Maternity Exam 1 - Chapter Q&A - Chapter 3, 4, 5, 10, 11, 12, 19, 20

Which are noncontraceptive benefits of combined oral contraceptives? Select all that apply. a. Protection against ovarian cancer b. Protection against endometrial cancer c. Protection against breast cancer d. Reduction in incidence of ectopic pregnancy e. Prevention of functional ovarian cysts f. Reduction in the risk of deep venous thrombosis g. Reduction in the risk of colorectal cancer

A, B, D, E, and G are correct responses: research studies have validated a reduced incidence of these cancers and conditions. C and F are incorrect: research has not shown a reduction, and some studies have actually found an increase in the incidence of breast cancer and deep vein thrombosis.

When interviewing a woman at her first prenatal visit, the nurse asks about her feelings. The woman replies, "I'm frightened and confused. I don't know whether I want to be pregnant or not. Being pregnant means changing our whole life, and now having somebody to care for all the time. I'm not sure I would be a good mother. Plus, I'm a bit afraid of all the changes that would happen to my body. Is this normal? Am I OK?" a. How should the nurse answer this question? b. What specific information is needed to support the client during this pregnancy?

A. How should the nurse answer this question? The feelings that the woman is describing are those of ambivalence, and they are very common in women when they first learn they are pregnant. The nurse needs to explain this to the woman, emphasizing that it is common for women to question themselves in relation to the pregnancy because it is "unreal" to them during this early period. Fetal movement helps to make the pregnancy a reality. B. What specific information is needed to support the client during this pregnancy? The nurse can be supportive to this woman during this time by providing emotional support and validating the various ambivalent feelings she is experiencing. Her husband and/or family members might also provide support for her.

The school nurse was asked to speak to a 10th-grade biology class about menstruation. The teacher felt that the students did not understand this monthly event and wanted the nurse to dispel some myths about it. After the nurse explains the factors influencing the menses, one girl asks, "Could someone get pregnant if she has sex during her period?" a. How should the nurse respond to this question? b. What factor regarding the menstrual cycle was not clarified? c. What additional topics might this question lead to that might be discussed?

A. How should the nurse respond to this question? The nurse should respond by explaining to the student that conception is achieved only during the time of ovulation, which occurs at midcycle and not during menstruation. Further explanation might outline the phases of the menstrual cycle and how each phase contributes to the preparation of the endometrial lining if conception were to take place. If conception does not occur, sloughing of the prepared endometrial lining takes place, and this is what is shed during menstruation. B. What factor regarding the menstrual cycle was not clarified? The student apparently did not understand the concept of ovulation and the potential uniting of sperm and ovum. At ovulation, bodily changes occur that assist the sperm to impregnate the ovum that was released from the ovary. It is only during this midcycle period that the sperm can find the ovum and begin a pregnancy. C. What additional topics might this question lead to that might be discussed? Sexually transmitted infections and barrier protection; abstinence until marriage and personal responsibility; responsibilities and outcomes of becoming a young parent; self-esteem and taking pride in their bodies; future educational and career goals

Monica, a 16-year-old high school student, is here for her first prenatal visit. Her LMP was 2 months ago, and she states she has been "sick ever since." She is 5 ft, 6 in tall and weighs 110 lb. In completing her dietary assessment, the nurse asks about her intake of milk and dairy products. Monica reports that she doesn't like "that stuff" and doesn't want to put on too much weight because it "might ruin my figure." a. In addition to the routine obstetric assessments, which additional ones might be warranted for this client? b. What dietary instruction should be provided to this client based on her history? c. What follow-up monitoring should be included in subsequent prenatal visits?

A. In addition to the routine obstetric assessments, which additional ones might be warranted for this teenager? Calculate Monica's body mass index (BMI) based on height and weight (BMI = 17.8, which places her at high risk for not gaining enough weight during pregnancy). Ask Monica if she takes drugs or alcohol, which might have a negative impact on the pregnancy. Request a 24-hour diet recall, which might reveal low calorie and calcium intake. Ascertain who does the cooking and food purchasing in her house; ask that the person accompany her to the clinic for her next visit for dietary teaching. Explore reasons why she won't drink milk, and provide her with information about other sources of calcium that she might substitute for milk, such as yogurt. B. What dietary instruction should be provided to this teenager based on her history? Stress the importance of gaining weight for the baby's health. Encourage her to eat three meals each day plus three high-fiber snacks. Go over the MyPlate with her to show her selections from each group that she needs to consume daily. Request that she take a peanut butter and jelly sandwich on whole-wheat bread to school to make sure she eats a good lunch each day. Instruct her on limiting her intake of sodas and caffeinated drinks. Encourage her to drink calcium-fortified orange juice for breakfast daily. Reinforce the importance of taking her prenatal vitamin daily. Send her home with printed materials for review. C. What follow-up monitoring should be included in subsequent prenatal visits? Increase the frequency of prenatal visits to every 2 weeks to monitor weight gain for the next few months. Refer Monica and her mother to the nutritionist in the WIC program for a more thorough dietary instruction. Request a 24-hour dietary recall at each prenatal visit to provide a basis for instruction and reinforcement.

Maria, a 27-year-old woman in her last trimester of pregnancy (34 weeks), complains to the clinic nurse that she is constipated and feels miserable most of the time. She reports that she has started taking laxatives, but they don't help much. When questioned about her dietary habits, she replies that she eats beans and rice and drinks tea with most meals. She says she has tried to limit her fluid intake so she doesn't have to go to the bathroom so often. a. What additional information would the nurse need to assess her complaint? b. What interventions would be appropriate for Maria? c. What adaptations will Maria need to make to alleviate her constipation?

A. What additional information would the nurse need to assess her complaint? Ask Maria for a 24-hour food intake recall to assess what other food she eats. Ask Maria if she had this problem before becoming pregnant. Ask Maria if she takes iron supplementation in addition to her prenatal vitamin. Ask Maria how much and what kind of fluid intake she has in 24 hours. Ask Maria whether she engages in any exercise consistently. B. What interventions would be appropriate for Maria? The nurse needs to discuss with her the reasons why she is constipated: heavy gravid uterus compressing the intestines, reduced peristalsis and smooth muscle relaxation secondary to progesterone, low-fiber and fluid intake, and limited exercise. To reduce the problem, Maria will need to make changes in the areas of food, fluid, and exercise. C. What adaptations will Maria need to make to alleviate her constipation? Maria will need to consume high-fiber foods (fruits and vegetables) and increase her fluid intake to 2,000 mL daily to overcome the constipation. In addition, she will need to get off the couch and get some exercise, perhaps walking. Finally, she will need to stop taking stimulant laxatives and change to bulk-forming ones if the increase in high-fiber foods and fluids doesn't work for her.

Sally, age 23, is 9 weeks pregnant. At her clinic visit she says, "I'm so tired I can barely make it home from work. Then once I'm home, I don't have the energy to make dinner." She says she is so sick in the morning that she is frequently late to work and spends much of the day in the bathroom. Sally's current lab work is within normal limits. a. What explanation can the nurse offer Sally about her discomforts? b. What interventions can the nurse offer to Sally?

A. What explanation can the nurse offer Sally about her discomforts? The nurse can explain in simple terms that the new embryo needs a great deal of her glucose and nutrients to grow, and thus her energy level will be affected during early pregnancy; this is why she is feeling tired frequently. The nurse can also inform her that her energy level will increase by the second trimester and she should not feel as drained. B. What interventions can the nurse offer to Sally? Interventions to help Sally cope with her fatigue during her early pregnancy would be for her to plan rest periods throughout the day and make sure she gets a good night's sleep daily. Taking naps on weekends to refresh her may also help her. Also, help with meal preparation would be beneficial.

Mr. and Mrs. Martin wish to start a family, but they can't agree on something important. Mr. Martin wants his wife to be tested for cystic fibrosis (CF) to see if she is a carrier. Mr. Martin had a brother with CF and watched his parents struggle with the hardship and the expense of caring for him for years, and he doesn't want to experience it in his own life. Mr. Martin has found out he is a CF carrier. Mrs. Martin doesn't want to have the test because she figures that once a baby is in their arms, they will be glad, no matter what. a. What information/education should this couple consider before deciding whether to have the test? b. How can you assist this couple in their decision-making process? c. What is your role in this situation if you don't agree with their decision?

A. What information/education should this couple consider before deciding whether to have the test? The nurse needs to outline the facts about the genetic inheritance: • CF is a recessive disorder that affects one in every 2,500 babies. • It predominately is seen in White infants and is less common in other races. • Because it is a recessive disorder, Mrs. Martin must also be a carrier to pass it on to their offspring. • If Mrs. Martin is a carrier, their chance of having a child with CF is one in four. • The risk is the same each time they have a child. • Information about the characteristics of cystic fibrosis. B. How can you assist this couple in their decision-making process? Start by providing all the facts about the nature of the inheritance risk. Also, outline all options so the couple can make an informed decision. Options include the following: • The couple does not receive genetic testing and takes their chances. • If Mrs. Martin is a CF carrier, then they could choose not to have children or adopt a baby. • Prenatal testing could be done on the fetus to determine whether both its genes carry a CF mutation. If so, the couple could elect to abort the pregnancy. • Use an ovum or sperm from a donor who does not carry CF. • Make a referral to a reproductive technology health facility for the couple to become educated regarding alternatives to maximize their outcome. • Be realistic with this couple about not having any guarantees that another genetic disorder might not occur. • Discuss the expense involved in genetic testing and in vitro fertilization that probably will not be covered by health insurance. C. What is your role in this situation if you don't agree with their decision? As a nurse, your role is to provide the facts and allow the couple to make their own decision about what they wish to do. They must live with their decision, not the nurse. As a nurse, your role would be to educate and respect and support whatever this couple decides to do.

A 16-year-old primigravida presents to the maternity clinic complaining of continual nausea and vomiting for the past 3 days. She states she is approximately 15 weeks pregnant and has been unable to keep anything she eats down or take any fluids in without throwing up for the past 3 days. She reports she is dizzy and weak. Upon examination, she appears pale and anxious. Her mucous membranes are dry, skin turgor is poor, and her lips are dry and cracked. a. What is your impression of this condition? b. What risk factors does the client have? c. What intervention is appropriate for this woman?

A. What is your impression of this condition? From her history, it appears she has hyperemesis gravidarum, because she is beyond the morning sickness time frame (6 to 12 weeks) and her symptoms are continual. B. What risk factors does the client have? Her risk factors include young age and primigravida status. C. What intervention is appropriate for this woman? • Question the client further concerning previous eating patterns and food intake. • Ask what measures she has used at home to stop the nausea and vomiting. • Consult the health care provider concerning hospitalization of the client for IV therapy to correct hypovolemia and electrolyte imbalances. • If home care is in order, advise her to avoid the intake of greasy or highly seasoned foods and to separate food from fluid intake; instruct her on antiemetic medication ordered and possible side effects; and instruct her to return to the clinic if symptoms do not subside within 48 hours.

An obese 39-year-old primigravida of African American descent is diagnosed with gestational hypertension. Her history reveals that her sister developed preeclampsia during her pregnancy. When describing her diet to the nurse, the client mentions that she tends to eat a lot of fast food. a. What risk factors does this client have that increase her risk for gestational hypertension? b. When assessing this client, what assessment findings would lead the nurse to suspect that this client has developed severe preeclampsia?

A. What risk factors does this client have that increase her risk for gestational hypertension? The client is a primigravida with a family history of preeclampsia (her sister). She also is an obese woman who is older than 35 years of age. Her diet of fast foods is most likely inadequate in nutritional content. She is also African American. B. When assessing this client, what assessment findings would lead the nurse to suspect that this client has developed severe preeclampsia? With severe preeclampsia, blood pressure is higher than 160/110 mm Hg on two occasions at least 6 hours apart, proteinuria is greater than 500 mg in 24 hours, and oliguria (less than 500 mL in 24 hours) is present. Other assessment findings may include pulmonary edema, cerebral or visual disturbances (altered level of consciousness, headache, blurred vision, and scotomata), hyperreflexia, and epigastric or right upper quadrant abdominal pain. Laboratory test findings would include increased hematocrit, creatinine, and uric acid levels, thrombocytopenia, and elevated liver enzymes.

Mary Jones comes to the Women's Health Center, where you work as a nurse. She is in her first trimester of pregnancy and tells you her main complaints are nausea and fatigue, to the point that she wants to sleep most of the time and eats one meal daily. She appears pale and tired. Her mucous membranes are pale. She reports that she gets 8 to 9 hours of sleep each night but still can't seem to stay awake and alert at work. She tells you she knows that she is not eating as she should, but she isn't hungry. Her hemoglobin and hematocrit are low. a. What subjective and objective data do you have to make your assessment? b. What is your impression of this woman? c. What nursing interventions would be appropriate for this client? d. How will you evaluate the effectiveness of your interventions?

A. What subjective and objective data do you have to make your assessment? Subjective data: reports feeling extreme fatigue; sleeps 8 to 9 hours each night; eats poorly Objective data: pale and tired appearance; pale mucous membranes; low H and H B. What is your impression of this woman? She is in her first trimester of pregnancy, when fatigue is a normal complaint due to the diversion of the maternal glucose to the developing fetus. In addition, she is anemic (low H and H) due to eating habits or perhaps pica. It is important for the nurse to report this finding to the health care professional for further investigation of the cause. C. What nursing interventions would be appropriate for this client? Reassure her that the fatigue is a common complaint of pregnancy in the first trimester, but her poor dietary habits are contributing to her fatigue. She is anemic and needs to improve her diet and increase the amount of iron and vitamin C she takes. She also needs to increase her fiber intake to prevent constipation. An iron supplement might be advised by the health care provider to address her anemia. Request that the client keep a food log to bring with her to the next visit to review. A referral for nutritional counseling would be appropriate. D. How will you evaluate the effectiveness of your interventions? To assess compliance with the iron supplement, ask her what color her stools are. If they are dark, then she is taking the iron; if not, she probably isn't. Ask what dietary changes she has made to improve her nutrition by reviewing her food log and making suggestions to increase her iron consumption. Also review the importance of good nutrition for the positive outcome of this pregnancy. Do another H and H level to monitor her anemia.

Sally, age 17, comes to the teen clinic saying that she is in pain and has some "crud" between her legs. The nurse takes her into the examining room and questions her about her symptoms. Sally states she had numerous genital bumps that had been filled with fluid, then ruptured and turned into ulcers with crusts. In addition, she has pain on urination and overall body pain. Sally says she had unprotected sex with several men when she was drunk at a party a few weeks back, but she thought they were "clean." a. Which STI would the nurse suspect? b. The nurse should give immediate consideration to which of Sally's complaints? c. What should be the goal of the nurse in teaching Sally about STIs?

A. Which STI would the nurse suspect? Based on the description of the genital lesions, the nurse would suspect genital herpes. Typically the herpetic lesions begin as erythematous papules that then develop into vesicles. The vesicles rupture and leave ulcerated lesions and then crust over. This is essentially what Sally described in her history. B. The nurse should give immediate consideration to which of Sally's complaints? As with any STI, treatment should aim at promoting comfort, promoting healing, preventing secondary infection, and decreasing transmission of the disease. A sample from a genital lesion should be obtained for a definitive diagnosis. A urine sample should be checked for bacteria to rule out a bladder infection. Giving information about the specific STI is important to promote understanding. Information concerning her antiviral medication therapy is paramount to reduce the viral shedding. Sitz baths and mild analgesics may be needed for pain relief. C. What should be the goal of the nurse in teaching Sally about STIs ?Although acyclovir or another antiviral medication can reduce the symptoms of herpes, the nurse needs to point out that it is not a cure for herpes. Antiviral drugs act to suppress viral replication but do not rid the body of them. This STI is a lifetime one, and she may experience numerous episodes. The nurse should teach Sally that this condition is manageable, but she will need to be able to identify stress factors that may trigger a recurrence and reduce them. Common triggers may include hormonal changes, such as ovulation during the menstrual cycle; prolonged exposure to sunlight; emotional distress; lack of sleep; and overwork. The final goal is to make sure Sally understands how to prevent transmission of herpes and what changes in her behaviors need to take place immediately to protect her health.

Ms. London, age 25, comes to your family planning clinic requesting to have an IUS inserted because "birth control pills give you cancer." In reviewing her history, you note she has been into the STI clinic three times in the past year with vaginal infections and was hospitalized for PID last month. When you question her about her sexual history, she reports having sex with multiple partners and not always using protection. a. Is an IUS the most appropriate method for this client? Why or why not? b. What myths/misperceptions will you address in your counseling session? c. Outline the safer sex discussion you plan to have with her.

A.Is an IUS the most appropriate method for her? Why or why not? In this case, based on her history of STIs, PID, and multiple partners, she is not a candidate for an IUS. This method would increase her risk of further ascending infections, which could hinder her future fertility. Unless her lifestyle choices change dramatically, she is placing herself at risk. She should be encouraged to use barrier methods for contraception. B. What myths/misperceptions will you address in your counseling session? This client states she isn't interested in using birth control pills because they cause cancer. That is not true, and an explanation of risk factors for cancer needs to be given, along with a discussion of the lower doses of estrogen in the birth control pills prescribed today. Positive non contraceptive impacts such as a reduction in ovarian and colorectal cancers and menstrual cycle regulation should also be addressed. C. Outline the safer sex discussion you plan to have with her.• Having a monogamous relationship reduces the incidence of STIs.• Using barrier methods (condom, cap, diaphragm) protects against both pregnancy and STIs.• Oral sex using a dental dam reduces the risk of STIs.• Dry kissing with no sores or broken skin reduces the risk of STIs.• Inform the client of the relationship between PID and infertility.• Encourage prompt treatment of any vaginal discharge

Find a website designed to help parents who have suffered a pregnancy loss secondary to a spontaneous abortion. What is its audience level? Is the information up to date?

Appropriate internet sites might include Sidelines High Risk Pregnancy Support Office (http://www.sidelines.org) and Resolve through Sharing (http://www.ectopicpregnancy.org).

Which is the best time for the genetic assessment of an alpha-fetoprotein (AFP) screening test? a. 12 to 14 weeks' gestation b. 16 to 18 weeks' gestation c. 22 to 24 weeks' gestation d. 28 to 30 weeks' gestation

B. The best time to get the most accurate reading of an AFP test is at 16-18 weeks gestation. Alpha-Fetoprotein is produced by the fetal liver and can be tested for via the maternal blood. It is a screening test to assess the risk for Neural Tube Defects (NTD) in each pregnancy. This test is best performed between 16 and 18 weeks gestation for increased reliability. If the test is abnormal, follow-up procedures to rule out NTD include genetic counseling for families with history of NTD, repeated AFP, high resolution ultrasound, and potentially an amniocentesis.

Go to your local health department's maternity clinic and interview several women regarding their feelings and the bodily changes that have taken place since they became pregnant. Based on your findings, place them into appropriate trimesters of their pregnancy

Depending on the information obtained from the interview, each symptom and/orfeeling can be placed on a list and matched to the appropriate trimester. For example, fatigue, breast tenderness, urinary frequency, ambivalence = first trimester. Increased energy level, less urinary frequency, fetal movement = second trimester. Backache, frequency, introspection = third trimester.

Select one of the websites listed in to explore the topic of genetics. Critique the information presented. Was it understandable to a layperson? What specifically did you learn? Share your findings with your classmates during a discussion group.

Depending on which website the student selects, the critique will vary. Most sites are very user friendly and are geared to the lay public's understanding. Student will choose their own area of interest, depending on their frame of reference. Their information would make for an educational discussion in class.

Select a website at the end of the chapter to explore. Educate yourself about one specific STI thoroughly and share your expertise with your clinical group.

Depending on which website the students select and which STI they choose to learn about, educated discussions will vary. We hope that each student will bring additional information to the discussion and will share interesting "finds" with his or her peers.

Ask a community health maternity nurse how the signs and symptoms of gestational hypertension (including preeclampsia and eclampsia) are taught and how effective efforts have been to reduce the incidence in the area.

Hopefully the signs and symptoms would be taught to women during their first trimester, and written material would be handed out too. During each prenatal visit, the information should be reinforced to make sure women understand whatthey are and what to do about them if they should occur.

Access the internet and locate three resources for infertile couples to consult that provide support and resources.

Numerous websites are available, many of them sponsored by infertility health care agencies

Sterilization is the most prevalent method of contraception used by married couples in the United States. Contact a local urologist and gynecologist to learn about the procedure involved and the cost of male and female sterilization. Which procedure poses less risk to the person and costs less?

Prices will be higher in metropolitan versus rural areas of the county. Students will discover that the risk is higher for a woman undergoing a tubal ligation than a man undergoing a vasectomy. The costs will vary, but male sterilization is generally both less risky and less expensive

Respond to the following as a topic sentence: "When I was growing up, talking about sexual matters with my parents was _____ because ______. Now the situation is ______."

Responses will be individualized, not generalized.

Select one of the various prenatal screening tests (alpha-fetoprotein, amniocentesis, chorionic villus sampling, or fetal nuchal translucency) and research it in depth. Role-play with another nursing student how you would explain its purpose, the procedure, and potential findings to an expectant couple at risk for a fetal abnormality.

Results will vary depending on which fetal screening test is chosen. An example might be the fetal nuchal translucency screening test. The purpose of the test is to identify genetic disorders and/or physical anomalies. The procedure involves ultrasound measurement of fluid in the nape of the neck between 10 and 14 weeks' gestation. A nuchal translucency measurement of 3 mm or more is highlysuggestive of fetal abnormalities and diagnostic genetic testing is indicated. The student playing the role of the nurse discussing this test should be very supportive, but factual to the expectant couple. They can reverse roles with a different fetal screening test to discuss.

Contact your local health department and request current statistics regarding three STIs. Ask them to compare the current number of cases reported to last year's. Are they less or more? What may be some of the reasons for the change in the number of cases reported?

Statistics will vary depending on the student's location. This research will help students learn what is happening in their area and what preventive measures are being used to reduce the incidence of STIs.

Obtain the video Miracle of Life, which shows conception and fetal development. What are your impressions? Is the title of this video realistic?

Student answers will vary. The video entitled Miracle of Life is a wonderful visualization of conception through fetal development and birth. A photographer was able to photograph sperm swimming and ovum being released from the ovary. He then photographed the developing embryo and fetal development through birth. It is realistic and a true wonder of life. The title depicts the images.

Draw your own family pedigree, identifying inheritance patterns. Share it with your family to validate its accuracy. What did you discover about your family's past health?

Students should draw their own family pedigree to identify their past health history. This information is important to determine genetic conditions and inheritable diseases. By identifying their past health ancestry, perhaps motivation for wiser lifestyle choices might surface.

Develop a teaching plan for an adolescent with PMS and dysmenorrhea.

Teaching plan for an adolescent with PMS: 1. Define the condition in simple terms to increase the teen's understanding of it. 2. Cite statistics about the incidence of it to let her know it is a common entity. 3. Assign her the task of tracking her symptoms that most profoundly bother her. 4. Carefully study the patterns/trends of the symptoms to explain what is occurring. 5. Discuss an overall comprehensive approach to managing her symptoms: a. Dietary changes i. Resist carbohydrate cravings premenstrually ii. Reduce caffeine intake, which tends to increase nervous tension iii. Vitamins B6, A, and E have shown some promise in studies b. Aerobic exercise throughout month helps in reducing panic. Medical therapy, if lifestyle changes don't work to relieve symptoms. Antidepressants. Tranquilizers Oral contraceptives

Practicing good oral hygiene is important for all women throughout pregnancy. As a nurse providing anticipatory guidance for pregnant women, what condition can result from periodontal disease if good dental care isn't practiced? a. Postdated pregnancy b. Large-for-gestational-age infant c. Advanced reproductive cancer d. Preterm or low-birth-weight infant

The correct response for this question is D because infections within the mouth caused by poor oral hygiene spread into the maternal circulatory system and cross into the fetal circulation which inhibits growth and development of the fetus. Their uterine environment is compromised and early birth is a risk. Response A is incorrect due to maternal infections which tend to create a hostile environment resulting in an early birth, not a prolonged gestation. Response B is incorrect because just the opposite happens with the fetal growth becoming compromised due to infections. Response C is incorrect because research has not established an association between periodontal disease and the etiology of any reproductive cancer yet.

Throughout life, a woman's most proactive activity to promote her health would be to engage in a. consistent exercise. b. socialization with friends. c. quality quiet time with herself. d. consuming water.

The correct response is A. Exercise is heart-healthy, weight-healthy, and emotionally healthy. The motto "Keep moving" is the basis for a healthy lifestyle, since it will help maintain an ideal weight, improve circulation, and improve moods. B is incorrect: socialization does not necessarily involve physical activity and would not be proactive in preserving health. C is incorrect: quiet time alone, although needed to reduce stress, reduces movement and may result in depression and weight gain. D is incorrect: water, although needed to hydrate the body, will not maintain circulation, prevent weight gain, or improve one's emotional mindset. Exercise will accomplish all three.

Which of the following is the major goal of genetic counseling? a. Identify and determine the role of heredity b. Reinforce previously presented test data c. Emphasize good communication skills d. Offer referral to community support groups

The correct response is A since the goals of genetic counseling include diagnosis, determining the role of genetics, assessing risks and options, and opening up lines of communication with the couple affected. The other responses (B, C, and D) are included in genetic counseling, but are not the major goals of it.

RhoGAM is given to Rh-negative women to prevent maternal sensitization. In addition to pregnancy, Rh-negative women would also receive this medication after which occurrence? a. Therapeutic or spontaneous abortion b. Head injury from a car accident c. Blood transfusion after a hemorrhage d. Unsuccessful artificial insemination procedure

The correct response is A. Any time there is a pregnancy with the chance of maternal and fetal blood mixing, RhoGAM is needed to prevent sensitization or antibody production. Head injury resulting from a car crash is not a situation in which there would be mixing of fetal or maternal blood. The trauma would cause hemorrhage, but not a sensitization reaction. A blood transfusion after hemorrhage would require typing and cross-matching of the client's blood; thus, she would receive blood with her own Rh factor, not one with Rh-positive blood. Because the artificial insemination procedure was unsuccessful, no pregnancy occurred and RhoGAM would not be necessary.

During pregnancy, which foods should the expectant mother reduce or avoid? a. Raw meat or uncooked shellfish b. Fresh, washed fruits and vegetables c. Whole grains and cereals d. Protein and iron from meat sources

The correct response is A. Consuming raw meat can increase the pregnant woman's risk of picking up toxoplasmosis, a parasitic infection that can be passed on to her fetus. Although toxoplasmosis may go unnoticed in the pregnant woman, it may cause abortion or result in the birth of an infant with the disease. Uncooked shellfish may contain high levels of mercury, which can damage the fetal central nervous system. Some raw or undercooked can also be contaminated with Listeria, which may result in abortion, stillbirth, or severe illness of the newborn. Raw or undercooked food items should be avoided during pregnancy.

Which combination contraceptive has been approved for extended continuous use? a. Seasonale b. Triphasil c. Ortho Evra d. Mirena

The correct response is A. Seasonale is one of several FDA-approved long-term oral contraceptives that is packaged to provide 84 days of continuous protection. Although any oral contraceptive can be taken continuously, the FDA has not approved this, and it would be considered an "off-label" use. B is incorrect: this product has not gained FDA approval for continuous use; it is to be left in 3 weeks and then removed for 1 week to create monthly cycles. C is incorrect: the FDA has not given approval to use this transdermal patch on a continuous basis; it is placed on the skin for 3 weeks and removed for 1 week. D is incorrect: this implantable device is protective for 5 years, but it is not a combination contraceptive; it releases synthetic progesterone only, not estrogen.

When teaching about HIV transmission, which of the following does the nurse explain that the virus cannot be transmitted by? a. Shaking hands b. Sharing drug needles c. Sexual intercourse d. Breastfeeding

The correct response is A. The HIV virus is not spread through casual contact between individuals. HIV is spread through unprotected sexual intercourse, breastfeeding, blood contact, or shared needles or sex toys. B is incorrect: HIV can be spread by sharing injection equipment because the user can come into contact with HIV-positive blood. C is incorrect: sexual intercourse (unprotected vaginal, anal, or oral) poses the highest risk of HIV transmission. D is incorrect: the newborn can receive the HIV virus through infected breast milk. HIV-positive women are advised not to breastfeed to protect their offspring from getting an HIV infection.

When obtaining a blood test for pregnancy, which hormone would the nurse expect the test to measure? a. Human chorionic gonadotropin (hCG) b. Human placental lactogen (hPL) c. Follicle-stimulating hormone (FSH) d. Luteinizing hormone (LH)

The correct response is A. hCG is produced by the trophoblast (outermost layer of the developing blastocyst) and maintains the ovarian corpus luteum (remainder of ovarian follicle after ovulation) by keeping levels of progesterone and estrogen elevated until the placenta can take over that function. hCG is secreted early after conception to signal that fertilization has taken place. Without fertilization, hCG is not detected. Thus, it is the basis for pregnancy tests. hPL is the hormone secreted by the placenta to prepare the breasts for lactation. It is also an antagonist to insulin, competing for receptor sites that force insulin secretion to increase to meet the body's demands. FSH is secreted by the anterior pituitary gland to stimulate the ovary to mature an ovum for ovulation. It is not detected during pregnancy tests. LH is secreted by the pituitary gland. An increase in LH occurs immediately before ovulation and is responsible for release of the ovum. It is not the basis for pregnancy tests.

Which activity will increase a woman's risk of CVD if she is taking oral contraceptives? a. Eating a high-fiber diet b. Smoking cigarettes c. Taking daily multivitamins d. Drinking alcohol

The correct response is B because smoking cigarettes causes vasoconstriction of the blood vessels, increasing peripheral vascular resistance and thus elevating blood pressure. These vascular changes increase the chances of CVD by placing additional pressure on the heart to pump blood with increasing vessel resistance. A is incorrect since fiber would be a positive diet addition and assist with elimination patterns and prevent straining, which stresses the heart. C is an incorrect response because vitamins do not cause narrowing of the vessel lumen, which places an additional burden on the heart. D is an incorrect response since alcohol produces vasodilation and reduces blood pressure. Alcohol in moderation is said to be good for the heart.

A pregnant woman who is at approximately 12 weeks' gestation comes to the emergency department after calling her health care provider's office and reporting moderate vaginal bleeding. Assessment reveals cervical dilation and moderately strong abdominal cramps. She reports that she has passed some tissue with the bleeding. The nurse interprets these findings to suggest which of the following? a. Threatened abortion b. Inevitable abortion c. Incomplete abortion d. Missed abortion

The correct response is B. An inevitable abortion is characterized by vaginal bleeding that is greater than slight, rupture of membranes, cervical dilation, strong abdominal cramping, and possible passage of products of conception. The threatened abortion involves slight vaginal bleeding, no cervical dilation and no change in cervical consistency, mild abdominal cramping, a closed cervical os, and no passage of fetal tissue. An incomplete abortion involves intense abdominal cramping, heavy vaginal bleeding, and cervical dilation. A missed abortion involves the absence of contractions and irregular spotting with possible progression to inevitable abortion.

The predominant anterior pituitary hormone that orchestrates the menstrual cycle is a. thyroid-stimulating hormone (TSH). b. follicle-stimulating hormone (FSH). c. corticotropin-releasing hormone (CRH). d. gonadotropin-releasing hormone (GnRH).

The correct response is B. FSH is secreted from the anterior pituitary gland to initiate the development of the ovarian follicles and the secretion of estrogen within the ovarian cycle. A is incorrect: TSH stimulates the thyroid gland and plays a limited role in the menstrual cycle. C is incorrect: CRH is released from the hypothalamus, not the anterior pituitary gland. D is incorrect: GnRH is released from the hypothalamus to stimulate the release of FSH and LH from the anterior pituitary gland.

A couple reports that the condom broke while they were having sexual intercourse last night. What would you advise to prevent pregnancy? a. Inject a spermicidal agent into the woman's vagina immediately. b. Obtain emergency contraceptives and take them immediately. c. Douche with a solution of vinegar and hot water tonight. d. Take a strong laxative now and again at bedtime.

The correct response is B. If EC is taken within 72 hours after unprotected sexual intercourse, pregnancy will be prevented by inhibiting implantation. The next morning would still afford time to take EC and not become pregnant. A is incorrect: it would be too late to use a spermicidal agent to prevent pregnancy, since the sperm has already traveled up into the female reproductive tract. C is incorrect: douching with vinegar and hot water 24 hours after unprotected sexual intercourse will not change the course of events; by then it is too late to prevent a pregnancy, and this combination would not be effective anyway. D is incorrect :a laxative will stimulate the gastrointestinal tract to produce defecation but will not disturb the reproductive tract, where fertilization takes place.

What factors would change during a pregnancy if the hormone progesterone were reduced or withdrawn? a. The woman's gums would become red and swollen and would bleed easily. b. The uterus would contract more, and peristalsis would increase. c. Morning sickness would increase and would be prolonged. d. The secretion of prolactin by the pituitary gland would be inhibited.

The correct response is B. Progesterone is an essential hormone to maintain the pregnancy and prevent early labor. Progesterone decreases systemic vascular resistance early in pregnancy, leading to a decline in blood pressure. It causes relaxation of the uterus and gastrointestinal smooth muscle, resulting in delayed gastric emptying and calming of the uterus. This relaxation mechanism is vital to reduce uterine contractions.

Which woman should receive RhoGAM postpartum? a. Nonsensitized Rh-negative mother with an Rh-negative newborn b. Nonsensitized Rh-negative mother with an Rh-positive newborn c. Sensitized Rh-negative mother with an Rh-positive newborn d. Sensitized Rh-negative mother with an Rh-negative newborn

The correct response is B. Rh incompatibility arises with exposure of an Rh-negative mother to Rh-positive fetal blood during pregnancy or birth, during which time erythrocytes from the fetus leak into the maternal circulation and isoimmunization occurs. Administering RhoGAM prevents this isoimmunization from occurring. The remaining three responses are incorrect because for RhoGAMto be effective, the sensitized process (mixing of fetal and maternal blood) should not have taken place. The fetus must also be Rh-positive and the mother Rh-negative for RhoGAM to be needed

A couple is considered infertile after how many months of trying to conceive? a. 6 months b. 12 months c. 18 months d. 24 months

The correct response is B. The definition of infertility is the inability of a couple to conceive after 12 months of unprotected sexual intercourse. A is incorrect: 6 months is not long enough to diagnose infertility in a couple not using birth control. C is incorrect: 18 months is 6 months beyond the time needed to diagnose infertility based on the definition. D is incorrect: 24 months is double the time needed to diagnose infertility

A woman with HPV is likely to present with which nursing assessment finding? a. Profuse, pus-filled vaginal discharge b. Clusters of genital warts c. Single painless ulcer d. Multiple vesicles on genitalia

The correct response is B. The human papillomavirus (HPV) causes warts in the genital region. HPV is a slow-growing DNA virus belonging to the papilloma group. Types 6 and 11 usually cause visible genital warts. Other HPV types in the genital region (16, 18, 31, 33, and 35) are associated with vaginal, anal, and cervical dysplasia. A is incorrect: a pus-filled discharge is not typical of an HPV infection, but rather a chlamydial or gonococcal STI. C is incorrect: a single painless ulcer would be indicative of primary syphilis rather than an HPV infection. D is incorrect: multiple vesicles would indicate a herpes outbreak, not an HPV infection. The woman would also experience tingling, itching, and pain in the affected area.

What event occurs during the proliferative phase of the menstrual cycle? a. Menstrual flow starts b. Endometrium thickens c. Ovulation occurs d. Progesterone secretion peaks

The correct response is B. Under the influence of estrogen, the uterine lining (endometrium) thickens and grows in preparation for the implantation of a conceptus if that occurs or to be sloughed off during the menses.

A woman is suspected of having placental abruption. Which finding would the nurse expect to assess as a classic symptom? a. Painless, bright red bleeding b. "Knife-like" abdominal pain c. Excessive nausea and vomiting d. Hypertension and headache

The correct response is B. When the placenta separates from the uterine wall, it causes irritation and bleeding into the muscle fibers, which causes pain. Painless,bright-red bleeding indicates placenta previa symptomatology. Excessive nausea and vomiting would be characteristic of hyperemesis gravidarum. Hypertension and headache would be associated with gestational hypertension.

Which of the following is an example of an autosomal dominant disorder? a. Phenylketonuria b. Tay-Sachs disease c. Polycystic kidney disease d. Cystic fibrosis

The correct response is C because polycystic kidney disease is an example of an autosomal dominant disease because the gene carrying the mutation is located on one of the autosomes of the affected parent and the affected person has a 50% chance of passing the abnormal gene to each of the children. Responses A,B, and D are all autosomal recessive inheritance disorders that need both parents must carry the abnormal gene and their offspring has a 25% probability of inheriting the two mutant genes.

The nurse is preparing to teach a class to a group of middle-aged women regarding the most common vasomotor symptoms experienced during menopause and possible modalities of treatment available. Which are common vasomotor symptoms? a. Chronic fatigue and confusion b. Forgetfulness and irritability c. Night sweats and hot flashes d. Decrease in sexual response and appetite

The correct response is C because vasomotor symptoms of menopause are usually described as night sweats and hot flashes. Vasomotor symptoms are the most commonly reported menopausal symptoms by women. These symptoms are associated with estrogen deficiency. Frequently, these symptoms can be controlled by lifestyle changes. Response A is incorrect as these symptoms are not directly related to menopause and can be associated with numerous other etiologies such as anemia or dementia. Response B is incorrect because they may be underlining symptoms of a variety of other pathologies such as stroke, sleep deficiency, or early Alzheimer disease. Response D is incorrect due to the fact that the hormone testosterone has more influence over sexual drive and response, but falling levels of estrogen may be associated indirectly. A decrease in appetite is not directly related to menopause and may be caused by a variety of other factors.

Which biophysical profile finding indicates poor oxygenation to the fetus? a. Two pockets of amniotic fluid b. Well-flexed arms and legs c. Nonreactive fetal heart rate d. Fetal breathing movements noted

The correct response is C. A nonreactive fetal heart rate is one of the biophysical profile findings that indicate poor oxygenation to the fetus.

Which of the following contraceptive methods offers protection against sexually transmitted infections (STIs)? a. Oral contraceptives b. Withdrawal c. Latex condom d. Intrauterine system

The correct response is C. It creates a mechanical barrier so that bacteria and viruses cannot gain access to the internal reproductive tract and proliferate. A is incorrect: there is no barrier or protection offered by taking an oral pill. Oral contraceptives offer protection against pregnancy by preventing ovulation, but none against STIs. B is incorrect: since an infected partner can still transmit the infection through pre-ejaculate fluids, which may contain an active STI. D is incorrect: an IUD offers no barrier to prevent entrance of bacteria or viruses into the internal reproductive tract. Because itis an internal device, the string emerging from the external uterine os can actually enhance STI infiltration into the uterus in susceptible women.

The nurse teaches the pregnant client how to perform Kegel exercises as a way to accomplish which action? a. Prevent perineal lacerations b. Stimulate labor contractions c. Increase pelvic muscle tone d. Lose pregnancy weight quickly

The correct response is C. Pelvic floor muscle (PFM) exercises help to tighten and strengthen pelvic floor muscles to improve tone. They can help prevent stress incontinence in women after childbirth. These exercises don't strengthen the perineal area on the outside to prevent lacerations, but rather the internal pelvic floor muscles. PFM exercises have nothing to do with the start of labor for postdate infants. A drop in progesterone levels and an increase in prostaglandins, not exercise, augment labor. PFM exercises don't burn calories

Reva Rubin identified four major tasks that the pregnant woman undertakes to form a mutually gratifying relationship with her infant. What is "binding in?" a. Ensuring safe passage through pregnancy, labor, and birth. b. Seeking acceptance of this infant by others. c. Seeking acceptance of self as mother to the infant. d. Learning to give of oneself on behalf of the infant.

The correct response is C. Seeking acceptance of self as mother to the infant is the basis for establishing a mutually gratifying relationship between mother and infant. This "binding in" is a process that changes throughout the pregnancy, starting with the mother's acceptance of the pregnancy and then the infant as a separate entity. Ensuring safe passage through pregnancy, labor, and birth focuses on the mother initially and her concern for herself. As the pregnancy progresses, the fetus is recognized and concern for its safety becomes a priority. The mother-infant relationship is not the mother's concern yet. Seeking acceptance of this infant by others includes the world around the mother and how they will integrate this new infant into their world. The infant-maternal relationship is not the focus in this task. Learning to give of oneself on behalf of one's infant focuses on delaying maternal gratification, focusing on the infant's needs before the mother's needs.

Which glands are located on either side of the female urethra and secrete mucus to keep the opening moist and lubricated for urination? a. Cowper b. Bartholin c. Skene d. Seminal

The correct response is C. Skene's glands are located close to the urethral opening and secrete mucus and lubricate during urination and sexual intercourse. A is incorrect: Cowper's glands are located on either side of the male urethra, not the female urethra. B is incorrect: Bartholin's glands are located on either side of the vaginal opening and secrete alkaline mucus that enhances the viability of the male sperm. D is incorrect: seminal glands are pouch-like structures at the base of the male urinary bladder that secrete an alkaline fluid to enhance the viability of the male sperm.

To confirm a finding of primary syphilis, the nurse would observe which of the following on the external genitalia? a. A highly variable skin rash b. A yellow-green vaginal discharge c. A nontender, indurated ulcer d. A localized gumma formation

The correct response is C. The classic chancre in primary syphilis can be described as a painless, indurated ulcer-like lesion at the site of exposure. A is incorrect: a highly variable rash is characteristic of secondary syphilis, not primary. B is incorrect: this is more descriptive of a trichomoniasis vaginal infection rather than primary syphilis, which manifests with a chancre on the external genitalia. D is incorrect: a localized gumma formation on the mucous membranes, such as the lips or nose, is characteristic of late syphilis, along with neurosyphilis and cardiovascular syphilis.

A nurse is working in a women's health clinic. Which woman would genetic counseling be most appropriate for? a. Had her first miscarriage at 10 weeks b. Is 30 years old and planning to conceive c. Has a history with a close relative with Down syndrome d. Is 18 weeks pregnant with a normal triple screen result

The correct response is C. The family history plays a critical role in identifying genetic disorders. A history of a previous child, parents, or close relative with an inherited disease, congenital abnormalities, metabolic disorders, developmental disorders, or chromosomal abnormalities can indicate an increased risk of genetic disorders, therefore referral to genetic counseling is appropriate.

Sperm maturation and storage in the male reproductive system occur in the a. testes. b. vas deferens. c. epididymis. d. seminal vesicles

The correct response is C. The function of the epididymis is to store and mature sperm until ejaculation occurs. A is incorrect: the testes manufacture sperm and send them to the epididymis for storage and continued maturation. B is incorrect: the main function of the vas deferens is to rapidly squeeze the sperm from their storage site (epididymis) into the urethra. D is incorrect: the function of the seminal vesicles is to secrete an alkaline fluid rich in fructose and prostaglandins to help provide an environment favorable to sperm motility and metabolism.

The nurse is preparing to teach a class to a group of middle-aged women regarding the most common vasomotor symptoms experienced during menopause and possible modalities of treatment available. Which is an example of a vasomotor symptom experienced by menopausal women? a. Weight gain b. Bone density c. Hot flashes d. Heart disease

The correct response is C. The only two vasomotor symptoms listed are night sweats and hot flashes. The remainder of the symptoms listed (fatigue, confusion, forgetfulness, irritability, loss of libido, and appetite) can be symptoms of menopause, but are not classified as vasomotor ones.

After teaching a woman about hyperemesis gravidarum and how it differs from the typical nausea and vomiting of pregnancy, which statement by the woman indicates that the teaching was successful? a. "I can expect the nausea to last through my second trimester." b. "I should drink fluids with my meals instead of in between them." c. "I need to avoid strong odors, perfumes, or flavors." d. "I should lie down after I eat for about 2 hours."

The correct response is C. The woman should avoid noxious stimuli such as strong flavors, odors, or perfumes because they might trigger nausea and vomiting.

Which is a presumptive sign or symptom of pregnancy? a. Restlessness b. Elevated mood c. Urinary frequency d. Low backache

The correct response is C. Urinary frequency occurs during early pregnancy secondary to pressure on the bladder by the expanding uterus. This is one of the presumptive signs of pregnancy. Restlessness or elevated mood is not a sign of pregnancy. As hormones increase during pregnancy, the mood might change, but it is not indicative of pregnancy. Low backache is frequently experienced by many women during the third trimester of pregnancy secondary to the change in their center of gravity, but it is not a presumptive sign of pregnancy.

The most common cause of menstrual abnormality in a reproductive-age woman is a. ectopic pregnancy. b. coagulopathy. c. carcinoma. d. anovulation.

The correct response is D because abnormal uterine bleeding typically occurs when menstrual ovulation doesn't occur within the monthly cycle. Chronic anovulation causes a variety of abnormal bleeding patterns. Response A is incorrect because amenorrhea would be present secondary to the pregnancy, although misplaced. Response B is incorrect because other symptoms would be present due to a coagulation problem systemically. Response C is incorrect since most uterine cancers occur in postmenopausal women, not reproductive-aged women.

A sexually active 19-year-old presents to the clinic with postcoital bleeding, dysuria, and a yellow discharge. Her cervix upon exam is red and friable. What might the nurse suspect? a. Cervical cancer b. A tampon injury c. Primary syphilis d. Chlamydia

The correct response is D because these clinical manifestations are typical of a chlamydia infection (post coital bleeding, dysuria, frequency, vaginal discharge, cervical tenderness with easily induced bleeding). Response A is incorrect because it would be rare to have cervical cancer at such a young age and the symptoms presented are not suggestive of this diagnosis. Response B is incorrect because the presenting symptoms are not suggestive of a cervical injury. Response C is incorrect because primary syphilis would present with a chancre lesion at the site where the bacteria entered the body, typically the vulva.

The nurse's discharge teaching plan for the woman hospitalized with PID should reinforce which of the following potentially life-threatening complications? a. Involuntary infertility b. Chronic pelvic pain c. Depression d. Ectopic pregnancy

The correct response is D. A ruptured tubal pregnancy secondary to an ectopic pregnancy can cause life-threatening hypovolemic shock. Without immediate surgical intervention, death can result. A is incorrect: involuntary infertility may be emotionally traumatic, but it is not life-threatening. B is incorrect: chronic pelvic pain secondary to adhesions is unpleasant but typically isn't life-threatening. C is incorrect: depression may be caused by the chronic pain or involuntary infertility but is not life-threatening.

The nurse is counseling a couple, one of whom is affected by an autosomal dominant disorder. They express concerns about the risk of transmitting the disorder. What is the best response by the nurse regarding the risk that their baby may have for the disease? a. "You have a one in four (25%) chance." b. "The risk is 12.5%, or a one in eight chance." c. "The chance is 100%." d. "Your risk is 50%, or a one in two chance."

The correct response is D. Autosomal dominant inheritance occurs when a single gene in the heterozygous state is capable of producing the phenotype. The affected person generally has an affected parent and an affected person generally has a 50% chance of passing the abnormal gene to each of his or her children. A is incorrect as it describes autosomal recessive inheritance. B and C are also incorrect as they do not describe the risk for an autosomal dominant disorder.

Which hormone is produced in high levels to prepare the endometrium for implantation just after ovulation by the corpus luteum? a. Estrogen b. Prostaglandins c. Prolactin d. Progesterone

The correct response is D. Progesterone is the dominant hormone after ovulation to prepare the endometrium for implantation. A is incorrect: estrogen levels decline after ovulation, since it assists in the maturation of the ovarian follicles before ovulation. Estrogen levels are highest during the proliferative phase of the menstrual cycle. B is incorrect: prostaglandin production increases during the follicular maturation and is essential during ovulation but not after ovulation. C is incorrect: prolactin is inhibited by the high levels of estrogen and progesterone during pregnancy; when their levels decline at birth, an increase in prolactin takes place to promote lactation

A feeling expressed by most women upon learning they are pregnant is a. acceptance. b. depression. c. jealousy. d. ambivalence

The correct response is D. The feeling of ambivalence is experienced by most women when they question their ability to become a mother. Feelings fluctuate between happiness about the pregnancy and anxiety and fear about the prospect of new responsibilities and a new family member. Acceptance usually develops during the second trimester after fetal movement is felt by the mother and the infant becomes real to her. Depression is not a universal feeling experienced by most women unless there is a past history of underlying depression experienced by the woman. Jealousy is not a universal feeling of pregnant women. It can occur in partners, because attention is being diverted from them to the pregnancy and the newborn

During a clinic visit, a pregnant client at 30 weeks' gestation tells the nurse, "I've had some mild cramps that are pretty irregular. What does this mean?" The cramps are probably a. the beginning of labor in the very early stages. b. an ominous finding indicating that the client is about to have a miscarriage. c. related to overhydration of the woman. d. Braxton Hicks contractions, which occur throughout pregnancy

The correct response is D. The uterus is constantly contracting throughout pregnancy, but the contractions are irregular and not usually felt by the woman, nor do they cause dilation of the cervix. Braxton Hicks contractions are not the start of early labor, since there aren't any measurable cervical changes. They are normal throughout the pregnancy, not an ominous sign of an impending abortion. A woman's hydration status is not related to Braxton Hicks contractions; they occur regardless of her fluid status.

Which comment by a woman would indicate that a diaphragm is not the best contraceptive device for her? a. "My husband says it is my job to keep from getting pregnant." b. "I have a hard time remembering to take my vitamins daily." c. "Hormones cause cancer and I don't want to take them." d. "I am not comfortable touching myself down there."

The correct response is D. This vaginal barrier contraceptive device is a dome-shaped rubber cup with a flexible rim that needs to be inserted into the woman's vagina before sexual intercourse. The dome of the diaphragm covers the cervix and the spermicidal cream or jelly applied to the rim prevents sperm from entering the cervix. Women who use this method of contraception must be able to insert the device in their vaginas before each sex act for it to be effective. If the woman is uncomfortable "touching" herself, this is not going to be a successful method and another method should be utilized.

A pregnant client's LMP was on August 10. Using Nagele's rule, the nurse calculates that her EDD will be when? a. June 23 b. July 10 c. July 30 d. May 17

The correct response is D. Using Nagele rule, 3 months are subtracted and 7 days are added, plus 1 year from the date of the last menstrual period.

Which measure helps prevent osteoporosis? a. Supplementing with iron b. Sleeping 8 hours nightly c. Eating lean meats only d. Weight-bearing exercise

The correct response is D. Weight-bearing exercise is an excellent preventive measure to preserve bone integrity, especially the vertebral column and hips. Walking strengthens the skeletal system and prevents breakdown that leads to osteoporosis. A is incorrect: iron does not prevent bone breakdown; while iron supplementation will build up blood and prevent anemia, it has a limited effect on bones. B is incorrect: being in the horizontal position while sleeping is not helpful to build bone. Weight-bearing on long bones helps to maintain their density, which prevents loss of bone matrix. C is incorrect: protein gained from eating lean meats helps the body to build tissue and muscles but has a limited effect on maintaining bone integrity or preventing loss of bone density.

A client comes to the clinic for pregnancy testing. The nurse explains that the test detects the presence of which hormone? a. Human placental lactogen (hPL) b. Human chorionic gonadotropin (hCG) c. Follicle-stimulating hormone (FSH) d. Thyroid-stimulating hormone (TSH)

The correct response to the question is B. As early as 3 days after conception, the trophoblasts make human chorionic gonadotropin (hCG), a hormone that ensures that the endometrium will be receptive to the implanting embryo. This hormone, hCG, is the basis for pregnancy tests. A is incorrect because human placental lactogen (hPL) modulates fetal and maternal metabolism, participates in the development of maternal breasts for lactation, and decreases maternal insulin sensitivity to increase its availability for fetal nutrition but does not play a role in detecting pregnancy. C and D are incorrect because follicle-stimulating hormone (FSH) stimulates the ovary to produce five to 20 immature follicles and thyroid-stimulating hormone (TSH) is a pituitary hormone that stimulates the thyroid gland but neither plays a role in detecting pregnancy.

A woman is being discharged after receiving treatment for a hydatidiform molar pregnancy. The nurse should include which information in the discharge teaching? a. Do not become pregnant for at least a year; use contraceptives to prevent it. b. Have your blood pressure checked weekly in the clinic. c. RhoGAM must be given within the next month at the clinic. d. An amniocentesis can detect a recurrence of this disorder in the future.

The correct response to this question is A because assessment of serum chorionicgonadotropin (hCG) is considered a specific tumor marker for gestational trophoblastic disease that isn't resolved. hCG levels are assayed at frequent intervals for up to a year. Pregnancy would obscure the evidence of choriocarcinoma by the normal secretion of hCG. Response B is incorrect because there is not a direct link between a molar pregnancy and hypertension continuing after the uterus is empty. Response C is incorrect because RhoGAM is given for Rh incompatibility to prevent sensitivity, not as treatment for a molar pregnancy. Response D is incorrect because an amniocentesis is not diagnostic of a molar pregnancy in the future.

Which is not true about breastfeeding? a. Breastfed infants experience more obesity and allergies. b. Breast milk is perfectly suited to the infant's nutritional needs. c. Breast milk contains maternal antibodies to stimulate infant's immunity. d. Breastfeeding enhances maternal bonding and attachment.

The correct response to this question is A because based on research, breast-feeding prevents childhood and adult obesity and infants who are breast-fed experience fewer allergies versus those that are bottle-fed. Responses B, C, and D are all true statements about breast-feeding. These responses represent the advantages of breast-feeding.

A pregnant client close to term comes in the clinic for an exam. The woman complains about experiencing shortness of breath. The nurse knows that this may be caused by the a. fetus needing more oxygen due to larger size. b. fundus of the uterus pushing the diaphragm upward. c. woman experiencing an allergic reaction because of high histamine levels d. oxygen partial pressure concentration becoming lower during the third trimester

The correct response to this question is B because of anatomical changes that affect breathing. The growing gravid uterus displaces the diaphragm upward which forces the entire thoracic cavity to compensate by increasing its dimensions so that more air can be inspired. Shortness of breath develops in most women during the last month of pregnancy. Response A is incorrect since the placenta is essentially the "lungs" for the growing fetus and thus the exchange of oxygen and carbon dioxide takes place there, not via the maternal respiratory system. Response C is incorrect since there isn't a histamine response taking place in a normal pregnancy to cause an allergy. Response D is incorrect since the partial pressure of oxygen increases throughout pregnancy, not lessens.

When administering magnesium sulfate to a client with preeclampsia, the nurse explains to her that this drug is given to a. reduce blood pressure. b. increase the progress of labor. c. prevent seizures. d. lower blood glucose levels.

The correct response to this question is C to prevent progression of pre eclampsia to seizures. Magnesium sulfate is administered to prevent initial or recurrent seizures, while anti hypertensives are used to reduce the maternal blood pressure to a safe range. Response A is incorrect since magnesium sulfate is not an antihypertensive drug. Typically, hydralazine, labetalol, or nifedipine is administered to lower maternal blood pressure. Response B is incorrect because magnesium sulfate does not impact the progress of labor, and doesn't speed it up. Response D is incorrect because it doesn't impact blood glucose levels.

After teaching a group of students about fertilization, the instructor determines that the teaching was successful when the group identifies which as the usual site of fertilization? a. Fundus of the uterus b. Endometrium of the uterus c. Distal portion of fallopian tube d. Follicular tissue of the ovary

The correct response to this question is C, because scientists have determined that conception/fertilization occurs in the upper portion of the fallopian tube. A isan incorrect response because this is where implantation takes place after fertilization has occurred. B is an incorrect response because this describes the inner lining of the uterus, where implantation takes place; not where fertilization of the ovum and sperm occurs. D is an incorrect response because the sperm does not travel outside the fallopian tube to the ovary, but rather meets the ovum for purposes of fertilization in the fallopian tube.

What is the first step in determining a couple's risk for a genetic disorder? a. Observing the client and family over time b. Conducting extensive psychological testing c. Obtaining a thorough family health history d. Completing an extensive exclusionary list

The correct response to this question is C, because uncovering an individual's family history can identify previous genetic disorders that have a high risk for recurrence in subsequent generations. A is an incorrect response to this question because observing a patient and their family would be costly and unproductive to diagnose a genetic disorder. This observation would have to take place over several generations to yield results. B is an incorrect response because psychological testing might not uncover genetic predispositions to disorders. D is an incorrect response because excluding the numerous genetic conditions would be a time-consuming and tedious task.

Which fish should be limited in a pregnant woman's diet because of its high mercury content? a. Salmon b. Cod c. Shrimp d. Swordfish

The correct response to this question is D because sword fish typically contains high levels of mercury when compared to other fish species which should be avoided during pregnancy. Responses A, B, and C are fish that have been assessed as having low levels of mercury.

Genital warts can be treated with which of the following? Select all that apply. a. Penicillin b. Podophyllin c. Imiquimod d. Cryotherapy e. Antiretroviral therapy f. Acyclovir

The correct responses are B, C, and D. All three therapies assist in reducing the viral load in the warty lesion. Treatment may reduce but does not necessarily eradicate infection. A is incorrect: penicillin is a bacteriostatic agent and is not effective against viruses. E is incorrect: antiretroviral therapy is used for HIV infections. F is incorrect: acyclovir is typically used to treat herpes infections.

Sperm cells and the male hormone testosterone are made in which structures? Select all that apply. a. Vas deferens b. Penis c. Scrotum d. Ejaculatory ducts e. Prostate gland f. Testes g. Seminiferous tubules h. Bulbourethral glands

The correct responses are F (testes) and G (seminiferous tubules). Sperm is produced in the seminiferous tubules of the testes. A is incorrect: the vas deferens is a cord-like duct that transports sperm from the epididymis and has no role in making sperm cells. B is incorrect: the penis is the organ for copulation and serves as the outlet for sperm, but it plays no role in the manufacture of sperm cells or testosterone. C is incorrect: the scrotum serves as the climate control system for the testes to allow for normal sperm development, but it plays no direct role in their manufacture. D is incorrect: the ejaculatory ducts secrete fluids to help nourish the sperm, but do not play a part in their development. E is incorrect: the prostate gland produces fluid that nourishes the sperm but does not participate in the production of sperm cells. H is incorrect: the bulbourethral glands (Cowper glands) secrete a mucus-like fluid that provides lubrication during the sex act.

Which would be considered risk factors for psychological well-being during pregnancy? Select all that apply. a. Limited support system and network of friends and family b. Introverted personality at any point in the pregnancy c. Ambivalence any time during the pregnancy d. High levels of stress due to family discord e. History of previous high-risk pregnancy with complications f. Depression prior to pregnancy and on medication

The correct responses for this question are A, D, E, and F because all of these factors will influence the pregnancy outcome in a negative way and the ability to cope with them might become challenging. These factors would be "red flags" in a client's history and counseling and education might be needed during this pregnancy. Responses B and C are both normal emotions that are universally experienced by most pregnant women. They would not indicate a problem.

The nurse is preparing her teaching plan for a woman who has just had her pregnancy confirmed. Which information should be included in it? Select all that apply. a. Prevent constipation by taking a daily laxative. b. Balance your dietary intake by increasing your calories by 300 daily. c. Continue your daily walking routine just as you did before this pregnancy. d. Tetanus, measles, mumps, and rubella vaccines will be given to you now. e. Avoid tub baths now that you are pregnant to prevent vaginal infections. f. Sexual activity is permitted as long as your membranes are intact. g. Increase your consumption of milk to meet your iron needs.

The correct responses to this question are B, C, E, and F because all of these are sound recommendations for a healthy pregnancy. Pregnant women are to avoid taking medications so the nurse would not recommend a daily laxative. Increasing fluids, exercise and fiber in the diet are better choices to prevent constipation. The vaccinations shown are contraindicated for pregnant women bythe CDC. Adverse outcomes could result if given while pregnant. Milk does not provide a good source of iron. Typically, iron and folic acid are supplemented in prenatal vitamins and good food sources to prevent anemia include meats, cereals, cooked beans, spinach, broccoli, and wheat germ.

What anticipatory guidance regarding sexual activity during pregnancy will be included in client teaching? Select all that apply. a. Sexual activity is contraindicated throughout pregnancy. b. Most women don't desire intimacy after the first trimester. c. Sexual activity may continue up until the end of the second trimester. d. Sexual intercourse is prohibited if a history of preterm labor exists. e. Women's sexual desire may change throughout the pregnancy. f. Couples can try a variety of positions of comfort during pregnancy.

The correct responses to this question are E and F since sexual desire changes throughout pregnancy based on hormones, energy levels, relationship, body image, fears of hurting the fetus, and cultural beliefs. Various positions of comfort for the woman are usually tried for most couples desiring intimacy. Responses A through D are incorrect because unless there is a medical reason why sexual intercourse isn't permitted, sexual activity may be continued throughout a healthy pregnancy.

Request permission to attend a local STI clinic to shadow a nurse for a few hours. Describe the nurse's counseling role with clients and what specific information is emphasized to clients.

The counseling role of the STI nurse should be one of patience and sensitivity. The nurse should be nonjudgmental and should see the client as someone who needs both treatment and education. The nurse should counsel the patient about high-risk behaviors and prevention of disease transmission.

List the predominant hormones and their functions in the menstrual cycle.

The predominant hormones involved in the menstrual cycle are gonadotropin-releasing hormone (GnRH), which is responsible for reproductive hormone control and timing of the cycle; follicle-stimulating hormone (FSH), which stimulates the ovary to produce estrogen and follicles in the ovary that will mature; luteinizing hormone (LH), which induces the mature ovum to burst from the ovary and stimulate production of corpus luteum; estrogen, which induces growth and thickening of the endometrial lining; progesterone, which prepares the endometrial lining for implantation; and prostaglandins, which help to free the mature ovum inside the Graafian follicle.

Search the internet for information about the psychological changes that occur during pregnancy. Share information from the websites you found with your clinical group

The student should select about three websites and present the URLs during a post conference or in a group with a thorough description of what each site has to offer.

Take a field trip to a local drugstore to check out the variety and costs of male and female condoms. How many different brands did you find? What was the range of costs?

The students will find numerous brands of male condoms and only one brand of female condom. Male condom prices can range from 35 cents each to over $4, depending on the manufacturer. Most female condoms are priced around $2.50 to $3.50 each.

Should sex education be taught in public schools, and if so, what topics should be addressed? Debate the pros and cons of teaching this, and outline which topics should be covered.

This answer will vary depending on which website the student selects and which topic of interest he or she researches. With luck, a variety of topics will be presented and lend themselves to a lively class discussion.

Arrange to shadow a nurse working in family planning for the morning. What questions does the nurse ask to ascertain the kind of family planning method that is right for each woman? What teaching goes along with each method? What follow-up care is needed? Share your findings with your classmates during a clinical conference.

Typically the family planning nurse will ask the woman about any sociocultural, spiritual, and religious beliefs that will influence the decision. Lifestyle and economics also play a big role in the choice of a family planning method. Ideally this should be a decision made by both partners, but rarely is the partner involved. Important teaching involves the risks, benefits, side effects, and efficacy of each method, along with instructions on how to use it correctly. Information regarding follow-up care should be stressed.

Discuss various activities a woman with a multiple gestation could engage in to help pass the time when ordered to be on bed rest at home for 2 months.

Various activities for the woman on prolonged bed rest at home could include watching TV, reading, visiting computer sites with chat rooms, talking on the telephone, playing cards or engaging in crafts, having visitors in frequently, and completing educational courses online. The woman could also use the time to develop lists for managing the house while on bed rest, read or play games with her other children, and expand her knowledge related to the upcoming birth of her babies.

Bringing a new infant into the family affects the siblings. What strategies can a nurse discuss when a mother asks how to deal with this?

What strategies can a nurse discuss when a mother asks how to deal with this? Strategies to integrate a new infant into the family unit would include involving the sibling in planning the nursery for the new brother or sister, answering their questions about the new infant during the pregnancy, using age-specific books to inform the sibling of the fetus's growth and development, and providing special time set aside to be with that sibling before and after the new infant arrives into the home.

Two common STIs that appear together and commonly are treated together regardless of identification of the secondary one are __________________ and _______________________.

chlamydia and gonorrhea

The most serious complication of hydatidiform mole is the development of ___________________ afterward

choriocarcinoma

When a pregnant woman in her third trimester lies on her back and experiences dizziness and light-headedness, the underlying cause of this is ___________________.

compression of the vena cava by the heavy gravid uterus

A laywoman with a specialized education and experience in assisting women during labor is a ___________________.

doula

A pregnancy in which the blastocyst implants outside the uterus is a(n) ___________________ pregnancy.

ectopic

Arrange to shadow a nurse midwife for a day to see her role in working with the childbearing family.

individualized response

Request permission to attend a childbirth education class in your local area and help a woman without a partner practice the paced breathing exercises. Present the information you learned and think about how you can apply it while taking care of a woman during labor

individualized response

Visit a freestanding birth center and compare it to a traditional hospital setting in terms of restrictions, type of pain management available, and costs.

individualized response

Visit the student resources on and select two of the supplied websites that correspond to this chapter. Note their target audience, the validity of information offered, and their appeal to expectant couples. Present your findings.

individualized response

The ovarian cycle describes the series of events associated with the development of the _____________ within the ovaries.

ovum or ova

During pregnancy, the plasma volume increases by 50% but the RBC volume increases by only 25% to 33%. This disproportion manifests as ___________________.

physiologic anemia of pregnancy

A 25-year-old woman presents to the clinic with complaints of nausea, vomiting, and urinary frequency. Based on this information, the nurse knows these are most indicative of what type of signs? a. Presumptive signs of pregnancy b. Positive signs of pregnancy c. Probable signs of pregnancy d. Signs of a urinary tract infection

presumptive