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
Explanation
Choice A rationale
Preterm infants lack coordination for sucking, swallowing, and breathing until approximately 32-34 weeks' gestation. Gavage feeding prevents aspiration by bypassing the immature oral motor mechanisms required for safe oral feeding.
Choice B rationale
Preterm infants can digest milk due to functional gastrointestinal enzymes. Digestive immaturity relates more to delayed gastric emptying rather than the inability to process nutrients, which is managed with small frequent feeds.
Choice C rationale
Monitoring intake is crucial for growth and hydration, but gavage feeding primarily addresses feeding immaturity, not intake measurement. Accurate intake can be monitored through oral feeds with supplemental measurements.
Choice D rationale
Gavage feeding does not directly prevent thrush. Thrush prevention involves oral hygiene and immune support rather than feeding methods, as thrush may still occur regardless of tube feeding or oral intake.
Correct Answer is B
Explanation
Choice A rationale
A cesarean delivery may increase infection risk due to surgical exposure, but a full-term infant born at 38 weeks has more mature immune defenses compared to preterm or growth-restricted infants.
Choice B rationale
A 36-week infant, small for gestational age, has underdeveloped immune function and possible intrauterine growth restriction, which increases susceptibility to infections. Immaturity in skin and mucosal barriers heightens the risk.
Choice C rationale
Infants born to mothers with gestational diabetes may experience metabolic complications, but infection risk is lower in full-term infants due to relatively mature immune function and adequate birth weight.
Choice D rationale
Caput succedaneum may present a localized risk of infection, but a 38-week infant has a more mature immune system compared to premature or growth-restricted infants, thus reducing overall susceptibility to infections.
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