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 ["A","C","D"]
Explanation
Choice A rationale
Postpartum hemorrhage may occur weeks after delivery due to subinvolution of the uterus or retained placental fragments. Educating about late risks ensures patients monitor symptoms and seek timely care.
Choice B rationale
Breastfeeding is encouraged even after postpartum hemorrhage as it helps stimulate uterine contractions, reducing bleeding risk. Recommending avoidance could delay recovery and is scientifically unsupported unless contraindicated.
Choice C rationale
Oxytocin may be prescribed for ongoing uterine atony or to prevent late postpartum hemorrhage. It is essential to educate patients about its purpose and correct administration for safety and effectiveness.
Choice D rationale
Saturating a peri-pad within 1 hour may indicate active bleeding. Reporting this promptly ensures swift intervention to prevent further complications, aligning with standard postpartum care protocols.
Choice E rationale
Postpartum hemorrhage is not limited to 24–48 hours after birth; late-onset hemorrhage, occurring up to weeks later, is a known complication. Misleading patients with this incorrect timeframe can delay critical interventions.
Correct Answer is D
Explanation
Choice A rationale
Infection of the uterus typically presents with fever, foul-smelling lochia, and uterine tenderness, not bright red vaginal bleeding with a firm fundus. Firm fundus decreases the likelihood of retained products causing infection.
Choice B rationale
Uterine atony causes excessive vaginal bleeding due to the uterus's inability to contract effectively, but it doesn't apply here since the fundus is firm, indicating adequate uterine tone.
Choice C rationale
Perineal hematoma results from blood vessel damage during delivery. It causes a tense, painful mass and vaginal or perineal swelling, not steady, bright red bleeding with a firm fundus.
Choice D rationale
Lacerations of the genital tract result in bright red bleeding despite a firm fundus, as the bleeding originates from tears in the vaginal or perineal tissues rather than uterine atony.
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