Chapter 26 The Newborn at Risk: Conditions Present at Birth

Chapter 26   The Newborn at Risk: Conditions Present at Birth

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

1) The nurse is caring for pregnant clients. Which of these clients should the nurse anticipate is most likely to have a newborn at risk for mortality or morbidity?

1. 37-year-old G8 P2323, works in a chemical factory
2. 23-year-old primipara, low socioeconomic status, unmarried
3. 16-year-old primipara, began prenatal care at 30 weeks
4. 28-year-old G2 P1001, history of gestational diabetes

Answer:  1

Explanation:  1. This client is at greatest risk because she has multiple risk factors: age older than 35, high parity, history of preterm birth, and exposure to chemicals that might be toxic.

2. The main risk factor for this client is her low socioeconomic status.
3. This client has two risk factors: young age and late onset of prenatal care.
4. This client has gestational diabetes history as her only risk factor.

Page Ref: 525-526

Cognitive Level:  Application

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Assessment/Coordination of care

Learning Outcome:  LO 26.1-Explain the factors present at birth that indicate an at-risk newborn.

MNL LO:  Correlate high-risk conditions present at birth to their associated nursing care.

 

 

2) Small-for-gestational-age infants often have complications at birth, but they may also experience long-term complications. The long-term effect that is most likely to occur in SGA infants is:

1. Change from thin and underweight as a child to overweight or obese as adolescents.
2. Poor fine motor coordination.
3. Paralysis below the hips.
4. Permanent disfiguration.

Answer:  2

Explanation:  1. This long-term effect is often seen in children with fetal alcohol syndrome, not SGA.

2. SGA infants are likely to develop cognitive disabilities such as poor fine motor coordination, hyperactivity, learning disabilities, and hearing loss.
3. Many infants with myelomeningocele will suffer life-long paralysis below the site of the cyst. Paralysis is not generally associated with SGA infants.
4. Although it may occur, disfiguration is not commonly associated with SGA infants. Instead, disfiguration is more likely to remain in infants with congenital anomalies such as cleft lip/cleft palate, even after corrective surgery.

Page Ref: 528

Cognitive Level:  Analyzing

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Planning/Coordination of care

Learning Outcome:  LO 26.2-Compare the underlying etiologies of the physiologic complications of small-for-gestational-age (SGA) newborns and preterm appropriate-for-gestational-age (PrAGA) newborns, and the nursing care management for each.

MNL LO:  Correlate high-risk conditions present at birth to their associated nursing care.

 

3) A 38-week newborn is found to be small for gestational age. Which of the following nursing interventions should be included in the care of this newborn?

1. Monitor for feeding difficulties.
2. Assess for facial paralysis.
3. Monitor for signs of hyperglycemia.
4. Maintain a warm environment.

Answer:  4

Explanation:  1. LGA newborns are more difficult to arouse to a quiet alert state and can have feeding difficulties.

2. LGA newborns often are prone to birth trauma, such as facial paralysis, due to cephalopelvic disproportion.
3. SGA newborns are more prone to hypoglycemia.
4. Hypothermia is a common complication of the SGA newborn; therefore, the newborn’s environment must remain warm to decrease heat loss.

Page Ref: 528-529

Cognitive Level:  Analyzing

Client Need&Sub:  Physiological Integrity | Reduction of Risk Potential

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Human flourishing | Nursing/Integrated Concepts: Nursing Process: Implementation/Coordination of care

Learning Outcome:  LO 26.2-Compare the underlying etiologies of the physiologic complications of small-for-gestational-age (SGA) newborns and preterm appropriate-for-gestational-age (PrAGA) newborns, and the nursing care management for each.

MNL LO:  Correlate high-risk conditions present at birth to their associated nursing care.

 

 

4) A 7 pound 14 ounce girl was born to an insulin-dependent type 2 diabetic mother 2 hours ago. The infant’s blood sugar is 45mg/dL. The best nursing action is:

1. Recheck the blood sugar in four hours.
2. Begin an IV of 10 percent dextrose.
3. Feed the baby one ounce of formula.
4. Document the findings in the chart.

Answer:  4

Explanation:  1. Infants of diabetic mothers should be fed frequently and should have their blood sugar assessed frequently. Four hours is too long a time frame.

2. 45mg/dL is considered a normal blood sugar reading for a neonate. No IV is needed.
3. Feeding would be appropriate if the infant’s blood sugar was below 40, but this infant’s reading is 45 mg/dL.
4. A blood sugar of 45 mg/dL is a normal finding; documentation is an appropriate action.

Page Ref: 529

Cognitive Level:  Analyzing

Client Need&Sub:  Health Promotion and Maintenance

Standards:  QSEN Competencies: Patient-centered care | AACN Essential Competencies: Essential IX: Baccalaureate generalist nursing practice | NLN Competencies: Nursing judgement | Nursing/Integrated Concepts: Nursing Process: Implementation/Coordination of care

Learning Outcome:  LO 26.3-Explain the impact of maternal diabetes mellitus on the newborn.

MNL LO:  Correlate high-risk conditions present at birth to their associated nursing care.