Nokea
If the neonatal nurse is suspicious of necrotizing enterocolitis in the infant, which intervention should take place first?
- A. Stop feeds
- B. Obtain a blood gas
- C. Call the practitioner
- D. Check electrolytes
Correct Answer: A
Rationale: The correct answer is A: Stop feeds. This is the first intervention because neonatal necrotizing enterocolitis is a serious condition that requires immediate action to prevent further complications. Stopping feeds helps reduce intestinal inflammation and allows the bowel to rest. This step is crucial in managing NEC and preventing perforation. Obtaining a blood gas or checking electrolytes can provide valuable information but are not as urgent as stopping feeds. Calling the practitioner is important but should come after initiating the immediate intervention of stopping feeds.
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Which nursing action is especially important for an SGA newborn?
- A. Promote bonding.
- B. Observe for and prevent dehydration.
- C. Observe for respiratory distress syndrom
- D. Prevent hypoglycemia with early and frequent feedings.
Correct Answer: D
Rationale: The correct answer is D because preventing hypoglycemia is crucial for Small for Gestational Age (SGA) newborns due to their decreased glycogen stores. Early and frequent feedings help maintain stable blood sugar levels. Option A, promoting bonding, is important for all newborns but not particularly crucial for SGA babies. Option B, preventing dehydration, is essential for all newborns but not specific to SGA. Option C, observing for respiratory distress syndrome, is important but not the most critical concern for SGA newborns.
The nurse notices that a neonate being treated for hyperbilirubinemia with phototherapy has had a daily increase of total bilirubin serum levels greater than 5 mg/dL for the past 2 days. The neonatal care provider prescribes an exchange transfusion. Which knowledge does the nurse apply to the procedure?
- A. The bilirubin indicates a severe hemolytic disease.
- B. Approximately 85% of the neonate’s RBCs are replaced.
- C. Donor RBCs are obtained from the neonate’s mother.
- D. The procedure is exclusive to pathological jaundice.
Correct Answer: A
Rationale: The correct answer is A because a daily increase of total bilirubin levels greater than 5 mg/dL in a neonate being treated for hyperbilirubinemia with phototherapy indicates severe hemolytic disease. This condition requires an exchange transfusion to remove excess bilirubin and replace damaged RBCs. Choice B is incorrect as the percentage of RBCs replaced during an exchange transfusion is closer to 50-60%. Choice C is incorrect as donor RBCs are typically obtained from a blood bank, not the neonate's mother. Choice D is incorrect as an exchange transfusion may be necessary for severe hyperbilirubinemia of various etiologies, not exclusively pathological jaundice.
Which factor does not influence bilirubin levels in the infant?
- A. Prematurity
- B. Maternal diabetes
- C. Exclusively breastfeeding
- D. Birth trauma
Correct Answer: D
Rationale: The correct answer is D: Birth trauma. Birth trauma does not directly influence bilirubin levels in infants. Prematurity can lead to immature liver function affecting bilirubin metabolism. Maternal diabetes can lead to increased risk of neonatal jaundice. Exclusively breastfeeding can lead to breastfeeding jaundice due to inadequate milk intake. Therefore, birth trauma is the only option that does not directly impact bilirubin levels in infants.
Which is the most common etiology for pathological jaundice in an infant?
- A. ABO incompatibility
- B. Physiological
- C. Inherited pathology
- D. Birth trauma
Correct Answer: A
Rationale: The correct answer is A: ABO incompatibility. This is the most common etiology for pathological jaundice in an infant because it occurs when the baby's blood type is incompatible with the mother's, leading to the destruction of the baby's red blood cells and subsequent release of bilirubin, causing jaundice. Physiological jaundice (B) is common but typically resolves on its own without treatment. Inherited pathologies (C) such as genetic conditions may cause jaundice, but they are less common than ABO incompatibility. Birth trauma (D) can lead to jaundice in rare cases, but it is not the most common etiology.
An infant weight is documented as being in the 90th percentile. What does the RN understand about this measurement?
- A. The infant’s weight is appropriate or average.
- B. The 90th percentile indicates LGA.
- C. Infants in the 90th percentile will be overweight as adults.
- D. The infant’s weight is less than 90% of all other infants’ weights.
Correct Answer: C
Rationale: The correct answer is C because being in the 90th percentile for weight as an infant does not necessarily mean the weight is appropriate or average (choice A) or that the infant is LGA (choice B). Choice D is incorrect because being in the 90th percentile means the infant's weight is greater than 90% of other infants, not less. Choice C is correct because research shows that infants in the 90th percentile for weight are more likely to be overweight as adults due to potential genetic factors and lifestyle habits developed early in life.