A woman who underwent a primary cesarean birth for a breech presentation states that her neonate seems to have so much more mucus than her first baby. Concerned, she asks why this has happened.
What is the best response by the nurse?
There is no scientific reason for this occurrence; your baby will be fine in a few hours.
All babies are different so it is unwise to make comparisons between your first baby and your new baby.
Babies born by cesarean section do not have the benefit of having the mucus in their lungs removed by the pressure experienced in the birth canal.
The pain medication given during the surgery may have contributed to the mucus build up in the neonate after birth.
The Correct Answer is C
Choice A rationale
This is an unscientific and dismissive response. There is a clear physiological reason for increased neonatal mucus following a cesarean birth. During a normal vaginal delivery, the thoracic squeeze exerted by the birth canal helps physically expel lung fluid and mucus, aiding the transition to extrauterine respiration.
Choice B rationale
While individual differences exist, this response fails to address the specific pathophysiology associated with the increased mucus observed in cesarean-born neonates. The lack of vaginal compression is a known factor that significantly impacts the clearance of fetal lung fluid and mucus, leading to transient tachypnea.
Choice C rationale
The lack of the "thoracic squeeze" during a cesarean birth means less fetal lung fluid and mucus are mechanically cleared compared to a vaginal birth. This remaining fluid can manifest as increased mucus-like secretions and often leads to conditions like Transient Tachypnea of the Newborn (TTN) as the lungs absorb the remaining fluid.
Choice D rationale
Pain medications like opioids, which may cross the placenta, primarily cause neonatal respiratory depression by acting on the central nervous system's respiratory centers, not by directly causing a physical build-up or inadequate clearance of mucus in the respiratory tract. Mucus clearance is a mechanical process.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice C rationale
Abruptio placentae is the premature separation of the placenta from the uterine wall. The classic signs include dark red vaginal bleeding (due to the pooling of blood behind the placenta), constant and intense abdominal pain, and a rigid, hypertonic uterus that does not relax between contractions. This rigidity is caused by the hemorrhage, clots, and resulting irritation and sustained contraction of the myometrium.
Choice A rationale
Preterm labor is characterized by regular uterine contractions causing cervical changes before 37 weeks' gestation. While contractions cause pain, the uterus typically relaxes completely between them, and the bleeding, if present, is usually bright red and less profuse than that seen with abruptio placentae, and it does not cause sustained uterine firmness.
Choice B rationale
Placenta previa is the implantation of the placenta over or near the cervical os. Its hallmark sign is painless, bright red vaginal bleeding that often occurs late in the second or third trimester. The uterus remains soft and relaxed, unlike the hard, board-like abdomen found with a severe placental abruption.
Choice D rationale
Placenta accreta involves abnormal adherence of the placenta to the uterine wall, typically becoming symptomatic at delivery when the placenta fails to separate. While it can cause bleeding, it does not typically present with the acute, severe abdominal pain and the sustained, board-like uterine rigidity seen before delivery, as it is a pathology of adherence, not separation.
Correct Answer is A
Explanation
Choice A rationale
Rho(D) immune globulin, or RhoGAM, is an exogenous preparation of anti-D antibodies that bind to any fetal Rh-positive red blood cells that enter the maternal circulation, effectively clearing them before the mother's immune system recognizes the D antigen and mounts an immune response. This prevents sensitization, allowing the woman to have unlimited subsequent Rh-positive children without the risk of developing hemolytic disease of the fetus and newborn (HDFN).
Choice B rationale
The recommendation is not limited to only two children if Rho(D) immune globulin is administered correctly. The medication provides passive immunity to prevent the mother from producing her own anti-D antibodies, which are the cause of HDFN in subsequent Rh-positive fetuses. Administration within 72 hours postpartum and often prophylactically around 28 weeks gestation is standard practice.
Choice C rationale
If Rh sensitization has occurred in a prior pregnancy or due to other exposure and Rho(D) immune globulin was not given, the mother's immune system will have produced anti-D antibodies. These immunoglobulin G (IgG) antibodies can cross the placenta and affect all subsequent Rh-positive fetuses, not just the next one, potentially causing fetal hemolysis and severe anemia.
Choice D rationale
Hemolytic disease of the fetus and newborn (HDFN) is determined by the fetal Rh status, specifically the presence of the D antigen on the fetal red blood cells, which is an autosomal dominant trait. The sex of the fetus (male or female) is genetically unrelated to the inheritance of the Rh factor and does not influence the severity or occurrence of the Rh incompatibility reaction.
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