A nurse is caring for a client who delivered a post-term infant vaginally with shoulder dystocia.
Which of the following findings should alert the nurse to possible injury in the infant?
Absent Moro reflex on the affected side.
Flaccid paralysis of both lower extremities.
Facial asymmetry when crying or smiling.
Inability to suck or swallow.
The Correct Answer is A
Absent Moro reflex on the affected side indicates a possible injury to the brachial plexus, which is the nerve network that controls the movements and sensations of the shoulder, arm, hand and fingers. Shoulder dystocia can cause brachial plexus injuries when the baby’s shoulder gets stuck behind the mother’s pubic bone during delivery.
Choice B is wrong because flaccid paralysis of both lower extremities is not a common complication of shoulder dystocia.
It could be a sign of spinal cord injury or other neurological disorders.
Choice C is wrong because facial asymmetry when crying or smiling is a sign of facial nerve palsy, which can occur due to compression of the facial nerve during delivery.
It is not specific to shoulder dystocia.
Choice D is wrong because inability to suck or swallow is not a typical sign of shoulder dystocia.
It could be caused by other factors such as prematurity, neurological problems, or congenital anomalies.
Normal ranges for Moro reflex are present at birth and disappear by 4 to 6 months of age.
Normal ranges for facial nerve function are symmetrical movements of both sides of the face.
Normal ranges for sucking and swallowing are coordinated and effective feeding within the first hour after birth.
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Correct Answer is D
Explanation
All of the above factors increase the risk of hyperbilirubinemia in this newborn.Hyperbilirubinemia is a condition of high levels of bilirubin in the blood that can cause jaundice and brain damage.
Choice A is wrong because prematurity is a risk factor for hyperbilirubinemia, especially in babies born before 38 weeks of gestation.Premature babies have immature livers that are less able to process bilirubin and eliminate it from the body.
Choice B is wrong because breastfeeding is a risk factor for hyperbilirubinemia, particularly in some breast-fed babies who do not get enough milk or calories.Breastfeeding can also cause increased enterohepatic circulation of bilirubin, which means that bilirubin is reabsorbed from the intestines into the bloodstream instead of being excreted in the stool.
Choice C is wrong because Asian ethnicity is a risk factor for hyperbilirubinemia, as some Asian populations have higher rates of glucose-6-phosphate dehydrogenase deficiency, a genetic condition that causes red blood cells to break down more easily and release more bilirubin.Asian infants may also have lower levels of uridine diphosphate glucuronosyltransferase, an enzyme that helps convert bilirubin into a form that can be excreted by the liver.
Normal ranges for bilirubin levels vary depending on the age, weight, and health status of the newborn.Generally, bilirubin levels peak between the third and seventh day after birth and then decline gradually.The AAP recommends using a nomogram based on the infant’s age in hours and serum bilirubin level to determine the risk of severe hyperbilirubinemia and the need for treatment.Treatment options include phototherapy and exchange transfusion.
Correct Answer is C
Explanation
Corn tortillas.
Celiac disease is a condition that causes damage to the small intestine when gluten is ingested.
Gluten is a protein found in wheat, barley, rye and oats.
Corn tortillas are made from corn flour, which does not contain gluten and is safe for people with celiac disease.
Choice A is wrong because whole wheat bread contains gluten, which can trigger an immune response and damage the small intestine in people with celiac disease.
Choice B is wrong because oatmeal cookies also contain gluten, either from the oats themselves or from cross-contamination with other grains.
Choice D is wrong because barley soup contains barley, which is another source of gluten that can harm people with celiac disease.
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