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How will the nurse safely ensure tube placement when preparing to initiate a gavage feeding?
- A. Check tube placement by injecting air into the stomach.
- B. Weigh the infant before the feeding.
- C. Aspirate stomach contents.
- D. Check serum glucose level.
Correct Answer: C
Rationale: When the preterm infant is gavage fed, the contents of the stomach should be aspirated before the feeding is started. Aspiration of the stomach contents ensures tube placement and also allows the nurse to assess the amount of feeding in the stomach.
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The nurse in a pediatrician's office is preparing to do a developmental assessment on a 3-month-old infant who was born at 36 weeks. The nurse knows that the infant should be evaluated in what month of achievement to adjust for the preterm birth?
- A. 1st
- B. 2nd
- C. 3rd
- D. 4th
Correct Answer: B
Rationale: The growth and development of a preterm infant are based on the current age minus the number of weeks before term that the infant was born.
The nurse explains to a patient in preterm labor that what may be ordered by the physician to accelerate fetal lung maturity?
- A. Prostaglandins
- B. Oxytocin
- C. Magnesium sulfate
- D. Corticosteroids
Correct Answer: D
Rationale: Surfactant production can be increased by administering corticosteroids to the mother before delivery.
What nursing action is appropriate to prevent possible retinopathy in a preterm infant requiring oxygen therapy?
- A. Monitor arterial oxygen levels with a pulse oximeter.
- B. Position the head slightly lower than the body.
- C. Administer low concentrations of oxygen.
- D. Keep the infant's eyes covered at all times.
Correct Answer: A
Rationale: Use of a pulse oximeter to carefully monitor arterial blood gases in high-risk infants continues to be a priority in the neonatal intensive care unit (NICU).
Why is the postterm neonate at risk for cold stress?
- A. Inadequate vernix caseosa
- B. Hypoxia from a deteriorated placenta
- C. Polycythemia
- D. Fat stores have been used in utero for nourishment
Correct Answer: D
Rationale: Fat stores have been used in utero for nourishment during the extended pregnancy.
An infant receives surfactant via endotracheal (ET) tube at birth for symptoms of respiratory distress syndrome (RDS). When will the nurse anticipate seeing improvement of lung function?
- A. Immediately
- B. Within 3 days
- C. 1 to 2 weeks
- D. At least 1 month
Correct Answer: B
Rationale: In preterm newborns, surfactant can be administered via ET tube at birth or when symptoms of RDS occur, with improvement of lung function seen within 72 hours.