A nurse is providing prenatal teaching to a client who practices a vegan diet and is trying to increase her intake of vitamin B12. Which of the following foods should the nurse recommend?

Choice A rationale:
Telangiectatic nevi are commonly known as "stork bites”. or "angel kisses”. and are superficial vascular areas commonly found on the nape of the neck or the eyelids of newborns? These are benign and pose no significant health risks.

Choice B rationale:
Erythema toxicum is a common, benign skin rash that appears in the first few days of life. It presents as small, raised red spots with a surrounding halo and is not related to a nuchal cord.

Choice C rationale:
Periauricular papillomas, also known as "ear tags,”. are small, skin-coloured nodules that can be found near the external ear. They are also benign and unrelated to a nuchal cord.

Choice D rationale:
Facial petechiae are tiny, red or purple pinpoint spots on the skin caused by minor haemorrhages. In newborns, facial petechiae can be associated with a nuchal cord, which is a condition where the umbilical cord is wrapped around the baby's neck during delivery. This condition is relatively common and usually resolves without complications. The nurse should monitor the baby for any signs of distress or complications related to the nuchal cord.

The correct answer is c. Ampicillin.

Rationale:

• Group B Streptococcus (GBS) B-hemolyticis a bacterium that can colonize the vagina and rectum of pregnant women.While usually harmless to the mother,it can be passed to the newborn during birth and cause serious infections,including pneumonia,meningitis,and sepsis.
• Ampicillinis thefirst-line antibioticrecommended by the Centers for Disease Control and Prevention (CDC) for theprevention of GBS disease in newborns.It belongs to thepenicillin classof antibiotics,which are highly effective against GBS and generally well-tolerated by pregnant women and newborns.
• Doxycyclineis not recommended for GBS prophylaxis due to its poor penetration into amniotic fluid and potential for causing tooth discoloration and bone development problems in newborns.
• Cefotetanis an alternative option for women with penicillin allergy,but ampicillin is still preferred due to its lower cost and broader spectrum of activity against GBS strains.
• Fluconazoleis an antifungal medication and has no activity against GBS bacteria.

Detailed Rationale for Each Choice:

a. Doxycycline:

• Rationale against:
  • Poor penetration into amniotic fluid:Doxycycline does not effectively reach the amniotic sac,where the baby is surrounded,and therefore may not adequately protect the newborn from GBS infection.
  • Adverse effects in newborns:Doxycycline can cause tooth discoloration and bone development problems in infants exposed in utero.

b. Cefotetan:

• Rationale for:
  • Alternative for penicillin allergy:Cefotetan is a cephalosporin antibiotic effective against GBS and can be used in women with penicillin allergy.
• Rationale against:
  • Second-line option:Ampicillin is the preferred choice due to its lower cost and broader spectrum of activity against GBS strains.

c. Ampicillin:

• Rationale for:
  • First-line antibiotic:Ampicillin is the CDC-recommended first-line antibiotic for GBS prophylaxis due to its:
    • High effectiveness against GBS:Ampicillin has a broad spectrum of activity against GBS strains.
    • Good safety profile:Ampicillin is generally well-tolerated by pregnant women and newborns.
    • Cost-effectiveness:Ampicillin is a relatively inexpensive antibiotic compared to other options.

d. Fluconazole:

• Rationale against:
  • Antifungal medication:Fluconazole is an antifungal medication and has no activity against GBS,which is a bacterium.