Chapter 30: High-Risk Newborn: Acquired and Congenital Conditions

Chapter 30: High-Risk Newborn: Acquired and Congenital Conditions

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

MULTIPLE CHOICE

 

1. The infant of a diabetic mother is hypoglycemic. Which type of feeding should be instituted first?

a.	Glucose water
b.	D5W intravenously
c.	Formula via nasogastric tube
d.	Small amount of glucose water followed by formula or breast milk

 

 

ANS:  D

Glucose followed by formula or breast milk is metabolized more slowly and results in longer normal glucose levels. High levels of dextrose correct the hypoglycemia but will stimulate the production of more insulin. Oral feedings are tried first; intravenous lines would be a later choice if the hypoglycemia continues. Formula results in longer normal glucose levels but would be administered via bottle, not by tube feeding.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   659

OBJ:   Nursing Process Step: Implementation

MSC:  Client Needs: Physiologic Integrity

 

2. Which defect is present with tetralogy of Fallot?

a.	Patent ductus arteriosus
b.	Coarctation of the aorta
c.	Hypertrophy of the right ventricle
d.	Transposition of the great arteries

 

 

ANS:  C

Tetralogy of Fallot has four characteristics—ventricular septal defect, positioning of the aorta over the defect, pulmonary stenosis, and hypertrophy of the right ventricle. Patent ductus arteriosus is a result of the failure of the ductus arteriosus to close after birth. Blood flow is impeded, though this constricted area of the aorta is not a characteristic of tetralogy of Fallot. In transposition of the great arteries, the positions of the aorta and pulmonary artery are reversed.

 

PTS:   1                    DIF:    Cognitive Level: Understanding       REF:   674

OBJ:   Nursing Process Step: Assessment   MSC:  Client Needs: Physiologic Integrity

 

3. The nurse is responsible for monitoring the feedings of the infant with hyperbilirubinemia every 2 to 3 hours around the clock. The purpose of these formula feedings or breastfeedings is to:

a.	prevent hyperglycemia.
b.	provide fluids and protein.
c.	decrease gastrointestinal motility.
d.	prevent rapid emptying of the bilirubin from the bowel.

 

 

ANS:  B

Proteins help maintain the albumin level in the blood, and the extra fluids help eliminate the excess bilirubin from the infant’s system. Feedings every 2 hours will help prevent hypoglycemia. Increased gastrointestinal motility can facilitate the prompt emptying of the bilirubin from the bowel. The feedings stimulate bowel movements and emptying of the bilirubin from the bowel.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   658

OBJ:   Nursing Process Step: Implementation

MSC:  Client Needs: Physiologic Integrity

 

4. An infant with severe meconium aspiration syndrome is not responding to conventional treatment. Which method of treatment may be available at a level III facility for use with this infant?

a.	Insertion of an endotracheal tube
b.	Respiratory support with a ventilator
c.	Extracorporeal membrane oxygenation
d.	Insertion of a laryngoscope and suctioning of the trachea

 

 

ANS:  C

Extracorporeal membrane oxygenation is a highly technical method that oxygenates the blood while bypassing the lungs, allowing the infant’s lungs to rest and recover. An endotracheal tube will be in place to facilitate deep tracheal suctioning and ventilation. The infant is likely to have been first connected to a ventilator. Laryngoscope insertion and tracheal suctioning are performed after birth, before the infant takes the first breath.

 

PTS:   1                    DIF:    Cognitive Level: Understanding       REF:   653

OBJ:   Nursing Process Step: Planning        MSC:  Client Needs: Physiologic Integrity

 

5. Four hours after the birth of a healthy neonate of an insulin-dependent (type 1) diabetic mother, the baby appears jittery and irritable and has a high-pitched cry. Which nursing action has top priority?

a.	Notify the clinician stat.
b.	Test for the blood glucose level.
c.	Start an intravenous line with D5W.
d.	Document the event in the nurses’ notes.

 

 

ANS:  B

These symptoms are signs of hypoglycemia in the newborn. Permanent damage can occur if glucose is not constantly available to the brain, but it is not common practice to give intravenous glucose to a newborn. Feeding the infant is preferable because the formula or breast milk will last longer. Determine the blood glucose level according to agency policy, treat symptoms with standing orders protocol, and notify the physician with the results. Documentation can wait until the infant has been tested and treated if a problem is present.

 

PTS:   1                    DIF:    Cognitive Level: Application           REF:   670

OBJ:   Nursing Process Step: Implementation

MSC:   Client Needs: Physiologic Integrity