregnancyuareupostuterm.uTheseuinfantsuareuatu
auhigheruriskuofuswallowinguoruaspiratingumeconiumuinuuterouoruafterubirth.uAsu
soonuasutheuinfantuisuborn,utheunurseuusuallyusuctionsuoututheusecretionsuanduf
luidsuinutheunewborn'sumouthuanduthroatubeforeutheufirstubreathutouavoiduaspirat
ionuofumeconiumuanduamnioticufluiduintoutheulungs.uSeizures,urespiratoryudistress
,ucyanosis,uandushrillucryuareusignsuandusymptomsuofuinfantsuwithuintracranialuh
emorrhage.uIntracranialuhemorrhageucanubeuaudangerousubirthuinjuryuthatuisupri
marilyuauproblemuforupretermunewborns,unotuposttermuneonates.uYellowuappeara
nceuofutheunewborn'suskinuisuusuallyuseenuinuinfantsuwithujaundice.uTremors,uirr
, itability,uhigh-
pitcheduoruweakucry,uandueyeurollinguareuseenuinuinfantsuwithuhypoglycemia.
Auclientuwithudiabetesugivesubirthutouaufull-
termuneonateuwhouweightsu10ulb,u1uozu(4,600ug).uWhileucaringuforuthisularge-
for-gestational-
ageu(LGA)uneonate,utheunurseupalpatesutheuclaviclesuforuwhichureason?
a.uNeonatesuofumothersuwithudiabetesuhaveubrittleubones.
b.uClaviclesuareucommonlyuabsentuinuneonatesuofumothersuwithudiabetes.
c.uOneuofutheuneonate'suclaviclesumayuhaveubeenubrokenuduringubirth.
d.uLGAuneonatesuhaveuglucoseudepositsuonutheiruclavicles.u-uans-
c.uOneuofutheuneonate'suclaviclesumayuhaveubeenubrokenuduringubirth.
Becauseuofutheuneonate'sulargeusize,uclavicularufracturesuareucommonuduringubir
th.uTheunurseushoulduassessualluLGAuneonatesuforuthisuoccurrence.uNoneuofuth
euotheruoptionsuareutrue.
Theunurseuobservesuauneonateubornuatu28uweeks'ugestation.uWhichufindinguwou
ldutheunurseuexpectutousee?
a.uTheuskinuisupale,uandunouvesselsushowuthroughuit.
b.uCreasesuappearuonutheuinteriorutwo-thirdsuofutheusole.
c.uTheupinnauofutheuearuisusoftuanduflatuandustaysufolded.
d.uTheuneonateuhasu7utou10ummuofubreastutissue.u-uans-
c.uTheupinnauofutheuearuisusoftuanduflatuandustaysufolded.
Theuearuhasuausoftupinnauthatuisuflatuandustaysufolded.uPaleuskinuwithunouvess
elsushowinguthroughuandu7utou10ummuofubreastutissueuareucharacteristicuofuau
neonateuatu40uweeks'ugestation.uCreasesuonutheuanteriorutwo-
thirdsuofutheusoleuareucharacteristicuofuauneonateuatu36uweeks'ugestation.
Au33-week-
gestationuinfantuhasujustubeenuborn.uTheuchild'suheartbeatuisunotuaudible.uWhat
uisutheupriorityunursinguintervention?
a.uDepressionuofutheusternumuwithubothuthumbsu1utou2ucmuatuaurateuofu100uti
mesuperuminute
b.uAdministrationuofuIVuepinephrine,uasuprescribed
c.uTransferutouautransitionaluoruhigh-
riskunurseryuforucontinuousucardiacusurveillance
d.uPalpationuforuaufemoralupulseu-uans-
a.uDepressionuofutheusternumuwithubothuthumbsu1utou2ucmuatuaurateuofu100uti
mesuperuminute
FAMILY WITH A HIGH-RISK NEWBORN
QUESTIONS AND ANSWERS
TheunurseuisuweighinguaunewbornuandudocumentsuAGAu(appropriateuforugestati
onaluage)uonutheunewbornurecord.uWhichuweightupercentileuisuanticipated?
a.u20th
b.u9th
c.u5th
d.u95thu-uans-a.u20th
Appropriateuforugestationuageuinfantsufallubetweenutheu10thuandu90thupercentileu
foruweight.
Whatuisuauconsequenceuofuhypothermiauinuaunewborn?
a.urespirationsuofu46
b.uhearturateuofu126
c.uholdsubreathu25useconds
d.uskinupinkuanduwarmu-uans-c.uholdsubreathu25useconds
Apneauisutheucessationuofubreathinguforuauspecificuamountuofutime,uanduinunew
bornsuituusuallyuoccursuwhenutheubreathuisuhelduforu15useconds.uApnea,ucyano
sis,urespiratoryudistress,uanduincreaseduoxygenudemanduareualluconsequencesuof
uhypothermia.
Aunurseuisuprovidingucareutouaularge-for-gestational-
ageunewborn.uTheunewborn'sublooduglucoseuleveluwasu32umg/
dluoneuhouruago.uBreastfeedinguwasuinitiated.uTheunurseuchecksutheunewborn'su
blooduglucoseuleveluandufindsuitutoubeu23umg/
dl.uWhichuactionuwouldutheunurseudounext?
a.uAdministeruintravenousuglucose.
b.uFeedutheunewbornu2uouncesuofuformula.
c.uInitiateublow-byuoxygenutherapy.
d.uPlaceutheunewbornuunderuauradiantuwarmer.u-uans-
a.uAdministeruintravenousuglucose
,Supervisedubreastfeedinguoruformulaufeedingumayubeutheuinitialutreatmentuoption
suinuasymptomaticuhypoglycemia.uHowever,usymptomaticuhypoglycemiaushouldual
waysubeutreateduwithufrequentubreastuoruformulaufeedingsuorudextroseugelumass
ageduintoutheubuccalumucosa.uIfuhypoglycemiaupersists,uthenuintravenousudextro
seumayubeuneeded.uOralufeedingsuwouldubeuusedutoumaintainutheunewborn'sugl
ucoseuleveluaboveu40umg/dl.uBlow-
byuoxygenuwoulduhaveunoueffectuonuglucoseulevels;uitumayubeuhelpfuluinupromo
tinguoxygenation.uPlacingutheunewbornuunderuauradiantuwarmeruwouldubeuaumor
euappropriateumeasureuforucoldustress.
Aunurseuisucaringuforuaupretermunewbornuwhouhasudevelopedurapid,uirregularure
spirationsuwithuperiodsuofuapnea.uWhichuadditionaluassessmentufindingushoulduth
eunurseuidentifyuasuanuindicationuofurespiratoryudistressusyndromeu(RDS)?
a.uDeepuinspiration
b.uExpiratoryulag
c.uSternaluretraction
d.uInspiratoryugruntu-uans-c.uSternaluretraction
Theunurseushoulduidentifyusternaluretractionuasuausignuofurespiratoryudistressusy
ndromeuinutheupretermunewborn.uDeepuinspirationuisunotuseenuduringurespiratory
udistress;urather,uaushallowuandurapidurespirationuisuseen.uThereuisuanuinspirato
ryulag,uinsteaduofuanuexpiratoryulag,uduringurespiratoryudistress.uThereuisuaugrun
tinguhearduwhenutheuairuisubreatheduout,uwhichuisuduringuexpirationuandunotudu
ringuinspiration.
Au35-year-
olduclientuhasujustugivenubirthutouauhealthyunewbornuduringuheru43rduweekuofu
gestation.uWhatushouldutheunurseuexpectuwhenuassessingutheuconditionuofutheu
newborn?
a.umeconiumuaspirationuinuuterouoruatubirth
b.useizures,urespiratoryudistress,ucyanosis,uandushrillucry
c.uyellowuappearanceuofutheunewborn'suskin
d.utremors,uirritability,uanduhigh-pitcheducryu-uans-
a.umeconiumuaspirationuinuuterouoruatubirth
Infantsubornuafteru42uweeksuofupregnancyuareupostuterm.uTheseuinfantsuareuatu
auhigheruriskuofuswallowinguoruaspiratingumeconiumuinuuterouoruafterubirth.uAsu
soonuasutheuinfantuisuborn,utheunurseuusuallyusuctionsuoututheusecretionsuanduf
luidsuinutheunewborn'sumouthuanduthroatubeforeutheufirstubreathutouavoiduaspirat
ionuofumeconiumuanduamnioticufluiduintoutheulungs.uSeizures,urespiratoryudistress
,ucyanosis,uandushrillucryuareusignsuandusymptomsuofuinfantsuwithuintracranialuh
emorrhage.uIntracranialuhemorrhageucanubeuaudangerousubirthuinjuryuthatuisupri
marilyuauproblemuforupretermunewborns,unotuposttermuneonates.uYellowuappeara
nceuofutheunewborn'suskinuisuusuallyuseenuinuinfantsuwithujaundice.uTremors,uirr
, itability,uhigh-
pitcheduoruweakucry,uandueyeurollinguareuseenuinuinfantsuwithuhypoglycemia.
Auclientuwithudiabetesugivesubirthutouaufull-
termuneonateuwhouweightsu10ulb,u1uozu(4,600ug).uWhileucaringuforuthisularge-
for-gestational-
ageu(LGA)uneonate,utheunurseupalpatesutheuclaviclesuforuwhichureason?
a.uNeonatesuofumothersuwithudiabetesuhaveubrittleubones.
b.uClaviclesuareucommonlyuabsentuinuneonatesuofumothersuwithudiabetes.
c.uOneuofutheuneonate'suclaviclesumayuhaveubeenubrokenuduringubirth.
d.uLGAuneonatesuhaveuglucoseudepositsuonutheiruclavicles.u-uans-
c.uOneuofutheuneonate'suclaviclesumayuhaveubeenubrokenuduringubirth.
Becauseuofutheuneonate'sulargeusize,uclavicularufracturesuareucommonuduringubir
th.uTheunurseushoulduassessualluLGAuneonatesuforuthisuoccurrence.uNoneuofuth
euotheruoptionsuareutrue.
Theunurseuobservesuauneonateubornuatu28uweeks'ugestation.uWhichufindinguwou
ldutheunurseuexpectutousee?
a.uTheuskinuisupale,uandunouvesselsushowuthroughuit.
b.uCreasesuappearuonutheuinteriorutwo-thirdsuofutheusole.
c.uTheupinnauofutheuearuisusoftuanduflatuandustaysufolded.
d.uTheuneonateuhasu7utou10ummuofubreastutissue.u-uans-
c.uTheupinnauofutheuearuisusoftuanduflatuandustaysufolded.
Theuearuhasuausoftupinnauthatuisuflatuandustaysufolded.uPaleuskinuwithunouvess
elsushowinguthroughuandu7utou10ummuofubreastutissueuareucharacteristicuofuau
neonateuatu40uweeks'ugestation.uCreasesuonutheuanteriorutwo-
thirdsuofutheusoleuareucharacteristicuofuauneonateuatu36uweeks'ugestation.
Au33-week-
gestationuinfantuhasujustubeenuborn.uTheuchild'suheartbeatuisunotuaudible.uWhat
uisutheupriorityunursinguintervention?
a.uDepressionuofutheusternumuwithubothuthumbsu1utou2ucmuatuaurateuofu100uti
mesuperuminute
b.uAdministrationuofuIVuepinephrine,uasuprescribed
c.uTransferutouautransitionaluoruhigh-
riskunurseryuforucontinuousucardiacusurveillance
d.uPalpationuforuaufemoralupulseu-uans-
a.uDepressionuofutheusternumuwithubothuthumbsu1utou2ucmuatuaurateuofu100uti
mesuperuminute
