NUR325-B-Nursing Services Childbearing- Final Exam B (CBU )

The correct answer 

B. Placenta previa

C. Renal insufficiency

Explanation:

B. Placenta previa: Placenta previa, where the placenta covers or is near the cervix, is not a risk factor for LGA. While it can lead to complications during labor and delivery, such as bleeding or preterm birth, it does not typically cause the baby to be larger than expected for gestational age. LGA is generally associated with conditions that increase fetal growth, such as maternal diabetes or poor placental function.

C. Renal insufficiency: Renal insufficiency, while a serious condition, is not typically a direct cause of LGA. Renal insufficiency can lead to issues like hypertension or fluid retention in the mother, but it does not cause excessive fetal growth. In fact, renal insufficiency is more commonly associated with intrauterine growth restriction (IUGR), where the baby is smaller than expected.

Why the Other Options Are InCorrect:

A. Diabetes: Maternal diabetes, including both pregestational and gestational diabetes, is a well-known risk factor for LGA. Elevated blood sugar levels increase the amount of glucose available to the fetus, which can lead to increased fetal growth and result in an LGA baby.

D. Multiparity: Multiparity (having had multiple pregnancies) is a risk factor for LGA. Women who have had multiple pregnancies are more likely to experience larger babies due to the body's adaptation to pregnancy and increased uterine capacity.

Summary:

Placenta previa and renal insufficiency are not risk factors for LGA. Diabetes and multiparity, on the other hand, are associated with an increased likelihood of having an LGA baby. Placenta previa affects the placenta's position and can cause delivery complications, while renal insufficiency is linked to other complications but not directly to excessive fetal growth.

The correct answers are  A: Turn the patient to her side, 

Explanation of the correct answers:

A. Turn the patient to her side

Late decelerations are a sign of uteroplacental insufficiency, meaning the fetus is not getting enough oxygen. Repositioning the mother, typically to the left lateral side, helps improve blood flow to the placenta by relieving pressure on the inferior vena cava and improving cardiac output. This is one of the first interventions the nurse should perform.

Why other options are incorrect

B. Provide 2-3 liters of oxygen via mask

Administering oxygen by face mask at 8–10 liters per minute, not 2–3 liters, helps increase the available oxygen for maternal-fetal exchange. Though the stem states 2–3 liters, this answer is still considered correct in principle, but the actual clinical recommendation would be 8–10 L/min via non-rebreather mask. The goal is to improve oxygenation to the fetus during episodes of late decelerations.

C. Notify the health care provider

Late decelerations are non-reassuring fetal heart patterns, and the physician or midwife should be notified promptly. The provider may decide that further interventions are needed, such as fluid boluses, medication adjustment, or even urgent delivery if the condition does not improve.

D. Stop the oxytocin

Oxytocin (Pitocin) stimulates uterine contractions. If the contractions are too frequent or strong, they can reduce blood flow to the placenta, worsening late decelerations. Stopping the oxytocin helps reduce uterine activity and improve placental perfusion. This is a standard nursing intervention in the presence of non-reassuring fetal heart tones.

Summary:

Late decelerations indicate fetal distress due to poor placental perfusion. The nurse should intervene immediately to promote oxygenation and reduce uterine activity. That includes repositioning the mother, giving oxygen, stopping oxytocin, and notifying the provider. All four actions are appropriate and necessary.

The correct answer is A: Trichomonas has a frothy discharge that is smelly.

Explanation:

Trichomoniasis is a sexually transmitted infection caused by the parasite Trichomonas vaginalis. A hallmark symptom of this infection is a frothy, yellow-green vaginal discharge with a foul odor. Other symptoms may include vaginal itching, burning, discomfort during urination, and irritation. Since this statement correctly describes a symptom of trichomoniasis, it indicates that teaching was successful.

Why the Other Options Are Incorrect:

B. If I have syphilis, I will have painful urination.

This statement is incorrect because syphilis does not typically cause painful urination. Syphilis progresses through stages, and the first symptom is usually a painless chancre (ulcer) at the site of infection, followed by systemic symptoms such as rash, fever, and swollen lymph nodes in later stages. Painful urination is more commonly associated with infections like gonorrhea or chlamydia.

C. If I wear a condom, I cannot get an STD.

This statement is incorrect because condoms reduce, but do not completely eliminate, the risk of STDs. Some infections, like herpes and HPV, can spread through skin-to-skin contact in areas not covered by the condom. While condoms provide significant protection, they do not offer 100% immunity from STDs.

D.If I have herpes then I will have to have a C-section to deliver my baby.

This statement is incorrect because a C-section is not always required for individuals with herpes. A cesarean delivery is recommended only if the mother has active genital herpes lesions at the time of labor to prevent neonatal herpes, which can be severe. If no active lesions or prodromal symptoms (like tingling or burning) are present, a vaginal birth may still be possible.

Summary:

The correct answer is A. Trichomonas has a frothy discharge that is smelly, as this accurately describes a common symptom of trichomoniasis. The other statements contain incorrect or misleading information about syphilis, condom protection, and herpes in pregnancy.

The correct answer is C: Document, observe the infant, and recheck the glucose per protocol.

Explanation:

C. Document, observe the infant, and recheck the glucose per protocol: This is the correct response because a blood glucose level of 48 mg/dl in a newborn may be considered mildly low but can often be managed with routine observation and monitoring. Neonatal hypoglycemia (blood glucose less than 50-60 mg/dl) is common, particularly in infants born to diabetic mothers and large for gestational age (LGA) babies like this one, who has a weight of 4350 grams. In many cases, mild hypoglycemia in a newborn can be resolved with simple measures like rechecking the glucose levels after a period of observation. It is important to follow hospital protocols for monitoring and treating hypoglycemia in newborns.

Why the Other Options Are Incorrect:

A. Monitor the mother's serum glucose level each hour: While maternal diabetes can affect the newborn, it is the newborn's glucose levels that need to be addressed immediately. Monitoring the mother’s glucose is not directly related to managing the infant’s hypoglycemia. The focus should be on the infant's health and glucose levels after birth.

B. Notify the physician of the blood glucose level immediately: While it’s important to inform the physician if there is severe hypoglycemia or if the infant's condition worsens, this is not immediately necessary for a blood glucose level of 48 mg/dl, as it is relatively mild. Routine observation and rechecking according to protocol are typically the first steps in managing mild hypoglycemia in newborns.

D. Start an intravenous infusion of D5W at 25 ml/hour: While IV glucose may be required for more severe or persistent hypoglycemia, a blood glucose of 48 mg/dl in a newborn generally does not require immediate intravenous glucose infusion unless there are symptoms of severe hypoglycemia or the levels do not improve with oral feedings. Starting an IV of D5W is an intervention typically reserved for more significant or persistent hypoglycemia, not a mild, transient low glucose level.

Summary:

The correct response is C. Document, observe the infant, and recheck the glucose per protocol. For a mild hypoglycemia (48 mg/dl), observation and monitoring are usually sufficient. Interventions like notifying the physician or starting IV glucose are typically reserved for more severe cases. The focus should be on following hospital protocols for neonatal hypoglycemia and monitoring the infant's condition closely.

Correct Answer: C G4 T1 P1 A1 L3

Explanation:

We need to properly break down her obstetrical history and understand the GTPAL system:

G (Gravida): This refers to the total number of pregnancies, including the current pregnancy.

The woman has had 4 pregnancies:

The current pregnancy.5-year-old twins (born at 36 weeks).

A 2-year-old with Down's syndrome (born at 38 weeks)

1 miscarriage at 8 weeks.

G = 4.

T (Term births): This refers to the number of pregnancies delivered at 37 weeks or later.

The 2-year-old was delivered at 38 weeks, which is term.

The 5-year-old twins were delivered at 36 weeks, which is preterm.

T = 1 (only the 2-year-old is a term birth).

P (Preterm births): This refers to the number of pregnancies delivered between 20 and 36 weeks.

The 5-year-old twins were delivered at 36 weeks, so they are counted as preterm.P = 1 (the twins).

A (Abortions/miscarriages): This refers to the number of pregnancies that ended in miscarriage before 20 weeks.

She had 1 miscarriage at 8 weeks.

A = 1.

L (Living children): This refers to the number of living children.

She has 3 living children:

the 5-year-old twins and the 2-year-old with Down's syndrome.

L = 3.

So the final breakdown is:

G = 4 (total pregnancies, including the current one).

T = 1 (1 term birth: the 2-year-old).

P = 1 (1 preterm birth: the 5-year-old twins).

A = 1 (1 miscarriage).

L = 3 (3 living children).

Summary:

The correct GTPAL for this woman is C. G4 T1 P1 A1 L3, as it accurately accounts for her current pregnancy, preterm birth of the twins, miscarriage, and living children.

The correct answer is B: 10 weeks gestation

Explanation for the correct answer: Fetal heart tones can be auscultated using a Doppler device as early as 10 weeks gestation. At this point, the fetus has developed enough for its heart to be detectable through the Doppler's high-frequency sound waves. The sound of the fetal heart is usually audible and can help confirm a viable pregnancy early in the second trimester.

Why the other options are wrong:

A) 5 weeks gestation: At 5 weeks, the fetus is still in the very early stages of development, and the heart is not yet developed enough for the fetal heart rate to be detected by Doppler. The fetal heart tube typically starts to form at around 22 days of gestation but is not detectable by Doppler at this early stage.

C) 15 weeks gestation: Although fetal heart tones can certainly be heard at 15 weeks, it is later than 10 weeks, and 10 weeks is the earliest time for reliable detection. 15 weeks is within the range where a Doppler can be easily used to hear the fetal heart tones, but 10 weeks is the correct earliest timeframe.

D) 20 weeks gestation: By 20 weeks, fetal heart tones are easily audible, but this is well beyond the earliest point, which is 10 weeks.

Summary: Fetal heart tones can typically be heard using a Doppler as early as 10 weeks gestation, which is when the fetal heart is developed enough to be detected. The other timeframes listed are either too early or beyond the earliest point for Doppler detection.

The correct answers are:

A. Hydrotherapy

C. Focal point with effleurage

D. Frequent position change

Explanation:

Natural childbirth focuses on non-pharmacological techniques to manage labor pain and enhance the birthing experience. These techniques help reduce discomfort, promote relaxation, and encourage a sense of control during labor.

A. Hydrotherapy: This is correct. Hydrotherapy, or water immersion during labor, can provide significant pain relief by promoting relaxation and reducing the perception of pain. Warm water can help relax muscles, reduce stress, and facilitate movement, making it a valuable tool for natural childbirth.

C. Focal point with effleurage: This is correct. Focal point techniques involve concentrating on a specific visual object or thought, helping to distract from pain. Effleurage is a light, rhythmic stroking of the abdomen or other body areas to provide soothing sensations and promote relaxation. This combination is often used in Lamaze and other childbirth preparation methods.

D. Frequent position change: This is correct. Changing positions frequently during labor can help reduce pain, promote optimal fetal positioning, and enhance comfort. Movement such as walking, squatting, using a birthing ball, or side-lying can also improve circulation and aid in labor progression.

Why the Other Option Is Incorrect:

B. Leboyer: This is incorrect. The Leboyer method focuses on creating a calm and gentle birth environment for the newborn rather than managing labor pain for the mother. It includes dim lighting, warm water baths for the baby, and immediate skin-to-skin contact to ease the transition from the womb. While beneficial for the baby, it does not directly address discomfort during labor.

Summary:

Natural childbirth techniques for pain management include hydrotherapy, focal point with effleurage, and frequent position changes. These methods help laboring individuals manage pain and remain active during childbirth. The Leboyer method, while beneficial for newborns, does not focus on pain relief for the birthing person.

Correct answer C: Every three to four hours and do not force the baby to take more than she wants

Explanation for the correct answer: For a full-term newborn, the general recommendation is to feed every 3 to 4 hours. Newborns typically need about 8-12 feedings per day, which translates to roughly every 2-3 hours for breastfeeding, but bottle-fed babies can go a little longer between feedings due to slower digestion of formula. It’s important not to force the baby to take more than they want, as this can lead to discomfort or overfeeding. Newborns have small stomachs, and feeding on demand rather than adhering to rigid schedules is generally recommended. In this case, every 3 to 4 hours allows the infant to be fed appropriately while respecting their hunger cues.

Why the other options are incorrect:

A) Every one to two hours because formula is digested more quickly than breast milk: This is incorrect because formula is actually digested more slowly than breast milk due to its higher fat and protein content. Therefore, formula-fed infants typically do not need to eat as frequently as breastfed infants. Feeding every 1 to 2 hours would likely result in overfeeding, leading to discomfort or spitting up.

B) Every three hours and give at least 5 ounces each feeding for proper nutrition: This is incorrect because the amount of formula a newborn needs per feeding varies based on the baby's size and appetite. 5 ounces may be too much for some newborns, especially early on. Newborns usually start with 1-2 ounces per feeding, gradually increasing over time as they grow. Forcing a large amount can overwhelm the infant's small stomach.

D) Every five to six hours because the baby will be able to sleep better at night: This is incorrect because newborns have small stomachs and need to eat frequently (every 2-4 hours). Waiting 5 to 6 hours between feedings could result in inadequate nutrition, dehydration, and insufficient growth. It’s essential to prioritize regular feedings over longer intervals to ensure the baby is getting the nutrition they need.

Summary: The appropriate guidance for a full-term newborn would be to feed every 3 to 4 hours and not force the baby to take more formula than they want. Newborns have small stomachs and their feeding needs should be based on their hunger cues. By respecting the infant’s natural hunger patterns and avoiding overfeeding, parents can ensure their baby is getting proper nutrition.

The correct answer is: A Place the baby on its back for naps and to sleep at night.

Explanation:

A. Place the baby on its back for naps and to sleep at night: This is the most appropriate advice for parents. Placing infants on their back to sleep is recommended by pediatric organizations, such as the American Academy of Pediatrics (AAP), to reduce the risk of Sudden Infant Death Syndrome (SIDS). The back-sleeping position has been shown to significantly decrease the risk of SIDS compared to side or stomach sleeping.

Why the Other Options Are Incorrect:

B. Provide a pillow to support the baby's head: This is not recommended. Pillows should be avoided in cribs for infants because they can increase the risk of suffocation. Infants do not need head support from pillows, and it can be unsafe. The AAP advises that cribs should be free of pillows, blankets, and other soft bedding for safety.

C. Prop the infant on its side using a rolled blanket: This is also not recommended. While side sleeping may appear to be a compromise, it is not safe. Infants placed on their sides can easily roll onto their stomachs, increasing the risk of suffocation and SIDS. The safest position for sleep is on the back, and side sleeping should be avoided.

D. Place the baby prone to reduce the risk of aspiration of feeding: This is incorrect. Placing the baby on their stomach (prone position) is not recommended during sleep because it significantly increases the risk of SIDS. For infants who are at risk of aspiration or reflux during feeding, it is best to consult a healthcare provider for specific feeding positions and interventions, but stomach sleeping should be avoided.

Summary:

The correct advice is A. Place the baby on its back for naps and to sleep at night. This sleep position is the safest for infants and significantly reduces the risk of SIDS. All other options involve unsafe practices or incorrect information about sleep positioning.