Which bone in an infant may be broken during a shoulder dystocia?

Femur

Humerus

Clavicle

Skull

Answer and Explanation

The Correct Answer is C

A. Femur: The femur is not typically involved in birth-related trauma during shoulder dystocia. This long bone is located in the thigh and is relatively well protected during delivery, making it an unlikely site for injury in this context.

B. Humerus: While the humerus can occasionally be fractured during difficult deliveries, especially if excessive traction is applied, it is less commonly injured than the clavicle during shoulder dystocia. Fractures of the humerus are usually secondary to more forceful maneuvers or malpositioning.

C. Clavicle: During shoulder dystocia, the baby's anterior shoulder gets stuck behind the mother's pubic bone. The clavicle is the most commonly fractured bone. Fracture can occur as a natural mechanism to reduce shoulder width or may result from delivery maneuvers, and it often facilitates passage of the shoulder through the birth canal.

D. Skull: Skull fractures are rare in shoulder dystocia because the head is typically already delivered by the time the dystocia is recognized. Skull fractures are more often associated with instrumental deliveries or cephalopelvic disproportion rather than shoulder entrapment.

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Correct Answer is C

Explanation

A. Suction the nose with a bulb syringe: While clearing nasal secretions is important, suctioning the mouth takes priority over the nose. Stimulating the nares before clearing the oral airway can cause aspiration if secretions are present in the mouth, especially in newborns with underdeveloped airway protective reflexes.

B. Use a suction catheter with low negative pressure: Suction catheters are typically reserved for cases requiring deeper or more controlled suctioning, such as in NICU settings. For routine post-delivery care, a bulb syringe is the safest and most effective tool to clear the newborn’s airway without risking trauma or excessive negative pressure.

C. Suction the mouth with a bulb syringe: Clearing the mouth first is the priority to prevent aspiration and ensure an open airway. Bulb syringe suctioning is gentle and effective for removing excess mucus or amniotic fluid from the oropharynx, facilitating spontaneous breathing and reducing respiratory distress in the immediate newborn period.

D. Turn the newborn on his side: Positioning the newborn on their side may aid in drainage of secretions, but it is not sufficient as a first action when secretions are visibly bubbling from the nose and mouth. Active suctioning is necessary to clear the airway and prevent obstruction or aspiration as the first step and the head should be placed in a sniffing position rather than turning.

A. Brachial plexus injury B. Increased deposits of fat in the chest and shoulder area C. Hyperinsulinemia D. Increased blood viscosity

Correct Answer is C

Explanation

A. Brachial plexus injury: While macrosomic infants are at risk for brachial plexus injuries due to shoulder dystocia, this condition is associated with motor deficits, not respiratory distress. It does not impair lung function or surfactant production, and thus is not the cause of respiratory distress syndrome (RDS).

B. Increased deposits of fat in the chest and shoulder area: Macrosomic infants may have excess adipose tissue, particularly in the shoulders and chest, which can complicate delivery, but this fat distribution does not impair respiratory function directly or lead to surfactant deficiency, the hallmark of RDS.

C. Hyperinsulinemia: Infants of diabetic mothers (IDMs), especially when maternal diabetes is poorly controlled, often experience hyperinsulinemia, which antagonizes cortisol, a hormone necessary for fetal lung maturation and surfactant synthesis. The lack of adequate surfactant leads to alveolar collapse and respiratory distress syndrome, even in term infants who would normally have mature lungs.

D. Increased blood viscosity: Polycythemia, or increased red blood cell mass, is common in IDMs due to chronic intrauterine hypoxia, but while it can lead to sluggish circulation and hypoxia, it is not a direct cause of RDS. Respiratory symptoms in RDS stem primarily from surfactant deficiency, not thickened blood.

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Which bone in an infant may be broken during a shoulder dystocia?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has just delivered a newborn. The nurse notes secretions bubbling out of the newborn's nose and mouth. Which of the following actions is the nurse's priority?

Correct Answer is C

Explanation

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Correct Answer is C

Explanation

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