A pregnant woman at 37 weeks’ gestation has had ruptured membranes for 38 hours. A cesarean is performed for failure to progress. FHR baseline before birth was 180 BPM with marked variability. At birth, the newborn had Apgar scores of 6 and 7 at one and five minutes and is now noted to be pale and tachypneic. Based on the maternal history, what is the most likely cause of this newborn’s distress?
Hypoxia.
Respiratory distress syndrome.
Sepsis.
Phrenic nerve injury.
The Correct Answer is C
Choice A rationale
Hypoxia may contribute to tachypnea and distress, but it is unlikely the primary cause, as baseline fetal heart rate of 180 BPM indicates infection-related stress rather than isolated oxygen deprivation.
Choice B rationale
Respiratory distress syndrome predominantly affects preterm infants due to surfactant deficiency. At 37 weeks’ gestation, surfactant levels should be adequate, making this an unlikely cause of the newborn’s tachypnea and pallor.
Choice C rationale
Prolonged rupture of membranes increases the risk of neonatal sepsis. Signs such as tachypnea, pallor, and elevated fetal heart rate with marked variability suggest systemic infection requiring immediate evaluation and treatment.
Choice D rationale
Phrenic nerve injury typically causes diaphragmatic paralysis, leading to asymmetric chest movement and respiratory distress. However, it does not explain the systemic signs like pallor or elevated heart rate, making it an unlikely cause.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Placing the infant prone increases the risk of sudden infant death syndrome (SIDS), particularly for neonates. Supine positioning reduces this risk and is supported by evidence-based guidelines for infant care.
Choice B rationale
Tightly swaddling and dimming lights mimic the in utero environment, reducing overstimulation and promoting self-regulation. This is especially vital for neonates with neonatal abstinence syndrome (NAS), who are sensitive to external stimuli.
Choice C rationale
Providing excessive stimulation can exacerbate stress responses in neonates with NAS. This may manifest as increased crying, irritability, and tachycardia, worsening their fragile physiological state.
Choice D rationale
Feeding half-strength formula is not advised as it may cause inadequate caloric intake and impaired weight gain. Normal feeding practices, with proper intervals, are crucial to supporting healthy growth and development.
Correct Answer is D
Explanation
Choice A rationale
Uterine prolapse involves the descent of the uterus into the vaginal canal and is not a direct fatal complication of postpartum hemorrhage. It primarily stems from weakened pelvic floor muscles or ligament damage.
Choice B rationale
Von Willebrand’s disease is a hereditary bleeding disorder related to factor VIII and von Willebrand factor deficiencies, predisposing individuals to bleeding. It is not a direct result of prolonged postpartum hemorrhage.
Choice C rationale
Preeclampsia is a hypertensive disorder associated with proteinuria and organ dysfunction during pregnancy, not a postpartum hemorrhage complication. It can lead to significant morbidity but is unrelated to hemorrhagic complications.
Choice D rationale
Disseminated Intravascular Coagulation (DIC) is a life-threatening condition involving widespread coagulation and fibrinolysis, leading to uncontrolled bleeding, often triggered by severe postpartum hemorrhage. Laboratory findings may include low platelets, prolonged PT/INR, and elevated D-dimer.
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