Chapter 09: The High-Risk Newborn and Family Test Bank for Wong's Nursing Care of Infants And Children 11th Edition by Hockenberry

TEST BANK FOR WONG'S NURSING CARE OF INFANTS AND CHILDREN 11TH EDITION BY HOCKENBERRY Chapter 09: The High-Risk Newborn and Family MULTIPLE CHOICE 1. Which refers to an infant whose rate of intrauterine growth has slowed and whose birth weight falls below the 10th percentile on intrauterine growth charts? a. Postterm b. Postmature c. Low birth weight d. Small for gestational age ANS: D A small-for-gestational-age, or small-for-date, infant is one whose rate of intrauterine growth has slowed and whose birth weight falls below the 10th percentile on intrauterine growth curves. A postterm, or postmature, infant is any child born after 42 weeks of gestation, regardless of birth weight. A low-birth-weight infant is a child whose birth weight is less than 2500 g, regardless of gestational age. DIF: Cognitive Level: Understanding TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance 2. A woman in premature labor delivers an extremely lowbirth-weight (ELBW) infant. Transport to a neonatal intensive care unit is indicated. The nurse explains that which level of service is needed? a. Level I b. Level IA c. Level II d. Level IIIB ANS: D A level IIIB neonatal unit has the capability of providing care for ELBW infants, including high-frequency ventilation and on-site access to medical subspecialties and pediatric surgery. A level I facility manages norma maternal and newborn care. Infants at less than 35 weeks of gestation are stabilized and transported to a facility that can provide appropriate care. A level IA facility does not exist. Level II facilities provide care for infants born at 32 weeks of gestation and weighing more than 1500 g. If the infant is ill, the health problems are expected to resolve rapidly and are not anticipated to require specialty care. DIF: Cognitive Level: Applying TOP: Integrated Process: Teaching/Learning MSC: Client Needs: Physiological Integrity 3. What is an essential component in caring for the very low or extremely lowbirth-weight infant? a. Holding the infant to help develop trust b. Using electronic monitoring devices exclusively c. Coordinating care to reduce environmental stress d. Incorporating infant stimulation elements during assessment ANS: C One of the principles of care for high-risk neonates is close observation and assessment with minimum handling. The nurse checks the apical rate against the monitor readings on a regular basis. The infants care is then clustered, and the infant is disturbed as little as possible. Holding an infant to help develop trust is not part of the assessment. In some areas, parents use skin-to-skin care with their infants. Although electronic monitoring devices are used, the nurse must validate the readings with the infants data. For an ill neonate, excessive stimulation creates stress. DIF: Cognitive Level: Understanding TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity 4. What explains why a neutral thermal environment is essential for a high-risk neonate? a. The neonate produces heat by increasing activity and shivering. b. Metabolism slows dramatically in the neonate experiencing cold stress. c. It permits the neonate to maintain a normal core temperature with minimum oxygen consumption. d. It permits the neonate to maintain a normal core temperature with increased caloric consumption. ANS: C A high-risk neonate is at greater risk for cold stress than a term infant because of the smaller muscle mass and fewer deposits of brown fat for producing heat, lack of insulating subcutaneous fat, and poor reflex control of skin capillaries. By definition, a neutral thermal environment is one that permits the infant to maintain a norma core temperature with minimum oxygen consumption and caloric expenditure. Smaller muscle mass and poor reflex control of skin capillaries decrease the ability of a high-risk neonate to compensate for an environment that is not thermoneutral. Metabolism increases in an infant experiencing cold stress, creating a compensatory increase in oxygen and caloric consumption. Increased caloric consumption is to be avoided. Neonates need available calories for growth. DIF: Cognitive Level: Analyzing MSC: Client Needs: Physiological Integrity 5. When caring for a neonate in a radiant warmer, what should the nurse be alert to? a. Exposure to prolonged cold stress b. Need for Plexiglas shields to protect the infant c. Transepidermal water loss leading to dehydration d. Increased risk of infection from the open environment ANS: C Radiant warmers result in greater evaporative fluid loss than normal, thus predisposing the infant to dehydration. Plastic wrap can help reduce this loss. Daily fluid requirements are increased to compensate. The radiant warmer protects the infant from cold stress. Plexiglas shields are not used in radiant warmers because they block the radiant heat waves. With clean and aseptic technique, there is not a greater risk of infection. DIF: Cognitive Level: Analyzing MSC: Client Needs: Physiological Integrity 6. The nurse is caring for a high-risk neonate who has an umbilical catheter and is in a radiant warmer. The nurse notes blanching of the feet. Which is the most appropriate nursing action? a. Place socks on the infants feet. b. Elevate the infants feet 15 degrees. c. Wrap the infants feet loosely in a prewarmed blanket. d. Report the findings immediately to the practitioner. ANS: D Blanching of the feet in a neonate with an umbilical catheter is an indication of vasospasm. Vasoconstriction of the peripheral vessels, triggered by the vasospasm, can seriously impair circulation. It is an emergency situation and must be reported immediately. DIF: Cognitive Level: Applying TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity 7. Which statement is true concerning the nutritional needs of preterm infants? a. The secretion of lactase is low. b. Carbohydrates and fats are better tolerated than protein. c. The demand for nutrients is less than in full-term infants. d. Breast milk lacks the proper concentration of nutrients. ANS: A The enzyme lactase is not readily available in an infants body until after 34 weeks of gestation. Formulas containing lactose are not well tolerated. Carbohydrates and fats are less well tolerated than protein. Preterm infants require significantly higher intake of calories and other nutrients than full-term infants. The American Academy of Pediatrics recommends 105 to 130 kcal/kg/day. Breast milk from the infants mother is considered the ideal enteral nutrition for the infant. Several commercial formulas are designed for preterm infants. DIF: Cognitive Level: Analyzing TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity 8. While a mother is feeding her high-risk neonate, the nurse observes the neonate having occasional apnea, pallor, and bradycardia. What is the most appropriate nursing action? a. Let the neonate rest before breastfeeding again. b. Resume gavage feedings until the neonate is asymptomatic. c. Recognize that this may indicate an underlying illness. d. Use a high-flow, pliable nipple because it requires less energy to use. ANS: C Apnea, pallor, and bradycardia may be signs of an underlying illness. The infant should be evaluated to ensure he or she is not developing problems. The infant can rest while waiting for the evaluation. If the child is becoming ill, the capacity to digest enteral feedings may be compromised. The type of nipple that is being used should not produce the signs being observed. DIF: Cognitive Level: Applying TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity 9. A preterm infant who is being fed commercial formula by gavage has had an increase in gastric residuals, abdominal distention, and apneic episodes. Which is the most appropriate nursing action? a. Notify the practitioner. b. Reduce the amount fed by gavage. c. Feed human milk by gavage. d. Feed only a glucose solution until the infant stabilizes. ANS: A These are signs that may indicate early necrotizing enterocolitis. The practitioner is notified for further evaluation. Enteral feedings are usually stopped until the cause of increased residuals is identified. DIF: Cognitive Level: Applying TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity 10. A mother planned to breastfeed her infant before giving birth at 33 weeks of gestation. The infant is stable and receiving oxygen. What is the most appropriate nursing action related to this?