MATERNITY EAQ
At a client's first prenatal visit, the healthcare provider performs a pelvic examination, stating that the client's cervix is bluish purple, which is known as the Chadwick sign. The client becomes concerned and asks whether something is wrong. The best response is "This is expected; it: 1) Helps confirm your pregnancy" 2) Is not unusual, even in women who are not pregnant" 3) Occurs because the blood is trapped by the pregnant uterus" 4) Is caused by increased blood flow to the uterus during pregnancy"
4) Is caused by increased blood flow to the uterus during pregnancy" Rationale: Stating that the Chadwick sign is caused by increased blood flow to the uterus during pregnancy underscores the normalcy of Chadwick's sign and provides a simple explanation of the cause; women often need reassurance that the physical changes associated with pregnancy are expected. Stating that the Chadwick sign helps confirm pregnancy answers part of the question but fails to explain why it occurs. The Chadwick sign is a probable sign of pregnancy; it is not seen in nonpregnant women. There is no free blood circulating in the uterus during pregnancy. Test-Taking Tip: Make certain that the answer you select is reasonable and obtainable under ordinary circumstances and that the action can be carried out in the given situation.
A client who is scheduled to have an abdominal panhysterectomy asks how the surgery will affect her periods. How should the nurse respond? 1) "You won't have any more periods." 2) "Your periods will become more regular." 3) "Your periods will become lighter and then disappear." 4) "You'll notice that the time between periods will be longer."
1) "You won't have any more periods." Rationale: A panhysterectomy in the premenopausal woman produces artificial onset of menopause. Because the uterus is removed, there will be no uterine endometrial proliferation and no desquamation. Test-Taking Tip: Practicing a few relaxation techniques may prove helpful on the day of an examination. Relaxation techniques such as deep breathing, imagery, head rolling, shoulder shrugging, rotating and stretching of the neck, leg lifts, and heel lifts with feet flat on the floor can effectively reduce tension while causing little or no distraction to those around you. It is recommended that you practice one or two of these techniques intermittently to avoid becoming tense. The more anxious and tense you become, the longer it will take you to relax.
What must the LPN observe first when planning to promote mother-infant attachment? 1) Mother-infant interaction 2) Mother-father interaction 3) The infant's physical status 4) The mother's ability to care for her infant
1) Mother-infant interaction Rationale: The extent and quality of the mother-infant interaction is believed to be a predictor of positive or negative . Mother-father interaction, the infant's physical status, and the mother's ability to care for her infant are also assessed but are not as significant as mother-infant interaction.
A genetic counselor is working with a couple, each of whom is a carrier of an autosomal recessive disorder. Which statement indicates that the couple has understood the teaching about this disorder? 1) "Most of our children will have the disorder." 2) "None of our children will have the disorder." 3) "There is a 1-in-4 chance of having a child with the disorder." 4) "There is a 1-in-2 chance of having a child with the disorder."
3) "There is a 1-in-4 chance of having a child with the disorder." Rationale: According to , when both parents are carriers of an autosomal recessive disorder there is a 25% probability that a child will have the disorder. There is a 25% probability that a child born to this couple will have the disorder. The statement that none will have the disorder, indicates that the couple does not understand Mendel's theory of probability. When both partners are carriers there is a 50% probability that a child will be a carrier and a 25% probability that a child will have the disorder. If one of the parents has the disorder there is a 50% probability that a child will have the disorder.
A nurse is interviewing a female client with a tentative diagnosis of cystitis pending laboratory results. The nurse anticipates that the causative agent of the cystitis is Escherichia coli. The nurse anticipates this microorganism because it: 1) Thrives in the kidneys 2) Is a virulent bacterium 3) Inhabits the intestinal tract 4) Competes with fungi for host sites
3) Inhabits the intestinal tract Rationale: E. coli is commonly found in the bowel and, because of anatomical proximity and possibly careless hygiene after bowel movements, may spread to the urethra. E. coli is not found in the kidneys. E. coli is no more virulent than other infective agents, nor does it compete with fungal organisms for host sites.
A client is receiving antibiotics and antifungal medications for the treatment of a recurring vaginal infection. What should the nurse encourage the client to do to compensate for the effect of these medications? 1) Eat yogurt daily 2) Avoid spicy foods 3) Drink more fruit juices 4) Take a multivitamin every day
1) Eat yogurt daily Rationale: Yogurt contains Lactobacillus acidophilus, which replaces the intestinal flora destroyed by antibiotics. The other options are not relevant to antibiotics or intestinal flora. Test-Taking Tip: You have at least a 25% chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses.
Methods of relieving back pain are explained during a childbirth class. What activities identified by the client permit the nurse to conclude that the teaching has been understood? (Select all that apply) 1) Tailor sitting 2) Pelvic rocking 3) Forward tilting 4) Sacral pressure 5) Kegel exercises
2) Pelvic rocking 3) Forward tilting 4) Sacral pressure Rationale: Eases tension in the muscles of the lumbar region. Lumbar pain during pregnancy results from the changes in posture as the uterus grows. Forward tilting eases tension in the muscles of the lumbar region. Lumbar pain during pregnancy results from the changes in posture as the uterus grows. Applying the heel of the hand to the laboring client's sacral area (counterpressure) helps relieve the back discomfort that may result when a fetus is in the occiput posterior position. Tailor sitting helps relax the muscles of the pelvic floor. Kegel exercises strengthen the muscles of the pelvic floor.
A 26-year-old woman whose sister recently had a mastectomy calls the local women's health center for an appointment for a mammogram. What should the nurse tell the client when preparing her for the mammogram? 1) Both breasts will be examined at the same time. 2) Schedule the test for 1 week before menstruation. 3) Each breast will be firmly compressed between two plates. 4) Mammography is more accurate in premenopausal than postmenopausal women.
3) Each breast will be firmly compressed between two plates. Rationale: Compression of the breast flattens mammary tissue and maximizes penetration of the breast by x-rays; this is especially important for the dense breast tissue of adolescents, young nulliparous women, and women with large breasts. Each breast is examined separately. The test should be scheduled for 2 weeks after the onset of menses, when the breasts are the least sensitive. Mammography is more accurate in postmenopausal than in premenopausal women.
A client who has had a cesarean birth seems upset. She has been having difficulty breastfeeding for 2 days and now asks the nurse to bring her a bottle of formula. What is the nurse's initial action? 1) Obtaining the requested formula 2) Administering the prescribed pain medication 3) Observing the client's breastfeeding technique 4) Notifying the practitioner of the client's request to switch feeding methods
3) Observing the client's breastfeeding technique Rationale: The nurse should assess the client to determine why she is having difficulty with breastfeeding. She may be uncomfortable or in need of assistance with her breastfeeding technique. Immediately providing the formula without assessing the situation does not meet the client's needs at this time. Pain may be a factor in the client's frustration with breastfeeding, but this should be determined through the assessment process. Notifying the practitioner of the client's request to switch feeding methods is premature. It is the nurse's responsibility to assess the situation and arrive at a solution in collaboration with the client.
The nurse is conducting teaching for a client being discharged after an abdominal hysterectomy. Which statement by the client indicates a need for further teaching? 1) "I know not to lift anything heavier than 5 lb." 2) "I'll limit my stair climbing to four times a day." 3) "I'll avoid crossing my legs at the knees when I sit." 4) "I'm glad I'll be able to get back into my jogging routine next week."
4) "I'm glad I'll be able to get back into my jogging routine next week." Rationale: Discharge instructions after abdominal hysterectomy include avoiding jogging, aerobic exercise, participating in sports, and other any strenuous activity for 2 to 6 weeks after the surgery. The statement indicating that the client plans to start jogging again by next week means that the client requires more teaching. Stair climbing should be limited to fewer than five times per day. Nothing heavier than 5 to 10 lb should be lifted. The client should not cross her legs at the knees when sitting. Those three statements by the client are accurate and indicate understanding of the teaching.
A primigravida at 12 weeks' gestation complains of nausea and vomiting during a visit to the prenatal clinic. Which pregnancy hormone should the nurse explain is thought to be responsible for nausea and vomiting during the first trimester? 1) Estrogen 2) Progesterone 3) Human placental lactogen (hPL) 4) Human chorionic gonadotropin (hCG)
4) Human chorionic gonadotropin (hCG) Rationale: hCG, secreted by the chorionic villi during early pregnancy, frequently causes nausea; as the level of hCG decreases, the nausea usually subsides. Estrogen is not associated with nausea; it makes the reproductive tract receptive to the embryo. Although progesterone may be associated with nausea, it is not the major cause of nausea in early pregnancy; it is essential for maintaining pregnancy and preventing spontaneous abortion. hPL is not associated with nausea; it is a hormone secreted by the placenta that stimulates maternal metabolism to supply nutrients for fetal growth.
What should be included in nursing care immediately after a sexual assault? 1) Obtaining the assault history from the client 2) Informing the police before the client is examined 3) Having the client void a clean-catch urine specimen 4) Testing the client's urine for seminal alkaline phosphatase
1) Obtaining the assault history from the client Rationale: Obtaining the assault history from the client provides a basis for assessing trauma; in a client of childbearing age it also is necessary to assess the risk for pregnancy. Examination may precede reporting; the decision to report is mandated by law. Urination may wash away spermatic or bloody evidence. A test for seminal acid phosphate, not seminal alkaline phosphatase, is performed.
While being admitted for a lumpectomy the client begins to cry and says, "I found the lump a few months ago, but I didn't go to the doctor because of what it could be." How should the nurse reply? 1) "This has been frightening for you." 2) "About 80% of breast lumps are benign." 3) "Cry as long as you like and get it out of your system." 4) "More than 95% of breast lumps are discovered by the woman herself."
1) "This has been frightening for you." Rationale: The correct response involves the use of reflective technique to acknowledge the client's feelings. Providing statistics does not acknowledge the client's feelings and may cut off communication. Providing false reassurance that crying will ease her concerns is inappropriate.
Four days after a vaginal hysterectomy a client calls the follow-up service and tells the nurse that she has a yellowish-green vaginal discharge. The nurse advises the client to return to the clinic for an evaluation. Which symptoms are suggestive of a vaginal infection? (Select all that apply) 1) Abdominal pain 2) Urinary frequency 3) Rising temperature 4) Decreased pulse rate 5) Decreased blood pressure
1) Abdominal pain 3) Rising temperature Rationale: A pelvic infection is suspected. One characteristic of this disorder is abdominal pain. A rising temperature is a sign of infection. Urinary frequency is associated with cystitis, not a pelvic infection. Increases, not decreases, in pulse rate and blood pressure are expected because the metabolic rate increases in the presence of an increased temperature. Test-Taking Tip: Be alert for details about what you are being asked to do. In this Question Type, you are asked to select all options that apply to a given situation or client. All options likely relate to the situation, but only some of the options may relate directly to the situation.
A client at 16 weeks' gestation arrives at the prenatal clinic for a routine visit. During the examination the nurse notes bruises on the client's face and abdomen. There are no bruises on her legs and arms. Further assessment is required to confirm: 1) Domestic abuse 2) Hydatidiform mole 3) Excessive exercise 4) Thrombocytopenic purpura
1) Domestic abuse Rationale: is likely to intensify during pregnancy, and attacks are usually directed toward the pregnant woman's abdomen. A hydatidiform mole manifests as an unusually enlarged uterus for gestational age accompanied by hypertension, nausea and vomiting, and vaginal bleeding, not bruises on the face and abdomen. Excessive exercise may cause cardiovascular or pulmonary problems. It will not result in bruising. Thrombocytopenic purpura and other bleeding disorders manifest as bruises and petechiae on many areas of the body's surface, not just the face and abdomen. Test-Taking Tip: Do not select answers that contain exceptions to the general rule, controversial material, or degrading responses.
A nurse is planning care for a client who gave birth to a preterm male infant. What most common response does the nurse anticipate that the mother may experience? 1) Feelings of failure and loss of control 2) Thoughts related to guilt and withdrawal 3) Fear of forming a healthy relationship with her son until he is out of danger 4) Need for increased attachment behaviors because of her son's life-threatening condition
1) Feelings of failure and loss of control Rationale: Attachment theory states that the experience of the birth of a preterm infant carries with it feelings of loss of control for the mother. Withdrawal from the situation is maladaptive and requires special help. A healthy relationship may develop regardless of the infant's health. There is no basis to believe that increased attachment behaviors are needed.
A nurse caring for a pregnant woman determines that she is engaging in the practice of pica. Why should the nurse prepare a teaching plan for this client? 1) Inedible items are being ingested. 2) The client has a need for a particular food. 3) Many foods can cause nausea and vomiting. 4) The client has a dislike for an essential group of foods.
1) Inedible items are being ingested. Rationale: Pica is the eating of inedibles such as starch or dirt. There is a cultural influence on this practice, but it may also be related to malnutrition or anemia. Food cravings frequently occur in pregnant women. If many foods are causing nausea and vomiting, the client has morning sickness. If it continues past the first trimester, it may be hyperemesis gravidarum. The dislike for essential food groups does not describe the practice of pica.
A 28-year-old woman seeks advice about oral contraceptives from the nurse in her company health office. What should the nurse tell her if she is a smoker? 1) Oral contraceptives can cause thrombophlebitis. 2) Oral contraceptives can be used with other methods. 3) Some oral contraceptives can be used without concern. 4) Some oral contraceptives are safe while others are not safe.
1) Oral contraceptives can cause thrombophlebitis. Rationale: Studies have shown that women who smoke at least a pack of cigarettes a day are more prone to cardiovascular problems such as thrombophlebitis. Using oral contraceptives with other methods of contraception is not necessary if there are no contraindications; oral contraceptives are effective used alone. There is no "safe" oral contraceptive for all women, or one that may be used without concern; any client at risk should be informed of the potential consequences of taking an oral contraceptive.
What does the nurse teach a client to do when performing breast self-examination? 1) Squeeze the nipples to examine for discharge 2) Use the right hand to examine the right breast 3) Place a pillow under the shoulder opposite the examined breast to raise it 4) Compress breast tissue to the chest wall with the palm to palpate for lumps
1) Squeeze the nipples to examine for discharge Rationale: Serous or bloody discharge from the nipple is pathological and must be reported. The right hand should be used to examine the left breast because this allows the flattened fingers to palpate the entire breast including the tail (upper, outer quadrant toward the axilla) and axillary area. A small pillow or rolled towel should be placed under the scapula of the side being examined because it helps raise the chest wall and spread and flatten out breast tissue. The flat part of the fingers, not the palm or fingertips, should be used for palpation.
The school nurse is teaching a group of 16-year-old girls about the female reproductive system. One student asks how long after ovulation it is possible for conception to occur. The most accurate response by the nurse is based on the knowledge that an ovum is no longer viable after: 1) 12 hours 2) 24 hours 3) 48 hours 4) 72 hours
2) 24 hours Rationale: The ovum is viable for about 24 hours after ovulation; if not fertilized before this time, it degenerates. For this reason, 12 hours, 48 hours, and 72 hours are all incorrect answers. Test-Taking Tip: The presence of absolute words and phrases can also help you determine the correct answer to a multiple-choice item. If answer choices contain an absolute (e.g., none, never, must, cannot ), be very cautious. Remember that there are not many things in the world that are absolute, and in an area as complex as nursing, an absolute may be a reason to eliminate it from consideration as the best choice. This is only a guideline and should not be taken to be true 100% of the time; however, it can help you reduce the number of choices.
A pregnant client who is scheduled for a nonstress test (NST) asks a nurse how the test can show that "my baby is all right." The nurse explains that it is a way of evaluating the condition of the fetus by comparing the fetal heart rate (FHR) with: 1) Fetal gestational age 2) Fetal physical activity 3) Maternal blood pressure 4) Maternal uterine contractions
2) Fetal physical activity Rationale: The FHR should increase with physical activity; a reactive NST reveals accelerations of 15 beats/min, lasting 15 seconds with fetal movement. This response indicates fetal well-being. Fetal gestational age is not a part of the evaluation of the fetus in the NST. Maternal blood pressure is not a part of the evaluation of the fetus in the NST. Maternal uterine contractions are assessed in a contraction stress test or during labor.
A young client tells the nurse that her mother complains about having dysmenorrhea and asks the nurse what this means. How should the nurse describe dysmenorrhea? 1) Cessation of menstrual periods 2) Spotting between menstrual periods 3) Uterine pain during the menstrual period 4) Scant bleeding at the time of an expected menstrual period
3) Uterine pain during the menstrual period Rationale: Uterine pain during the menstrual period is the definition of dysmenorrhea. Cessation of menstrual periods occurs with menopause and during pregnancy. Spotting between menstrual periods is bleeding that occurs at any time other than during the menstrual period; there may or may not be pain. Scant bleeding at the time of an expected menstrual period may occur if the client is taking an oral contraceptive or in the first month or two of pregnancy.
During a class for prepared childbirth, the nurse teacher discusses the importance of the spurt of energy that occurs before labor. Why is it important to conserve this energy? 1) Fatigue may increase the progesterone level. 2) Extra energy decreases the intensity of contractions. 3) Extra energy is needed to push during the first stage 4) Fatigue may influence pain medication requirements.
4) Fatigue may influence pain medication requirements. Rationale: Fatigue will interfere with the successful use of other coping strategies such as distraction; this may lead to the client's need for pain medication. Neither fatigue nor energy influences the progesterone level, which is decreased at this time. Energy will increase the intensity of contractions. The client does not push during the first stage of labor; pushing is done during the second stage.
A pregnant client is experiencing nausea and vomiting. The nurse determines that this discomfort: 1) Is always present during early pregnancy 2) Will disappear when lightening occurs 3) Is a common response to an unwanted pregnancy 4) May be related to an increased human chorionic gonadotropin level
4) May be related to an increased human chorionic gonadotropin level Rationale: An increased level of human chorionic gonadotropin, or hCG, may and vomiting, but the exact reason is unknown. Some pregnant women do not experience nausea and vomiting. Lightening occurs at the end of the third trimester; nausea and vomiting usually cease at the end of the first trimester. Nausea and vomiting are unrelated to whether a pregnancy is desired or unwanted.