Chapter 30 The Newborn at Risk: Conditions Present at Birth
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.
1
Copyright 2016 Pearson Education, Inc.
3) The nurse is caring for a prenatal client. Reviewing the clients 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 mothers low socioeconomic status
2. Maternal age of 26
3. Mothers 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.
2
Copyright 2016 Pearson Education, Inc.
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 newborns environment must remain warm, to
decrease heat loss.
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.
1
Copyright 2016 Pearson Education, Inc.
3) The nurse is caring for a prenatal client. Reviewing the clients 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 mothers low socioeconomic status
2. Maternal age of 26
3. Mothers 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.
2
Copyright 2016 Pearson Education, Inc.
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 newborns environment must remain warm, to
decrease heat loss.
