Chapter 29: Perinatal Disorders
Garzon Maaks: Burns’ Pediatric Primary Care, 7th Edition
MULTIPLE CHOICE
1. The parent of a 2-week-old infant reports that the infant was diagnosed with transient
tachypnea of the newborn shortly after birth. The primary care pediatric nurse practitioner
understands that, in this condition what is true?
a. Antibiotic therapy is generally necessary to prevent severe infection.
b. Home oxygen therapy is needed until the infant grows out of the condition.
c. Recovery is usually complete with minimal intervention and treatments.
d. Treatment with exogenous surfactant and mechanical ventilation is needed.
ANS: C
TTN results from incomplete evacuation of fetal lung fluid in full term infants and usually
resolves in 24 to 48 hours. Supplemental oxygen therapy is sometimes needed, based on
symptoms. Mechanical ventilation is rarely used. Antibiotic therapy is sometimes indicated
for meconium aspiration to prevent pneumonia. Home oxygen therapy, exogenous surfactant,
and mechanical ventilation are all commonly used for infants with respiratory distress
syndrome, which occurs more commonly with preterm infants.
2. The parent of a 4-week-old infant reports that the infant began having forceful vomiting 1
week prior, which has worsened over time. The infant continues to nurse well but is losing
weight. A physical examination reveals a 90-g weight loss over the past 2 weeks, dry mucous
membranes, and a sunken fontanel. What will the primary care pediatric nurse practitioner do?
a. Encourage the mother to nurse the infant more frequently for shorter duration.
b. Obtain serum electrolytes and hospitalize for surgical intervention.
c. Recommend oral rehydration fluids for 24 to 48 hours to correct dehydration.
d. Suggest trying a soy-based or hydrolyzed protein formula until vomiting resolves.
ANS: B
This infant has symptoms characteristic of pyloric stenosis. Surgical intervention is necessary
after dehydration and electrolyte imbalance has been corrected. The PNP may order lab work
and admit to the hospital for a surgical consult. Infants with regurgitation disorders should
nurse for shorter periods more frequently to prevent spitting up. Oral rehydration fluids are
not indicated since the infant will vomit everything that goes into the stomach. Switching to
other formulas is not indicated.
3. A 5-day-old infant who was delivered at home has abdominal distension and poor feeding.
The mother is worried that the infant is constipated because he didn’t have a first stool until
yesterday and has only passed a small amount of meconium. What will the primary care
pediatric nurse practitioner do?
a. Obtain a sweat chloride skin test to evaluate for possible cystic fibrosis.
b. Order an abdominal radiograph and refer the infant to a pediatric surgeon.
c. Prescribe glycerin suppositories to use as needed until bowel function is normal.
d. Suggest that the mother increase her fluid intake to help with constipation.
ANS: B
These are symptoms of Hirschprung disease, and evaluation and possible surgical intervention
are necessary. Although failure to pass meconium in the first 24 to 48 hours may be an early
sign of CF, this testing is part of newborn screening that should be obtained. Glycerin
suppositories and increasing fluid intake are not indicated until the cause of the constipation is
determined.
4. The parent of a 4-day-old infant tells the primary care pediatric nurse practitioner that the
infant was diagnosed with hydronephrosis while in utero and asks what will be done. What
will the nurse practitioner tell this parent?
a. Renal function will be abnormal and will require lifetime treatment.
b. Spontaneous resolution often occurs within 6 months to a year of age.
c. The affected kidney will be non-functional but the other kidney will compensate.
d. The infant will eventually require renal transplantation for that kidney.
ANS: B
Hydronephrosis is often diagnosed with a prenatal sonogram, and many cases self-resolve
within 6 to 12 months. If resolution does not occur, renal function will not be normal and
treatment is based on the severity of symptoms.
5. A 2-month-old infant has increased head circumference from the 10th percentile at the 2-week
exam to the 30th percentile today. What will the primary care pediatric nurse practitioner do?
a. Order a magnetic resonance imaging exam of the infant’s head.
b. Refer the infant immediately to a pediatric neurosurgeon.
c. Schedule frequent clinic visits to monitor head growth.
d. Watch the infant closely over time if the rest of the exam is normal.
ANS: B
The infant has rapid enlargement of the skull and should be promptly referred to a pediatric
neurosurgeon for possible VP shunting. The initial radiographic exam is a CT, not MRI. The
infant has already demonstrated rapid enlargement; continued observation will only delay
necessary treatment.
6. The primary care pediatric nurse practitioner is performing a well-baby examination on a 7-
day-old infant born to a Chlamydia-positive mother. The infant’s eyes are clear without
exudate. The infant is free from cough and lungs are clear. What will the primary care
pediatric nurse practitioner do to prevent illness in this infant?
a. Administer a single dose of intramuscular ceftriaxone.
b. Obtain bacterial cultures of both conjunctivae.
c. Prescribe prophylactic erythromycin suspension.
d. Schedule a follow-up appointment in 1 week.
ANS: D
Infants born to Chlamydia-positive mothers have an increased risk of conjunctivitis and
pneumonia and must be watched for development of these for several weeks after delivery – a
few days to several weeks for conjunctivitis and 2 to 19 weeks for pneumonia. IM ceftriaxone
is given as prophylaxis for gonorrhea. Routine bacterial cultures are not helpful. Prophylactic
erythromycin is not recommended because of an increased risk of hypertrophic pyloric
stenosis.
