A neonate has been diagnosed with caput succedaneum. Which statement is correct about this condition?
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Solution
It involves swelling of tissue over the presenting part of the presenting head.
Caput succedaneum is the swelling of tissue over the presenting part of the fetal scalp due to sustained pressure; it resolves in 3-4 days.
By keeping the nursery temperature warm and wrapping the neonate in blankets, the nurse is preventing which type of heat loss?
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Solution
Convection.
Convection heat loss is the flow of heat from the body surface to the cooler air.
Neonates of mothers with diabetes are at risk for which complication following birth?
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Solution
Macrosomia.
Neonates of mothers with diabetes are at increased risk for macrosomia (excessive fetal growth) as a result of the combination of the increased supply of maternal glucose and an increase in fetal insulin.
After reviewing the client’s maternal history of magnesium sulfate during labor, which condition would the nurse anticipate as a potential problem in the neonate?
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Solution
Respiratory depression.
Magnesium sulfate crosses the placenta and adverse neonatal effects are respiratory depression, hypotonia, and Bradycardia.
A client has just given birth at 42 weeks’ gestation. When assessing the neonate, which physical finding is expected?
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Solution
Desquamation of the epidermis.
Postdate fetuses lose the vernix caseosa, and the epidermis may become desquamated. These neonates are usually very alert. Lanugo is missing in the postdate neonate.
A client with group AB blood whose husband has group O has just given birth. The major sign of ABO blood incompatibility in the neonate is which complication or test result?
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Solution
Jaundice within the first 24 hours of life.
The neonate with ABO blood incompatibility with its mother will have jaundice (pathologic) within the first 24 hours of life. The neonate would have a positive Coombs test result.
The nurse is aware that a neonate of a mother with diabetes is at risk for what complication?
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Solution
Hypoglycemia.
Neonates of mothers with diabetes are at risk for hypoglycemia due to increased insulin levels. During gestation, an increased amount of glucose is transferred to the fetus across the placenta. The neonate’s liver cannot initially adjust to the changing glucose levels after birth. This may result in an overabundance of insulin in the neonate, resulting in hypoglycemia.
While assessing a 2-hour old neonate, the nurse observes the neonate to have acrocyanosis. Which of the following nursing actions should be performed initially?
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Solution
Do nothing because acrocyanosis is normal in the neonate.
Acrocyanosis, or bluish discoloration of the hands and feet in the neonate (also called peripheral cyanosis), is a normal finding and shouldn’t last more than 24 hours after birth.
Which action best explains the main role of surfactant in the neonate?
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Solution
Helps the lungs remain expanded after the initiation of breathing.
Surfactant works by reducing surface tension in the lung. Surfactant allows the lung to remain slightly expanded, decreasing the amount of work required for inspiration.
The nurse decides on a teaching plan for a new mother and her infant. The plan should include:
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Solution
Showing by example and explanation how to care for the infant.
Teaching the mother by example is a non-threatening approach that allows her to proceed at her own pace.