Nokea
The mother of a postterm infant asks the nurse why the infant is being watched so closely. What is the nurse's most appropriate response?
- A. The placenta does not function adequately as it ages.'
- B. Infants born postmaturely are generally large.'
- C. Delivery of the postterm infant is more difficult.'
- D. There is less amniotic fluid.'
Correct Answer: A
Rationale: Fetal distress may occur in the postterm infant because placental functioning becomes inadequate with maturity.
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The mother of a 4-month-old infant, born prematurely, asks the nurse if her daughter will always be small for her age. What is the most appropriate nursing response?
- A. Preterm infants usually remain smaller than term infants throughout childhood.'
- B. Your daughter will be the same size as other children by the time she is 1 year old.'
- C. Prematurity is associated with short stature but does not affect weight gain.'
- D. It takes about two years for the preterm infant to catch up to a full-term infant.'
Correct Answer: D
Rationale: In the absence of severe birth defects and complications, the growth rate of the preterm newborn nears that of the term infant by about the second year.
How often will the nurse caring for a preterm infant in an incubator record the temperature of the infant and the incubator?
- A. Every hour
- B. Every 2 hours
- C. Every 4 hours
- D. Every 8 hours
Correct Answer: B
Rationale: The temperature of the incubator is adjusted to a level that will maintain an optimal body temperature in the infant. The nurse records the temperature of the infant and the incubator every 2 hours.
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.
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 caring for an infant born at 36 weeks of gestation assesses tremors and a weak cry. The nurse is aware that these symptoms indicate what?
- A. Respiratory distress syndrome
- B. Hypoglycemia
- C. Necrotizing enterocolitis
- D. Renal failure
Correct Answer: B
Rationale: The preterm infant, before 38 weeks, should be assessed for hypoglycemia because the infant's glycogen stores are not adequate.