2024-FA-UT NUR325-B-Nursing Services Childbearing- Final Exam B (CBU )

The correct answer is B: 2500

Explanation:

During breastfeeding, a woman needs to increase her caloric intake to support milk production. On average, lactating women require an additional 300 to 500 calories per day. Since the woman consumed 2000 calories per day before pregnancy, adding approximately 500 calories brings her new total to 2500 calories per day. This recommendation applies especially to the first 6 months of exclusive breastfeeding, where milk production is highest and energy demands are elevated. The additional calories support not only milk synthesis but also the mother's energy balance and nutritional needs.

Why the Other Options Are Incorrect:

A. 2300: This is only a 300-calorie increase from the baseline, which is on the lower end of the recommended additional caloric intake for lactating women. While some sources may list 330 calories as a minimum, most guidelines recommend closer to 500 additional calories per day, especially for exclusively breastfeeding mothers. Therefore, 2300 is likely insufficient to fully meet the energy demands of lactation.

C. 2750: Although this amount could be appropriate for a woman with higher activity levels or greater energy needs, it exceeds the standard recommendation for most breastfeeding women who previously consumed 2000 calories. Unless the mother is particularly active or underweight, 2750 calories may lead to unnecessary weight gain. Thus, it is not the general recommendation for the average lactating woman.

D. 3000: This option overshoots the recommended intake for most breastfeeding mothers by a wide margin. While highly active women or those nursing multiples might require this level of caloric intake, it is not the standard recommendation. For the average woman, 3000 calories per day would likely be excessive, potentially leading to weight gain and other imbalances.

Summary: A breastfeeding woman who previously consumed 2000 calories per day is generally advised to increase her intake to 2500 calories per day, reflecting an additional 500 calories to support milk production. This level aligns with standard dietary guidelines for lactating women. Therefore, B. 2500 is the correct answer. The other options either understate or overstate the typical caloric needs during lactation.

The correct answer is B: You will receive Rhogam at 28 weeks of pregnancy.

Explanation:

B. You will receive Rhogam at 28 weeks of pregnancy:

This is the correct answer. A woman who is Rh-negative and carrying an Rh-positive baby will receive Rhogam at 28 weeks of pregnancy. Rhogam is given to prevent the development of antibodies against Rh-positive blood cells, which could harm the fetus in subsequent pregnancies. It is given to prevent sensitization in case the baby’s blood cells cross into the mother's bloodstream.

Why the Other Options Are Incorrect:

A. You will receive Rhogam 4 days after delivery:

This is incorrect. Rhogam is typically given within 72 hours (not 4 days) after delivery of an Rh-positive baby to prevent sensitization. If a woman is Rh-negative and delivers an Rh-positive baby, the Rhogam injection must be administered as soon as possible after birth, ideally within 72 hours.

C. You do not need Rhogam because your previous baby was Rh+:

This is incorrect. Even if a woman had an Rh-positive baby previously, she may need Rhogam for subsequent pregnancies. The risk is higher if the current pregnancy involves an Rh-positive baby. Rhogam is given to prevent the mother from becoming sensitized to Rh-positive blood cells, which could lead to complications in future pregnancies.

D. Your partner is at risk as well as the baby:

This is incorrect. The partner is not at risk in this scenario. Rhogam is used to protect the mother from developing antibodies against the Rh-positive blood type of the baby. The partner’s Rh status does not affect the treatment or outcome unless there is a potential for the partner's Rh status to influence the pregnancy, but this is not a concern here.

Summary:

The correct statement is B, as Rhogam is given at 28 weeks of pregnancy for an Rh-negative mother carrying an Rh-positive baby to prevent Rh sensitization. Rhogam is also administered within 72 hours after delivery.

The correct answer is D: Dry the baby and place it skin to skin with its mother.

Explanation:

The best way to support thermoregulation in a newborn immediately after birth is to dry the baby to prevent evaporative heat loss and then place the baby skin-to-skin with the mother. This practice, known as kangaroo care, helps regulate the newborn’s temperature, heart rate, and breathing, while also promoting bonding and breastfeeding initiation. The mother's body acts as a natural heat source, keeping the baby warm through conduction.

Why the other options are incorrect:

A. Dry the baby in an open crib then double wrap:

While drying the baby is essential to prevent evaporative heat loss, leaving the baby in an open crib exposes the infant to cold air, increasing the risk of convection heat loss. Skin-to-skin contact is more effective at maintaining the newborn’s core temperature.

B. Place the newborn with his extremities extended:

Positioning the newborn with extended extremities increases surface area exposure, making the baby lose heat more rapidly. Newborns naturally assume a flexed position to minimize heat loss.

C. Double wrap the baby and place a hat on the head:

While swaddling and using a hat can reduce heat loss, it is less effective than skin-to-skin contact. Additionally, over-wrapping can lead to overheating if not carefully monitored.

Summary:

The most effective method for supporting thermoregulation in a newborn immediately after birth is to dry the baby and place it skin-to-skin with the mother. This method prevents heat loss, stabilizes vital signs, and promotes maternal-newborn bonding. Other methods like swaddling are helpful but not as effective as direct skin contact in the immediate post-birth period.

The correct answer is C: It may take months for sperm in the semen to be eliminated.

Explanation:

C. It may take months for sperm in the semen to be eliminated: After a vasectomy, sperm can still be present in the semen for some time before the body completely clears them. Typically, it may take several weeks to months (often around 3 months) for the sperm to be eliminated after the procedure. During this time, the man must continue using contraception until a follow-up semen analysis confirms that no sperm are present. This is an important point to explain to the client, as they may assume immediate contraception effectiveness, which is not the case.

Why the Other Options Are Incorrect:

A. Contraceptive is 100% effective: While vasectomy is highly effective, it is not 100% effective. The failure rate is very low (approximately 1 in 1000 men), but it is important to clarify to clients that no contraceptive method is guaranteed to be 100% effective. The client should understand the slight risk of failure and the importance of follow-up testing to ensure the procedure’s success.

B. It can be performed under general anesthesia: Vasectomy is typically performed under local anesthesia, not general anesthesia. The procedure is minimally invasive and does not require the patient to be fully sedated. General anesthesia is unnecessary, and this point would be an incorrect explanation of the procedure.

D. Voluntary reversal is impossible: While vasectomy reversal is more complicated and not always successful, it is not impossible. In some cases, vasectomy reversal can be performed successfully, though the success rate declines over time since the procedure. It's important to explain to the client that although reversal is difficult and not always guaranteed, it is still possible under certain conditions.

Summary:

The correct explanation is C. It may take months for sperm in the semen to be eliminated. This is an important detail when discussing the timeline for vasectomy effectiveness, as the sperm will still be present in the semen for some time after the procedure. The other options are incorrect because vasectomy is not 100% effective, is generally performed under local anesthesia, and can sometimes be reversed, though it is not guaranteed.

The correct answer is A: Hemoglobin 12 g/dl

Explanation for the correct answer: In a newborn, hemoglobin levels are typically between 13–20 g/dl at birth. A hemoglobin level of 12 g/dl is below the normal range and would be considered abnormal. Low hemoglobin levels can be indicative of anemia, which could require further investigation, particularly in a newborn.

Why the other options are wrong:

B) White blood cell count 15,000/mm³: A WBC count of 15,000/mm³ in a newborn is within the normal range. Newborns typically have a range of 9,000 to 30,000/mm³, and this value would not be considered abnormal unless it is significantly higher, which could indicate infection or another concern.

C) Platelets 185,000/mm³: The normal platelet count for a newborn is typically between 150,000 and 450,000/mm³. A platelet count of 185,000/mm³ is within the normal range and does not suggest any abnormalities.

D) Red blood cell count 5.6 million/mm³: The normal red blood cell count for a newborn is usually between 4.5 to 6.5 million/mm³, so a count of 5.6 million/mm³ falls within the normal range and is not abnormal.

Summary: The abnormal finding in this case is the hemoglobin level of 12 g/dl, as it is lower than the normal range for a newborn, which is typically between 13–20 g/dl. The other values for WBC, platelets, and RBC are all within the expected range for a newborn.

The correct answer is  C) : A decrease in the second trimester may occur due to placental growth.

Explanation for the correct answer: During pregnancy, it is common for a slight decrease in blood pressure to occur, particularly in the second trimester. This drop in blood pressure is generally due to the growth of the placenta and the associated increase in vascular resistance. As the placenta develops, it produces hormones that can cause vasodilation (widening of blood vessels), which lowers vascular resistance and results in a temporary decrease in blood pressure. This physiological change is typically more pronounced during the second trimester and is considered normal unless it is associated with significant symptoms or further complications.

Why the other options are incorrect:

A) Normally, blood pressure increases steadily throughout pregnancy. This statement is incorrect because blood pressure does not increase steadily during pregnancy. It typically decreases during the second trimester due to physiological changes, such as the development of the placenta and the body's adaptation to pregnancy. Blood pressure may start to increase again in the third trimester as the body prepares for delivery, but it does not steadily increase throughout the entire pregnancy.

B) Blood pressure remains stable until decreasing the day of the delivery. This statement is also incorrect. Blood pressure typically decreases during the second trimester due to the effects of the growing placenta, and it may remain slightly lower than pre-pregnancy levels until the third trimester. Blood pressure may then gradually rise toward the end of pregnancy as the body prepares for labor, but it does not remain stable until delivery.

D) Blood pressure progressively decreases throughout the entire pregnancy. This is not accurate. While blood pressure tends to decrease in the second trimester, it does not continue to decrease throughout the entire pregnancy. As mentioned earlier, blood pressure may rise again in the third trimester as the body adjusts to the increasing demands of the growing fetus and prepares for delivery.

Summary: A slight decrease in blood pressure during the second trimester of pregnancy is a normal finding and is primarily due to placental growth and the physiological changes that occur to accommodate the pregnancy. Blood pressure generally stabilizes or begins to increase slightly in the third trimester. Understanding this trend is important for distinguishing between normal physiological changes and potential complications, such as preeclampsia, which involves elevated blood pressure.

Correct anwer D: Tubal damage from PID.

Explanation:

The most likely cause of infertility in this patient is tubal damage from pelvic inflammatory disease (PID). PID is an infection of the upper reproductive tract (including the uterus, fallopian tubes, and ovaries) that can result from sexually transmitted infections (STIs) like chlamydia or gonorrhea. This condition can cause inflammation, scarring, and blockage of the fallopian tubes, preventing the egg from meeting the sperm, which leads to infertility. Studies show that up to 20% of women with a history of PID may experience infertility due to tubal factor damage.

Why the Other Options Are Incorrect:

A. Tubal damage from hyperglycemia:

While uncontrolled diabetes can affect hormonal balance and ovulation, it does not directly cause tubal damage. There is no evidence that hyperglycemia leads to physical injury of the fallopian tubes.

B. Tubal damage from migraine headaches:

Migraines are neurological in origin and do not impact reproductive anatomy. They have no direct effect on fallopian tube function or fertility. Although migraines can cause discomfort, they do not lead to tubal scarring or blockage.

C. Tubal damage from fibromyalgia:

Fibromyalgia is a chronic pain condition characterized by widespread musculoskeletal pain and fatigue, but it does not cause tubal damage. This condition does not interfere with reproductive organs or fallopian tube integrity.

Summary:

The correct answer is D. Tubal damage from PID because pelvic inflammatory disease is a known and common cause of tubal infertility due to inflammation, scarring, and blockage of the fallopian tubes. The other options do not cause structural damage to the fallopian tubes and are therefore not likely reasons for infertility.

The correct answer is A: It affects females more than it does males.

Explanation:

X-linked diseases are more likely to affect males than females because males have only one X chromosome (XY). If a male inherits an X chromosome carrying a defective gene, there is no second X chromosome to counteract the mutation. Females, however, have two X chromosomes (XX), which means a healthy X chromosome can often compensate for the defective one, making them more likely to be carriers rather than being affected.

Why the other options are correct:

B. The defective gene is on the X chromosome:

This is correct because X-linked diseases are caused by mutations on the X chromosome, which is one of the two sex chromosomes.

C. Only females are carriers of the disease:

This is correct in the context of X-linked recessive diseases. Females with one affected X chromosome are carriers and typically do not show symptoms. Males cannot be carriers because if they inherit the defective X chromosome, they express the disease.

D. Males cannot pass on X-linked diseases:

This is correct because males pass their Y chromosome to their sons and their X chromosome to their daughters. A father with an X-linked disease cannot pass it to his sons, but all of his daughters will inherit the affected X chromosome and become carriers (if the disease is recessive).

Summary:

The statement It affects females more than it does males" is incorrect because males are more commonly and severely affected by X-linked diseases due to having only one X chromosome. The other statements accurately reflect the characteristics of X-linked inheritance.

The correct answer is B: Alteration in comfort: dysmenorrhea

Explanation:

Endometriosis is a chronic condition in which endometrial-like tissue grows outside the uterus, leading to inflammation, scarring, and adhesions. The most common symptom is dysmenorrhea (painful menstruation), along with chronic pelvic pain, dyspareunia (pain during intercourse), and infertility.

B. Alteration in comfort: dysmenorrhea

Correct. Pain is the most prominent symptom of endometriosis, especially severe dysmenorrhea and chronic pelvic pain. The presence of ectopic endometrial tissue causes an inflammatory response, leading to cramping, pelvic pain, and discomfort, making this the priority nursing diagnosis.

Why the Other Options Are Incorrect:

A. Infection: At risk for

Incorrect. Endometriosis is not an infectious disease, and it does not inherently increase the risk of infection. While surgical interventions (such as laparoscopy) can pose a risk for infection, it is not the primary concern in managing endometriosis.

C. Incontinence: Functional urinary

Incorrect. Urinary incontinence is not a primary symptom of endometriosis. However, some women may experience urinary urgency or bladder discomfort if the endometrial lesions affect the bladder. But this is not a priority concern compared to pain management.

D. Constipation: At risk for

Incorrect. While endometriosis affecting the bowel can contribute to bloating or constipation, this is not the most pressing issue. Pain management takes priority over potential bowel issues.

Summary:

Endometriosis is primarily associated with pain, especially severe dysmenorrhea and chronic pelvic pain. "Alteration in comfort: dysmenorrhea" is the most appropriate nursing diagnosis because pain is the chief complaint and has the greatest impact on the patient’s quality of life.