The nurse is giving report to a student about a newborn they suspect has toxoplasmosis.
Which statement by the student on how and when the infection was transmitted to the newborn does not require further teaching?
Through a prolonged rupture of membranes.
In the postpartum period through infected droplets.
During birth as the fetus was expelled through the vaginal canal.
In utero through the placenta.
The Correct Answer is D
Choice A rationale
Transmission of Toxoplasma gondii is typically not associated with a prolonged rupture of membranes. Although ascending infection from the vagina can occur with other pathogens, Toxoplasma is generally transmitted hematogenously. Prolonged rupture of membranes primarily raises the risk for bacterial chorioamnionitis and subsequent neonatal sepsis, not congenital toxoplasmosis. The primary risk time is in utero.
Choice B rationale
Postpartum transmission through infected droplets is characteristic of respiratory viruses, like influenza or respiratory syncytial virus (RSV), not Toxoplasma gondii. Congenital toxoplasmosis occurs when the mother acquires the infection during pregnancy, leading to parasitemia and subsequent transplacental spread to the fetus, not via postnatal droplet spread.
Choice C rationale
Transmission of Toxoplasma gondii during the birth process as the fetus moves through the vaginal canal is the route for organisms like Herpes Simplex Virus (HSV) or Group B Streptococcus (GBS). Congenital toxoplasmosis is an intrauterine infection, resulting from the trophozoite form crossing the placenta from a recently infected, parasitemic mother.
Choice D rationale
Toxoplasmosis is classically transmitted in utero via the placenta. If a non-immune mother acquires the primary infection with Toxoplasma gondii during pregnancy, the tachyzoites can cross the placental barrier and infect the fetus, causing congenital toxoplasmosis, which can lead to severe neurologic and ocular defects.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
Green-stained amniotic fluid in a fetus, especially one who is post-term (41 weeks), is highly suggestive of meconium staining. This occurs when the fetus passes its first stool (meconium) in utero. While the meconium is expelled, its presence in the amniotic fluid is often a sign of fetal stress or compromise, which can lead to complications such as meconium aspiration syndrome.
Choice B rationale
Although green or foul-smelling amniotic fluid can indicate intrauterine infection (chorioamnionitis), particularly if accompanied by maternal fever or uterine tenderness, meconium staining is a more common cause in a post-term pregnancy with a breech presentation. Chorioamnionitis involves ascending infection of the membranes and fluid, not solely the color change due to meconium.
Choice C rationale
Neural tube defects, like spina bifida or anencephaly, are congenital structural abnormalities resulting from incomplete closure of the embryonic neural tube. While they can sometimes be associated with oligohydramnios or specific markers, they do not typically cause the amniotic fluid to turn green. Green fluid is a sign of a physiological event, not an anatomical malformation.
Choice D rationale
Meconium passage in utero, resulting in green amniotic fluid, is frequently an indicator of fetal distress or compromise, often due to hypoxia (oxygen deprivation) or umbilical cord compression. The fetus may pass meconium secondary to vagal nerve stimulation from stress. Therefore, the nurse's finding immediately alerts the team that fetal well-being may be acutely threatened, necessitating close monitoring and potential intervention.
Correct Answer is ["B","D","F"]
Explanation
Choice A rationale
Amniocentesis is generally a brief, outpatient procedure performed under sterile conditions, and hospitalization for 48 hours is unnecessary. The client is usually monitored for a short time after the procedure for complications like bleeding or leaking amniotic fluid, then discharged home with instructions for rest and monitoring for signs of infection or labor.
Choice B rationale
Amniocentesis is a diagnostic procedure where a sterile needle is inserted transabdominally into the amniotic sac under ultrasound guidance. The purpose is to aspirate a small amount of amniotic fluid, which contains fetal cells and biochemical substances, for genetic, chromosomal, or biochemical analysis to assess fetal health and maturity.
Choice C rationale
Changing of abdominal curvature is a normal finding throughout pregnancy as the uterus grows and the fetus develops. However, it is not a specific, expected finding immediately following an amniocentesis procedure, which involves minimal abdominal trauma from a fine-gauge needle puncture, and the curvature change is gradual and related to gestation.
Choice D rationale
Ultrasound guidance is a critical safety measure during an amniocentesis. It is used to precisely locate the placenta, fetus, and pockets of amniotic fluid, ensuring the needle avoids the fetus, umbilical cord, and placenta, thereby minimizing the risk of fetal trauma or maternal complications during the aspiration process.
Choice E rationale
A fever is a sign of infection (e.g., chorioamnionitis or local wound infection) and is not an expected or normal finding after an amniocentesis. Clients are instructed to report any signs of infection, such as fever (greater than 100.4°F or 38°C), chills, uterine tenderness, or unusual vaginal discharge, to the healthcare provider immediately.
Choice F rationale
Amniocentesis carries a small risk of fetomaternal hemorrhage (fetal red blood cells entering the maternal circulation) across the placental barrier. For Rh-negative clients, this exposure can lead to Rh sensitization. Therefore, a dose of RhoGAM (Rh immune globulin) is administered prophylactically to prevent the production of maternal anti-Rh antibodies.
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