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Chapter 28: The Newborn at Risk: Acquired and Congenital Problems
Test Bank
MULTIPLE CHOICE
1. A pregnant woman at 37 weeks of gestation has had ruptured membranes for 26 hours. A
Caesarean section is performed for failure to progress. The fetal heart rate (FHR) before birth
is 180 beats/min with limited variability. At birth, the newborn has Apgar scores of 6 at one
minute and 7 at five minutes, and is noted to be pale and tachypneic. On the basis of maternal
history, the cause of this newborn’s distress is most likely to be which of the following?
a. Hypoglycemia
b. Phrenic nerve injury
c. Respiratory distress syndrome
d. Sepsis
ANS: D
The prolonged rupture of membranes and the tachypnea (before and after birth) both suggest
sepsis. A FHR of 180 beats/min is also indicative. This infant is at high risk for sepsis.
DIF: Cognitive Level: Comprehension
TOP: Nursing Process: Assessment
REF: page 747
OBJ: 7
MSC: CRNE: CH-62
2. What is the most important nursing action for preventing neonatal infection?
a. Good hand washing
b. Isolation of infected infants
c. Separate gown technique
d. Standard precautions
ANS: A
Virtually all controlled clinical trials have demonstrated that effective hand washing is
responsible for the prevention of nosocomial infection in nursery units. Measures to be taken
include standard precautions/routine practices, careful and thorough cleaning, frequent
replacement of used equipment, and disposal of excrement and linens in an appropriate
manner. Overcrowding must be avoided in nurseries. However, the most important nursing
action for preventing neonatal infection is effective hand washing.
DIF: Cognitive Level: Comprehension
TOP: Nursing Process: Implementation
REF: page 748
OBJ: 3
MSC: CRNE: CH-59
3. A pregnant woman presents in labour at term, having had no prenatal care. After birth, her
infant is noted to be small for gestational age, with small eyes and a thin upper lip. The infant
also is microcephalic. On the basis of her infant’s physical findings, this woman should be
questioned about her use of which substance during pregnancy?
a. Alcohol
b. Cocaine
c. Heroin
d. Marijuana
ANS: A
The description of the infant suggests fetal alcohol syndrome (FAS), which is consistent with
maternal alcohol consumption during pregnancy. Fetal brain, kidney, and urogenital system
malformations have been associated with maternal cocaine ingestion. Heroin use in pregnancy
frequently results in intrauterine growth restriction. The infant may have a shrill cry and sleep
cycle disturbances and present with poor feeding, tachypnea, vomiting, diarrhea, hypothermia
or hyperthermia, and sweating. Studies have found a higher incidence of meconium staining
in infants born of mothers who used marijuana during pregnancy.
DIF: Cognitive Level: Comprehension
REF: page 757, Table 28-4
OBJ: 4
TOP: Nursing Process: Assessment
MSC: CRNE: CH-5
4. What should be included in a plan of care for an infant experiencing symptoms of drug
withdrawal?
a. Administer chloral hydrate for sedation.
b. Feed every 4 to 6 hours to allow extra rest.
c. Swaddle the infant snugly and hold him or her tightly.
d. Play soft music during feeding.
ANS: C
The infant should be wrapped snugly to reduce self-stimulation behaviours and protect the
skin from abrasions. Phenobarbital or diazepam may be administered to decrease central
nervous system (CNS) irritability. The infant should be fed in small, frequent amounts and
burped well to diminish aspiration and maintain hydration. The infant should not be
stimulated (such as with music) because this will increase activity and potentially increase
CNS irritability.
DIF: Cognitive Level: Application
TOP: Nursing Process: Implementation
REF: page 760
OBJ: 4
MSC: CRNE: CH-20
5. How can human immunodeficiency virus (HIV) be transmitted from mother to infant?
a. Only in the third trimester from the maternal circulation.
b. From a needlestick injury at birth from unsterile instruments.
c. Only through the infant’s ingestion of amniotic fluid.
d. Through the ingestion of breast milk from an infected mother.
ANS: D
Postnatal transmission of HIV through breastfeeding may occur. Transmission of HIV from
mother to infant may occur transplacentally at various gestational ages. Transmission close to
or at the time of birth is thought to account for 50% to 80% of cases.
DIF: Cognitive Level: Comprehension
TOP: Nursing Process: Planning
REF: page 780
OBJ: 2
MSC: CRNE: CH-8
6. The use of which substance during pregnancy is the leading cause of cognitive impairment?
a. Alcohol
b. Tobacco
c. Marijuana
d. Heroin
ANS: A
Alcohol abuse during pregnancy is recognized as one of the leading causes of cognitive
impairment in newborns.
DIF: Cognitive Level: Knowledge
TOP: Nursing Process: Assessment
REF: page 758
OBJ: 4
MSC: CRNE: CH-8
7. During a prenatal examination, the woman reports having two cats at home. The nurse
informs her that she should not be cleaning the litter box while she is pregnant. When the
woman asks why, what should the nurse’s response be?
a. “Your cats could be carrying toxoplasmosis. This is a parasite that can infect you
and have severe effects on your unborn child.”
b. “You and your baby can be exposed to the human immunodeficiency virus (HIV)
in your cats’ feces.”
c. “It’s just gross. You should make your husband clean the litter box.”
d. “Cat feces are known to carry Escherichia coli, which can cause severe infections
in both you and your baby.”
ANS: A
Toxoplasmosis is a multisystem disease caused by the protozoal Toxoplasma gondii parasite
commonly found in cats, dogs, pigs, sheep, and cattle. About 30% of women who contract
toxoplasmosis during gestation transmit the disease to their offspring. Clinical features
ascribed to toxoplasmosis include hydrocephalus or microcephaly, chorioretinitis, seizures, or
cerebral calcifications. HIV is not transmitted by cats. Although suggesting that the woman’s
husband clean the litter boxes may be a valid statement, it is not appropriate, does not answer
the client’s question, and is not the nurse’s best response. E. coli is found in normal human
fecal flora. It is not transmitted by cats.
DIF: Cognitive Level: Application
REF: pages 749-750
OBJ: 2
TOP: Nursing Process: Planning
MSC: CRNE: HW-20
8. A primigravida has just delivered a healthy infant girl. The nurse is about to administer
erythromycin ointment to the infant’s eyes when the mother asks, “What is that medicine
for?” What is the nurse’s best response?
a. “It is an eye ointment to help your baby see you better.”
b. “It is to protect your baby from contracting herpes from your vaginal tract.”
c. “Erythromycin is given prophylactically to all newborns to prevent a gonorrheal
infection.”
d. “This medicine will protect your baby’s eyes from drying out over the next few
days.”
ANS: C
With the prophylactic use of erythromycin, the incidence of gonococcal conjunctivitis has
declined to less than 0.5%. Eye prophylaxis is administered at or shortly after birth to prevent
ophthalmia neonatorum. Erythromycin has no bearing on enhancing vision, is used to prevent
infections caused by gonorrhea, not herpes, and is not used for eye lubrication.
DIF: Cognitive Level: Application
TOP: Nursing Process: Planning
REF: page 750
OBJ: 2
MSC: CRNE: HW-20
9. What should nurses be aware of with regard to skeletal injuries sustained by a neonate during
labour or birth?
a. A newborn’s skull is still forming and fractures fairly easily.
b. Unless a blood vessel is involved, linear skull fractures heal without special
treatment.
c. Clavicle fractures often need to be set with an inserted pin for stability.
d. Other than the skull, the most common skeletal injuries are to leg bones.
ANS: B
About 70% of neonatal skull fractures are linear. Because the newborn skull is flexible,
considerable force is required to fracture it. Clavicle fractures need no special treatment. The
clavicle is the bone most often fractured during birth, not the leg bones.
DIF: Cognitive Level: Comprehension
TOP: Nursing Process: Planning
REF: page 744
OBJ: 1
MSC: CRNE: CH-8
10. With regard to injuries to the infant’s plexus during labour and birth, nurses should be aware
of which of the following?
a. If the nerves are stretched with no avulsion, they should recover completely in
three to six months.
b. Erb palsy is caused by damage to the lower plexus.
c. Parents of children with brachial palsy are taught to pick up the child from under
the axillae.
d. Breastfeeding is not recommended for infants with facial nerve paralysis until the
condition resolves.
ANS: A
If the nerves are stretched with no avulsion, they should recover completely in three to six
months. However, if the ganglia are disconnected completely from the spinal cord, the
damage is permanent. Erb palsy is caused by damage to the upper plexus and is less serious
than brachial palsy. Parents of children with brachial palsy are taught to avoid picking up the
child under the axillae or by pulling on the arms. Breastfeeding is not contraindicated, but
both mother and infant will need help from the nurse at the start.
DIF: Cognitive Level: Comprehension
TOP: Nursing Process: Planning
REF: page 745
OBJ: 1
MSC: CRNE: CH-8
11. With regard to central nervous system injuries to the infant during labour and birth, nurses
should be aware of which of the following?
a. Intracranial hemorrhage (ICH) as a result of birth trauma is more likely to occur in
preterm, low-birth weight infants.
b. Subarachnoid hemorrhage (the most common form of ICH) occurs in term infants
as a result of hypoxia.
c. Signs of hemorrhage in many full-term infants are absent and can be diagnosed
only through laboratory tests.
d. Spinal cord injuries almost always result from forceps-assisted deliveries.
ANS: C
Abnormalities in lumbar punctures or red blood cell counts, for instance, or in visuals on
computed tomography (CT) scans might reveal a hemorrhage. ICH as a result of birth trauma
is more likely to occur in a full-term, large infant. Subarachnoid hemorrhage in term infants is
a result of trauma; in preterm infants it is a result of hypoxia. Spinal cord injuries are almost
always caused by breech births, but they are rare today because Caesarean section is often
used for breech presentation.
DIF: Cognitive Level: Comprehension
TOP: Nursing Process: Planning
REF: page 746
OBJ: 1
MSC: CRNE: CH-3
12. What should the nurse be aware of with regard to the classification of a neonatal bacterial
infection?
a. Congenital infection progresses more slowly than nosocomial infection.
b. Nosocomial infection can be prevented by effective hand washing; early-onset
infections cannot.
c. Infections occur with about the same frequency in boy and girl infants, although
female mortality is higher.
d. The clinical sign of a rapid, high fever makes infection easier to diagnose.
ANS: B
Hand washing is an effective preventive measure for late-onset (nosocomial) infections
because these come from the infant’s environment. Early-onset or congenital infections are
caused by the normal flora of the maternal vaginal tract and progress more rapidly than
nosocomial infections. Infection occurs about twice as often in boys and results in higher
mortality for them. Clinical signs of neonatal infection are nonspecific and similar to
non-infectious problems, making diagnosis difficult.
DIF: Cognitive Level: Comprehension
TOP: Nursing Process: Implementation
REF: page 749
OBJ: 2
MSC: CRNE: HW-2
13. Near the end of the first week of life, an infant who has not been treated for any infection
develops a copper-coloured, maculopapular rash on the palms and around the mouth and anus.
What is the newborn showing signs of?
a. Gonorrhea
b. Herpes simplex virus
c. Congenital syphilis
d. Human immunodeficiency virus (HIV)
ANS: C
The rash is indicative of congenital syphilis. The lesions may extend over the trunk and
extremities.
DIF: Cognitive Level: Analysis
TOP: Nursing Process: Diagnosis
REF: page 750
OBJ: 10
MSC: CRNE: CH-6
14. Which bacterial infection is definitely decreasing because of effective drug treatment?
a. Escherichia coli infection
b. Tuberculosis
c. Candidiasis
d. Group B streptococcal infection
ANS: D
Penicillin has significantly decreased the incidence of group B streptococcal infections. E. coli
may be increasing, perhaps because of the increased use of ampicillin (resulting in a more
virulent E. coli strain resistant to the drug). Tuberculosis is increasing in Canada and the
United States. Candidiasis is a fairly benign fungal infection.
DIF: Cognitive Level: Comprehension
TOP: Nursing Process: Evaluation
REF: page 755
OBJ: 6
MSC: CRNE: CH-44
15. In caring for a mother who has abused (or is abusing) alcohol and her infant, what should
nurses be aware of?
a. The pattern of growth restriction of the fetus begun in prenatal life is halted after
birth, and normal growth takes over.
b. Two-thirds of newborns with fetal alcohol syndrome (FAS) are boys.
c. Alcohol-related neurodevelopmental disorders that do not meet FAS criteria (such
as learning disabilities, speech and language problems) are often not detected until
the child goes to school.
d. Both the distinctive facial features of the FAS infant and the diminished mental
capacities tend toward normal over time.
ANS: C
Some learning problems do not become evident until the child is at school. The pattern of
growth restriction persists after birth. Two-thirds of newborns with FAS are girls. Although
the distinctive facial features of the FAS infant tend to become less evident, mental capacities
never become normal.
DIF: Cognitive Level: Comprehension
TOP: Nursing Process: Planning
REF: page 757
OBJ: 4
MSC: CRNE: HW-17
16. What does a careful review of the literature on mothers addicted to various recreational and
illicit drugs reveal?
a. More long-term studies are needed to assess the lasting effects on infants when
mothers have taken or are taking illegal drugs.
b. Heroin and methadone cross the placental barrier; marijuana, cocaine, and
phencyclidine (PCP) do not.
c. Mothers should get off heroin (detox) any time they can during pregnancy.
d. Methadone withdrawal is less severe for infants and has a shorter duration than
heroin withdrawal.
ANS: A
Studies on the effects of marijuana and cocaine use by mothers are somewhat
contradictory—more long-range studies are needed. Just about all of these drugs cross the
placenta, including marijuana, cocaine, and PCP. Drug withdrawal for the mother is
accompanied by fetal withdrawal, which can lead to fetal death. Therefore, detoxification
from heroin during pregnancy is not recommended, particularly later on. Methadone
withdrawal is more severe and more prolonged than heroin withdrawal.
DIF: Cognitive Level: Analysis
REF: page 757 | page 759
OBJ: 4
TOP: Nursing Process: Evaluation
MSC: CRNE: PP-15
17. What should the nurse understand about the treatment of infants born to mothers who are
substance users?
a. Infants born to addicted mothers are also addicted.
b. Mothers who use one substance likely will use or abuse another, compounding the
infant’s difficulties.
c. The NICU Network Neurobehavioral Scale (NNNS) is designed to assess the
damage the mother has done to herself.
d No laboratory procedures are available that can identify the intrauterine drug
exposure of the infant.
ANS: B
Mothers who use multiple substances (even when these are just alcohol and tobacco) make it
difficult to assess the problems of the exposed infant, particularly concerning withdrawal
manifestations. Infants of substance-using mothers may demonstrate some of the
physiological signs of addiction, but are not addicted in the behavioural sense. “Drug-exposed
newborn” is a more accurate description than “addict.” The NNNS is designed to assess the
neurological, behavioural, and stress/abstinence function of the neonate. Newborn urine, hair,
or meconium sampling may be used to identify an infant’s intrauterine drug exposure.
DIF: Cognitive Level: Comprehension
REF: pages 756-757 | page 762
OBJ: 4
TOP: Nursing Process: Evaluation
MSC: CRNE: CH-7
18. Providing care for a neonate born to a mother who uses substances can present a challenge for
the health care team. Nursing care for this infant requires a multisystem approach. What is the
first step to take when providing care for this infant?
a. Pharmacological treatment
b. Reduction of environmental stimuli
c. Neonatal abstinence syndrome scoring
d. Adequate nutrition and maintenance of fluid and electrolyte balance
ANS: C
Neonatal abstinence syndrome (NAS) is the term used to describe the cohort of symptoms
associated with drug withdrawal in neonates. The Neonatal Abstinence Scoring System
evaluates CNS, metabolic, vasomotor, respiratory, and gastrointestinal disturbances. This
evaluation tool enables the health care team to develop an appropriate plan of care. The infant
is scored throughout the length of his or her stay, and the treatment plan is adjusted
accordingly. Pharmacologic treatment is based on the severity of withdrawal symptoms.
Symptoms are determined with a standard assessment tool. The medications of choice are
morphine, phenobarbital, diazepam, or a diluted tincture of opium. Swaddling, holding, and
reducing environmental stimuli are essential when providing care to an infant who is
experiencing withdrawal. These nursing interventions are appropriate for an infant who
displays central nervous system (CNS) disturbances. Poor feeding is one of the
gastrointestinal symptoms common to this client population. Fluid and electrolyte balance
must be maintained, and adequate nutrition provided. These infants often have a poor suck
reflex and may need to be fed via gavage.
DIF: Cognitive Level: Application
TOP: Nursing Process: Assessment
REF: page 762
OBJ: 4
MSC: CRNE: CH-4
19. While completing a newborn assessment, the nurse should be aware that which one of the
following is the most common birth injury?
a. Injury to the soft tissues
b. Caused by forceps gripping the head on delivery
c. Fracture of the humerus and femur
d. Fracture of the clavicle
ANS: D
The most common birth injury is fracture of the clavicle (collarbone). It usually heals without
treatment, although the arm and shoulder may be immobilized for the infant’s comfort.
DIF: Cognitive Level: Knowledge
TOP: Nursing Process: Assessment
REF: page 744
OBJ: 1
MSC: CRNE: CH-7
20. Which drug is contraindicated for infants born to narcotic-addicted mothers?
a. Naloxone
b. Gentamycin
c. Vitamin K
d. Erythromycin
ANS: A
The use of naloxone (Narcan) is contraindicated for infants born to narcotic addicts because it
may exacerbate neonatal abstinence syndrome (NAS) and cause seizures.
DIF: Cognitive Level: Knowledge
TOP: Nursing Process: Diagnosis
REF: page 761
OBJ: 5
MSC: CRNE: CH-44
21. Which infant is more likely to have Rh incompatibility?
a. An infant with an Rh-negative mother and Rh-positive father homozygous for the
Rh factor
b. An infant who is Rh negative and whose mother is Rh negative
c. An infant with an Rh-negative mother and Rh-positive father heterozygous for the
Rh factor
d. An infant who is Rh positive and whose mother is Rh positive
ANS: A
If the mother is Rh negative and the father is Rh positive and homozygous for the Rh factor,
all the offspring will be Rh positive. Only Rh-positive offspring of an Rh-negative mother are
at risk for Rh incompatibility. If the mother is Rh negative and the father is Rh positive and
heterozygous for the factor, there is a 50% chance that each infant born of the union will be
Rh positive, and a 50% chance that each will be born Rh negative.
DIF: Cognitive Level: Comprehension
TOP: Nursing Process: Planning
REF: page 765
OBJ: 8
MSC: CRNE: CH-8
22. What is a major nursing intervention for an infant born with myelomeningocele?
a. Protect the sac from injury.
b. Prepare the parents for the infant’s paralysis from the waist down.
c. Prepare the parents for closure of the sac at around 2 years of age.
d. Assess for cyanosis.
ANS: A
A major preoperative nursing intervention for a neonate with a myelomeningocele is
protection of the protruding sac from injury to prevent its rupture and the resultant risk of
central nervous system infection. The long-term prognosis in an affected infant can be
determined to a large extent at birth, with the degree of neurological dysfunction related to the
level of the lesion, which determines the nerves involved. A myelomeningocele should be
surgically closed within 24 hours. Although the nurse should assess for multiple potential
problems in this infant, the major nursing intervention would be to protect the sac from injury.
DIF: Cognitive Level: Comprehension
REF: page 769
OBJ: 10
TOP: Nursing Process: Planning | Nursing Process: Implementation
MSC: CRNE: CH-20
23. What is priority nursing diagnosis for a newborn diagnosed with a diaphragmatic hernia?
a. Risk for impaired parent–infant attachment
b. Imbalanced nutrition: less than body requirements
c. Risk for infection
d. Impaired gas exchange
ANS: D
Herniation of the abdominal viscera into the thoracic cavity may cause severe respiratory
distress and represent a neonatal emergency. Oxygen therapy, mechanical ventilation, and the
correction of acidosis are necessary in infants with large defects. Although the diagnoses of
Risk for impaired parent–infant attachment, Imbalanced nutrition: less than body
requirements, and Risk for infection may be accurate for a newborn with a diaphragmatic
hernia, the priority nursing diagnosis concerns oxygenation issues that arise from lung
hypoplasia.
DIF: Cognitive Level: Application
TOP: Nursing Process: Diagnosis
REF: page 771
OBJ: 1
MSC: CRNE: CH-65
24. Which one of the following would an infant diagnosed with erythroblastosis fetalis
characteristically exhibit?
a. Edema
b. Immature red blood cells
c. Enlargement of the heart
d. Ascites
ANS: B
Erythroblastosis fetalis occurs when the fetus compensates for the anemia associated with Rh
incompatibility by producing a large number of immature erythrocytes to replace those that
have been hemolyzed. Edema would occur with hydrops fetalis, a more severe form of
erythroblastosis fetalis. A fetus with hydrops fetalis may exhibit effusions into the peritoneal,
pericardial, and pleural spaces. An infant with hydrops fetalis displays signs of ascites.
DIF: Cognitive Level: Comprehension
TOP: Nursing Process: Assessment
REF: page 767
OBJ: 8
MSC: CRNE: CH-8
25. What should the nurse be aware of concerning hemolytic diseases of the newborn?
a. Rh incompatibility matters only when Rh-negative offspring are born to an
Rh-positive mother.
b. ABO incompatibility is more likely than Rh incompatibility to precipitate
significant anemia.
c. Exchange transfusions are frequently required in the treatment of hemolytic
disorders.
d. The indirect Coombs’ test is performed on the mother before birth; the direct
Coombs’ test is performed on the cord blood after birth.
ANS: D
An indirect Coombs’ test may be performed on the mother a few times during pregnancy.
Only the Rh-positive offspring of an Rh-negative mother is at risk. ABO incompatibility is
more common than Rh incompatibility but causes less severe problems; significant anemia,
for instance, is rare with ABO. Exchange transfers are needed infrequently because of the
decrease in the incidence of severe hemolytic disease in newborns from Rh incompatibility.
DIF: Cognitive Level: Comprehension
TOP: Nursing Process: Planning
REF: page 767
OBJ: 8
MSC: CRNE: CH-4
26. What should the nurse be aware of concerning congenital anomalies of the cardiovascular and
respiratory systems?
a. Cardiac disease may manifest as respiratory symptoms.
b. Screening for congenital anomalies of the respiratory system need only be done for
infants in respiratory distress.
c. Choanal atresia can be corrected by a suction catheter.
d. Congenital diaphragmatic hernias are diagnosed and treated after birth.
ANS: A
The cardiac and respiratory systems function together. Screening for congenital respiratory
system anomalies is necessary even for infants who appear normal at birth. Choanal atresia
requires emergency surgery. Congenital diaphragmatic hernias are discovered prenatally on
ultrasound.
DIF: Cognitive Level: Comprehension
TOP: Nursing Process: Assessment
REF: page 770
OBJ: 10
MSC: CRNE: CH-8
27. When attempting to diagnose and treat developmental dysplasia of the hip (DDH), what
should the nurse do?
a. Know how to perform Ortolani and Barlow tests.
b. Teach double or triple diapering for added support.
c. Explain to the parents the need for serial casting.
d. Carefully monitor infants for DDH at follow-up visits.
ANS: D
Because DDH often is not detected at birth, infants should be monitored carefully at follow-up
visits. The Ortolani and Barlow tests must be performed by experienced clinicians to prevent
fracture or other damage to the hip. Double or triple diapering is not recommended because it
promotes hip extension, thus worsening the problem. Serial casting is done for clubfeet, not
DDH.
DIF: Cognitive Level: Comprehension
TOP: Nursing Process: Planning
REF: page 775
OBJ: 10
MSC: CRNE: CH-1
28. Cleft lip or palate is a common congenital midline fissure or opening in the lip or palate
resulting from the primary palate’s failure to fuse. Multiple genetic, and to a lesser extent,
environmental factors may lead to the development of a cleft lip or palate. Which of the
following is one factor?
a. Alcohol consumption
b. Female gender
c. Use of antispasmodic medication
d. Antibiotic use in pregnancy
ANS: A
Factors that are associated with the potential development of cleft lip or palate are maternal
infection, tobacco exposure, radiation exposure, alcohol ingestion, and the use of medications
such as corticosteroids, some tranquilizers, and anti-epileptics. Cleft lip is more common in
male infants. The use of antibiotic and antispasmodic medications during pregnancy is not
associated with the development of cleft lip or palate.
DIF: Cognitive Level: Comprehension
TOP: Nursing Process: Planning
REF: page 772
OBJ: 10
MSC: CRNE: CH-8
29. For infants of mothers who used heroin during their pregnancy, which statement is true?
a. They have an increased incidence of IUGR.
b. They have a higher-than-average birth weight.
c. They have more risk of congenital anomalies.
d. They have a decreased risk of SIDS.
ANS: A
Heroin crosses the placenta and often results in IUGR. Infants usually have a
lower-than-average birth weight. There is less of a risk of congenital anomalies. There is an
increased risk of SIDS.
DIF: Cognitive Level: Comprehension
TOP: Nursing Process: Assessment
REF: page 761
OBJ: 10
MSC: CRNE: CH-8