A nurse is caring for a client who is at 37 weeks of gestation and is being tested for group B streptococcus B-hemolytic (GBS). The client is multigravida and multipara with no history of GBS. She asks the nurse why the test was not conducted earlier in her pregnancy. Which of the following is an appropriate response by the nurse?

Explanation

Choice A Reason:

Absent Moro reflex is incorrect. The Moro reflex, also known as the startle reflex, is typically present in newborns and is characterized by the infant's arms extending and then flexing in response to a sudden movement or loud noise. While NAS can affect neurological function, causing irritability and hyperactivity, it typically does not result in the absence of the Moro reflex.

Choice B Reason:

Excessive crying is correct. Neonatal abstinence syndrome (NAS) occurs in newborns who were exposed to addictive opiate drugs while in the womb. Withdrawal symptoms can manifest in the neonate within the first few days after birth. Excessive crying is a common finding in infants with NAS. The crying may be inconsolable and difficult to soothe. This excessive crying is thought to be due to central nervous system irritability resulting from withdrawal.

Choice C Reason:

Diminished deep tendon reflexes are not typically associated with neonatal abstinence syndrome. Instead, NAS is more commonly characterized by hyperirritability of the central nervous system, leading to symptoms such as tremors, hypertonicity, and increased reflexes.

Choice D Reason:

Decreased muscle tone, or hypotonia, is not a typical finding in newborns with neonatal abstinence syndrome. Instead, infants with NAS may exhibit increased muscle tone (hypertonia) and jitteriness due to central nervous system hyperirritability.

Explanation

Choice A Reason:

Vaginal candidiasis is an infection that affects the vagina and does not directly contraindicate the use of a rectal suppository. However, if the suppository is intended for vaginal use, it may not be suitable in the presence of vaginal candidiasis due to the risk of exacerbating the infection.

Choice B Reason:

Afterpains refer to uterine contractions that occur after childbirth as the uterus returns to its normal size. Afterpains are not a contraindication to the use of a rectal suppository for constipation.

Choice C Reason:

Third-degree perineal laceration is correct. A suppository is a medication delivery system that is inserted into the rectum or vagina. In the case of constipation, rectal suppositories are often used to stimulate bowel movements. However, in the presence of a third-degree perineal laceration, the insertion of a rectal suppository could potentially worsen the injury or cause discomfort.

Choice D Reason:

Abdominal distention, or bloating, is a common symptom that may accompany constipation. It is not a contraindication to the use of a rectal suppository for constipation; in fact, relieving constipation may help alleviate abdominal distention.