Which nursing diagnosis is most appropriate for a newborn diagnosed with a diaphragmatic hernia?

Correct Answer: D

Rationale: In the case of a newborn diagnosed with a diaphragmatic hernia, the most appropriate nursing diagnosis is "D) Reduced gas exchange." This is the correct answer because a diaphragmatic hernia can lead to compression of the lungs, impacting the newborn's ability to exchange oxygen and carbon dioxide efficiently. This can result in respiratory distress and hypoxemia, making it crucial for nurses to prioritize interventions that support optimal gas exchange. Option A, "Potential for impaired parent-infant attachment," may be relevant in other situations but is not the priority in this case where the newborn's physiological needs take precedence. Option B, "Inadequate nutrition," is not directly related to the immediate concern of gas exchange. Option C, "Potential for infection," is important to consider but is not the most immediate concern compared to the compromised gas exchange in a newborn with a diaphragmatic hernia. Educationally, understanding the prioritization of nursing diagnoses based on the newborn's condition is crucial in providing safe and effective care. By focusing on the most critical issue, nurses can intervene promptly to support the newborn's respiratory function and overall well-being. This rationale highlights the importance of clinical judgment and critical thinking in nursing practice, especially in neonatal care settings.

Correct Answer: D

Rationale: The correct answer is option D: "The indirect Coombs’ test is performed on the mother before birth; the direct Coombs’ test is performed on the cord blood after birth." This statement is accurate because the indirect Coombs' test is used to detect antibodies in the mother's blood that may cross the placenta and attack the baby's red blood cells, leading to hemolytic disease of the newborn. Performing this test before birth allows healthcare providers to assess the risk of hemolytic disease in the baby and take appropriate preventive measures. Option A is incorrect because Rh incompatibility can lead to hemolytic disease of the newborn even if the child is Rh-positive. If an Rh-negative mother is sensitized to Rh-positive blood, subsequent pregnancies with Rh-positive babies can be at risk. Option B is incorrect because Rh incompatibility typically results in more severe hemolytic disease compared to ABO incompatibility, which is usually milder and less likely to cause significant anemia in the newborn. Option C is incorrect because while exchange transfusions may be necessary in severe cases of hemolytic disease, they are not frequently required in all cases. Treatment options vary depending on the severity of the condition and the response to initial interventions. In an educational context, understanding the intricacies of hemolytic diseases of the newborn is crucial for healthcare providers involved in maternal and neonatal care. Knowledge of the Coombs' tests, risk factors, and treatment options is essential for the early detection and management of these conditions to prevent complications in newborns.

Correct Answer: D

Rationale: In the context of maternal diseases during pregnancy, understanding the primary fetal risks associated with specific conditions is crucial for healthcare providers. In the case of anemia in the mother, the primary fetal risk is reduced oxygen delivery, which is best represented by option D. Anemia in the mother leads to a decreased ability to transport oxygen to the fetus, potentially resulting in fetal hypoxia and its associated complications. Option A, neonatal anemia, is incorrect because the focus of the question is on the fetal risks, not the neonatal risks that occur after birth. Option B, elevated bilirubin level, is not directly related to anemia in the mother and is more commonly associated with conditions such as hemolytic disease of the newborn. Option C, limited infection defenses, is also not directly linked to maternal anemia and is more associated with conditions affecting the immune system. Educationally, understanding the impact of maternal health on fetal well-being is essential in obstetric care. Anemia in the mother can have profound effects on the developing fetus, underscoring the importance of early detection and management of maternal conditions during pregnancy to optimize outcomes for both mother and baby. The correct answer, reduced oxygen delivery, highlights the critical role of oxygen in fetal development and the potential consequences of inadequate oxygen supply to the fetus in the presence of maternal anemia.

Correct Answer: D

Rationale: In the context of maternal diseases during pregnancy, the best way to reduce congenital rubella is by immunizing susceptible women at least 28 days before they become pregnant. This is because rubella is a viral infection that can have severe consequences for the developing fetus if contracted during pregnancy. By ensuring that women are immune to rubella before conception, the risk of transmission to the fetus is significantly reduced. Option A, avoiding contact with young children when infections are prevalent, is not a practical or effective strategy for reducing congenital rubella. Rubella is highly contagious and can be transmitted through the air, so complete avoidance of contact is nearly impossible. Option B, taking prophylactic antibiotics during the second half of pregnancy, is not effective against rubella as it is a viral infection and antibiotics are not effective against viruses. Option C, testing the rubella titer at the first prenatal visit to determine immunity, is important for identifying women who are not immune to rubella. However, relying solely on testing during pregnancy may not allow enough time to immunize susceptible women before they conceive. In an educational context, it is crucial for healthcare providers to educate women of childbearing age about the importance of being up to date on their vaccinations, including the MMR (measles, mumps, rubella) vaccine. Preconception counseling should emphasize the need for rubella immunity to protect both the mother and the developing fetus from the serious complications associated with congenital rubella syndrome. This underscores the significance of timely immunization as a preventive measure in maternal health and pregnancy outcomes.

Correct Answer: A

Rationale: The correct answer is A) Avoid all intramuscular injections until 1 month of age. This is the correct injection technique for infants of mothers who are known carriers of hepatitis B virus because newborns of HBV-positive mothers should receive both the hepatitis B vaccine and hepatitis B immune globulin (HBIG) within 12 hours of birth, followed by the vaccine series. Giving intramuscular injections to these infants can increase the risk of transmission of the virus, as HBV is a bloodborne pathogen. Option B) Diluting intramuscular injections with added normal saline is incorrect because dilution does not mitigate the risk of HBV transmission. Option C) Mixing all injections that the infant will need in a single syringe is incorrect as it can lead to contamination and inaccurate dosing. Option D) Bathing the area where the infant will receive injections is irrelevant to preventing HBV transmission and does not address the specific risk posed by intramuscular injections in HBV-positive infants. In an educational context, understanding the correct injection technique for infants born to HBV-positive mothers is crucial for healthcare providers working in maternal and child health settings to prevent the transmission of infectious diseases. Implementing proper protocols in such cases can significantly impact the health outcomes of newborns at risk.