Old's Maternal-Newborn Nursing and Women's Health, 11e (Davidson/London/Ladewig)

Chapter 30 The Newborn at Risk: Conditions Present at Birth

1. The nurse is caring for the newborn of a diabetic mother whose blood glucose level is 39 m g/d L. What should the nurse include in the plan of care for this newborn?
2. Offer early feedings with formula or breast milk.
3. Provide glucose water exclusively.
4. Evaluate blood glucose levels at 12 hours after birth.
5. Assess for hyperthermia.

Page Ref: 758

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Quality and Safety: Use technologies that contribute to safety. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 4 Explain the impact of maternal diabetes mellitus on the newborn.

M N L L O: Demonstrate understanding of conditions present at birth that place the newborn at risk.

1. The nurse is caring for several pregnant clients. Which client should the nurse anticipate is most likely to have a newborn at risk for mortality or morbidity?
2. 37-year-old, with a history of multiple births and preterm deliveries who works in a chemical factory
3. 23-year-old of low socioeconomic status, unmarried
4. 16-year-old who began prenatal care at 30 weeks
5. 28-year-old with a history of gestational diabetes

Page Ref: 754

Cognitive Level: Analyzing

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 1 Explain the factors present at birth that indicate an at-risk newborn.

M N L L O: Demonstrate understanding of conditions present at birth that place the newborn at risk.

1. The nurse is caring for an infant born at 37 weeks that weighs 1750 g (3 pounds 10 ounces). The head circumference and length are in the 25th percentile. What statement would the nurse expect to find in the chart?
2. Preterm appropriate for gestational age, symmetrical I U G R
3. Term small for gestational age, symmetrical I U G R
4. Preterm small for gestational age, asymmetrical I U G R
5. Preterm appropriate for gestational age, asymmetrical I U G R

Page Ref: 755

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅵ. B. 2. Apply technology and information management tools to support safe processes of care. | A A C N Essentials Competencies: Ⅳ. 6. Evaluate data from all relevant sources, including technology, to inform the delivery of care. | N L N Competencies: Quality and Safety: Use technologies that contribute to safety. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 2 Compare the underlying etiologies of the physiologic complications of small-for-gestational-age (S G A) newborns and preterm appropriate-for-gestational-age (Pr A G A) newborns and the nursing management for each.

M N L L O: Demonstrate understanding of conditions present at birth that place the newborn at risk.

1. A 38-week newborn is found to be small for gestational age (S G A). Which nursing intervention should be included in the care of this newborn?
2. Monitor for feeding difficulties.
3. Assess for facial paralysis.
4. Monitor for signs of hyperglycemia.
5. Maintain a warm environment.

Page Ref: 756

Cognitive Level: Applying

Client Need/Sub: Safe and Effective Care Environment: Management of Care

Standards: Q S E N Competencies: Ⅴ. B. 2. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Quality and Safety: Use technologies that contribute to safety. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 3 Describe the potential complications for large-for-gestational-age (L G A) newborns.

M N L L O: Demonstrate understanding of conditions present at birth that place the newborn at risk.

1. The nurse is caring for a 2-hour-old newborn whose mother is diabetic. The nurse assesses that the newborn is experiencing tremors. Which nursing action has the highest priority?
2. Obtain a blood calcium level.
3. Take the newborn's temperature.
4. Obtain a bilirubin level.
5. Place a pulse oximeter on the newborn.

Page Ref: 762

Cognitive Level: Analyzing

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Quality and Safety: Use technologies that contribute to safety. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 4 Explain the impact of maternal diabetes mellitus on the newborn.

M N L L O: Demonstrate understanding of conditions present at birth that place the newborn at risk.

1. A 7 pound 14 ounce girl was born to an insulin-dependent type Ⅱ diabetic mother 2 hours ago. The infant's blood sugar is 47 m g/d L. What is the best nursing action?
2. To recheck the blood sugar in 6 hours
3. To begin an I V of 10% dextrose
4. To feed the baby 1 ounce of formula
5. To document the findings in the chart

Page Ref: 762

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Quality and Safety: Use technologies that contribute to safety. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 4 Explain the impact of maternal diabetes mellitus on the newborn.

M N L L O: Demonstrate understanding of conditions present at birth that place the newborn at risk.

1. The nurse is caring for the newborn of a diabetic mother. Which of the following should be included in the nurse's plan of care for this newborn?
2. Offer early feedings.
3. Administer an intravenous infusion of glucose.
4. Assess for hypercalcemia.
5. Assess for hyperbilirubinemia immediately after birth.

Page Ref: 764

Cognitive Level: Understanding

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Quality and Safety: Use technologies that contribute to safety. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 4 Explain the impact of maternal diabetes mellitus on the newborn.

M N L L O: Demonstrate understanding of conditions present at birth that place the newborn at risk.

1. The nurse caring for a postterm newborn would not perform what intervention?
2. Providing warmth
3. Frequently monitoring blood glucose
4. Observing respiratory status
5. Restricting breastfeeding

Page Ref: 764

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Quality and Safety: Use technologies that contribute to safety. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 5 Compare the characteristics and potential complications that influence nursing management of the postterm newborn and the newborn with postmaturity syndrome.

M N L L O: Demonstrate understanding of conditions present at birth that place the newborn at risk.

1. The pregnant client at 41 weeks is scheduled for labor induction. She asks the nurse whether induction is really necessary. What response by the nurse is best?
2. "Babies can develop postmaturity syndrome, which refers to a number of complications that can occur after 42 weeks of pregnancy."
3. "When infants are born 2 or more weeks after their due date, they have meconium in the amniotic fluid."
4. "Sometimes the placenta ages excessively, and we want to take care of that problem before it happens."
5. "The doctor wants to be proactive in preventing any problems with your baby if he gets any bigger."

Page Ref: 764

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 5 Compare the characteristics and potential complications that influence nursing management of the postterm newborn and the newborn with postmaturity syndrome.

M N L L O: Demonstrate understanding of conditions present at birth that place the newborn at risk.

1. The mother of a premature newborn questions why a gavage feeding catheter is placed in the mouth of the newborn and not in the nose. What is the nurse's best response?
2. "Most newborns are nose breathers."
3. "The tube will elicit the sucking reflex."
4. "A smaller catheter is preferred for feedings."
5. "Most newborns are mouth breathers."

Page Ref: 772

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 6 Compare the physiologic and behavioral characteristics of the preterm newborn that predispose each body system to various complications and are used in the development of a plan of care that includes nutritional management.

M N L L O: Demonstrate understanding of conditions present at birth that place the newborn at risk.

1. A 3-month-old baby who was born at 25 weeks has been exposed to prolonged oxygen therapy. The nurse explains to the parents that due to oxygen therapy, their infant is at a greater risk for which of the following?
2. Visual impairment
3. Hyperthermia
4. Central cyanosis
5. Sensitive gag reflex

Page Ref: 774

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 6 Compare the physiologic and behavioral characteristics of the preterm newborn that predispose each body system to various complications and are used in the development of a plan of care that includes nutritional management.

M N L L O: Demonstrate understanding of conditions present at birth that place the newborn at risk.

1. A N I C U nurse plans care for a preterm newborn that will provide opportunities for development. Which interventions support development in a preterm newborn in a N I C U?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Schedule care throughout the day.
2. Silence alarms quickly.
3. Place a blanket over the top portion of the incubator.
4. Do not offer a pacifier.
5. Dim the lights.

Page Ref: 779

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅰ. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Relationship-Centered Care: Appreciate the patient as a whole person, with his or her own life story and ideas about the meaning of health or illness. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 6 Compare the physiologic and behavioral characteristics of the preterm newborn that predispose each body system to various complications and are used in the development of a plan of care that includes nutritional management.

M N L L O: Demonstrate understanding of conditions present at birth that place the newborn at risk.

1. The nurse assesses the gestational age of a newborn and informs the parents that the newborn is premature. Which of the following assessment findings is not congruent with prematurity?
2. Cry is weak and feeble
3. Clitoris and labia minora are prominent
4. Strong sucking reflex
5. Lanugo is plentiful

Page Ref: 766

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅴ. B. 4. Communicate observations or concerns related to hazards and errors to patients, families, and the healthcare team. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 6 Compare the physiologic and behavioral characteristics of the preterm newborn that predispose each body system to various complications and are used in the development of a plan of care that includes nutritional management.

M N L L O: Demonstrate understanding of conditions present at birth that place the newborn at risk.

1. The nurse is working with parents who have just experienced the birth of their first child at 34 weeks. Which statement(s) by the parents indicate that additional teaching is needed?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. "Our baby will be in an incubator to keep him warm."
2. "Breathing might be harder for our baby because he is early."
3. "The growth of our baby will be faster than if he were term."
4. "Tube feedings will be required because his stomach is small."
5. "Because he came early, he will not produce urine for 2 days."

Page Ref: 766

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅰ. B. 10. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 6 Compare the physiologic and behavioral characteristics of the preterm newborn that predispose each body system to various complications and are used in the development of a plan of care that includes nutritional management.

M N L L O: Demonstrate understanding of conditions present at birth that place the newborn at risk.

1. The neonatal special care unit nurse is overseeing the care provided by a nurse new to the unit. Which action requires immediate intervention?
2. The new nurse holds the infant after giving a gavage feeding.
3. The new nurse provides skin-to-skin care.
4. The new nurse provides care when the baby is awake.
5. The new nurse gives the feeding with room-temperature formula.

Page Ref: 766

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Quality and Safety: Use technologies that contribute to safety. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 6 Compare the physiologic and behavioral characteristics of the preterm newborn that predispose each body system to various complications and are used in the development of a plan of care that includes nutritional management.

M N L L O: Demonstrate understanding of conditions present at birth that place the newborn at risk.

1. Benefits of skin-to-skin care as a developmental intervention include which of the following?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Routine discharge
2. Stabilization of vital signs
3. Increased periods of awake-alert state
4. Decline in episodes of apnea and bradycardia
5. Increased growth parameters

Page Ref: 780

Cognitive Level: Understanding

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 3. Provide patient-centered care with sensitivity and respect for the diversity of human experience. | A A C N Essentials Competencies: Ⅸ. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | N L N Competencies: Relationship-Centered Care: Factors that contribute to or threaten health. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 6 Compare the physiologic and behavioral characteristics of the preterm newborn that predispose each body system to various complications and are used in the development of a plan of care that includes nutritional management.

M N L L O: Demonstrate understanding of conditions present at birth that place the newborn at risk.

1. In caring for the premature newborn, the nurse must assess hydration status continually. Assessment parameters should include which of the following?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Volume of urine output
2. Weight
3. Blood p H
4. Head circumference
5. Bowel sounds

Page Ref: 777

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Quality and Safety: Use technologies that contribute to safety. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 6 Compare the physiologic and behavioral characteristics of the preterm newborn that predispose each body system to various complications and are used in the development of a plan of care that includes nutritional management.

M N L L O: Demonstrate understanding of conditions present at birth that place the newborn at risk.

1. The nurse is planning care for a preterm newborn. Which nursing diagnosis has the highest priority?
2. Tissue Integrity, Impaired
3. Infection, Risk for
4. Gas Exchange, Impaired
5. Family Processes, Dysfunctional

Page Ref: 756

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Physiological Adaptation

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 5. Deliver compassionate, patient-centered, evidence-based care that respects patient and family preferences. | N L N Competencies: Quality and Safety: Use technologies that contribute to safety. | Nursing/Integrated Concepts: Nursing Process: Diagnosis.

Learning Outcome: 6 Compare the physiologic and behavioral characteristics of the preterm newborn that predispose each body system to various complications and are used in the development of a plan of care that includes nutritional management.

M N L L O: Demonstrate understanding of conditions present at birth that place the newborn at risk.

1. The nurse is teaching the parents of an infant with an inborn error of metabolism how to care for the infant at home. What information does teaching include?
2. Specially prepared formulas
3. Cataract problems
4. Low glucose concentrations
5. Administration of thyroid medication

Page Ref: 801

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 11 Explain the special care needed by a newborn diagnosed with an inborn error of metabolism.

M N L L O: Demonstrate understanding of conditions present at birth that place the newborn at risk.

1. The nurse is caring for a newborn in the special care nursery. The infant has hydrocephalus, and is positioned in a prone position. The nurse is especially careful to cleanse all stool after bowel movements. This care is most appropriate for an infant born with which of the following?
2. Omphalocele
3. Gastroschisis
4. Diaphragmatic hernia
5. Myelomeningocele

Page Ref: 786

Cognitive Level: Applying

Client Need/Sub: Safe and Effective Care Environment: Safety and Infection Control

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Quality and Safety: Use technologies that contribute to safety. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 7 Summarize the nursing assessments and initial interventions for a newborn born with selected congenital anomalies.

M N L L O: Demonstrate understanding of conditions present at birth that place the newborn at risk.

1. During discharge planning for a drug-dependent newborn, the nurse explains to the mother how to do which of the following?
2. Place the newborn in a prone position.
3. Limit feedings to three a day to decrease diarrhea.
4. Place the infant supine and operate a home apnea-monitoring system.
5. Wean the newborn off the pacifier.

Page Ref: 795

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 9 Explain the special care needed by an in utero alcohol- or drug-exposed newborn.

M N L L O: Demonstrate understanding of conditions present at birth that place the newborn at risk.

1. The nurse is assessing a drug-dependent newborn. Which symptom would require further assessment by the nurse?
2. Occasional watery stools
3. Spitting up after feeding
4. Jitteriness and irritability
5. Nasal stuffiness

Page Ref: 795

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Quality and Safety: Use technologies that contribute to safety. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 9 Explain the special care needed by an in utero alcohol- or drug-exposed newborn.

M N L L O: Demonstrate understanding of conditions present at birth that place the newborn at risk.

1. Parents have been told their child has fetal alcohol syndrome (F A S). Which statement by a parent indicates that additional teaching is required?
2. "Our baby's heart murmur is from this syndrome."
3. "He might be a fussy baby because of this."
4. "His face looks like it does due to this problem."
5. "Cuddling and rocking will help him stay calm."

Page Ref: 791

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 9 Explain the special care needed by an in utero alcohol- or drug-exposed newborn.

M N L L O: Demonstrate understanding of conditions present at birth that place the newborn at risk.

1. The nurse is caring for the newborn of a drug-addicted mother. Which assessment findings would be typical for this newborn?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Hyperirritability
2. Decreased muscle tone
3. Exaggerated reflexes
4. Low pitched cry
5. Transient tachypnea

Page Ref: 793

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Relationship-Centered Care: Factors that contribute to or threaten health. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 9 Explain the special care needed by an in utero alcohol- or drug-exposed newborn.

M N L L O: Demonstrate understanding of conditions present at birth that place the newborn at risk.

1. In planning care for the fetal alcohol syndrome (F A S) newborn, which intervention would the nurse include?
2. Allow extra time with feedings.
3. Assign different personnel to the newborn each day.
4. Place the newborn in a well-lit room.
5. Monitor for hyperthermia.

Page Ref: 791

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Reduction of Risk Potential

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 9 Explain the special care needed by an in utero alcohol- or drug-exposed newborn.

M N L L O: Demonstrate understanding of conditions present at birth that place the newborn at risk.

1. The nurse is teaching the parents of a newborn who has been exposed to H I V how to care for the newborn at home. Which instructions should the nurse emphasize?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Use proper hand-washing technique.
2. Provide three feedings per day.
3. Place soiled diapers in a sealed plastic bag.
4. Cleanse the diaper changing area with a 1:10 bleach solution after each diaper change.
5. Take the temperature rectally.

Page Ref: 799

Cognitive Level: Applying

Client Need/Sub: Safe and Effective Care Environment: Safety and Infection Control

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 10 Relate the consequences of maternal H I V/A I D S to the management of and issues for caregivers of newborns at risk for H I V/A I D S in the neonatal period.

M N L L O: Demonstrate understanding of conditions present at birth that place the newborn at risk.

1. A mother who is H I V-positive has given birth to a term female. What plan of care is most appropriate for this infant?
2. Test with an H I V serologic test at 8 months.
3. Begin prophylactic A Z T (Zidovudine) administration.
4. Provide 4 to 5 large feedings throughout the day.
5. Encourage the mother to breastfeed the child.

Page Ref: 799

Cognitive Level: Applying

Client Need/Sub: Health Promotion and Maintenance: Ante/Intra/Postpartum and Newborn Care

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 10 Relate the consequences of maternal H I V/A I D S to the management of and issues for caregivers of newborns at risk for H I V/A I D S in the neonatal period.

M N L L O: Demonstrate understanding of conditions present at birth that place the newborn at risk.

1. An H I V-positive mother delivered 2 days ago. The infant will be placed in foster care. The nurse is planning discharge teaching for the foster parents on how to care for the newborn at home. Which instructions should the nurse include?
2. Do not add food supplements to the baby's diet.
3. Place soiled diapers in a sealed plastic bag.
4. Wash soiled linens in cool water with bleach.
5. Shield the baby's eyes from bright lights.

Page Ref: 800

Cognitive Level: Applying

Client Need/Sub: Safe and Effective Care Environment: Safety and Infection Control

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Planning.

Learning Outcome: 10 Relate the consequences of maternal H I V/A I D S to the management of and issues for caregivers of newborns at risk for H I V/A I D S in the neonatal period.

M N L L O: Demonstrate understanding of conditions present at birth that place the newborn at risk.

1. Many newborns exposed to H I V/A I D S show signs and symptoms of disease within days of birth that include which of the following?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Swollen glands
2. Hard stools
3. Smaller than average spleen and liver
4. Rhinorrhea
5. Interstitial pneumonia

Page Ref: 798

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Diagnosis.

Learning Outcome: 10 Relate the consequences of maternal H I V/A I D S to the management of and issues for caregivers of newborns at risk for H I V/A I D S in the neonatal period.

M N L L O: Demonstrate understanding of conditions present at birth that place the newborn at risk.

1. The nurse is analyzing assessment findings on four newborns. Which finding might suggest a congenital heart defect?
2. Apical heart rate of 140 beats per minute
3. Respiratory rate of 40
4. Temperature of 36.5°C
5. Visible, blue discoloration of the skin

Page Ref: 787

Cognitive Level: Analyzing

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅴ. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | A A C N Essentials Competencies: Ⅸ. 1. Conduct comprehensive and focused physical, behavioral, psychological, spiritual, socioeconomic, and environmental assessments of health and illness parameters in patients, using developmentally and culturally appropriate approaches. | N L N Competencies: Relationship-Centered Care: Factors that contribute to or threaten health. | Nursing/Integrated Concepts: Nursing Process: Assessment.

Learning Outcome: 8 Identify physical examination findings during the early newborn period that would make the nurse suspect a congenital cardiac defect or congestive heart failure.

M N L L O: Demonstrate understanding of conditions present at birth that place the newborn at risk.

1. The parents of a newborn have just been told their infant has tetralogy of Fallot. The parents do not seem to understand the explanation given by the physician. What statement by the nurse is best?
2. "With this defect, not enough of the blood circulates through the lungs, leading to a lack of oxygen in the baby's body."
3. "The baby's aorta has a narrowing in a section near the heart that makes the left side of the heart work harder."
4. "The blood vessels that attach to the ventricles of the heart are positioned on the wrong sides of the heart."
5. "Your baby's heart doesn't circulate blood well because the left ventricle is smaller and thinner than normal."

Page Ref: 787

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Implementation.

Learning Outcome: 8 Identify physical examination findings during the early newborn period that would make the nurse suspect a congenital cardiac defect or congestive heart failure.

M N L L O: Demonstrate understanding of conditions present at birth that place the newborn at risk.

1. The nurse is preparing an educational session on phenylketonuria for a family whose neonate has been diagnosed with the condition. Which statement by a parent indicates that teaching was effective?
2. "This condition occurs more frequently among Japanese people."
3. "We must be very careful to avoid most proteins to prevent brain damage."
4. "Carbohydrates can cause our baby to develop cataracts and liver damage."
5. "Our baby's thyroid gland isn't functioning properly."

Page Ref: 801

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Physiological Adaptation

Standards: Q S E N Competencies: Ⅰ. B. 10. Engage patients or designated surrogates in active partnerships that promote health, safety and well-being, and self-care management. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Relationship-Centered Care: Communicate information effectively; listen openly and cooperatively. | Nursing/Integrated Concepts: Nursing Process: Evaluation.

Learning Outcome: 11 Explain the special care needed by a newborn diagnosed with an inborn error of metabolism.

M N L L O: Demonstrate understanding of conditions present at birth that place the newborn at risk.

1. The nurse is observed conducting the following measurement. For what will this measurement be used?

1. Determine fetal length
2. Gauge stomach contents
3. Placement of gavage tube
4. Estimate chest circumference

Page Ref: 771

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Basic Care and Comfort

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Assessment: Nursing Process.

Learning Outcome: 2 Compare the underlying etiologies of the physiologic complications of small-for-gestational-age (S G A) newborns and preterm appropriate-for-gestational-age (Pr A G A) newborns and the nursing management for each.

M N L L O: Demonstrate understanding of conditions present at birth that place the newborn at risk.

1. The nurse is caring for a newborn with the following anomaly. What actions should the nurse take when caring for this infant?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Select all that apply.

1. Burp frequently
2. Assess patency of nares
3. Assist with parental coping
4. Clean the area with sterile water
5. Feed with a special nipple and bottle

Page Ref: 782

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Basic Care and Comfort

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 8. Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Nursing Process.

Learning Outcome: 7 Summarize the nursing assessments and initial interventions for a newborn born with selected congenital anomalies.

M N L L O: Demonstrate understanding of conditions present at birth that place the newborn at risk.

1. The nurse is preparing teaching material for the parents of a newborn with tracheoesophageal fistula. Where on the diagram should the nurse identify the location of this disorder?

1. A
2. B
3. C
4. D

Page Ref: 783

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Basic Care and Comfort

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Teaching/Learning.

Learning Outcome: 7 Summarize the nursing assessments and initial interventions for a newborn born with selected congenital anomalies.

M N L L O: Demonstrate understanding of conditions present at birth that place the newborn at risk.

1. The nurse is preparing teaching material for the parents of a newborn. For which health problem should the nurse select the following diagram to be used for teaching?

1. Gastroschisis
2. Omphalocele
3. Diaphragmatic hernia
4. Prune belly syndrome

Page Ref: 784

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Basic Care and Comfort

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Teaching/Learning.

Learning Outcome: 7 Summarize the nursing assessments and initial interventions for a newborn born with selected congenital anomalies.

M N L L O: Demonstrate understanding of conditions present at birth that place the newborn at risk.

1. An infant is diagnosed with an atrial-septal defect. When teaching the parents of this infant about the disorder, which diagram should the nurse use?

Page Ref: 788

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Basic Care and Comfort

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 7. Provide appropriate patient teaching that reflects developmental stage, age, culture, spirituality, patient preferences, and health literacy considerations to foster patient engagement in their care. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Teaching/Learning.

Learning Outcome: 7 Summarize the nursing assessments and initial interventions for a newborn born with selected congenital anomalies.

M N L L O: Demonstrate understanding of conditions present at birth that place the newborn at risk.

1. The nurse is preparing to gavage-feed a preterm infant. Put the steps in the order in which the nurse should provide this feeding.
2. Check p H of the gastric aspirate
3. Elevate the syringe 6-8 inches above the infant's head
4. Measure from the tip of the nose to the earlobe to the xiphoid process
5. Clear the tubing with 2-3 m L of air
6. Lubricate the tube by dipping it into sterile water

Page Ref: 771

Cognitive Level: Applying

Client Need/Sub: Physiological Integrity: Basic Care and Comfort

Standards: Q S E N Competencies: Ⅰ. A. 1. Integrate understanding of multiple dimensions of patient-centered care. | A A C N Essentials Competencies: Ⅸ. 3. Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across the lifespan, and in all healthcare settings. | N L N Competencies: Context and Environment: Practice; conduct population-based transcultural health assessments and interventions. | Nursing/Integrated Concepts: Implementation: Nursing Process.

Learning Outcome: 6 Compare the physiologic and behavioral characteristics of the preterm newborn that predispose each body system to various complications and are used in the development of a plan of care that includes nutritional management.

M N L L O: Demonstrate understanding of conditions present at birth that place the newborn at risk.