A nurse is admitting a full-term baby boy delivered 12 hours ago to the nursery following a cesarean birth.
The nurse observes that the newborn's skin is slightly yellow.
This finding indicates the newborn is experiencing a complication related to which of the following?
Maternal/newborn blood group incompatibility.
Physiologic jaundice.
Maternal cocaine abuse.
Absence of vitamin K. .
The Correct Answer is B
Choice A rationale:
Maternal/newborn blood group incompatibility can lead to jaundice in newborns, but it typically occurs within the first 24 hours of life. In this scenario, the baby is delivered 12 hours ago, and the yellowing of the skin is described as "slight.”. Physiologic jaundice, which occurs in the majority of newborns, typically appears on the second or third day after birth, so this choice is less likely.
Choice B rationale:
Physiologic jaundice is the most likely cause of the slight yellowing of the newborn's skin. It typically appears on the second or third day after birth and is related to the immature liver's inability to efficiently process bilirubin. Physiologic jaundice is a common and self-limiting condition that does not usually require treatment.
Choice C rationale:
Maternal cocaine abuse can lead to various neonatal complications, but it is not typically associated with jaundice. The yellowing of the skin in this scenario is more likely related to another cause.
Choice D rationale:
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale:
Quickening occurs between the first and second months of pregnancy. This statement is incorrect. Quickening is the term used to describe the first sensations of fetal movement, which usually occur between the 18th and 20th weeks of pregnancy. During the first and second months of pregnancy, the fetus is too small for the mother to feel any movement. This choice is inaccurate.
Choice B rationale:
Quickening occurs between the fourth and fifth months of pregnancy. This is the correct choice. Quickening typically occurs between the 18th and 20th weeks of pregnancy. It marks an important milestone in pregnancy when the mother can start feeling the baby's movements. This is a key point to include in teaching.
Choice C rationale:
Quickening starts soon after implantation. This statement is inaccurate. Quickening does not occur immediately after implantation. Implantation typically occurs around 6-10 days after fertilization. Quickening happens much later in pregnancy, as previously mentioned, between the fourth and fifth months.
Choice D rationale:
Quickening starts during the last weeks of pregnancy. This statement is also incorrect. Quickening is a term used to describe the first movements of the fetus, and it occurs during the second trimester of pregnancy, not during the last weeks. This choice is not accurate.
Correct Answer is A
Explanation
Choice A rationale:
As mentioned in the previous question, Rho(D) immune globulin should be administered to Rh-negative pregnant clients when the newborn is Rh positive. This is essential to prevent Rh sensitization and hemolytic disease of the newborn in future pregnancies. So, if the client is Rh negative and the newborn is Rh positive, the nurse should administer Rho(D) immune globulin to prevent complications. Choice A is the correct answer.
Choice B rationale:
If both the client and the newborn are Rh positive, there is no risk of Rh incompatibility, and Rho(D) immune globulin administration is not necessary. Choice B is not the correct answer.
Choice C rationale:
When both the client and the newborn are Rh negative, there is no risk of Rh incompatibility, and therefore, Rho(D) immune globulin administration is not required. Choice C is not the correct answer.
Choice D rationale:
If the client is Rh positive and the newborn is Rh negative, there is no risk of Rh incompatibility, and Rho(D) immune globulin administration is not necessary in this scenario. Choice D is not the correct answer.
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