Chapter 27 The Newborn at Risk: Birth-Related Stressors

Chapter 27   The Newborn at Risk: Birth-Related Stressors

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

1) A laboring mother has recurrent late decelerations. At birth, the infant has a heart rate of 100, is not breathing, and is limp and bluish in color. What nursing action is best?

1. Begin chest compressions.
2. Deep suction the airways.
3. Begin bag-and-mask ventilation.
4. Assess blood pressure.

Answer:  3

Explanation:  1. Chest compressions are not initiated until the heart rate is less than 60 and respirations have been established.

2. This would be appropriate if there were meconium-stained fluid. There is no information about the amniotic fluid.
3. When an infant is not breathing and has poor muscle tone, bag-and-mask ventilation is the appropriate resuscitation measure.
4. Establishment of airway and breathing take priority over assessment of blood pressure.

Page Ref: 576

Cognitive Level:  Application

Client Need&Sub:  Physiological Integrity

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 27.1-Describe how to identify newborns in need of resuscitation and the appropriate method of resuscitation based on the antepartum/labor record and physiologic indicators.

MNL LO:  Examine characteristics of the high-risk newborn.

 

2) The nurse is assessing a 2-hour-old newborn delivered by cesarean at 38 weeks. The amniotic fluid was clear. His mother had preeclampsia. His respiratory rate is 80; he is grunting and has nasal flaring. What is the most likely cause of this infant’s condition?

1. Meconium aspiration syndrome
2. Transient tachypnea of the newborn
3. Respiratory distress syndrome
4. Prematurity of the neonate

Answer:  2

Explanation:  1. There was no meconium in the amniotic fluid, which rules out meconium aspiration syndrome.

2. The infant is term and born by cesarean. He is most likely experiencing transient tachypnea of the newborn.
3. The infant is not premature and therefore is not likely to be experiencing respiratory distress syndrome.
4. The infant is not premature. Prematurity alone does not cause respiratory distress; the lack of surfactant causes respiratory distress syndrome.

Page Ref: 581-586

Cognitive Level:  Understanding

Client Need&Sub:  Physiological Integrity

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 27.2-Differentiate, based on clinical manifestations, among the various types of respiratory distress (respiratory distress syndrome, transient tachypnea of the newborn, and meconium aspiration syndrome) in the newborn and the nursing care related to each type.

MNL LO:  Explain cardiopulmonary changes that occur during transition from intrauterine to extrauterine life.

 

3) A nurse is caring for a newborn on a ventilator who has respiratory distress syndrome (RDS). The nurse informs the parents that the newborn is improving. Which of the following data supports the nurse’s assessment?

1. Decreased urine output
2. Increased pulmonary vascular resistance
3. Increased PCO2
4. Increased urination

Answer:  4

Explanation:  1. As fluid moves out of the lungs and into the bloodstream, alveoli open, and kidney perfusion increases, thereby increasing urine output.

2. Pulmonary vascular resistance increases with hypoxia.
3. Increased PCO2results from alveolar hypoventilation.
4. Increased urination could be an indication that the newborn’s condition is improving.

Page Ref: 584-586

Cognitive Level:  Analyzing

Client Need&Sub:  Physiological Integrity

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

Learning Outcome:  LO 27.2-Differentiate, based on clinical manifestations, among the various types of respiratory distress (respiratory distress syndrome, transient tachypnea of the newborn, and meconium aspiration syndrome) in the newborn and the nursing care related to each type.

MNL LO:  Utilize the findings of the newborn assessment to teach and involve parents in newborn care.

 

4) The nurse is caring for an infant who delivered in a car on the way to the hospital and who has developed cold stress. Which finding requires immediate intervention?

1. Vasoconstriction and pallor
2. Blood glucose level of 45
3. Room temperature IV running
4. Positioned under radiant warmer

Answer:  3

Explanation:  1. Vasoconstriction is the first physiologic response to a lowering temperature and will cause pallor.

2. This is an adequate blood sugar in a neonate. Less than 40 is hypoglycemic.
3. IV fluids should be warmed prior to administration and wrapped in a blanket or other insulating material to keep them warm. Room temperature IV fluids will increase the cold stress.
4. Radiant warmers are used to gradually increase the neonate’s temperature.

Page Ref: 589

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: Implementation/Coordination of care

Learning Outcome:  LO 27.3-Discuss the types of metabolic abnormalities (cold stress and hypoglycemia), their effects on the newborn, and their nursing implications.

MNL LO:  Examine characteristics of the high-risk newborn.