A client is attempting to deliver vaginally despite the fact that her previous delivery was by cesarean birth.
Her contractions are 2-3 minutes apart, lasting from 75 to 100 seconds.
Suddenly, the client complains of intense abdominal pain, and the fetal monitor stops picking up contractions.
The nurse recognizes that which of the following has occurred?

Choice A rationale

Mongolian spots are benign, flat bluish or bluish-gray birthmarks that commonly appear on the buttocks, lower back, or thighs of newborns, particularly those with darker skin tones, including African Americans, Asians, and Hispanics. They are caused by the entrapment of melanocytes (pigment-producing cells) deep within the dermis during fetal development. These spots typically fade spontaneously within a few years and are not indicative of any underlying medical condition or trauma.

Choice B rationale

Lanugo is fine, downy hair that covers the body of some newborns, especially preterm infants. It is usually shed within the last few weeks of gestation or shortly after birth and is unrelated to bruising or pigmented spots on the buttocks.

Choice C rationale

Nevus flammeus, also known as a port-wine stain, is a vascular malformation of the skin that appears as a flat, pink, red, or purple birthmark. It is caused by dilated capillaries and does not typically occur as bluish spots on the buttocks. Port-wine stains are usually permanent and may darken with age.

Choice D rationale

Vascular nevus, also known as a strawberry hemangioma, is a raised, red, bumpy birthmark composed of extra blood vessels. While it is a type of birthmark, it does not present as flat, bluish spots on the buttocks. Hemangiomas typically grow rapidly in the first few months of life and then gradually shrink over several years.

Choice A rationale

A glucose reading of 58 mg/dL in a newborn is below the normal range (typically 40-60 mg/dL in the first hours of life, rising to 50-90 mg/dL). While this requires intervention to prevent hypoglycemia, other parameters might indicate a more immediate threat to the newborn's well-being.

Choice B rationale

A temperature of 97.4°F (36.3°C) is below the normal range for a newborn (typically 97.7°F to 99.5°F or 36.5°C to 37.5°C). Hypothermia in a newborn can lead to cold stress, increasing oxygen and glucose consumption, potentially leading to respiratory distress and hypoglycemia. Therefore, a low temperature requires immediate assessment and intervention to warm the newborn.

Choice C rationale

A respiratory rate of 48 breaths/minute is within the normal range for a newborn (typically 30-60 breaths/minute). While the respiratory rate should be monitored, it does not indicate an immediate critical issue in this case.

Choice D rationale

A pulse of 134 beats/minute is within the normal range for a newborn (typically 110-160 beats/minute). While the heart rate should be monitored, it does not indicate an immediate critical issue in this case. .