Nursing 328 Final Exam 2024: Questions and Answers, Exams of Nursing

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Nursing 328 Final Exam 2024. Questions

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Why do external reproductive structures enlarge during pregnancy? - ANSWER- D/t increased vascularity. Nipples enlarge, become more erectile and darken. Breasts are fuller and heavier. As blood vessels enlarge, veins beneath the skin of the breasts become more visible. Cervix softens, takes on bluish colour during second month due to increased vasculature as well What does estrogen and progesterone cause? - ANSWER- The uterus to lengthen and enlarge What organ produces estrogen and progesterone until the placenta is formed and functioning? - ANSWER- The corpus luteum What is leukorrhea? - ANSWER- White, thick, odourless and acidic vaginal secretions which increase. The acidity helps prevent bacterial infections but can increase yeast infections What hormones does the placenta secrete? - ANSWER- hCG, hPL, relaxin and prostaglandins, progesterone and estrogen

What does hPL stand for? - ANSWER- human placental lactogen but AKA human chorionic somatomammotropin What does hPL do? - ANSWER- Promotes fat breakdown, providing the pt with an alternative source of energy so that glucose is available for fetal growth. What other hormones have an impact on the action of insulin? - ANSWER- Estrogen Progesterone Cortisol hPL resulting in increased insulin need throughout pregnancy What do prostaglandins do during pregnancy? - ANSWER- Affect smooth muscle contractility to such an extent that they may trigger labour at pregnancy's term What can high levels of estrogen and progesterone do in relation to the pituitary gland? - ANSWER- stop the pituitary gland from producing follicle- stimulating hormone and luteinizing hormone. Increased production of growth hormone and melanocyte-stimulating hormone causes skin pigment changes How is the thyroid gland affected during pregnancy? - ANSWER- the thyroid gland's production of thyroxin binding protein increases causing

total thyroxine (T4) levels to rise. Bc of the amount of unbound T4 doesn't increase, these thyroid changes don't cause hyperthyroidism; however, they increase BMR, CO, HR, vasodilation and heat intolerance. How much does BMR increase during the second and third trimesters? - ANSWER- 20% as the growing fetus places additional demands for energy. Does the adrenal gland change during pregnancy? - ANSWER- Yes, it increases production of corticosteroid and aldosterone increases which increases fluid retention in case of PPH and to have a larger circulating blood volume to get nutrients to fetus. What does the pancreas do in response to additional glucocorticoids being produced? - ANSWER- Increases insulin production How is the resp system changed during pregnancy? - ANSWER- Diaphragm rises, preventing lungs from fully expanding so it compensates by increasing its outward expansion. We have more thoracic breathing How is the diaphragm able to expand outwards? - ANSWER- The progesterone relaxes ligaments that join the rib cage What effect can increased estrogen have on the resp system? - ANSWER- Can lead to increased vascularity of upper resp tract. As a result, the pt may develop resp congestion, voice changes and epistaxis as capillaries become engorged in the nose, pharynx, larynx, trachea, bronchi and vocal cords.

How much more air do you breath in during pregnancy? - ANSWER- 30- 40% What can an elevated diaphragm cause? - ANSWER- Decreased functional residue capacity, which contributes to hyperventilation. How do mothers protect the fetus from excessive levels of CO2? - ANSWER- Hyperventilation Is the BP higher or lower in pregnancy? - ANSWER- In most woman, BP actually decreases slightly during second trimester bc of the lowered peripheral resistances to circulation that occurs as placenta rapidly expands. Why does the heart enlarge during pregnancy? - ANSWER- Due to increased blood volume and CO What are some blood changes that occurs during pregnancy? - ANSWER- Blood is able to clot more easily d/t increased lvls of clotting factors. Fibrinogen levels are increased to prevent hemorrhage Why would a woman have anemia during pregnancy if blood volume increases? - ANSWER- As plasma volume first increases, the concentration of hemoglobin and erythrocytes may decline, giving the woman physiological anemia or pseudo anemia

Body's demand for iron is increased bc it promotes RBC production and accommodates the increased blood volume Why do women feel the increased need to pee during pregnancy? - ANSWER- The pressure of uterus on bladder Hormonal changes relax bladder Dilation of renal pelves and ureters d/t smooth muscle relaxation from progesterone & estrogen Why are women more at risk for UTIs when pregnant? - ANSWER- Smooth muscle of utterers undergo hypertrophy causes changes to slow flow of urine Why do women c/o constipation and heartburn during pregnancy? - ANSWER- Gastric tone and motility decrease, thus slowing the stomach's emptying time and possible regurg Why do pregnant women get hemorrhoids? - ANSWER- The enlarged uterus displaces the large intestine and puts increased pressure on veins below the uterus. Can pregnant women get subclinical jaundice? - ANSWER- Yes bc as smooth muscles relax, the gallbladder empties sluggishly. This can lead to reabsorption of bilirubin into maternal bloodstream, causing subclinical jaundice (general itching)

Hepatic blood flow may increase slightly, causing liver's workload to increase as BMR increases. Factors within the liver as well as increased estrogen and progesterone can decrease bile flow What other liver changes do we see in pregnancy? - ANSWER- Decreased albumin & plasma cholinesterase levels as well as increased plasma globulin This would indicate liver disease in regular people but not pregnant ones Why do pregnant ppl get N&V? - ANSWER- Due to hCG and progesterone levels beginning to rise Also decreased glucose or increased estrogen When can FHR be detected? - ANSWER- 10 weeks with a doppler and 20 weeks with a fetoscope Normal is 110- When will the mother feel movement? - ANSWER- 14-26 weeks What is the human chorionic gonadotropin hormone used for? - ANSWER- To detect pregnancy but can also detect certain tumours that secrete it What can an amniocentesis detect? - ANSWER- Fetal abnormalities, particularly chromosomal and neural tube defects Hemolytic disease Metabolic disorders

Assess fetal lung maturity Determine fetal age and maturity Detect presence of meconium or blood Measure amniotic levels of estriol and fetal thyroid hormone Identify gender When will gestation HTN develop? - ANSWER- Typically after 20 weeks When is gestational HTN most common? - ANSWER- In nulliparous (first pregnancy) women In teenagers and primiparas (first child) over 35 What is preeclampsia? - ANSWER- The nonconvulsive form, is marked by the onset of HTN after 20 weeks 7% of women What is eeclampsia? - ANSWER- the convulsive form, occurs between 24 weeks and end of the first postpartum weeks What other syndrome is associated with severe preeclampsia? - ANSWER- HELLP Hemolysis, elevated liver enzymes levels and low platelet count What are some complications with gest. HTN? - ANSWER- IURG Placental infarcts Abruptio placentae Stillbirth

Seizures Coma Premature labour Renal failure Hepatic damage in mother What is the cause of gest. HTN? - ANSWER- Exact cause is unknown Possible causes could be toxic sources, autointoxication, uremia, maternal sensitization of total proteins and pyelonephritis What is the classic triad of S&S for gest. HTN? - ANSWER- HTN Proteinuria Edema What can happen as preeclampsia worsens? - ANSWER- Pt may demonstrate oliguria Blurred vision caused by retinal arteriolar spasm Epigastric pain Heartburn Irritability Emotional tension What are the readings in severe preeclampsia? - ANSWER- 160/110 or higher on two occasions, 6 hours apart, during bed rest What is the tmt for preeclampsia? - ANSWER- Complete bed rest in the preferred left lateral recumbent position to enhance venous return

Admin of antihypertensives Admin of magnesium to promote diuresis, reduce BP and prevent seizures What is fetal presentation? - ANSWER- The relationship fo the fetus to the cervix What are the primary factors to determine fetal presentation? - ANSWER- Fetal lie, attitude and position What is fetal lie? - ANSWER- The relationship of the spine of the mother to the spine of the fetus. It can be longitudinal, transverse (perpendicular), or oblique. What is fetal attitude? - ANSWER- The relationship of the fetal parts to one another. The fetal attitude can be flexion or extension. What is fetal position? - ANSWER- the relationship of the presenting part to the four quadrants of the maternal pelvis. Fetal position is defined using three letters. First letter designates whether the presenting part is facing women's L or R side. The second letter refers to the presenting part of fetus. Third letter refers whether the presenting part is pointing to the anterior, posterior or transverse section of pelvis. What are the most common positions? - ANSWER- LOA ROA

What is a compound breech presentation? - ANSWER- An extremity presents itself with another major presenting part during delivery What is the breech position? - ANSWER- When fetus presents with buttocks feet or both first. What are some complications with breech? - ANSWER- Cord prolapse, anoxia, intracranial hemorrhage caused by rapid molding of the head, neck trauma and shoulder, arm, hip and leg dislocation or fractures may occur in fetus. In mother, perineal tears and cervical lacerations during delivery and infection from premature rupture of membranes What are the three types of breech? - ANSWER- Complete, Incomplete, & Frank Breech What is a frank breech? - ANSWER- Butt down, thigh flexed, legs extended (~pancake) What is an incomplete breech? - ANSWER- One or both of the knees or legs and presenting What is station? When is the station at 0? - ANSWER- Relation of the fetal head and the pelvis, when the fetal head reaches the ischial spines= 0 station Can be -1 to -3 and +1 to + +4 is crowning

What is a ripe cervix? - ANSWER- Soft and supple to touch rather than firm Softening of cervix allows for cervical effacement, dilation and effective coordination of contractions When should labour not be stimulated? - ANSWER- transverse fetal position Umbilical cord prolapse Active genital herpes Women who have had previous myomectomy (fibroid removal) from uterus What are some increased risks with stimulation of the uterus? - ANSWER- Placenta previa Abruptio placentae Uterine rupture decreased fetal blood supply caused by the increased intensity or duration of contractions What are some methods for stimulating labour? - ANSWER- Breast stimulation Amniotomy (artificial membrane breaking) Oxytocin admin Ripening agent application What are the 5 P's of factors influencing labour? - ANSWER- Powers- contraction & pushing effort Passage- Pelvis, soft tissues & scar tissue Passenger- fetal size, presentation, position, attitude

Position- woman's body position can move fetus (squatting, walking up stairs, leaning forward) Psyche Provider, patience, pain relief When does true labour begin? - ANSWER- When women has bloody show, her membranes rupture and she has painful contractions of the uterus that cause effacement and dilation of cervix What are the preliminary S&S of labour? - ANSWER- Lightening Increased level of activity Braxton hicks Ripening of cervix restlessness Anxiety Sleeplessness What happens during the transition phase of the first stage of labour? - ANSWER- When contraction reach their max intensity, frequency and duration- they each last 60-90 seconds and recur every 2-3 minutes Cervix dilates from 7-10 cm to fully dilated May experience mood swings Where are contractions strongest? - ANSWER- Top of the Uterus, forcing baby toward cervix

What happens in the first stage of labour? - ANSWER- When effacement and dilation occurs, begins with the onset of true uterine contractions and ends when the cervix is fully dilated. It is divided in three phases: latent, active and transition What is the latent phase? How often are contractions? - ANSWER- Begins with onset of regular contractions. Usually mild, last 20-40 seconds and recur every 5-30 minutes Premature analgesia admin, poor fetal position, cephalopelvic disproportion and a cervix that hasn't soften sufficiently may increase duration of this phase What is the active phase? - ANSWER- Stronger contractions, each lasting 40-60 seconds and recur every 3-5 minutes 3-7 cm dilation, fetus begins to descend through pelvis at an increased rate What are some systemic changes in the active phase of labour? - ANSWER- Increased BP, CO, RR & O2 consumption Supine hypotension Possible hyperventilation Increased pain threshold and sedation Dehydration Decreased motility Slow absorption of solid food N&D Diaphoresis

Fatigue Backage Joint pain Leg cramps Decreased progesterone BG levels Increased estrogen, prostaglandins, oxytocin and metabolism Difficulty voiding and proteinuria What is the second stage of labour? - ANSWER- Encompasses actual birth, begins when cervix is fully dilated and ends with delivery of fetus The frequency of contractions are every 3-4 minutes lasting 60-90 seconds and are accompanied by the uncontrollable urge to push or bear down The decreased frequency gives women chance to rest What is labouring down? - ANSWER- is simply when the woman does not push with contractions but allows the the contractions to do the work What is traditional closed glottis pushing? - ANSWER- Making no noise, holding ones breath for a coat of 10 and quickly gasping in air and repeated What is open glottis pushing? - ANSWER- mom pushes only when she has the urge for about 6-8 seconds: she continues to breathe which keeps glottis open Results in less fetal stress and greater perineal relaxation What is the third stage of labour? - ANSWER- Also called the placental stage

Begins immediately after the neonate is delivered and end when the placenta is delivered. What are the two phases in stage three? - ANSWER- Placental separation and placental explusion What are some signs that the placenta has separated and is ready to be delivered? - ANSWER- Absence of cord pulse Lengthening of umbilical cord Sudden gush of vaginal blood Change in shape of uterus How can we avoid gross hemorrhage when the placenta is separating? - ANSWER- Never exert pressure on uterus that isn't contracted What is stage four of labour? - ANSWER- Begins after delivery of the placenta Homeostasis is reestablished What will a women's VS be in the fourth stage and how often should we monitor them? - ANSWER- They will be slightly elevated d/t the birth process, excitement and oxytocin admin Monitor VS q15 minutes for a minimum of one hour How can we establish a baseline FHR? - ANSWER- Auscultate FHR for 30-60 seconds immediately after a contraction has ended

External uterine palpation can tell you the frequency, duration and intensity of contractions and the relaxation time between them What are some sources of pain during labour? - ANSWER- Uterine contractions Dilation and stretching of the cervix and lower uterine Distention Pressure on adjacent organs Tension What are some hormones present in labour? - ANSWER- Relaxin hCG hPL Progesterone Estrone Estradiol Prolactin What are some labour supports and pain management? - ANSWER- Breathing Massage Acupressure Aromatherapy Focal point Music Environment Positioning

Hyponosis TENS Sterile water injections What are some maternal factors leading to c-section? - ANSWER- Cephalopelvic disproportion Active genital herpes Previous c-section Disabling conditions Inadequate progress Malignant tumours What are some placental factors that can lead to c-section? - ANSWER- Placental previa Placental accreta Abruptio placentae Premature separation of the placenta What are some fetal factors that can lead to c-section? - ANSWER- Transverse fetal lie Extremely low fetal size Fetal distress- fetal hypoxia, living fetus with prolapse cord, abnormal FHR patterns Compound conditions, such as macrocosmic fetus in a breech lie What are some bodily effects that occur after c-section? - ANSWER- Thrombophlebitis

Blood loss Decreased BP Edema Inflammation PPH Self-image & self-esteem Body defences What are some maternal complications with c-section? - ANSWER- resp tract infection Wound dehiscence Thromboembolism Paralytic ileus Hemorrhage GU tract infection Bowel, bladder or uterine injury What is chloasma? - ANSWER- Pigmentation increases on the face and neck What additional effect can colostrum have? - ANSWER- The high protein level of colostrum aids in the binding of bilirubin and also has a laxative effect When will your period return after you give birth? - ANSWER- Breastfeeding women- 2 to 18 months Non lactating women resume in 6-10 weeks

When is breastfeeding contraindicated? - ANSWER- Maternal HIV/active TB infection Drug abuse Certain medications (tetracycline, chloramphenicol) Has breast cancer Herpes on nipples Restricted diet that interferes with adequate nutrition What are some maternal advantages to BF? - ANSWER- Protection against breast cancer Assistance in uterine involution d/t the release of oxytocin Empowerment Less prep time and less cost than formula More calorie loss What are some fetal advantages to BF? - ANSWER- Protection against infections Promotes rapid brain growth Neurologic cell building Electrolyte and mineral composition Improves ability to regulate calcium and phosphorus Reduces dental arch malformation What is considered PPH? - ANSWER- exceeds 500 mls in first 24 hour period

What are some risk factors for PPH? - ANSWER- Abruptio placentae Missed abortion Placenta previa Uterine infection Placenta accrete Uterine inversion Severe preeclampsia Amniotic fluid embolism Intrauterine fetal death Precipitous labour Macrosomia Multiple gestation Prolonged labour Multiparity What is uterine atony? - ANSWER- Uterine relaxation When the uterus doesn't contract properly, vessels at the placental site remain open allowing blood loss What are some causes of PPH? - ANSWER- Uterine atony Lacerations Retained placenta or placental fragments Disseminated intravascular coagulation (DIC) What is a puerperal infection? - ANSWER- -bacterial infections after child birth -occurs within 28 days of abortion or delivery

-found inside or outside of vagina Can resulting endometritis, parametrizes, pelvic and femoral thrombophlebitis and peritonitis What are some causes of puerperal infection? Bacteria wise - ANSWER- Groups A, B, or G hemolytic streptoccus Gardnerella vaginalis Chlamydia What are some S&S of puerperal infection? - ANSWER- Temp at least 38 Chills HA Restlessness Malaise Anxiety Localized perineal infection Endometritis What are the risk factors for DVT? - ANSWER- Hx of varicose veins Obesity Previous DVT Multiple gestations Increased age Family hx Smoking c-section

multiparity What are the S&S of a femoral DVT? - ANSWER- Temp increases at day 10 PP, malaise, chills, pain, stiffness & swelling, shiny white skin on extremity What are the S&S of a pelvic DVT? - ANSWER- Onset at day 14 or 15, tachycardia and abdominal or flank pain What stimulates the neonate's breathing at birth? - ANSWER- Low blood O2 levels Increased blood CO2 levels Low pH Temp change from environment Fluid is squeezed out or absorbed into lungs What does the infant's first breath trigger? - ANSWER- The start of the cardiopulmonary changes During this transition from fetal circulation to postnatal circulation, the foramen oval, ductus arterioles and ductus enosis close. When the lungs are inflated, pulmonary vascular resistance to blood flow is reduced and pulmonary artery pressure drops. Pressure in the right atrium decreases and the increased blood flow to the left side of the heart increases the pressure int he right atrium. This change in pressure causes the foramen oval to close.

When does the renal system function fully in the neonate? - ANSWER- Until first year of life When does the meconium pass? - ANSWER- During first 24 hours of life How does the neonate maintain body temp? - ANSWER- Produce heat through non shivering thermogenesis Brown fat is another source of thermogenesis that is unique to neonate When is apgar scoring performed on infants? - ANSWER- At 1 minute and again at 5 minutes after the birth What is the normal birth weight range? - ANSWER- 2000g to 4000g What could decreased temp suggest? - ANSWER- Prematurity Infection Low temp environment Dehydration What could increased temp suggest? - ANSWER- Infection High environment temp Excess clothing Proximity to heater Drug addiction Diarrhea and dehydration

What are some common findings on a neonate's assessment? - ANSWER- Acrocyanosis Milia-clogged sebaceous glands Lanugo- fine, downy hair Vernix caseosa- white, cheesy protective coating Erythema toxic neonatorum- transient, maculopapular rash Telangiectasia- flat, reddened vascular areas appearing on neck, upper eyelid or lip Sudamina or militia- distended sweat glands Mongolian spots- bluish black areas of back and buttocks of dark skinned infants When could hyperbilirubinemia resolve? - ANSWER- 7-10 days what could happen if hyperbilirubinemia doesn't get treated? - ANSWER- May result in bilirubin encephalopathy, a neuroscientist syndrome caused by unconjugated bilirubin deposing in brain cells What are some causes of hyperbilirubinemia? - ANSWER- As erythrocytes break down at the end of their neonatal life cycle, hemoglobin separates into globing (protein) and heme fragments. Heme fragments form unconjugated to liver cells to conjugated with glucuronide and form direct bilirubin What are some factors the may affect whether a neonate develops hyperbilirubinemia? - ANSWER- Certain drugs Decreased hepatic function

Increased RBC production Maternal enzymes What is the treatment for hyperbilirubinemia? - ANSWER- Exchange transfusions High intensity phototherapy Albumin infusion IV globing What is abruptio placentae? - ANSWER- Premature separation of a normally implanted placenta after the 20th week but before birth What are some predisposing factors for abruptio placentae? - ANSWER- Traumatic injury Placental site bleeding Chronic HTN Multiparity Short umbilical cord Dietary deficiency Smoking Cocaine abuse Preterm Premature Rupture of Membranes (PPROM) Pressure on vena cava what are the S/s of abruptio placenta - ANSWER- Sudden, forceful severe and steady pain Hard, boardlike ab