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

The correct answer is A: Transient tachypnea of the newborn (TTN).

Explanation:

Transient tachypnea of the newborn (TTN) is a common respiratory condition in neonates, particularly those born via C-section. It occurs due to delayed clearance of fetal lung fluid, leading to mild respiratory distress. Risk factors for TTN include C-section delivery without labor, late preterm or term gestation, and male sex.

The key signs of TTN that match this case include:

Tachypnea (respiratory rate >60 breaths per minute).

Nasal flaring and mild respiratory distress.

High-pitched breathing sounds (indicative of fluid retention in the lungs).

Acrocyanosis (bluish hands and feet), which is normal in the first few hours of life.

History of C-section birth (without the squeezing effect of vaginal delivery, which helps expel lung fluid).

TTN is usually self-limited, resolving within 24–72 hours with supportive care such as oxygen therapy and monitoring.Why the Other Options Are Incorrect:

B. Respiratory Distress Syndrome (RDS):

RDS is caused by surfactant deficiency, leading to alveolar collapse and significant respiratory distress. It is more common in preterm infants (<37 weeks), not in a full-term infant like this one (39 weeks). RDS presents with grunting, retractions, cyanosis, and worsening distress, which this baby does not exhibit.

C. Meconium Aspiration Syndrome (MAS):

MAS occurs when a newborn inhales meconium-stained amniotic fluid, causing lung inflammation and obstruction. Risk factors include post-term gestation, fetal distress, and meconium-stained amniotic fluid—none of which are present in this case. Babies with MAS typically have severe respiratory distress, cyanosis, and coarse breath sounds, not mild tachypnea with wheezing.

D. Tracheoesophageal Fistula (TEF):

TEF is a congenital defect where there is an abnormal connection between the trachea and esophagus, leading to difficulty swallowing, choking, and respiratory distress. It presents with excessive drooling, choking with feeds, and an inability to pass a nasogastric tube into the stomach—symptoms not described in this case.

Summary:

The most likely diagnosis is Transient Tachypnea of the Newborn (TTN) due to C-section birth, tachypnea, nasal flaring, and wheezing. Other conditions like RDS, MAS, and TEF are less likely because they involve different causes and clinical presentations.

The correct answer is D: Recognize and treat multiple genetic or metabolic disorders.

Explanation:

Newborn screening tests, including the phenylketonuria (PKU) test, are conducted to detect genetic or metabolic disorders that could cause serious health complications if left untreated. These screenings allow for early intervention, preventing intellectual disabilities, organ damage, and other complications. PKU, the first disorder to be screened, is a metabolic condition where the body cannot break down phenylalanine, leading to toxic buildup and brain damage if not managed through diet. Over time, newborn screening has expanded to include numerous other disorders, such as congenital hypothyroidism, sickle cell disease, and cystic fibrosis.

Why the Other Options Are Incorrect:

A. Keep the state records updated: While newborn screening results are recorded, the primary purpose of the test is not for state record-keeping but rather for early detection of treatable conditions. The data collected may contribute to public health initiatives, but this is secondary to the health benefits of identifying disorders in newborns.

B. Determine ABO incompatibilities: ABO incompatibilities occur when a mother’s blood type is different from the baby’s, potentially leading to jaundice or hemolytic disease of the newborn. While blood type screening is sometimes performed, newborn screening is not primarily designed to detect these incompatibilities. Instead, it focuses on metabolic and genetic disorders.

C. Determine if the infant has hypoglycemia: Hypoglycemia in newborns is typically diagnosed through blood glucose testing, not through newborn screening. While some metabolic disorders detected through newborn screening can contribute to hypoglycemia, the screening itself is not intended specifically for identifying low blood sugar levels.

Summary:

The primary purpose of newborn screening is to recognize and treat multiple genetic or metabolic disorders, ensuring early intervention to prevent severe complications. It is not intended for updating state records, identifying ABO incompatibilities, or diagnosing hypoglycemia.

Correct Answer B: The major risk to you after a molar pregnancy is a type of cancer that can be diagnosed only by measuring the same hormone that your body produces during pregnancy. If you were to get pregnant, it would make the diagnosis of this cancer more difficult.

Explanation:

After a molar pregnancy (hydatidiform mole), there is a risk of developing gestational trophoblastic neoplasia (GTN), including choriocarcinoma, a rare but aggressive cancer. The primary method of detecting GTN is through monitoring human chorionic gonadotropin (hCG) levels over time.

If a woman becomes pregnant too soon after a molar pregnancy, hCG levels will rise naturally due to pregnancy, making it difficult to distinguish whether the increase is due to a normal pregnancy or a malignant transformation of trophoblastic tissue.

To ensure early detection of GTN, women are advised to avoid pregnancy for at least one year and undergo regular hCG monitoring until levels return to normal and remain stable.

Why the Other Options Are Incorrect:

A. If you get pregnant within one year, you will have another molar pregnancy, but if you wait for two years, the odds are better to have a normal pregnancy with a better outcome.

Incorrect: While there is a slightly increased risk of another molar pregnancy, waiting does not necessarily reduce the risk. The primary concern is monitoring for GTN, not preventing recurrence.

C. The procedure you had causes scarring of your tubes. You should wait for at least a year to get pregnant so that you can avoid an ectopic pregnancy.

Incorrect: Suction curettage for molar pregnancy does not directly cause tubal scarring. While scarring can occur after uterine surgery, the primary reason for delaying pregnancy is to allow proper hCG monitoring for cancer detection, not to prevent ectopic pregnancy.

D. Birth control will suppress the cancer that grows after a molar pregnancy. Therefore, you need to take oral contraceptives for a year to suppress your periods and decrease your chances of having choriocarcinoma.

 Incorrect: Birth control does not prevent GTN or choriocarcinoma. However, contraception is recommended to prevent pregnancy while hCG levels are being monitored, but it does not actively suppress cancer growth.

Summary:

The correct response focuses on the importance of hCG monitoring to detect potential malignancy without interference from a new pregnancy. Therefore, option B is the best answer.

The correct answers are:

B. HIV

E. Toxoplasmosis screen

F. Vaginal cultures for STDs

Explanation:

These selected tests are the most critical for this patient based on her history. She is at increased risk for sexually transmitted infections (STIs), which can significantly impact both her health and the baby’s development. Additionally, her exposure to a cat at home raises concerns about toxoplasmosis, which can cause congenital infections leading to severe fetal complications.

B. HIV: This test is crucial because the patient has a history of multiple sexual partners and is unsure of the baby's father, which increases her risk for HIV infection. If a pregnant person is HIV-positive, early intervention with antiretroviral therapy (ART) is essential to reduce the risk of vertical transmission to the baby.

E. Toxoplasmosis screen: Toxoplasmosis is a parasitic infection transmitted through cat feces, undercooked meat, and contaminated food. Since the patient has a cat, she is at potential risk. If a pregnant woman contracts toxoplasmosis for the first time during pregnancy, it can lead to severe fetal complications such as brain damage, blindness, or miscarriage.

F. Vaginal cultures for STDs: Given her history of multiple partners and uncertainty about paternity, she is at a higher risk for sexually transmitted infections such as gonorrhea, chlamydia, syphilis, and trichomoniasis. These infections can lead to preterm labor, low birth weight, neonatal blindness, or congenital infections if left untreated.

Why the Other Options Are Incorrect:

A. Glucose Tolerance Test: This test is used to screen for gestational diabetes, but it is typically performed between 24-28 weeks of pregnancy, not at 12 weeks. There is no specific history indicating a high risk for gestational diabetes, such as obesity or a family history of diabetes.

C. Urine glucose: While checking for glucose in the urine can help screen for gestational diabetes, it is not the most pressing concern at this stage of pregnancy. Urine glucose can fluctuate and is not a diagnostic test.

D. Rubella Titer: This test checks for immunity against rubella (German measles), but since routine prenatal panels already include it, it is not a priority based on her history. If she is non-immune, she would receive the MMR vaccine postpartum, as it cannot be given during pregnancy.

G. Maternal Serum Fetal Alphaprotein (MSAFP): This test screens for neural tube defects (such as spina bifida) and chromosomal abnormalities (such as Down syndrome) but is typically performed between 15-20 weeks gestation. While important, it is not directly related to the patient’s sexual history or cat exposure.

88.

Mongolian spots, also known as congenital dermal melanocytosis, are bluish-gray birthmarks that are most commonly found on the lower back and buttocks of newborns, particularly in infants of African, Asian, Hispanic, and Native American descent.

The image is asking where to place the cursor, the most appropriate location would be on the lower back or sacral area of the baby in the image. 

The correct answer is B: Impending seizures

Explanation:

B. Impending seizures: This is the correct answer. In a patient with pregnancy-induced hypertension (PIH), which includes preeclampsia and eclampsia, pounding headache and epigastric pain (often described as right upper quadrant abdominal pain) are classic warning signs of worsening disease and an impending eclamptic seizure. These symptoms reflect severe central nervous system and hepatic involvement, such as cerebral edema or liver capsule distention (as in HELLP syndrome). Immediate interventions to prevent seizures, such as administration of magnesium sulfate and preparation for potential emergency delivery, are warranted.

Why the Other Options Are Incorrect:

A. Anxiety due to hospitalization: While anxiety may cause symptoms like headache or gastrointestinal discomfort, it does not typically cause both a pounding headache and epigastric pain in the context of PIH. These are serious signs of systemic involvement and should never be attributed to emotional causes without ruling out medical emergencies. Misinterpreting these symptoms as anxiety can delay life-saving interventions.

C. Effects of magnesium sulfate: Magnesium sulfate is used to prevent or treat seizures in patients with preeclampsia or eclampsia. Its common side effects include flushing, nausea, muscle weakness, and lethargy—not pounding headache or epigastric pain. Additionally, a patient experiencing magnesium toxicity would present with absent deep tendon reflexes, respiratory depression, and low urine output, not the symptoms described in the question.

D. Panic attack: Panic attacks may cause symptoms like chest tightness, shortness of breath, and headache, but epigastric pain in a hypertensive pregnant patient is not typical of a panic attack and should not be attributed to psychological causes without a thorough medical evaluation. Again, the clinical context here is critical—this is a known PIH patient, and such symptoms are red flags for eclampsia.

Summary: In a patient with pregnancy-induced hypertension, symptoms like pounding headache and epigastric pain are warning signs of impending eclampsia and require immediate intervention. These signs are linked to cerebral irritation and liver involvement. Therefore, B. Impending seizures is the correct answer. The other choices fail to recognize the seriousness of these clinical indicators and could lead to dangerous delays in care.

The correct answer is  A: Category 1 tracing

Explanation:

A Category 1 fetal heart rate (FHR) tracing is considered normal and reassuring because it indicates adequate fetal oxygenation and no signs of fetal distress. The key characteristics of a Category 1 tracing include:

Baseline FHR of 110–160 bpm (The FHR in this case is 155 bpm, which is within the normal range.)

Moderate variability (This indicates a well-oxygenated fetus with a responsive central nervous system.)

Accelerations present (Accelerations are a reassuring sign of fetal well-being.)

Early decelerations may be present (Early decelerations are caused by fetal head compression and are considered benign.)

No late or variable decelerations

Since this fetal heart tracing meets all the criteria for Category 1, it is a normal and reassuring finding.

Why the Other Options Are Incorrect:

B. Category 2 tracing:

A Category 2 tracing is indeterminate and may include abnormal findings that require continued monitoring and possible interventions. Examples include:

Minimal or marked variability

Recurrent variable decelerations

Prolonged decelerations

Tachycardia or bradycardia without absent variability

Since this tracing does not show these concerning features, it is not Category 2.

C. Category 3 tracing:

A Category 3 tracing is abnormal and requires immediate intervention, such as intrauterine resuscitation or emergency delivery. Features of Category 3 include:

Absent variability with recurrent late or variable decelerations or bradycardia

Sinusoidal pattern

Because this fetal heart tracing shows moderate variability, accelerations, and early decelerations, it is not a Category 3 tracing.

D. Category 4 tracing:

There is no Category 4 in the three-tier FHR classification system used by the American College of Obstetricians and Gynecologists (ACOG). The three recognized categories are Category 1 (normal), Category 2 (indeterminate), and Category 3 (abnormal).

Summary:

This fetal heart rate tracing is classified as Category 1 because it has a normal baseline (155 bpm), moderate variability, accelerations, and early decelerations (which are benign). This indicates a well-oxygenated fetus with no signs of distress.

The correct answer is  C: Massage the client's fundus.

Explanation:

The priority action in this scenario is to massage the client’s fundus. Postpartum hemorrhage is a serious and potentially life-threatening condition, and a boggy (soft, non-contracted) uterus is a leading cause. Uterine atony, where the uterus fails to contract effectively, can lead to excessive bleeding. Massaging the fundus helps stimulate uterine contractions, promoting hemostasis and reducing bleeding.

Why the Other Options Are Incorrect:

A. Assess the client's blood pressure:

While monitoring the client’s vital signs is important in a postpartum hemorrhage situation, it is not the immediate priority. By the time blood pressure drops significantly, significant blood loss has already occurred. The nurse must first address the likely cause of the excessive bleeding—uterine atony—by massaging the fundus.

B. Assess the bladder for distention:

A full bladder can contribute to uterine atony by preventing the uterus from contracting effectively. However, assessing the bladder is not the first priority when active hemorrhage is occurring. Fundal massage should be performed first to immediately control bleeding, and then the nurse can assess for bladder distention if necessary.

D. Prepare to administer a prescribed oxytocic preparation:

Administering oxytocin or another uterotonic medication (e.g., methylergonovine, carboprost, misoprostol) is an appropriate intervention to help contract the uterus, but it is not the first action. Fundal massage should be initiated immediately, as it is a non-invasive intervention that can be performed while preparing the medication. If massage does not stop the bleeding, the nurse should then proceed with administering the prescribed medication.

Summary:

The first action the nurse should take is to massage the client's fundus to stimulate uterine contraction and reduce bleeding. While assessing blood pressure, checking for bladder distention, and administering uterotonic medications are important interventions, they should follow fundal massage as part of the overall management of postpartum hemorrhage.

The Correct Answer is  C:Terbutaline

Explanation:

Terbutaline is a tocolytic medication that relaxes the uterus. In the context of postpartum hemorrhage caused by a boggy uterus (uterine atony), administering terbutaline would worsen the condition by further preventing uterine contractions. Uterine contractions are crucial to stop postpartum bleeding by compressing the blood vessels where the placenta was attached. This medication is typically used to stop preterm labor, not to treat postpartum hemorrhage. Given the patient’s ongoing heavy bleeding, terbutaline would exacerbate the issue and should be questioned if ordered.

Why the Other Options Are Incorrect:

A. Methylergonovine

This medication is a uterotonic that promotes strong uterine contractions, which helps manage postpartum hemorrhage by firming the uterus and reducing blood loss. While methylergonovine is contraindicated in patients with hypertension, there is no indication that this patient has elevated blood pressure. In this case, it would be an appropriate medication to control the bleeding and would not be questioned.

B. Misoprostol

Misoprostol is a prostaglandin that stimulates uterine contractions and is commonly used for postpartum hemorrhage management. It is effective and safe for patients with type 1 diabetes. This medication helps to contract the uterus and would be appropriate in this scenario. Therefore, it should not be questioned.

D. Oxytocin

Oxytocin is the first-line medication used to treat and prevent postpartum hemorrhage. It works by stimulating the uterus to contract, which helps stop excessive bleeding. Oxytocin is both safe and effective for patients with type 1 diabetes and is routinely administered after delivery. This medication is appropriate and would not be questioned.

Summary:

The correct answer is C. Terbutaline because it relaxes the uterus and would worsen postpartum hemorrhage caused by uterine atony. The other options—methylergonovine, misoprostol, and oxytocin—are uterotonics that help contract the uterus and control bleeding, making them appropriate for this clinical situation.

The correct answer is  B: The patient who is 34 weeks pregnant complaining of a persistent cough.

Explanation:

A persistent cough in a 34-week pregnant patient with a known cardiac condition is concerning because it may indicate pulmonary edema or congestive heart failure (CHF). Pregnancy increases blood volume and cardiac output, which places additional stress on the heart. In cardiac patients, persistent coughing may signal fluid accumulation in the lungs, a sign of worsening heart function. This patient requires immediate evaluation to prevent life-threatening complications.

Why the Other Options Are Incorrect:

A. The patient who is 35 weeks pregnant and complaining of swelling in her feet.

Mild swelling (edema) of the feet is a common and expected symptom during late pregnancy due to increased blood volume and venous pressure from the enlarging uterus. Unless the swelling is sudden, severe, or associated with other symptoms (such as headache or vision changes suggestive of preeclampsia), it does not require urgent attention.

C. The client who is 33 weeks pregnant who said she gets tired and now requires a nap in the afternoon.

Fatigue is a normal experience in the third trimester due to hormonal changes, increased energy demands, and physical strain. Needing a nap is not unusual and does not indicate an acute cardiac issue without other alarming symptoms like shortness of breath or chest pain.

D. A client who is 39 weeks pregnant and complains of a sudden weight loss of 1.5 lbs.

A small weight loss near the end of pregnancy is a normal sign that the body is preparing for labor. Hormonal changes and decreased fluid retention may cause slight weight fluctuations. This symptom is not typically related to cardiac complications and does not require urgent assessment.

Summary:

B. The patient who is 34 weeks pregnant complaining of a persistent cough is the most critical patient to assess immediately because it may indicate pulmonary edema or heart failure, both of which are life-threatening in a pregnant cardiac patient. The other symptoms, while common in pregnancy, are not emergent or directly related to cardiac decompensation.