Maternal/OB 50 w Explanation

Which of the following behaviors would the nurse expect to observe in a primipara client by the third postpartum day? 1. Greater interest in learning about infant care 2. Requests for help with her activities of daily living 3. Sleeping most of the time when the infant is not in the room 4. Very talkative about the birth experience to friends

Looking for answers(s):1 Explanation: A greater interest in learning about infant care reflects the "taking hold" phase of expressing interests outside of self and taking interest in the infant. Requests for help with activities of daily living reflect passive, dependent behavior characteristic of the "taking in" phase (1 to 2 days after delivery). Basic needs of the woman need to be met in the passive, dependent "taking in" phase (1 to 2 days after delivery). During the "taking in" phase (1 to 2 days after delivery), the client integrates the birth experience into her being by frequently reviewing the experience.

Which of the following contraceptive methods would the nurse identify as the least effective in preventing conception? 1. Coitus interruptus 2. Condoms with spermicides 3. Intrauterine devices 4. Hormonal contraceptives

Looking for answers(s):1 Explanation: A high percentage of conception (20% to 25%) occurs with coitus interruptus primarily because sperm exist in the preejaculatory fluid. This method also requires a great deal of self-control to withdraw in the midst of intercourse before ejaculation of semen. The use of spermicides with condoms has an effectiveness rate of 80% to 85% if the method is used consistently and correctly. Intrauterine devices have an efficacy of 98% to 99%. Hormonal contraceptives have a 97% effectiveness rate.

When advising the client who wants to discontinue hormonal contraceptives in order to become pregnant, the nurse would recommend stopping the hormonal contraceptive at least 3 months before conception for which of the following reasons? 1. To allow the client's hormone levels to return to normal 2. To permit healing of the uterine scar tissue 3. To prevent teratogenic effects on the fetus 4. To promote normalization of the endometrial lining

Looking for answers(s):1 Explanation: A vasectomy is considered to be minor surgery, often performed as an outpatient procedure under local anesthesia. Although it is about 99% effective, there is an occasional failure associated with vasectomy. Sperm are not eliminated immediately from the reproductive tract. It takes almost 1 month for complete sperm elimination. Although reversal is possible, the clinical success of fertility following reversal is decreased.

Which of the following should the nurse recommend to a client experiencing nausea and vomiting during the first trimester? 1. Consuming a few crackers before arising 2. Eating chicken noodle soup three times a day 3. Eating three regular large meals per day 4. Skipping meals when the nausea is present

Looking for answers(s):1 Explanation: Along with rising hormone levels, alterations in carbohydrate metabolism with a resultant decrease in blood glucose level are thought to contribute to nausea in pregnancy. Dry, starchy foods such as crackers supply complex carbohydrates to raise the blood glucose level and decrease nausea. Chicken noodle soup contains excess salt and fat and should be avoided in pregnancy. Small, frequent meals prevent overloading of the stomach, which can cause nausea or vomiting. Skipping meals may worsen the nausea and cause a low serum glucose level, which could harm the fetus.

Which of the following would be the nurse's best response to a client who asks the nurse to explain the purpose of a nonstress test (NST)? 1. "It determines how the baby's heart responds to uterine contractions." 2. "The test demonstrates the fetus's response to oxytocin." 3. "The test helps to give an accurate estimate of the gestational age." 4. "The test provides information about the size of the baby."

Looking for answers(s):1 Explanation: An NST demonstrates the fetal heart response to spontaneous or induced uterine contractions, which stress the fetus by decreasing uterine perfusion. If the fetus is already compromised, the contractions may alter the heart rate. Oxytocin is not used in an NST. An NST does not give information about the gestational age or the size of the infant.

A client reports swelling of her feet and hands on arising each morning. A 24-hour dietary recall reveals a salt intake in excess of 2 g/day. Which of the following should the nurse recommend? 1. Avoidance of high-sodium foods 2. Elimination of all salt from her diet 3. Request to the physician for a diuretic 4. Restriction of fluid intake

Looking for answers(s):1 Explanation: Avoiding foods high in sodium is recommended to prevent fluid retention while providing the recommended sodium requirements for pregnancy. Neither sodium nor fluid can be severely restricted without untoward effects. During pregnancy, sodium needs are slightly increased because the body water (ECF) is expanding. Therefore, elimination of all dietary salt intake is problematic. Diuretics are contraindicated in pregnancy unless they are essential for an accompanying medical problem. Water intake is essential for the expanding ECF and to facilitate renal perfusion.

While preparing a primigravida for her first pelvic exam, the client expresses fear and begins to cry. Which of the following would be the nurse's best response? 1."Can you tell me what is making you so afraid?" 2. "I will make sure that you are covered with a sheet at all times." 3. "The physician will tell you exactly what he is going to do." 4. "We'll postpone the exam until you are more comfortable."

Looking for answers(s):1 Explanation: Because the client is upset and verbalizing fear, the nurse needs to gather additional information for use in developing a plan for a most appropriate action. Although telling the client that the nurse will keep her covered is reassuring, the nurse is ignoring the client's anxiety and making assumptions about the cause of the client's upset. Although it is important to explain all procedures to the client, telling the client that the physician will tell her exactly what's going on ignores the client's fears and also makes assumptions about the cause of the client's upset. The pelvic examination at this time is important to obtain data to determine the client's risk status. Postponing the exam would possibly place the client at risk for complications. Additionally, this response doesn't address the client's feeling

When teaching a childbirth education class on infection prevention after delivery, the nurse would instruct the woman to perform perineal care how often? 1. After each voiding or defecation 2. Every 8 hours 3. Once each day 4. When she has perineal pain

Looking for answers(s):1 Explanation: Cleansing the perineum reduces the number of perianal microorganisms present. It also removes lochia and moisture, favorable for the growth of bacteria. Every 8 hours is not frequent enough. Any excreta need to be removed quickly to prevent infection. Once-daily cleansing will not be effective in preventing bacterial growth. Perineal care provides cleanliness and promotes comfort, but it does not relieve pain. Additionally, pain is not an adequate indicator for the need to perform perineal care.

When teaching a class at a clinic for homeless males, which of the following would the nurse relate as the most effective contraceptive for the prevention of sexually transmitted diseases (STDs)? 1. Condoms 2. Diaphragm 3. Sterilization 4. Vaginal Sponge

Looking for answers(s):1 Explanation: Condoms are a barrier method of contraception and provide the best protection available against STDs, including HIV. The effectiveness is increased when condoms are used with a spermicidal jelly. Although the diaphragm is a barrier method, STDs can still be introduced into the vagina. Sterilization is very effective in preventing pregnancy, but offers no protection against STDs. Although the vaginal sponge is considered a barrier method that traps and absorbs spermatozoa, it is ineffective in preventing STDs.

Which of the following statements by the nurse would be most appropriate for a client who smokes 1/2 to 1 pack of cigarettes per day? 1. "Here's some information on effective ways to quit smoking." 2. "Try to reduce the number of cigarettes you smoke per day." 3. "You should quit smoking immediately." 4. "Your smoking is harmful to you and to the infant."

Looking for answers(s):1 Explanation: Giving the client information on effective ways to quit smoking provides her with useful information that she may try. Although reducing the number of cigarettes per day is helpful, this does not prevent harm to the fetus—even a few cigarettes a day are too many. The client needs information about effective ways to quit smoking. Telling the client to quit smoking immediately does not provide her with the tools to quit. Merely telling the client that her smoking is harmful does not give her the necessary information or tools to quit. It is public knowledge that smoking during pregnancy is harmful to both the mother and fetus.

When advising the client who wants to discontinue hormonal contraceptives in order to become pregnant, the nurse would recommend stopping the hormonal contraceptive at least 3 months before conception for which of the following reasons? 1. To allow the client's hormone levels to return to normal 2. To permit healing of the uterine scar tissue 3. To prevent teratogenic effects on the fetus 4. To promote normalization of the endometrial lining

Looking for answers(s):1 Explanation: Hormonal contraceptives inhibit the release of follicle-stimulating hormone and luteinizing hormone to prevent the release of an ovum. Therefore, these agents should be stopped for approximately 3 months before conception to allow these hormone levels to return to normal. Using hormonal contraceptives does not cause uterine scars. Although any medication may be teratogenic to the fetus, this is not the rationale for stopping hormonal contraceptives prior to conception. Hormonal contraceptives inhibit ovulation, but do not alter the endometrial lining.

Which of the following would be most important for the nurse to determine if the prenatal blood panel of a primigravida reveals that she is Rh negative? 1. Blood type of the father of the baby 2. Hemoglobin and hematocrit levels 3. Her religious preference 4. Previous administration of RhoGAM

Looking for answers(s):1 Explanation: If the father is Rh positive (or if his blood type is unknown), an antibody screen is done to determine if the woman has developed isoimmunity to the Rh antigen. If the father is negative, there is less chance of this problem. Although hemoglobin and hematocrit are important in prenatal blood work, they are unrelated to the client's Rh status and possible Rh isoimmunization. Religious preference would only be pertinent if isoimmunization was severe enough to require exchange transfusion of the infant. RhoGAM is only administered during or following pregnancy with a fetus that is Rh positive (or an abortus in which the blood Rh is unknown). This is the client's first pregnancy.

The nurse determines that a client understands the natural cervical mucus contraceptive method when the client describes the cervical mucus during her fertile period as which of the following? 1. Clear, wet, and sticky 2. Cloudy, white, and sticky 3. Thick and cloudy 4. Yellow and sticky

Looking for answers(s):1 Explanation: In response to high estrogen and progesterone levels during the fertile period, the mucus is clear, wet, and sticky and slippery (like an egg white) and is more abundant. Cloudy white and sticky mucus occurs after ovulation. Thick cloudy mucus is present in the postovulatory phase. The mucus has a yellowish color in the preovulatory phase.

Which of the following would the nurse use to explain the term quickeningto a client who is at 18 weeks' gestation? 1. A light fluttering sensation when the fetus moves 2. A vaginal infection caused by yeast 3. Descent of the fetus into the pelvis 4. Vascular congestion and tenderness of the breast tissue

Looking for answers(s):1 Explanation: Quickening is defined as maternal perception of fetal movement, usually as a light fluttering sensation when the fetus moves, typically between the 16th and 20th weeks of pregnancy. A vaginal yeast infection is candidiasis, a vaginitis caused by Candida albicans. Descent of the fetus into the pelvis is engagement and occurs in the last weeks of pregnancy. Vascular congestion and tenderness of the breast tissue is commonly called engorgement.

The nurse recognizes that the client understands how to take her oral contraceptive when the nurse hears the client tell her friend which of the following? 1. "I have to take one pill each day at the same time." 2. "I will need to have a complete physical every 3 months." 3. "If I take antibiotics, I should stop taking my pills." 4. "The pills have practically few serious side effects."

Looking for answers(s):1 Explanation: To maintain a constant hormone level, the pill should be taken at the same time each day. The client will need to have a physical exam and Pap smear once a year. If antibiotic therapy is needed, it is best to continue the pills as usual. In addition, an alternative method of contraception should be used. Some of the adverse effects, such as blood clots and pulmonary embolism, are life-threatening.

Which of the following instructions would be included for a client who is scheduled to have an abdominal ultrasound? 1. Bathing with an antibacterial soap to remove bacteria from the skin 2. Drinking a quart or more of fluids 2 hours before the test and not voiding 3. Remaining in a fasting state from midnight until after the test is completed 4. Taking 2 ounces of mineral oil to facilitate bowel evacuation

Looking for answers(s):2 Explanation: A full bladder, accomplished with the intake of at least 1 quart of fluid, elevates the uterus and its contents out of the pelvis, facilitating better visualization. The full bladder also serves as a landmark in reading the ultrasound image. Ultrasonography is a noninvasive test. Bacteria on the skin will not affect the outcome. Ultrasonography does not require the client to fast. For an ultrasound, the bowel does not need to be evacuated for adequate visualization of the uterus and its contents.

When questioning a client about the number of extra calories eaten per day, the nurse knows the client is receiving adequate calories when she states the following? 1. 1,000 2. 300 3. 500 4. 750

Looking for answers(s):2 Explanation: A pregnant client needs 300 extra calories per day for adequate nutrition. An intake of 1,000 extra calories per day is in excess of the recommended daily requirement of extra calories needed for pregnancy. An intake of 500 extra calories per day is in excess of the recommended daily requirement of extra calories needed for pregnancy. An intake of 750 extra calories per day is in excess of the recommended daily requirement of extra calories needed for pregnancy.

A client, who is 8 weeks pregnant, tells the nurse, "We wanted a baby, but I'm not sure this is the best time." The nurse would interpret that the client is expressing feelings of which of the following? 1. Acceptance 2. Ambivalence 3. Apathy 4. Attachment

Looking for answers(s):2 Explanation: Ambivalence refers to simultaneous occurrence of conflicting emotions, ideas, or wishes. The client is verbalizing the desire for a baby, but at a more convenient time. Acceptance is a belief that the woman is pregnant. Apathy is an indifference to or absence or suppression of emotion, feelings, or concern. Attachment is strong emotional ties as a result of parent-infant interaction.

When measuring the fundal height of a client during a prenatal visit, the nurse finds the fundus at the level of the umbilicus. The nurse would document the approximate gestational age of the fetus as which of the following? 1. 10 weeks 2. 20 weeks 3. 30 weeks 4. 40 weeks

Looking for answers(s):2 Explanation: At 20 weeks' gestation, the fundus is normally at the level of the umbilicus. At 10 weeks, the fundus would be below the symphysis pubis and therefore unmeasurable. The uterus rises into the pelvis at about 12 weeks. At 30 weeks, the fundus would be above the umbilicus. At 40 weeks, the fundus would be at the level of the xiphoid process.

Which of the following questions would be most important to ask when obtaining a client's prenatal history? 1. "Are your immunizations up to date?" 2. "Do you regularly take any medication?" 3. "Have you ever had a sexually transmitted disease?" 4. "What is your usual prepregnant weight?"

Looking for answers(s):2 Explanation: Because any medication may be teratogenic to a fetus, it is most important for the nurse to question the client about medications that are taken regularly, including any and all prescribed and over-the-counter medications. Doing so minimizes the risk to the fetus. Any immunizations that may be needed by the client are not given during pregnancy unless a special need arises. A past history of sexually transmitted disease indicates high-risk behavior. Although this is important overall, this information is not the most crucial to obtain at this time. Knowing the client's prepregnant weight is important for nutritional assessment and teaching, but it is not the priority at this time.

At what point in the pregnancy would the nurse expect to administer a 1-hour, 50-gram glucose-screening test to low to moderate risk clients? 1. 12 and 20 weeks' gestation 2. 24 and 28 weeks' gestation 3. 34 and 38 weeks' gestation 4. 8 and 12 weeks' gestation

Looking for answers(s):2 Explanation: Beginning in the second trimester, many women have pregnancy-induced glucose intolerance. Early detection provides opportunity to prevent complications arising from the intolerance. Typically, a screening test for glucose is obtained between 24 and 28 weeks' gestation. At 12 and 20 weeks, it is too early for physiologic changes in carbohydrate metabolism to produce glucose intolerance. Signs of gestational diabetes commonly occur before 34 and 38 weeks' gestation. Waiting until this time would be too late. At 8 and 12 weeks, it is too early for physiologic changes in carbohydrate metabolism to produce glucose intolerance.

Which of the following would the nurse include in a client's teaching plan about the danger signs of pregnancy? 1. Backache 2. Blurred vision 3. Edematous feet 4. Quickening

Looking for answers(s):2 Explanation: Blurred vision is a sign of pregnancy-induced hypertension that requires further investigation. Backache is a common discomfort of pregnancy associated with the hormonal effects on the musculoskeletal system. Lower extremity edema is normally a sign of venous stasis, especially if there is no edema of the hands or face. Although it may be uncomfortable, edematous feet are not a danger sign. Quickening is fetal movement as perceived by the mother and is normal during pregnancy.

Which of the following areas would be the priority for client education in the first trimester? 1. Constipation 2. Danger signs 3. Lactation 4. Leg cramps

Looking for answers(s):2 Explanation: Education in the first trimester should focus on the possible danger signs of pregnancy. In fact, this information should be addressed on the first health care visit. The signs signify impending danger and indicate a need for medical attention. Constipation most frequently occurs in the second and third trimesters and should be addressed then. Infant-feeding techniques should be introduced during the early prenatal period and discussed again nearer to the end of the pregnancy. Leg cramps occur most commonly in the third trimester and should be addressed just prior to the client beginning the third trimester.

Which of the following terms best describes the conscious process by which a couple decides on the number and spacing of children and the timing of births? 1. Emergency contraception 2. Family planning 3. Infertility management 4. Preconception planning

Looking for answers(s):2 Explanation: Family planning is allowing the couple to choose when they want to conceive and have children, not just the prevention of pregnancy. It empowers them to feel ready physically, emotionally, and financially for the roles and tasks of parenthood. Emergency contraception is a hormonal form of birth control given within 72 hours of unprotected sexual intercourse to prevent implantation and pregnancy. This is a situational crisis and it is not considered planning. Although family planning may involve management of infertility, this answer is not inclusive of all aspects of planning for a family. Preconception planning offers couples an opportunity to enhance the probability of having a healthy newborn by examining the health history of both partners and providing appropriate guidance and counseling.

Which of the following would the nurse include in a teaching plan on sexuality and the major physiologic effects of hormonal contraceptives for teens in a local high school? 1. Decrease in sperm motility 2. Inhibition of the release of an ovum 3. Prevention of implantation 4. Production of thin cervical mucus

Looking for answers(s):2 Explanation: Hormonal contraceptives contain estrogen and progesterone, which inhibit follicle-stimulating hormone, thus inhibiting ovulation—the release of the ovum. Hormonal contraceptives have no affect on sperm. Without the release of an ovum, there is no fertilization and no need for implantation. The cervical mucus remains thick with hormonal contraceptive use, which becomes an unsuitable environment for the sperm.

Which of the following is the primary factor to consider when assisting a client in choosing the optimum contraceptive method? 1. Compatibility with cultural values 2. Consistent and correct use 3. Few side effects 4. Lowest failure rate

Looking for answers(s):2 Explanation: The efficacy of the method chosen by the partners is directly proportional to the consistent and correct use of the method chosen. The optimal contraceptive method, therefore, is the one that is most effective for that couple when used consistently and correctly. Although cultural compatibility is important, it is not the most important aspect of the choice of contraception. Although few side effects is important, this is not the most important aspect of the chosen method of contraception. No contraceptive method has been scientifically proven to be 100% effective in the prevention of contraception. Even with a low failure rate, if the method is not used consistently and correctly, optimal effectiveness will not be achieved.

Which of the following would be included in the teaching plan for a client who has just had an intrauterine device (IUD) implanted? 1. Consistent douching immediately after intercourse 2. Need to check for correct placement periodically 3. The estimated rate of pregnancy is 0% during the first year

Looking for answers(s):2 Explanation: To prevent pregnancy, the IUD must be in the intrauterine cavity. The woman must check for the IUD thread after menstruation to rule out expulsion of the device. Douching does not improve the efficacy of IUDs. A 0% pregnancy rate is unrealistic. The effectiveness rate varies between 93% and 97%. Spermicidal creams or jellies are never used with IUDs.

Question 10. For which of the following clients would the nurse understand that oral contraceptive agents are contraindicated? 1. A 29-year-old female with alcohol abuse 2. A 30-year-old female who had three spontaneous abortions 3. A 36-year-old female with a history of thrombophlebitis 4. A teenager with regular menses for the past 4 years

Looking for answers(s):3 Explanation: A client with a past medical history of blood clots is an absolute contraindication to the use of oral contraceptives because the estrogen contained in the pills may stimulate clot formation. Although the client with alcohol abuse may take the pills irregularly, alcohol abuse is not a contraindication to the use of oral contraceptives. Spontaneous abortion is not a reason to avoid oral contraceptive agents. The teenage years are not a contraindication for the use of oral contraceptive agents. It is recommended that the teenager have well-established menstrual cycles for at least 2 years before beginning oral contraceptives.

When obtaining an intake history from a new client in the antepartum clinic, which of the following factors, if found in the multigravida's history, would identify her as being at increased risk for gestational diabetes? 1. Age of 25 2. Five living children 3. Prior birth of a large infant 4. Smoking two packs a day

Looking for answers(s):3 Explanation: An elevated glucose level stimulates the secretion of fetal insulin and results in macrosomia and an infant with a birth weight greater than 9 pounds. Thus, a history suggesting previous birth of a large infant would be a risk factor. Maternal age over 30 years is a risk factor for gestational diabetes. Increased number of pregnancies is not a risk factor for gestational diabetes. Smoking does not alter glucose metabolism. Because of the vasoconstrictive effects of nicotine, these infants usually have a low birth weight.

Which of the following nursing diagnoses would be most appropriate for a woman in her third trimester who tells her husband that she does not want to go out in public "while I'm this pregnant"? 1. Altered Role Performance 2. Anxiety 3. Body Image Disturbance 4. Ineffective Family Coping

Looking for answers(s):3 Explanation: Bodily changes during pregnancy often cause a negative body image. At the end of the pregnancy, the woman often feels "out of shape" and "fat," leading to a nursing diagnosis of body image disturbance. Altered role performance applies to the state in which an individual experiences or is at risk for experiencing a disruption in the way she perceives her role performance. There is no evidence in this situation to suggest this nursing diagnosis. Anxiety applies to a state in which an individual experiences feelings of uneasiness (apprehension) with activation of the autonomic nervous system in response to a vague, nonspecific threat. There is no evidence in this situation to suggest this nursing diagnosis. Ineffective family coping focuses on family, not on an individual problem.

For which of the following would the nurse be alert if the client is receiving medroxyprogesterone (Depo-Provera) injections? 1. Hepatitis B 2. Myocardial infarction 3. Venous thrombosis 4. Pelvic inflammatory disease

Looking for answers(s):3 Explanation: Medroxyprogesterone (Depo-Provera) carries an increased risk of venous thrombosis and thromboembolism. Hepatitis B is transmitted by contact with contaminated blood and body fluids. It is not associated with the use of Depo-Provera. Pelvic inflammatory disease is primarily caused by microorganisms that ascend from the vagina to the uterus and adnexa.

During the initial interview of a pregnant client, the nurse uses Nigele's rule to determine the estimated date of delivery (EDD). Which of the following questions would be essential to ask? 1. "On what day did your previous menstrual period stop?" 2. "What type of contraception are you using at this time?" 3. "When was the first day of your last menstrual period?" 4. "When was the last time that you had sexual intercourse?"

Looking for answers(s):3 Explanation: Nigele's rule assumes the woman has a 28-day cycle and that the pregnancy occurred on the 14th day. To calculate the EDD, the nurse must know the first day of the client's last menstrual period, add 7 days, and then subtract 3 months. Using the last day of the previous cycle and following Nigele's rule, conception would have occurred before ovulation. The question is unrelated to the determination of the EDD. Pregnancy has already been confirmed if the nurse is calculating the EDD. The client could have had intercourse after conception.

A client tells the nurse, "I had my tubes tied 5 years ago. I want to get pregnant now. Is it possible to reverse the sterilization?" The nurse bases her response on the knowledge of which of the following? 1. Female reversal produces a pregnancy rate of 90% 2. Male sterilization reversal is easier than a female's 3. Reversal is possible with tubal reconstruction 4. Reversal of bilateral tubal ligation is not possible

Looking for answers(s):3 Explanation: Reversal is possible but it is expensive and difficult (requiring microsurgery), and the results are uncertain. Tubal reconstruction has a 50% to 70% success rate. The incidence of a successful pregnancy after reanastomosis ranges from 50% to 70%. Reversal of a vasectomy is more difficult with a success rate less than that of fallopian tubal reversal. It is possible with microsurgery to reverse a bilateral tubal ligation.

The nurse informs the client who comes to the clinic for a subdermal implant of progesterone (Norplant) about its advantages. Which would the nurse include? 1. Effectiveness for 3 months 2. Noninvasive technique for insertion 3. Reversible and inexpensive 4. Very few complications or side effects

Looking for answers(s):3 Explanation: Subdermal implants may be removed at any time. Although the initial insertion is expensive, use of this method is inexpensive when one considers the length of time it is effective and that it requires little attention other than health care visits for problems. Subdermal implants are 96% effective until 5 years after insertion. It is recommended that they be replaced at this time to maintain maximum efficacy. Insertion, an invasive procedure, is through a half-inch surgical incision on the inside surface of the nondominant arm. Subdermal implants have multiple side effects, including tenderness and bruising at the insertion site, irregular bleeding, headaches, weight changes, and breast tenderness. Complications include infection, migration or breaking of rods, heavy bleeding, irregularity of menses, and abdominal pain.

Which of the following statements about the female sheath/condom is accurate? 1. A success rate of 99% if used consistently and correctly 2. Need to leave in place for at least 6 hours after intercourse 3. Provides female protection against sexually transmitted diseasesReusable after cleaning and inspecting for tears

Looking for answers(s):3 Explanation: The female should use the latex sheath along with a spermicidal jelly. The sheath protects the entire vagina and urethral area from contact with the shaft and base of the penis, reducing the risk of pregnancy and sexually transmitted infections. Although clinical trials show the female sheath/condom to be as effective as the diaphragm, it is only about 85% to 87% effective in preventing pregnancy. The female condom should be removed after male ejaculation takes place. It does not need to be left in place for effectiveness. Like all condoms, the female condom/sheath is disposable and intended for one-time use only.

Using the five-digit system, which of the following denotes the correct obstetric history for a client who is 6 weeks pregnant, and has a son born at 36 weeks' gestation and a daughter born at 40 weeks' gestation? 1. G2 T1 P1 A0 L2 2. G2 T2 P0 A0 L2 3. G3 T1 P1 A0 L2 4. G3 T2 P0 A0 L2

Looking for answers(s):3 Explanation: This is the client's third pregnancy (G3). One child was born at term (40 weeks; T1) and one was delivered prior to 38 weeks' gestation (preterm; P1). There is no history of abortions (A0) and both children are living (L2). G2 represents a client who has been pregnant two times. This client has been pregnant three times.

A client calls the clinic because she has forgotten to take her oral contraceptive for the past 2 days. Which of the following should the nurse advise the client to do? 1. Continue to take the remaining pills for the rest of the cycle 2. Discontinue the pills for the rest of the cycle and use condoms 3. Take two pills for the next 2 days and use condoms the rest of the cycleTake two pills immediately and change to condoms for the rest of the cycle

Looking for answers(s):3 Explanation: To maintain hormone levels, the client should take the two pills for the next 2 days (to compensate for the missed pills) and then complete the rest of the pills. To decrease the risk of pregnancy, the client should also use an alternative method of contraception such as condoms for the rest of cycle. When two pills have been missed, an alternative form of contraception must be used. Discontinuing the pills for the rest of the cycle would cause a drop in estrogen and progesterone levels with resultant physiologic effects. Taking two pills immediately and then changing to condoms would cause a drop in the levels of estrogen and progesterone with resultant physiologic effects.

The nurse asks a client who is using the basal body temperature (BBT) method of contraception, "When do you and your partner have intercourse?" Which of the following replies is consistent with the BBT method? 1. "During the first few days after my period ends." 2. "From the last day of menses to the first day of temperature elevation." 3. "From the third day of temperature elevation until menses start." 4. "On any day my temperature is not elevated more than 1°."

Looking for answers(s):3 Explanation: When using the BBT method of birth control, coitus is limited to the postovulatory period. Body temperature rises under the influence of progesterone produced by the corpus luteum. The woman should assume that she might be fertile from the last day of menses until the temperature has remained elevated for 3 consecutive days. Intercourse should not occur during the preovulatory period. Although temperature is not elevated, preovulatory days for coitus are prohibited. Ovulation cannot be precisely predicted for all women.

A client who is 24 hours postpartum has the following morning vital signs: Temperature 100° F; BP 124/78; P58; R16. The nurse should do which of the following? 1. Assess the vital signs hourly instead of every 4 hours.Recognize the client's vital signs are normal. 2. Report the changes in vital signs to the physician. 3. Retake the pulse rate after the client ambulates. 4. Recognize the client's vital signs are normal.

Looking for answers(s):4 Explanation: A temperature elevation greater than 100.4° F on any two consecutive readings is considered febrile. A temperature of 100° F reflects the body's normal response to tissue damage or repair and to slight dehydration from labor. Because the client's vital signs are within normal limits, there is no indication to assess vital signs more frequently. All of the vital signs are within normal limits and therefore do not need to be reported to the physician. As a result of the increased stroke volume from a large amount of venous blood returning to the heart (because it is no longer obstructed by the gravid uterus), the pulse rate may be 50 to 90 beats/minute the first 1 to 2 days after delivery. Counting the pulse rate after ambulation would not be necessary.

or which of the following contraceptive methods would the health care provider obtain a signed informed consent? 1. Cervical cap 2. Diaphragm 3. Symptothermal method 4. Vasectomy

Looking for answers(s):4 Explanation: A vasectomy is an invasive surgical procedure and requires signed informed consent. The cervical cap is a barrier method and does not require a signed informed consent. Measurement and application of a diaphragm is not an invasive procedure and does not require a signed informed consent. Symptothermal method determines the fertile period and is not an invasive procedure.

Question 36. When explaining to a client about the primary cause of constipation during pregnancy, the nurse would include which of the following? 1. Decreased water reabsorption 2. Delayed gastric emptying time 3. Increased peristalsis 4. Relaxation of GI tract muscle

Looking for answers(s):4 Explanation: During pregnancy, hormonal influences and subsequent relaxation of the smooth muscle lining the bowel lead to decreased motility and constipation. Decreased water reabsorption would cause liquid stools. Although present during pregnancy, decreased gastric emptying time does not cause constipation. Increased peristalsis would lead to decreased water absorption and liquid stools.

Which of the following patterns of weight gain is normal for a client who weighed 100 pounds before becoming pregnant? 1. 110 pounds by 10 weeks' gestation 2. 112 pounds by 20 weeks' gestation 3. 115 pounds by 30 weeks' gestation 4. 135 pounds by 40 weeks' gestation

Looking for answers(s):4 Explanation: During pregnancy, the woman should gain 25 to 35 pounds. Thus, the client should weigh around 135 pounds at 40 weeks' gestation. By 12 weeks, the client typically should have gained 3.5 to 5 pounds. By 20 weeks, the client typically should have gained 10 pounds. By 30 weeks, the client typically should have gained 10 pounds. By 40 weeks, the client typically should have gained 10 pounds. Typical weight gain is 3.5 to 5 pounds during the first trimester, followed by an average gain of 1 pound per week during the last two trimesters.

Which of the following would the nurse include in the teaching plan for a high school class on human sexuality as a positive sign of pregnancy? 1. Abdominal enlargement 2. Persistent amenorrhea 3. Positive urine HCG 4. Presence of fetal heart tones

Looking for answers(s):4 Explanation: Fetal heart tones heard by the examiner are a positive sign of pregnancy. Abdominal enlargement can be caused by multiple factors, such as tumors or ascites. Amenorrhea can be caused by numerous conditions, including endocrine problems, stress, nutritional status, excessive exercise, or gynecologic problems. Urine HCG tests can be falsely positive owing to protein or blood in the urine or in a turbid specimen. HCG can also originate from a source other than a pregnancy (ie, tumors of the pancreas, ovaries, and breasts). Postmenopausal women may have low levels of circulating HCG

Teenagers in a health class ask the nurse educator, "Do spermicidal jellies ever work?" Which of the following would be the nurse's best reply? 1. "Spermicides are effective for repeated intercourse for 24 hours." 2. "They are not effective unless used with a male or female condom." 3. "They are the least effective of all contraceptives." 4. "They must be placed within 30 minutes before intercourse to be effective."

Looking for answers(s):4 Explanation: For maximum effectiveness, spermicidal agents should be inserted about 30 minutes prior to intercourse. For most spermicides, effectiveness is limited to 1 hour. Spermicides are effective for only one episode of intercourse. Reapplication is essential prior to each subsequent intercourse. The efficacy of spermicides is improved when used with condoms, but they are 70% effective when used alone, if used consistently and correctly. Coitus interruptus is the least effective of all contraceptive methods.

A client asks, "How will sitting in a sitz bath help me?" The nurse's best response would be which of the following? 1. "It is the best way to prevent you from getting a uterine and episiotomy infection." 2. "It will increase urinary bladder muscle tone and facilitate bladder emptying." 3. "Sitting in the water promotes muscle contraction and prevents hemorrhaging." 4. "The warmth of the water will help to facilitate the healing process."

Looking for answers(s):4 Explanation: Local moist heat, such as with a sitz bath, increases circulation, bringing white blood cells and removing waste products from the area, thus facilitating healing. Although warmth facilitates the healing process, there is no guarantee that infection will be prevented. Heat does not increase muscle tone and thus will not facilitate bladder emptying. Warmth promotes muscle relaxation. Heat would increase blood flow and increase bleeding—not prevent hemorrhaging.

When planning a teaching session for teenage girls on the use of a diaphragm for contraconception, which of the following would be included? 1. Having the diaphragm refitted after a weight loss or gain of 20 pounds 2. Inserting the diaphragm at least 8 hours prior to intercourse 3. Leaving the diaphragm in place for 24 hours after intercourse 4. Using a spermicidal jelly in the center and around the rim

Looking for answers(s):4 Explanation: Spermicidal preparations increase the efficacy of the diaphragm and should always be used. A diaphragm should be refitted after childbirth or after a weight loss or gain of 15 or more pounds. For maximum effectiveness, the diaphragm should be inserted no more than 2 hours before intercourse. The diaphragm should be left in place for at least 6 hours after coitus for maximum protection against pregnancy.

The nurse should recommend which of the following contraceptive methods for a 16-year-old female prostitute who has a history of tobacco, alcohol, and intravenous drug abuse? 1. Female condoms 2. Intrauterine device (IUD) 3. Oral contraceptives 4. Subdermal implants

Looking for answers(s):4 Explanation: Subdermal implants are 99% effective and require no effort to maintain contraception. Her age and history do not indicate that she would consistently use a female condom. As a prostitute, the client is at high risk for sexually transmitted diseases, which could cause pelvic inflammatory disease with the IUD in the uterine cavity. The client's age and substance abuse history make her a likely candidate for inconsistent use of the pill.

Which of the following denotes the correct technique for fundal massage for a postpartum client exhibiting a large amount of blood on the perineal pad? 1. Compressing the fundus on one side while supporting the other side of the uterus 2. Massaging above the symphysis pubis while one hand supports the uterine fundus 3. Pressing deeply into the abdomen while compressing the fundus with both hands 4. Supporting the fundus while massaging the uterus just above the symphysis pubis

Looking for answers(s):4 Explanation: Supporting the fundus while massaging the uterus just above the symphysis pubis provides support to the lower uterine segment while stimulating contraction of the fundus. It also prevents inversion of the uterus, which is an obstetric emergency. The top (fundus) of the uterus is massaged, not the sides. Massaging at the symphysis pubis would not provide effective uterine contractions. One hand is used to massage the fundus. It is not necessary to press deep into the abdomen.

Which of the following would be included in the nurse's explanation about the natural calendar method for a client whose religious preferences prevent the use of artificial contraception? 1. Including irregular bleeding episodes as menses 2. Planning for intercourse during her fertile periods 3. Practicing abstinence for 1 year 4. Recording the menstrual cycle for several months

Looking for answers(s):4 Explanation: The calendar method is based on the fact that ovulation occurs 14 days before the onset of menses. Recording cycles is necessary to calculate the fertile period. Irregular bleeding must not be confused with menses or the calculation of the fertile period will not be accurate. Use of the calendar method for contraception relies on avoidance of sexual intercourse during fertile periods. Although periods of abstinence may be essential for the prevention of pregnancy during the accurate calculation of the fertile period, a year of abstinence is unnecessary.

Which of the following factors would be most influential to the outcome of a class on human sexuality that includes both males and females ranging in age from adolescence through middle-aged adults? 1. Availability of written handouts to reinforce the content 2. Cognitive level of the information to be presented 3. Environmental setting where the class will take place 4. The nurse's comfort level in discussing the subject matter

Looking for answers(s):4 Explanation: The nurse must demonstrate comfort with human sexuality content to facilitate an effective presentation to a class. Although important in reinforcement of concepts, availability of written handouts is not the most important aspect to influence the outcome of the class. Although important, the cognitive level of the information to be presented is not the most important factor in the determination of the effectiveness of the class. The setting for the class presentation facilitates effectiveness, but it is not the primary factor in the determination of the client learning outcomes.