A nurse is assessing the newborn of a client who reports methadone use during pregnancy.

The nurse should expect the newborn to exhibit which of the following manifestations?

Choice A rationale:
Hypotension is a common adverse effect of epidural analgesia due to the blockage of sympathetic nerve fibers, which can lead to vasodilation and decreased cardiac output.
Choice B rationale:
Polyuria is not typically associated with epidural analgesia. It could be related to other factors such as fluid administration or underlying medical conditions.
Choice C rationale:
A fetal heart rate of 152/min is within the normal range (110-160 beats/min) and is not an adverse effect of epidural analgesia.
Choice D rationale:
A maternal temperature of 37.4° C (99.4° F) is within the normal range (36.1° C to 37.2° C or 97° F to 99° F) and is not an adverse effect of epidural analgesia.

Myelomeningocele is the most severe type of spina bifida, a birth defect in which the spinal cord and its protective covering (meninges) protrude outside the body through an opening in the spine. This can cause nerve damage, muscle weakness, bladder and bowel dysfunction, and/or paralysis. Myelomeningocele requires surgical treatment after birth to repair the opening in the spine and prevent infections and further complications. According to the Mayo Clinic, the following actions should be included in the plan of care for a newborn who has a myelomeningocele that is leaking cerebrospinal fluid:

Cover the sac with a sterile, moist dressing to prevent it from drying out and becoming infected.
Place the baby in a prone position (on the stomach) or on the side to avoid putting pressure on the sac.
Monitor the vital signs, especially the temperature, as the baby may have difficulty regulating body temperature.
Administer antibiotics as prescribed to prevent meningitis and other infections.
Prepare for surgical closure of the sac within the first 24 to 48 hours after birth.
Therefore, the correct answer to your question is d. Administer broad-spectrum antibiotics. The other options are not appropriate for the immediate postnatal care of a newborn with myelomeningocele. Preparing for surgical closure after 72 hours is too late, as the risk of infection and complications increases with time. Monitoring the rectal temperature every 4 hours is not enough, as the baby may need more frequent checks and interventions to maintain a normal body temperature. Cleansing the site with povidone-iodine is not recommended, as it may irritate the delicate tissues and cause more harm than good