NUR 1600 Neonate Exam Review

NUR 1600 Neonate Exam Review Question 1 See full question A nurse is teaching the mother of an infant about the importance of immunizations. The nurse should teach her that active immunity: Correct response: • results from exposure of an antigen through immunization or disease contact. Question 2 See full question A nurse is conducting an assessment of a neonate born 3 hours ago. Which finding makes the nurse suspect a congenital hip dislocation? Correct response: • Unequal gluteal folds Explanation: Unequal gluteal folds are a sign of congenital hip dislocation. Other signs include unequal thighs, limited adduction of the affected side, and shortening of the limb on the affected side. Crepitus of the affected hip isn't felt, but an audible click may be heard when the hip on the affected side is adducted. Remediation: Question 3 See full question Twenty-four hours after cesarean birth, a neonate at 30 weeks’ gestation is diagnosed with respiratory distress syndrome (RDS). When explaining to the parents about the cause of this syndrome, the nurse should include a discussion about an alteration in the body’s secretion of which substance? • surfactant Explanation: RDS, previously called hyaline membrane disease, is a developmental condition involving a decrease in lung surfactant leading to improper expansion of the lung alveoli. Surfactant contains a group of surface-active phospholipids, of which one component—lecithin—is the most critical for alveolar stability. Surfactant production peaks at about 35 weeks’ gestation. This syndrome primarily attacks preterm neonates, although it can also affect term and postterm neonates. Altered somatotropin secretion is associated with growth disorders such as gigantism or dwarfism. Altered testosterone secretion is associated with masculinization. Altered progesterone secretion is associated with spontaneous abortion during pregnancy. Remediation: Question 4 See full question Which finding would the nurse most expect to find in a neonate born at 28 weeks’ gestation who is diagnosed with intraventricular hemorrhage (IVH)? • bulging fontanels Explanation: Remediation: Question 5 See full question When teaching a primiparous client who used cocaine during pregnancy how to comfort her fussy neonate, the nurse can advise the mother to: You Selected: • tightly swaddle the neonate. Correct response: • tightly swaddle the neonate. Explanation: Remediation: Question 6 See full question After a lengthy labor, a primigravid client gives birth to a healthy newborn boy with a moderate amount of skull molding. What information would the nurse include when explaining to the parents about this condition? You Selected: • It usually lasts a day or two before resolving. Correct response: • It usually lasts a day or two before resolving. Explanation: Remediation: Question 7 See full question When preparing for the discharge of a newborn after surgery to correct tracheoesophageal fistula (TEF), the nurse teaches the parents about the need for long- term health care because their child has a high probability of developing which complication? You Selected: • speech problems Correct response: • esophageal stricture Explanation: Dilatation at the anastomosis site is needed during the first years of childhood in about 50% of children who have had corrective surgery for TEF. Recurrent mild diarrhea with dehydration is not likely to develop with this surgery. Speech problems can occur if other abnormalities are present to produce them; the larynx and structures of speech are not affected by TEF. Dysphagia and strictures may decrease food intake, and poor weight gain may be noted, but gastric ulcers should not develop from surgery to repair TEF. Remediation: Question 8 See full question During a home visit to a primiparous client 1 week postpartum who is bottle-feeding her neonate, the client tells the nurse that her mother has suggested that she feed the neonate cereal so he will sleep through the night. What would be the nurse's best response? You Selected: • "If cereal is given too early in life, the undigested food can lead to a need for surgery." Correct response: • "Formula is the food best digested by the baby until about 4 to 6 months of age." Explanation: The American Academy of Pediatrics recommends that all neonates should receive only formula or breast milk for the first 4 to 6 months of life. Cereal will not help the neonate sleep through the night and may result in allergies and other digestive disorders. Remediation: Question 9 See full question A woman who has recently immigrated from Africa and given birth to a term neonate a short time ago requests that a “special bracelet” be placed on the baby’s wrist. The nurse should: You Selected: • apply the bracelet on the neonate’s wrist as the mother requests. Correct response: • apply the bracelet on the neonate’s wrist as the mother requests. Explanation: Remediation: Question 10 See full question The nurse is to assess a newborn for incurving of the trunk. Which illustration indicates the position in which the nurse should place the newborn? You Selected: • Correct response: • Explanation: When assessing the incurving of the trunk tests for automatic reflexes in the newborn, the nurse places the infant horizontally and in a prone position with one hand, and strokes the side of the newborn’s trunk from the shoulder to the buttocks using the other hand. If the reflex is present, the newborn’s trunk curves toward the stimulated side. Answer 2 shows a figure for testing for a stepping response. Answer 3 shows a figure for testing for a tonic neck reflex. Answer 4 shows a figure for testing for the Moro (startle) reflex. Question 1 See full question When teaching parents of a neonate the proper position for the neonate's sleep, a nurse stresses the importance of placing the neonate on his back to reduce the risk of: You Selected: • sudden infant death syndrome (SIDS) Correct response: • sudden infant death syndrome (SIDS) Explanation: Remediation: Question 2 See full question A nurse places a neonate with hyperbilirubinemia under a phototherapy lamp, covering the eyes and gonads for protection. The parents asked the nurse to tell them how their baby will benefit from having phototherapy done. Which statement by the nurse is the most appropriate response about phototherapy? You Selected: • "Phototherapy decreases the serum unconjugated bilirubin level." Correct response: • "Phototherapy decreases the serum unconjugated bilirubin level." Explanation: Remediation: Question 3 See full question The nurse covers the myelomeningocele of a neonate with a sterile dressing. Which of the following statements directs the nurses action? You Selected: • preventing infection. Correct response: • preventing infection. Explanation: Remediation: Question 4 See full question A nurse assigns to a neonate an Apgar score of 8 at 5 minutes. The nurse understands that this score indicates: You Selected: • a neonate who's in good condition. Correct response: • a neonate who's in good condition. Explanation: Remediation: Question 5 See full question A mother with a history of gestational hypertension gives birth to a neonate at 26 weeks' gestation. After the neonate receives surfactant through an endotracheal tube in the delivery room, a nurse takes him to the neonatal intensive care unit (NICU), places him on an overbed warmer, and provides mechanical ventilation. When the mother arrives in the NICU for the first time, the nurse's priority should be to: You Selected: • enhance bonding by pointing out the neonate's features. Correct response: • enhance bonding by pointing out the neonate's features. Explanation: Remediation: Question 6 See full question Parents who bring a 3-week-old neonate to the hospital report that he's been "throwing up after every feeding." A nurse notes projectile vomiting while assessing the neonate. X-rays confirm: You Selected: • pyloric stenosis. Correct response: • pyloric stenosis. Explanation: Projectile vomiting is a classic symptom of pyloric stenosis, which typically occurs within the first weeks of life. Upper GI X-rays confirm this diagnosis. Gastroschisis, diaphragmatic hernia, and imperforate anus would have been evident in the hours immediately after birth, and the reported symptoms don't characterize these conditions. Remediation: Question 7 See full question A client who has tested positive for the human immunodeficiency virus (HIV) gives birth to a girl. When she asks whether her baby has acquired immunodeficiency syndrome (AIDS), how should the nurse respond? You Selected: • "She may have acquired HIV in utero, but we won't know for sure until she's older." Correct response: • "She may have acquired HIV in utero, but we won't know for sure until she's older." Explanation: The nurse should explain to the mother that the neonate might have acquired HIV in utero, but that a diagnosis can't be made until the neonate is older. Diagnosing AIDS in neonates is difficult because all neonates of women with HIV receive maternal antibodies and therefore initially test positive for HIV antibodies. Saying, "Don't worry. It's too soon to tell" minimizes the mother's concern and doesn't provide specific information. Saying that chances are the neonate will be okay could promote false hope. Stating that all neonates born to HIV-positive women are infected isn't true. Neonates of HIV-positive mothers have a 25% to 30% chance of developing HIV. Remediation: Question 8 See full question The nurse is caring for a neonate weighing 4,536 g (10 lb) who was born via cesarean section 1 hour ago to a mother with insulin-dependent diabetes. She asks the nurse, “Why is my baby in the neonatal intensive care unit?” The nurse bases a response on the understanding that neonates of mothers with diabetes commonly develop which condition? You Selected: • hypoglycemia Correct response: • hypoglycemia Explanation: Hypoglycemia is caused by the rapid depletion of glucose stores. In addition, neonates born to class women with insulin dependent diabetes are about seven times more likely to suffer from respiratory distress syndrome than neonates born to nondiabetic women. This neonate should be closely monitored for symptoms of hypoglycemia and respiratory distress. Neonates of diabetic mothers commonly have polycythemia, not anemia. Anemia and hemolytic disease are associated with erythroblastosis fetalis. Persistent pulmonary hypertension is associated with meconium aspiration syndrome. Remediation: Question 9 See full question The nurse is caring for a neonate diagnosed with early onset sepsis and is being treated with intravenous antibiotics. Which instructions will the nurse include in the parents’ teaching plan? You Selected: • Wash hands thoroughly before touching the neonate. Correct response: • Wash hands thoroughly before touching the neonate.