A pregnant woman at 37 weeks’ gestation has had ruptured membranes for 38 hours. A cesarean is performed for failure to progress. FHR baseline before birth was 180 BPM with marked variability. At birth, the newborn had Apgar scores of 6 and 7 at one and five minutes and is now noted to be pale and tachypneic. Based on the maternal history, what is the most likely cause of this newborn’s distress?
Hypoxia.
Respiratory distress syndrome.
Sepsis.
Phrenic nerve injury.
The Correct Answer is C
Choice A rationale
Hypoxia may contribute to tachypnea and distress, but it is unlikely the primary cause, as baseline fetal heart rate of 180 BPM indicates infection-related stress rather than isolated oxygen deprivation.
Choice B rationale
Respiratory distress syndrome predominantly affects preterm infants due to surfactant deficiency. At 37 weeks’ gestation, surfactant levels should be adequate, making this an unlikely cause of the newborn’s tachypnea and pallor.
Choice C rationale
Prolonged rupture of membranes increases the risk of neonatal sepsis. Signs such as tachypnea, pallor, and elevated fetal heart rate with marked variability suggest systemic infection requiring immediate evaluation and treatment.
Choice D rationale
Phrenic nerve injury typically causes diaphragmatic paralysis, leading to asymmetric chest movement and respiratory distress. However, it does not explain the systemic signs like pallor or elevated heart rate, making it an unlikely cause.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Preterm infants lack coordination for sucking, swallowing, and breathing until approximately 32-34 weeks' gestation. Gavage feeding prevents aspiration by bypassing the immature oral motor mechanisms required for safe oral feeding.
Choice B rationale
Preterm infants can digest milk due to functional gastrointestinal enzymes. Digestive immaturity relates more to delayed gastric emptying rather than the inability to process nutrients, which is managed with small frequent feeds.
Choice C rationale
Monitoring intake is crucial for growth and hydration, but gavage feeding primarily addresses feeding immaturity, not intake measurement. Accurate intake can be monitored through oral feeds with supplemental measurements.
Choice D rationale
Gavage feeding does not directly prevent thrush. Thrush prevention involves oral hygiene and immune support rather than feeding methods, as thrush may still occur regardless of tube feeding or oral intake.
Correct Answer is D
Explanation
Choice A rationale
Gastric problems later in life, such as gastrointestinal motility issues, may occur in infants with myelomeningocele but are not an immediate risk requiring urgent intervention.
Choice B rationale
Respiratory depression is not a direct consequence of myelomeningocele unless associated with other congenital anomalies or complications like Chiari malformation affecting brainstem function.
Choice C rationale
Decreased cardiac output is not a primary concern in myelomeningocele unless secondary to severe infection or other systemic complications, which are less immediate risks.
Choice D rationale
Infection is the greatest immediate risk due to the exposed neural tissue in myelomeningocele, which provides a direct pathway for pathogens, necessitating prompt surgical closure and sterile management.
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