Early postnatal exposure to dexamethasone, within the 1st wk of life, in VLBW infants, is associated with the following EXCEPT

Correct Answer: D

Rationale: In this question, the correct answer is D) cerebral palsy. Early postnatal exposure to dexamethasone in very low birth weight (VLBW) infants is associated with various adverse effects. Metabolic derangements and poor growth are potential consequences of dexamethasone use in the neonatal period. Additionally, dexamethasone can increase the risk of sepsis due to its immunosuppressive effects. Cerebral palsy is not typically associated with early postnatal exposure to dexamethasone. It is crucial for pediatric clinical nurse specialists to understand the potential risks and benefits of medications used in neonatal care. Dexamethasone is a potent corticosteroid that can have significant impacts on a vulnerable population like VLBW infants. Nurses must be vigilant in monitoring for adverse effects and advocating for safe and evidence-based practices in neonatal care. It is important to educate healthcare providers and families about these potential risks to ensure the best outcomes for these fragile infants.

Correct Answer: C

Rationale: In neonatal necrotizing enterocolitis (NEC), the correct answer is C) in most situations, a pathogen is identified. This is because NEC is often a polymicrobial infection without a single causative pathogen. The incorrect options can be explained as follows: A) In fatal cases, gangrene may extend from the stomach to the rectum, which is true in severe cases of NEC due to bowel ischemia and necrosis. B) The greatest risk factor for NEC is prematurity, as preterm infants have an underdeveloped gastrointestinal tract and immune system, making them more susceptible. D) NEC is much less common in infants fed human milk, as breast milk contains protective factors that reduce the risk of NEC compared to formula-fed infants. Educationally, understanding the pathology of NEC is crucial for pediatric clinical nurse specialists as they care for vulnerable neonates. Recognizing the risk factors, clinical presentation, and complications of NEC is essential for early detection and intervention to improve outcomes in this high-risk population.

Correct Answer: B

Rationale: In hemolytic disease of the newborn caused by Rh incompatibility, the correct answer is B) Never occur in first-born infant. Rh incompatibility occurs when an Rh-negative mother carries an Rh-positive fetus, leading to maternal antibodies attacking the fetal red blood cells. This process typically happens in subsequent pregnancies, not in the first-born infant. Option A is incorrect because the infant being Rh positive is a characteristic of Rh incompatibility. Option C is correct as maternal antibody titers can indeed help predict the severity of fetal disease by indicating the level of maternal sensitization. Option D is also correct as severe anemia is a common consequence of hemolytic disease of the newborn due to the destruction of red blood cells. In an educational context, understanding hemolytic disease of the newborn is crucial for pediatric clinical nurse specialists as it impacts the care of newborns at risk. Recognizing the false statement helps in accurate assessment and intervention planning for infants affected by Rh incompatibility. This knowledge ensures appropriate monitoring and treatment to prevent complications associated with hemolytic disease.

Correct Answer: A

Rationale: Intrauterine transplacental infection refers to the transmission of infectious agents from the mother to the fetus through the placenta during pregnancy. In this question, the correct answer is A) Hepatitis B virus (HBV). HBV is of significant concern because it can be transmitted vertically from mother to child during childbirth, leading to chronic infection in the newborn. This transmission can result in serious complications such as chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma. Therefore, it is crucial for pregnant women to be screened for HBV to prevent vertical transmission to the newborn. Regarding the other options: - B) Rubella: Rubella infection during pregnancy can cause congenital rubella syndrome in the fetus, but it is not primarily transmitted through the placenta. - C) Toxoplasmosis: Toxoplasmosis is usually acquired through ingestion of contaminated food or water, not primarily through vertical transmission. - D) Parvovirus B19: Although Parvovirus B19 can cause fetal complications, it is not as commonly associated with vertical transmission as HBV. Educationally, understanding the mechanisms of intrauterine infections and their implications for fetal and neonatal health is crucial for healthcare professionals working with pregnant women and newborns. Proper screening, prevention, and management strategies can help reduce the risk of vertical transmission of infections and improve outcomes for both mother and child.

Correct Answer: D

Rationale: Neonatal sepsis is a life-threatening condition in newborns with a high mortality rate. The correct answer, D) Pseudomonas, is associated with the highest case fatality rate among neonates due to its virulence factors, ability to resist antibiotics, and propensity to cause severe infections. Pseudomonas sepsis can progress rapidly, leading to septic shock and organ failure in neonates with compromised immune systems. Option A) Staphylococcus - coagulase negative, while a common cause of neonatal sepsis, does not typically result in as high a fatality rate as Pseudomonas. Group B streptococcus (Option B) and Escherichia coli (Option C) are also common culprits in neonatal sepsis, but they are not as notorious for causing severe and rapidly progressive infections as Pseudomonas in this population. In an educational context, understanding the specific pathogens that pose the greatest risk to neonates with sepsis is crucial for pediatric clinical nurse specialists. This knowledge allows for prompt recognition, appropriate treatment, and improved outcomes for these vulnerable patients. It underscores the importance of vigilant monitoring, timely interventions, and infection control practices in neonatal care settings to prevent sepsis-related fatalities.