A woman gives birth to a small infant with a malformed skull.

The infant grows abnormally slowly and shows signs of substantial cognitive and intellectual deficits.

The child also has facial abnormalities including a short nose and thin lip that become more striking as it develops.

The correct answer is choice D.

Choice A rationale:

Superficial structures above the muscle refer to first-degree lacerations, which only involve the skin of the perineum and vaginal mucosa.

Choice B rationale:

A fourth-degree laceration does not stop at the anterior rectal wall. It extends through the anal sphincter and into the rectal mucosa.

Choice C rationale:

While a fourth-degree laceration does involve the anal sphincter muscle, it also includes the underlying rectal mucosa.

Choice D rationale:

A fourth-degree laceration involves the perineal muscles, the anal sphincter, and the underlying rectal mucosa.

The correct answer is choice D.

Choice A rationale:

Rho (D) immunoglobulin is not administered when both the client and the newborn are Rh negative.

Choice B rationale:

Rho (D) immunoglobulin is not administered when both the client and the newborn are Rh positive.

Choice C rationale:

Rho (D) immunoglobulin is not administered when the client is Rh positive and the newborn is Rh negative.

Choice D rationale:

Rho (D) immunoglobulin is administered when the client is Rh negative and the newborn is Rh positive. Therefore, this choice is correct.