A primigravida is being monitored at the prenatal clinic for preeclampsia. Which finding is of greatest concern to the nurse?

Choice A reason: This statement is incorrect, as it describes the direct Coombs test, not the indirect Coombs test. The direct Coombs test is performed on the newborn's blood, and it detects the presence of maternal antibodies that have attached to the newborn's red blood cells. The direct Coombs test can help diagnose hemolytic disease of the newborn, which is a condition where the maternal antibodies destroy the newborn's red blood cells, causing anemia and jaundice.

Choice B reason: This statement is incorrect, as it is not the purpose of the indirect Coombs test, but rather a possible complication of hemolytic disease of the newborn. Kernicterus is a severe form of jaundice that occurs when the bilirubin level in the blood is very high, and it can cause brain damage, deafness, or death. Kernicterus can be prevented by treating the jaundice with phototherapy or exchange transfusion.

Choice C reason: This statement is correct, as it describes the indirect Coombs test, which is performed on the mother's blood, and it detects the presence of Rh-positive antibodies that have formed in response to the exposure to the Rh-positive blood of the newborn. The indirect Coombs test can help identify the risk of hemolytic disease of the newborn, and guide the administration of Rh immunoglobulin, which is a medication that prevents the formation of Rh-positive antibodies.

Choice D reason: This statement is incorrect, as it is not possible for the newborn to have Rh-negative antibodies, since the newborn has Rh-positive blood. Rh-negative antibodies are produced by Rh-negative individuals who have been exposed to Rh-positive blood, such as Rh-negative mothers who have Rh-positive newborns. Rh-negative antibodies can cross the placenta and attack the Rh-positive red blood cells of the newborn, causing hemolytic disease of the newborn.

Choice A reason: Hypoglycemia is a low blood sugar level that can affect newborns, especially those who are premature, small for gestational age, or have diabetic mothers. However, hypoglycemia does not explain the high FHR, the low Apgar scores, or the pale and tachypneic appearance of the newborn.

Choice B reason: Phrenic nerve injury is a rare complication of cesarean section that can cause diaphragmatic paralysis and respiratory distress in the newborn. However, phrenic nerve injury usually affects only one side of the chest, and does not cause high FHR, low Apgar scores, or pallor.

Choice C reason: Sepsis is a serious infection that can affect newborns, especially those who are exposed to prolonged rupture of membranes, as in this case. Sepsis can cause high FHR, low Apgar scores, pale and tachypneic appearance, and other signs of shock and organ failure.

Choice D reason: Meconium aspiration syndrome is a condition where the newborn inhales meconium-stained amniotic fluid into the lungs, causing respiratory distress. However, meconium aspiration syndrome usually occurs in term or post-term infants, and is associated with low FHR, not high FHR. Meconium aspiration syndrome also causes cyanosis, not pallor.