Review Post-term birth

Newborn Complications > Maternal & Newborn

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Post-term birth

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Total Questions : 5

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Question 1:

A nurse is caring for a post-term newborn who has meconium staining on the nails and umbilical cord.

What is the most likely cause of this finding?

A. The newborn has a bowel obstruction. B. The newborn has a congenital anomaly. C. The newborn experienced fetal distress. D. The newborn has an infection.

Answer and Explanation

Choice A:

A bowel obstruction would not cause meconium staining of the nails and umbilical cord.

Choice B:

A congenital anomaly would not necessarily cause meconium passage or staining.

Choice C:

The newborn experienced fetal distress.Meconium staining is often caused by fetal hypoxia or other physiologic stress that triggers the fetus to pass meconium into the amniotic fluid before delivery.If the fetus aspirates the meconium, it can cause lung injury and respiratory distress, termed meconium aspiration syndrome.

Choice D:

An infection may cause fetal distress, but it is not the direct cause of meconium staining.Meconium staining may be a sign of infection in the newborn.

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Question 2:

A nurse is assessing a post-term newborn who has oligohydramnios.

What is the main complication associated with this condition?

A. Cord compression. B. Fetal malposition. C. Placental abruption. D. Premature rupture of membranes.

Answer and Explanation

Choice A:

Oligohydramnios is a condition where there is too little amniotic fluid surrounding the fetus. This can cause the umbilical cord to become compressed by the fetal body parts or the uterine wall, reducing blood flow and oxygen to the fetus. This can lead to fetal distress, hypoxia, and acidosis.

Choice B:

Fetal malposition is not directly caused by oligohydramnios. Fetal malposition is when the fetus is in an abnormal position for delivery, such as breech, transverse, or face presentation. This can increase the risk of complications during labor and delivery, such as cord prolapse, dystocia, or birth trauma.

Choice C:

Placental abruption is not directly caused by oligohydramnios. Placental abruption is when the placenta separates from the uterine wall before delivery, causing bleeding and reduced blood flow to the fetus. This can be triggered by trauma, hypertension, or cocaine use.

Choice D:

Premature rupture of membranes (PROM) is not directly caused by oligohydramnios. PROM is when the amniotic sac breaks before the onset of labor, causing leakage of fluid and increased risk of infection. This can be caused by infection, cervical incompetence, or mechanical factors.

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Question 3:

A nurse is preparing to perform a heel stick blood glucose test on a post-term newborn who has macrosomia.

What is the rationale for this test?

A. To detect hypoglycemia due to increased insulin production. B. To detect hyperglycemia due to decreased insulin sensitivity. C. To detect polycythemia due to increased erythropoietin secretion. D. To detect anemia due to decreased hemoglobin synthesis.

Answer and Explanation

Choice A:

A post-term newborn who has macrosomia is at risk of hypoglycemia because the fetus produces more insulin in response to the high glucose levels from the mother. After birth, the glucose supply from the mother is cut off, but the newborn still has high insulin levels, which can cause low blood glucose. A heel stick blood glucose test is done to monitor the newborn’s blood glucose level and prevent complications from hypoglycemia.

Choice B:

Hyperglycemia is not a common problem for post-term newborns with macrosomia. Hyperglycemia occurs when there is too much glucose and not enough insulin in the blood. This is more likely to happen in infants of diabetic mothers who have poor glycemic control during pregnancy.

Choice C:

Polycythemia is not related to insulin or glucose levels. Polycythemia is a condition where there are too many red blood cells in the blood, which can cause increased blood viscosity and clotting. This can happen in post-term newborns due to chronic hypoxia in utero, which stimulates erythropoietin secretion.

Choice D:

Anemia is not related to insulin or glucose levels. Anemia is a condition where there are not enough red blood cells or hemoglobin in the blood, which can cause decreased oxygen delivery to the tissues. This can happen in newborns due to blood loss, hemolysis, or decreased production of red blood cells.

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Question 4:

A nurse is educating the parents of a post-term newborn who has hyperbilirubinemia and requires phototherapy.

What should the nurse include in the teaching?

A. The newborn should be exposed to sunlight for at least 15 minutes a day. B. The newborn should wear eye shields and a diaper during phototherapy. C. The newborn should be fed formula instead of breast milk during phototherapy. D. The newborn should have blood tests every 12 hours to monitor bilirubin levels.

Answer and Explanation

Choice A:

Exposing the newborn to sunlight is not an effective treatment for hyperbilirubinemia and can cause sunburn.

Choice B:

This is because phototherapy exposes the newborn to intense light that can damage the eyes and skin, and also increases water loss through the skin. Eye shields protect the eyes from the light and a diaper prevents overexposure of the genital area. The newborn should also be turned frequently to expose different parts of the body to light.

Choice C:

Breast milk does not interfere with phototherapy and breastfeeding should be continued as normal.

Choice D:

Blood tests are not needed every 12 hours, but only when indicated by the bilirubin level or risk factors.

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Question 5:

A nurse is reviewing the laboratory results of a post-term newborn who has polycythemia and hypoxemia.

What is the most likely hematocrit value for this newborn?

A. 35%. B. 45%. C. 55%. D. 65%.

Answer and Explanation

Choice A:

35% is wrong because it is below the normal range for newborns, which is 45% to 61%. A hematocrit value of 35% would indicate anemia, which is a low number of red blood cells.

Choice B:

45% is wrong because it is at the lower end of the normal range for newborns. A hematocrit value of 45% would not indicate polycythemia or hypoxemia.

Choice C:

55% is wrong because it is within the normal range for newborns. A hematocrit value of 55% would not indicate polycythemia or hypoxemia.

Choice D:

A hematocrit value of 65% indicates polycythemia, which is an abnormally high number of red blood cells. Polycythemia can occur in post-term newborns who have hypoxemia, which is a low level of oxygen in the blood. Hypoxemia stimulates the production of erythropoietin, a hormone that increases red blood cell formation.

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Post-term birth

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