A nurse is caring for a client who has borderline personality disorder (BPD). As part of the client's plan of care, the nurse reviews the day's schedule with the client each morning. As the nurse begins to review the schedule with the client, the client says, "Why don't you shut up already? I can read it myself, you know!" Which of the following responses should the nurse give the client?

Rationale:

A) Congenital anomalies: Congenital anomalies, also known as birth defects, are structural or functional abnormalities present at birth. They can affect any part of the body and may cause physical or developmental disabilities, as well as contribute to infant mortality. These anomalies can result from genetic factors, environmental exposures during pregnancy, or a combination of both. Preventive measures such as prenatal care, genetic counseling, and maternal health promotion play crucial roles in reducing the incidence and impact of congenital anomalies.

B) Respiratory distress: While respiratory distress can be a significant concern in newborns, especially those born prematurely or with certain medical conditions, it is not the leading cause of death among infants. Respiratory distress syndrome (RDS) occurs primarily in premature infants due to immature lung development and surfactant deficiency, requiring supportive care and sometimes mechanical ventilation to manage.

C) Sudden infant death syndrome (SIDS): SIDS is the sudden and unexplained death of an otherwise healthy infant, typically occurring during sleep. While SIDS is a devastating tragedy and a major public health concern, it is not the leading cause of death among infants. Strategies to reduce the risk of SIDS include placing infants on their backs to sleep, avoiding soft bedding and overheating, and promoting a safe sleep environment.

D) Low birth weight: Low birth weight, defined as a birth weight of less than 2,500 grams (5.5 pounds), is associated with an increased risk of neonatal complications and long-term health issues. While low birth weight infants may face various health challenges, including respiratory problems and developmental delays, low birth weight itself is not the leading cause of death among infants. Efforts to reduce low birth weight include prenatal care, nutrition support, and management of maternal risk factors such as smoking and substance abuse.

A. Projectile vomiting: Pyloric stenosis is a condition characterized by the narrowing of the pylorus, the opening between the stomach and the small intestine. This narrowing leads to obstruction of the gastric outlet, causing the stomach to become distended with food. When the infant feeds, the stomach fills up, but the food cannot pass through the narrowed pylorus efficiently. As a result, the infant forcefully expels the contents of the stomach in a characteristic manner known as projectile vomiting. Projectile vomiting is forceful, often occurring shortly after feeding, and the vomited material is usually not bile-stained.

B. Ridged abdomen: While abdominal distension can occur due to the buildup of gastric contents in pyloric stenosis, the term "ridged abdomen" is not typically associated with this condition. Instead, clinicians may palpate an olive-shaped mass in the right upper quadrant of the abdomen, which represents the hypertrophied pylorus. The ridged appearance may be more indicative of conditions such as peritonitis or muscular rigidity, rather than pyloric stenosis.

C. Distended neck veins: Distended neck veins are not typically associated with pyloric stenosis. This symptom is more commonly observed in conditions affecting the cardiovascular system, such as congestive heart failure. In pyloric stenosis, the primary manifestations are related to gastrointestinal obstruction, particularly projectile vomiting, rather than signs of circulatory compromise.

D. Red currant jelly stools: Red currant jelly stools are a characteristic finding in intussusception, a condition where one portion of the intestine telescopes into another, causing obstruction and compromise of the blood supply. This leads to the passage of stools containing blood and mucus, resembling red currant jelly in appearance. Pyloric stenosis primarily affects gastric emptying and does not typically result in bloody stools. Instead, the hallmark symptom is projectile vomiting due to gastric outlet obstruction.