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High risk of Newborn
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High risk of Newborn
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Chapter 9.The High-Risk Newborn and FamilyMULTIPLE 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
h a
ANS: D
Ta
A small-for-gestational-age, or small-for-date, infant is one whose rate of intrauterine growth has
b
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
e
weight. A low-birth-weight infant is a child whose birth weight is less than 2500 g, regardless of
gestational age.
b e
DIF: Cognitive Level: Understanding REF: MCS: 338
a
TOP: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance
H
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 normal 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 REF: MCS:
339 TOP: Integrated Process: Teaching/
h a
Learning MSC: Client Needs: Physiological
T a
3. What is an essential component in caring for the very low or extremely lowbirth-weight
Integrity
infant?
a. Holding the infant to help develop trust
e
b. Using electronic monitoring devices exclusivelyb
b e
c. Coordinating care to reduce environmental stress
d. Incorporating infant stimulation elements during assessment
ANS: C
H a
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 REF: MCS: 339
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
h a
a
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
T
fat, and poor reflex control of skin capillaries. By definition, a neutral thermal environment is
one that permits the infant to maintain a normal core temperature with minimum oxygen
consumption and caloric expenditure. Smaller muscle mass and poor reflex control of skin
e b
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
b e
be avoided. Neonates need available calories for growth.
DIF: Cognitive Level: Analyzing REF: MCS: 342 TOP: Nursing Process: Planning
H a
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 REF: MCS: 343 TOP: Nursing Process: Planning
MSC: Client Needs: Physiological Integrity
h a
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. Ta
ANS: D
e b
d. Report the findings immediately to the practitioner.
b e
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
H a
circulation. It is an emergency situation and must be reported immediately.
DIF: Cognitive Level: Applying REF: MCS: 344
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.
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