ATI RN
Caring for a Newborn who is Experiencing Complications ATI Questions
Question 1 of 5
The premature neonate is more susceptible to skin breakdown than a term neonate. Which skin care interventions will the nurse implement for the premature neonate? Select all that apply.
Correct Answer: C
Rationale: The correct answer is C: Perform daily skin assessment to identify problems early. Premature neonates have fragile skin due to their immature epidermal barrier, making them more susceptible to skin breakdown. Daily skin assessments help in early detection of any skin issues, allowing prompt intervention to prevent complications. A: Using a neutral pH cleanser and sterile water for bathing is important, but it is not specific to premature neonates. B: Gently applying emollients is beneficial, but it does not address the need for regular skin assessments. D: Using water, air, or gel mattresses is more related to pressure ulcer prevention rather than general skin care for premature neonates.
Question 2 of 5
The nurse is providing care for a neonate born to a mother with preexisting diabetes mellitus. Which neonatal assessment findings do the nurse expect? Select all that apply.
Correct Answer: A
Rationale: The correct answer is A: Macrosomia. This is expected in neonates born to mothers with preexisting diabetes mellitus due to excessive glucose crossing the placenta, leading to increased fetal growth. Hyperglycemia (choice B) is not a neonatal assessment finding but rather a maternal condition. Hypocalcemia (choice C) and jaundice (choice D) are not directly associated with maternal diabetes mellitus in neonates.
Question 3 of 5
A newborn’s blood glucose level is recorded at 42 mg/dL. What is the next step the nurse should take?
Correct Answer: C
Rationale: The correct answer is C: Report the blood glucose level to the practitioner. A blood glucose level of 42 mg/dL in a newborn is considered low and may indicate hypoglycemia. It is important to involve the practitioner immediately for further evaluation and management. Reporting to the practitioner ensures timely intervention and appropriate treatment. Summary: A: Recording the number in the chart without taking any action may lead to delayed intervention. B: Immediately asking the mother to feed the newborn may not address the underlying cause of the low blood glucose level. D: Observing for hypoglycemia is important but reporting to the practitioner should be prioritized for proper management.
Question 4 of 5
A newborn born 72 hours ago was diagnosed with jaundice, requiring phototherapy. Which is most important to educate the family on at this time?
Correct Answer: B
Rationale: The correct answer is B: Covering the newborn’s eyes during phototherapy. This is important because exposure to the bright lights used in phototherapy can harm the newborn’s eyes. Covering the eyes with a protective mask or eye patches helps prevent damage. Incorrect choices: A: Anticipatory guidance regarding immunization schedules is important but not the most immediate concern in this scenario. C: Proper clothing for the newborn during seasonal changes is important for general care but not as critical as protecting the eyes during phototherapy. D: How to accurately measure the newborn’s temperature is essential but not as urgent as ensuring eye protection during phototherapy. In summary, educating the family on covering the newborn’s eyes during phototherapy is crucial to prevent eye damage, making it the most important consideration in this situation.
Question 5 of 5
As the newborn nursery nurse, you are assessing your patients. Which assessment warrants further investigation?
Correct Answer: B
Rationale: The correct answer is B: Periodic episodes of grunting during expiration. This warrants further investigation as grunting during expiration is a sign of respiratory distress in newborns, indicating potential respiratory compromise. It can be a sign of underlying lung pathology or inadequate oxygenation. It is important to assess and address this promptly to prevent further deterioration. Incorrect choices: A: Irregular patterns of breathing with periods of apnea lasting 5 seconds - While apnea can be concerning, it is common in newborns. This alone may not warrant immediate further investigation. C: Breathing at a rate of 45 breaths per minute - A respiratory rate of 45 breaths per minute can be within normal range for a newborn. It may not be abnormal unless accompanied by other signs of distress. D: Mild sternal retractions - Sternal retractions can be a sign of increased work of breathing, but mild retractions alone may not be as concerning as grunting during expiration.