The nurse is presenting an early pregnancy class to a group of ...

[BrownTown3]

The nurse is presenting an early pregnancy class to a group of pregnant women. Which statement indicates a need for further education? The placenta:
 
  1. Develops and grows larger until about 20 weeks' gestation.
  2. Creates hormones and enzymes that are necessary during pregnancy.
  3. Ages and becomes less permeable during the last month of pregnancy.
  4. Floats in the amniotic sac and filters waste products from the fetus.

Question 2

The nurse is reviewing charts of newborns. Which infant requires immediate intervention?
 
  1. 24-hour-old term male with total bilirubin level of 2.0
  2. 3-day-old term bottle-fed female with bilirubin of 11.0
  3. 2-week-old post-term breastfed male with bilirubin of 10.0
  4. 12-hour-old preterm female exhibiting icterus and lethargy

[bassamabas]

Answer to Question 1

4
Rationale:
1. The chorionic villi of the placenta become more differentiated with time. The placenta grows in size until about 20 weeks. After this point, the placenta thickens but does not increase in size.
2. The placenta creates glycogen, cholesterol, hormones such as human chorionic gonadotropin (hCG), and enzymes such as sulfatase and insulinase.
3. The placenta is designed to last for 40 weeks, the average length of human gestation. The permeability to nutrients and oxygen begins to decrease starting at about 36 weeks as a part of the aging of the placenta.
4. The placenta is attached to the uterine wall, and does not float in the amniotic sac. One function of the placenta is to filter metabolic waste products from the baby's blood so that they can be excreted by the mother.

Answer to Question 2

4
Rationale:
1. Total bilirubin levels under 3.0 are expected in the first 24 hours of life.
2. Physiologic jaundice peaks between days 3 and 5; a total bilirubin level of 11.0 is not treated with phototherapy, regardless of feeding method.
3. Breast milk jaundice peaks at 23 weeks of age, and commonly presents with a total bilirubin level of 5.010.0.
4. Jaundice is an indication of hyperbilirubinemia, and is not an expected finding in the first day of life. Lethargy can be a sign of kernicterus developing. Preterm infants are more likely to develop jaundice.