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

The correct answer is: C. Infertility.

Explanation:

C. Infertility: Endometriosis is strongly associated with infertility, affecting approximately 30-50% of women with the condition. The presence of endometrial tissue outside the uterus can interfere with normal reproductive processes, such as ovulation, implantation, and embryo development. Scar tissue (adhesions) can also obstruct the fallopian tubes or cause other structural issues that impair fertility.

Why the Other Options Are Incorrect:

A. Primary dysmenorrhea: While primary dysmenorrhea (painful menstruation) is common in many women, it is not specific to endometriosis. Primary dysmenorrhea occurs in women with normal reproductive anatomy and typically involves pain without underlying pathology. In contrast, secondary dysmenorrhea, which is caused by an underlying condition like endometriosis, can result in more severe or chronic pain, but it is not synonymous with endometriosis.

B. Pain radiating to the right shoulder: This symptom is more commonly associated with ectopic pregnancy, especially if the fallopian tube ruptures and causes internal bleeding that irritates the diaphragm, leading to referred pain in the right shoulder. This is not typical of endometriosis.

D. Cyclic pain: While endometriosis does cause cyclic pain, this pain is typically related to the menstrual cycle, as endometrial tissue responds to hormonal changes in the same way as the uterine lining. However, cyclic pain alone is not a unique feature of endometriosis and can be seen in various other conditions such as fibroids, pelvic inflammatory disease, or ovarian cysts.

Summary:

C. Infertility is most strongly associated with endometriosis, as the condition can impair fertility due to structural and functional issues in the reproductive system. While cyclic pain and dysmenorrhea are common in endometriosis, they are not as specific to the condition as infertility, which is a hallmark issue in many women with endometriosis. Pain radiating to the right shoulder is more typical of an ectopic pregnancy rather than endometriosis.

The correct answers are:

A. Brethine (Terbutaline)

D. Betamethasone

F. IV Fluids

Explanation:

This patient is at 34 weeks gestation and experiencing regular contractions every 3–5 minutes with a cervical exam of 2 cm/70%/-3. Since she is preterm, the goal is to stop or slow preterm labor and enhance fetal lung maturity.

A. Brethine (Terbutaline):

Correct. Terbutaline is a tocolytic used to temporarily stop preterm labor. It works as a beta-adrenergic agonist, relaxing the uterine muscles to delay delivery. Since the patient is only 34 weeks, stopping contractions can provide time for corticosteroids to improve fetal lung maturity.

D. Betamethasone:

Correct. Betamethasone is a corticosteroid given to accelerate fetal lung development by stimulating surfactant production. It is indicated in pregnancies between 24–34 weeks gestation when preterm birth is a risk. Administering two doses, 24 hours apart, can significantly reduce neonatal respiratory distress syndrome (RDS).

F. IV Fluids:

Correct. Hydration can help reduce uterine irritability and contractions. Dehydration can cause an increase in oxytocin release, leading to contractions. Administering IV fluids, such as Lactated Ringer’s or normal saline, can sometimes slow contractions.

Why the Other Options Are Incorrect:

B. Pitocin 20 u in 500cc RL to run at 125cc per hour:

Incorrect. Pitocin (oxytocin) is used to induce or augment labor, not to stop preterm contractions. Since this patient is preterm at 34 weeks, inducing labor is not the priority unless there is a maternal or fetal indication (such as infection or distress).

C. Misoprostol (Cytotec):

Incorrect. Misoprostol is a prostaglandin used to induce labor or ripen the cervix. Since the goal is to stop preterm labor, administering a labor-inducing medication would be contraindicated.

E. Oxytocin (Pitocin):

Incorrect. As mentioned above, oxytocin stimulates uterine contractions and is used in labor induction or augmentation. Since this patient is preterm, promoting labor progression is not the goal.

Summary:

The best recommendations for this 34-week pregnant patient in preterm labor are Brethine (Terbutaline) to stop contractions, Betamethasone to mature fetal lungs, and IV fluids to reduce uterine irritability. Labor-inducing agents like Pitocin and Misoprostol are inappropriate, as the priority is prolonging pregnancy to improve neonatal outcomes.

The correct answer is D: I will have a one-hour glucola test (glucose tolerance test) to screen for gestational diabetes during the second trimester.

Explanation:

This statement is correct because the one-hour glucose tolerance test (glucola test) is the standard screening method for gestational diabetes during the second trimester (24-28 weeks of pregnancy). If the results are elevated, a follow-up three-hour glucose tolerance test (GTT) is performed to confirm the diagnosis.

Why the Other Options Are Incorrect:

A. I will get my A1C checked every visit.

This is incorrect because HbA1c is not a routine test for diagnosing gestational diabetes. HbA1c reflects long-term glucose control (over approximately three months) and is more commonly used for diagnosing pre-existing diabetes rather than gestational diabetes.

B. A fasting glucose done in the first trimester of pregnancy will show if I have gestational diabetes.

This is incorrect because a fasting glucose test in the first trimester is used to identify pre-existing diabetes, not gestational diabetes. Gestational diabetes develops later in pregnancy (typically after 20 weeks) due to insulin resistance caused by placental hormones.

C. All women are tested in the second trimester with a three-hour glucose tolerance test to determine if they have gestational diabetes."

This is incorrect because not all women undergo the three-hour glucose tolerance test. Instead, the one-hour glucola test is done first, and only women with elevated results on the one-hour test undergo the three-hour test for confirmation.

The correct answer is A: Ectopic pregnancy.

Explanation:

Damage to the fallopian tube, such as malformation or scarring, increases the risk of ectopic pregnancy. The fallopian tubes are responsible for transporting the fertilized egg to the uterus. If scarring narrows or blocks the tube, the fertilized egg may implant in the fallopian tube instead of reaching the uterus, leading to an ectopic pregnancy. This condition is a medical emergency because the growing embryo can rupture the tube, causing severe bleeding and life-threatening complications.

Why the Other Options Are Incorrect:

B. Urinary tract infections:

Incorrect. Fallopian tube scarring does not increase the risk of urinary tract infections (UTIs), as UTIs are related to the urinary system (kidneys, bladder, urethra) rather than the reproductive system.

C. A decrease in estrogen levels:

Incorrect. Damage to the fallopian tubes does not directly impact estrogen production, which is primarily regulated by the ovaries.

D. Early menopause:

Incorrect. Early menopause is primarily caused by ovarian failure, genetic factors, autoimmune diseases, or medical treatments (e.g., chemotherapy, radiation), not by fallopian tube abnormalities.

Summary:

A client with fallopian tube scarring is at high risk for an ectopic pregnancy due to the potential blockage or narrowing of the tube, preventing normal implantation in the uterus.

The correct answer is C: January 22

Explanation:

Naegle’s Rule is used to estimate a pregnant person's due date (estimated date of delivery or EDD). The formula is:

Take the first day of the last menstrual period (LMP).

Subtract three months from the month.

Add seven days to the day.

Adjust the year if necessary.

For this patient:

LMP: April 15

Subtract 3 months → January 15

Add 7 days → January 22

Thus, the estimated due date is January 22.

The correct answer is B: The umbilical cord normally contains two veins and one artery.

Explanation

B. The umbilical cord normally contains two veins and one arteryThe normal umbilical cord contains two arteries and one vein, not two veins and one artery. The veins carry oxygenated blood to the fetus, and the arteries carry deoxygenated blood from the fetus to the placenta. This statement would require additional teaching to correct the misconception.

Why other options are correct;

A. The high blood volume and Wharton's jelly content of the umbilical cord prevent compression of the cord: This statement is correct. Wharton's jelly is a gel-like substance that surrounds the blood vessels in the umbilical cord, helping to protect the vessels from compression. It helps maintain the integrity of the cord and ensures the proper flow of blood to the fetus.

C. The fetal heart starts to beat at 4 weeks: This statement is correct. The fetal heart begins to beat around 4 weeks of gestation. The heart starts to develop early in pregnancy, and by 4 weeks, it starts to show a regular rhythm.

D. 8 to 12 weeks heart rate can be heard with a doppler: This statement is correct. A Doppler ultrasound can typically detect the fetal heart rate between 8 to 12 weeks of gestation. It allows the healthcare provider to assess the fetal heart rate non-invasively.

Summary:

The statement that needs additional teaching is B. The umbilical cord contains two arteries and one vein, not two veins and one artery. The other statements about fetal development and the umbilical cord are correct.

The correct answer is C: Wet it

Explanation:

When using a contraceptive sponge, the first step is to wet it with water before insertion. This action activates the spermicide already embedded in the sponge and ensures it is effective in killing or immobilizing sperm. The sponge acts as both a physical barrier to block sperm from entering the cervix and a chemical barrier due to the spermicide.

Why the other options are incorrect:

A. Get it fitted:

Unlike a diaphragm, a contraceptive sponge does not require a fitting by a healthcare provider. It is one-size-fits-most and can be purchased over-the-counter without a prescription.

B. Apply spermicide:

The sponge already contains spermicide (usually nonoxynol-9), so you do not need to add any extra spermicide. Simply wetting the sponge activates the spermicide for effectiveness.

D. Insert it:

While inserting the sponge is part of the process, wetting it must happen first to activate the spermicide. Inserting it dry reduces its ability to properly block and kill sperm.

Summary:

The first step when using a contraceptive sponge is to wet it to activate the spermicide. This ensures the sponge is effective at preventing pregnancy by blocking and killing sperm.

The correct answer is C: Venous thrombosis

Explanation:

C. Venous thrombosis: This is the correct answer because venous thrombosis (or a history of blood clots) is a contraindication for using the contraceptive ring (NuvaRing). The NuvaRing contains estrogen, which can increase the risk of blood clots (thrombosis), particularly in individuals with a history of venous thrombosis or other clotting disorders. The increased estrogen levels from the ring may promote clot formation, potentially leading to deep vein thrombosis (DVT), pulmonary embolism, or stroke, especially in women who have other risk factors for clotting.

Why the Other Options Are Incorrect:

A. Hepatitis B: Hepatitis B is not a contraindication for the use of the contraceptive ring. While certain liver conditions might require caution in hormone therapy, hepatitis B alone is generally not a contraindication unless the liver function is significantly impaired. If the woman has chronic liver disease or impaired liver function, then a different contraceptive method may need to be considered.

B. Pelvic inflammatory disease (PID): While a history of PID may warrant extra caution when considering intrauterine devices (IUDs), it is not a contraindication for the use of the NuvaRing. In fact, the NuvaRing may be a suitable option for contraception in women with a history of PID, as long as they do not have any current active infection or complications from PID.

D. Urinary tract infection (UTI): A UTI is not a contraindication for the use of the NuvaRing. While UTIs can cause discomfort, they are not related to hormonal contraceptive methods like the NuvaRing. UTIs are common and can be treated with antibiotics without affecting the use of the contraceptive ring.

Summary:

The most important contraindication for the NuvaRing is C. Venous thrombosis, due to the increased risk of blood clot formation caused by estrogen. The other options, including hepatitis B, pelvic inflammatory disease, and urinary tract infections, are not contraindications for the use of the NuvaRing, though they may require additional considerations or management in certain circumstances.

The correct answer is B: 2500

Explanation:

During breastfeeding, a woman needs to increase her caloric intake to support milk production. On average, lactating women require an additional 300 to 500 calories per day. Since the woman consumed 2000 calories per day before pregnancy, adding approximately 500 calories brings her new total to 2500 calories per day. This recommendation applies especially to the first 6 months of exclusive breastfeeding, where milk production is highest and energy demands are elevated. The additional calories support not only milk synthesis but also the mother's energy balance and nutritional needs.

Why the Other Options Are Incorrect:

A. 2300: This is only a 300-calorie increase from the baseline, which is on the lower end of the recommended additional caloric intake for lactating women. While some sources may list 330 calories as a minimum, most guidelines recommend closer to 500 additional calories per day, especially for exclusively breastfeeding mothers. Therefore, 2300 is likely insufficient to fully meet the energy demands of lactation.

C. 2750: Although this amount could be appropriate for a woman with higher activity levels or greater energy needs, it exceeds the standard recommendation for most breastfeeding women who previously consumed 2000 calories. Unless the mother is particularly active or underweight, 2750 calories may lead to unnecessary weight gain. Thus, it is not the general recommendation for the average lactating woman.

D. 3000: This option overshoots the recommended intake for most breastfeeding mothers by a wide margin. While highly active women or those nursing multiples might require this level of caloric intake, it is not the standard recommendation. For the average woman, 3000 calories per day would likely be excessive, potentially leading to weight gain and other imbalances.

Summary: A breastfeeding woman who previously consumed 2000 calories per day is generally advised to increase her intake to 2500 calories per day, reflecting an additional 500 calories to support milk production. This level aligns with standard dietary guidelines for lactating women. Therefore, B. 2500 is the correct answer. The other options either understate or overstate the typical caloric needs during lactation.