Maternal And Child Health Nursing Test I - Set A

During the antepartum period, it is important to promptly report any signs of leaking amniotic fluid. This is because it could indicate a rupture of the amniotic sac, which can lead to complications such as infection or preterm labor. Prompt reporting allows for timely medical intervention to ensure the health and safety of both the mother and the baby. Constipation, breast tenderness, and nasal stuffiness are common discomforts during pregnancy but do not pose the same level of risk as leaking amniotic fluid.

The Babinski reflex is a normal reflex in newborns. It is characterized by the hyperextension and fanning apart of the toes when the sole of the foot is stroked. This reflex is a sign of a healthy nervous system in infants.

When uterine rupture occurs, the priority would be to limit hypovolemic shock. Uterine rupture can lead to severe bleeding, which can cause hypovolemia, a condition where there is a significant decrease in blood volume. This can result in inadequate perfusion to vital organs and can be life-threatening. Therefore, the immediate focus should be on controlling the bleeding and preventing further blood loss to stabilize the patient's condition and minimize the risk of hypovolemic shock.

Preterm labor refers to labor that starts after 20 weeks gestation but before 37 weeks gestation. This means that the woman goes into labor earlier than expected, which can have potential risks for the baby's health and development. It is important to monitor and manage preterm labor to ensure the best possible outcome for both the mother and the baby.

If the uterus becomes overstimulated by oxytocin during the induction of labor, tetanic contractions prolonged to more than 90 seconds may occur. This means that the contractions become very strong and last longer than normal, which can be dangerous for both the mother and the baby. It can lead to decreased blood flow to the placenta, causing fetal distress and potentially leading to complications such as fetal hypoxia or uterine rupture. Therefore, it is important to closely monitor the contractions and adjust the oxytocin dosage to prevent this from happening.

The most pertinent nursing diagnosis for this couple would be self-esteem disturbance related to infertility. This is because the couple's statement about their friends having children while they are unable to conceive suggests that they may be experiencing feelings of inadequacy, low self-worth, and a negative impact on their self-esteem due to their infertility.

Breast injury caused by overdistention, stasis, and cracking of the nipples is the primary predisposing factor related to mastitis. This is because when the nipples are cracked or injured, it creates a pathway for bacteria to enter the breast tissue. Overdistention and stasis can also lead to milk buildup, creating an environment that is conducive to bacterial growth. These factors increase the risk of infection and inflammation in the breast, leading to mastitis.

The correct answer is Blink, cough, sneeze, gag. These reflexes are present at birth and remain unchanged through adulthood. The blink reflex is an automatic response to protect the eyes from potential harm. Coughing and sneezing reflexes help to clear the airways of irritants or foreign objects. The gag reflex is a protective mechanism that prevents choking by triggering the contraction of the throat muscles. These reflexes are essential for maintaining the safety and health of an individual.

During the first trimester of pregnancy, it is common for women to experience ambivalence, fear, and fantasies. Ambivalence refers to having mixed feelings or uncertainty about the pregnancy, as it can bring both joy and anxiety. Fear is a natural emotional reaction due to the physical and emotional changes happening in the body, as well as concerns about the health and well-being of the baby. Fantasies can include daydreaming about the future, imagining what the baby will be like, or envisioning the role of being a parent. These emotional reactions are typical during the initial stage of pregnancy.

Before birth, the foramen ovale connects the right and left auricles of the heart. This is a small opening in the septum between the two atria. It allows blood to bypass the lungs, as the fetus receives oxygen from the placenta instead of breathing air. After birth, when the baby takes its first breath, the foramen ovale typically closes and becomes the fossa ovalis.

Multiple gestation, or carrying more than one fetus, is a known risk factor for placenta previa. This condition occurs when the placenta partially or completely covers the cervix, which can lead to bleeding during pregnancy. With multiple gestation, there is a higher likelihood of the placenta implanting lower in the uterus, increasing the risk of placenta previa. Uterine anomalies, abdominal trauma, and renal or vascular disease may also have an impact on placenta previa, but multiple gestation is a more direct and specific risk factor.

During pregnancy, the uterus expands in size and puts pressure on the blood vessels in the pelvic area, including the veins in the legs. This increased pressure can lead to aching and swollen leg veins. Thrombophlebitis refers to inflammation of a vein due to a blood clot, which is not the most probable cause in this case. Pregnancy-induced hypertension is a condition characterized by high blood pressure during pregnancy, which may cause various complications but is not directly related to aching swollen leg veins. The force of gravity pulling down on the uterus does not specifically explain the aching swollen leg veins.

Cervical softening and uterine souffle are classified as probable signs. These signs are not definitive proof of pregnancy, but they strongly suggest its presence. Cervical softening refers to the softening of the cervix, which occurs due to increased blood flow and hormonal changes. Uterine souffle is a soft blowing sound heard over the pregnant uterus, caused by increased blood flow through the uterine arteries. These signs are considered probable because they are commonly associated with pregnancy, but they can also occur in other conditions.

Mechanical factors refer to physical obstructions or difficulties during childbirth that can lead to dystocia. This can include issues such as a large fetus, abnormal fetal position, or problems with the birth canal. These mechanical factors can prevent the normal progression of labor and delivery, causing complications and potentially endangering both the mother and the baby.

A newborn's heart rate can vary depending on their activity level. When a newborn is sleeping, a heart rate of 100 beats per minute would be considered normal. This is because during sleep, the body is in a relaxed state and the heart rate tends to decrease slightly. Heart rates below 100 beats per minute may indicate bradycardia, while heart rates above 100 beats per minute may indicate tachycardia.

During the third stage of labor, which is the delivery of the placenta, the nurse's main focus is on promoting parent-newborn interaction. This stage involves the bonding and initial interaction between the parents and their newborn. The nurse may encourage the parents to hold and interact with the baby, facilitate skin-to-skin contact, and provide emotional support and guidance to promote a positive parent-infant relationship. This intervention is crucial for the emotional well-being of both the parents and the baby.

FHR stands for fetal heart rate and refers to the heartbeat of the fetus. Auscultation is the process of listening to sounds within the body using a stethoscope or fetoscope. The question asks at what stage of gestation FHR can be auscultated with a fetoscope. The correct answer is 20 weeks gestation. This means that at around 20 weeks of pregnancy, the fetal heartbeat can be heard using a fetoscope.

Edema of the hands and face is a classic sign of PIH (pregnancy-induced hypertension) because it is caused by the retention of fluid in the body. PIH is a condition that occurs during pregnancy and is characterized by high blood pressure and damage to organs such as the liver and kidneys. Edema, or swelling, is a common symptom of PIH and is often seen in the hands and face due to the increased pressure in the blood vessels. This can be a result of the body's inability to eliminate excess fluid properly.

When umbilical cord prolapse occurs, the nurse's initial action is to place the client in a knee-chest position in bed. This position helps to relieve pressure on the cord and prevent further compression, which can lead to fetal distress or compromise. By placing the client in a knee-chest position, gravity helps to shift the weight of the fetus off the cord, allowing for better blood flow. This action should be taken immediately to ensure the safety of both the mother and the baby.

The most commonly assessed findings in cystitis are nocturia (frequent urination at night), frequency (frequent urination), urgency (sudden and strong need to urinate), dysuria (painful urination), hematuria (blood in the urine), fever, and suprapubic pain (pain in the lower abdomen). These symptoms are typically seen in individuals with cystitis and are used to diagnose the condition.

When preparing a client for cesarean delivery, it is important to modify preoperative teaching to meet the needs of either a planned or emergency cesarean birth. This is because the client may have different concerns and questions depending on whether the cesarean is planned or unexpected. By tailoring the teaching to the specific situation, the nurse can address any fears or uncertainties the client may have and provide appropriate information and support. This ensures that the client is well-prepared and informed for the procedure, leading to better outcomes and satisfaction.

Performing a pregnancy test less than 10 days after an abortion can cause a false-positive result. After an abortion, the hormone hCG (human chorionic gonadotropin) may still be present in the body, which is the hormone detected by pregnancy tests. It takes time for hCG levels to decrease after an abortion, so if a test is done too soon, it may detect the remaining hCG and give a false-positive result. Therefore, performing a test within 10 days of an abortion can lead to a false-positive result.

Between 50% and 80% of all new mothers report some form of postpartum blues. This answer reflects the frequency of reported postpartum "blues" as it suggests that a significant majority of new mothers experience this condition. The answer range of 50% to 80% indicates that a substantial portion of new mothers are affected by postpartum blues, highlighting the prevalence of this phenomenon.

Thrombophlebitis is the inflammation of the vascular endothelium, which is the inner lining of the blood vessels, combined with the formation of a blood clot on the vessel wall. This condition occurs when the blood components combine and form an aggregate body, leading to inflammation and clot formation. It is not specific to any particular blood vessel, such as the pulmonary blood vessels or the femoral vein.

Barbiturates are not given for pain relief during active labor because they rapidly transfer across the placenta and lack an antagonist, making them generally unsuitable. This means that the drugs can easily reach the fetus, causing depressive effects in the newborn shortly after injection. Additionally, the lack of an antagonist means that there is no medication available to counteract any adverse effects that may occur. Therefore, barbiturates can pose risks to both the mother and the baby during labor.