A nurse is collecting data from a preterm infant.
Which of the following findings is consistent with an infant born at 33 weeks?
The muscles are still developing.
The eyes are still developing.
The skin is smooth.
The pancreas is not producing insulin.
The Correct Answer is A
Choice A rationale
At 33 weeks of gestation, an infant is considered moderately preterm, and while many organs are functional, the musculoskeletal system is still in a significant phase of development. Muscle tone is often decreased compared to a full-term infant, and the infant may exhibit a more extended posture rather than the flexed position seen in babies born closer to 40 weeks. The accumulation of muscle mass and the refinement of neuromuscular coordination continue throughout the final weeks of pregnancy.
Choice B rationale
By 33 weeks, the eyes are generally well-developed. The eyelids, which are fused earlier in pregnancy, typically open between weeks 26 and 28. A 33-week infant can blink and has some pupillary response to light, although the visual system continues to mature after birth. The suggestion that the eyes are still in a primary developmental stage is more accurate for extremely preterm infants born before the third trimester begins, rather than at 33 weeks.
Choice C rationale
The skin of a 33-week infant is usually not smooth; it is often thin, translucent, and may still be covered in vernix caseosa and lanugo. Smooth, plump skin is a characteristic of full-term infants who have had more time to accumulate subcutaneous fat. In a preterm infant, the lack of this insulating fat layer makes the skin appear wrinkled or red, and makes the baby much more susceptible to heat loss and temperature instability.
Choice D rationale
The pancreas begins producing insulin as early as the end of the first trimester, around week 10 to 12. By 33 weeks, the fetal pancreas is fully capable of secreting insulin in response to glucose levels in the blood. While preterm infants may struggle with glucose regulation due to immature liver function and limited glycogen stores, the statement that the pancreas is not producing insulin at all is physiologically incorrect for this stage of development.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
Polycystic ovarian syndrome is characterized by hormonal imbalances, irregular menstrual cycles, and excess androgen levels. While it can cause pelvic discomfort or heavy bleeding, it is not the classic cause of secondary dysmenorrhea. Instead, PCOS is frequently associated with anovulation and metabolic issues rather than the specific painful uterine contractions or structural obstructions found in conditions like endometriosis. It typically results in oligomenorrhea or amenorrhea rather than consistent painful menstruation.
Choice B rationale
Lynch syndrome is a hereditary condition that significantly increases the risk of various cancers, particularly colorectal and endometrial cancer. While individuals with Lynch syndrome require close monitoring of the reproductive tract, the syndrome itself is a genetic predisposition to malignancy rather than a direct cause of dysmenorrhea. Painful menstruation is usually a result of structural or inflammatory processes within the pelvic cavity rather than the presence of DNA mismatch repair mutations.
Choice C rationale
Endometriosis is a common cause of secondary dysmenorrhea where endometrial-like tissue grows outside the uterine cavity. This ectopic tissue responds to hormonal changes during the menstrual cycle, leading to internal bleeding, inflammation, and the formation of painful adhesions and scar tissue. The resulting inflammatory environment and prostaglandin release during menstruation cause intense pelvic pain that often exceeds the discomfort of primary dysmenorrhea. It is a leading structural cause of chronic pelvic pain.
Choice D rationale
Combined oral contraceptives are actually a primary treatment for dysmenorrhea rather than a cause. COCs work by suppressing ovulation and thinning the endometrial lining, which significantly reduces the production of prostaglandins. Prostaglandins are the primary chemical mediators responsible for uterine contractions and pain during menses. By lowering these levels, COCs effectively decrease the severity of menstrual cramps and flow, making them a therapeutic option rather than an etiological factor for the condition.
Correct Answer is C
Explanation
Choice C rationale
Prolactin is a hormone secreted by the anterior pituitary gland that progressively increases throughout pregnancy. Its primary biological role is to stimulate the growth of mammary alveolar tissue and promote the synthesis of milk proteins. The rising levels lead to noticeable physical changes, including increased breast volume and tenderness. While high progesterone levels inhibit actual milk production during pregnancy, the prolactin ensures the breast architecture is fully prepared for lactation immediately after delivery.
Choice A rationale
This statement is scientifically inaccurate because human chorionic gonadotropin, not progesterone, is the hormone detected in maternal blood and urine to confirm pregnancy. HCG is produced by the syncytiotrophoblast cells of the placenta shortly after implantation. Progesterone is indeed vital for maintaining the uterine lining and preventing contractions, but it is not the biomarker used in standard pregnancy tests. Normal progesterone levels vary significantly throughout the menstrual cycle and the different trimesters.
Choice B rationale
Estrogen levels actually increase significantly throughout pregnancy rather than decreasing. Estrogen promotes vasodilation and increases blood flow to the uterus, but it also contributes to salt and water retention in the interstitial tissues. This physiological increase in estrogen, combined with increased venous pressure from the enlarging uterus, is a primary cause of dependent edema or swelling in the extremities. A decrease in estrogen would not be a typical finding in a healthy pregnancy.
Choice D rationale
Human chorionic gonadotropin is primarily responsible for maintaining the corpus luteum during the first trimester to ensure continued progesterone production. It does not play a direct role in cervical ripening. Cervical softening, or effacement, is primarily mediated by prostaglandins and the hormone relaxin, which break down collagen fibers in the cervix. These changes allow the cervix to become thin and pliable in preparation for the mechanical stresses of labor and fetal passage.
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