Review Macrosomia

Newborn Complications > Maternal & Newborn

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Macrosomia

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Total Questions : 5

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Question 1:

A nurse is caring for a newborn with macrosomia who was born vaginally with shoulder dystocia.

Which of the following assessments should the nurse perform to check for a possible brachial plexus injury?

A. Palpate the clavicles for crepitus or deformity. B. Observe the range of motion of the shoulders and arms. C. Measure the head circumference and compare it with the chest circumference. D. Auscultate the lungs for crackles or wheezes.

Answer and Explanation

Choice A:

Palpating the clavicles for crepitus or deformity is a way to check for a possible clavicular fracture, not a brachial plexus injury.

Choice B:

This is because a brachial plexus injury affects the nerve network that provides feeling and muscle control in the shoulder, arm, forearm, hand, and fingers.A baby with a brachial plexus injury may have full or partial lack of movement, a weakened grip, numbness, or an odd position of the affected arm. Observing the range of motion of the shoulders and arms can help detect any signs of nerve damage or weakness.

Choice C:

Measuring the head circumference and comparing it with the chest circumference is a way to check for a possible cephalopelvic disproportion (CPD), not a brachial plexus injury.

Choice D:

Auscultating the lungs for crackles or wheezes is a way to check for a possible respiratory distress, not a brachial plexus injury.

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Question 2:

A nurse is teaching a pregnant client who has diabetes mellitus about the risk of having a baby with macrosomia.

Which of the following statements by the client indicates a need for further teaching?

A. “I should monitor my blood glucose levels closely and follow my prescribed diet.” B. “I should have regular prenatal visits and ultrasounds to monitor my baby’s growth.” C. “I should expect to have a cesarean section because vaginal delivery is too risky.” D. “I should be aware of the signs of hypoglycemia in my baby after birth.”.

Answer and Explanation

Choice A:

It is a correct statement. Women with diabetes mellitus should monitor their blood glucose levels closely and follow their prescribed diet to prevent hyperglycemia and fetal macrosomia.

Choice B:

It is also a correct statement. Women with diabetes mellitus and macrosomia should have regular prenatal visits and ultrasounds to monitor their baby’s growth and well-bein

Choice C:

This statement indicates a need for further teaching because it is not true that all women with diabetes mellitus and macrosomia need to have a cesarean section. The mode of delivery depends on several factors, such as the estimated fetal weight, the maternal pelvic size, the fetal position, and the presence of any complications. The nurse should explain to the client that vaginal delivery may be possible if the conditions are favorable and the risks are low.

Choice D:

It is another correct statement. Women with diabetes mellitus and macrosomia should be aware of the signs of hypoglycemia in their baby after birth, such as jitteriness, lethargy, poor feeding, and low temperature. The baby may need glucose supplementation or intravenous fluids to maintain normal blood glucose levels. Normal ranges: • Blood glucose levels: 70-110 mg/dL (3.9-6.1 mmol/L) for fasting; <140 mg/dL (<7.8 mmol/L) for postprandial • Estimated fetal weight: 2500-4000 g (5.5-8.8 lb) for term

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Question 3:

A nurse is reviewing the laboratory results of a newborn with macrosomia who has polycythemia.

Which of the following findings should the nurse expect?

A. Hematocrit of 75% B. Hemoglobin of 12 g/dL C. Platelet count of 150,000/mm3 D. White blood cell count of 9,000/mm3.

Answer and Explanation

Choice A:

A hematocrit of 75% indicates polycythemia, which is a condition of having too many red blood cells. Polycythemia is a common complication of macrosomia, which is a condition of having a birth weight of more than 8 pounds, 13 ounces. Polycythemia can cause problems such as jaundice, seizures, and organ dysfunction.

Choice B:

hemoglobin of 12 g/dL is within the normal range for a newborn, which is 14 to 24 g/dL.

Choice C:

Platelet count of 150,000/mm3 is within the normal range for a newborn, which is 150,000 to 450,000/mm3.

Choice D:

White blood cell count of 9,000/mm3 is within the normal range for a newborn, which is 9,000 to 30,000/mm3.

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Question 4:

A nurse is preparing to administer phototherapy to a newborn with macrosomia who has hyperbilirubinemia.

Which of the following interventions should the nurse include in the plan of care?

A. Cover the newborn’s eyes with eye shields or patches. B. Apply sunscreen lotion to the newborn’s skin before exposure. C. Feed the newborn every 4 hours to prevent dehydration. D. Turn off the phototherapy lights during blood draws.

Answer and Explanation

Choice A:

Cover the newborn’s eyes with eye shields or patches. This is because phototherapy exposes the newborn to high-intensity light that can damage the retina and cause eye irritation. Eye shields or patches should be removed every 4 hours to check for eye infection, injury, or displacement.

Choice B:

Sunscreen lotion can block the effect of phototherapy and increase the risk of skin irritation and infection. The newborn’s skin should be exposed as much as possible to the light source.

Choice C:

Feeding the newborn every 4 hours is not enough to prevent dehydration. Phototherapy can increase insensible water loss and fluid requirements. The newborn should be fed every 2 to 3 hours or on demand, and the urine output and weight should be monitored closely.

Choice D:

turning off the phototherapy lights during blood draws can reduce the efficacy of the treatment and prolong the duration of exposure. The lights should be turned off only when absolutely necessary, such as during physical examination or parental bonding.

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Question 5:

A nurse is feeding a newborn with macrosomia who has hypoglycemia.

Which of the following actions should the nurse take?

A. Feed the newborn formula or breast milk as prescribed. B. Feed the newborn glucose water as prescribed. C. Feed the newborn honey or corn syrup as prescribed. D. Feed the newborn rice cereal or oatmeal as prescribed.

Answer and Explanation

Choice A:

Feed the newborn formula or breastmilk as prescribed. This is because newborns with macrosomia (large birth weight) are at risk of hypoglycemia (low blood sugar) due to increased insulin production in response to high glucose levels in the womb. Formula or breastmilk provide adequate glucose and nutrients to prevent or treat hypoglycemia.

Choice B:

Glucose water does not provide enough calories or protein for growth and development.

Choice C:

Honey or corn syrup can cause infant botulism, a serious infection that affects the nervous system.

Choice D:

Rice cereal or oatmeal are not appropriate for newborns, as they can cause choking, allergies, or overfeeding.

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Macrosomia

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