The nurse is caring for a newborn born at 30 weeks gestation.
Which assessment finding should the nurse anticipate?

Choice A rationale

Anti-A and anti-B antibodies are typically of the IgM class, which generally do not cross the placental barrier effectively due to their large molecular size. Therefore, these antibodies are not the primary cause of hemolytic disease of the newborn in Rh incompatibility. ABO incompatibility involves different antibody mechanisms and usually results in less severe hemolysis compared to Rh incompatibility.

Choice B rationale

If the client's blood contains the Rh factor (Rh-positive) and the newborn's does not (Rh-negative), sensitization and antibody formation in the fetus typically do not occur. The issue arises when the mother is Rh-negative and the fetus is Rh-positive, leading to maternal antibody production against fetal Rh antigens.

Choice C rationale

In Rh incompatibility, an Rh-negative client exposed to Rh-positive fetal blood during pregnancy or delivery produces anti-Rh (IgG) antibodies. These smaller IgG antibodies can readily cross the placental barrier into the fetal circulation, where they bind to and destroy fetal Rh-positive red blood cells, leading to hemolytic anemia and subsequent hyperbilirubinemia due to increased heme breakdown.

Choice D rationale

A history of receiving a transfusion with Rh-negative blood would not typically lead to Rh incompatibility with an Rh-positive fetus. In fact, receiving Rh-negative blood when one is Rh-negative would be a compatible transfusion and would not induce anti-Rh antibody production. The problem arises from exposure to Rh-positive blood.

Choice A rationale

Low birth weight is not a common characteristic of newborns with Trisomy 21 (Down Syndrome). In fact, infants with Trisomy 21 often have birth weights within the normal range or can even be slightly above average, although growth patterns after birth may vary.

Choice B rationale

Newborns with Trisomy 21 (Down Syndrome) typically exhibit hypotonia, which is decreased muscle tone, rather than hypertonia. This generalized hypotonia contributes to developmental delays and can affect feeding, motor skills, and overall posture.

Choice C rationale

A protruding tongue is a common characteristic of newborns with Trisomy 21 (Down Syndrome). This feature is often due to a combination of hypotonia of the tongue and mouth muscles, a smaller oral cavity, and sometimes a larger tongue, contributing to feeding difficulties.

Choice D rationale

Simian palmar creases, also known as a single transverse palmar crease, are a common characteristic found in newborns with Trisomy 21 (Down Syndrome). This distinct crease across the palm is a dermatoglyphic anomaly associated with chromosomal abnormalities. .