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Which causes infants of diabetic mothers to be large for gestational age?
- A. Maternal insulin crosses the placenta and makes the baby large.
- B. Blood flow across the placenta is greater than normal.
- C. Maternal doses of insulin are absorbed by the infant and cause increased body growth.
- D. Maternal glucose crosses the placenta and causes the infant to produce more insulin than usual, resulting in greater body growth.
Correct Answer: D
Rationale: Step 1: Maternal diabetes leads to high blood glucose levels.
Step 2: Maternal glucose crosses the placenta to the fetus.
Step 3: Fetal pancreas produces more insulin in response to high glucose.
Step 4: Excess insulin promotes fetal growth, leading to macrosomia.
Summary:
A: Incorrect - Maternal insulin doesn't cross placenta in significant amounts.
B: Incorrect - Blood flow doesn't directly cause fetal overgrowth.
C: Incorrect - Maternal insulin doesn't directly cause increased growth.
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Which rationale is true regarding jaundice in newborns?
- A. Jaundice can result in a newborn when the mother and newborn have the same blood type.
- B. A mother who breastfeeds her newborn who develops jaundice may have to begin formula temporarily.
- C. Bilirubin levels will drop in newborns who have jaundice and may cause brain abnormalities.
- D. Keeping a newborn with jaundice below 98.7°F is essential in lowering bilirubin levels.
Correct Answer: B
Rationale: Step 1: Breast milk jaundice is a common cause of jaundice in newborns due to a substance in breast milk that can increase bilirubin levels.
Step 2: Switching to formula temporarily can help resolve the issue as formula-fed babies have lower incidences of jaundice.
Step 3: This is supported by medical guidelines recommending temporary cessation of breastfeeding in cases of severe jaundice.
Summary:
A: Blood type compatibility does not directly cause jaundice in newborns.
C: Bilirubin levels need to be monitored and managed in newborns with jaundice to prevent brain damage.
D: Maintaining a specific temperature is not the primary method of managing jaundice in newborns.
Which clinical sign is most concerning immediately following the delivery of a high-risk neonate?
- A. Axillary temperature of 97.8°F
- B. Blood glucose of 35 g/dL
- C. Oxygen saturation of 90%
- D. Blue-tinged hands and feet
Correct Answer: B
Rationale: The correct answer is B: Blood glucose of 35 g/dL. This is the most concerning sign as hypoglycemia in neonates can lead to serious neurological complications. Low blood glucose levels can result in seizures, brain damage, and even death if not promptly addressed. It is crucial to maintain appropriate blood glucose levels in neonates to support their brain development and overall health.
Explanation of other choices:
A: Axillary temperature of 97.8°F - Slightly below normal but not immediately concerning.
C: Oxygen saturation of 90% - Suboptimal but not as critical as severe hypoglycemia.
D: Blue-tinged hands and feet - Could indicate poor circulation, but hypoglycemia is more urgent to address.
Which diagnosis is most common in a newborn born at 35 + 3 gestational age?
- A. Hyperglycemia
- B. Respiratory distress syndrome
- C. Infection
- D. Altered nutrition, more than body requirements
Correct Answer: B
Rationale: The correct answer is B: Respiratory distress syndrome. At 35 + 3 weeks gestational age, the newborn's lungs may not be fully developed, leading to respiratory distress. This condition is common in premature babies due to surfactant deficiency, resulting in difficulty breathing. Hyperglycemia, infection, and altered nutrition are less likely in this scenario as they are not typically associated with prematurity at this gestational age. Respiratory distress is the most common concern in premature infants and requires prompt medical intervention to support breathing and lung function.
Based on the following risk factors, which newborn is least at risk for developing persistent pulmonary hypertension? Select all that apply.
- A. Late or postdates delivery
- B. Born to a mother with gestational diabetes
- C. Appropriate for gestational age
- D. Meconium aspiration
Correct Answer: C
Rationale: The correct answer is C: Appropriate for gestational age. Newborns who are appropriate for gestational age are least at risk for developing persistent pulmonary hypertension because they have not experienced intrauterine growth restriction or other complications that can lead to lung problems. Being born late or postdates (A) can increase the risk of complications, including pulmonary hypertension. Being born to a mother with gestational diabetes (B) can also increase the risk due to potential metabolic issues. Meconium aspiration (D) can lead to respiratory distress and increase the risk of pulmonary hypertension.
The newborn is having occasional gasping respirations with a heart rate of 90 beats per minute. Skin color is cyanotic with poor muscle tone. Interpreting relevant clinical data in this scenario, what problems are possible? Select all that apply.
- A. The newborn is hypothermic.
- B. The newborn is full term.
- C. The newborn is experiencing respiratory distress.
- D. The newborn is anemic.
Correct Answer: C
Rationale: The correct answer is C: The newborn is experiencing respiratory distress. Gasping respirations, low heart rate, cyanotic skin, and poor muscle tone are indicative of respiratory distress in a newborn. Gasping is an abnormal breathing pattern seen in severe respiratory distress. A low heart rate is a compensatory response to decreased oxygen levels. Cyanotic skin color indicates poor oxygenation. Poor muscle tone can be a sign of inadequate oxygen delivery to tissues.
Explanation for other choices:
A: The newborn may be hypothermic due to poor temperature regulation, but the primary concern in this scenario is respiratory distress.
B: Being full term does not directly explain the newborn's clinical presentation, so it is not a likely cause.
D: Anemia could contribute to poor oxygen delivery, but the clinical presentation suggests a more acute issue related to respiratory distress.