NUR 325 Nursing Services Childbearing Family

Correct Answers:

A. Fundal tone

B. Lochia

E. Vital Signs

F. Bladder distension

Explanation:

A. Fundal tone

Assessing fundal tone is critical to ensure the uterus is firm and contracting, which helps prevent postpartum hemorrhage.

B. Lochia

The nurse evaluates lochia (vaginal bleeding) to assess for normal postpartum discharge and identify excessive bleeding or hemorrhage early.

E. Vital Signs

Frequent monitoring of blood pressure, pulse, respiratory rate, and temperature helps detect early signs of shock, hemorrhage, or infection.

F. Bladder distension

A full bladder can displace the uterus and interfere with uterine contractions, increasing the risk of postpartum hemorrhage, so it must be assessed.

Why the Other Options Are Incorrect:

C. Transcutaneous bilirubin

This test is used later to screen for jaundice, typically after 24 hours of age. It is not part of immediate fourth-stage postpartum assessments.

D. Engorgement

Breast engorgement develops a few days postpartum as milk comes in, not during the immediate recovery period after delivery.

Correct Answer A: Total parenteral nutrition or IV hydration.

Explanation:

A. Total parenteral nutrition or IV hydration.

Hyperemesis gravidarum involves severe, persistent nausea and vomiting, often leading to dehydration, electrolyte imbalance, and nutritional deficiencies. The most appropriate initial intervention is IV hydration to correct fluid and electrolyte imbalances. In severe or prolonged cases where oral intake is not possible, total parenteral nutrition (TPN) may be required.

Why the Other Options Are Incorrect:

B. A high protein diet rich in kilocalories.

This may be appropriate once the patient is stabilized, but during the acute phase of hyperemesis, the patient is often unable to tolerate oral intake.

C. A 24-hour urine collection to check for protein.

This is used to screen for preeclampsia, not to manage hyperemesis gravidarum.

D. Fasting blood sugar and one hour postprandial.

These tests assess for gestational diabetes and are unrelated to the management of hyperemesis gravidarum.

Correct Answer C: An A1c would be considered good diabetic control with results of <6%.

Explanation:

C. An A1c would be considered good diabetic control with results of <6%.

Hemoglobin A1c reflects the average blood glucose levels over the past 2 to 3 months. For patients with diabetes, an A1c result of less than 6% indicates excellent glycemic control, especially in pregnancy where tight glucose control is important to reduce the risk of fetal complications.

Why the Other Options Are Incorrect:

A. An A1c shows the amount of hemoglobin the liver can absorb.

This is incorrect. A1c has nothing to do with liver function or hemoglobin absorption. It measures the percentage of hemoglobin molecules bound with glucose.

B. An A1c provides current glucose levels in the blood.

A1c does not reflect current or real-time glucose levels. It reflects a long-term average, unlike a fingerstick or fasting glucose test.

D. An A1c is done between 24 to 28 weeks on all pregnant women.

This is incorrect. A1c is not a routine test for all pregnant women. Instead, a 1-hour glucose screening test is done between 24–28 weeks to screen for gestational diabetes, not Type 1 diabetes monitoring. A1c is used for those with pre-existing diabetes to assess long-term control.

Correct Answers:

C. Maternal Serum Alpha Fetoprotein (MSAFP)

D. Chorionic Villus Sampling (CVS)

Explanation:

C. Maternal Serum Alpha Fetoprotein (MSAFP)

MSAFP is part of the quad screen performed during the second trimester to assess the risk of certain fetal chromosomal and structural anomalies, including trisomy 21. Abnormal levels may indicate increased risk and lead to further diagnostic testing.

D. Chorionic Villus Sampling (CVS)

CVS is a diagnostic test performed in the first trimester to detect chromosomal abnormalities such as trisomy 21. It analyzes placental tissue to provide definitive genetic information.

Why the Other Options Are Incorrect:

A. Amniotic Fluid Indexing (AFI)

AFI measures the amount of amniotic fluid to assess for oligohydramnios or polyhydramnios, not chromosomal abnormalities. It is unrelated to screening or diagnosing Down syndrome.

B. Fetal Fibronectin (fFN)

fFN is used to assess the risk of preterm labor, not chromosomal or genetic conditions. It detects a glycoprotein that acts as a "biological glue" and is not involved in genetic screening.

Correct Answer A: She experienced an abruptio placenta and preeclampsia with her labor.

Explanation:

A. She experienced an abruptio placenta and preeclampsia with her labor.

Both placental abruption and severe preeclampsia are known risk factors for Disseminated Intravascular Coagulation (DIC). In placental abruption, thromboplastin is released into maternal circulation, triggering widespread coagulation and consumption of clotting factors, leading to bleeding and petechiae. Preeclampsia also causes endothelial damage and may precipitate DIC.

Why the Other Options Are Incorrect:

B. She had a 4100 gm baby.

Delivering a large infant (macrosomia) may increase the risk for perineal trauma or shoulder dystocia, but it is not associated with the pathophysiology of DIC.

C. This is her 5th child.

Multiparity alone is not a risk factor for DIC. It may increase risk for postpartum hemorrhage but not coagulopathy unless accompanied by other complications.

D. She had hyperemesis gravidarum her first trimester.

Hyperemesis gravidarum is related to electrolyte imbalance and nutritional deficiencies but is not linked to DIC development.

Correct Answer D: Condom and spermicide jelly

Explanation:

D. Condom and spermicide jelly

Condoms and spermicides are barrier methods, not part of natural family planning. Natural family planning involves tracking fertility signs (like cervical mucus, temperature, or cycle length) to avoid or achieve pregnancy without using medications or physical barriers.

Why the Other Options Are Correct:

A. Checking for Spinnbarkeit

Spinnbarkeit refers to the stretchiness of cervical mucus, which increases during ovulation. This is a natural indicator used in fertility awareness.

B. Checking her cervical mucous

Monitoring cervical mucus changes is part of the Billings Ovulation Method, a natural family planning technique.

C. Using the Calendar Method to find her longest and shortest cycle then avoiding sex during potential fertile times

This is a natural calendar-based method of family planning, used to predict ovulation and avoid intercourse during fertile windows.

Correct Answers:

C. Late decelerations with absent variability

D. Sinusoidal Pattern

E. Absent variability with no periodic changes

F. Bradycardia with absent variability

Explanation;

C. Late decelerations with absent variability

This is a Category III pattern indicating fetal hypoxia. The combination of late decelerations and absent variability suggests significant fetal compromise.

D. Sinusoidal Pattern

A sinusoidal pattern is a smooth, wave-like, undulating FHR baseline pattern and is a Category III finding. It is associated with severe fetal anemia or hypoxia.

E. Absent variability with no periodic changes

Absent variability alone, especially with no accelerations or decelerations, reflects a non-reassuring tracing and is considered Category III due to the risk of fetal acidemia.

F. Bradycardia with absent variability

Prolonged fetal bradycardia combined with absent variability indicates severe compromise and requires immediate evaluation or intervention.

Why the Other Options Are Incorrect:

A. Tachysystole

This refers to excessive uterine contractions and is a uterine activity issue. It is not a Category III criterion on its own.

B. Tachycardia with minimal variability

This is considered a Category II finding. Minimal variability with tachycardia can indicate fetal stress but does not meet Category III criteria unless variability is absent.

G. Late decelerations with moderate variability

Moderate variability is a reassuring sign. Although late decelerations are concerning, their presence with moderate variability makes this a Category II, not Category III pattern.

H. Variable decelerations with absent variability

This can be a Category II or concerning pattern, but on its own, it does not meet Category III criteria unless prolonged or recurrent with additional non-reassuring features.

Correct Answer C: Consuming a nutritional diet with 300 kcal more than normal.

Explanation:

C. Consuming a nutritional diet with 300 kcal more than normal.

This statement is inaccurate in the context of preconception health. The recommendation to increase calorie intake by about 300 kcal/day applies during pregnancy, not before conception. Preconception nutrition should focus on balance, weight management, and vitamin intake, not on increased caloric consumption.

Why the Other Options Are Correct:

A. Taking prenatal vitamins with 400 mcg of folic acid.

Folic acid should be started at least one month before conception to help prevent neural tube defects.

B. Normalizing HgA1c levels, if diabetic, prior to conception.

Good glycemic control reduces the risk of congenital anomalies and other complications. Preconception care for diabetics includes optimizing blood glucose and A1c levels.

D. Going to the dentist for a routine check up and cleaning.

Oral health is important prior to pregnancy. Poor oral hygiene and untreated periodontal disease are linked to adverse pregnancy outcomes such as preterm birth.

Correct Answer A: Trichomonas has a frothy discharge that is smelly.

Explanation:

A. Trichomonas has a frothy discharge that is smelly.

This is a correct description of Trichomoniasis, which often presents with a frothy, yellow-green vaginal discharge that may have a foul odor, along with itching or irritation. This statement reflects accurate understanding of one STD's clinical presentation.

Why the Other Options Are Incorrect:

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

Syphilis typically begins with a painless chancre at the site of infection, not painful urination. Painful urination is more characteristic of gonorrhea or chlamydia.

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

Condoms greatly reduce the risk of STD transmission but do not eliminate it entirely. Skin-to-skin contact (as with herpes or HPV) can still result in transmission even with condom use.

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

A C-section is only required if active genital herpes lesions are present at the time of labor. Women with a history of herpes but no active outbreak can often have a vaginal delivery.