A woman with a history of crack cocaine use is admited to the Labor and Birthing Unit. While caring for the patient, the nurse notes a sudden onset of fetal bradycardia. The patient also complains of acute abdominal pain that is continuous and she has dark red vaginal bleeding. Which of the following would the nurse suspect?
Select one:

Shoulder dystocia.

Placental abruption.

Anaphylactoid syndrome of pregnancy.

Placenta previa.

Answer and Explanation

The Correct Answer is B

Choice A Reason: Shoulder dystocia. This is an incorrect answer that describes a diﬀerent obstetric complication. Shoulder dystocia is a condition where the baby's shoulder gets stuck behind the mother's pubic bone during delivery, which can cause nerve injury, fracture, or asphyxia to the baby. Shoulder dystocia does not cause fetal bradycardia, abdominal pain, or vaginal bleeding.

Choice B Reason: Placental abruption. This is a correct answer that explains the symptoms of fetal bradycardia, abdominal pain, and vaginal bleeding in a woman with a history of crack cocaine use. Placental abruption. This is because placental abruption is a condition where the placenta separates from the uterine wall before delivery, which can cause fetal distress, maternal hemorrhage, and shock. Placental abruption can be triggered by maternal hypertension, trauma, or substance abuse, such as crack cocaine.

Choice C Reason: Anaphylactoid syndrome of pregnancy. This is an incorrect answer that refers to a rare and fatal condition also known as amniotic ﬂuid embolism. Anaphylactoid syndrome of pregnancy is a condition where amniotic ﬂuid enters into the maternal bloodstream and causes an allergic reaction, which can lead to respiratory failure, cardiac arrest, coagulopathy, and coma. Anaphylactoid syndrome of pregnancy does not cause fetal bradycardia or vaginal bleeding.

Choice D Reason: Placenta previa. This is an incorrect answer that indicates another placental disorder. Placenta previa is a condition where the placenta covers or is near the cervix, which can cause painless bright red bleeding during pregnancy or labor. Placenta previa does not cause fetal bradycardia or abdominal pain.

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Correct Answer is D

Explanation

Choice A Reason: Apical pulse of 148 beats per minute. This is not a finding that would support a diagnosis of RDS, but rather a normal finding for a newborn. A normal apical pulse for a newborn ranges from 120 to 160 beats per minute. A high pulse rate may indicate fever, infection, anemia, or dehydration. A low pulse rate may indicate hypothermia, hypoxia, or heart block.

Choice B Reason: Respiratory rate of 40 during sleep. This is not a finding that would support a diagnosis of RDS, but rather a normal finding for a newborn. A normal respiratory rate for a newborn ranges from 40 to 60 breaths per minute. A high respiratory rate may indicate respiratory distress, infection, or metabolic acidosis. A low respiratory rate may indicate respiratory depression, hypothermia, or narcotic exposure.

Choice C Reason: Skin color jaundiced. This is not a finding that would support a diagnosis of RDS, but rather a diﬀerent condition called jaundice. Jaundice is a yellowish discoloration of the skin and mucous membranes caused by elevated levels of bilirubin in the blood. Bilirubin is a breakdown product of hemoglobin that is normally excreted by the liver and kidneys. Jaundice can occur in newborns due to immature liver function, increased red blood cell breakdown, or blood group incompatibility. Jaundice does not aﬀect lung function or oxygenation.

Choice D Reason: Chest retractions. This is because chest retractions are a sign of respiratory distress that indicate increased work of breathing and reduced lung compliance. Chest retractions occur when the chest wall sinks in between the ribs or below the sternum during inhalation, creating a negative pressure that helps draw air into the lungs. RDS is a serious condition where the newborn's lungs are immature and lack sufficient surfactant, which is a substance that reduces surface tension and prevents alveolar collapse. RDS can cause respiratory distress, hypoxia, acidosis, and organ failure. It is more common in preterm infants, especially those born before 37 weeks' gestation.

A. Grunting and nasal ﬂaring. B. Acrocyanosis. C. Abdominal breathing. D. Respiratory rate of 54 breaths/minute.

Correct Answer is A

Explanation

Choice A Reason: Grunting and nasal ﬂaring. These are signs of respiratory distress in newborns, which indicate that their oxygenation needs are not being met. Grunting and nasal ﬂaring. This is because grunting and nasal ﬂaring are signs of respiratory distress in newborns, which indicate inadequate oxygenation and ventilation. Grunting is a noise made by the newborn when exhaling, which reﬂects an atempt to keep the alveoli open and increase lung volume.

Nasal ﬂaring is a widening of the nostrils when inhaling, which reﬂects an eﬀort to reduce airway resistance and increase airﬂow.

Choice B Reason: Acrocyanosis. This is not a sign of respiratory distress in newborns, but rather a common condition called acrocyanosis. Acrocyanosis means bluish discoloration of the hands and feet due to poor peripheral circulation in response to cold exposure or stress. It does not aﬀect oxygenation or ventilation and usually disappears within 24 to 48 hours after birth.

Choice C Reason: Abdominal breathing. This is not a sign of respiratory distress in newborns, but rather a normal patern of breathing for them. Abdominal breathing means that the newborn's abdomen rises and falls with each breath, which reﬂects the use of the diaphragm as the primary respiratory muscle.

Choice D Reason: Respiratory rate of 54 breaths/minute. This is not a sign of respiratory distress in newborns, but rather a normal range of respiratory rate for them. A normal respiratory rate for a newborn ranges from 40 to 60 breaths per minute.

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Naxlex Comprehensive Predictor Exams

A nurse explains to new parents that their newborn has developed respiratory distress syndrome (RDS). Which of the following assessments that the nurse makes would support a diagnosis of RDS? Select one:

Correct Answer is D

Explanation

The nurse assesses a 1-day-old newborn. Which finding indicates that the newborn's oxygenation needs are not being met? Select one:

Correct Answer is A

Explanation

The nurse assesses a newborn at 36 weeks' gestation, and the following behaviors are noted: nasal ﬂaring, labored breathing, and excessive mucus. The nurse is most concerned about: Select one:

The nurse administers vitamin K intramuscularly as prophylaxis to the newborn based on which of the following rationales? Select one:

Before applying a cord clamp, the nurse assesses the umbilical cord for vessels. The nurse expects to find: Select one:

The nurse is performing a newborn physical assessment and is about to elicit the Moro reﬂex. Which of the following responses should the nurse expect to see? Select one:

Narcotic analgesia is administered to a laboring client at 10:00 a.m. The infant is delivered at 10:35 A.M. The nurse would anticipate that the narcotic analgesia could: Select one:

The nurse is reading the results of non-stress test (NST) strips completed that day. Which of the following strips meets the criteria for a reactive NST? Select one:

The Mother-Baby nurse is caring for a two hour old newborn who is 36 4/7 weeks gestation. The nurse assesses that the newborn is experiencing tremors (jiteriness). What nursing action has the highest priority? Select one:

During a physical assessment of a newborn, the nurse observes bluish markings across the newborn's lower back. The nurse interprets this finding as: Select one: