ATI RN
Assessment and Management of Newborn Complications Quizlet Questions
Question 1 of 5
Which nursing diagnosis would be considered a priority for a newborn infant who is receiving phototherapy in an isolette?
Correct Answer: C
Rationale: The correct answer is C: Fluid volume deficit related to phototherapy treatment. Priority nursing diagnoses are based on ABCs (Airway, Breathing, Circulation). Fluid volume deficit can result from phototherapy due to increased insensible water loss. This can lead to dehydration and electrolyte imbalances, impacting circulation and overall well-being. Hypothermia (choice A) is important but not the priority in this case. Impaired skin integrity (choice B) is a potential issue but not as critical as fluid volume deficit. Knowledge deficit (choice D) is important for parental education but not an immediate concern compared to fluid balance in the newborn.
Question 2 of 5
Edward, a newborn delivered at 41 weeks' gestation, weighs 10 lb 4 oz. Vaginal delivery for this G1P1 mother was assisted with forceps. The nurse is completing her assessment and notes a sharply demarcated swelling over the parietal bones. The occipital and frontal skull bones are not affected. The neck does not appear edematous and is soft to the touch with full mobility. The infant is awake and active and has been breast-feeding well. What is the most probable cause of the swelling?
Correct Answer: A
Rationale: The correct answer is A: cephalohematoma. Cephalohematoma is a subperiosteal collection of blood that occurs due to trauma during delivery, such as with forceps assistance. The swelling is sharply demarcated because it is bound by suture lines of the skull bones. In this case, the parietal bones are affected, while the other skull bones are not involved. The absence of edema in the neck and the infant's good activity and feeding suggest no significant underlying issues. Summary: B: Subgaleal hemorrhage involves bleeding into the potential space between the periosteum and the skull, resulting in diffuse swelling extending beyond suture lines. C: Caput succedaneum is soft tissue swelling that crosses suture lines and involves the scalp, not just the parietal bones. D: Skull fracture would present with additional signs such as crepitus, misshapen skull, or neurological deficits, which are not mentioned
Question 3 of 5
The nurse has access to the results of a karyotype sent out for their patient via an electronic medical record. The parents have accessed the results on their MyChart phone application and have asked the nurse what the results 45, X mean. What is the best response from the nurse?
Correct Answer: A
Rationale: The correct answer is A: The results indicate your child may have Turner syndrome. This is the best response because 45, X is the karyotype typically associated with Turner syndrome, a genetic condition where a female is missing part or all of one X chromosome. This response shows the nurse's knowledge of genetics and ability to interpret karyotype results accurately. Summary of incorrect choices: B: Your results are 45, X; you will have to wait to talk with the geneticist - This response delays providing crucial information to the parents and does not address their immediate concerns. C: Your results indicate that your daughter has a serious lifelong disease - This choice is too vague and alarming, lacking specificity about the condition associated with the karyotype results. D: I’m not sure; I’ll call the provider - This response shows a lack of knowledge on the nurse's part and does not offer any immediate information or reassurance to the parents.
Question 4 of 5
A premature infant with respiratory distress syndrome (RDS) receives artificial surfactant. How does the nurse explain surfactant therapy to the parents?
Correct Answer: B
Rationale: The correct answer is B because artificial surfactant improves the ability of the infant's lungs to exchange oxygen and carbon dioxide. Surfactant reduces surface tension in the alveoli, preventing collapse and helping with gas exchange. This explanation directly relates to the purpose of surfactant therapy in treating RDS. Choices A, C, and D are incorrect because they do not accurately describe the mechanism or purpose of surfactant therapy. Choice A is incorrect as surfactant does not affect sedation needs, choice C is incorrect as surfactant is not used to address tachycardia, and choice D is incorrect as surfactant is not used to treat respiratory tract infections.
Question 5 of 5
The newborn is having occasional gasping respirations with a heart rate of 90 beats per minute. Skin color is cyanotic with poor muscle tone. Interpreting relevant clinical data in this scenario, what problems are possible? Select all that apply.
Correct Answer: C
Rationale: The correct answer is C: The newborn is experiencing respiratory distress. Gasping respirations, low heart rate, cyanotic skin, and poor muscle tone are indicative of respiratory distress in a newborn. Gasping is an abnormal breathing pattern seen in severe respiratory distress. A low heart rate is a compensatory response to decreased oxygen levels. Cyanotic skin color indicates poor oxygenation. Poor muscle tone can be a sign of inadequate oxygen delivery to tissues. Explanation for other choices: A: The newborn may be hypothermic due to poor temperature regulation, but the primary concern in this scenario is respiratory distress. B: Being full term does not directly explain the newborn's clinical presentation, so it is not a likely cause. D: Anemia could contribute to poor oxygen delivery, but the clinical presentation suggests a more acute issue related to respiratory distress.