Which of the following is a potential adverse reaction to betamethasone?
Hyperglycemia.
Hyperkalemia.
Hypotension.
Bradycardia.
The Correct Answer is A
Choice A rationale
Betamethasone is a potent synthetic glucocorticoid corticosteroid. Its mechanism involves complex metabolic effects, including promoting gluconeogenesis (glucose production) and reducing peripheral glucose uptake and utilization by decreasing insulin sensitivity. This action can lead to hyperglycemia (elevated blood glucose, normal fasting range is 70-100 mg/dL), requiring careful monitoring, especially in pregnant clients with gestational diabetes.
Choice B rationale
Corticosteroids like betamethasone can cause hypokalemia (low potassium, normal range 3.5-5.0 mEq/L) due to their mineralocorticoid-like effect, which promotes sodium reabsorption in exchange for potassium excretion in the renal tubules. Therefore, it is more likely to cause hypokalemia than hyperkalemia (elevated potassium), making this option an incorrect adverse reaction.
Choice C rationale
Betamethasone is not typically associated with hypotension (low blood pressure). If anything, the mineralocorticoid effects of corticosteroids can sometimes lead to fluid retention and an increase in blood pressure due to increased sodium reabsorption, although this is less pronounced than with true mineralocorticoids, and the primary concern is the metabolic effect.
Choice D rationale
Bradycardia (slow heart rate, normal newborn heart rate 110-160 beats per minute) is not a characteristic adverse reaction of systemic corticosteroids like betamethasone. While some drugs affect heart rate, glucocorticoids generally have a minimal direct impact on cardiac chronotropy at therapeutic doses, and their main adverse effects are metabolic and immune-related.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
Hip dislocation is more commonly associated with overt forms of spina bifida, particularly meningocele or myelomeningocele, which involve neurological deficits causing muscle imbalances and subsequent joint deformities. Spina bifida occulta, characterized by a bony defect in the vertebral arch without protrusion of the spinal cord or meninges, typically does not involve the severe neurological or musculoskeletal deficits required to cause hip dislocation.
Choice B rationale
Hydrocephalus (excess cerebrospinal fluid in the brain ventricles) is a significant complication frequently seen in myelomeningocele due to the associated Chiari II malformation, which obstructs cerebrospinal fluid flow. In spina bifida occulta, the neural structures are generally intact and the spinal cord is not involved, so the complex pathophysiology leading to hydrocephalus is absent, and thus, it is not an expected finding.
Choice C rationale
A dimple in the sacral area (a localized skin abnormality over the defect) is a classic, though not always present, external sign of spina bifida occulta, often accompanied by a tuft of hair or a birthmark (e.g., hemangioma). This finding is a cutaneous marker indicating the underlying failure of the posterior vertebral arches to fuse completely, forming the bony defect.
Choice D rationale
Flaccid paralysis of the lower extremities is indicative of severe lower motor neuron damage, which occurs when the spinal cord or nerve roots are significantly involved, as in myelomeningocele. Spina bifida occulta is distinguished by its occult (hidden) nature, as the spinal cord and meninges are typically covered by skin and often remain structurally and neurologically intact, thus not causing paralysis.
Correct Answer is ["A","B","D"]
Explanation
Choice A rationale
Macrosomic newborns of diabetic mothers frequently experience hyperbilirubinemia (jaundice) due to several factors, including polycythemia (increased red blood cell mass secondary to chronic intrauterine hypoxia) and the large size often leading to birth trauma (e.g., bruising, cephalohematoma), both of which increase the erythrocyte breakdown, overloading the conjugation capacity of the immature liver. Normal bilirubin is less than 5.2 mg/dL.
Choice B rationale
Hypocalcemia (serum calcium level <7.0 mg/dL) is common in these newborns, usually appearing in the first 24-48 hours of life. The proposed mechanism involves functional hypoparathyroidism in the infant, potentially due to rapid drops in maternal calcium or magnesium levels postpartum, and birth stress, leading to a temporary inability to maintain calcium homeostasis.
Choice C rationale
Macrosomia is defined by excessive growth, typically a weight greater than 4000 g (approx 8 lbs 13 oz) at term, and is characterized by increased subcutaneous fat, particularly over the shoulders and trunk, due to fetal hyperinsulinemia. Insulin acts as a primary growth factor, promoting the synthesis and storage of fat and glycogen, so decreased fat is an incorrect finding.
Choice D rationale
Macrosomia is generally defined as a birth weight greater than the 90th percentile for gestational age, or an absolute weight of 4000 grams (8 lbs 13 oz) or more, regardless of gestational age. A weight of 9 pounds (4082 grams) or more is a clear indicator of this condition, often resulting from the hyperinsulinemic state caused by sustained maternal hyperglycemia.
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