A nurse is visiting a postpartum woman who delivered a healthy newborn 5 days ago.
Which of the following would the nurse expect to find?

Choice A rationale

Hypertension is not a typical sign; often, hypotension occurs due to sepsis or shock. Absence of apnea is incorrect; apnea (cessation of breathing) is a common, generalized sign of serious illness in neonates, including NEC, reflecting central nervous system compromise or sepsis. Ruddy skin color is the opposite of the pallor or mottling often seen due to poor peripheral perfusion associated with septic shock in NEC.

Choice B rationale

A scaphoid abdomen suggests a sunken appearance, whereas NEC typically causes abdominal distention due to intestinal gas accumulation and paralytic ileus. No residual with feedings is an atypical finding; often, increased gastric residuals are observed due to decreased peristalsis. Increased urinary output is contrary to the oliguria often seen in infants with NEC due to third spacing or shock, indicating poor renal perfusion.

Choice C rationale

Hypertonia (increased muscle tone) is generally not an initial sign; neonates with severe systemic illness often exhibit lethargy and hypotonia. Tachycardia is a common response to systemic inflammation or shock. Metabolic alkalosis is incorrect; the typical finding is metabolic acidosis due to poor tissue perfusion leading to anaerobic metabolism and lactic acid production, often compounded by fluid loss.

Choice D rationale

Abdominal distention results from gas accumulation and paralytic ileus caused by inflammation and mucosal damage. Temperature instability (either hypothermia or fever) is a generalized sign of neonatal sepsis, which is a frequent precursor or complication of NEC, reflecting a dysfunctional thermoregulatory system. Grossly bloody stools occur due to intestinal mucosal necrosis and sloughing, a hallmark of advanced NEC, indicating capillary bleeding.

Choice A rationale

Infection typically manifests as fever, elevated white blood cell count (normal range: 4,500–11,000 cells/μL), and localized signs of inflammation or systemic signs of sepsis like altered mental status and hypotension, but it usually develops more gradually than the abrupt onset described. The sudden, severe symptoms of cardiovascular collapse (hypotension 78/36 mmHg), respiratory distress (dyspnea, cyanosis), and tachycardia point more specifically to an acute, mechanical obstruction or profound circulatory shock, which is characteristic of an embolism.

Choice B rationale

Placenta accreta, where the placenta abnormally adheres to the uterine wall, primarily causes life-threatening postpartum hemorrhage and retained placental fragments immediately following birth. While hemorrhage also causes hypotension and tachycardia, the described acute onset of severe chest pain and dyspnea strongly suggests an embolic event originating from the venous circulation or amniotic fluid, rather than solely hemorrhagic shock from a placental issue.

Choice C rationale

Amniotic Fluid Embolism (AFE) is a rare but catastrophic event caused by amniotic fluid entering the maternal circulation, leading to a sudden, severe, triphasic reaction: pulmonary vasospasm (causing dyspnea, cyanosis), pulmonary hypertension, and acute cardiovascular collapse (hypotension 78/36 mmHg, tachycardia). This abrupt, profound presentation immediately post-delivery, involving simultaneous respiratory and hemodynamic failure, is the classic hallmark of AFE.

Choice D rationale

Deep Vein Thrombosis (DVT) formation is a risk postpartum, but its classic presentation involves localized symptoms like unilateral leg pain, swelling, and warmth. A DVT can lead to a Pulmonary Embolism (PE), which presents with chest pain, dyspnea, and tachycardia, but a massive PE causing immediate, severe hypotension (78/36 mmHg) and cyanosis is less common immediately after labor and is more often preceded by signs of DVT; AFE is more rapid and fulminant.