2024-FA-UT NUR325-B-Nursing Services Childbearing- Final Exam B (CBU )

The correct answer is C: The twins are dizygotic because they are not the same sex

Explanation:

C. The twins are dizygotic because they are not the same sex: This is the correct answer. Dizygotic twins, also known as fraternal twins, develop from two separate eggs fertilized by two different sperm. As a result, they can be the same or different sexes, and they have genetic similarities comparable to regular siblings. Monozygotic twins, or identical twins, originate from a single fertilized egg that splits into two embryos; therefore, they are always the same sex and have identical genetic material. Since the ultrasound clearly shows one boy and one girl, they cannot be monozygotic. The presence of different sexes definitively confirms that the twins are dizygotic.

Why the Other Options Are Incorrect:

A. Genetic testing when the babies are delivered will need to be done to determine this: This is incorrect because genetic testing is not necessary in this case. The sex difference revealed by the ultrasound is enough to conclude that the twins are dizygotic. Identical twins are genetically identical and must be the same sex. Therefore, the presence of one boy and one girl rules out monozygosity.

B. They are dizygotic because the ultrasound shows one is bigger than the other: This is incorrect because size differences alone do not determine zygosity. It is not unusual for monozygotic twins to have differences in growth due to factors such as unequal placental sharing or cord insertion issues. So, one twin being larger than the other does not necessarily indicate that they are fraternal.

D. They are monozygotic because they are in different amniotic sacs: This is incorrect because being in separate amniotic sacs (diamniotic) does not confirm monozygosity. Dizygotic twins are always diamniotic, but monozygotic twins can also be diamniotic if the embryo splits early enough (typically before day 4 post-fertilization). Therefore, the amniotic sac arrangement alone is not a reliable indicator of zygosity, especially in the presence of different sexes, which rules out monozygosity.

Summary: The presence of one male and one female twin definitively confirms that the twins are dizygotic (fraternal), as identical (monozygotic) twins are always the same sex. Therefore, C. The twins are dizygotic because they are not the same sex is the correct answer. The other options either misinterpret the relevance of sac structure or size, or suggest unnecessary genetic testing when sex differentiation already provides the answer.

The correct answer is  B: This is known as a military presentation.

Explanation:

This image depicts a military presentation, which refers to the fetal head being in a neutral position (neither flexed nor extended). In this presentation, the diameter of the fetal head that presents is 12.5 cm, which is the occipitofrontal diameter. This larger diameter can lead to a more difficult and prolonged labor compared to a vertex presentation where the head is well-flexed.

Why the other options are incorrect:

A. If the baby delivers vaginally the baby can have a supratentorial tear:

This is incorrect because supratentorial refers to a region of the brain. This term is not related to obstetric lacerations. While perineal tears can occur during delivery, they are not described as supratentorial.

C. This is a ROT presentation:

This is incorrect because ROT stands for Right Occiput Transverse, which describes the position of the occiput (back of the fetal head) relative to the mother’s pelvis. The image shows a military attitude, not a specific fetal position like ROT.

D. This presentation allows the smallest part of the head to deliver first:

This is incorrect because in a military presentation, the occipitofrontal diameter is the widest part of the fetal head. In a well-flexed vertex presentation, the suboccipitobregmatic diameter (9.5 cm) is the smallest and most favorable for delivery.

Summary:

The correct answer is B. This is known as a military presentation because the fetal head is in a neutral position, resulting in a larger diameter of the head presenting, which can make vaginal delivery more difficult.

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 A: Any time the baby shows signs of hunger.

Explanation:

Feeding a formula-fed baby on demand—whenever the baby shows signs of hunger—is the most appropriate approach. Hunger cues indicate when the baby is ready to eat and can vary from day to day. Responding to these signals helps ensure the baby is adequately nourished and promotes a healthy feeding relationship. Common hunger cues in infants include:

Rooting reflex (turning the head and opening the mouth)

Sucking motions or putting hands to the mouth

Fussiness or crying (a late sign of hunger)

While formula-fed babies typically eat 6 to 8 times in 24 hours, it's essential to prioritize the baby's hunger signals rather than a strict feeding schedule. This approach supports better growth, hydration, and overall well-being.

Why the Other Options Are Incorrect:

B. 6-8 times in 24 hours.

While this is a general guideline for how often a formula-fed baby eats, it is not as accurate as feeding on demand. Babies' needs can change due to growth spurts or other factors, and limiting feedings to a specific number may lead to underfeeding or ignoring signs of hunger.

C. 4-6 times in 24 hours.

This frequency is too low for most formula-fed newborns. Feeding this infrequently may not provide sufficient nutrition or hydration, particularly during the first few months when babies need regular, consistent nourishment to support rapid growth and development.

D. 8 to 12 times in 24 hours.

This frequency is more typical for breastfed babies rather than formula-fed infants. Formula takes longer to digest, so formula-fed babies usually require less frequent feedings. Feeding this often may lead to overfeeding or digestive discomfort.

Summary:

The best answer is "Any time the baby shows signs of hunger" because feeding on demand ensures the baby receives appropriate nutrition based on their individual needs. While general guidelines suggest 6 to 8 feedings per day, it is more accurate and beneficial to follow the baby's hunger cues.

The correct answer is C: Hyperbilirubinemia

Explanation:

A cephalohematoma is a collection of blood between the periosteum and the skull bone due to birth trauma, typically caused by pressure during delivery (e.g., forceps or vacuum-assisted birth). Since this is extravasated blood, the body will eventually break it down, leading to an increase in bilirubin levels, which can result in hyperbilirubinemia (newborn jaundice).

The breakdown of red blood cells from the cephalohematoma leads to an increase in unconjugated (indirect) bilirubin, which the newborn's immature liver may struggle to process efficiently.

As bilirubin accumulates in the blood, jaundice can develop, presenting as yellowing of the skin and sclera.

Severe cases of hyperbilirubinemia can lead to kernicterus, a serious condition that can cause brain damage.

Why the Other Options Are Incorrect:

A. Hypoxemia:

Incorrect. Hypoxemia (low oxygen levels in the blood) is not a direct consequence of a cephalohematoma. While difficult deliveries can sometimes lead to birth asphyxia, a cephalohematoma itself does not impair oxygenation.

B. Hypoglycemia:

Incorrect. Hypoglycemia (low blood sugar) is more common in infants of diabetic mothers, preterm newborns, or those with intrauterine growth restriction (IUGR). A cephalohematoma does not directly affect glucose metabolism.

D. Hyperglycemia:

Incorrect. Hyperglycemia (high blood sugar levels) is rare in newborns and usually occurs in response to stress, prematurity, or excessive glucose administration via IV fluids. A cephalohematoma does not cause hyperglycemia.

Summary:

A newborn with a cephalohematoma is at risk for hyperbilirubinemia due to the breakdown of red blood cells from the bleeding under the periosteum. Early monitoring of bilirubin levels and jaundice symptoms is essential to prevent complications such as kernicterus. Hypoxemia, hypoglycemia, and hyperglycemia are not direct risks associated with cephalohematoma.

The correct answer is C: Abruptio may cause severe abdominal pain.

Explanation:

Placental abruption (abruptio placentae) occurs when the placenta prematurely detaches from the uterine wall before delivery. This often leads to severe abdominal pain, uterine tenderness, and potentially concealed or visible bleeding. The pain results from uterine muscle contractions and blood accumulation behind the placenta, which irritates the uterus.

Why the Other Options Are Incorrect:

A. They both have bright red bleeding.

This is partially incorrect. While placenta previa typically presents with painless, bright red vaginal bleeding, placental abruption can present with dark red bleeding or even concealed bleeding when the blood is trapped behind the placenta. Additionally, placenta previa is painless, whereas abruptio placentae is painful.

B. One can be seen on ultrasound and the other cannot.

This is incorrect. Both conditions can be detected via ultrasound, though placental abruption is often diagnosed clinically based on symptoms (such as pain and uterine tenderness) rather than just imaging. Placenta previa, however, is easily visualized on ultrasound as the placenta is covering the cervix.

D. Placenta previa is treated by induction of labor.

This is incorrect. Induction of labor is contraindicated in placenta previa because the placenta covers the cervix, leading to a high risk of hemorrhage. Instead, a cesarean section is the preferred method of delivery if the previa persists in the third trimester.

Summary:

The best answer is Abruptio may cause severe abdominal pain because placental abruption typically causes sudden, intense abdominal pain due to the placenta separating from the uterine wall. The other options contain misleading or incorrect information about bleeding, ultrasound diagnosis, and treatment approaches.

The correct answer is C: Postpartum hemorrhage and urinary tract infection.

Explanation:

In the postpartum period, frequent urination is crucial to prevent bladder distension and urinary retention, as both can cause serious complications. An overdistended bladder may prevent the uterus from contracting effectively, which increases the risk of postpartum hemorrhage (PPH). Additionally, urinary stasis (when urine remains in the bladder) provides a breeding ground for bacteria, increasing the likelihood of developing a urinary tract infection (UTI).

Why the other options are incorrect:

A. Postpartum hemorrhage and hematoma formation:

While postpartum hemorrhage is a valid concern, bladder distension does not directly cause hematoma formation. Hematomas usually result from trauma during delivery or improper suturing of episiotomies or lacerations, not from urinary retention.

B. Fever and foul-smelling lochia:

Fever and foul-smelling lochia are signs of endometritis (uterine infection), which is not directly caused by urinary retention or bladder distension. However, poor bladder emptying can contribute to infection risk over time but does not typically lead to these specific symptoms on its own.

D. Urinary tract infection and uterine involution:

While urinary tract infections are a risk, uterine involution refers to the uterus returning to its pre-pregnancy size. Bladder distension can impede uterine contractions, but it does not prevent involution altogether.

Summary:

The most accurate answer is C. Postpartum hemorrhage and urinary tract infection because bladder overdistension can prevent proper uterine contraction, leading to PPH, and urinary retention increases the risk of UTIs due to bacterial growth. Frequent urination helps prevent these complications during the postpartum period.

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.

The correct answer is  B: Physiologic Jaundice

Explanation:

Physiologic Jaundice is the most common type of jaundice in newborns, and it typically occurs after the first 24 hours of life, often peaking around 48-72 hours. This condition is generally considered normal and occurs due to the immature liver’s inability to process bilirubin efficiently. The newborn's body produces more bilirubin than the liver can eliminate, leading to the yellowing of the skin and eyes (jaundice). This type of jaundice often resolves on its own as the newborn's liver matures, and it can be treated with phototherapy (biliblanket) and frequent feedings to help flush out the bilirubin.

Why the other options are incorrect:

A. Kernicterus

Kernicterus is a severe, rare complication of untreated jaundice, where high levels of bilirubin in the blood lead to brain damage. It typically results from pathological jaundice that goes untreated, not from physiologic jaundice. This condition is associated with extremely high levels of bilirubin and requires immediate medical attention.

C. Pathological Jaundice

Pathological jaundice occurs when the jaundice appears within the first 24 hours of life, or if the bilirubin level rises rapidly or reaches abnormally high levels. This can be due to a variety of underlying causes, such as infections or blood incompatibilities, and requires further investigation. Since this newborn developed jaundice at 48 hours, it is more likely to be physiologic rather than pathological.

D. Erythroblastosis Fetalis

Erythroblastosis fetalis is a condition caused by Rh incompatibility between the mother and fetus, where the mother's antibodies attack the fetus’s red blood cells. This results in hemolysis, causing severe jaundice. It usually presents with early onset jaundice (within 24 hours) and is more serious than physiologic jaundice. However, in this case, the jaundice appeared at 48 hours, which is typical of physiologic jaundice rather than erythroblastosis fetalis.

Summary:

The newborn most likely has physiologic jaundice, which is common and occurs after 24 hours of life, typically resolving with treatment such as biliblankets and frequent feedings. This is different from pathological jaundice, which usually presents earlier or is caused by more severe underlying conditions.