NUR325-B-Nursing Services Childbearing- Final Exam B (CBU )

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 B: Impending seizures

Explanation:

B. Impending seizures: This is the correct answer. In a patient with pregnancy-induced hypertension (PIH), which includes preeclampsia and eclampsia, pounding headache and epigastric pain (often described as right upper quadrant abdominal pain) are classic warning signs of worsening disease and an impending eclamptic seizure. These symptoms reflect severe central nervous system and hepatic involvement, such as cerebral edema or liver capsule distention (as in HELLP syndrome). Immediate interventions to prevent seizures, such as administration of magnesium sulfate and preparation for potential emergency delivery, are warranted.

Why the Other Options Are Incorrect:

A. Anxiety due to hospitalization: While anxiety may cause symptoms like headache or gastrointestinal discomfort, it does not typically cause both a pounding headache and epigastric pain in the context of PIH. These are serious signs of systemic involvement and should never be attributed to emotional causes without ruling out medical emergencies. Misinterpreting these symptoms as anxiety can delay life-saving interventions.

C. Effects of magnesium sulfate: Magnesium sulfate is used to prevent or treat seizures in patients with preeclampsia or eclampsia. Its common side effects include flushing, nausea, muscle weakness, and lethargy—not pounding headache or epigastric pain. Additionally, a patient experiencing magnesium toxicity would present with absent deep tendon reflexes, respiratory depression, and low urine output, not the symptoms described in the question.

D. Panic attack: Panic attacks may cause symptoms like chest tightness, shortness of breath, and headache, but epigastric pain in a hypertensive pregnant patient is not typical of a panic attack and should not be attributed to psychological causes without a thorough medical evaluation. Again, the clinical context here is critical—this is a known PIH patient, and such symptoms are red flags for eclampsia.

Summary: In a patient with pregnancy-induced hypertension, symptoms like pounding headache and epigastric pain are warning signs of impending eclampsia and require immediate intervention. These signs are linked to cerebral irritation and liver involvement. Therefore, B. Impending seizures is the correct answer. The other choices fail to recognize the seriousness of these clinical indicators and could lead to dangerous delays in care.

The correct answers are:

B. Your husband should wear boxer shorts.

D. Using an ovulation predictor kit can help identify fertile days.

E. While actively trying to get pregnant avoid hot tubs.

Explanation:

B. Your husband should wear boxer shorts.

Correct. Wearing loose-fitting underwear, such as boxers, can help improve sperm production and motility. Tight underwear, like briefs, can increase scrotal temperature, which may negatively impact sperm quality.

D. Using an ovulation predictor kit can help identify fertile days.

Correct. Ovulation predictor kits (OPKs) detect luteinizing hormone (LH) surges, which occur 24 to 36 hours before ovulation. This helps couples time intercourse for the most fertile window, increasing the likelihood of conception.

E. While actively trying to get pregnant avoid hot tubs.

Correct. Excessive heat exposure, such as hot tubs, saunas, or frequent hot baths, can negatively affect sperm production by raising scrotal temperature. Men who are trying to conceive should avoid prolonged exposure to high temperatures.

Why the Other Options Are Incorrect:

A. Avoid large meals prior to having sex.

Incorrect. While eating a heavy meal before intercourse may cause discomfort, it does not have a direct effect on fertility. Fertility is more influenced by timing intercourse, sperm health, and ovulation tracking rather than meal size.

C. Having sex the day after your period has ended.

Incorrect. This is too early for most women to conceive. Ovulation typically occurs around day 14 of a 28-day cycle, though it can vary. To improve the chances of pregnancy, couples should have intercourse during the fertile window (usually days 10–17 of the cycle) or use an ovulation predictor kit to determine the best time.

Summary:

To enhance fertility, men should wear boxer shorts to maintain optimal sperm temperature, ovulation predictor kits can help track the best days for conception, and hot tubs should be avoided to prevent heat damage to sperm. Avoiding large meals before intercourse has no direct impact on fertility, and having sex immediately after a period is not the most effective strategy for conception.

Correct anwer C: To determine fetal lung maturity

Explanation:

At 34 weeks of gestation, the primary reason for performing an amniocentesis in a patient with preeclampsia is to determine fetal lung maturity. Preeclampsia increases the risk of preterm delivery due to complications like maternal organ dysfunction or fetal distress. If early delivery is necessary, assessing whether the baby's lungs are mature enough to function outside the womb is critical for newborn survival. This test measures the levels of lecithin-sphingomyelin (L/S ratio) or phosphatidylglycerol (PG), which indicate the fetus's ability to breathe independently.

Why the Other Options Are Incorrect:

A. To identify abnormal fetal cells:

This is a purpose of early amniocentesis (typically performed at 15-20 weeks of pregnancy) to screen for chromosomal abnormalities like Down syndrome. However, at 34 weeks, the concern is fetal lung maturity, not genetic screening.

B. To detect metabolic disorders:

Amniocentesis can identify inherited metabolic conditions (e.g., Tay-Sachs disease) but is usually performed earlier in pregnancy if there is a known family history. At 34 weeks, the focus shifts to preparing for delivery, making this irrelevant for the patient’s current condition.

D. To identify the sex of the fetus:

While amniocentesis can reveal fetal sex through chromosomal analysis, this information is usually determined earlier if needed. At this stage, knowing the fetal lung maturity is far more clinically important due to the potential need for early delivery.

Summary:

The correct answer is C. To determine fetal lung maturity because preeclampsia increases the risk of preterm birth, making it essential to assess whether the fetus’s lungs are mature enough to function after delivery. The other options refer to purposes of early amniocentesis and are not appropriate at 34 weeks.

The correct answer is A: Hydrocephalus

Explanation:

A. Hydrocephalus: This is the correct answer because a bulging fontanelle is a classic sign of hydrocephalus, a condition where there is an abnormal accumulation of cerebrospinal fluid (CSF) within the ventricles of the brain, leading to increased intracranial pressure. This increased pressure can cause the fontanelles to bulge, especially if the condition is severe. Hydrocephalus can be congenital or acquired and requires prompt diagnosis and treatment, which may include surgical interventions like a shunt placement to drain the excess fluid.

Why the Other Options Are Incorrect:

B. Dehydration: Dehydration typically causes sunken fontanelles, not bulging ones. Sunken fontanelles are a sign of fluid loss or inadequate intake, often seen in cases of severe dehydration. A bulging fontanelle, on the other hand, suggests an increase in intracranial pressure, which is not directly associated with dehydration.

C. Hypoglycemia: Hypoglycemia in newborns can present with symptoms like lethargy, poor feeding, jitteriness, or seizures, but it does not cause a bulging fontanelle. While hypoglycemia can lead to other neurological signs, it is not a direct cause of increased intracranial pressure or a bulging fontanelle.

D. Cranial molding: Cranial molding refers to the temporary shaping of the newborn's head due to pressure during the birth process, particularly if the baby had a prolonged labor or was delivered vaginally. This typically results in flattening or elongation of the skull and does not cause bulging fontanelles. Cranial molding resolves naturally in the first few days after birth and is not associated with any abnormal neurological findings like a bulging fontanelle.

Summary:

A bulging fontanelle in a newborn is a concerning sign that suggests A. Hydrocephalus, a condition involving increased intracranial pressure due to fluid buildup. The other options, including dehydration (which causes sunken fontanelles), hypoglycemia, and cranial molding, do not typically cause bulging fontanelles and are therefore less likely in this scenario. Hydrocephalus requires urgent evaluation and management.

The correct answer is C: An A1c would be considered good diabetic control with results of <6%.

Explanation:

The Hemoglobin A1c (HbA1c) test measures average blood glucose levels over the past 2 to 3 months. It reflects long-term glucose control and is commonly used to monitor diabetes management. A HbA1c level below 6% is considered good diabetic control, while levels above 7% indicate poor control and an increased risk of complications.

Why the Other Options Are Incorrect:

A. An A1c shows the amount of hemoglobin the liver can absorb:

Incorrect. HbA1c does not measure hemoglobin absorption by the liver. Instead, it represents glucose molecules that attach to hemoglobin in red blood cells over time.

B. An A1c provides current glucose levels in the blood:

Incorrect. The A1c test does not measure current blood glucose levels (like a fingerstick or fasting glucose test). Instead, it reflects the average blood sugar levels over the past 2 to 3 months.

D. An A1c is done between 24 to 28 weeks on all pregnant women:

Incorrect. The oral glucose tolerance test (OGTT) is the preferred screening test for gestational diabetes between 24-28 weeks, not the A1c. The A1c test may be used for women with preexisting diabetes, but it is not part of routine gestational diabetes screening.

Summary:

The HbA1c test measures long-term glucose control, and a result below 6% indicates good diabetic control. It is not used for current glucose levels or routine gestational diabetes screening.

The correct answer is A:  BP 88/56

Explanation:

Nifedipine is a calcium channel blocker used to relax uterine muscles and suppress preterm labor. It works by inhibiting calcium from entering smooth muscle cells, which reduces uterine contractions. However, it also causes vasodilation, which can lower blood pressure. A blood pressure of 88/56 is considered hypotension, and administering nifedipine could further lower blood pressure, leading to dizziness, fainting, or inadequate blood flow to the mother and fetus.

Why the other options are incorrect:

B. Ruptured membranes:

Nifedipine may still be used with ruptured membranes to delay labor if the benefits outweigh the risks. While ruptured membranes increase the risk of infection, nifedipine does not directly affect the amniotic sac or increase infection risk.

C. Temperature 101:

A temperature of 101°F (38.3°C) suggests a possible infection (e.g., chorioamnionitis), which needs evaluation. However, this is not a direct contraindication to nifedipine. The nurse should monitor the patient for signs of infection but would not automatically question the nifedipine order based on temperature alone.

D. Pulse 122:

An elevated pulse is a common side effect of nifedipine due to vasodilation. While the nurse should monitor the patient's heart rate, a pulse of 122 bpm is not a strict contraindication unless it worsens or other symptoms of cardiovascular instability appear.

Summary:

The nurse would question the nifedipine order due to the patient's low blood pressure (88/56) because the medication may further lower BP and compromise maternal and fetal circulation. Other factors, like ruptured membranes, fever, or increased pulse, do not directly prevent the use of nifedipine in preterm labor but require close monitoring.

The correct answers are:

A. Active stage of labor.

C. The fetus is minus 1 cm above the pelvic outlet.

E. The cervix is greater than half way effaced.

Explanation:

A. Active stage of labor:

Correct. Labor is divided into three stages, with the first stage being further divided into latent, active, and transition phases. The active phase occurs when cervical dilation is between 6 cm and 10 cm, with regular contractions leading to progressive cervical changes. Since L.C. is 6 cm dilated, she is in the active phase of labor.

C. The fetus is minus 1 cm above the pelvic outlet:

Correct. Fetal station refers to the position of the presenting part in relation to the ischial spines. A station of -1 means the fetal head is 1 cm above the ischial spines, indicating the baby has descended but is not yet engaged in the pelvis.

E. The cervix is greater than half way effaced:

Correct. Cervical effacement is measured in percentages, with 100% indicating complete effacement. Since L.C. is 80% effaced, her cervix is more than halfway thinned out, which is expected in the active phase of labor.

Why the Other Options Are Incorrect:

B. 80% dilated:

Incorrect. The cervix is 80% effaced, not 80% dilated. Cervical dilation refers to the opening of the cervix, measured from 0 cm to 10 cm. L.C. is 6 cm dilated, not 80%.

D. The presenting part is 1 cm below the ischial spines:

Incorrect. A fetal station of +1 means the baby’s presenting part is 1 cm below the ischial spines, but L.C.'s fetal station is -1, meaning the baby is still above the ischial spines.

F. L.C. is in the latent phase of labor:

Incorrect. The latent phase occurs when the cervix is 0–5 cm dilated. Since L.C. is 6 cm dilated, she has progressed to the active phase of labor.

Summary:

L.C. is in the active phase of labor because she is 6 cm dilated. The fetus is at station -1, meaning the head is 1 cm above the ischial spines. The cervix is 80% effaced, meaning it has thinned significantly but is not yet fully effaced. The incorrect options misunderstand effacement vs. dilation, fetal station, and labor phase progression.

The correct answer is D: Recognize and treat multiple genetic or metabolic disorders.

Explanation:

Newborn screening tests, including the phenylketonuria (PKU) test, are conducted to detect genetic or metabolic disorders that could cause serious health complications if left untreated. These screenings allow for early intervention, preventing intellectual disabilities, organ damage, and other complications. PKU, the first disorder to be screened, is a metabolic condition where the body cannot break down phenylalanine, leading to toxic buildup and brain damage if not managed through diet. Over time, newborn screening has expanded to include numerous other disorders, such as congenital hypothyroidism, sickle cell disease, and cystic fibrosis.

Why the Other Options Are Incorrect:

A. Keep the state records updated: While newborn screening results are recorded, the primary purpose of the test is not for state record-keeping but rather for early detection of treatable conditions. The data collected may contribute to public health initiatives, but this is secondary to the health benefits of identifying disorders in newborns.

B. Determine ABO incompatibilities: ABO incompatibilities occur when a mother’s blood type is different from the baby’s, potentially leading to jaundice or hemolytic disease of the newborn. While blood type screening is sometimes performed, newborn screening is not primarily designed to detect these incompatibilities. Instead, it focuses on metabolic and genetic disorders.

C. Determine if the infant has hypoglycemia: Hypoglycemia in newborns is typically diagnosed through blood glucose testing, not through newborn screening. While some metabolic disorders detected through newborn screening can contribute to hypoglycemia, the screening itself is not intended specifically for identifying low blood sugar levels.

Summary:

The primary purpose of newborn screening is to recognize and treat multiple genetic or metabolic disorders, ensuring early intervention to prevent severe complications. It is not intended for updating state records, identifying ABO incompatibilities, or diagnosing hypoglycemia.