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Which patient should be assessed first?
- A. Infant with a blood glucose level of 45 mg/dL, maternal history of gestational diabetes
- B. Infant who is plotted on the growth chart between the 75th and 85th percentile for weight and length and the 50th percentile for head circumference
- C. Infant born at 42 weeks gestation to 40-year-old mother who was otherwise healthy during pregnancy and at the time of delivery
- D. Infant born at 38 weeks gestation with a green stain and bruising noted on initial assessment at delivery
Correct Answer: A
Rationale: The correct answer is A. An infant with a blood glucose level of 45 mg/dL and a maternal history of gestational diabetes should be assessed first to rule out hypoglycemia, which can be life-threatening in newborns. Hypoglycemia can lead to seizures, brain damage, or even death if not promptly treated. Infants born to mothers with gestational diabetes are at higher risk for hypoglycemia due to their own insulin production in response to high maternal glucose levels. Therefore, immediate assessment and intervention are crucial.
Choice B is incorrect because growth parameters within normal ranges do not indicate an immediate need for assessment. Choice C is also incorrect as the mother's age and gestational age do not necessarily indicate an urgent need for assessment. Choice D is incorrect as the presence of a green stain and bruising may indicate meconium aspiration syndrome, but hypoglycemia poses a more immediate threat to the infant's health.
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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.
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.
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.
Whose baby is at highest risk of developing jaundice based on risk factors?
- A. A 16-year-old mother who labored with Pitocin and had an uncomplicated delivery.
- B. A 23-year-old mother who made it to the hospital after a delivery at home, umbilical cord cut at the hospital.
- C. A 28-year-old mother with type A blood and a father with O+ blood type delivered a newborn with nuchal cord x2; forceps used
- D. A 30-year-old mother who delivered twins via cesarean section; newborn A was breech; father unknown
Correct Answer: C
Rationale: The correct answer is C because the newborn has both type A blood (from the mother) and O+ blood (from the father), leading to a higher risk of jaundice due to ABO incompatibility. The presence of nuchal cord x2 and the use of forceps during delivery also increase the risk of newborn jaundice.
Choice A is incorrect because the mother's age and use of Pitocin do not inherently increase the risk of jaundice. Choice B is incorrect because the baby being born at home and the timing of the umbilical cord cutting are not directly related to jaundice risk. Choice D is incorrect because the method of delivery and the father's unknown blood type do not specifically indicate a high risk of jaundice compared to the scenario in Choice C.