Which characteristics are typically found in a patient diagnosed with Down syndrome? Select all that apply.
- A. Low-set ears
- B. Broad nasal bridge
- C. Round occiput
- D. Small tongue
Correct Answer: C
Rationale: The correct answer is C: Round occiput. In Down syndrome, individuals often exhibit a round-shaped head at the back (occiput) due to the abnormal growth patterns of the skull bones. This characteristic is a common physical feature seen in individuals with Down syndrome.
A: Low-set ears - While low-set ears can be a feature in some cases of Down syndrome, it is not a defining characteristic and not always present.
B: Broad nasal bridge - Broad nasal bridge is a common feature in Down syndrome, but it is not specific enough to be a defining characteristic.
D: Small tongue - While individuals with Down syndrome may have slightly smaller tongues compared to the general population, it is not a prominent characteristic and not typically used for diagnosis.
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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.
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 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.
Which nursing diagnosis would be considered a priority for a newborn infant who is receiving phototherapy in an isolette?
- A. Hypothermia because of phototherapy treatment
- B. Impaired skin integrity related to diarrhea as a result of phototherapy
- C. Fluid volume deficit related to phototherapy treatment
- D. Knowledge deficit (parents) related to initiation of medical therapy
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.
Which intervention should the nurse instruct the parents to do for their newborn who has acute diaper rash?
- A. Apply the diaper loosely to infant, allowing for better air circulation.
- B. Change the newborn every 4 hours to prevent a moist environment.
- C. Wash the newborn’s diaper area with an antibacterial soap and newborn wipes.
- D. Wipe off the diaper cream thoroughly between diaper changes.
Correct Answer: A
Rationale: The correct answer is A: Apply the diaper loosely to infant, allowing for better air circulation. This is the best intervention for acute diaper rash as it helps reduce moisture and promotes healing. Tight diapers trap moisture, worsening the rash. Choice B is incorrect as changing every 2-3 hours is recommended to maintain a dry environment. Choice C is incorrect as antibacterial soap can be harsh and disrupt the skin's natural flora. Choice D is incorrect as wiping off diaper cream thoroughly can irritate the skin further.