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NUR 221 Final Exam Questions and
Answers 100% Pass
What are some non-pulmonary causes of respiratory distress in neonates?
Sepsis, cardiac defects (structural or functional), hemolytic disease, CNS defects, exposure to cold, airway obstruction (atresia), intraventricular hemorrhage, hypoglycemia, metabolic acidosis, acute blood loss and drugs.
What appears to be the principle factor in the development of Respiratory Distress Syndrome?
Surfactant deficiency.
What are the clinical manifestations of Respiratory Distress Syndrome?
1.) Tachypnea (greater than or equal to 60 breaths/min) initially 2.) Dyspnea 3.) Pronounced intercostal or substernal retractions 4.) Fine respiratory crackles 5.) Audible expiratory grunt 6.) Flaring of the external nares 7.) Cyanosis or pallor 8.) Apnea 9.) With progression of condition, deteriorating vital signs including blood pressure, apnea, body temperature instability
In addition to Respiratory Distress Syndrome, what is surfactant therapy also being used in?
Infants with meconium aspiration, infectious pneumonia, sepsis, persistent pulmonary hypertension, and pulmonary hemorrhage.
How is surfactant administered?
Via an endotracheal (ET) tube directly into the infant's trachea.
What is Acrocyanosis?
The bluish discoloration of the hands and feet that is a normal finding within the first 24 hours after birth.
What are the clinical manifestations of Infants of Diabetic Mothers (IDMs)?
1.) Large for gestational age (>4g) 2.) Very plump and full faced 3.) Abundant vernix caseosa 4.) Plethora 5.) Listless and lethargic 6.) Possibly meconium stained at birth 7.) Hypotonia
What are the risk factors for hypoglycemia in the infant?
Hypoglycemia in IDMs is related to hypertrophy and hyperplasia of the pancreatic islet cells and the transient state of hyperinsulinism. High maternal blood glucose levels during fetal life provide a continual stimulus to the fetal islet cells for insulin production (glucose easily passes the placental barrier from maternal to fetal side, however, insulin does not cross the placental barrier).
SAFETY ALERT (pg. 454):
Every birth should be attended by at least one person whose only responsibility is the baby and who is capable of initiating resuscitation. Either that person or someone else who is immediately available should have the skills required to perform a complete resuscitation, including endotracheal suctioning to remove meconium, if necessary.
What is the immediate management of the newborn with meconium stained amniotic fluid before birth?
1.) Assess the amniotic fluid for the presence of meconium after rupture of membranes. 2.) If the amniotic fluid is meconium stained, gather equipment and supplies that might be necessary for neonatal resuscitation. 3.) Have at least one person capable of performing endotracheal intubation on the baby present at the birth.
What is the immediate management of the newborn with meconium stained amniotic fluid after birth?
1.) Assess the baby's respiratory efforts, heart rate, and muscle tone 2.) Suction only the baby's mouth and nose, using either a bulb syringe or a large bore suction catheter if the baby has: strong respiratory efforts, good muscle tone, heart rate > beats/minute 3.) Suction the trachea using an endotracheal tube connected to a meconium aspiration device and suction source to remove any meconium present before many spontaneous respirations have occurred or assisted ventilation has been initiated if the baby has: depressed respirations, decreased muscle tone, heart rate <100 beats/minute
What are the guidelines for treating Hypercyanotic spells?
1.) Place infant in knee/chest position. 2.) Use a calm, comforting approach. 3.) Administer 100% "blow by" oxygen. 4.) Give morphine subcutaneously or through an existing IV line. 5.) Begin full IV replacement and volume expansion if needed. 6.) Repeat morphine administration.
What does the acronym TORCH stand for?
T - Toxoplasmosis O - Other (e.g., HBV, parvovirus, HIV, West Nile virus) R - Rubella C - CMV Infection H - Herpes Simplex
To be effective, when must Rhlg (e.g., RhoGAM) be administered to unsensitized mothers?
During first pregnancies and within 72 hours after the birth or spontaneous or therapeutic abortion. It is also administered during subsequent pregnancies at 26 to 28 weeks of gestation and after pregnancy losses. Rhlg is also given after any other event in which there is risk that RBCs can enter the maternal circulation such as amniocentesis or external version.
malocculsions 3.) Enhanced neurodevelopmental outcomes, including higher intelligence
What kind of immunity does breastfeeding give infants?
Passive
What are the benefits of breastfeeding for the mother?
1.) Decreased postpartum bleeding and more rapid uterine involution 2.) Reduced risk for ovarian cancer, breast cancer, type 2 diabetes, hypertension, hypercholesterolemia, cardiovascular disease, rheumatoid arthritis 3.) More rapid postpartum weight loss 4.) Delayed return of menses 5.) Unique bonding experience 6.) Increased maternal role attainment
What is the cause of breast milk jaundice?
The infant not feeding effectively, so there is less caloric and fluid intake and possible dehydration. Hepatic clearance of bilirubin is reduced. With less intake, there are fewer stools. As a result, bilirubin is reabsorbed from the intestine back into the bloodstream and must be conjugated again so it can be excreted.
What is essential in preventing hyperbilirubinemia?
Adequate feeding. Newborns should breastfeed early (within 1 to 2 hours after birth) and often (at least 8 to 12 times/24 hours). Colostrum acts as a laxative to promote stooling, which helps
rid the body of bilirubin. Formula fed infants should be fed after birth when their physiologic status has stabilized and therefore every 3 to 4 hours.
How is Universal Newborn Screening performed?
Capillary blood samples are obtained using a heel stick and blood is collected on a special filter paper and sent to a designated state laboratory for analysis.
What is the purpose of Universal Newborn Screening?
To screen for 34 core disorders and 26 secondary disorders. The core disorders include hemoglobinopathies (e.g., sickle cell disease), inborn errors of metabolism (e.g., phenylketonuria [PKU], galactosemia), severe combined immunodeficiency, hearing loss, and critical congenital heart disease.
What are the first line interventions for Shoulder Dystocia?
The McRoberts maneuver and suprapubic pressure.
What are the common indicators for cesarean birth?
1.) Maternal: Specific cardiac disease (e.g., Marfan syndrome with dilated aortic root)
2.) Fetal: Nonreassuring fetal status, malpresentation (breach or transverse lie), active maternal herpes infection
A test done at 1 and 5 minutes after birth which permits a rapid assessment of the newborns transition to extrauterine life based on five signs that indicate the physiologic state of the neonate: heart rate, respiratory effort, muscle tone, reflex irritability and generalized skin color.
APGAR Score - Heart rate
0 - Absent 1 - Slow (<100/min) 2 - >100/min
APGAR Score - Respiratory effort
0 - Absent 1 - Slow, weak cry 2 - Good cry
APGAR Score - Muscle tone
0 - Flaccid 1 - Some flexion of extremities 2 - Well flexed
APGAR Score - Reflex irritability
0 - No response 1 - Grimace 2 - Cry
APGAR Score - Color
0 - Blue, pale 1 - Body pink, extremities blue 2 - Completely pink
What should you teach parents regarding infant safe sleep?
1.) Always lay the baby flat in bed (in the bassinet or crib) on his or her back for sleep, for naps, and at night. Do not place your infant on the abdomen for sleep. 2.) Room sharing, but not bed sharing, is recommended during the early weeks. 3.) There should be no bumper pads, blankets, stuffed toys, or other soft objects in the baby's crib because of the risk for suffocation. 4.) Do not cover the baby with blankets or quilts; dress the baby in light sleep clothing such as a sleep sack or one piece sleeper.
SAFETY ALERT (pg. 597):
Infants and toddlers should use a rear facing car seat at least until the age of 2 years. The safest area is in the back seat. A car safety seat that faces the rear gives the best protection for an infant's disproportionately weak neck and heavy head. In this position, the force of a frontal crash is spread over the head, neck, and back; the back of the car safety seat supports the spine.
SAFETY ALERT (pg. 598):
If an infant develops Transient Tachypnea of the Newborn, what symptoms would you expect to see?
Tachypnea with rates up to 100 breaths/minute can be present along with intermittent grunting, nasal flaring, and mild retractions.
When does Transient Tachypnea of the Newborn usually resolve?
In 24 to 48 hours.
What is a Myelomeningocele?
Hernial protrusion of a saclike cyst containing meninges, spinal fluid, and a portion of the spinal cord with its nerves.
How is an infant with a Myelomeningocele positioned?
Before surgery, the infant is kept in the prone position to minimize tension on the sac and the risk for trauma. The prone position allows for optimal positioning of the legs especially in cases of associated hip dysplasia. The infant is placed prone with the hips slightly flexed and supported to reduce tension on the defect. The legs are maintained in abduction with a pad between the
knees to counteract hip subluxation, and a small roll is placed under the ankles to maintain a neutral foot position. A variety of aids, including diaper rolls, foam pads, or specially designed frames and appliances can be used to maintain the desired position.
What are the laboratory tests during the prenatal period?
1.) Hemoglobin, hematocrit, WBC, differential 2.) Hemoglobin electrophoresis 3.) Blood type, Rh, and irregular antibody 4.) Rubella titer 5.) Tuberculin skin test; chest X-ray after 20 weeks of gestation in women with reactive tuberculin tests 6.) Urinalysis, including microscopic examination of urinary sediment, pH, specific gravity, color, glucose, albumin, protein, RBCs, WBCs, casts, acetone, hCG 7.) Urine culture 8.) Renal function tests: BUN, creatinine, electrolytes, creatinine clearance, total protein excretion 9.) Pap test 10.) Cervical cultures for Neisseria gonorrhoeae, Chlamydia Vaginal/anal culture 11.) RPR, VDRL, or FTA-ABS 12.) HIV antibody, hepatitis B surface antigen, toxoplasmosis 13.) 1-hour glucose tolerance 14.) 3 hour glucose tolerance 15.) Cardiac evaluation, ECG, chest X-ray, and echocardiogram
What is the greatest predictor of violence during pregnancy?
Gravida: Number of pregnancies the woman has had, regardless of the duration. The current pregnancy is also included.
What does the T in GTPAL stand for?
Term: The number of pregnancies that ended in term birth.
What does the P in GTPAL stand for?
Preterm: A pregnancy that has reached 20 weeks of gestation but ends BEFORE 37 weeks 0 days of gestation.
What does the A in GTPAL stand for?
Abortions: The number of pregnancies that ended in miscarriage (elective or spontaneous abortion) BEFORE the end of 20 weeks gestation.
What does the L in GTPAL stand for?
Living: Number of children currently living.
How can Variability of the FHR be described?
As irregular waves or fluctuations in the baseline FHR of two cycles per minute or greater. It is a characteristic of the baseline FHR and does not include accelerations or decelerations of the FHR. Variability is quantified in beats per minute and is measured from the peak to the trough of a single cycle.
How are Accelerations of the FHR defined?
As a visually apparent abrupt onset to peak increase in FHR above the baseline rate. The peak is at least 15 beats/min above the baseline, and the acceleration lasts 15 seconds or more, with the return to baseline less than 2 minutes from the beginning of the acceleration.
What are Early Decelerations of the FHR?
A visually apparent, gradual decrease in and return to baseline FHR associated with uterine contractions.
What are the causes of Early Decelerations?
Head compression resulting from the following: 1.) Uterine contractions 2.) Vaginal examination 3.) Fundal pressure 4.) Placement of internal mode of monitoring
What are Late Decelerations of the FHR?
A visually apparent, decrease in and return to baseline FHR associated with uterine contractions.
What are the causes of Late Decelerations?
Disruption of oxygen transfer from environment to fetus, resulting in transient fetal hypoxemia. Late decelerations are caused by the following: 1.) Uterine tachysystole 2.) Maternal supine hypotension 3.) Epidural or spinal anesthesia 4.) Placenta previa
Umbilical cord compression caused by the following: 1.) Maternal position with cord between fetus and pelvis 2.) Cord around fetal neck, arm, leg, or other body part 3.) Short cord 4.) Knot in cord 5.) Prolapsed cord
What are the nursing interventions for Variable Decelerations?
1.) Discontinue oxytocin if infusing 2.) Change maternal position (side to side, knee chest) 3.) Administer oxygen at 10 L/min by nonrebreather face mask 4.) Notify physician or nurse-midwife 5.) Assist with vaginal or speculum examination to assess for cord prolapse 6.) Assist with amnioinfusion if ordered 7.) Assist with birth (vaginal or cesarean) if pattern cannot be corrected
What are Prolonged Decelerations of the FHR?
A visually apparent decrease in FHR of at least 15 beats/min below the baseline and lasting more than 2 minutes but less than 10 minutes.
What is the criteria for a reactive non-stress test (NST)?
Two accelerations in a 20 minute period, each lasting at least 15 seconds and peaking at least 15 beats/min above the baseline. (Before 32 weeks of gestation, an acceleration is defined as a rise of at least 10 beats/min lasting at least 10 seconds from onset to offset.)
How is Magnesium Sulfate administered?
Intravenously (piggyback) with an initial loading dose of 4 to 6 g infused over 15 to 30 minutes. This dose is followed by a maintenance dose that is diluted in an IV solution (e.g., 40 g in 1000 mL of Lactated Ringer's solution) and administered by an infusion pump at 2 to 3 g/hr. This dose should maintain a therapeutic serum magnesium level of 4 to 7 mEq/L.
What are the symptoms of Magnesium toxicity?
1.) Absent deep tendon reflexes 2.) Respiratory depression 3.) Blurred vision 4.) Slurred speech 5.) Severe muscle weakness 6.) Cardiac arrest
MEDICATION ALERT (pg. 291):
