Answer key Midwifery 1 Final Term Examination

1.3 2.4 3.4 4.2 5.2 6.3 7.4 8.1 9.1 10.4 11.2 12.1 13.1 14.1 15.4

16.2 17.1 18.4 19.1 20.4 21.4 22.3 23.1 24.2 25.2 26.3 27.3 28.1 29.2 30.2

31.4 32.1 33.1 34.1 35.2 36.4 37.1 38.4 39.2 40.2

1. What appropriate health teachings should a nurse provide a pregnant women infected with HIV about caring for her baby? Give atleast two. (2 points) * Reinforce regularly and clearly the notion that, when the mother cares for herself, she is caring for her infant. Talk with the patient about stress, the importance of adequate mild-to-moderate exercise, and sufficient rest. * Emphasize that regular prenatal care is extremely important to prevent complications of pregnancy. * Use of a prenatal vitamin supplement is important, but cannot replace healthy food intake. Develop a plan with the patient for attaining the desired weight gain during pregnancy, while maintaining a healthy nutritional intake. * Cigarette, alcohol, and drug use contribute to poor maternal nutrition and can harm the developing fetus. Illicit drug use increases the risk of transmitting HIV to the infant. Injection drug use can transmit HBV, HCV, and CMV to the mother and to the baby. Encourage cessation of cigarette, alcohol, and drug use, and offer referrals for treatment, as needed. * Be sure the woman understands all planned procedures and treatments and understands their potential risks and benefits both to herself and to the fetus. * Discuss the risks and benefits (to the woman and fetus) of each medication to be taken during pregnancy, including those for which there are limited data on teratogenicity. * Discuss ART as part of the strategy to reduce the risk of perinatal HIV transmission to the fetus or newborn. For women at risk, diligent use of "safer sex" during pregnancy is important for preventing transmission of STIs and CMV, which can cause more complications when HIV is present. STIs can harm fetal development and may increase the risk of HIV transmission to the baby. New genital herpes infections during pregnancy can cause severe complications and even death in neonates. * For women with negative Toxoplasmatiters, explain the need to avoid undercooked meat, soil, and cat feces. * Teach the pregnant woman how to obtain medical attention quickly at the first signs of OI or other complication. Discuss what to watch for and how to get help when emergencies arise in the evenings or on weekends or holidays. * Help the patient clarify her child care options and encourage her to begin putting in place long-term child care and guardianship plans in case she becomes too sick to care for her child or children.

2. What problems can the baby develop from a pregnant woman infected with rubella? (2 points) The baby can have something called Rubella Syndrome if the mother has rubella in her first trimester. Quote from the Related Link below: The classic triad for congenital rubella syndrome is: Sensorineural deafness - (58% of patients) Eye abnormalities - especially cataract and microphthalmia (43% of patients) Congenital heart disease - especially patent ductus arteriosus (50% of patients) Other manifestations of CRS may include: spleen, liver or bone marrow problems (some of which may disappear shortly after birth) mental retardation small head size (microcephaly) eye defects low birth weight thrombocytopenic purpura (presents as a characteristic "blueberry muffin" rash) hepatomegaly micrognathia

3. What is the difference between oligohydramnios and polyhydramnious? ( 2 points) Oligohydramnios is a condition where there is too little amniotic fluid. It is most common in the last trimester, but it can occur during anytime of the pregnancy. Polyhydraminos is a condition that happens when a woman has too much amniotic fluid surrounding the baby. In most of the cases where this condition occurs, it usually goes away on its own. 4. What are the possible complications of a pregnant woman with hyperthyroidism? ( 3 points) Pregnancies complicated by uncontrolled hyperthyroidism may result in higher incidences of:

Spontaneous abortion Preterm labor Low birth-weight babies Stillbirths Complications of pregnancy, including pre-eclampsia (a condition associated with hypertension, low blood platelet count, protein in the urine and mental changes) and heart failure.

5. What health teachings must a nurse give to a pregnant woman with asthma? Give atleast three. (3points) If more than one health professional is involved in the pregnancy and asthma care, they must communicate with each other about treatment. The obstetrician must be involved with asthma care. Monitor lung function carefully throughout your pregnancy to ensure that your growing fetus gets enough oxygen. Because asthma severity changes for about 2 out of 3 women during pregnancy, you should have monthly checkups with your doctor to monitor your symptoms and lung function.1 Your doctor will use either spirometry or a peak flow meter to measure your lung function. Monitor fetal movements daily after 28 weeks.

If your asthma is not well controlled or if you have moderate or severe asthma, think about having ultrasounds after 32 weeks to monitor fetal growth.1 Ultrasound exams can also help your doctor check on the fetus after an asthma attack. Try to do more to avoid and control asthma triggers (such as tobacco smoke or dust mites), so that you can take less medicine if possible. Many women have nasal symptoms, and there may be a link between increased nasal symptoms and asthma attacks. Gastroesophageal reflux disease (GERD), which is common in pregnancy, may also cause symptoms. It is important that you have extra protection against the flu (influenza). Get the flu vaccine as soon as it's available, whether you are in your first, second, or third trimester at the time.The flu vaccine is effective for one season. The flu vaccine is safe in pregnancy and is recommended for all pregnant women.

6. What health teachings must a nurse provide to a pregnant woman infected with syphilis? Give atleast three. (3 points). * Reinforce regularly and clearly the notion that, when the mother cares for herself, she is caring for her infant. Talk with the patient about stress, the importance of adequate mild-to-moderate exercise, and sufficient rest. * Emphasize that regular prenatal care is extremely important to prevent complications of pregnancy. * Use of a prenatal vitamin supplement is important, but cannot replace healthy food intake. Develop a plan with the patient for attaining the desired weight gain during pregnancy, while maintaining a healthy nutritional intake. * Cigarette, alcohol, and drug use contribute to poor maternal nutrition and can harm the developing fetus. Illicit drug use increases the risk of transmitting HIV to the infant. Injection drug use can transmit HBV, HCV, and CMV to the mother and to the baby. Encourage cessation of cigarette, alcohol, and drug use, and offer referrals for treatment, as needed. * Be sure the woman understands all planned procedures and treatments and understands their potential risks and benefits both to herself and to the fetus. * Discuss the risks and benefits (to the woman and fetus) of each medication to be taken during pregnancy, including those for which there are limited data on teratogenicity. * Discuss ART as part of the strategy to reduce the risk of perinatal HIV transmission to the fetus or newborn. For women at risk, diligent use of "safer sex" during pregnancy is important for preventing transmission of STIs and CMV, which can cause more complications when HIV is present. STIs can harm fetal development and may increase the risk of HIV transmission to the baby. New genital herpes infections during pregnancy can cause severe complications and even death in neonates. * For women with negative Toxoplasmatiters, explain the need to avoid undercooked meat, soil, and cat feces. * Teach the pregnant woman how to obtain medical attention quickly at the first signs of OI or other complication. Discuss what to watch for and how to get help when emergencies arise in the evenings or on weekends or holidays. * Help the patient clarify her child care options and encourage her to begin putting in place long-term child care and guardianship plans in case she becomes too sick to care for her child or children.

7. If you were the nurse in the delivery room and you found out that a pregnant woman has an abnormal fetal heart rate, what will you do? Please give a step by step answer and give the reasons to support them. (4 points) 1. Change the clients position (lateral, left side preferred to relieve pressure on the vena cava, aorta or umbilical cord to improve maternal and fetal circulation) 2. Fetal monitoring every 15-30 minutes and record findings on the flow chart. 3. Administer O2 to the client with tight face mask at 6-10 L /min per physician order to improve oxygenation of the client and fetus. 4. If the fetal heart rate is still abnormal, tell the physician to change the treatment 8. In assessing a pregnant woman, what items will you include in the following categories: (9 points). Examples are given for you. Category Past Medical History Items 1. Acute medical condition, Chronic medical condition, gynecological conditions/surgery, Infertility, Genetic conditions, Domestic Abuse, STD History, Nutrition history, Anemia, Cancer, Breast Health, Mental Health 1.Number of pregnancies, Number of term pregnancies, Number of live births, abortions, Deceased children, Obstetrical complications ( prenatal, intrapartal, postpartum) 1. Mental Health, Acute medical conditions, chronic medical conditions, mental health, allergies, medications, infertility treatment, STD, immunization status, Sexual activity, smoking, substance use, nausea/vomiting, vaginal bleeding, urinary symptoms.

Past Obstetrical History

Current Health Status

9. Identify and describe the following fetal heart rate patterns. ( 2 points each, 4 points) A.

This is the baseline fetal heart rate.Specifically, a normal fetal heart rate in between 110 and 150 bpm.

B.

This shows fetal bradychardia which may result from fetal hypoxia, medications, epidurals, maternal hypotension and prolapsed umbilical cord. 10. What are the three primary mechanisms by which uterine contractions can cause a decrease in fetal heart rate? (3 points) Compression of the fetal head Compression of the umbilical cord Compression of uterine myometrial vessels 11. Fill in the blanks with the letter of the correct answer from the choices given below.(5 points) A. B. C. D. E. 1. 2. 3. 4. Type 2 DM Gestational Diabetes Mellitus Infection (vaginitis, UTI) Generalized edema CHF

___A___ Insulin resistance. ___C___Effect of diabetes in pregnancy. ___B__Glucose intolerance with the onset of pregnancy. ____E__If a pregnant woman's heart cannot handle increase workload, it may result to______.

5. ___D__One manifestation of congestive heart failure during pregnancy.

12. Twin pregnancy complications Aside from preterm labor, there are several possible problems:

Twins and triplets often don't have a chance to reach a healthy weight before they're born. While the average single baby weighs 7 pounds at birth, the average twin weighs 5.5 pounds. Triplets typically weigh 4 pounds each, and quads weigh 3 pounds each. Babies born at under 5.5 pounds are considered to have a low birth weight. Babies with low birth weights are likely to have health problems even if they weren't born prematurely. Low-birthweight babies often have trouble breathing on their own. They may not be fully prepared to fight infections, control their body temperature, or put on weight. For these reasons, almost all low-birthweight babies have to spend time in a neonatal intensive care unit before going home.

Preeclampsia, a disorder characterized by high blood pressure and protein in the urine, develops in roughly 10 to 15 percent of women carrying twins, twice the rate of women carrying one baby. The condition tends to develop earlier as well. And once it starts, it can be especially severe. When preeclampsia is severe, it can affect many of your organs and cause serious or even life-threatening problems. Gestational diabetes seems to be more common in women carrying more than one baby. If you develop gestational diabetes, your practitioner will monitor you closely. You'll most likely be able to keep your blood sugar levels under control with diet and exercise, and by getting insulin shots if you need them. Poorly controlled diabetes can have serious consequences for you and your babies. Placental abruption, when the placenta detaches from the uterine wall before delivery, is also more likely when you're carrying more than one baby. It can happen any time in the second half of pregnancy and can lead to growth problems, preterm delivery, or stillbirth. In multiple pregnancies, abruption is especially common just after the first baby has been delivered vaginally. Once abruption has occurred, the other baby or babies may have to be delivered by cesarean section.

Twin-to-twin transfusion syndrome is a rare but serious complication that occurs in identical twins when blood flows from one baby to the other through their shared placenta. According to the March of Dimes, 15 percent of identical twins develop the syndrome. The condition is usually treated by draining amniotic fluid from the sac of the baby receiving the extra blood. The survival rate after this treatment is about 60 percent two to three times higher than without treatment.

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