Chpt 3: Perinatal Substance Abuse, Chpt 27 In Review

Front 1

A newborn exhibits the following characteristics: small for gestational age, dysmorphic facial features, and central nervous system abnormalities. These characteristics were most likely caused by perinatal exposure to:
A. heroin
B. alcohol
C. cocaine
D. amphetamines

Back 1

1. B. Alcohol is a know teratogen causing growth restriction, facial anomalies, and sever central nervous system dysfunction. Perinatal exposure to heroin may cause neonatal abstinence syndrome and low birth weight, but is not a cause of facial anomalies. perinatal exposure to cocaine or amphetamiens is assoc with low birht weight and central nervous system dysfunction or irritability, but not facial anomalies.

Front 2

When caring for a full-term infant whose mother used cocaine during her pregnancy, the nurse should assess the infant for complication including:
A. macrosomia
B. absence of the startle reflex
C. neonatal abstinence syndrome
D. central nervous system irritability

Back 2

2. D. Cocaine-exposed infants are restless, irritable, tremulous, and hypertonic. Perinatal exposure to cocaine is assoc with low birth weight. The startle reflex is easily elicited in infants exposed to cocaine. Infants do not experience withdrawal from cocaine.

Front 3

When providing care for an infnat who was prenatally exposed to heroin, the nurse demonstrates appropriate use of the Neonatal Abstinence Scoring System by:
A. scoring the infant twice daily until symptoms subside
B. determining a treatment plan based on the initial score
C. initiating pharmacologic treatment when the score is less than 8
D. scoring the infant every 4 hours to monitor the progression of symptoms.

Back 3

3. D. The Neonatal ABstinence Scoring System should be used every 4 hours for 86 hours to detect the onset and progressio of withdrawal symptoms and to evaluate the effectiveness of therapeutic interventions. Assessment should begin at 2 hours of age. The initial score determines the need for additional assessment. If the infant's score is 8 or higher, scoring should be done every 2 hours for at least 24 hours. Pharmacologic treatment should be considered of three sucessive scores are 8 or higher.

Front 4

An infant is receiving oral morphine for treatment of neonatal abstinence syndrome. Which finding indicates to the nurse that the morphine is effective in controlling signs of withdrawal?
A. trmeors subside with swaddling
B. the respiratory rate is less than 55 breaths/min
C. the infant remains in a drowsy state.
D. Neonatal Abstinence Scoring System scores are between 4 and 8.

Back 4

4. D. Neonatal abstinence scores of 8 or less are indicative of control of withdrawal symptoms. Tremors may decrease with swaddling, but this factor alone is not useful in evaluating treatment efficacy. Although respiratory rate is part of the Neonatal Abstinence Scoring System, this rate alone is not used to evaluate the effectiveness of treatment. The infant should develop a rhythmic sleep-wake cycle.

Front 5

Which medication would most likely be used in the treatment of neonatal abstinence syndrome?
A. Fentanyl (Sublimaze)
B. Clonidine (Catapres)
C. Naloxone (Narcan)
D. Midazolam (Versed)

Back 5

5. B. Clonidine, chlorpromazine, diazepam, methadone, morphine, paragoric, phenobarbital, and tincture of opium are used to treat opioid withdrawal in infants. Fentanyl is a narcotic analgesic, and midazolam is a benzodiazepine. Neither drug is used in the treatment of opioid withdrawal in infants. The administration of naloxone, a narcotic antagonist, may result in rapid withdrawal and seizures in the infant.

Front 6

What information should be included in discharge education for the parents of a full-term newborn who is experiencing the effects of perinatal cocaine exposure?
A. Use of a prone infant sleeping position to decrease irritability
B. Correct method of adminitstering methadone to treat withdrawal symptoms
C. Omission of bottle feedings if the infant exhibits poor suck and swallow
D. calming strategies, such as swaddling and decreasing environmental stimuli

Back 6

6. D. Infants with perinatal cocaine exposure are irritable and restless. Swaddling and decreasing environmental stimulation are effective strategies. Supine positioning for sleep is recommended for full-term infants to reduce the risk of sudden infant death syndrome. Pharmacologic therapy is not used in managing the symptoms of perinatal cocaine exposure. Cocaine-exposed infants are at risk for poor nutritional intake. These infants need small, frequent feedings.

Front 7

What is the most acurate and effective strategy for assessing neonates for perinatal exposure to drugs?
A. neonatal meconium analysis
B. use of the Neonatal Abstinence Scoring System
C. maternal history and self-report
D. neonatal urine toxicologic screening

Back 7

7. A. Meconium analysis is a noninvasive method that can be used to detect perinatal drug exposure as early as the second trimester. Signs associated with neonatal abstinence syndrome, such as tremors or irritability, may also be caused by glucose or electrolyte imbalances. Maternal history may be used to determine whether neonatal drug screening is needed. Urine toxicologic testing detects only recent maternal drug use, within 5 days or less.

Front 8

Tobacco: effects on pregnancy and fetus/neonate

Back 8

pregnancy: spontaneous abortion, placenta previa, abruptio placentae, preterm labor, premature rupture of membranes, csection
fetus/newborn: IUGR (non-head sparing), congenital malformations ie hypospadias, inguinal hernia, eye and ear malformations, polycystic kidneys, aortopulmonary septum defects, gastroschisis, and skull deformities, cognitivie, psychomotor, and language skills, increased risk of SIDS, increased mortality

Front 9

Alcohol: effects on pregnancy and fetus/neonate

Back 9

pregnancy: increased risk of spontaneous abortion, abruptio placentae,breech presentation, increased rsk of perterm delivery
fetus/newborn; FAS the leading cause of mental retardation, congenital anomalies include, cardiac; asd/vsd, tetralogy of Fallot, skeletal, renal;aplastic or dysplastic kidneys, hydronephrosis, ocular; strabismus, optic nerve hypoplasia, increased tortuosity of the retinal vessels, impaired vision, auditory; conductive or neurosensory hearing loss

Front 10

Alcohol withdrawal symptoms

Back 10

onset birth to 12 hours, hyopertonia, tremors, opisthotonos, weak suck and poor feeding pattern, little sleep, cry more, exaggerated mouthing behavior

Front 11

adverse effects of cocaine use

Back 11

abruptio placentae, fetal hypoxia and stillbirth, meconium staining, spontaneous abortion, precipitous delivery, pih, preterm labor, seizures, tremors, cerebral infarction, increased startle, atrial/ventricular arrhythmia, htn, decreased cardiac output, apnea, renal ectopia, increased incidence of nec and perf, vascular lesions, rentinal hemorrhage

Front 12

s/s of cocaine withdrawal

Back 12

irritability, restless, tremulous, hypertonic, followed by drowsiness, lethargy, easily startled, hypertonic or hypotonic, abnormal suck/swallow, abnormal movements.