Chapter 31 The Newborn at Risk: Conditions Present at Birth

Chapter 31   The Newborn at Risk: Conditions Present at Birth

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

1) The nurse is caring for the newborn of a diabetic mother whose blood glucose level is 39 mg/dL. What should the nurse include in the plan of care for this newborn?

1. Offer early feedings with formula or breast milk.
2. Provide glucose water exclusively.
3. Evaluate blood glucose levels at 12 hours after birth.
4. Assess for hypothermia.

Answer:  1

Explanation:  1. IDMs whose serum glucose falls below 40 mg/dL should have early feedings with formula or breast milk (colostrum).

Page Ref: 766

Cognitive Level:  Applying

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

Standards:  QSEN Competencies: V. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | AACN 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. | NLN Competencies: Quality and Safety: Use technologies that contribute to safety. | Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome:  3 Describe the impact of maternal diabetes mellitus on the newborn.

MNL LO:  4.5.3 Correlate high-risk conditions present at birth to their associated nursing care.

 

2) 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?

1. 37-year-old, with a history of multiple births and preterm deliveries who works in a chemical factory
2. 23-year-old of low socioeconomic status, unmarried
3. 16-year-old who began prenatal care at 30 weeks
4. 28-year-old with a history of gestational diabetes

Answer:  1

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

Page Ref: 758, 759

Cognitive Level:  Analyzing

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

Standards:  QSEN Competencies: V. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | AACN 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. | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Assessment

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

MNL LO:  4.5.1 Examine characteristics of the high-risk newborn.

3) The nurse is caring for a prenatal client. Reviewing the client’s pregnancy history, the nurse identifies risk factors for an at-risk newborn, including 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. The mother’s low socioeconomic status
2. Maternal age of 26
3. Mother’s exposure to toxic chemicals
4. More than three previous deliveries
5. Maternal hypertension

Answer:  1, 3, 4, 5

Explanation:  1. Low socioeconomic status is associated with at-risk newborns.

3. Exposure to environmental dangers, such as toxic chemicals is associated with at-risk newborns.
4. Maternal factors such as multiparity are associated with at-risk newborns.
5. Preexisting maternal conditions, such as heart disease, diabetes, hypertension, hyperthyroidism, and renal disease are associated with at-risk newborns.

Page Ref: 758, 759

Cognitive Level:  Applying

Client Need/Sub:  Physiological Integrity: Physiological Adaptation

Standards:  QSEN Competencies: V. B. 1. Demonstrate effective use of technology and standardized practices that support safety and quality. | AACN 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. | NLN Competencies: Quality and Safety: Communicate potential risk factors and actual errors. | Nursing/Integrated Concepts: Nursing Process: Assessment

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

MNL LO:  4.5.1 Examine characteristics of the high-risk newborn.

 

 

4) 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?

1. Preterm appropriate for gestational age, symmetrical IUGR
2. Term small for gestational age, symmetrical IUGR
3. Preterm small for gestational age, asymmetrical IUGR
4. Preterm appropriate for gestational age, asymmetrical IUGR

Answer:  3

Explanation:  3. The infant is preterm at 37 weeks. Because the weight is below the 10th percentile, the infant is small for gestational age. Head circumference and length between the 10th and 90th percentiles indicate asymmetrical IUGR.

Page Ref: 761

Cognitive Level:  Applying

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

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

Learning Outcome:  2 Differentiate the underlying etiologies of the physiologic complications of small-for-gestational-age (SGA) newborns and preterm appropriate-for-gestational-age (Pr AGA) newborns and the nursing care management for each.

MNL LO:  4.5.2 Determine nursing care for the high-risk newborn as it relates to gestational age.

5) A 38-week newborn is found to be small for gestational age (SGA). Which nursing intervention 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:  4. Hypothermia is a common complication in the SGA newborn; therefore, the newborn’s environment must remain warm, to decrease heat loss.

Page Ref: 762

Cognitive Level:  Applying

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

Standards:  QSEN Competencies: V. B. 2. Demonstrate effective use of technology and standardized practices that support safety and quality. | AACN 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. | NLN Competencies: Quality and Safety: Use technologies that contribute to safety. | Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome:  2 Differentiate the underlying etiologies of the physiologic complications of small-for-gestational-age (SGA) newborns and preterm appropriate-for-gestational-age (Pr AGA) newborns and the nursing care management for each.

MNL LO:  4.5.2 Determine nursing care for the high-risk newborn as it relates to gestational age.