Neonatal Intensive Care Unit Flashcards, test questions and answers

Question 1

A newborn was admitted to the neonatal intensive care unit (NICU) after being delivered at 29 weeks of gestation to a 28-year-old multiparous, married, Caucasian woman whose pregnancy was uncomplicated until the premature rupture of membranes and preterm birth. The newborn’s parents arrive for their first visit after the birth. The parents walk toward the bedside but remain approximately 5 feet away from the bed. What is the nurse’s most appropriate action? a.Wait quietly at the newborn’s bedside until the parents come closer. b.Go to the parents, introduce him or herself, and gently encourage them to meet their infant. Explain the equipment first, and then focus on the newborn. c.Leave the parents at the bedside while they are visiting so that they have some privacy. d.Tell the parents only about the newborn’s physical condition and caution them to avoid touching their baby.

Answer

ANS: B The nurse is instrumental in the initial interactions with the infant. The nurse can help the parents see the infant rather than focus on the equipment. The importance and purpose of the apparatus that surrounds their infant also should be explained to them. Parents often need encouragement and recognition from the nurse to acknowledge the reality of the infant’s condition. Parents need to see and touch their infant as soon as possible to acknowledge the reality of the birth and the infant’s appearance and condition. Encouragement from the nurse is instrumental in this process. Telling the parents to avoid touching their baby is inappropriate and unhelpful.
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Question 2

A mother with a history of gestational hypertension gives birth to a neonate at 26 weeks’ gestation. After the neonate receives surfactant through an endotracheal tube in the delivery room, a nurse takes him to the neonatal intensive care unit (NICU), places him on an overbed warmer, and provides mechanical ventilation. When the mother arrives in the NICU for the first time, the nurse’s priority should be to

Answer

Enhancing bonding by pointing out the neonate’s features
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Question 3

After reading about Harlow’s contact comfort theory, Dr. Borden wonders if touch and cuddling would speed weight gain in premature babies in the neonatal intensive care unit. He designs a study to test this idea. What type of research is Dr. Borden’s study? 1. basic 2. predictive 3. translational 4. applied

Answer

translational The Basic-Applied Research Cycle—Since Dr. Borden’s research is connecting Harlow’s basic research to an application, it is translational.
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Question 4

10. A 42-week gestation neonate is admitted to the NICU (neonatal intensive care unit). This neonate is at risk for which complication? a. Meconium aspiration syndrome b. Failure to thrive c. Necrotizing enterocolitis d. Intraventricular hemorrhage

Answer

ANS: a a. Although there is nothing in the scenario that states that the amniotic fluid is green tinged, post-term babies are high risk for meconium aspiration syndrome. b. Post-term babies often gain weight very quickly. c. Preterm, not post-term, babies are high risk for necrotizing enterocolitis. d. Preterm, not post-term, babies are high risk for intraventricular hemorrhages.
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Question 5

A plan of care is created for a term small-for-gestational-age (SGA) neonate who was admitted to the neonatal intensive care unit (NICU). The goal was for the newborn to reach 5 pounds by a specified date. On the specified date the infant weighs 4 pounds, 2 ounces. What should the nurse do next? 1. Increase the daily number of calories 2. Change the goal to a more realistic number 3. Reassess the problem before altering the plan 4. Postpone the evaluation date for another month

Answer

3 Before further intervention, the reason for the inadequate weight gain should be evaluated. Evaluation should take place before changing the plan or altering the goal. 1 This intervention is premature. 2 This intervention is premature. 4 This is unsafe; the reason for the lack of goal attainment must be identified.
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Question 6

A child is admitted to the neonatal intensive care unit (NICU). The parents are concerned because they cannot stay for long hours to visit. Which statement made by the nurse is most appropriate? 1. “One of you might take a leave of absence to be here more.” 2. “Parents often feel this way; would you be interested in talking with others who have experienced having a child in the NICU?” 3. “Perhaps the grandparents can make the visits for you.” 4. “Why can’t you visit after work every day?”

Answer

Correct Answer: 2 Rationale 1: “Parents often feel this way; would you be interested in talking with others who have experienced having a child in the NICU?” is therapeutic; it focuses on feelings and offers support to the parents. The other options do not focus on how the parents feel and attempt to solve the issue rather than allow for the parents to deal with their feelings and form solutions.
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Question 7

The mother of a preterm infant tells her nurse that she would like to visit her newborn, who is in the neonatal intensive care unit (NICU). Which of the following would be the most appropriate response by the nurse? a) “I’m sorry. You may not visit your son until he has been released from the NICU.” b) “Certainly. You may only observe the child from a distance, however, as his immune system is still not developed adequately.” c) “Certainly. You will need to wash your hands and gown before you can hold him, however.” d) “I’m sorry. You may not visit the NICU, but we can arrange to have your son brought to your room so that you can hold him.”

Answer

“Certainly. You will need to wash your hands and gown before you can hold him, however.” Correct Explanation: Be certain the parents of a high-risk newborn are kept informed of what is happening with their child. They should be able to visit the special nursing unit to which the newborn is admitted as soon and as often as they choose, and, after washing and gowning, hold and touch their newborn, both actions which help make the child’s birth more real to them.
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Question 8

4. A nurse assigned to the neonatal intensive care unit (NICU) has spent most of a day working with a critically ill infant, with the mother standing by. The infant experiences a cardiac arrest and does not survive. The mother spends an hour crying and holding the baby, saying good-bye. Which spiritual care intervention(s) is/are most appropriate for the nurse to implement? (Select all that apply.) a. If desired, briefly hold the baby to say good-bye after the mother leaves. b. Follow procedures to prepare the body for transport to the morgue. c. Visit the mother the next day to see how she is doing. d. Call the family spiritual adviser or the chaplain. e. Ask the mother if you could call a family member or friend to be with her.

Answer

Answers: a, d, e It is important for nurses to take time to say “good-bye” to patients with whom they have developed a relationship. In this case, it would be appropriate for the nurse to hold the infant briefly, if desired, after the family has left before preparing the body for the morgue. With consent, the mother needs to be surrounded by appropriate persons to provide spiritual support, including a chaplain, family members, and friends. Although it is critical that the nurse follow procedures in preparing bodies for the morgue, it is not considered spiritual care. Visiting the mother after her loss could be viewed as a violation of professional boundaries, especially for a nurse who worked with the family for a day only.
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Question 9

A 25-year-old female at 31 weeks gestation presents to the labor wing with painful uterine contractions every 3 minutes. On examination her cervix is 3 cm dilated and 50% effaced. Her membranes are intact and fetal heart monitoring is reassuring. She is treated with tocolysis,betamethasone, antibiotics, and intravenous hydration, and cultured for group B Streptococcus. The neonatal intensive care unit is notified, but the contractions ease and eventually stop. After 2 days of observation, her cervix is unchanged and she is discharged home. One week later, the patient presents with contractions for the last 8 hours. Her cervical findings are unchanged. Her group B Streptococcus culture was negative. Which one of the following would be the most appropriate next step in the management of this patient? (check one) A. Repeat tocolysis, betamethasone, antibiotics, and intravenous hydration B. Betamethasone, antibiotics, and intravenous hydration only C. Antibiotics and intravenous hydration only D. Tocolysis only E. Expectant management

Answer

E. Expectant management. The purpose of obstetric management of preterm labor before 34 weeks gestation is to allow time to administer corticosteroids. Treatment does not substantially delay delivery beyond 1 week. Repeated administration of corticosteroids does not confer more benefit than a single course. Antibiotics are administered for prophylaxis of group B Streptococcus and are useful for delaying delivery if membranes are ruptured. They do not add any benefit otherwise, even though subclinical amnionitis may be a causative factor in many cases of preterm labor. Prolonged and repeated tocolysis is believed to be harmful. Tocolysis would not be indicated in this patient because she has had no cervical change and is therefore having preterm contractions, not preterm labor. Careful monitoring for fetal compromise, consultation with obstetric colleagues, and neonatal intensive-care unit involvement should be part of expectant management of preterm labor cases.
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