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The NICU nurse encourages the mother of a premature neonate to bring breast milk to the unit for enteral feedings to her baby. For which reason does the nurse make this suggestion?
- A. The baby will be more likely to breastfeed later.
- B. The mother will feel more involved with the baby.
- C. The neonate will gain weight faster on breast milk.
- D. Breast milk helps prevent necrotizing enterocolitis.
Correct Answer: D
Rationale: The correct answer is D because breast milk helps prevent necrotizing enterocolitis (NEC) in premature neonates. Breast milk contains protective factors that reduce the risk of NEC, a serious gastrointestinal condition common in preterm infants. Other choices are incorrect: A is not directly related to feeding breast milk, B focuses on emotional involvement rather than physiological benefits, and C does not address the specific health benefits of breast milk in preventing NEC.
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Which infant is at greatest risk for developing hypoglycemia after birth?
- A. Severe small for gestational age infant
- B. Appropriate for gestational age infant
- C. Infant of a diabetic mother with maternal glucose control
- D. Cold-stressed term infant
Correct Answer: A
Rationale: The correct answer is A: Severe small for gestational age (SGA) infant, as they have limited glycogen stores and are at higher risk for hypoglycemia. SGA infants often have poor growth in utero, leading to decreased nutrient reserves. This puts them at increased risk for low blood sugar levels after birth.
Incorrect choices:
B: Appropriate for gestational age infants typically have adequate glycogen stores and are at lower risk for hypoglycemia.
C: Infants of diabetic mothers with good maternal glucose control are less likely to have hypoglycemia due to stable blood sugar levels in utero.
D: Cold-stressed term infants may have transient hypoglycemia, but they are not at the greatest risk compared to severe SGA infants.
Which patient should be assessed first?
- A. Infant with a blood glucose level of 45 mg/dL, maternal history of gestational diabetes
- B. Infant who is plotted on the growth chart between the 75th and 85th percentile for weight and length and the 50th percentile for head circumference
- C. Infant born at 42 weeks gestation to 40-year-old mother who was otherwise healthy during pregnancy and at the time of delivery
- D. Infant born at 38 weeks gestation with a green stain and bruising noted on initial assessment at delivery
Correct Answer: A
Rationale: The correct answer is A. An infant with a blood glucose level of 45 mg/dL and a maternal history of gestational diabetes should be assessed first to rule out hypoglycemia, which can be life-threatening in newborns. Hypoglycemia can lead to seizures, brain damage, or even death if not promptly treated. Infants born to mothers with gestational diabetes are at higher risk for hypoglycemia due to their own insulin production in response to high maternal glucose levels. Therefore, immediate assessment and intervention are crucial.
Choice B is incorrect because growth parameters within normal ranges do not indicate an immediate need for assessment. Choice C is also incorrect as the mother's age and gestational age do not necessarily indicate an urgent need for assessment. Choice D is incorrect as the presence of a green stain and bruising may indicate meconium aspiration syndrome, but hypoglycemia poses a more immediate threat to the infant's health.
Which rationale is true regarding jaundice in newborns?
- A. Jaundice can result in a newborn when the mother and newborn have the same blood type.
- B. A mother who breastfeeds her newborn who develops jaundice may have to begin formula temporarily.
- C. Bilirubin levels will drop in newborns who have jaundice and may cause brain abnormalities.
- D. Keeping a newborn with jaundice below 98.7°F is essential in lowering bilirubin levels.
Correct Answer: B
Rationale: Step 1: Breast milk jaundice is a common cause of jaundice in newborns due to a substance in breast milk that can increase bilirubin levels.
Step 2: Switching to formula temporarily can help resolve the issue as formula-fed babies have lower incidences of jaundice.
Step 3: This is supported by medical guidelines recommending temporary cessation of breastfeeding in cases of severe jaundice.
Summary:
A: Blood type compatibility does not directly cause jaundice in newborns.
C: Bilirubin levels need to be monitored and managed in newborns with jaundice to prevent brain damage.
D: Maintaining a specific temperature is not the primary method of managing jaundice in newborns.
What term best describes an infant born with a birth weight below the 10th percentile for gestational age?
- A. Appropriate for gestational age
- B. Failure to thrive
- C. Small for gestational age
- D. Infant born to mother of gestational diabetes
Correct Answer: C
Rationale: The correct answer is C: Small for gestational age. This term describes an infant born with a birth weight below the 10th percentile for gestational age, indicating intrauterine growth restriction. This term specifically addresses the infant's size in relation to their gestational age, distinguishing it from other choices.
A: Appropriate for gestational age refers to infants whose birth weight falls within the normal range for their gestational age, not below the 10th percentile.
B: Failure to thrive is a broader term encompassing various factors affecting a child's growth and development, not specifically related to birth weight percentile.
D: Infant born to mother of gestational diabetes pertains to a specific maternal condition that may affect the infant's health but does not directly address the infant's birth weight percentile.
The nurses in a NICU are concerned about the appropriate levels of oxygen therapy during the care of premature neonates. The nurses referenced an article by Newman (2014) titled, “Oxygen Saturation Limits and Evidence supporting the Targets.” On which evidence-based conclusion will the nurses develop guidelines?
- A. Oxygen saturation limits of 85% to 89% are effective.
- B. Oxygen saturation rates of 91% to 95% are effective.
- C. Infants are within saturation limits about 75% of the time.
- D. Oxygen saturation limits need to be between 87% to 94%.
Correct Answer: B
Rationale: The correct answer is B: Oxygen saturation rates of 91% to 95% are effective. This range is supported by the article by Newman (2014) as the optimal oxygen saturation levels for premature neonates. Here's the rationale:
1. The range of 91% to 95% falls within the typical target range for oxygen saturation in premature neonates, ensuring adequate oxygenation without the risk of hyperoxia or hypoxia.
2. Maintaining oxygen saturation within this range has been shown to improve outcomes and reduce the risk of complications in premature neonates.
3. The article by Newman likely provides evidence-based research supporting this specific range as the most effective for neonatal care.
In summary, choices A, C, and D are incorrect because they do not align with the evidence-based optimal oxygen saturation range for premature neonates as supported by the referenced article.