A nurse is caring for a client who is experiencing severe pain during active labor.
Which of the following medications should the nurse plan to administer and document in the client's medical record?

Choice A rationale

The critical congenital heart disease (CCHD) screening is typically performed when the newborn is between 24 and 48 hours of age, or just prior to discharge if that occurs earlier. Performing the test too early, such as between 6 and 12 hours, might yield false negative results due to the persistence of transitional circulation.

Choice B rationale

The results of the CCHD screening are typically available immediately, or within a few minutes, as it involves pulse oximetry readings. There is no waiting period of 1 to 2 weeks for the results, allowing for prompt identification and management of potential cardiac defects, preventing delays in care.

Choice C rationale

The CCHD screening specifically compares the oxygen saturation in the newborn's right hand (pre-ductal) and either foot (post-ductal). A significant difference between these two readings can indicate a shunt or obstruction within the heart or great vessels, suggesting a potential critical congenital heart defect.

Choice D rationale

Collecting a blood sample from the newborn's heel is the procedure for the newborn metabolic screening, which screens for various genetic and metabolic disorders, not the critical congenital heart disease screening. The CCHD screening is a non-invasive test performed using pulse oximetry.

Choice A rationale

Meconium aspiration syndrome is primarily associated with post-term gestation or fetal distress, where the fetus passes meconium in utero and subsequently aspirates it. While fetal distress can occur with PPROM, it is not the *most* direct or primary complication anticipated in the newborn due to preterm premature rupture of membranes itself.

Choice B rationale

Polycythemia, an abnormally high red blood cell count, is not a direct complication expected in a newborn specifically due to preterm premature rupture of membranes. It is more commonly associated with chronic hypoxia, maternal diabetes, or certain genetic conditions, and not a direct consequence of prolonged membrane rupture.

Choice C rationale

Sepsis is a significant and highly anticipated complication in a newborn following preterm premature rupture of the membranes (PPROM). The prolonged absence of the amniotic sac, which normally acts as a protective barrier, increases the risk of ascending infection from the maternal genital tract to the fetus, leading to neonatal sepsis.

Choice D rationale

Hyperbilirubinemia, or jaundice, is common in newborns, especially preterm infants, due to immature liver function. However, it is not a specific complication directly and primarily caused by preterm premature rupture of membranes. While prematurity itself is a risk factor for hyperbilirubinemia, PPROM does not directly induce elevated bilirubin levels. .