The Newborn at Risk- Congenital Disorders

Chapter 21: The Newborn at Risk: Congenital Disorders A student nurse is learning about congenital heart defects in newborns and correctly identifies which of the following to be the most common intracardiac defect? Correct response: • ventricular septal defect The nurse is caring for an infant diagnosed with a ventricular septal defect. Which assessment findings does the nurse anticipate? Correct response: • a harsh murmur Which clinical manifestation is seen in the child with hydrocephalus? Correct response: • An extremely large and rapidly growing head During cardiac surgery, the surgeon reduces the child's body temperature to decrease the effects of the surgery on the brain and other body organs. This process is referred to as inducing which of the following? Correct response: • hypothermia The nurse is reviewing the medical record of the antepartum client with an abnormal maternal serum alpha-fetoprotein test. The mother is distraught and states, “How bad can it be?” The nurse is correct to describe which? Correct response: • a type of spina bifida It would be best to place an infant with a meningomyelocele in which position prior to surgery? Correct response: • on the stomach (prone) Which assessment findings are most prominent in the infant with tetralogy of Fallot and significant pulmonary stenosis? Correct response: • dyspnea on limited exertion, fatigue, cyanosis 1 The nurse is working in the emergency department when a 2-week-old is brought in for restlessness, a cry that has become high-pitched and projectile vomiting. The infant's head circumference has grown by 4 cm from birth measurements. What nursing action is most appropriate? Correct response: • witnessing a consent for surgery A nursing student is learning about newborn congenital defects. The defect with symptoms that include a shiny scalp, dilated scalp veins, a bulging anterior fontanel (fontanelle), and eyes pushed downward with the sclera visible above the irises is which defect? Correct response: • hydrocephalus The parent of a newborn diagnosed with Turner syndrome asks the nurse about the treatment that will be required for their newborn. Complete the following sentence(s) by choosing from the lists of options. The nurse should educate the parents on the primary treatments used in the treatment of Turner syndrome, which includes Growth hormone antibiotics and estrogen therapy A nursing student is learning about newborn congenital defects. The defect with symptoms that include a shiny scalp, dilated scalp veins, a bulging anterior fontanel (fontanelle), and eyes pushed downward with the sclera visible above the irises is which defect? Correct response: • hydrocephalus A nurse is providing preoperative care to a female newborn client with the congenital abnormality myelomeningocele. Which intervention is the priority? Correct response: • preventing infection A baby is born with spina bifida with meningocele. The parents are visibly upset. The father states, "What did we do wrong? How will I ever love this child?" What is the priority action by the nurse? 2 Correct response: • Encourage the parents to express their feelings and emotions openly. A new mother is concerned because she fears that her infant's head is larger than normal. What would be the nurse's best response? Correct response: • A large head at birth in itself is not indicative of hydrocephalus, but we will keep a check on it. During cardiac surgery, the surgeon reduces the child's body temperature to decrease the effects of the surgery on the brain and other body organs. This process is referred to as inducing which of the following? Correct response: • hypothermia A nurse in the newborn nursery has noticed that an infant is frothing and appears to have excessive drooling. Further assessment reveals that the baby has episodes of respiratory distress with choking and cyanosis. What disorder should the nurse suspect based on these findings? Correct response: • esophageal atresia It would be best to place an infant with a meningomyelocele in which position prior to surgery? Correct response: • on the stomach (prone) Which feeding method is best for the infant with a cleft lip and palate? Correct response: • Breastfeeding Which health care provider assessment technique does the nurse anticipate being used to determine developmental dysplasia of the hip (DDH) on a newborn? Correct response: • Barlow sign and Ortolani click Which assessment findings are most prominent in the infant with tetralogy of Fallot and significant pulmonary stenosis? 3 Correct response: • dyspnea on limited exertion, fatigue, cyanosis A nursing student is learning about newborn congenital defects. The defect with symptoms that include a shiny scalp, dilated scalp veins, a bulging anterior fontanel (fontanelle), and eyes pushed downward with the sclera visible above the irises is which defect? Correct response: • hydrocephalus A nurse is providing preoperative care to a female newborn client with the congenital abnormality myelomeningocele. Which intervention is the priority? Correct response: • preventing infection A baby is born with spina bifida with meningocele. The parents are visibly upset. The father states, "What did we do wrong? How will I ever love this child?" What is the priority action by the nurse? Correct response: • Encourage the parents to express their feelings and emotions openly. A new mother is concerned because she fears that her infant's head is larger than normal. What would be the nurse's best response? Correct response: • A large head at birth in itself is not indicative of hydrocephalus, but we will keep a check on it. During cardiac surgery, the surgeon reduces the child's body temperature to decrease the effects of the surgery on the brain and other body organs. This process is referred to as inducing which of the following? Correct response: • hypothermia A nurse in the newborn nursery has noticed that an infant is frothing and appears to have excessive drooling. Further assessment reveals that the baby has episodes of respiratory distress with choking and cyanosis. What disorder should the nurse suspect based on these findings? 4 Correct response: • esophageal atresia It would be best to place an infant with a meningomyelocele in which position prior to surgery? Correct response: • on the stomach (prone) Which feeding method is best for the infant with a cleft lip and palate? Correct response: • Breastfeeding Which health care provider assessment technique does the nurse anticipate being used to determine developmental dysplasia of the hip (DDH) on a newborn? Correct response: • Barlow sign and Ortolani click Which assessment findings are most prominent in the infant with tetralogy of Fallot and significant pulmonary stenosis? Correct response: • dyspnea on limited exertion, fatigue, cyanosis Immediately after birth, the nurse is caring for a newborn with a myelomeningocele. What intervention should the nurse provide to prevent drying out of the sac to avoid damage? Correct response: • Apply a sterile dressing moistened in a warm, sterile saline solution. A nurse is caring for a child with complex esophageal atresia who will be undergoing surgery for repair. What comment by the parents indicates further teaching is required? Correct response: • "After this surgery is done tomorrow, my baby will be able to eat and drink." It would be best to place an infant with a meningomyelocele in which position prior to surgery? Correct response: 5 • on the stomach (prone) Which health care provider assessment technique does the nurse anticipate being used to determine developmental dysplasia of the hip (DDH) on a newborn? Correct response: • Barlow sign and Ortolani click A nurse is providing preoperative care to a female newborn client with the congenital abnormality myelomeningocele. Which intervention is the priority? Correct response: • preventing infection A nurse in the newborn nursery has noticed that an infant is frothing and appears to have excessive drooling. Further assessment reveals that the baby has episodes of respiratory distress with choking and cyanosis. What disorder should the nurse suspect based on these findings? Correct response: • esophageal atresia The parent of a newborn diagnosed with Turner syndrome asks the nurse about the treatment that will be required for their newborn. Complete the following sentence(s) by choosing from the lists of options. The nurse should educate the parents on the primary treatments used in the treatment of Turner syndrome, which includes growth hormone and estrogen therapy A newborn was diagnosed as having hypothyroidism at birth. The parent asks the nurse how the disease could be discovered this early. Which is the nurse's best answer? Correct response: • A simple blood test to diagnose hypothyroidism is required in most states. The nurse is reviewing the medical record of the antepartum client with an abnormal maternal serum alpha-fetoprotein test. The mother is distraught and states, “How bad can it be?” The nurse is correct to describe which? Correct response: 6 • a type of spina bifida What assessment should the nurse perform daily on an infant suspected of having hydrocephalus? Correct response: • daily head circumference The nurse is caring for a neonate with an exstrophy of the bladder. When the nurse is planning care, which client goal is the priority? Correct response: • The neonate will be free from infection. A nurse is caring for a newborn client who is diagnosed with myelomeningocele. Which nursing intervention would protect the newborn from injury? Correct response: • Place the newborn in a prone or lateral position. When planning preoperative care for a newborn with a cleft lip and palate, the nurse would plan interventions for which major need? Correct response: • nutrition The nurse is reviewing the medical record of the antepartum client with an abnormal maternal serum alpha-fetoprotein test. The mother is distraught and states, “How bad can it be?” The nurse is correct to describe which? Correct response: • a type of spina bifida The nurse is providing education to the parents of an infant who was just diagnosed with transposition of the great arteries. The parents ask, “Which vessels were involved?” The nurse is correct to educate about: Correct response: • the aorta and pulmonary artery. A nurse is performing a newborn assessment and notes the blood pressures in the upper extremities are higher than the lower extremities. The nurse should suspect which congenital newborn abnormality? 7 Correct response: • coarctation of the aorta When examining a newborn for developmental dysplasia of the hip (DDH), which motion would the newborn's hip be unable to accomplish? Correct response: • abduction The parent of a newborn diagnosed with Turner syndrome asks the nurse about the treatment that will be required for their newborn. Complete the following sentence(s) by choosing from the lists of options. The nurse should educate the parents on the primary treatments used in the treatment of Turner syndrome, which includes growth hormone and estrogen therapy A newborn boy is diagnosed with esophageal atresia and tracheoesophageal fistula. After the nurse provides preoperative teaching, which statement indicates that the parents need additional teaching? Correct response: • "We can probably start feeding him with the bottle about a day after the surgery." From which pair of metabolic disorders must the nurse instruct the parents to eliminate breast and cow’s milk from the diet? Correct response: • Galactosemia and phenylketonuria The nurse is working in the emergency department when a 2-week-old is brought in for restlessness, a cry that has become high-pitched and projectile vomiting. The infant's head circumference has grown by 4 cm from birth measurements. What nursing action is most appropriate? Correct response: • witnessing a consent for surgery 8 A nurse is caring for a newborn with a repaired cleft lip. What intervention can the nurse provide to facilitate drainage of mucus and secretions to prevent aspiration? Correct response: • Position the child on the side. A student nurse is learning about congenital heart defects in newborns and correctly identifies which of the following to be the most common intracardiac defect? Correct response: • ventricular septal defect Which assessment findings are most prominent in the infant with tetralogy of Fallot and significant pulmonary stenosis? Correct response: • dyspnea on limited exertion, fatigue, cyanosis The parent reports that the health care provider said that the infant had a hernia but cannot remember which type. When recalling what the health care provider said, the parent said that a surgeon will repair it soon and there is no problem with the testes. Which hernia type is anticipated? Correct response: • inguinal hernia When planning preoperative care for a newborn with a cleft lip and palate, the nurse would plan interventions for which major need? Correct response: • nutrition The parent of a newborn diagnosed with Turner syndrome asks the nurse about the treatment that will be required for their newborn. Complete the following sentence(s) by choosing from the lists of options. The nurse should educate the parents on the primary treatments used in the treatment of Turner syndrome, which includes growth hormone and estrogen therapy 9 A newborn is diagnosed with congenital hypothyroidism prior to discharge from the hospital. What medication does the nurse anticipate administering to the newborn? Correct response: • levothyroxine Which congenital condition is an immediate emergency requiring notification of the health care provider? Correct response: • Tracheoesophageal fistula The parent has brought a 2-year-old to the public clinic for immunizations. The nurse documents the following characteristics: A duck waddle gait Shortened extremity Asymmetry of the gluteal folds Protruding abdomen The nurse then refers the toddler to the health care provider for potential diagnosis of which? Correct response: • Developmental dysplasia of the hip (DDH) 10