D: Necrotizing enterocolitis (NEC) - answer✔C: Respiratory distress syndrome (RDS)
Which intervention is the most important to prevent necrotizing enterocolitis?
A: Exclusive human milk feeding
B: Surfactant
C: Oxygen
D: Ventilator support - answer✔A: Exclusive human milk feeding
Which type of IUGR has better developmental outcomes?
A macrosomic infant is born after a difficult forceps-assisted delivery. After stabilization the
infant is weighed, and the birth weight is 4550 g (9 pounds, 6 ounces). The nurse's most
appropriate action is to:
a. Leave the infant in the room with the mother.
b. Take the infant immediately to the nursery.
c. Perform a gestational age assessment to determine whether the infant is large for gestational
age.
d. Monitor blood glucose levels frequently and observe closely for signs of hypoglycemia. -
answer✔d. Monitor blood glucose levels frequently and observe closely for signs of
hypoglycemia.
(This infant is macrosomic (more than 4000 g) and is at high risk for hypoglycemia. Blood
glucose levels should be monitored frequently, and the infant should be observed closely for
signs of hypoglycemia. Observation may occur in the nursery or in the mother's room, depending
on the condition of the fetus. Regardless of gestational age, this infant is macrosomic.)
Infants of mothers with diabetes (IDMs) are at higher risk for developing:
a. Anemia.
b. Hyponatremia.
c. Respiratory distress syndrome.
d. Sepsis. - answer✔c. Respiratory distress syndrome.
(IDMs are at risk for macrosomia, birth injury, perinatal asphyxia, respiratory distress syndrome,
hypoglycemia, hypocalcemia, hypomagnesemia, cardiomyopathy, hyperbilirubinemia, and
polycythemia. They are not at risk for anemia, hyponatremia, or sepsis.)
An infant was born 2 hours ago at 37 weeks of gestation and weighing 4.1 kg. The infant appears
chubby with a flushed complexion and is very tremulous. The tremors are most likely the result
of:
(Hypoglycemia is common in the macrosomic infant. Signs of hypoglycemia include jitteriness,
apnea, tachypnea, and cyanosis.)
When assessing the preterm infant the nurse understands that compared with the term infant, the
preterm infant has:
a. Few blood vessels visible through the skin.
b. More subcutaneous fat.
c. Well-developed flexor muscles.
d. Greater surface area in proportion to weight. - answer✔d. Greater surface area in proportion to
weight.
(Preterm infants have greater surface area in proportion to their weight. More subcutaneous fat
and well-developed muscles are indications of a more mature infant.)
On day 3 of life, a newborn continues to require 100% oxygen by nasal cannula. The parents ask
whether they can hold their infant during his next gavage feeding. Given that this newborn is
physiologically stable, what response would the nurse give?
a. "Parents are not allowed to hold infants who depend on oxygen."
b. "You may hold only your baby's hand during the feeding."
c. "Feedings cause more physiologic stress, so the baby must be closely monitored. Therefore, I
don't think you should hold the baby."
d. "You may hold your baby during the feeding." - answer✔d. "You may hold your baby during
the feeding."
("You may hold your baby during the feeding" is an accurate statement. Parental interaction via
holding is encouraged during gavage feedings so that the infant will associate the feeding with
positive interactions. Nasal cannula oxygen therapy allows for easier feedings and psychosocial
interactions. The parent can swaddle the infant during gavage feedings to help the infant
associate the feeding with positive interactions. Some parents like to do kangaroo care while
gavage feeding their infant. Swaddling or kangaroo care during feedings provides positive
interactions for the infant.)
A premature infant with respiratory distress syndrome receives artificial surfactant. How would
the nurse explain surfactant therapy to the parents?
a. "Surfactant improves the ability of your baby's lungs to exchange oxygen and carbon dioxide."
b. "The drug keeps your baby from requiring too much sedation."
c. "Surfactant is used to reduce episodes of periodic apnea."
d. "Your baby needs this medication to fight a possible respiratory tract infection." - answer✔a.
"Surfactant improves the ability of your baby's lungs to exchange oxygen and carbon dioxide."
(Surfactant can be administered as an adjunct to oxygen and ventilation therapy. With
administration of artificial surfactant, respiratory compliance is improved until the infant can
generate enough surfactant on his or her own. Surfactant has no bearing on the sedation needs of
the infant. Surfactant is used to improve respiratory compliance, including the exchange of
oxygen and carbon dioxide. The goal of surfactant therapy in an infant with respiratory distress
syndrome (RDS) is to stimulate production of surfactant in the type 2 cells of the alveoli. The
clinical presentation of RDS and neonatal pneumonia may be similar. The infant may be started
on broad-spectrum antibiotics to treat infection.)
When providing an infant with a gavage feeding, which of the following should be documented
each time?
a. The infant's abdominal circumference after the feeding
b. The infant's heart rate and respirations
c. The infant's suck and swallow coordination
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