2024-FA-UT 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. 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: 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 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 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.

The correct answer is A: IUGR/Small for gestational age.

Explanation:

A woman who does not receive prenatal care is at a higher risk of having a baby with intrauterine growth restriction (IUGR) or being small for gestational age (SGA). This is because prenatal care helps identify and manage conditions that affect fetal growth, such as poor maternal nutrition, hypertension, substance use, and infections. Without routine check-ups, these issues may go undiagnosed and untreated, leading to restricted fetal growth.

Why the Other Options Are Incorrect:

B. LGA – Large for gestational age:

While LGA can occur due to conditions like gestational diabetes, it is less likely without prenatal care. Uncontrolled diabetes increases LGA risk, but prenatal care typically detects and manages these conditions. Without care, poor nutrition and undiagnosed maternal conditions are more likely to lead to IUGR than LGA.

C. Molar Pregnancy:

Molar pregnancy is a rare complication caused by abnormal trophoblastic tissue growth. Prenatal care may detect it through ultrasounds and hormone monitoring, but lack of care does not cause it. It is not directly related to the absence of prenatal visits.

D. Cervical Insufficiency:

Cervical insufficiency involves the premature opening of the cervix, leading to miscarriage or preterm birth. While prenatal care helps identify risk factors (such as a history of cervical trauma), the absence of care does not directly cause cervical insufficiency.

Summary:

A woman who does not receive prenatal care is most likely to experience IUGR or have a small-for-gestational-age infant due to unmonitored maternal health conditions, poor nutrition, and undetected fetal complications. Prenatal care is crucial in identifying and preventing growth restrictions and improving fetal outcomes.

The correct answer is B: Pulmonary arteries

Explanation for the correct answer:

After birth, the pulmonary arteries are responsible for carrying deoxygenated blood from the right ventricle to the lungs for oxygenation. This is an important transition from fetal circulation, where the lungs are bypassed, to postnatal circulation where the lungs are now responsible for oxygenating the blood. The pulmonary arteries receive blood directly from the right ventricle after birth.

Why the other options are wrong:

A) Ductus arteriosus: This is incorrect. The ductus arteriosus is a fetal structure that connects the pulmonary artery to the aorta. It allows blood to bypass the lungs in utero since the fetus gets oxygen through the placenta. After birth, the ductus arteriosus closes and no longer carries blood, making it irrelevant to post-birth blood flow.

C) Aorta: This is incorrect. The aorta carries oxygenated blood from the left ventricle to the body. It does not receive blood from the right ventricle. The aorta plays a vital role in postnatal circulation, but its source of blood is the left ventricle, not the right ventricle.

D) Inferior vena cava: This is incorrect. The inferior vena cava is a large vein that returns deoxygenated blood from the lower half of the body to the right atrium. It does not receive blood from the right ventricle; instead, it delivers blood back to the heart for oxygenation.

Summary:

After birth, the pulmonary arteries are the vessels that receive blood only from the right ventricle, which pumps deoxygenated blood to the lungs for oxygenation. This marks a major change in circulation, as the lungs become the primary organ for oxygen exchange. The other options—ductus arteriosus, aorta, and inferior vena cava—do not receive blood from the right ventricle and are not involved in this specific post-birth function.

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 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.

Summary:

The correct answer is D because the one-hour glucola test is the standard screening test for gestational diabetes in the second trimester. The other options are incorrect because they either misrepresent the timing or type of tests used for diagnosing gestational diabetes.