A neonate at 25 weeks gestation requires

A neonate at 25 weeks gestation requires oxygen via mechanical ventilation. Prolonged oxygen therapy in the pre-term neonate is associated with which of the following complications? Hyperbilirubinemia Neonatal asphyxia Neonatal tachycardia Retinopathy of prematurity Kangaroo care: gets infants ready for breastfeeding. helps infants to directly interact with their parents and enhances temperature regulation. helps infants with motor and central nervous system impairment. is adopted from classical British nursing traditions. A premature infant with respiratory distress syndrome receives artificial surfactant. How would the nurse explain surfactant therapy to the parents? “Surfactant improves the ability of your baby’s lungs to exchange oxygen and carbon dioxide.” “Surfactant is used to reduce episodes of periodic apnea.” “The drug keeps your baby from requiring too much sedation.” “Your baby needs this medication to fight a possible respiratory tract infection.” A 3-day-old neonate, born at 34 weeks’ gestation, is experiencing temperature instability, apnea, lethargy and bloody stools. These assessment findings are most likely related to: Bronchopulmonary Dysplasia (BPD) Necrotizing Enterocolitis (NEC) Periventricular Hemorrhage (PVH) Respiratory Distress Syndrome (RSD) The perinatal nurse is assisting the student nurse with completion of documentation. The laboring woman has just given birth to a 3200 gram infant at 36 weeks gestation. The most appropriate term for this is: Large for gestational age infant Late preterm birth Small for gestational age infant Term birth — not sure if this is correct?? A baby was born 24 hours ago to a mother who received no prenatal care. The infant is experiencing tremors, excessive and frantically suckling, and has a shrill, high-pitched cry. The baby’s serum glucose levels are normal. For which of the following should the nurse request an order from the pediatrician? Biophysical profile Chest and abdominal ultrasounds Oxygen saturation and blood gas Urine drug screen A pregnant woman at 35 weeks of gestation has had ruptured membranes for 26 hours. A cesarean section is performed for failure to progress. Maternal temp immediately prior to surgery was 101.7 and the fetal heart rate was 180 beats/min with minimal variability. At birth, the newborn had Apgar scores of 6 and 7 at 1 and 5 minutes respectively and is noted to be pale with respirations of 78 per minute. Classified as late preterm and appropriate-for-gestational age, which factor most increases the infant’s risk for respiratory distress syndrome? Maternal steroid therapy Prolonged rupture of membranes The neonate is a female. The neonate’s extremely preterm status. Based on the maternal history, the cause of this newborn’s distress is most likely to be: hypoglycemia. phrenic nerve injury. respiratory apneic syndrome. sepsis. For which of the following signs/symptoms should the nursery nurse closely observe this baby? Acrocyanosis Grunting, flaring, retractions Hydrocele Pseudostrabismus The laboratory reported that the L/S ratio (lecithin/sphingomyelin) results from an amniocentesis of a gravid Type 1 Diabetic patient with preeclampsia are 2:1. The nurse interprets the result as which of the following? The baby’s kidneys are functioning poorly. The baby’s lung fields are immature. The mother is high risk for eclampsia. The mother is high risk for hemorrhage. A neonate is born at 28 weeks’ gestation with a birth weight of 1450 grams. This neonate would be classified as: Exceedingly premature Extremely low birth weight Low birth weight Very low birth weight A Roman Catholic couple, 36 wks gestation, has just delivered an infant who was not expected to survive delivery due to intestinal anomalies incompatible with life. The baby was born with Apgars of 1/2/1 at 1 minute, 5 minutes and 10 minutes respectively. The parents have declined heroic interventions to prolong the infant’s life. Their parish priest is not available at this time, nor is the hospital chaplain. Which one of the following interventions is appropriate? Advise the parents that they should consider perinatal hospice care. Ask the parents whether they would like the nurse to baptize the baby. Inform the parents that a priest will baptize the baby if he arrives before the infant’s demise. Leave the parents alone to work through their thoughts and feelings. Which one of the following nursing actions is appropriate at this time? Ask the couple if they would like to bathe their baby. ? Obtain and order for a milk suppressant for the mother. Recommend that the woman be moved to a medical unit. Refrain from discussing the loss with the couple. The following four babies are in the newborn nursery. Which one of the babies should the nurse request that the neonatal nurse practitioner see as soon as possible? 1-day-old, HR 170 bpm, crying 2-day-old, T 98.9°F, Transcutaneous bilirubin (TCB) of 4.3 3-day-old, breastfeeding q 2 h, rooting 4-day-old, T 97.1, R 78 per minute Upon arrival to the birthing center 10 minutes ago, Carol was 7 cm dilated and experiencing contractions every 1 to 2 minutes which she describes as “strong.” Carol reports that labor started 1 hour ago immediately following spontaneous rupture of membranes. Carol is most likely experiencing Hypertonic contractions Hypotonic contractions Precipitous labor Uterine hyperstimulation A 42-week gestation neonate is admitted to the neonatal intensive care unit (NICU) after a prolonged labor. This neonate is at risk for which one of the following complications? Failure to thrive Intraventricular hemorrhage Meconium aspiration syndrome Necrotizing enterocolitis The postpartum nurse assesses that a full-term neonate’s temperature is 36.2°C. The first nursing action is to: Turn up the heat in the room. Place the neonate skin to skin on the mother’s chest with a warm blanket over the mother and baby. Take the neonate to the nursery and place in a radiant warmer. Notify the neonate’s primary provider. The patient, 42 wks, G1p0, has been in the second stage of labor for 4 hours (two hours of passive descent and two hours of active pushing) with very little progress in fetal descent. The nurse determines that the patient may be exhibiting signs of which one of the following? Breech presentation Cephalopelvic disproportion – baby too big, WCO – won’t come out Normal Spontaneous Vaginal Delivery Shoulder dystocia The patient refuses to undergo a c-section due to her strict religious and cultural beliefs related to the method of birth for a first born son. Assessment of the fetal heart rate indicates a stable baseline with moderate variability. The CNM and RN, in collaboration with the patient, develop a plan of care which includes A) a request that the CRNA bolus the epidural to ensure continued patient comfort, B) frequent repositioning from side to side and C) letting the patient rest for an additional two hours to allow for further passive descent of the fetus. Continue on next page The nursing interventions of rest combined with frequent patient repositioning has proven effective. The assessment now reveals an encouraging change in fetal station and the woman begins to push again. An hour later, the vertex is crowning and delivery is imminent. The nurse should nevertheless anticipate the possibility of Breech presentation Cephalopelvic disproportion Normal Spontaneous Vaginal Delivery Shoulder dystocia In which one of the following situations should the nurse question the following order? Date Medication / Dosage / Frequency / Route 5/2/13 Start Pitocin at 2 mu/min; Increase by 2 mu/min every 30 minutes Multigravida who is colonized with group B streptococci Multigravida with extrinsic asthma Primigravida who is 38 years old Primigravida with complete placenta previa A 34-week gestation multigravida, G3 P2 is admitted to the labor suite. She is contracting every 7 minutes for approximately 40 seconds each. Which one of the following comorbidities is most consistent with the clinical picture? Congestive heart failure Kyphosis Systemic Lupus Erythromatosis Urinary tract infection A patient, G4 P3, is admitted to the labor and delivery unit for cervical ripening the night prior to a scheduled induction of labor. The following assessments were made on admission: Bishop score of 4, fetal heart rate 140s with moderate variability and no decelerations, TPR 98.6ºF, 88, 20, BP 120/80, negative obstetrical history. A Cervidil (dinoprostone) vaginal suppository was inserted at 1830. Which of the following findings, 8 hours after insertion, would warrant the removal of the suppository? Bishop score of 5 Contraction frequency of every 2 minutes Fetal heart of 155 bpm with moderate variability and accelerations Respiratory rate of 20 rpm Per patient request, the nurse agrees to delay the administration of Pitocin until the originally scheduled time to give the patient an opportunity to progress naturally. At 0730, the physician, citing lack of progress, performs an amniotomy (Artificial rupture of membranes – AROM). Two hours later, it is evident that AROM has failed to elicit an adequate labor pattern. The patient then agrees to the augmentation of labor with Oxytocin. Augmentation of labor: Is an operative vaginal delivery that uses vacuum cups Is elective induction of labor Is part of the active management of labor instituted when the labor process is unsatisfactory and uterine contractions are inadequate Relies on more invasive methods when oxytocin and amniotomy have failed During labor augmentation with oxytocin, the fetal heart rate baseline is in the 140s with moderate variability and occasional accelerations. Contraction frequency is assessed to be every 3 minutes with duration of 60 seconds. Contraction strength is moderate to intense via palpation. Based on this assessment, the nurse should take which action? Decrease oxytocin infusion rate by 2 mU/min and report to physician. Increase oxytocin infusion rate per physician’s protocol. Maintain present oxytocin infusion rate and continue to assess. Stop oxytocin infusion immediately. A nurse is caring for a patient in the active phase of labor. The woman’s BOW spontaneously ruptures. The woman experiences a sudden onset of dyspnea. The fetal response to this sudden change in status is a prolonged deceleration into the 50’s. The nurse suspects Amniotic fluid embolism Uterine rupture Prolapsed umbilical cord Pulmonary Edema A patient, G3P2, 32 weeks twin gestation, presented to triage with signs and symptoms of preterm labor. Her cervical exam was 2/50/-3. She was given terbutaline (Brethine) as noted on the MAR. Which one of the following common medication effects would the nurse expect the patient to exhibit? Date Medication / Dosage / Frequency / Route 07:00 – 18:59 19:00 – 06:59 5/2/13 Terbutaline / Brethine 0.25mg subcutaneously Every 20 min x 3 doses Hold for HR >120 bpm P 88 0810 CC P106 0830 CC Diarrhea Increased serum glucose Nervousness Urticaria The nurse recognizes that preterm labor has been effectively suppressed when the: fetal heart rate shows a range of 120 to 160 beats per minute. patient no longer complains of pain. patient’s vital signs are stable. pattern of contractions changed from regular to less than six contractions in one hour. The physician admits the patient to the antepartum unit and orders betamethasone (Celestone) as follows: Date Medication / Dosage / Frequency / Route 2/17/22 Celestone (betamethasone) 12 mg IM now and repeat in 24 hours 2/17/22 Brethine (terbutaline) 5 mg po every 4 hours. Hold for HR greater than 120. The nurse would question the use of this drug in a pregnancy complicated by: Advanced cervical dilation. Hyperemesis gravidarum. Pregnancy induced hypertention. Uncontrolled diabetes. The physician has written an order for this patient to be discharged home on bed rest with home uterine activity monitoring twice daily until term. While discussing the plan of care with the patient, which one of the following concerns needs to be addressed by the nurse? Additional oral terbutaline will be necessary to prevent recurrence of preterm labor. Nursing assessments will be different than those done in the hospital setting. Prolonged bed rest may cause negative physiological side effects. Specialized home health care providers will be necessary. A 24 year old G1P1 delivered an infant weighing 4535 gms after a 4 minute episode of shoulder dystocia. The infant team at the bedside provided emergent resuscitative care, Apgars 1 / 4 / 6 / 8 at 1, 5, 10 and 15 minutes respectively, after which the infant was transferred to the NICU for further evaluation. Twenty-four hours post-delivery, the nurse documents the following: Nursing Notes 5/2/13 @ 1945 Infant resting quietly in open crib. VSS. Afebrile. Assessment completed. No distress noted at this time. Left and right arms remain flaccid and are rotated medially. Remainder of assessment WNL——————————- CCrider, RNC This assessment is consistent with which one of the following conditions? Anoxic brain injury indicative of cerebral palsy Bilateral clavicular fractures?? Brachial plexus injury Hypoxic ischemic encephalopathy The nurse is providing patient education to a patient with class II cardiac disease. According to Dobbenga-Rhodes & Prive (2006), the nurse should instruct the patient to notify the physician if she experiences which one of the following conditions? Emotional stress at work Increased dyspnea even while resting Mild pedal and ankle edema Weight gain of 1 pound in 1 week A patient’s admitting medical diagnosis is “third-trimester bleeding secondary to placenta previa further complicated by placenta percreta.” Each time the nurse enter the patient’s room, the patient asks, “Please tell me, do you think the baby will be alright?” Which one of the following is an appropriate nursing diagnosis for this patient? Anticipatory grieving r/t imminent fetal loss. Anxiety r/t uncertain pregnancy outcome. Altered parenting r/t complications of pregnancy. Situational low self-esteem r/t to blood loss. A multigravida, G3P2, had her previous children by cesarean sections. Which one of the following situations would mandate that this current delivery also be by cesarean section? The baby is in the occiput posterior position. The pregnancy is postdates. The previous uterine incisions were vertical. \?? The woman refuses to have regional anesthesia.

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