Maternity Unit I All Chapters: Combined Questions from Quizlet, Study Guide, and the book's Evolve Resources online (duplications deleted, but question variations retained)

The rate of fertility declines dramatically after age 35. While explaining the cause of this rapid decline in fertility to the client, the nurse is aware that the primary reason for this is related to: A. Endometriosis B. Abnormalities of oocytes C. Infection D. Metabolic disease

A. By age 40, the total number of ovarian follicles is diminishing and the quality of the remaining eggs is poor. Endometriosis is more common in women who delay childbearing until after age 30. Like infection and metabolic disease, it is a cumulative factor that may contribute to age-related infertility.

18. Which information regarding amniotic fluid is important for the nurse to understand? a. Amniotic fluid serves as a source of oral fluid and a repository for waste from the fetus. b. Volume of the amniotic fluid remains approximately the same throughout the term of a healthy pregnancy. c. The study of fetal cells in amniotic fluid yields little information. d. A volume of more than 2 L of amniotic fluid is associated with fetal renal abnormalities.

ANS: A Amniotic fluid serves as a source of oral fluid, serves as a repository for waste from the fetus, cushions the fetus, and helps maintain a constant body temperature. The volume of amniotic fluid constantly changes. The study of amniotic fluid yields information regarding the sex of the fetus and the number of chromosomes. Too much amniotic fluid (hydramnios) is associated with gastrointestinal and other abnormalities.

2. What kind of fetal anomalies are most often associated with oligohydramnios? a. Renal b. Cardiac c. Gastrointestinal d. Neurologic

ANS: A An amniotic fluid volume of less than 300 ml (oligohydramnios) is often associated with fetal renal anomalies. The amniotic fluid volume has no bearing on the fetal cardiovascular system. Gastrointestinal anomalies are associated with hydramnios or an amniotic fluid volume greater than 2 L. The amniotic fluid volume has no bearing on the fetal neurologic system.

6. A woman in labor passes some thick meconium as her amniotic fluid ruptures. The client asks the nurse where the baby makes the meconium. What is the correct response by the nurse? a. Fetal intestines b. Fetal kidneys c. Amniotic fluid d. Placenta

ANS: A As the fetus nears term, fetal waste products accumulate in the intestines as dark green-to-black, tarry meconium. Meconium is not produced by the fetal kidneys nor should it be present in the amniotic fluid, which may be an indication of fetal compromise. The placenta does not produce meconium.

7. To provide culturally competent care to an Asian-American family, which question should the nurse include during the assessment interview? a. Do you prefer hot or cold beverages? b. Do you want some milk to drink? c. Do you want music playing while you are in labor? d. Do you have a name selected for the baby?

ANS: A Asian-Americans often prefer warm beverages. Milk is usually excluded from the diet of this population. Asian-American women typically labor in a quiet environment. Delaying naming the child is not uncommon for Asian-American families.

From the nurse's perspective, what measure should be the focus of the health care system in order to reduce the rate of infant mortality further? A. Implementing programs to ensure women's early participation in ongoing prenatal care B. Increasing the length of stay in a hospital after vaginal birth from 2 to 3 days C. Expanding the number of neonatal intensive care units (NICUs) D. Mandating that all pregnant women receive care from an obstetrician

A. Early prenatal care allows for early diagnosis and appropriate interventions to reduce the rate of infant mortality. An increased length of stay has been shown to foster improved self-care and parental education; however, it does not affect the incidences of leading causes of infant mortality, such as low birth weight. Early prevention and diagnosis reduce the rate of infant mortality. NICUs offer care to high-risk infants after they are born. Expanding the number of NICUs would offer better access for high-risk care, but this is not the primary focus for further reduction of infant mortality rates. A mandate that all pregnant women receive obstetrician care would be nearly impossible to enforce. Furthermore, certified nurse-midwives (CNMs) have been demonstrated to provide reliable, safe care for pregnant women.

The two most frequently reported maternal medical risk factors are: A. Hypertension associated with pregnancy and diabetes. B. Drug use and alcohol abuse. C. Homelessness and lack of insurance. D. Behaviors and lifestyles.

A. Hypertension and diabetes are the most frequently reported maternal risk factors. Both are associated with obesity. Approximately 20% of U.S. women who give birth are obese. Obesity in pregnancy is associated with the use of more health care services and longer hospital stays. Both drug use and alcohol abuse continue to increase in the maternal population; they are associated with low-birth-weight infants, mental retardation, and birth defects. The number of clients who are homeless or lack health care insurance is increasing; however, these are not the most common risks. Behavior and lifestyle choices do contribute to the health of the mother and fetus.

What is not a trend in the delivery of health care in the United States? A. Greater emphasis has been placed on curing disease and disability than on preventing them. B. Hospital stays for many conditions have been shortened. C. Acute care is increasingly provided through home-based services. D. Hospital-based nurses are increasingly involved in follow-up care after discharge.

A. Prevention now is emphasized. Hospitalization has been shortened to reduce cost. Acute care is increasingly done at home. Nurses now are more involved in postdischarge follow-up care.

The uterus is a muscular pear-shaped organ that is responsible for: A. Cyclic menstruation. B. Sex hormone production. C. Fertilization. D. Sexual arousal.

A. The uterus is an organ for reception, implantation, retention, and nutrition of the fertilized ovum; it also is responsible for cyclic menstruation. Hormone production and fertilization occur in the ovaries. Sexual arousal is a feedback mechanism involving the hypothalamus, the pituitary gland, and the ovaries.

9. A woman is 16 weeks pregnant and has elected to terminate her pregnancy. Which is the most common technique used for the termination of a pregnancy in the second trimester? a. Dilation and evacuation (D&E) b. Methotrexate administration c. Prostaglandin administration d. Vacuum aspiration

ANS: A D&E can be performed at any point up to 20 weeks of gestation. It is more commonly performed between 13 and 16 weeks of gestation. Methotrexate is a cytotoxic drug that causes early abortion by preventing fetal cell division. Prostaglandins are also used for early abortion and work by dilating the cervix and initiating uterine wall contractions. Vacuum aspiration is used for abortions in the first trimester.

13. Which term best describes the conscious decision concerning when to conceive or avoid pregnancy as opposed to the intentional prevention of pregnancy during intercourse? a. Family planning b. Birth control c. Contraception d. Assisted reproductive therapy

ANS: A Family planning is the process of deciding when and if to have children. Birth control is the device and/or practice used to reduce the risk of conceiving or bearing children. Contraception is the intentional prevention of pregnancy during sexual intercourse. Assisted reproductive therapy is one of several possible treatments for infertility.

What opiate causes euphoria, relaxation, drowsiness, and detachment from reality and has possible effects on the pregnancy, including preeclampsia, intrauterine growth restriction, and premature rupture of membranes? a. Heroin b. Alcohol c. PCP d. Cocaine

ANS: A A The opiates include opium, heroin, meperidine, morphine, codeine, and methadone. The signs and symptoms of heroin use are euphoria, relaxation, relief from pain, detachment from reality, impaired judgment, drowsiness, constricted pupils, nausea, constipation, slurred speech, and respiratory depression. Possible effects on pregnancy include preeclampsia, intrauterine growth restriction, miscarriage, premature rupture of membranes, infections, breech presentation, and preterm labor. B Alcohol is not an opiate. C PCP is not an opiate. D Cocaine is not an opiate.

8. Ovarian function and hormone production decline during which transitional phase? a. Climacteric b. Menarche c. Menopause d. Puberty

ANS: A The climacteric phase is a transitional period during which ovarian function and hormone production decline. Menarche is the term that denotes the first menstruation. Menopause refers only to the last menstrual period.Puberty is a broad term that denotes the entire transitional period between childhood and sexual maturity.

11. Which female reproductive organ(s) is(are) responsible for cyclic menstruation? a. Uterus b. Ovaries c. Vaginal vestibule d. Urethra

ANS: A The uterus is responsible for cyclic menstruation and also houses and nourishes the fertilized ovum and the fetus. The ovaries are responsible for ovulation and the production of estrogen. The vaginal vestibule is an external organ that has openings to the urethra and vagina. The urethra is not a reproductive organ, although it is found in the area.

3. Which nursing diagnoses would be most applicable for battered women? (Select all that apply.) a. Loss of trust b. Ineffective family coping c. Situational low self-esteem d. Risk for self-directed violence e. Enhanced communication

ANS: A, B, C, D Loss of trust, ineffective family coping, situational low self-esteem, and risk for self-directed violence are potential nursing diagnoses associated with battered women. A more appropriate nursing diagnosis for a battered woman would be impaired communication.

13. Which phase of the endometrial cycle best describes a heavy, velvety soft, fully matured endometrium? a. Menstrual b. Proliferative c. Secretory d. Ischemic

ANS: C The secretory phase extends from the day of ovulation to approximately 3 days before the next menstrual cycle. During this secretory phase, the endometrium becomes fully mature again. During the menstrual phase, the endometrium is shed. The proliferative phase is a period of rapid growth. During the ischemic phase, the blood supply is blocked and necrosis develops.

Danazol (androgens) may be prescribed for an infertile woman if she has: a. Thyroid dysfunction b. Elevated levels of prolactin c. Inadequate levels of follicle-stimulating hormone (FSH) d. Endometriosis

ANS: D Danazol treats endometriosis by suppressing ovarian activity and eliminating stimulation of endometrial tissue. Thyroid dysfunction is not treated with danazol. Danazol is not an appropriate treatment for a client with elevated levels of prolactin. Inadequate levels of FSH do not respond to treatment with danazol.

22. Which hormone is responsible for the maturation of mammary gland tissue? a. Estrogen b. Testosterone c. Prolactin d. Progesterone

ANS: D Progesterone causes maturation of the mammary gland tissue, specifically acinar structures of the lobules. Estrogen increases the vascularity of the breast tissue. Testosterone has no bearing on breast development. Prolactin is produced after birth and released from the pituitary gland; it is produced in response to infant suckling and an emptying of the breasts.

15. Which statement regarding gamete intrafallopian transfer (GIFT) is most accurate? a. Semen is collected after laparoscopy. b. Women must have two normal fallopian tubes. c. Ovulation spontaneously occurs. d. Ova and sperm are transferred to one tube.

ANS: D Similar to in vitro fertilization (IVF), GIFT requires the woman to have at least one normal tube. Ovulation is induced, and the oocytes are aspirated during laparoscopy. Semen is collected before laparoscopy. The ova and sperm are then transferred to one uterine tube, permitting natural fertilization and cleavage.

When caring for women, nurses should focus on helping their patients to decrease their risk for the leading cause of death for women, which is: A. Breast cancer B. Heart disease C. Cervical cancer D. Diabetes mellitus

Choice B is correct; while choices A, C, and D are major mortality risks for women, the leading cause of death is heart disease.

2. Individual irregularities in the ovarian (menstrual) cycle are most often caused by what? a. Variations in the follicular (preovulatory) phase b. Intact hypothalamic-pituitary feedback mechanism c. Functioning corpus luteum d. Prolonged ischemic phase

ANS: A Almost all variations in the length of the ovarian cycle are the result of variations in the length of the follicular phase. An intact hypothalamic-pituitary feedback mechanism would be regular, not irregular. The luteal phase begins after ovulation. The corpus luteum is dependent on the ovulatory phase and fertilization. During the ischemic phase, the blood supply to the functional endometrium is blocked, and necrosis develops. The functional layer separates from the basal layer, and menstrual bleeding begins.

In the United States, the leading cause of maternal mortality is which one of the following? a. Unsafe abortion b. Infection c. Gestational hypertension d. Diabetes

c

With regard to emergency contraception pills, nurses should be aware that: A. The pills should be readily available during the initial learning phase when a woman is using a new method of contraception. B. The pills must be taken no later than 48 hours after unprotected intercourse or birth control mishap. C. The pills protect the woman against pregnancy even if she engages in unprotected intercourse in the days after treatment. D. Emergency contraception has no medical contraindications.

A. A backup method of birth control is also a good idea for beginners. The woman has up to 120 hours after unprotected intercourse to take emergency contraception pills; they do not, however, protect against pregnancy from subsequent unprotected intercourse. These pills are contraindicated during pregnancy and if the woman has undiagnosed abnormal vaginal bleeding.

During a health history interview, a woman tells the nurse that her husband physically abuses her. The nurse's first response should be to: A. Advise the woman of mandatory state reporting laws pertaining to abuse and confidentiality. B. Reassure the woman that the abuse is not her fault. C. Give the woman referrals to local agencies and shelters where she can obtain help. D. Formulate an escape plan for the woman that she can use the next time her husband abuses her.

A. Although all of these responses are appropriate when dealing with an abused woman, the nurse first should discuss the legal implications of this type of situation. Many states have mandatory reporting laws for health care providers. It is important to inform the woman that you may need to report what she has told you. Nurses should be knowledgeable about the reporting requirements of the state in which they practice.

A maternity nurse should be aware of which fact about the amniotic fluid? A. It serves as a source of oral fluid and as a repository for waste from the fetus. B. The volume remains about the same throughout the term of a healthy pregnancy. C. A volume of less than 300 ml is associated with gastrointestinal malformations. D. A volume of more than 2 L is associated with fetal renal abnormalities.

A. Amniotic fluid also cushions the fetus and helps maintain a constant body temperature. Its volume changes constantly; too little fluid (oligohydramnios) is associated with renal abnormalities, and too much fluid (polyhydramnios) is associated with gastrointestinal and other abnormalities.

A mother's household consists of her husband, his mother, and another child. She is living in a/an: A. Extended family. B. Single-parent family. C. Married-blended family. D. Trinuclear family.

A. An extended family includes blood relatives living with the nuclear family. Married-blended refers to families reconstructed after divorce.

A woman inquires about herbal alternative methods for improving fertility. Which statement by the nurse is the most appropriate for instructing the woman about which herbal preparations to avoid while trying to conceive? A. "You should avoid nettle leaf, dong quai, and vitamin E while you are trying to get pregnant." B. "You may want to avoid licorice root, lavender, fennel, sage, and thyme while you are trying to conceive." C. "You should not take anything with vitamin E, calcium, or magnesium. They will make you infertile." D. "Herbs have no bearing on fertility."

B. Although most herbal remedies have not been proven clinically to promote fertility, herbs that a woman should avoid while trying to conceive include licorice root, yarrow, wormwood, ephedra, fennel, goldenseal, lavender, juniper, flaxseed, pennyroyal, passionflower, wild cherry, cascara, sage, thyme, and periwinkle. Nettle leaf, dong quai, and vitamin E promote fertility; calcium and magnesium may promote fertility and conception.

Semen analysis is a common diagnostic procedure related to infertility. In instructing a male client regarding this test, the nurse would tell him to: A. Ejaculate into a sterile container. B. Obtain the specimen after a period of abstinence from ejaculation of 2 to 5 days. C. Transport specimen with container packed in ice. D. Ensure that the specimen arrives at the laboratory within 30 minutes of ejaculation.

B. An ejaculated sample should be obtained after a period of abstinence to get the best results. The male must ejaculate into a clean container or a plastic sheath that does not contain a spermicide. He should avoid exposing the specimen to extremes of temperature, either heat or cold, and the specimen should be taken to the laboratory within 2 hours of ejaculation.

A woman is 8 months pregnant. She tells the nurse that she knows her baby listens to her, but her husband thinks she is imagining things. Which response by the nurse is most appropriate? A. "Many women imagine what their baby is like." B. "A baby in utero does respond to the mother's voice." C. "You'll need to ask the doctor if the baby can hear yet." D. "Thinking that your baby hears will help you bond with the baby."

B. Fetuses respond to sound by 24 weeks. The fetus can be soothed by the sound of the mother's voice, and the nurse should instruct the mother so. Although statement A is accurate, it is not the most appropriate response. Statement D is not appropriate because it gives the mother impression that her baby cannot hear her and belittles her interpretation of her fetus's behaviors.

Sexual assault is: A. Limited to rape. B. An act of force in which an unwanted and uncomfortable sexual act occurs. C. A legal term for sexual violence. D. An act of violence in which the partner is unknown.

B. Sexual assault is a broad term that encompasses a wide range of sexual victimization, including unwanted or uncomfortable touches, kisses, hugs, petting, intercourse, or other sexual acts. It may include but is not limited to rape. Sexual violence is a term for rape, not sexual assault, which encompasses a broader range of activities. A sexual act of violence, or rape, may be categorized as sexual assault. Statistically, the victim of sexual assault knows the assailant.

In reviewing the history of a woman who wants to become pregnant, which medication profile would indicate a potential concern relative to toxic exposure? Select all that apply. A. Tylenol OTC occasionally for a headache; twice last week B. Anticonvulsant for seizure disorder C. Lithium for bipolar disorder D. Coumadin for atrial fibrillation E. Multivitamins once a day

B., C., D. A patient being treated with an anticonvulsant or lithium is at risk for toxic effects during pregnancy. Warfarin (Coumadin) can put a patient at risk during pregnancy. Although acetaminophen (Tylenol) can have toxic effects on the liver, the reported frequency is not a concern at this time. Taking multivitamins is a healthy recommended option.

Which statements are true regarding the occurrence of obesity in the United States? Select all that apply. A. 25% of women in the United States are currently considered to be obese. B. Women in the age group 40 to 59 years have the highest prevalence. C. Obesity is associated with hypercholesterolemia. D. Obesity is associated with a decreased incidence of diabetes. E. Women who are obese may be more likely to have irregularities of the menstrual cycle.

B., C., E. More than 33% of women in the United States are currently considered to be obese. Obesity is associated with an increased incidence of diabetes. The statements in B, C, and E are true according to reported evidence.

Providing treatment and rehabilitation for people who have developed disease is part of: A. Primary preventive care. B. Secondary preventive care. C. Tertiary preventive care. D. Primordial preventive care.

C. Primary preventive care involves promoting healthy lifestyles. Secondary preventive care involves targeting populations at risk. Tertiary preventive care is the treatment or rehabilitation of those who already have a specific disease. Primordial preventive care refers to prevention of the risk factors themselves at either the social or environmental level.

Which finding, if present in both the male and female of a couple, could present an issue with regard to the couple's fertility? A. Male and female are the same age, 35. B. Both partners have had children in their past marriage. C. History of endocrine problems. D. History of hypertension.

C. A history of endocrine problems should be investigated further because it may have an effect on the couple's fertility. Age is a relative factor but the recorded age, 35 years, does not in itself represent a significant fertility factor unless there are additional factors. The fact that both the man and the woman have already had children is a favorable sign in fertility. Although hypertension is a relevant clinical finding, it may not have a direct bearing on the couple's fertility.

A woman at 35 weeks of gestation has had an amniocentesis. The results reveal that surface-active phospholipids are present in the amniotic fluid. The nurse is aware that this finding indicates that: A. The fetus is at risk for Down syndrome. B. The woman is at high risk for developing preterm labor. C. The lungs are mature. D. Meconium is present in the amniotic fluid.

C. The detection of the presence of pulmonary surfactants, surface-active phospholipids, in amniotic fluid has been used to determine fetal lung maturity, or the ability of the lungs to function after birth. This occurs at approximately 35 weeks of gestation. This result is unrelated to Down syndrome and in no way indicates risk for preterm labor. Meconium should not be present in the amniotic fluid.

Which personal safety precaution should guide the nurse working in home care? A. Do not carry personal items, such as extra car keys or a cellular phone. B. Avoid making a visit with another nurse. C. Schedule visits during daylight hours. D. Never wear a name tag.

C. The nurse should carry keys and a cell phone in the event that the keys must be used for self-defense or the cell phone is needed to call for help. Making a visit in pairs is a good personal strategy for nurses visiting families with a history of violence or substance abuse. For the nurse's personal safety, all home visits should be conducted during daylight hours. Dress should be casual but professional and should include a name tag.

A patient has been sexually assaulted and presents to the Emergency Department for a sexual assault examination. Which action would be a priority for the nurse assigned to take care of the patient? A. Provide the patient with a washcloth and allow her to provide needed hygiene measures. B. Ask the patient for her insurance card so that you can validate information. C. Maintain chain of custody for collection of evidence. D. Provide the patient with contact information regarding psychological resources that may help her with dealing with this situation.

C. The nurse should place priority on maintaining the chain of custody for the collection of evidence. Because the sexual assault examination is used as part of the evidentiary process when a suspected crime has been committed, the nurse should be mindful not to invalidate physical findings that might affect the course of legal action, such as washing. Psychological referrals may be necessary, but the priority action is to preserve the evidence and assess physical and emotional well-being. Although it is important to obtain information relevant to insurance coverage, this is not the priority action at this time in the context of a sexual assault victim.

Which of the following could affect female fertility? Select all that apply. A. Partner relationship status B. Financial history C. A clinical diagnosis of anemia D. Bicornate uterus E. Uterine abnormality F. Cephalopelvic disproportion (CPD)

C., E. A diagnosis of anemia and the presence of a uterine abnormality can both affect a woman's fertility status. Partner relationship status, although important in one's well-being, does not typically affect female fertility, and financial history is not a factor.The presence of CPD relates to whether or not a woman can successfully deliver a baby vaginally on the basis of obtained pelvic measurements.

An infertile woman is given clomiphene citrate (Clomid) to achieve which of the following therapeutic outcomes? A. Stimulate the pituitary gland to secrete FSH and LH B. Enhance the development of a secretory endometrium C. Induce the formation of the corpus luteum D. Increase the secretion of favorable cervical mucus to enhance sperm viability

Choice A is correct; Clomid is used to increase FH and LH secretion by stimulating the pituitary gland.

A nurse caring for pregnant women needs to be aware that physical abuse during pregnancy can result in which of the following outcomes? (Circle all that apply.) A. Excessive weight gain B. Use of alcohol or tobacco as a means of coping C. Increased risk for giving birth to a low-birth-weight (LBW) baby D. Postterm pregnancy E. Sexually transmitted infections (STIs)

Choices B, C, and E are correct; anxiety and depression can lead to use of alcohol, tobacco, and drugs as a means of coping; inadequate diet results in low maternal weight gain, increasing the risk for anemia and giving birth to an LBW newborn; the rate of preterm birth and LBW is increased; abused women are more likely to experience STIs, pelvic pain, and bleeding.

Which health services represent the primary level of preventive care? (Circle all that apply.) A. Breast self-examination and testicular self-examination education programs B. Providing flu immunizations in pharmacies C. A safer-sex informational pamphlet provided to adolescents during a health education class D. Blood pressure and cholesterol screening at a health fair E. Instituting a wheelchair, cane, and walker exchange program for persons whose health insurance does not cover these items F. A car-seat fitting fair at local automobile dealerships

Choices B, C, and F are correct; choices A and D are secondary levels of prevention and choice E is a tertiary level of prevention.

When teaching a class of pregnant women about fetal development, the nurse would include which statements? (Circle all that apply.) A. "The sex of your baby is determined by the 9th week of pregnancy." B. "Your baby will be able to suck and hiccup while in your uterus." C. "The baby's heart begins to pump blood during the 10th week of pregnancy." D. "The baby's heartbeat will be audible using a special ultrasound stethoscope beginning at the 18th week of pregnancy." E. "You should be able to feel your baby move by week 16 to 20 of pregnancy." F. "By the 24th week of your pregnancy you will notice your baby responding to sounds in the environment, including music and your voice."

Choices B, E, and F are correct; feeling of movement is called quickening; the sex of a baby is determined at conception; the heart begins to pump blood by the end of the 3rd week and a heartbeat can be heard with ultrasound by the 8th week of gestation.

A woman has had a ParaGard T380A IUD inserted. The nurse should recognize that the woman needs further teaching if she says: (Circle all that apply.) A. "This IUD remains effective for 10 years." B. "It is normal to experience an increase in bleeding and cramping within the first year after it has been inserted." C. "My IUD works by releasing progesterone." D. "I should avoid using NSAIDs such as Motrin if I have cramping." E. "I must use risk prevention measures, including condoms, to prevent infections in my uterus."

Choices C and D are correct; there is no hormone in this IUD; copper serves as a spermicide and it inflames the endometrium, preventing fertilization; NSAIDs are recommended to decrease cramping,

A sexual assault victim is brought into the Emergency Department for triage. Which health care provider should be contacted to perform the assessment? A. Emergency Room physician B. RN C. LPN D. SANE

D. Although the ER doctor may be needed to examine any patient brought into the ED setting, and an RN or LPN can interact with the patient, a sexual assault nurse examiner (SANE), if available, would be the most appropriate choice to care for the patient. A SANE is someone who has been trained and credentialed to care for assault victims.

What important aspects do all the fertility awareness-based (FAB) methods have in common? A. They all require a woman to be able to touch her genitals to assess cervical mucus. B. They all involve abstinence at some point. C. They all rely on measurement of body temperature. D. They all require the cooperation of the woman's partner.

D. Fertile phases can be determined in a number of ways, but the sexual partner must cooperate in the method. Not all FAB methods calculate fertility phases by examining mucus; some use body temperatures and other signs. Some methods use chemical or physical barriers to conception during fertile periods.

A patient has been sexually assaulted and is receiving an initial evaluation in the Emergency Department. She is concerned that she may become pregnant. Which priority action should the nurse implement so as to address the patient's concern? A. Ask the patient to provide information about the date of her LMP. B. Perform a pregnancy test, and as long as the results are negative, the patient does not have to worry about pregnancy. C. Have the patient sign a consent form for a dilatation and curettage to be performed. D. Determine the length of time after assault, and if it is less than 120 hours, emergency contraception may be provided.

D. It would be most important for the nurse to determine when the assault occurred so as to interpret this information relative to the pregnancy test results. Even if results of a pregnancy test are negative, the patient may still be pregnant, and further evaluation should be performed. Although the nurse may want to ask about the LMP, it will not provide evidence about whether or not the patient may be pregnant. A D&C may prove to be needed but not at this time.

The perinatal continuum of care begins with: A. The diagnosis of pregnancy. B. The interval just before birth. C. Identification of a pregnant woman as high risk. D. Family planning and preconception care.

D. The continuum of care begins with family planning and preconception care, not at the beginning of pregnancy.

An integrative health care approach implies which of the following? (Circle all that apply.) a. The focus is on the whole person. b. Conventional Western modalities of treatment are not included. c. The beliefs, values, and desires of the patient in terms of health and health care are respected. d. Patient autonomy is limited in terms of choosing alternative therapies. e. The patient's disease complex is the primary consideration when choosing treatment approaches.

a, c; conventional Western modalities are included, patient autonomy and decision making is encouraged, and the whole patient and not just the disease process is the primary consideration.

When communicating with an abused woman, which of the following statements should be avoided? (Circle all that apply.) a. "Why do you think your husband hits you even though you are pregnant?" b. "I cannot believe how terrible your husband is being to you." c. "The violence you are experiencing now is likely to continue and to get even worse as your pregnancy progresses." d. "Tell me why you did not go to the shelter I recommended to you; they are very helpful and you would have avoided this beating if you had gone." e. "Next time you come in for care, I want you to be sure to bring your husband so I can talk to him myself." f. "I am afraid for your safety and the safety of your other children."

a, b, d, and e; asking "why" questions re-victimizes and blames the victim; the nurse should not talk negatively about the abuser nor talk directly to him about suspicions of abuse.

A nurse is teaching a class of young women in a drug rehabilitation program about the risks associated with using illicit drugs during pregnancy. Which of the following statements if made by the students indicate that they understood the nurse's instructions? (Circle all that apply.) a. "My baby won't get enough oxygen if I smoke marijuana." b. "Cocaine can make my baby grow too big and make my pregnancy last too long." c. "Cocaine can make the placenta separate from my baby too early." d. "If I use heroin during pregnancy my baby will go through withdrawal after birth." e. "Methamphetamine exposure can make my baby's head too big." f. "My baby might get birth defects, especially in the heart and lungs, if I use PCP."

a, c, and d; cocaine reduces fetal growth and increases the risk for preterm labor and birth; babies exposed to methamphetamines can have smaller heads; the major concern with using phencyclidine is polydrug abuse and neurobehavioral effects on the neonate.

Joyce has chosen the diaphragm as her method of contraception. Which of the following actions would indicate that Joyce is using the diaphragm effectively? (Circle all that apply.) a. Joyce came to be refitted after healing was complete following the term vaginal birth of her son. b. Joyce applies a spermicide only to the rim of the diaphragm just before insertion because she dislikes the stickiness of the spermicide. c. Joyce empties her bladder before inserting the diaphragm. d. Joyce inserts the diaphragm about 3 to 4 hours before intercourse to increase spontaneity. e. Joyce applies more spermicide for each act of intercourse. f. Joyce removes the diaphragm within 1 hour of intercourse. g. After removal, Joyce washes the diaphragm with warm water and an antiseptic-type soap, dries it, and then applies baby powder. h. Joyce always uses the diaphragm during her menstrual periods.

a, c, d, and e; spermicide should be applied to the surface of the diaphragm and the rim; diaphragm should not be removed for at least 6 hours; it should be washed with warm water and mild soap, and then cornstarch should be applied; it should not be used during menstruation to prevent TSS.

When assessing women, it is important for the nurse to keep in mind the possibility that they are victims of violence. The nurse should: a. use an abuse assessment screen during the assessment of every woman. b. recognize that abuse rarely occurs during pregnancy. c. assess a woman's legs and back as the most commonly injured areas. d. notify the police immediately if abuse is suspected.

a; all women should be screened because abuse can happen to any woman; abuse often escalates during pregnancy; the most commonly injured sites are head, neck, chest, abdomen, breasts, and upper extremities. If abuse is suspected the nurse needs to assess further to encourage disclosure and then assist the woman to take action and formulate a plan.

The most common, and for some women the most distressing, side effect of progestin-only contraceptives such as the minipill would be which of the following? a. Irregular vaginal bleeding b. Headache c. Nervousness d. Nausea

a; although choices b, c, and d are all temporary side effects, the most common is the irregular pattern of vaginal bleeding that occurs; women report that this bleeding is also the most distressing side effect.

A 52-year-old woman asks the nurse practitioner about how often she should be assessed for the common health problems women of her age could experience. The nurse would recommend which of the following screening measures? (Circle all that apply.) a. An endometrial biopsy every 2 to 3 years b. A fecal occult blood test every year c. A mammogram every other year d. Clinical breast examination every year e. Bone mineral density testing every year beginning when she is 55 f. Vision examination every 2 to 4 years

b, d, and f; endometrial biopsies are not recommended on a routine basis for most women but women at risk for endometrial cancer should have one done at menopause; mammograms should be done annually for women over 50 years of age and bone mineral density beginning at age 65

18. A women's health nurse practitioner is preparing an education presentation on the topic of intimate partner violence (IPV) to a group of women who come to the clinic where she practices. As part of the presentation, she plans to dispel commonly held myths regarding IPV. Which of the following statements represent the facts related to IPV? (Circle all that apply.) a. Battering almost always affects women who are poor. b. Of women who experience battering, 25% are battered by an intimate partner. c. Women usually are safe from battering while they are pregnant, although the battering will resume after they have the baby. d. Women tend to leave the relationship if the battering is bad. e. Counseling may be successful in helping the batterer stop his behavior. f. Women do not like to be beaten and will often do anything to avoid a confrontation.

b, e, and f; IPV can occur in any family; battering frequently begins or escalates during pregnancy; women may stay even if the battering is bad because of fear and financial dependence, and shelters often have long waiting lists.

A newly married 25-year-old woman has been smoking since she was a teenager. She has come to the women's health clinic for a checkup before she begins trying to get pregnant. The woman demonstrates a need for further instruction about the effects of smoking on reproduction and health when she makes which of the following statements? (Circle all that apply.) a. "Smoking can interfere with my ability to get pregnant." b. "My husband also needs to stop smoking because secondhand smoke can have an adverse effect on my pregnancy and the development of the baby." c. "Smoking can make my pregnancy last longer than it should." d. "Smoking can reduce the amount of calcium in my bones." e. "Smoking will mean I will experience menopause at an older age than my friends who do not smoke."

c and e; smoking is associated with preterm birth, not postterm pregnancies; smoking can reduce the age for menopause.

A pregnant woman in her first trimester tells her nurse midwife that although she does drink during pregnancy, she does so only on the weekend and only a little bit. What should the nurse's initial response be to this woman's comment? a. "You need to realize that use of alcohol, in any amount, will result in your child being mentally retarded." b. "I am going to refer you to a counseling center for women with alcohol problems." c. "Tell me what you mean by drinking a little on the weekend." d. "Antioxidants can reduce the effect of alcohol exposure for your baby. I will tell you what you can take."

c; it is essential to first determine what she drinks and how much; once that is established, then intervention regarding alcohol use that is individualized for her can occur.

Women using Depo-Provera should be carefully screened for which of the following possible adverse reactions to its use? a. Diabetes mellitus—type 2 b. Reproductive tract infection c. Decrease in bone mineral density d. Weight loss

c; the longer a woman uses DMPA, the more significant the loss of bone mineral density; weight gain not loss can occur.

To enhance the accuracy of the Papanicolaou (Pap) test, the nurse should instruct the patient to do which of the following? a. Schedule the test just prior to the onset of menses. b. Stop taking birth control pills for 2 days before the test. c. Avoid intercourse for 24 to 48 hours before the test. d. Douche with a specially prepared antiseptic solution the night before the test.

c; women should not use vaginal medications or douche for 24 to 48 hours before the test; OCPs (oral contraceptive pills) can continue; the best time for the test is midcycle.

A woman experiencing infertility will begin taking clomiphene citrate (Clomid). In order to ensure she takes this medication safely and effectively, the nurse should do which of the following? a. Teach the patient's husband how to give his wife an IM injection. b. Show the woman how to spray the medication into one of her nostrils, emphasizing that she use a different nostril for each dose. c. Tell her to inject one dose of human chorionic gonadotropin subcutaneously the day after she takes the last does of the clomiphene citrate. d. Tell her to begin taking a 150 mg tablet daily on the 5th day of menstruation.

d; Clomid is taken orally; therefore, there is no need to teach the patient's husband how to give an IM injection; b refers to nafarelin and c is used as part of treatment with menotropins.

The term used to describe professional interaction among health care providers in the clinical nursing practice is: A. Collegiality B. Ethics C. Evaluation D. Accountability

A. Collegiality refers to a working relationship with one's colleagues. Ethics refers to a code to guide practice. Evaluation refers to examination of the effectiveness of interventions in relation to expected outcomes. Accountability refers to legal and professional responsibility for practice.

Which of the following conditions has not contributed to an increase in maternity-related health care costs? A. Early postpartum discharges B. Maternal medical risk factors, such as diabetes C. The use of high-tech equipment D. The cost of care for low-birth-weight (LBW) infants

A. Early postpartum discharges are associated with decreased health care costs. High-risk factors and high-tech equipment both increase such costs. Clinical evidence indicates that maternity-related health care costs are increased for LBW and high-risk infants.

Practices such as providing recommended immunizations, infant car seats, and school health education are part of: A. Primary preventive care. B. Secondary preventive care. C. Tertiary preventive care. D. Primordial preventive care.

A. These activities are designed to improve general health and the quality of life, which is the focus of primary preventive care. Mammograms and prostate screening are examples of secondary preventive care. Rehabilitation for a stroke victim is an example of tertiary care. Eliminating the cause of illness beginning in childhood would be in keeping with primordial prevention (i.e., healthy eating and the elimination of fast food to prevent obesity).

Which action taken made by the nurse would indicate that he or she is practicing appropriate family-centered care techniques? A. The nurse encourages the mother and father to make choices whenever possible. B. The nurse updates the family about what is going to happen but instructs the client's sister that she cannot be present in the room during the birth. C. The nurse believes that he or she is acting in the best interest of the client and commands her what to do throughout labor. D. The father is discouraged from accompanying his wife during a cesarean birth.

A. With family-centered maternity care (FCMC), it is important to allow for choices for the couple and to include the partner in the care process. Also, FCMC involves collaboration between the health care team and the client. Unless there is an institutional policy prohibiting the number of attendees at a birth, the client should be allowed to have whomever she desires with her. In a family-centered care model, the partner or even a grandparent may be present for a cesarean birth (unless of course the birth is an emergency, for which guests may be requested to leave).

Which is correct concerning the performance of a Papanicolaou (Pap) test? A. The woman should not douche, use vaginal medications, or have intercourse for at least 24 hours before the test. B. It should be performed once a year beginning with the onset of puberty. C. A lubricant such as Vaseline should be used to ease speculum insertion. D. The specimen for the Pap test should be obtained after specimens are collected for cervical infection.

A. Women should not douche, use vaginal medications, or have sexual intercourse for 24 hours before a Pap smear specimen is collected so as not to alter the cytology results. Also, only warm water should be used on the speculum so as not to alter the cytology results. The cytologic specimen should be obtained first. Pap tests are performed annually for sexually active women or by age 18, especially if risk factors for cervical cancer or reproductive tract infections are present. Pap tests may be performed every 3 years in low-risk women after three negative results on consecutive annual examinations.

A woman was treated recently for toxic shock syndrome (TSS). She has intercourse occasionally and uses over-the-counter protection. On the basis of her history, what contraceptive method should she and her partner avoid? A. Cervical cap B. Condom C. Vaginal film D. Vaginal sheath

A. Women with a history of TSS should not use a cervical cap. Condoms, vaginal film, and vaginal sheaths are not contraindicated for a woman with a history of TSS.

1. The practice of the calendar rhythm method is based on the number of days in each menstrual cycle. The fertile period is determined after monitoring each cycle for 6 months. The beginning of the fertile period is estimated by subtracting 18 days from the longest cycle and 11 days from the shortest. If the womans cycles vary in length from 24 to 30 days, then her fertile period would be day _____ through day ______.

ANS: 6; 19 To avoid pregnancy, the couple must abstain from intercourse on days 6 through 19. Ovulation occurs on day 12 (plus or minus 2 days either way).

The nurse caring for the laboring woman should know that meconium is produced by: a. Fetal intestines. b. Fetal kidneys. c. Amniotic fluid. d. The placenta.

ANS: A A As the fetus nears term, fetal waste products accumulate in the intestines as dark green-to-black, tarry meconium. B Meconium is an accumulation of fetal waste products found in the intestines. C Meconium is an accumulation of fetal waste products found in the intestines. D Meconium is an accumulation of fetal waste products found in the intestines.

Maternity nurses can work to dispel the health disparities among women through: a. Increased education for mothers. b. Late prenatal care. c. Increased number of cesarean sections. d. Making all women take more vitamins.

ANS: A A Educating mothers enables them to recognize problems they should report to their health care provider and teaches them ways to take better care of themselves. B Late prenatal care is one factor that contributes to health disparities. C Cesarean sections are performed for various reasons, although they may be the result of health concerns related to the mother. D Taking vitamins may improve overall health, but it does not necessarily ensure health or dispel health disparities.

15. Which pictorial tool can assist the nurse in assessing the aspects of family life related to health care? a. Genogram b. Ecomap c. Life-cycle model d. Human development wheel

ANS: A A genogram depicts the relationships of the family members over generations. An ecomap is a graphic portrayal of the social relationships of the woman and her family. The life-cycle model, in no way, illustrates a family genogram; rather, it focuses on the stages that a person reaches throughout life. The human development wheel describes various stages of growth and development rather than the family members relationships to each other.

23. A clients household consists of her husband, his mother, and another child. To which family configuration does this client belong? a. Multigenerational family b. Single-parent family c. Married-blended family d. Nuclear family

ANS: A A multigenerational family includes three or more generations living together. Both parents and a grandparent are living in this extended family. Single-parent families comprise an unmarried biologic or adoptive parent who may or may not be living with other adults. Married-blended families refer to those who are reconstructed after divorce. A nuclear family comprises male and female partners and their children living together as an independent unit.

8. In vitro fertilizationembryo transfer (IVF-ET) is a common approach for women with blocked fallopian tubes or with unexplained infertility and for men with very low sperm counts. A husband and wife have arrived for their preprocedural interview. Which explanation regarding the procedure is most accurate? a. The procedure begins with collecting eggs from your wifes ovaries. b. A donor embryo will be transferred into your wifes uterus. c. Donor sperm will be used to inseminate your wife. d. Dont worry about the technical stuff; thats what we are here for.

ANS: A A womans eggs are collected from her ovaries, fertilized in the laboratory with the partners sperm, and transferred to her uterus after normal embryonic development has occurred. Transferring a donor embryo to the womans uterus describes the procedure for a donor embryo. Inseminating the woman with donor sperm describes therapeutic donor insemination. Telling the client not to worry discredits the clients need for teaching and is not the most appropriate response.

24. Which term is an accurate description of the process by which people retain some of their own culture while adopting the practices of the dominant society? a. Acculturation b. Assimilation c. Ethnocentrism d. Cultural relativism

ANS: A Acculturation is the process by which people retain some of their own culture while adopting the practices of the dominant society. This process takes place over the course of generations. Assimilation is a loss of cultural identity. Ethnocentrism is the belief in the superiority of ones own culture over the cultures of others. Cultural relativism recognizes the roles of different cultures.

7. A young woman arrives at the emergency department and states that she thinks she has been raped. She is sobbing and expresses disbelief that this could happen because the perpetrator was a very close friend. Which statement is most appropriate at this time? a. Rape is not limited to strangers and frequently occurs by someone who is known to the victim. b. I would be very upset if my best friend did that to me; that is very unusual. c. You must feel very betrayed. In what way do you think you might have led him on? d. This does not sound like rape. Didnt you just change your mind about having sex after the fact?

ANS: A Acquaintance rape involves individuals who know one another. Sexual assault occurs when the trust of a relationship is violated. Victims may be less prone to recognize what is happening to them because the dynamics are different from those of stranger rape. It is not at all unusual for the victim to know and trust the perpetrator. Stating that the woman might have led the man to attack her indicates that the sexual assault was somehow the victims fault. This type of mentality is not constructive. Nurses must first reflect on their own feelings and learn to be unbiased when dealing with victims. A statement of this type can be very psychologically damaging to the victim. Nurses must display compassion by first believing what the victim states. The nurse is not responsible for deciphering the facts involving the victims claim.

9. Which statement indicates that a client requires additional instruction regarding BSE? a. Yellow discharge from my nipple is normal if Im having my period. b. I should check my breasts at the same time each month, after my period. c. I should also feel in my armpit area while performing my breast examination. d. I should check each breast in a set way, such as in a circular motion.

ANS: A Discharge from the nipples requires further examination from a health care provider. The breasts should be checked at the same time each month. The armpit should also be examined. A circular motion is the best method during which to ascertain any changes in the breast tissue.

7. Which statement regarding emergency contraception is correct? a. Emergency contraception requires that the first dose be taken within 72 hours of unprotected intercourse. b. Emergency contraception may be taken right after ovulation. c. Emergency contraception has an effectiveness rate in preventing pregnancy of approximately 50%. d. Emergency contraception is commonly associated with the side effect of menorrhagia.

ANS: A Emergency contraception should be taken as soon as possible or within 72 hours of unprotected intercourse to prevent pregnancy. If taken before ovulation, follicular development is inhibited, which prevents ovulation. The risk of pregnancy is reduced by as much as 75%. The most common side effect of postcoital contraception is nausea.

7. A woman asks the nurse, What protects my babys umbilical cord from being squashed while the babys inside of me? What is the nurses best response? a. Your babys umbilical cord is surrounded by connective tissue called Whartons jelly, which prevents compression of the blood vessels. b. Your babys umbilical cord floats around in blood and amniotic fluid. c. You dont need to be worrying about things like that. d. The umbilical cord is a group of blood vessels that are very well protected by the placenta.

ANS: A Explaining the structure and function of the umbilical cord is the most appropriate response. Connective tissue called Whartons jelly surrounds the umbilical cord, prevents compression of the blood vessels, and ensures continued nourishment of the embryo or fetus. The umbilical cord does not float around in blood or fluid. Telling the client not to worry negates her need for information and discounts her feelings. The placenta does not protect the umbilical cord.

1. In evaluating the level of a pregnant womans risk of having a low-birth-weight (LBW) infant, which factor is the most important for the nurse to consider? a. African-American race b. Cigarette smoking c. Poor nutritional status d. Limited maternal education

ANS: A For African-American births, the incidence of LBW infants is twice that of Caucasian births. Race is a nonmodifiable risk factor. Cigarette smoking is an important factor in potential infant mortality rates, but it is not the most important. Additionally, smoking is a modifiable risk factor. Poor nutrition is an important factor in potential infant mortality rates, but it is not the most important. Additionally, nutritional status is a modifiable risk factor. Maternal education is an important factor in potential infant mortality rates, but it is not the most important. Additionally, maternal education is a modifiable risk factor.

13. What is the minimum level of practice that a reasonably prudent nurse is expected to provide? a. Standard of care b. Risk management c. Sentinel event d. Failure to rescue

ANS: A Guidelines for standards of care are published by various professional nursing organizations. Risk management identifies risks and establishes preventive practices, but it does not define the standard of care. Sentinel events are unexpected negative occurrences. They do not establish the standard of care. Failure to rescue is an evaluative process for nursing, but it does not define the standard of care.

11. A recently graduated nurse is attempting to understand the reason for increasing health care spending in the United States. Which information gathered from her research best explains the rationale for these higher costs compared with other developed countries? a. Higher rate of obesity among pregnant women b. Limited access to technology c. Increased use of health care services along with lower prices d. Homogeneity of the population

ANS: A Health care is one of the fastest growing sectors of the U.S. economy. Currently, 17.4% of the gross domestic product is spent on health care. Higher spending in the United States, as compared with 12 other industrialized countries, is related to higher prices and readily accessible technology along with greater obesity rates among women. More than one third of women in the United States are obese. In the population in the United States, 16% are uninsured and have limited access to health care. Maternal morbidity and mortality are directly related to racial disparities.

19. An expectant couple attending childbirth classes have questions regarding multiple births since twins run in the family. What information regarding multiple births is important for the nurse to share? a. Twinning and other multiple births are increasing because of the use of fertility drugs and delayed childbearing. b. Dizygotic twins (two fertilized ova) have the potential to be conjoined twins. c. Identical twins are more common in Caucasian families. d. Fraternal twins are the same gender, usually male.

ANS: A If the parents-to-be are older and have taken fertility drugs, then they would be very interested to know about twinning and other multiple births. Conjoined twins are monozygotic; that is, they are from a single fertilized ovum in which division occurred very late. Identical twins show no racial or ethnic preference, and fraternal twins are more common among African-American women. Fraternal twins can be different genders or the same gender, and identical twins are the same gender.

18. Which statement best describes Kegel exercises? a. Kegel exercises were developed to control or reduce incontinent urine loss. b. Kegel exercises are the best exercises for a pregnant woman because they are so pleasurable. c. Kegel exercises help manage stress. d. Kegel exercises are ineffective without sufficient calcium in the diet.

ANS: A Kegel exercises help control the urge to urinate. Although these exercises may be fun for some, the most important factor is the control they provide over incontinence. Kegel exercises help manage urination, not stress. Calcium in the diet is important but not related to Kegel exercises.

10. A nurse caring for a pregnant client should be aware that the U.S. birth rate shows what trend? a. Births to unmarried women are more likely to have less favorable outcomes. b. Birth rates for women 40 to 44 years of age are declining. c. Cigarette smoking among pregnant women continues to increase. d. Rates of pregnancy and abortion among teenagers are lower in the United States than in any other industrialized country.

ANS: A LBW infants and preterm births are more likely because of the large number of teenagers in the unmarried group. Birth rates for women in their early 40s continue to increase. Fewer pregnant women smoke. Teen pregnancy and abortion rates are higher in the United States than in any other industrial country.

1. A married couple lives in a single-family house with their newborn son and the husbands daughter from a previous marriage. Based on this information, what family form best describes this family? a. Married-blended family b. Extended family c. Nuclear family d. Same-sex family

ANS: A Married-blended families are formed as the result of divorce and remarriage. Unrelated family members join to create a new household. Members of an extended family are kin or family members related by blood, such as grandparents, aunts, and uncles. A nuclear family is a traditional family with male and female partners along with the children resulting from that union. A same-sex family is a family with homosexual partners who cohabit with or without children.

1. Historically, what was the justification for the victimization of women? a. Women were regarded as possessions. b. Women were the weaker sex. c. Control of women was necessary to protect them. d. Women were created subordinate to men.

ANS: A Misogyny, patriarchy, devaluation of women, power imbalance, a view of women as property, gender-role stereotyping, and acceptance of aggressive male behaviors as appropriate contributed and continue to contribute to the subordinate status of women in many of the worlds societies. Viewing women as the weaker sex is a cultural and modern stereotype that contributes to the victimization of women. Control of women to protect them is another cultural and modern stereotype that contributes to the victimization of women. Yet another cultural stereotype that contributes to the victimization of women is the idea that women were created as subordinate to men.

20. The nurse caring for a pregnant client is evaluating his or her health teaching regarding fetal circulation. Which statement from the client reassures the nurse that his or her teaching has been effective? a. Optimal fetal circulation is achieved when I am in the side-lying position. b. Optimal fetal circulation is achieved when I am on my back with a pillow under my knees. c. Optimal fetal circulation is achieved when the head of the bed is elevated. d. Optimal fetal circulation is achieved when I am on my abdomen.

ANS: A Optimal circulation is achieved when the woman is lying at rest on her side. Decreased uterine circulation may lead to intrauterine growth restriction. Previously, it was believed that the left lateral position promoted maternal cardiac output, enhancing blood flow to the fetus. However, it is now known that the side-lying position enhances uteroplacental blood flow. If a woman lies on her back with the pressure of the uterus compressing the vena cava, then blood return to the right atrium is diminished. Although having the head of the bed elevated is recommended and ideal for later in pregnancy, the woman still must maintain a lateral tilt to the pelvis to avoid compressing the vena cava. Many women find lying on their abdomen uncomfortable as pregnancy advances. Side-lying is the ideal position to promote blood flow to the fetus.

5. Which health care service represents a primary level of prevention? a. Immunizations b. Breast self-examination (BSE) c. Home care for high-risk pregnancies d. Blood pressure screening

ANS: A Primary prevention involves health promotion and disease prevention activities to reduce the occurrence of illness and enhance the general health and quality of life. This level of care includes, for example, immunizations, using infant car seats, and providing health education to prevent tobacco use. BSE is an example of secondary prevention that involves early detection of health problems. Home care for a high-risk pregnancy is an example of tertiary prevention. This level of care follows the occurrence of a defect or disability. Blood pressure screening is an example of secondary prevention and is a screening tool for early detection of a health care problem.

23. A new mother asks the nurse about the white substance covering her infant. How should the nurse explain the purpose of vernix caseosa? a. Vernix caseosa protects the fetal skin from the amniotic fluid. b. Vernix caseosa promotes the normal development of the peripheral nervous system. c. Vernix caseosa allows the transport of oxygen and nutrients across the amnion. d. Vernix caseosa regulates fetal temperature.

ANS: A Prolonged exposure to the amniotic fluid during the fetal period could result in the breakdown of the skin without the protection of the vernix caseosa. Normal development of the peripheral nervous system was dependent on nutritional intake of the mother. The amnion was the inner membrane that surrounded the fetus and was not involved in the oxygen and nutrient exchange. The amniotic fluid helped maintain fetal temperature.

18. Maternity nurses can enhance communication among health care providers by using the SBAR technique. The acronym SBAR stands for what? a. Situation, background, assessment, recommendation b. Situation, baseline, assessment, recommendation c. Subjective, background, analysis, recommendation d. Subjective, background, analysis, review

ANS: A SBAR is an easy-to-remember, useful, and concrete mechanism for communicating important information that requires a clinicians immediate attention. Baseline is not discussed as part of SBAR. Subjective and analysisare not specific to the SBAR acronym. Subjective, analysis, and review are not specific to the SBAR acronym.

7. Which condition would be inappropriate to treat with exogenous progesterone (human chorionic gonadotropin)? a. Thyroid dysfunction b. Recent miscarriage c. PCOD d. Oocyte retrieval

ANS: A Synthroid is administered for anovulation associated with hypothyroidism. For women with polycystic ovulation syndrome or a history of miscarriage, oocyte retrieval may have insufficient progesterone and require exogenous progesterone until placental production is sufficient.

1. A woman has chosen the calendar method of conception control. Which is the most important action the nurse should perform during the assessment process? a. Obtain a history of the womans menstrual cycle lengths for the past 6 to 12 months. b. Determine the clients weight gain and loss pattern for the previous year. c. Examine skin pigmentation and hair texture for hormonal changes. d. Explore the clients previous experiences with conception control.

ANS: A The calendar method of conception control is based on the number of days in each cycle, counting from the first day of menses. The fertile period is determined after the lengths of menstrual cycles have been accurately recorded for 6 months. Weight gain or loss may be partly related to hormonal fluctuations, but it has no bearing on the use of the calendar method. Integumentary changes may be related to hormonal changes, but they are not indicators for use of the calendar method. Exploring previous experiences with conception control may demonstrate client understanding and compliancy, but these experiences are not the most important aspect to assess for the discussion of the calendar method.

15. The various systems and organs of the fetus develop at different stages. Which statement is most accurate? a. Cardiovascular system is the first organ system to function in the developing human. b. Hematopoiesis originating in the yolk sac begins in the liver at 10 weeks of gestation. c. Body changes from straight to C-shape occurs at 8 weeks of gestation. d. Gastrointestinal system is mature at 32 weeks of gestation.

ANS: A The heart is developmentally complete by the end of the embryonic stage. Hematopoiesis begins in the liver during the sixth week. The body becomes C-shaped at 21 weeks of gestation. The gastrointestinal system is complete at 36 weeks of gestation.

2. An infertility specialist prescribes clomiphene citrate (Clomid, Serophene) for a woman experiencing infertility. She is very concerned about the risk of multiple pregnancies. What is the nurses most appropriate response? a. This is a legitimate concern. Would you like to discuss further the chances of multiple pregnancies before your treatment begins? b. No one has ever had more than triplets with Clomid. c. Ovulation will be monitored with ultrasound to ensure that multiple pregnancies will not happen. d. Ten percent is a very low risk, so you dont need to worry too much.

ANS: A The incidence of multiple pregnancies with the use of these medications is higher than 25%. The clients concern is legitimate and should be discussed so that she can make an informed decision. Stating that no one has ever had more than triplets with Clomid is inaccurate and negates the clients concerns. Ultrasound cannot ensure that a multiple pregnancy will not occur, and 10% is inaccurate. Furthermore, the clients concern is discredited with a statement such as, dont worry.

A woman is 16 weeks pregnant and has elected to terminate her pregnancy. The nurse knows that the most common technique used for medical termination of a pregnancy in the second trimester is: a. Administration of prostaglandins b. Instillation of hypertonic saline into the uterine cavity c. IV administration of Pitocin d. Vacuum aspiration

ANS: A The most common technique for medical termination of a pregnancy in the second trimester is administration of prostaglandins. Hypertonic solutions injected directly into the uterus account for less than 1% of all abortions because other methods are safer and easier to use. IV administration of Pitocin is used to induce labor in a woman with a third-trimester fetal demise. Vacuum aspiration is used for abortions in the first trimester.

14. Through the use of social media technology, nurses can link with other nurses who may share similar interests, insights about practice, and advocate for clients. Which factor is the most concerning pitfall for nurses using this technology? a. Violation of client privacy and confidentiality b. Institutions and colleagues who may be cast in an unfavorable light c. Unintended negative consequences for using social media d. Lack of institutional policy governing online contact

ANS: A The most significant pitfall for nurses using this technology is the violation of client privacy and confidentiality. Furthermore, institutions and colleagues can be cast in an unfavorable light with negative consequences for those posting information. Nursing students have been expelled from school and nurses have been fired or reprimanded by their Board of Nursing for injudicious posts. The American Nurses Association has published six principles for social networking and the nurse. All institutions should have policies guiding the use of social media, and the nurse should be familiar with these guidelines.

12. Although reported in small numbers, toxic shock syndrome (TSS) can occur with the use of a diaphragm. If a client is interested in this form of conception control, then the nurse must instruct the woman on how best to reduce her risk of TSS. Which comment by the nurse would be most helpful in achieving this goal? a. You should always remove your diaphragm 6 to 8 hours after intercourse. Dont use the diaphragm during menses, and watch for danger signs of TSS, including a sudden onset of fever over 38.4 C, hypotension, and a rash. b. You should remove your diaphragm right after intercourse to prevent TSS. c. Its okay to use your diaphragm during your menstrual cycle. Just be sure to wash it thoroughly first to prevent TSS. d. Make sure you dont leave your diaphragm in for longer than 24 hours, or you may get TSS.

ANS: A The nurse should instruct the client on the proper use and removal of the diaphragm and include the danger signs of TSS. The diaphragm must remain against the cervix for 6 to 8 hours to prevent pregnancy, but it should not remain in place longer than 8 hours to avoid the risk of TSS. The diaphragm should not be used during menses.

8. The womans family members are present when the nurse arrives for a postpartum and newborn visit. What should the nurse do? a. Observe the family members interactions with the newborn and one another. b. Ask the woman to meet with her and the baby alone. c. Perform a brief assessment on all family members who are present. d. Reschedule the visit for another time so that the mother and infant can be privately assessed.

ANS: A The nurse should introduce her or himself to the client and to the other family members who are present. Family members in the home may be providing care and assistance to the mother and infant. However, this care may not be based on sound health practices. Nurses should take the opportunity to dispel myths while family members are present. The responsibility of the home care maternal-child nurse is to provide care to the new postpartum mother and to her infant, not to all family members. The nurse can politely ask about the other people in the home and their relationships with the mother. Unless an indication is given that the woman would prefer privacy, the visit may continue.

9. When the nurse is alone with a battered client, the client seems extremely anxious and says, It was all my fault. The house was so messy when he got home, and I know he hates that. What is the most suitable response by the nurse? a. No one deserves to be hurt. Its not your fault. How can I help you? b. What else do you do that makes him angry enough to hurt you? c. He will never find out what we talk about. Dont worry. Were here to help you. d. You have to remember that he is frustrated and angry so he takes it out on you.

ANS: A The nurse should stress that the client is not at fault. Asking what the client did to make her husband angry is placing the blame on the woman and would be an inappropriate statement. The nurse should not providefalse reassurance. To assist the woman, the nurse should be honest. Often the batterer will find out about the conversation.

1. Due to the effects of cyclic ovarian changes in the breast, when is the best time for breast self-examination (BSE)? a. Between 5 and 7 days after menses ceases b. Day 1 of the endometrial cycle c. Midmenstrual cycle d. Any time during a shower or bath

ANS: A The physiologic alterations in breast size and activity reach their minimal level approximately 5 to 7 days after menstruation ceases. Therefore, BSE is best performed during this phase of the menstrual cycle. Day 1 of the endometrial cycle is too early to perform an accurate BSE. After the midmenstrual cycle, breasts are likely to become tender and increase in size, which is not the ideal time to perform BSE. Lying down after a shower or bath with a small towel under the shoulder of the side being examined is appropriate teaching for BSE. A secondary BSE may be performed while in the shower.

17. Which nonpharmacologic contraceptive method has a failure rate of less than 25%? a. Standard days variation b. Periodic abstinence c. Postovulation d. Coitus interruptus

ANS: A The standard days variation on the calendar method has a failure rate of 12% and is a variation of the calendar rhythm method with a fixed number of days for fertility in each cycle. The periodic abstinence method has a failure rate of 25% or higher. The postovulation method has a failure rate of 25% or higher. The coitus interruptus method has a failure rate of 27% or higher.

19. Healthy People 2020 has established national health priorities that focus on a number of maternal-child health indicators. Nurses are assuming greater roles in assessing family health and are providing care across the perinatal continuum. Which of these priorities has made the most significant progress? a. Reduction of fetal deaths and use of prenatal care b. LBW infants and preterm births c. Elimination of health disparities based on race d. Infant mortality and the prevention of birth defects

ANS: A Trends in maternal child health indicate that progress has been made in relation to reduced infant and fetal deaths and increased prenatal care. Notable gaps remain in the rates of LBW infants and preterm births. According to the March of Dimes, persistent disparities still exist between African-Americans and non-Hispanic Caucasians. Many of these negative outcomes are preventable through access to prenatal care and the use of preventive health practices. These preventable negative outcomes demonstrate the need for comprehensive community-based care for all mothers, infants, and families.

25. Which development related to the integumentary system is correct? a. Very fine hairs called lanugo appear at 12 weeks of gestation. b. Eyelashes, eyebrows, and scalp hair appear at 28 weeks of gestation. c. Fingernails and toenails develop at 28 weeks of gestation. d. By 32 weeks, scalp hair becomes apparent.

ANS: A Very fine hairs, called lanugo appear first at 12 weeks of gestational age on the fetus eyebrows and upper lip. By 20 weeks of gestation, lanugo covers the entire body. By 20 weeks of gestation the eyelashes, eyebrows, and scalp hair also begin to grow. By 28 weeks of gestation, the scalp hair is longer than these fine hairs, which is thin and may disappear by term. Fingernails and toenails develop from thickened epidermis, beginning during the 10th week. Fingernails reach the fingertips at 32 weeks of gestation, and the toenails reach the toe tips at 36 weeks of gestation.

13. To provide adequate care, the nurse should be cognitive of which important information regarding infertility? a. Is perceived differently by women and men. b. Has a relatively stable prevalence among the overall population and throughout a womans potential reproductive years. c. Is more likely the result of a physical flaw in the woman than in her male partner. d. Is the same thing as sterility.

ANS: A Women tend to be more stressed about infertility tests and to place more importance on having children. The prevalence of infertility is stable among the overall population, but it increases with a womans age, especially after age 40 years. Of cases with an identifiable cause, approximately 40% are related to female factors, 40% to male factors, and 20% to both partners. Sterility is the inability to conceive. Infertility or subfertility is a state of requiring a prolonged time to conceive.

1. The nurse who is evaluating the client for potential abuse should be aware that IPV includes a number of different forms of abuse, including which of the following? (Select all that apply.) a. Physical b. Sexual c. Emotional d. Psychologic e. Financial

ANS: A, B, D, E Physical, sexual, financial, and psychologic abuse can all be components in a relationship with IPV. Emotional abuse is a form of psychologic abuse.

4. A thorough abuse assessment screen should be completed on all female clients. This screen should include which components? (Select all that apply.) a. Asking the client if she has ever been slapped, kicked, punched, or physically hurt by her partner b. Asking the client if she is afraid of her partner c. Asking the client if she has been forced to perform sexual acts d. Diagramming the clients current injuries on a body map e. Asking the client what she did wrong to elicit the abuse

ANS: A, B, C, D Asking the client if she has been slapped, kicked, punched, or physically hurt by her partner, if she is afraid of her partner, or if she has been forced to perform sexual acts are questions that should be posed to all clients. If any physical injuries are present, then they should be marked on a form that indicates their locations on the body. Implying that a client did something wrong can be very emotionally damaging. Many victims of violence are not aware that they are in an abusive relationship. They may not respond to questions about abuse. Using general descriptive words such as slap, kick, or punch to elicit information is best.

1. Many factors, male and female, contribute to normal fertility. Approximately 40% of cases of infertility are related to the female partner. Which factors are possible causes for female infertility? (Select all that apply.) a. Congenital or developmental b. Hormonal or ovulatory c. Tubal or peritoneal d. Uterine e. Emotional or psychologic

ANS: A, B, C, D Female infertility can be attributed to alterations in any one of these systems along with possible vaginal-cervical factors. Although the diagnosis and treatment of infertility require considerable emotional investment and may cause psychologic stress, these are not considered factors associated with infertility. Feelings connected with infertility are many and complex. Resolveis an organization that provides support, advocacy, and education for both clients and health care providers.

4. Which methods help alleviate the problems associated with access to health care for the maternity client? (Select all that apply.) a. Provide transportation to prenatal visits. b. Provide child care to enable a pregnant woman to keep prenatal visits. c. Increase the number of providers that will care for Medicaid clients. d. Provide low-cost or no-cost health care insurance. e. Provide job training.

ANS: A, B, C, D Lack of transportation to prenatal visits, child care, access to skilled obstetric providers, and affordable health insurance are prohibitive factors associated with the lack of prenatal care. Although job training may result in employment and income, the likelihood of significant changes during the time frame of the pregnancy is remote.

Congenital disorders refer to conditions that are present at birth. These disorders may be inherited and caused by environmental factors or maternal malnutrition. Toxic exposures have the greatest effect on development between 15 and 60 days of gestation. For the nurse to be able to conduct a complete assessment of the newly pregnant patient, she should understand the significance of exposure to known human teratogens. These include (choose all that apply): a. Infections. b. Radiation. c. Maternal conditions. d. Drugs. e. Chemicals.

ANS: A, B, C, D, E Exposure to radiation and a number of infections may result in profound congenital deformities. These include but are not limited to varicella, rubella, syphilis, parvovirus, cytomegalovirus, and toxoplasmosis. Certain maternal conditions such as diabetes and phenylketonuria may also affect organs and other parts of the embryo during this developmental period. Drugs such as antiseizure medication and some antibiotics, as well as chemicals, including lead, mercury, tobacco, and alcohol, also may result in structural and functional abnormalities.

While completing an assessment, the nurse should be aware of ailments for which homeless women are at higher risk. Choose all that apply. a. Tuberculosis b. Chlamydia c. Anemia d. Hypothermia e. Alcoholism

ANS: A, B, C, D, E Poor living conditions contribute to higher rates of infectious disease. Many homeless individuals engage in sexual favors, which may expose them to sexually transmitted infections (STIs). Poor nutrition can lead to anemia. Exposure to cold temperatures and harsh environmental surroundings may lead to hypothermia. Many homeless people turn to alcohol as a coping mechanism.

1. While completing an assessment of a homeless woman, the nurse should be aware of which of the following ailments this client is at a higher risk to develop? (Select all that apply.) a. Infectious diseases b. Chronic illness c. Anemia d. Hyperthermia e. Substance abuse

ANS: A, B, C, E Poor living conditions contribute to higher rates of infectious disease. Many homeless individuals engage in sexual favors, which may expose them to sexually transmitted infections (STIs). Poor nutrition can lead to anemia. Lifestyle factors also contribute to chronic illness. Exposure to cold temperatures and harsh environmental surroundings may lead to hypothermia. Many homeless people turn to alcohol and other substances as coping mechanisms.

4. Many pregnant teenagers wait until the second or third trimester to seek prenatal care. What should the nurse recognize as reasons for this delay? (Select all that apply.) a. Lack of realization that they are pregnant b. Uncertainty as to where to go for care c. Continuing to deny the pregnancy d. Desire to gain control over their situation e. Wanting to hide the pregnancy as long as possible

ANS: A, B, C, E These reasons are all valid explanations why teens delay seeking prenatal care. An adolescent often has little to no understanding of the increased physiologic needs that a pregnancy places on her body. Once care is sought, it is often sporadic, and many appointments are usually missed. The nurse should formulate a diagnosis that assists the pregnant teen to receive adequate prenatal care. Planning for her pregnancy and impending birth actually provides some sense of control for the teen and increases her feelings of competency. Receiving praise from the nurse when she attends her prenatal appointments will reinforce the teens positive self-image.

3. The nurse is responsible for providing health teaching regarding the side effects of COCs. These side effects are attributed to estrogen, progesterone, or both. Which side effects are related to the use of COCs? (Select all that apply.) a. Gallbladder disease b. Myocardial infarction and stroke c. Hypotension d. Breast tenderness and fluid retention e. Dry skin and scalp

ANS: A, B, D Serious side effects include stroke, myocardial infarction, hypertension, gallbladder disease, and liver tumors. More common side effects include nausea, breast tenderness, fluid retention, increased appetite, oily skin and scalp, and chloasma.

1. Congenital disorders refer to those conditions that are present at birth. These disorders may be inherited and caused by environmental factors or maternal malnutrition. Toxic exposures have the greatest effect on development between 15 and 60 days of gestation. For the nurse to be able to conduct a complete assessment of the newly pregnant client, he or she should be knowledgeable regarding known human teratogens. Which substances might be considered a teratogen? (Select all that apply.) a. Cytomegalovirus (CMV) b. Ionizing radiation c. Hypothermia d. Carbamazepine e. Lead

ANS: A, B, D, E Exposure to radiation and a number of infections may result in profound congenital deformities. These include but are not limited to varicella, rubella, syphilis, parvovirus, CMV, and toxoplasmosis. Certain maternal conditions such as diabetes and phenylketonuria (PKU) may also affect organs and other parts of the embryo during this developmental period. Drugs such as antiseizure medications (e.g., carbamazepine) and some antibiotics, as well as chemicals including lead, mercury, tobacco, and alcohol, may also result in structural and functional abnormalities.

2. The Patient Protection and Affordable Care Act (ACA) was signed into law by President Obama in early 2010. The Act provides some immediate benefits, and other provisions will take place over the next several years. The practicing nurse should have a thorough understanding of how these changes will benefit his or her clients. Which outcomes are goals of the ACA? (Select all that apply.) a. Insurance affordability b. Improve public health c. Treatment of illness d. Elimination of Medicare and Medicaid e. Cost containment

ANS: A, B, E The ACA goals are to make insurance more affordable, contain costs, and strengthen Medicare and Medicaid. The Act contains provisions that promote the prevention of illness and improve access to public health. The ultimate goal of the Act is to improve the quality of care for all Americans while reducing waste, fraud, and abuse of the current system.

2. Relating to the fetal circulatory system, which special characteristics allow the fetus to obtain sufficient oxygen from the maternal blood? (Select all that apply.) a. Fetal hemoglobin (Hb) carries 20% to 30% more oxygen than maternal Hb. b. Fetal Hb carries 40% to 50% more oxygen than maternal Hb. c. Hb concentration is 50% higher than that of the mother. d. Fetal heart rate is 110 to 160 beats per minute. e. Fetal heart rate is 160 to 200 beats per minute.

ANS: A, C, D The following three special characteristics enable the fetus to obtain sufficient oxygen from maternal blood: (1) the fetal Hb carries 20% to 30% more oxygen; (2) the concentration is 50% higher than that of the mother; and (3) the fetal heart rate is 110 to 160 beats per minute, a cardiac output that is higher than that of an adult.

2. A probable cause for increasing infertility is the societal delay in pregnancy until later in life. What are the natural reasons for the decrease in female fertility? (Select all that apply.) a. Ovulation dysfunction b. Endocrine dysfunction c. Organ damage from toxins d. Endometriosis e. Tubal infections

ANS: A, C, D, E All of these factors may result in a cumulative effect, decreasing fertility in women. Male infertility is more often caused by unfavorable sperm production attributable to endocrine dysfunction or cumulative metabolic disease.

MULTIPLE RESPONSE 1. The nurse is reviewing the educational packet provided to a client about tubal ligation. Which information regarding this procedure is important for the nurse to share? (Select all that apply.) a. It is highly unlikely that you will become pregnant after the procedure. b. Tubal ligation is an effective form of 100% permanent sterilization. You wont be able to get pregnant. c. Sterilization offers some form of protection against STIs. d. Sterilization offers no protection against STIs. e. Your menstrual cycle will greatly increase after your sterilization.

ANS: A, D A woman is unlikely to become pregnant after tubal ligation. However, sterilization offers no protection against STIs and is not 100% effective. Typically, the menstrual cycle remains the same after a tubal ligation.

2. Which statements regarding menstruation (periodic uterine bleeding) are accurate? (Select all that apply.) a. Menstruation occurs every 28 days. b. During menstruation, the entire uterine lining is shed. c. Menstruation begins 7 to 10 days after ovulation. d. Menstruation leads to fertilization. e. Average blood loss during menstruation is 50 ml.

ANS: A, E Menstruation is the periodic uterine bleeding that is controlled by a feedback system involving three cycles: the endometrial cycle, the hypothalamic-pituitary cycle, and the ovarian cycle. The average length of a menstrual cycle is 28 days; however, variations are normal. During the endometrial cycle, the functional two thirds of the endometrium is shed. The average blood loss is 50 ml with a normal range of 20 to 80 ml. Menstruation occurs 14 days after ovulation. The lack of fertilization leads to menstruation.

12. Which body part both protects the pelvic structures and accommodates the growing fetus during pregnancy? a. Perineum b. Bony pelvis c. Vaginal vestibule d. Fourchette

ANS: B The bony pelvis protects and accommodates the growing fetus. The perineum covers the pelvic structures. The vaginal vestibule contains openings to the urethra and vagina. The fourchette is formed by the labia minor.

Which test used to diagnose the basis of infertility is done during the luteal or secretory phase of the menstrual cycle? a. Hysterosalpingogram b. Endometrial biopsy c. Laparoscopy d. Follicle-stimulating hormone (FSH) level

ANS: B A A hysterosalpingogram is scheduled 2 to 5 days after menstruation to avoid flushing potentially fertilized ovum out through a uterine tube into the peritoneal cavity. B Endometrial biopsy is scheduled after ovulation, during the luteal phase of the menstrual cycle. C Laparoscopy usually is scheduled early in the menstrual cycle. D Hormone analysis is performed to assess endocrine function of the hypothalamic-pituitary-ovarian axis when menstrual cycles are absent or irregular.

During the past 20 years, the prevalence of obesity has increased dramatically in the United States, with one-third of women older than 20 years of age being obese. Body mass index is defined as the measure of an adults weight in relation to his or her height. This is currently the most accurate measure of weight. It is an important part of the health screening process because obesity is closely associated with: a. The non-Hispanic Caucasian population. b. A large number of chronic conditions. c. Mostly acute illnesses. d. Improved mental well-being.

ANS: B A In the United States, the prevalence of obesity is highest among non-Hispanic black women, followed by Hispanic women and non-Hispanic Caucasian women. B Overweight and obesity are known risk factors for diabetes, heart disease, dyslipidemia, stroke, hypertension, arthritis, osteoporosis, and some types of cancer. C Overweight and obesity are most frequently linked to chronic conditions. D This is a myth. In fact, obesity is associated with depression and increased stress.

With regard to the structure and function of the placenta, the maternity nurse should be aware that: a. As the placenta widens, it gradually thins to allow easier passage of air and nutrients. b. As one of its early functions, the placenta acts as an endocrine gland. c. The placenta is able to keep out most potentially toxic substances such as cigarette smoke to which the mother is exposed. d. Optimal blood circulation is achieved through the placenta when the woman is lying on her back or standing.

ANS: B A The placenta widens until week 20 and continues to grow thicker. B The placenta produces four hormones necessary to maintain the pregnancy. C Toxic substances such as nicotine and carbon monoxide readily cross the placenta into the fetus. D Optimal circulation occurs when the woman is lying on her side.

The nurse should be aware that a statistic widely used to compare the health status of different populations would be the: a. Incidence of specific infections such as acquired immunodeficiency syndrome (AIDS) and tuberculosis. b. Infant mortality rate. c. Maternal morbidity rate. d. Incidence of low-birth-weight infants.

ANS: B A These factors may be the target of research studies, but maternal and infant mortality rates are particularly important. B City, county, and state health departments provide annual reports of births and deaths. Maternal and infant death rates are particularly important because they reflect health outcomes that may be preventable. C These factors may be the target of research studies, but maternal and infant mortality rates are particularly important. D These factors may be the target of research studies, but maternal and infant mortality rates are particularly important.

14. Which statement regarding the Family Systems Theory is inaccurate? a. Family system is part of a larger suprasystem. b. Family, as a whole, is equal to the sum of the individual members. c. Changes in one family member affect all family members. d. Family is able to create a balance between change and stability.

ANS: B A family, as a whole, is greater than the sum of its individual members. The other statements are accurate and can be attributed to the Family Systems Theory.

16. Which information regarding substance abuse is important for the nurse to understand? a. Although cigarette smoking causes a number of health problems, it has little direct effect on maternity-related health. b. Women, ages 21 to 34 years, have the highest rates of specific alcohol-related problems. c. Coffee is a stimulant that can interrupt body functions and has been related to birth defects. d. Prescription psychotherapeutic drugs taken by the mother do not affect the fetus; otherwise, they would not have been prescribed.

ANS: B Although a very small percentage of childbearing women have alcohol-related problems, alcohol abuse during pregnancy has been associated with a number of negative outcomes. Cigarette smoking impairs fertility and is a cause of low-birth-weight infants. Caffeine consumption has not been related to birth defects. Psychotherapeutic drugs have some effect on the fetus, and that risk must be weighed against their benefit to the mother.

24. A woman who is 16 weeks pregnant asks the nurse, Is it possible to tell by ultrasound if the baby is a boy or girl yet? What is the best answer? a. A babys sex is determined as soon as conception occurs. b. The baby has developed enough to enable us to determine the sex by examining the genitals through an ultrasound scan. c. Boys and girls look alike until approximately 20 weeks after conception, and then they begin to look different. d. It might be possible to determine your babys sex, but the external organs look very similar right now.

ANS: B Although gender is determined at conception, the external genitalia of males and females look similar through the ninth week. By the twelfth week, the external genitalia are distinguishable as male or female.

26. Which statement about the development of cultural competence is inaccurate? a. Local health care workers and community advocates can help extend health care to underserved populations. b. Nursing care is delivered in the context of the clients culture but not in the context of the nurses culture. c. Nurses must develop an awareness of and a sensitivity to various cultures. d. Cultures economic, religious, and political structures influence practices that affect childbearing.

ANS: B Although the cultural context of the nurse affects the delivery of nursing care and is very important, the work of local health care workers and community advocates, developing sensitivity to various cultures, and the impact of economic, religious, and political structures are all parts of cultural competence.

15. Which statement regarding human trafficking is correct? a. Human trafficking is a multibillion-dollar business that primarily exists in the United States. b. Victims often experience the Stockholm syndrome. c. Vast majority of the victims are young boys and girls. d. Human trafficking primarily refers to commercial sex work.

ANS: B Although victims of sex trafficking can be young boys and girls, the vast majority are women and girls. They are often lured by false promises, such as a job or marriage, sold by their parents, or kidnapped by traffickers. These individuals are forced into sex work, hard labor, and organ donation. This $32 billion business exists in the United States and internationally. The Stockholm syndrome occurs when the slaves become attached to their enslavers. Health care professionals may interact with victims who are in captivity should they require emergent health care. The nurse is challenged to find an opportunity to speak with the client alone and assess for victimization.

5. Which statement regarding the structure and function of the placenta is correct? a. Produces nutrients for fetal nutrition b. Secretes both estrogen and progesterone c. Forms a protective, impenetrable barrier to microorganisms such as bacteria and viruses d. Excretes prolactin and insulin

ANS: B As one of its early functions, the placenta acts as an endocrine gland, producing four hormones necessary to maintain the pregnancy and to support the embryo or fetus: human chorionic gonadotropin (hCG), human placental lactogen (hPL), estrogen, and progesterone. The placenta does not produce nutrients. It functions as a means of metabolic exchange between the maternal and fetal blood supplies. Many bacteria and viruses can cross the placental membrane.

18. Which contraceptive method best protects against STIs and the HIV? a. Periodic abstinence b. Barrier methods c. Hormonal methods d. Same protection with all methods

ANS: B Barrier methods, such as condoms, protect against STIs and the HIV the best of all contraceptive methods. Periodic abstinence and hormonal methods, such as birth control pills, offer no protection against STIs or the HIV.

The nurse suspects that a client who comes to the maternity clinic for a pregnancy test is in an abusive relationship. The nurse includes the abuse assessment screen as part of the assessment. Although the woman was very emotional and hesitant in responding to the questions, verbally she denied abuse as being a problem. While waiting for the results of the pregnancy test, the nurse decides to teach the client about partner abuse anyway. The rationale for the nurses decision is that all women should be informed about: a. The nurses ethical responsibility to protect clients b. The cycle of violence, which continues and escalates over time once it begins c. Womens legal right not to be controlled by men d. The masochistic nature of women who stay in abusive relationships

ANS: B Because of the cycle of violence and the loving respite phase, denial is a coping mechanism often used by battered women. During pregnancy the nurse should assess for abuse at each prenatal visit and on admission to labor. Although the nurse may feel an ethical responsibility to protect the client, it is not the best rationale for the nurses behavior. Although women have a right not to be controlled by men, it is not the reason the nurse should continue the teaching with this client. The belief that women are masochistic is simply a myth.

3. A woman who has a seizure disorder and takes barbiturates and phenytoin sodium daily asks the nurse about the pill as a contraceptive choice. What is the nurses best response? a. Oral contraceptives are a highly effective method, but they have some side effects. b. Your current medications will reduce the effectiveness of the pill. c. Oral contraceptives will reduce the effectiveness of your seizure medication. d. The pill is a good choice for a woman of your age and with your personal history.

ANS: B Because the liver metabolizes oral contraceptives, their effectiveness is reduced when they are simultaneously taken with anticonvulsants. Stating that the pill is an effective birth control method with side effects is a true statement, but this response is not the most appropriate. The anticonvulsant reduces the effectiveness of the pill, not the other way around. Stating that the pill is a good choice for a woman of her age and personal history does not teach the client that the effectiveness of the pill may be reduced because of her anticonvulsant therapy.

2. Which key factors play the most powerful role in the behaviors of individuals and families? a. Rituals and customs b. Beliefs and values c. Boundaries and channels d. Socialization processes

ANS: B Beliefs and values are the most prevalent factors in the decision-making and problem-solving behaviors of individuals and families. This prevalence is particularly true during times of stress and illness. Although culture may play a part in the decision-making process of a family, ultimately, values and beliefs dictate the course of action taken by family members. Boundaries and channels affect the relationship between the family members and the health care team, not the decisions within the family. Socialization processes may help families with interactions within the community, but they are not the criteria used for decision making within the family.

5. Which statement is most accurate regarding the reporting of IPV in the United States? a. Asian women report more IPV than do other minority groups. b. Caucasian women report less IPV than do non-Caucasians. c. Native-American women report IPV at a rate similar to other groups. d. African-American women are less likely to report IPV than Caucasian women.

ANS: B Caucasian women report less IPV than other ethnic groups. Asian women report significantly less IPV than do other racial groups. Native-American and Alaska Native women report significantly more IPV than do women of any other racial background. African-American women tend to report violence at a slightly higher rate than Caucasian women.

6. Which statement best exemplifies contemporary maternity nursing? a. Use of midwives for all vaginal deliveries b. Family-centered care c. Free-standing birth clinics d. Physician-driven care

ANS: B Contemporary maternity nursing focuses on the familys needs and desires. Fathers, partners, grandparents, and siblings may be present for the birth and participate in activities such as cutting the babys umbilical cord. Both midwives and physicians perform vaginal deliveries. Free-standing clinics are an example of alternative birth options. Contemporary maternity nursing is driven by the relationship between nurses and their clients.

25. Nurses, certified nurse-midwives, and other advanced practice nurses have the knowledge and expertise to assist women in making informed choices regarding contraception. A multidisciplinary approach should ensure that the womans social, cultural, and interpersonal needs are met. Which action should the nurse first take when meeting with a new client to discuss contraception? a. Obtain data about the frequency of coitus. b. Determine the womans level of knowledge concerning contraception and her commitment to any particular method. c. Assess the womans willingness to touch her genitals and cervical mucus. d. Evaluate the womans contraceptive life plan.

ANS: B Determining the womans level of knowledge concerning contraception and her commitment to any particular method is the primary step of this nursing assessment and necessary before completing the process and moving on to a nursing diagnosis. Once the clients level of knowledge is determined, the nurse can interact with the woman to compare options, reliability, cost, comfort level, protection from STIs, and her partners willingness to participate. Although important, obtaining data about the frequency of coitus is not the first action that the nurse should undertake when completing an assessment. Data should include not only the frequency of coitus but also the number of sexual partners, level of contraceptive involvement, and the partners objections. Assessing the womans willingness to touch herself is a key factor for the nurse to discuss should the client express an interest in using one of the fertility awareness methods of contraception. The nurse must be aware of the clients plan regarding whether she is attempting to prevent conception, delay conception, or conceive.

8. An unmarried young woman describes her sex life as active and involving many partners. She wants a contraceptive method that is reliable and does not interfere with sex. She requests an intrauterine device (IUD). Which information is most important for the nurse to share? a. The IUD does not interfere with sex. b. The risk of pelvic inflammatory disease will be higher with the IUD. c. The IUD will protect you from sexually transmitted infections. d. Pregnancy rates are high with the IUD.

ANS: B Disadvantages of IUDs include an increased risk of pelvic inflammatory disease (PID) in the first 20 days after insertion, as well as the risks of bacterial vaginosis and uterine perforation. The IUD offers no protection against sexually transmitted infections (STIs) or the human immunodeficiency virus (HIV), as does a barrier method. Because this woman has multiple sex partners, she is at higher risk of developing an STI. Stating that an IUD does not interfere with sex may be correct; however, it is not the most appropriate response. The typical failure rate of the IUD is approximately 1%.

25. During a health history interview, a woman states that she thinks that she has bumps on her labia. She also states that she is not sure how to check herself. The correct response by the nurse would be what? a. Reassure the woman that the examination will reveal any problems. b. Explain the process of vulvar self-examination, and reassure the woman that she should become familiar with normal and abnormal findings during the examination. c. Reassure the woman that bumps can be treated. d. Reassure her that most women have bumps on their labia.

ANS: B During the assessment and evaluation, the responsibility for self-care, health promotion, and enhancement of wellness is emphasized. The pelvic examination provides a good opportunity for the practitioner to emphasize the need for regular vulvar self-examination. Providing reassurance to the woman concerning the bumps would not be an accurate response.

3. Which trait is least likely to be displayed by a woman experiencing intimate partner violence (IPV)? a. Socially isolated b. Assertive personality c. Struggling with depression d. Dependent partner in a relationship

ANS: B Every segment of society is represented among women who are suffering abuse. However, traits of assertiveness, independence, and willingness to take a stand have been documented as more characteristic of women who are in nonviolent relationships. Women who are financially more dependent have fewer resources and support systems, exhibit symptoms of depression, and are more often seen as victims.

12. Which statement best describes maternity nursing care that is based on knowledge gained through research and clinical trials? a. Maternity nursing care is derived from the Nursing Intervention Classification. b. Maternity nursing care is known as evidence-based practice. c. Maternity nursing care is at odds with the Cochrane School of traditional nursing. d. Maternity nursing care is an outgrowth of telemedicine.

ANS: B Evidence-based practice is based on knowledge gained from research and clinical trials. The Nursing Intervention Classification is a method of standardizing language and categorizing care. Dr. Cochrane systematically reviewed research trials and is part of the evidence-based practice movement. Telemedicine uses communication technologies to support health care.

2. A married couple is discussing alternatives for pregnancy prevention and has asked about fertility awareness methods (FAMs). Which response by the nurse is most appropriate? a. Theyre not very effective, and it is very likely that youll get pregnant. b. FAMs can be effective for many couples; however, they require motivation. c. These methods have a few advantages and several health risks. d. You would be much safer going on the pill and not having to worry.

ANS: B FAMs are effective with proper vigilance about ovulatory changes in the body and with adherence to coitus intervals. FAMs are effective if correctly used by a woman with a regular menstrual cycle. The typical failure rate for all FAMs is 24% during the first year of use. FAMs have no associated health risks. The use of birth control has associated health risks. In addition, taking a pill daily requires compliance on the clients part.

9. With regard to the assessment of female, male, or couple infertility, the nurse should be aware of which important information? a. The couples religious, cultural, and ethnic backgrounds provide emotional clutter that does not affect the clinical scientific diagnosis. b. The investigation will take several months and can be very costly. c. The woman is assessed first; if she is not the problem, then the male partner is analyzed. d. Semen analysis is for men; the postcoital test is for women.

ANS: B Fertility assessment and diagnosis take time, money, and commitment from the couple. Religious, cultural, and ethnic-bred attitudes about fertility and related issues always have an effect on diagnosis and assessment. Both partners are systematically and simultaneously assessed, first as individuals and then as a couple. Semen analysis is for men; however, the postcoital test is for the couple.

11. In 1979, Lenore Walker pioneered the cause of women as victims of violence when she published her book The Battered Woman. While Walker conducted her research, she found a similar pattern of abuse among many of the women. This concept is now referred to as the cycle of violence. Which phase does not belong in this three-cycle pattern of violence? a. Tension-building state b. Frustration, followed by violence c. Acute battering incident d. Kindness and contrite, loving behavior

ANS: B Frustration, followed by violence, is not part of the cycle of violence. The tension-building state is also known as phase I of the cycle. The batterer expresses dissatisfaction and hostility with violent outbursts. The woman senses anger and anxiously tries to placate him. An acute battering incident is phase II of the cycle. It results in the mans uncontrollable discharge of tension toward the woman. Outbursts can last from several hours to several days and may involve kicking, punching, slapping, choking, burns, broken bones, and the use of weapons. Phase III of the cycle is sometimes referred to as the honeymoon, kindness and contrite,and loving behavior phase, during which the batterer feels remorseful and profusely apologizes. He tries to help the woman and often showers her with gifts.

16. Which statement concerning neurologic and sensory development in the fetus is correct? a. Brain waves have been recorded on an electroencephalogram as early as the end of the first trimester (12 weeks of gestation). b. Fetuses respond to sound by 24 weeks of gestation and can be soothed by the sound of the mothers voice. c. Eyes are first receptive to light at 34 to 36 weeks of gestation. d. At term, the fetal brain is at least one third the size of an adult brain.

ANS: B Hearing develops early and is fully developed at birth. Brain waves have been recorded at week 8. Eyes are receptive to light at 28 weeks of gestation. The fetal brain is approximately one fourth the size of an adult brain.

6. What is the primary difference between hospital care and home health care? a. Home care is routinely and continuously delivered by professional staff. b. Home care is delivered on an intermittent basis by professional staff. c. Home care is delivered for emergency conditions. d. Home care is not available 24 hours a day.

ANS: B Home care is generally delivered on an intermittent basis by professional staff members. The primary difference between health care in a hospital and home care is the absence of the continuous presence of professional health care providers in a clients home. In a true emergency, the client should be directed to call 9-1-1 or to report to the nearest hospitals emergency department. Generally, home health care entails intermittent care by a professional who visits the clients home for a particular reason and provides on-site care for periods shorter than 4 hours at a time.

17. The secondary level of prevention is best illustrated by which example? a. Approved infant car seats b. BSE c. Immunizations d. Support groups for parents of children with Down syndrome

ANS: B Infant car seats are an example of primary prevention. BSE is an example of the secondary level of prevention, which includes health-screening measures for early detection of health problems. Immunizations are an example of the primary level of prevention. Support groups are an example of tertiary prevention, which follows the occurrence of a defect or disability (e.g., Down syndrome).

26. The pancreas forms in the foregut during the 5th to 8th week of gestation. A client with poorly controlled gestational diabetes asks the nurse what the effects of her condition will be on the fetus. What is the best response by the nurse? Poorly controlled maternal gestational diabetes will: a. produce fetal hypoglycemia. b. result in a macrocosmic fetus. c. result in a microcosmic fetus. d. enhance lung maturation.

ANS: B Insulin is produced by week 20 of gestation. In the fetus of a mother with uncontrolled diabetes, maternal hypoglycemia produces fetal hypoglycemia and macrocosmia results. Hyperinsulinemia blocks lung maturation, placing the neonate at risk for respiratory distress.

6. The nurse working with clients who have infertility concerns should be aware of the use of leuprolide acetate (Lupron) as a gonadotropin-releasing hormone (GnRH) agonist. For which condition would this medication be prescribed? a. Anovulatory cycles b. Uterine fibroids c. Polycystic ovary disease (PCOD) d. Luteal phase inadequacy

ANS: B Leuprolide acetate is used to treat endometriosis and uterine fibroids. Anovulatory cycles are treated with Clomid, Serophene, Pergonal, or Profasi, all of which stimulate ovulation induction. Metrodin is used to treat PCOD. Progesterone is used to treat luteal phase inadequacy.

22. A woman is 15 weeks pregnant with her first baby. She asks how long it will be before she feels the baby move. What is the nurses best answer? a. You should have felt the baby move by now. b. Within the next month, you should start to feel fluttering sensations. c. The baby is moving; however, you cant feel it yet. d. Some babies are quiet, and you dont feel them move.

ANS: B Maternal perception of fetal movement usually begins 16 to 20 weeks after conception. Because this is her first pregnancy, movement is felt toward the later part of the 16- to 20-week time period. Stating, you should have felt the baby move by now is incorrect and may be an alarming statement to the client. Fetal movement should be felt by 16 to 20 weeks. If movement is not felt by the end of that time, then further assessment is necessary.

1. A newly married couple plans to use the natural family planning method of contraception. Understanding how long an ovum can live after ovulation is important to them. The nurse knows that his or her teaching was effective when the couple responds that an ovum is considered fertile for which period of time? a. 6 to 8 hours b. 24 hours c. 2 to 3 days d. 1 week

ANS: B Most ova remain fertile for approximately 24 hours after ovulation, much longer than 6 to 8 hours. However, ova do not remain fertile for 2 to 3 days or are viable for 1 week. If unfertilized by a sperm after 24 hours, the ovum degenerates and is reabsorbed.

23. A male client asks the nurse why it is better to purchase condoms that are not lubricated with nonoxynol-9 (a common spermicide). Which response by the nurse is the most accurate? a. The lubricant prevents vaginal irritation. b. Nonoxynol-9 does not provide protection against STIs as originally thought; it has also been linked to an increase in the transmission of the HIV and can cause genital lesions. c. The additional lubrication improves sex. d. Nonoxynol-9 improves penile sensitivity.

ANS: B Nonoxynol-9 does not provide protection against STIs as originally thought; it has also been linked to an increase in the transmission of the HIV and can cause genital lesions. Nonoxynol-9 may cause vaginal irritation, has no effect on the quality of sexual activity, and has no effect on penile sensitivity.

12. A woman inquires about herbal alternative methods for improving fertility. Which statement by the nurse is most appropriate when informing the client on which herbal preparations may improve ovulation induction therapy? a. You should avoid nettle leaf, dong quai, and vitamin E while you are trying to get pregnant. b. You may want to try black cohosh or phytoestrogens. c. You should take vitamins E and C, selenium, and zinc. d. Herbs have no bearing on fertility.

ANS: B Ovulation therapy may have better outcomes when supplemented by black cohosh, progesterone, or plant estrogens. Antioxidant vitamins E and C, selenium, zinc, coenzyme 10, and ginseng have been shown to improve male fertility. Although most herbal remedies have not been clinically proven, many women find them helpful. They should be prescribed by a health care provider who has knowledge of herbalism.

15. What fatty acids (classified as hormones) are found in many body tissues with complex roles in many reproductive functions? a. GnRH b. Prostaglandins (PGs) c. FSH d. Luteinizing hormone (LH)

ANS: B PGs affect smooth muscle contraction and changes in the cervix. GnRH is part of the hypothalamic-pituitary cycle, which responds to the rise and fall of estrogen and progesterone. FSH is part of the hypothalamic-pituitary cycle, which responds to the rise and fall of estrogen and progesterone. LH is part of the hypothalamic-pituitary cycle, which responds to the rise and fall of estrogen and progesterone.

3. How would the physiologic process of the sexual response best be characterized? a. Coitus, masturbation, and fantasy b. Myotonia and vasocongestion c. Erection and orgasm d. Excitement, plateau, and orgasm

ANS: B Physiologically, according to Masters (1992), sexual response can be analyzed in terms of two processes: vasocongestion and myotonia. Coitus, masturbation, and fantasy are forms of stimulation for the physical manifestation of the sexual response. Erection and orgasm occur in two of the four phases of the sexual response cycle. Excitement, plateau, and orgasm are three of the four phases of the sexual response cycle.

16. Significant advances have been made with most reproductive technologies. Which improvement has resulted in increased success related to preimplantation genetic diagnosis? a. Embryos are transferred at the cleavage stage. b. Embryos are transferred at the blastocyst stage. c. More than two embryos can be transferred at a time. d. Two cells are removed from each embryo.

ANS: B Preimplantation genetic diagnosis can be performed on a single cell removed from each embryo after 3 to 4 days. With the availability of extended culture mediums, embryos are transferred at the blastocyst stage (day 5), which increases the chance of a live birth, compared with the older practice of transferring embryos at the cleavage stage (day 3). No more than two embryos should be transferred at a time.

11. The lactational amenorrhea method (LAM) of birth control is popular in developing countries and has had limited use in the United States. As breastfeeding rates increase, more women may rely upon this method for birth control. Which information is most important to provide to the client interested in using the LAM for contraception? a. LAM is effective until the infant is 9 months of age. b. This popular method of birth control works best if the mother is exclusively breastfeeding. c. Its typical failure rate is 5%. d. Feeding intervals should be 6 hours during the day.

ANS: B The LAM works best if the mother is exclusively or almost exclusively breastfeeding. Disruption of the breastfeeding pattern increases the risk of pregnancy. After the infant is 6 months of age or menstrual flow has resumed, effectiveness decreases. The typical failure rate is 1% to 2%. Feeding intervals should be no greater than 4 hours during the day and 6 hours at night.

What is not a potential pitfall or disadvantage of the fertility awareness methods (FAMs)? a. Adherence to strict record keeping b. Alterations in the menstrual flow pattern with chemicals and hormones c. Decreased effectiveness in women with irregular cycles d. Time-consuming training sessions

ANS: B The absence of chemicals or hormones to alter the menstrual flow is an advantage. The strict record keeping FAMs require creates a potential risk. FAMs are less effective for women with irregular cycles. FAMs require time-consuming training for effective use.

15. Which benefit regarding FAMs makes it an appealing choice for some women? a. Adherence to strict recordkeeping b. Absence of chemicals and hormones c. Decreased involvement and intimacy of partner d. Increased spontaneity of coitus

ANS: B The absence of chemicals or hormones to alter the natural menstrual flow is extremely important to some women. The strict recordkeeping with FAMs may be difficult and creates a potential risk for failure. These methods require increased involvement by the partner; however, they also reduce the spontaneity of coitus.

4. A woman who is 6 months pregnant has sought medical attention, saying she fell down the stairs. What scenario would cause an emergency department nurse to suspect that the woman has been a victim of IPV? a. The woman and her partner are having an argument that is loud and hostile. b. The woman has injuries on various parts of her body that are in different stages of healing. c. Examination reveals a fractured arm and fresh bruises. d. She avoids making eye contact and is hesitant to answer questions.

ANS: B The client may have multiple injuries in various stages of healing that indicates a pattern of violence. An argument is not always an indication of battering. A fractured arm and fresh bruises could be caused by the reported fall and do not necessarily indicate IPV.It may be normal for the woman to be reticent and have a dull affect.

21. The unique muscle fibers that constitute the uterine myometrium make it ideally suited for what? a. Menstruation b. Birth process c. Ovulation d. Fertilization

ANS: B The myometrium is made up of layers of smooth muscle that extend in three directions. These muscles assist in the birth process by expelling the fetus, ligating blood vessels after birth, and controlling the opening of the cervical os.

24. A 62-year-old woman has not been to the clinic for an annual examination for 5 years. The recent death of her husband reminded her that she should come for a visit. Her family physician has retired, and she is going to see the womens health nurse practitioner for her visit. What should the nurse do to facilitate a positive health care experience for this client? a. Remind the woman that she is long overdue for her examination and that she should come in annually. b. Carefully listen, and allow extra time for this womans health history interview. c. Reassure the woman that a nurse practitioner is just as good as her old physician. d. Encourage the woman to talk about the death of her husband and her fears about her own death.

ANS: B The nurse has an opportunity to use reflection and empathy while listening, as well as ensure an open and caring communication. Scheduling a longer appointment time may be necessary because older women may have longer histories or may need to talk. A respectful and reassuring approach to caring for women older than age 50 years can help ensure that they continue to seek health care. Reminding the woman about her overdue examination, reassuring the woman that she has a good practitioner, and encouraging conversation about the death of her husband and her own death are not the best approaches.

18. Which key point is important for the nurse to understand regarding the perinatal continuum of care? a. Begins with conception and ends with the birth b. Begins with family planning and continues until the infant is 1 year old c. Begins with prenatal care and continues until the newborn is 24 weeks old d. Refers to home care only

ANS: B The perinatal continuum of care begins with family planning and continues until the infant is 1 year old. It takes place both at home and in health care facilities. The perinatal continuum does not end with the birth. The perinatal continuum begins before conception and continues after the birth. Home care is one delivery component; health care facilities are another.

13. The maternity nurse is cognizant of what important structure and function of the placenta? a. As the placenta widens, it gradually thins to allow easier passage of air and nutrients. b. As one of its early functions, the placenta acts as an endocrine gland. c. The placenta is able to keep out most potentially toxic substances, such as cigarette smoke, to which the mother is exposed. d. Optimal blood circulation is achieved through the placenta when the woman is lying on her back or standing.

ANS: B The placenta produces four hormones necessary to maintain the pregnancy: hCG, hPL, estrogen, and progesterone. The placenta widens until 20 weeks of gestation and continues to grow thicker. Toxic substances such as nicotine and carbon monoxide readily cross the placenta into the fetus. Optimal circulation occurs when the woman is lying on her side.

12. Nurses must remember that pregnancy is a time of risk for all women. Which condition is likely the biggest risk for the pregnant client? a. Preeclampsia b. IPV c. Diabetes d. Abnormal Pap test

ANS: B The prevalence of IPV during pregnancy is estimated at 6% of all pregnant women. The risk for IPV and even IPV-related homicide is more common than all of the other pregnancy-related conditions. Although preeclampsia poses a risk to the health of the pregnant client, it is less common than IPV. Gestational diabetes continues to be a complication of pregnancy; however, it is less common than IPV during pregnancy. Some women are at risk for an abnormal Pap screening during pregnancy, but this finding is not as common as IPV.

20. Importantly, the nurse must be aware of which information related to the use of IUDs? a. Return to fertility can take several weeks after the device is removed. b. IUDs containing copper can provide an emergency contraception option if inserted within a few days of unprotected intercourse. c. IUDs offer the same protection against STIs as the diaphragm. d. Consent forms are not needed for IUD insertion.

ANS: B The woman has up to 5 days to insert the IUD after unprotected sex. The return to fertility is immediate after the removal of the IUD. IUDs offer no protection against STIs. A consent form is required for insertion, as is a negative pregnancy test.

28. Which statement by the client indicates that she understands BSE? a. I will examine both breasts in two different positions. b. I will examine my breasts 1 week after my menstrual period starts. c. I will examine only the outer upper area of the breast. d. I will use the palm of the hand to perform the examination.

ANS: B The woman should examine her breasts when hormonal influences are at their lowest level. The client should be instructed to use four positions: standing with arms at her sides, standing with arms raised above her head, standing with hands pressed against hips, and lying down. The entire breast needs to be examined, including the outer upper area. The client should use the sensitive pads of the middle three fingers.

15. During a prenatal intake interview, the client informs the nurse that she would prefer a midwife to provide both her care during pregnancy and deliver her infant. Which information is most appropriate for the nurse to share with this client? a. Midwifery care is only available to clients who are uninsured because their services are less expensive than an obstetrician. b. She will receive fewer interventions during the birth process. c. She should be aware that midwives are not certified. d. Her delivery can take place only at home or in a birth center.

ANS: B This client will be able to participate actively in all decisions related to the birth process and is likely to receive fewer interventions during the birth process. Midwifery services are available to all low-risk pregnant women, regardless of the type of insurance they have. Midwifery care in all developed countries is strictly regulated by a governing body to ensure that core competencies are met. In the United States, this body is the American College of Nurse-Midwives (ACNM). Midwives can provide care and delivery at home, in freestanding birth centers, and in community and teaching hospitals.

1. Which test is performed around the time of ovulation to diagnose the basis of infertility? a. Hysterosalpingogram b. Ultrasonography c. Laparoscopy d. Follicle-stimulating hormone (FSH) level

ANS: B Ultrasonography is performed around the time of ovulation to assess pelvic structures for abnormalities, to verify follicular development, and to assess the thickness of the endometrium. A hysterosalpingogram is scheduled 2 to 5 days after menstruation to avoid flushing a potentially fertilized ovum out through a uterine tube into the peritoneal cavity. Laparoscopy is usually scheduled early in the menstrual cycle. Hormone analysis is performed to assess endocrine function of the hypothalamic-pituitary-ovarian axis when menstrual cycles are absent or irregular.

12. When the services of an interpreter are needed, which is the most important factor for the nurse to consider? a. Using a family member who is fluent in both languages b. Using an interpreter who is certified, and documenting the persons name in the nursing notes c. Directing questions only to the interpreter d. Using an interpreter only in an emergency

ANS: B Using a certified interpreter ensures that the standards of care are met and that the information exchanged is reliable and unaltered. The name of the interpreter should be documented for legal purposes. Asking a family member to interpret may not be appropriate, although many health care personnel must adopt this approach in an emergency. Furthermore, most states require that certified interpreters be used when possible. When using an interpreter, the nurse should direct questions to the client. The interpreter is simply a means by which the nurse communicates with the client. Every attempt should be made to contact an interpreter whenever one is needed. During an emergency, health care workers often rely on information interpreted by family members. This information may be private and should be protected under the rules established by the Health Insurance Portability and Accountability Act (HIPAA). Furthermore, family members may skew information or may not be able to interpret the exact information the nurse is trying to obtain.

3. Which statements indicate that the nurse is practicing appropriate family-centered care techniques? (Select all that apply.) a. The nurse commands the pregnant woman to do as she is told. b. The nurse allows time for the partner to ask questions. c. The nurse allows the mother and father to make choices when possible. d. The nurse informs the family about what is going to happen. e. The nurse tells the clients sister, who is a nurse, that she cannot be in the room during the delivery.

ANS: B, C Including the partner in the care process and allowing the couple to make choices are important elements of family-centered care. The nurse should never tell the client what to do. Family-centered care involves collaboration between the health care team and the client. Unless an institutional policy limits the number of attendants at a delivery, the client should be allowed to have whomever she wants present (except when the situation is an emergency and guests are asked to leave).

3. Women who have undergone an oophorectomy, have ovarian failure, or a genetic defect may be eligible to receive donor oocytes (eggs). Which statements regarding oocyte donation are accurate? (Select all that apply.) a. Donor is inseminated with semen from the parent. b. Donor eggs are fertilized with the male partners sperm. c. Donors are under 35 years of age. d. Recipient undergoes hormonal stimulation. e. Ovum is placed into a surrogate.

ANS: B, C, D Oocyte donation is usually provided by healthy women under the age of 35 years, who are recruited and paid to undergo ovarian stimulation and oocyte retrieval. The donor eggs are fertilized in a laboratory with the male partners sperm. The woman undergoes hormonal stimulation to allow the development of the uterine lining. Embryos are then transferred. A donor that is inseminated with the male partners semen or receives the fertilized ovum and then carries it to gestation is known as a surrogate mother.

3. Women of all ages will receive substantial and immediate benefits from smoking cessation. The process is not easy, and most people have attempted to quit numerous times before achieving success. Which organizations provide self-help and smoking cessation materials? (Select all that apply.) a. Leukemia and Lymphoma Society b. March of Dimes c. American Cancer Society d. American Lung Association e. Easter Seals

ANS: B, C, D The March of Dimes, the American Lung Association, and the American Cancer Society have self-help materials available. The Leukemia and Lymphoma Society support research for these two types of cancer. Easter Seals is best known for its work with disabled children.

5. What are the responsibilities of the nurse who suspects or confirms any type of violence against a woman? (Select all that apply.) a. Report the incident to legal authorities. b. Provide resources for domestic violence shelters. c. Call a client advocate who can assist in the clients decision about what actions to take. d. Accurately and concisely document the incident (or findings) in the clients record. e. Reassure and support the client.

ANS: B, C, D, E Domestic violence is considered a crime in all states; however, mandatory reporting remains controversial. Nurses must become knowledgeable on the laws that apply in the state in which they practice. Caring for a client who may be a victim of domestic abuse is an ideal opportunity to provide the woman with information for safe houses or support groups for herself and her children. The nurse may assist in reaching out to a client advocate, which often occurs when potential legal action is taken or if the woman is seeking shelter. Documentation must be accurate and timely to be useful to the client later in court if she chooses to press charges. The primary functions for the nurse are to reassure the client and to provide her with emotional support.

2. Postabortion instructions may differ among providers regarding tampon use and the resumption of intercourse. However, education should be provided regarding serious complications. When should the woman who has undergone an induced abortion be instructed to return to the emergency department? (Select all that apply.) a. Fever higher than 39 C b. Chills c. Foul-smelling vaginal discharge d. Bleeding greater than four pads in 2 hours e. Severe abdominal pain

ANS: B, C, E The client should report to a health care facility for any of the following symptoms: fever higher than 38 C, chills, bleeding more than two saturated pads in 2 hours or heavy bleeding lasting for days, foul-smelling discharge, abdominal tenderness or pain, and cramping or backache.

4. The client and her partner are considering male sterilization as a form of permanent birth control. While educating the client regarding the risks and benefits of the procedure, which information should the nurse include? (Select all that apply.) a. Sterilization should be performed under general anesthesia. b. Pain, bleeding, and infection are possible complications. c. Pregnancy may still be possible. d. Vasectomy may affect potency. e. Secondary sex characteristics are unaffected.

ANS: B, C, E Vasectomy is the most commonly used procedure for male sterilization and is performed on an outpatient basis under local anesthesia. Pain, bleeding, swelling, and infection are considered complications. Reversal is generally unsuccessful; however, it may take several weeks to months for all sperm to be cleared from the sperm ducts. Another form of contraception is necessary until the sperm counts are zero. Vasectomy has no effect on potency, and secondary sex characteristics are not affected.

MULTIPLE RESPONSE 1. What are the two primary functions of the ovary? (Select all that apply.) a. Normal female development b. Ovulation c. Sexual response d. Hormone production e. Sex hormone release

ANS: B, D The two functions of the ovaries are ovulation and hormone production. The presence of ovaries does not guarantee normal female development. The ovaries produce estrogen, progesterone, and androgen. Ovulation is the release of a mature ovum from the ovary. Sexual response is a feedback mechanism involving the hypothalamus, anterior pituitary gland, and ovaries.

1. Greater than one third of women in the United States are now obese (body mass index [BMI] of 30 or greater). Less than one quarter of women in Canada exhibit the same BMI. Obesity in the pregnant woman increases both maternal medical risk factors and negative outcomes for the infant. The nurse is about to perform an assessment on a client who is 28 weeks pregnant and has a BMI of 35. What are the most frequently reported complications for which the nurse must be alert while assessing this client? (Select all that apply.) a. Potential miscarriage b. Diabetes c. Fetal death in utero d. Decreased fertility e. Hypertension

ANS: B, E The two most frequently reported maternal medical risk factors associated with obesity are hypertension associated with pregnancy and diabetes. Decreased fertility, miscarriage, fetal death, and congenital anomalies are also associated with obesity. These clients often experience longer hospital stays and increased use of health services.

Recent trends in childbirth practices in the United States indicate that: a. Only 15% of mothers receive prenatal care in the first trimester. b. The percentage of Hispanics, non-Hispanic African-Americans, and Caucasians who received prenatal care was essentially the same. c. Ninety-nine percent of births occurred in the hospital. d. Cesarean births have been declining as a percentage of live births.

ANS: C A Approximately 84% of women receive prenatal care in the first trimester. B Minority women are twice as likely to receive late prenatal care. C Almost no births occur outside the hospital. D The percentage of cesarean births is increasing.

A 20-year-old patient calls the clinic to report that she has found a lump in her breast. The nurses best response is: a. Dont worry about it. Im sure its nothing. b. Wear a tight bra, and it should shrink. c. Many women have benign lumps and bumps in their breasts. However, to make sure that its benign, you should come in for an examination by your physician. d. Check it again in 1 month and call me back if its still there.

ANS: C A Discrediting the patients findings may discourage her from continuing with breast self-examination. B Wearing a tight bra may irritate the skin and will not cause the lump to shrink. C Try to ease the patients fear, but provide a time for a thorough evaluation of the lump because it may indicate abnormal changes in the breast. D Delaying treatment may allow proliferation of abnormal cells.

A woman had unprotected intercourse 36 hours ago and is concerned that she may become pregnant because it is her fertile time. She asks the nurse about emergency contraception. The nurse tells her that: a. It is too late; she needed to begin treatment within 24 hours after intercourse. b. Preven, an emergency contraceptive method, is 98% effective at preventing pregnancy. c. An over-the-counter antiemetic can be taken 1 hour before each contraceptive dose to prevent nausea and vomiting. d. The most effective approach is to use a progestin-only preparation.

ANS: C A Emergency contraception is used within 72 hours of unprotected intercourse to prevent pregnancy. B Postcoital contraceptive use is 74% to 90% effective at preventing pregnancy. C To minimize the side effect of nausea that occurs with high doses of estrogen and progestin, the woman can take an over-the-counter antiemetic 1 hour before each dose. D Oral emergency contraceptive regimens may include progestin-only and estrogen-progestin pills. Women with contraindications to estrogen use should use progestin-only pills.

A pregnant woman at 25 weeks of gestation tells the nurse that she dropped a pan last week and her baby jumped at the noise. Which response by the nurse is most accurate? a. That must have been a coincidence; babies cant respond like that. b. The fetus is demonstrating the aural reflex. c. Babies respond to sound starting at about 24 weeks of gestation. d. Let me know if it happens again; we need to report that to your midwife.

ANS: C A This statement is inaccurate. Fetuses respond to sound by 24 weeks. Acoustic stimulations can evoke a fetal heart rate response. B There is no such thing as an aural reflex. C This statement is accurate. D This statement is not appropriate; it gives the impression that something is wrong.

14. Which statement regarding the development of the respiratory system is a high priority for the nurse to understand? a. The respiratory system does not begin developing until after the embryonic stage. b. The infants lungs are considered mature when the L/S ratio is 1:1, at approximately 32 weeks of gestation. c. Maternal hypertension can reduce maternal-placental blood flow, accelerating lung maturity. d. Fetal respiratory movements are not visible on ultrasound scans until at least 16 weeks of gestation.

ANS: C A reduction in placental blood flow stresses the fetus, increases blood levels of corticosteroids, and thus accelerates lung maturity. The development of the respiratory system begins during the embryonic phase and continues into childhood. The infants lungs are considered mature when the L/S ratio is 2:1, at approximately 35 weeks of gestation. Lung movements have been visualized on ultrasound scans at 11 weeks of gestation.

20. Which questionnaire would be best for the nurse to use when screening an adolescent client for an eating disorder? a. Four Cs b. Dietary Guidelines for Americans c. SCOFF screening tool d. Dual-energy x-ray absorptiometry (DEXA) scan

ANS: C A screening tool specifically developed to identify eating disorders uses the acronym SCOFF. Each question scores 1 point. A score of 2 or more indicates that the client may have anorexia nervosa or bulimia. The letters represent the following questions: Do you make yourself Sick because you feel too full? Do you worry about loss of Control over the amount that you eat? Have you recently lost more than One stone (14 pounds) in a 3-month period? Do you think that you are too Fat, even if others think you are thin? Does Food dominate your life? The 4 Cs are used to determine cultural competence. Dietary Guidelines for Americans provide nutritional guidance for all, not only for those with eating disorders. The DEXA scan is used to determine bone density.

14. Documentation of abuse can be useful to women later in court, should they elect to press charges. It is of key importance for the nurse to document accurately at the time that the client is seen. Which entry into the medical record would be the least helpful to the court? a. Photographs of injuries b. Clear and legible written documentation c. Summary of information (e.g., The client is a battered woman.) d. Accurate description of the clients demeanor

ANS: C A statement such as, The client is a battered woman lacks the supporting factual information and will render the report inadmissible. More appropriate documentation would include exact statements from the woman in quotations (e.g., My husband kicked me in the stomach). The time and date of the examination should also be included.

5. Which client would be an ideal candidate for injectable progestins such as Depo-Provera (DMPA) as a contraceptive choice? a. The ideal candidate for DMPA wants menstrual regularity and predictability. b. The client has a history of thrombotic problems or breast cancer. c. The ideal candidate has difficulty remembering to take oral contraceptives daily. d. The client is homeless or mobile and rarely receives health care.

ANS: C Advantages of DMPA include its contraceptive effectiveness, compared with the effectiveness of combined oral contraceptives, and the requirement of only four injections a year. The disadvantages of injectable progestins are prolonged amenorrhea and uterine bleeding. The use of injectable progestin carries an increased risk of venous thrombosis and thromboembolism. To be effective, DMPA injections must be administered every 11 to 13 weeks. Access to health care is necessary to prevent pregnancy or potential complications.

6. A woman arrives at the clinic for her annual examination. She tells the nurse that she thinks she has a vaginal infection, and she has been using an over-the-counter cream for the past 2 days to treat it. How should the nurse initially respond? a. Inform the woman that vaginal creams may interfere with the Papanicolaou (Pap) test for which she is scheduled. b. Reassure the woman that using vaginal cream is not a problem for the examination. c. Ask the woman to describe the symptoms that indicate to her that she has a vaginal infection. d. Ask the woman to reschedule the appointment for the examination.

ANS: C An important element of the health history and physical examination is the clients description of any symptoms she may be experiencing. The best response is for the nurse to inquire about the symptoms the woman is experiencing. Women should not douche, use vaginal medications, or have sexual intercourse for 24 to 48 hours before obtaining a Pap test. Although the woman may need to reschedule a visit for her Pap test, her current symptoms should still be addressed.

3. A pregnant woman at 25 weeks of gestation tells the nurse that she dropped a pan last week and her baby jumped at the noise. Which response by the nurse is most accurate? a. That must have been a coincidence; babies cant respond like that. b. The fetus is demonstrating the aural reflex. c. Babies respond to sound starting at approximately 24 weeks of gestation. d. Let me know if it happens again; we need to report that to your midwife.

ANS: C Babies respond to external sound starting at approximately 24 weeks of gestation. Acoustic stimulations can evoke a fetal heart rate response. There is no such thing as an aural reflex. The last statement is inappropriate and may cause undue psychologic alarm to the client.

As a girl progresses through development, she may be at risk for a number of age-related conditions. While preparing a 21-year-old client for her first adult physical examination and Pap test, the nurse is aware of excessive shyness. The young woman states that she will not remove her bra because, There is something wrong with my breasts; one is way bigger. What is the best response by the nurse in this situation? a. Please reschedule your appointment until you are more prepared. b. It is okay; the provider will not do a breast examination. c. I will explain normal growth and breast development to you. d. That is unfortunate; this must be very stressful for you.

ANS: C During adolescence one breast may grow more quickly than the other. Full development of the breasts is not achieved until after the end of the first pregnancy and period of lactation. The client should be reassured regarding this aspect of growth and development. Female teenagers usually enter the health system for screening (Pap tests begin at age 21 or 3 years after first sexual activity). Situations such as these can produce great stress for the teenager, and the nurse and health care provider should treat her carefully. Asking her to reschedule will likely result in the client not returning for her appointment at all. A breast examination at her age is part of the complete physical examination. Young women should be taught about normal breast development and begin doing breast self-examinations. This response is inappropriate. Although acknowledging the clients stress shows empathy on the part of the nurse, it will not meet the clients need of deficient knowledge related to normal growth and development.

10. Nurses who provide care to victims of IPV should be keenly aware of what? a. Relationship violence usually consists of a single episode that the couple can put behind them. b. Violence often declines or ends with pregnancy. c. Financial coercion is considered part of IPV. d. Battered women are generally poorly educated and come from a deprived social background.

ANS: C Economic coercion may accompany physical assault and psychologic attacks. IPV almost always follows an escalating pattern. It rarely ends with a single episode of violence. IPV often begins with and escalates during pregnancy. It may include both psychologic attacks and economic coercion. Race, religion, social background, age, and education level are not significant factors in differentiating women at risk.

25. In which culture is the father more likely to be expected to participate in the labor and delivery? a. Asian-American b. African-American c. European-American d. Hispanic

ANS: C European-Americans expect the father to take a more active role in the labor and delivery of a newborn than the other cultures.

10. The nurse is having her first meeting with a couple experiencing infertility. The nurse has formulated the nursing diagnosis, Deficient knowledge, related to lack of understanding of the reproductive process with regard to conception. Which nursing intervention does not apply to this diagnosis? a. Assess the current level of factors promoting conception. b. Provide information regarding conception in a supportive manner. c. Evaluate the couples support system. d. Identify and describe the basic infertility tests.

ANS: C Evaluating the couples support system would be a nursing action more suitable to the diagnosis, Ineffective individual coping, related to the ability to conceive.

5. The nurse guides a woman to the examination room and asks her to remove her clothes and put on an examination gown with the front open. The woman replies, I have special undergarments that I do not remove for religious reasons. Which is the most appropriate response from the nurse? a. You cant have an examination without removing all your clothes. b. Ill ask the physician to modify the examination. c. Tell me about your undergarments. Ill explain the examination procedure, and then we can discuss how you can comfortably have your examination. d. I have no idea how we can accommodate your beliefs.

ANS: C Explaining the examination procedure reflects cultural competence by the nurse and shows respect for the womans religious practices. The nurse must respect the rich and unique qualities that cultural diversity brings to individuals. The examination can be modified to ensure that modesty is maintained. In recognizing the value of cultural differences, the nurse can modify the plan of care to meet the needs of each woman. Telling the client that her religious practices are different or strange is inappropriate and disrespectful to the client.

Which situation would be considered safest by a nurse who is making a home visit? a. A group of teens is sitting on the stairs in front of the clients apartment. b. Parking is only possible 3 blocks from the clients house because no space is available in front of the house. c. The family dog is on a chain in the front yard. d. The door of the home is open when the nurse arrives.

ANS: C Home care nurses should not enter a yard that has an unrestrained dog. While walking to the clients home, nurses should not walk near groups of strangers who are in doorways or alleys. Home care nurses should park and lock their cars in a safe place that is visible from the street and the clients home. The home should not be entered if the nurse has any safety concerns, such as an open front door.

17. To ensure client safety, the practicing nurse must have knowledge of The Joint Commissions current Do Not Use list of abbreviations. Which term is acceptable for use regarding medication administration? a. q.o.d. or Q.O.D. b. MSO4 or MgSO4 c. International Unit d. Lack of a leading zero

ANS: C I.U. and i.u. are no longer acceptable because they could be misread as I.V. or the number 10. Q.O.D. should be written out as every other day. The period after the Q could be mistaken for an I and the o could also be mistaken for an i. Confusing one medication for another is too easy. Medications are used for very different purposes and could place a client at risk for an adverse outcome. For example, these medications should be written as morphine sulfate and magnesium sulfate. The decimal point should never be missed before a number (e.g., 0.4 rather than .4). A leading zero is the preferred form.

4. A woman who has just undergone a first-trimester abortion will be using oral contraceptives. To protect against pregnancy, the client should be advised to do what? a. Avoid sexual contact for at least 10 days after starting the pill. b. Use condoms and foam for the first few weeks as a backup. c. Use another method of contraception for 1 week after starting the pill. d. Begin sexual relations once vaginal bleeding has ended.

ANS: C If oral contraceptives are to be started within 3 weeks after an abortion, additional forms of contraception should be used throughout the first week to avoid the risk of pregnancy.

4. The nurse is developing a plan of care for a Hispanic client who just delivered a newborn. Which cultural variation is most important to include in the care plan? a. Breastfeeding is encouraged immediately after birth. b. Male infants are typically circumcised. c. Maternal grandmother participates in the care of the mother and her infant. d. Bathing is encouraged immediately after delivery.

ANS: C In the Hispanic family, the expectant mother is strongly influenced by her mother or mother-in-law. Breastfeeding is often delayed until the third postpartum day. Hispanic male infants are not usually circumcised. Bathing after delivery is most often delayed.

14. In the acronym BRAIDED, which letter is used to identify the key components of informed consent that the nurse must document? a. B stands for birth control. b. R stands for reproduction. c. A stands for alternatives. d. I stands for ineffective.

ANS: C In the acronym BRAIDED, A stands for alternatives and information about other viable methods. B stands for benefits and information about the advantages of a particular birth control method and its success rates. Rstands for risks and information about the disadvantages of a particular method and its failure rates. I stands for inquiries and the opportunity to ask questions.

Proper documentation of the abuse as reported by the victim is a crucial role of the nurse. Evaluate the following data, which include information from the victim, and choose the best documentation by the nurse. A 34-year-old Caucasian arrives at the emergency department with a black right eye; she also is bleeding from the left side of her head. She reports that her boyfriend has been abusing her physically. The nurse performs a history and physical examination and documents her findings. a. Client alleges that her boyfriend beat her up. b. Client reports that her boyfriend hit her in the eye and head. c. Client is a 34-year-old Caucasian female. Presents with periorbital ecchymosis on right side. Laceration of left parietal area, 3 cm long with tissue bridging. Approximately 1 cm deep. Client states that her boyfriend threw a brick from 10 feet away, aiming at my head. The corner of the brick hit the left side of my head. She reports that he also hit me in the eye. Client indicates that the hit was with her boyfriends closed left fist. d. Client presents with a black eye and a cut on the left side of her head. Reports being abused.

ANS: C It is important to list the name of the abuser, if possible, because a defense strategy is to portray the victim as having more than one partner. Listing the name eliminates any confusion as to who the abuser was. In addition, using accurate medical terminology is crucial. If you are unsure of the proper descriptive terms to use in documentation, simply describe what you see without labeling the injury. Photographs should be taken. Documenting only that the client states that her boyfriend beat her lacks specificity and important details related to the event. In addition, improper medical terminology is used. This type of documentation would be detrimental to the victims case if she were to pursue legal recourse against the abuser. Documenting only that the client states that her boyfriend hit her in the eye and head lacks specificity and important details related to the event. In addition, improper medical terminology is used. This type of documentation would be detrimental to the victims case if she were to pursue legal recourse against the abuser. Documenting only that the client reports being abused lacks specificity and important details related to the event. In addition, improper medical terminology is used. This type of documentation would be detrimental to the victims case if she were to pursue legal recourse against the abuser.

Prostaglandins are produced in most organs of the body, most notably the endometrium. Another/Other source(s) of prostaglandins is/are: a. Ovaries. b. Breast milk. c. Menstrual blood. d. The vagina.

ANS: C Menstrual blood is a potent source of prostaglandins. The ovaries are not a source of prostaglandins. Prostaglandins are produced in most organs of the body and in menstrual blood. Breast milk is not a source of prostaglandins. Prostaglandins are produced in most organs of the body and in menstrual blood. The vagina is not a source of prostaglandins.

Menstruation is periodic uterine bleeding: a. That occurs every 28 days b. In which the entire uterine lining is shed c. That is regulated by ovarian hormones d. That leads to fertilization

ANS: C Menstruation is periodic uterine bleeding that is controlled by a feedback system involving three cycles: the endometrial cycle, the hypothalamic-pituitary cycle, and the ovarian cycle. The average length of a menstrual cycle is 28 days, but variations are normal. During the endometrial cycle, the functional two thirds of the endometrium is shed.

17. An infertile woman is about to begin pharmacologic treatment. As part of the regimen, she will take purified FSH (Metrodin). The nurse instructs her that this medication is administered in the form of what? a. Intranasal spray b. Vaginal suppository c. Intramuscular (IM) injection d. Tablet

ANS: C Metrodin is only administered by IM injection, and the dose may vary. An intranasal spray or a vaginal suppository are not appropriate routes for Metrodin, nor can Metrodin be given by mouth in tablet form.

16. The nurse is providing contraceptive instruction to a young couple who are eager to learn. The nurse should be cognizant of which information regarding the natural family planning method? a. The natural family planning method is the same as coitus interruptus or pulling out. b. This contraception method uses the calendar method to align the womans cycle with the natural phases of the moon. c. This practice is the only contraceptive method acceptable to the Roman Catholic Church. d. The natural family planning method relies on barrier methods during the fertility phases.

ANS: C Natural family planning is the only contraceptive practice acceptable to the Roman Catholic Church. Pulling out is not the same as periodic abstinence, another name for natural family planning. The phases of the moon are not part of the calendar method or any method. Natural family planning is another name for periodic abstinence, which is the accepted way to pass safely through the fertility phases without relying on chemical or physical barriers.

27. A client at 24 weeks of gestation says she has a glass of wine with dinner every evening. Why should the nurse counsel her to eliminate all alcohol intake? a. Daily consumption of alcohol indicates a risk for alcoholism. b. She is at risk for abusing other substances as well. c. Alcohol places the fetus at risk for altered brain growth. d. Alcohol places the fetus at risk for multiple organ anomalies.

ANS: C No period during pregnancy is safe to consume alcohol. The documented effects of alcohol consumption during pregnancy include fetal mental retardation, learning disabilities, high activity level, and short attention span. The fetal brain grows most rapidly in the third trimester and is vulnerable to alcohol exposure during this time. Abuse of other substances has not been linked to alcohol use.

7. A 38-year-old Hispanic woman vaginally delivered a 9-pound, 6-ounce baby girl after being in labor for 43 hours. The baby died 3 days later from sepsis. On what grounds could the woman have a legitimate legal case for negligence? a. Inexperienced maternity nurse was assigned to care for the client. b. Client was past her due date by 3 days. c. Standard of care was not met. d. Client refused electronic fetal monitoring.

ANS: C Not meeting the standard of care is a legitimate factor for a case of negligence. An inexperienced maternity nurse would need to display competency before being assigned to care for clients on his or her own. This client may have been past her due date; however, a term pregnancy often goes beyond 40 weeks of gestation. Although fetal monitoring is the standard of care, the client has the right to refuse treatment. This refusal is not a case for negligence, but informed consent should be properly obtained, and the client should have signed an against medical advice form when refusing any treatment that is within the standard of care.

29. What is the primary reason why a woman who is older than 35 years may have difficulty achieving pregnancy? a. Personal risk behaviors influence fertility. b. Mature women have often used contraceptives for an extended time. c. Her ovaries may be affected by the aging process. d. Prepregnancy medical attention is lacking.

ANS: C Once the mature woman decides to conceive, a delay in becoming pregnant may occur because of the normal aging of the ovaries. Older adults participate in fewer risk behaviors than younger adults. The past use of contraceptives is not the problem. Prepregnancy medical care is both available and encouraged.

5. The nurses working at a newly established birthing center have begun to compare their performance in providing maternal-newborn care against clinical standards. This comparison process is most commonly known as what? a. Best practices network b. Clinical benchmarking c. Outcomes-oriented practice d. Evidence-based practice

ANS: C Outcomes-oriented practice measures the effectiveness of the interventions and quality of care against benchmarks or standards. The term best practice refers to a program or service that has been recognized for its excellence. Clinical benchmarking is a process used to compare ones own performance against the performance of the best in an area of service. The term evidence-based practice refers to the provision of care based on evidence gained through research and clinical trials.

7. Preconception and prenatal care have become important components of womens health. What is the guiding principal of preconception care? a. Ensure that pregnancy complications do not occur. b. Identify the woman who should not become pregnant. c. Encourage healthy lifestyles for families desiring pregnancy. d. Ensure that women know about prenatal care.

ANS: C Preconception counseling guides couples in how to avoid unintended pregnancies, how to identify and manage risk factors in their lives and in their environment, and how to identify healthy behaviors that promote the well-being of the woman and her potential fetus. Preconception care does not ensure that pregnancy complications will not occur. In many cases, problems can be identified and treated and may not recur in subsequent pregnancies. For many women, counseling can allow behavior modification before any damage is done, or a woman can make an informed decision about her willingness to accept potential hazards. If a woman is seeking preconception care, then she is likely aware of prenatal care.

16. Which statement is the most comprehensive description of sexual violence? a. Sexual violence is limited to rape. b. Sexual violence is an act of force during which an unwanted and uncomfortable sexual act occurs. c. Sexual violence encompasses a number of sexual acts. d. Sexual violence includes degrading sexual comments and behaviors.

ANS: C Sexual violence is a broad term that includes a range of sexual victimization including sexual assault, sexual harassment, and rape. It may include but is not limited to rape. Sexual assault includes unwanted or uncomfortable touches, kisses, hugs, petting, intercourse, or other sexual acts. It is a component of sexual violence. Unwelcome or degrading e-mail messages, comments, contact, or behavior, such as exhibitionism, that makes any environment feel unsafe is known as sexual harassment.

13. In the 1970s, the rape-trauma syndrome (RTS) was identified as a cluster of symptoms and related behaviors observed in the weeks and months after an episode of rape. Researchers identified three phases related to this condition. Which phase is not displayed in a client with RTS? a. Acute Phase: Disorganization b. Outward Adjustment Phase c. Shock/Disbelief: Disorientation Phase d. Long-Term Process: Reorganization Phase

ANS: C Shock, disbelief, or disorientation is a component of the Acute Phase. The rape survivor feels embarrassed, degraded, fearful, and angry. She may feel unclean and want to bathe and douche repeatedly, even though doing so may destroy evidence. The victim relives the scene over and over in her mind, thinking of things she should have done. During the Outward Adjustment Phase, the victim may appear to have resolved her crisis and return to activities of daily living and work. Other women may move, leave their job, and buy a weapon to protect themselves. Disorientation is a reaction during which the victim may feel disoriented, have difficulty concentrating, or have poor recall. The Long-Term Process is the reorganization phase. This recovery phase may take years and may be difficult and painful.

18. A couple arrives for their first appointment at an infertility center. Which of the following is a noninvasive test performed during the initial diagnostic phase of testing? a. Hysterosalpingogram b. Endometrial biopsy c. Sperm analysis d. Laparoscopy

ANS: C Sperm analysis is the basic noninvasive test performed during initial diagnostic phase of testing for male infertility. Radiographic film examination allows visualization of the uterine cavity after the instillation of a radiopaque contrast medium through the cervix. The endometrial biopsy is an invasive procedure, during which a small cannula is introduced into the uterus and a portion of the endometrium is removed for histologic examination. Laparoscopy is useful to view the pelvic structures intraperitoneally and is an invasive procedure.

10. The measurement of lecithin in relation to sphingomyelin (lecithin/sphingomyelin [L/S] ratio) is used to determine fetal lung maturity. Which ratio reflects fetal maturity of the lungs? a. 1.4:1 b. 1.8:1 c. 2:1 d. 1:1

ANS: C The L/S ratio indicates a 2:1 ratio of lecithin to sphingomyelin, which is an indicator of fetal lung maturity and occurs at approximately the middle of the third trimester. L/S ratios of 1.4:1, 1.8:1, and 1:1 each indicate immaturity of the fetal lungs.

19. The microscopic examination of scrapings from the cervix, endocervix, or other mucous membranes to detect premalignant or malignant cells is called what? a. Bimanual palpation b. Rectovaginal palpation c. Papanicolaou (Pap) test d. Four As procedure

ANS: C The Pap test is a microscopic examination for cancer that should be regularly performed, depending on the clients age. Bimanual palpation is a physical examination of the vagina. Rectovaginal palpation is a physical examination performed through the rectum. The four As procedure is an intervention to help a client stop smoking.

17. A womans cousin gave birth to an infant with a congenital heart anomaly. The woman asks the nurse when such anomalies occur during development. Which response by the nurse is most accurate? a. We dont really know when such defects occur. b. It depends on what caused the defect. c. Defects occur between the third and fifth weeks of development. d. They usually occur in the first 2 weeks of development.

ANS: C The cardiovascular system is the first organ system to function in the developing human. Blood vessel and blood formation begins in the third week, and the heart is developmentally complete in the fifth week. We dont really know when such defects occur is an inaccurate statement. Regardless of the cause, the heart is vulnerable during its period of developmentin the third to fifth weeks; therefore, the statement, They usually occur in the first 2 weeks of development is inaccurate.

2. What is the primary theme of the feminist perspective regarding violence against women? a. Role of testosterone as the underlying cause of mens violent behavior b. Basic human instinctual drive toward aggression c. Male dominance and coercive control over women d. Cultural norm of violence in Western society

ANS: C The contemporary social view of violence is derived from the feminist theory. With the primary theme of male dominance and coercive control, this view enhances an understanding of all forms of violence against women, including wife battering, stranger and acquaintance rape, incest, and sexual harassment in the workplace. The role of testosterone as an underlying cause of mens violent behavior, the basic human instinctual drive toward aggression, and the cultural norm of violence in Western society are not associated with the feminist perspective regarding violence against women.

3. Using the family stress theory as an interventional approach for working with families experiencing parenting challenges, the nurse can assist the family in selecting and altering internal context factors. Which statement best describes the components of an internal context? a. Biologic and genetic makeup b. Maturation of family members c. Familys perception of the event d. Prevailing cultural beliefs of society

ANS: C The family stress theory is concerned with the familys reaction to stressful events. Internal context factors include elements that a family can control such as psychologic defenses, family structure, and philosophic beliefs and values. The family stress theory focuses on ways that families react to stressful events. Maturation of family members is more relevant to the family life-cycle theory. The family stress theory focuses on internal elements that a family might be able to alter.

26. Which statement regarding female sexual response is inaccurate? a. Women and men are more alike than different in their physiologic response to sexual arousal and orgasm. b. Vasocongestion is the congestion of blood vessels. c. Orgasmic phase is the final state of the sexual response cycle. d. Facial grimaces and spasms of the hands and feet are often part of arousal.

ANS: C The final state of the sexual response cycle is the resolution phase after orgasm. Men and women are surprisingly alike. Vasocongestion causes vaginal lubrication and engorgement of the genitals. Arousal is characterized by increased muscular tension (myotonia).

13. Which traditional family structure is decreasing in numbers and attributable to societal changes? a. Extended family b. Binuclear family c. Nuclear family d. Blended family

ANS: C The nuclear family has long represented the traditional American family in which husband, wife, and children live as an independent unit. As a result of rapid changes in society, this number is steadily decreasing as other family configurations are socially recognized. Extended families involve additional blood relatives other than the parents. A binuclear family involves two households. A blended family is reconstructed after divorce and involves the merger of two families.

11. A client arrives for her initial prenatal examination. This is her first child. She asks the nurse, How does my baby get air inside my uterus? What is the correct response by the nurse? a. The babys lungs work in utero to exchange oxygen and carbon dioxide. b. The baby absorbs oxygen from your blood system. c. The placenta provides oxygen to the baby and excretes carbon dioxide into your bloodstream. d. The placenta delivers oxygen-rich blood through the umbilical artery to the babys abdomen.

ANS: C The placenta delivers oxygen-rich blood through the umbilical vein, not the artery, to the fetus and excretes carbon dioxide into the maternal bloodstream. The fetal lungs do not function as respiratory gas exchange in utero. The baby does not simply absorb oxygen from a womans blood system; rather, blood and gas transport occur through the placenta.

6. Intervention for the sexual abuse survivor is often not attempted by maternity and womens health nurses because of the concern about increasing the distress of the woman and the lack of expertise in counseling. What initial intervention is appropriate and most important in facilitating the womans care? a. Initiating a referral to an expert counselor b. Setting limits on what the client discloses c. Listening and encouraging therapeutic communication skills d. Acknowledging the nurses discomfort to the client as an expression of empathy

ANS: C The survivor needs support on many different levels, and a womens health nurse may be the first person to whom she relates her story. Therapeutic communication skills and listening are initial interventions. Referring this client to a counselor is an appropriate measure but not the most important initial intervention. A client should be allowed to disclose any information she feels the need to discuss. A nurse should provide a safe environment in which she can do so. Either verbal or nonverbal shock and horror reactions from the nurse are particularly devastating. Professional demeanor and professional empathy are essential.

27. Which statement accurately describes the walking survey as a data collection tool? a. The walking survey determines how much exercise an expectant mother has been getting, to help her make health care decisions. b. The walking survey usually takes place on the maternity ward but can be expanded to other areas of the hospital. c. The walking survey is a method of observing the resources and health-related environment of the community. d. The walking survey is performed by government census takers as part of their canvas.

ANS: C The walking survey is a valuable tool for the nurses in the community and has nothing to do with exercise. It is an observational method used to assess the health environment of the community. A walking survey takes place in the community, not the maternity ward, and is not part of the census; it is conducted by nurses in the community.

4. At a routine prenatal visit, the nurse explains the development of the fetus to her client. At approximately ____ weeks of gestation, lecithin is forming on the alveolar surfaces, the eyelids open, and the fetus measures approximately 27 cm crown to rump and weighs approximately 1110 g. The client is how many weeks of gestation at todays visit? a. 20 b. 24 c. 28 d. 30

ANS: C These milestones in human development occur at 28 weeks of gestation. These milestones have not occurred by 20 or 24 weeks of gestation but have been reached before 30 weeks of gestation.

4. A couple comes in for an infertility workup, having attempted to achieve pregnancy for 2 years. The woman, 37 years of age, has always had irregular menstrual cycles but is otherwise healthy. The man has fathered two children from a previous marriage and had a vasectomy reversal 2 years ago. The man has had two normal semen analyses, but the sperm seem to be clumped together. What additional testing is needed? a. Testicular biopsy b. Antisperm antibodies c. FSH level d. Examination for testicular infection

ANS: C This scenario does not indicate that the woman has had any testing related to her irregular menstrual cycles. Hormone analysis is performed to assess endocrine function of the hypothalamic-pituitary-ovarian axis when menstrual cycles are absent or irregular. Determining the blood levels of prolactin, FSH, luteinizing hormone (LH), estradiol, progesterone, and thyroid hormones may be necessary to diagnose the cause of the womans irregular menstrual cycles. A testicular biopsy is indicated only in cases of azoospermia (no sperm cells) or severe oligospermia (low number of sperm cells). Although unlikely to be the case because the husband has already produced children, antisperm antibodies may be produced by the man against his own sperm. Examination for testicular infection would be performed before semen analysis. Furthermore, infection would affect spermatogenesis.

10. A woman will be taking oral contraceptives using a 28-day pack. What advice should the nurse provide to protect this client from an unintended pregnancy? a. Limit sexual contact for one cycle after starting the pill. b. Use condoms and foam instead of the pill for as long as the client takes an antibiotic. c. Take one pill at the same time every day. d. Throw away the pack and use a backup method if two pills are missed during week 1 of her cycle.

ANS: C To maintain adequate hormone levels for contraception and to enhance compliance, clients should take oral contraceptives at the same time each day. If contraceptives are to be started at any time other than during normal menses or within 3 weeks after birth or an abortion, then another method of contraception should be used through the first week to prevent the risk of pregnancy. Taken exactly as directed, oral contraceptives prevent ovulation, and pregnancy cannot occur. No strong pharmacokinetic evidence indicates a link between the use of broad-spectrum antibiotics and altered hormonal levels in oral contraceptive users. If the client misses two pills during week 1, then she should take two pills a day for 2 days and finish the package and use a backup contraceptive method for the next 7 consecutive days.

20. When weighing the advantages and disadvantages of planning home care for perinatal services, what information should the nurse use in making the decision? a. Home care for perinatal services is more dangerous for vulnerable neonates at risk of acquiring an infection from the nurse. b. Home care for perinatal services is more cost-effective for the nurse than office visits. c. Home care for perinatal services allows the nurse to interact with and include family members in teaching. d. Home care for perinatal services is made possible by the ready supply of nurses with expertise in maternity care.

ANS: C Treating the whole family is an advantage of home care. Forcing neonates out in inclement weather and in public is more risky. Office visits are more cost-effective for the providers such as nurses because less travel time is involved. Unfortunately, home care options are limited by the lack of nurses with expertise in maternity care.

5. A couple is attempting to cope with an infertility problem. They want to know what they can do to preserve their emotional equilibrium. What is the nurses most appropriate response? a. Tell your friends and family so that they can help you. b. Talk only to other friends who are infertile, because only they can help. c. Get involved with a support group. Ill give you some names. d. Start adoption proceedings immediately, because adopting an infant can be very difficult.

ANS: C Venting negative feelings may unburden the couple. A support group may provide a safe haven for the couple to share their experiences and gain insight from others experiences. Although talking about their feelings may unburden them of negative feelings, infertility can be a major stressor that affects the couples relationships with family and friends. Limiting their interactions to other infertile couples may be a beginning point for addressing psychosocial needs. However, depending on where the other couple is in their own recovery process, limiting their interactions may not be of assistance to them. Telling the couple to start adoption proceedings immediately is not supportive of the psychosocial needs of this couple and may be detrimental to their well-being.

2. What is the primary role of practicing nurses in the research process? a. Designing research studies b. Collecting data for other researchers c. Identifying researchable problems d. Seeking funding to support research studies

ANS: C When problems are identified, research can be properly conducted. Research of health care issues leads to evidence-based practice guidelines. Designing research studies is only one factor of the research process. Data collection is another factor of research. Financial support is necessary to conduct research, but it is not the primary role of the nurse in the research process.

4. Which procedure falls into the category of micromanipulation techniques of the follicle? (Select all that apply.) a. Intrauterine insemination b. Preimplantation genetic diagnosis c. Intracytoplasmic sperm injection (ISCI) d. Assisted hatching e. IVF-ET

ANS: C, D ISCI makes it possible to achieve fertilization even with a few or poor quality sperm by introducing sperm beneath the zone pellucid into the egg. Another micromanipulation technique is assisted hatching. An infrared laser breaks through the thick or tough zone pellucid, enabling the blastocyst to hatch.

2. What are some common characteristics of a potential male batterer? (Select all that apply.) a. High level of self-esteem b. High frustration tolerance c. Substance abuse problems d. Excellent verbal skills e. Personality disorders

ANS: C, E Substance abuse and personality disorders are often observed in batterers. Typically, the batterer has low self-esteem. Batterers usually have a low frustration level (i.e., they easily lose their temper). Batterers characteristically have poor verbal skills and can especially have difficulty expressing their feelings.

As a powerful central nervous system stimulant, which of these substances can lead to miscarriage, preterm labor, premature separation of the placenta, and stillbirth? a. Heroin b. Alcohol c. PCP d. Cocaine

ANS: D A Heroin is an opiate. Its use in pregnancy is associated with preeclampsia, intrauterine growth restriction, miscarriage, premature rupture of membranes, infections, breech presentation, and preterm labor. B The most serious effect of alcohol use in pregnancy is fetal alcohol syndrome. C The major concerns regarding PCP use in pregnant women are its association with polydrug abuse and the neurobehavioral effects on the neonate. D Cocaine is a powerful central nervous system stimulant. Effects on pregnancy associated with cocaine use include abruptio placentae, preterm labor, precipitous birth, and stillbirth.

11. Which resource best describes a health care service representing the tertiary level of prevention? a. Stress management seminars b. Childbirth education classes for single parents c. BSE pamphlet and teaching d. Premenstrual syndrome (PMS) support group

ANS: D A PMS support group is an example of tertiary prevention, which follows the occurrence of a defect or disability (e.g., PMS). Stress management seminars are a primary prevention technique for preventing health care issues associated with stress. Childbirth education is a form of primary prevention. BSE information is a form of secondary prevention, which is aimed toward early detection of health problems.

10. During the childbearing experience, which behavior might the nurse expect from an African-American client? a. Seeking prenatal care early in her pregnancy b. Avoiding self-treatment of pregnancy-related discomfort c. Requesting liver in the postpartum period to prevent anemia d. Arriving at the hospital in advanced labor

ANS: D African-American women often arrive at the hospital in far-advanced labor and may view pregnancy as a state of wellness, which is often the reason for the delay in seeking prenatal care. African-American women practice many self-treatment options for various discomforts of pregnancy. African-American women may also request liver in the postpartum period, which is based on a belief that liver has a higher blood content.

12. What is the most basic information that a nurse should be able to share with a client who asks about the process of conception? a. Ova are considered fertile 48 to 72 hours after ovulation. b. Sperm remain viable in the womans reproductive system for an average of 12 to 24 hours. c. Conception is achieved when a sperm successfully penetrates the membrane surrounding the ovum. d. Implantation in the endometrium occurs 6 to 10 days after conception.

ANS: D After implantation, the endometrium is called the decidua. Ova are considered fertile for approximately 24 hours after ovulation. Sperm remain viable in the womans reproductive system for an average of 2 to 3 days. Penetration of the ovum by the sperm is called fertilization. Conception occurs when the zygote, the first cell of the new individual, is formed.

9. The National Quality Forum has issued a list of never events specifically pertaining to maternal and child health. These include all of the following except: a. infant discharged to the wrong person. b. kernicterus associated with the failure to identify and treat hyperbilirubinemia. c. artificial insemination with the wrong donor sperm or egg. d. foreign object retained after surgery.

ANS: D Although a foreign object retained after surgery is a never event, it does not specifically pertain to obstetric clients. A client undergoing any type of surgery may be at risk for this event. An infant discharged to the wrong person specifically pertains to postpartum care. Death or serious disability as a result of kernicterus pertains to newborn assessment and care. Artificial insemination affects families seeking care for infertility.

14. Although remarkable developments have occurred in reproductive medicine, assisted reproductive therapies are associated with numerous legal and ethical issues. Nurses can provide accurate information about the risks and benefits of treatment alternatives to enable couples to make informed decisions about their choice of treatment. Which concern is unnecessary for the nurse to address before treatment? a. Risks of multiple gestation b. Whether or how to disclose the facts of conception to offspring c. Freezing embryos for later use d. Financial ability to cover the cost of treatment

ANS: D Although the method of payment is important, obtaining this information is not the responsibility of the nurse. Many states have mandated some form of insurance to assist couples with coverage for infertility. Multiple gestation is a risk of treatment of which the couple needs to be aware. To minimize the chance of multiple gestation, generally only three or fewer embryos are transferred. The couple should be informed that multifetal reduction may be needed. Nurses can provide anticipatory guidance on this matter. Depending on the therapy chosen, donor oocytes, sperm, embryos, or a surrogate mother may be needed. Couples who have excess embryos frozen for later transfer must be fully informed before consenting to the procedure. A decision must be made regarding the disposal of embryos in the event of death or divorce or if the couple no longer wants the embryos at a future time.

26. What is the importance of obtaining informed consent for a number of contraceptive methods? a. Contraception is an invasive procedure that requires hospitalization. b. The method may require a surgical procedure to insert a device. c. The contraception method chosen may be unreliable. d. The method chosen has potentially dangerous side effects.

ANS: D Being aware of the potential side effects is important for couples who are making an informed decision about the use of contraceptives. The only contraceptive method that is a surgical procedure and requires hospitalization is sterilization. Some methods have greater efficacy than others, and this efficacy should be included in the teaching.

17. Women with severe and persistent mental illness are likely to be more vulnerable to being involved in controlling and/or violent relationships; however, many women develop mental health problems as a result of long-term abuse. Which condition is unlikely to be a psychologic consequence of continued abuse? a. Substance abuse b. Posttraumatic stress disorder (PTSD) c. Eating disorders d. Bipolar disorder

ANS: D Bipolar disorder is a specific illness (also known as manic depressive disorder) not related to abuse. Substance abuse is a common method of coping with long-term abuse. The abuser is also more likely to use alcohol and other chemical substances. PTSD is the most prevalent mental health sequela of long-term abuse. The traumatic event is persistently re-experienced through distress recollection and dreams. Eating disorders, depression, psychologic-physiologic illness, and anxiety reactions are all mental health problems associated with repeated abuse.

17. As part of their participation in the gynecologic portion of the physical examination, which approach should the nurse take? a. Take a firm approach that encourages the client to facilitate the examination by following the physicians instructions exactly. b. Explain the procedure as it unfolds, and continue to question the client to get information in a timely manner. c. Take the opportunity to explain that the trendy vulvar self-examination is only for women at risk for developing cancer. d. Help the woman relax through the proper placement of her hands and proper breathing during the examination.

ANS: D Breathing techniques are important relaxation techniques that can help the client during the examination. The nurse should encourage the client to participate in an active partnership with the health care provider. Explanations during the procedure are fine, but many women are uncomfortable answering questions in the exposed and awkward position of the examination. Vulvar self-examination on a regular basis should be encouraged and taught during the examination.

8. Which structure is responsible for oxygen and carbon dioxide transport to and from the maternal bloodstream? a. Decidua basalis b. Blastocyst c. Germ layer d. Chorionic villi

ANS: D Chorionic villi are fingerlike projections that develop out of the trophoblast and extend into the blood-filled spaces of the endometrium. The villi obtain oxygen and nutrients from the maternal bloodstream and dispose carbon dioxide and waste products into the maternal blood. The decidua basalis is the portion of the decidua (endometrium) under the blastocyst where the villi attach. The blastocyst is the embryonic development stage after the morula; implantation occurs at this stage. The germ layer is a layer of the blastocyst.

3. A man smokes two packs of cigarettes a day. He wants to know if smoking is contributing to the difficulty he and his wife are having getting pregnant. Which guidance should the nurse provide? a. Your sperm count seems to be okay in the first semen analysis. b. Only marijuana cigarettes affect sperm count. c. Although smoking has no effect on sperm count, it can give you lung cancer. d. Smoking can reduce the quality of your sperm.

ANS: D Cigarette smoking has detrimental effects on sperm and has been associated with abnormal sperm, a decreased number of sperm, and chromosomal damage. The nurse may suggest a smoking cessation program to increase the fertility of the male partner. Sperm counts vary from day to day and are dependent on emotional and physical status and sexual activity. Therefore, a single analysis may be inconclusive. A minimum of two analyses must be performed several weeks apart to assess male fertility. Marijuana use may depress the number and motility of sperm. Smoking is indeed a causative agent for lung cancer.

3. A 23-year-old African-American woman is pregnant with her first child. Based on the statistics for infant mortality, which plan is most important for the nurse to implement? a. Perform a nutrition assessment. b. Refer the woman to a social worker. c. Advise the woman to see an obstetrician, not a midwife. d. Explain to the woman the importance of keeping her prenatal care appointments.

ANS: D Consistent prenatal care is the best method of preventing or controlling risk factors associated with infant mortality. Nutritional status is an important modifiable risk factor, but it is not the most important action a nurse should take in this situation. The client may need assistance from a social worker at some time during her pregnancy, but a referral to a social worker is not the most important aspect the nurse should address at this time. If the woman has identifiable high-risk problems, then her health care may need to be provided by a physician. However, it cannot be assumed that all African-American women have high-risk issues. In addition, advising the woman to see an obstetrician is not the most important aspect on which the nurse should focus at this time, and it is not appropriate for a nurse to advise or manage the type of care a client is to receive.

24. Which statement regarding the term contraceptive failure rate is the most accurate? a. The contraceptive failure rate refers to the percentage of users expected to have an accidental pregnancy over a 5-year span. b. It refers to the minimum rate that must be achieved to receive a government license. c. The contraceptive failure rate increases over time as couples become more careless. d. It varies from couple to couple, depending on the method and the users.

ANS: D Contraceptive effectiveness varies from couple to couple, depending on how well a contraceptive method is used and how well it suits the couple. The contraceptive failure rate measures the likelihood of accidental pregnancy in the first year only. Failure rates decline over time because users gain experience.

9. A woman who is 8 months pregnant asks the nurse, Does my baby have any antibodies to fight infection? What is the most appropriate response by the nurse? a. Your baby has all the immunoglobulins necessary: immunoglobulin G (IgG), immunoglobulin M (IgM), and immunoglobulin A (IgA). b. Your baby wont receive any antibodies until he is born and you breastfeed him. c. Your baby does not have any antibodies to fight infection. d. Your baby has IgG and IgM.

ANS: D During the third trimester, IgG is the only immunoglobulin that crosses the placenta; it provides passive acquired immunity to specific bacterial toxins. However, the fetus produces IgM by the end of the first trimester. IgA immunoglobulins are not produced by the baby. Therefore, by the third trimester, the fetus has both IgG and IgM. Breastfeeding supplies the newborn infant with IgA.

8. When the nurse is unsure how to perform a client care procedure that is high risk and low volume, his or her best action in this situation would be what? a. Ask another nurse. b. Discuss the procedure with the clients physician. c. Look up the procedure in a nursing textbook. d. Consult the agency procedure manual, and follow the guidelines for the procedure.

ANS: D Following the agencys policies and procedures manual is always best when seeking information on correct client procedures. These policies should reflect the current standards of care and the individual states guidelines. Each nurse is responsible for his or her own practice. Relying on another nurse may not always be a safe practice. Each nurse is obligated to follow the standards of care for safe client care delivery. Physicians are responsible for their own client care activity. Nurses may follow safe orders from physicians, but they are also responsible for the activities that they, as nurses, are to carry out. Information provided in a nursing textbook is basic information for general knowledge. Furthermore, the information in a textbook may not reflect the current standard of care or the individual state or hospital policies.

According to Friedmans classifications, providing such physical necessities as food, clothing, and shelter is the: a. Economic family function b. Socialization family function c. Reproductive family function d. Health care family function

ANS: D Health care is considered part of such physical necessities as food, clothing, and shelter. The economic function provides resources but is not concerned with health care and other basic necessities. The socialization function teaches the child cultural values. The reproductive function is concerned with ensuring family continuity.

21. Which statement is the most complete and accurate description of medical abortions? a. Medical abortions are performed only for maternal health. b. They can be achieved through surgical procedures or with drugs. c. Medical abortions are mostly performed in the second trimester. d. They can be either elective or therapeutic.

ANS: D Medical abortions can be either elective (the womans choice) or therapeutic (for reasons of maternal or fetal health) and are performed through the use of medications rather than surgical procedures. Medical abortions are usually performed in the first trimester.

28. A Native-American woman gave birth to a baby girl 12 hours ago. The nurse notes that the woman keeps her baby in the bassinet except for bottle feeding and states that she will wait until she gets home to begin breastfeeding. The nurse recognizes that this behavior is most likely a reflection of what? a. Delayed attachment b. Embarrassment c. Disappointment in the sex of the baby d. Belief that babies should not be fed colostrum

ANS: D Native Americans often use cradle boards and often avoid handling their newborn. They also believe that the infant should not be fed colostrum. Delayed attachment is a developmental concern, not a cultural belief. Embarrassment is not likely the cause for a delay in the initiation of breastfeeding and should be explored further by the nurse. The mother may voice her disappointment that the infant is a girl; however, this would rarely cause her to delay breastfeeding and would exhibit itself in other ways.

8. Nurses are often the first health care professional with whom a woman comes into contact after being sexually assaulted. Which statement best describes the initial care of a rape victim? a. All legal evidence is preserved during the physical examination. b. The victim appreciates the legal information; however, decides not to pursue legal proceedings. c. The victim states that she is going to advocate against sexual violence. d. The victim leaves the health care facility without feeling re-victimized.

ANS: D Nurses can assist clients through an examination that is as nontraumatic as possible with kindness, skill, and empathy. The initial care of the victim affects her recovery and decision to receive follow-up care. Preservation of all legal evidence is very important; however, this may not be the best measure in terms of evaluating the care of a rape victim. Offering legal information is not the best measure of evaluating the care that this victim received. The victim may well decide not to pursue legal proceedings. Advocating against sexual violence may be extremely therapeutic for the client after her initial recovery but not a measure of evaluating her care.

4. During a prenatal intake interview, the nurse is in the process of obtaining an initial assessment of a 21-year-old Hispanic client with limited English proficiency. Which action is the most important for the nurse to perform? a. Use maternity jargon to enable the client to become familiar with these terms. b. Speak quickly and efficiently to expedite the visit. c. Provide the client with handouts. d. Assess whether the client understands the discussion.

ANS: D Nurses contribute to health literacy by using simple, common words, avoiding jargon, and evaluating whether the client understands the discussion. Speaking slowly and clearly and focusing on what is important will increase understanding. Most client education materials are written at a level too high for the average adult and may not be useful for a client with limited English proficiency.

In their role of implementing a plan of care for infertile couples, nurses should: a. Be comfortable with their own sexuality and nonjudgmental about others to effectively counsel their clients b. Know about such nonmedical remedies as diet, exercise, and stress management c. Be able to direct clients to sources of information about what herbs to take that might help and which ones to avoid d. Do all of these plus be knowledgeable about potential drug and surgical remedies

ANS: D Nurses should also be cognizant that a number of surgical procedures can be used for problems related to female infertility. Nurses can help couples express and discuss their feelings as honestly as possible. The nurse must be comfortable with his or her own sexuality. The nurse should be aware that simple changes in lifestyle may be effective in assisting the infertile couple. Most herbal remedies have not been proven effective.

9. What is a limitation of a home postpartum visit? a. Distractions limit the nurses ability to teach. b. Identified problems cannot be resolved in the home setting. c. Necessary items for infant care are not available. d. Home visits to different families may require the nurse to travel a great distance.

ANS: D One limitation of home health visits is the distance the nurse must travel between clients. Driving directions should be obtained by telephone before the visit. The home care nurse is accustomed to distractions but may request that the television be turned off so that attention can be focused on the client and her family. Problems cannot always be resolved; however, appropriate referrals may be arranged by the nurse. The nurse is required to bring any necessary equipment, such as a thermometer, baby scale, or laptop computer, for documentation.

11. Male fertility declines slowly after age 40 years; however, no cessation of sperm production analogous to menopause in women occurs in men. What condition is not associated with advanced paternal age? a. Autosomal dominant disorder b. Schizophrenia c. Autism spectrum disorder d. Down syndrome

ANS: D Paternal age older than 40 years is associated with an increased risk for autosomal dominant disorder, schizophrenia, and autism spectrum disorder in their offspring. Although Down syndrome can occur in any pregnancy, it is often associated with advanced maternal age.

Which area is appropriate to include in a physical assessment of the home? a. Bathtub, toilets, sinks, countertops, inside china cabinet drawers b. Babys bed, changing table, babys clothes, inside diaper bag, inside keepsake box c. Bedroom closets, inside jewelry boxes, under beds d. Electrical wall outlets, telephones, bathroom sink and faucets, stove, and refrigerator

ANS: D Physical assessment of the home environment is an essential element of the home care assessment. The major areas of the home environment assessment include physical features of the home, access to the home, sanitary conditions, the presence of utilities (phone, electricity, plumbing), safety features, and access to transportation and emergency support. The nurse may evaluate sanitary conditions and cleanliness of the bathroom; however, there is no reason to check inside the china cabinet. Although the nurse may want to evaluate the nursery, it is inappropriate to request to see the inside of the infants keepsake box. The purpose of a physical assessment of the home is to assess safety issues, such as sanitary conditions and the presence of utilities, not to account for the clients possessions or to look inside drawers.

16. When attempting to communicate with a client who speaks a different language, which action is the most appropriate? a. Promptly and positively respond to project authority. b. Never use a family member as an interpreter. c. Talk to the interpreter to avoid confusing the client. d. Provide as much privacy as possible.

ANS: D Providing privacy creates an atmosphere of respect and puts the client at ease. The nurse should not rush to judgment and should ensure she or he clearly understands the clients message. In crisis situations, the nurse may need to use a family member or neighbor as a translator. The nurse should speak directly to the client to create an atmosphere of respect.

21. Some of the embryos intestines remain within the umbilical cord during the embryonic period. What is the rationale for this development of the gastrointestinal system? a. Umbilical cord is much larger at this time than it will be at the end of pregnancy. b. Intestines begin their development within the umbilical cord. c. Nutrient content of the blood is higher in this location. d. Abdomen is too small to contain all the organs while they are developing.

ANS: D The abdominal contents grow more rapidly than the abdominal cavity; therefore, part of their development takes place in the umbilical cord. By 10 weeks of gestation, the abdomen is large enough to contain them. Intestines begin their development within the umbilical cord but only because the liver and kidneys occupy most of the abdominal cavity. Blood supply is adequate in all areas.

22. A woman is using the basal body temperature (BBT) method of contraception. She calls the clinic and tells the nurse, My period is due in a few days, and my temperature has not gone up. What is the nurses mostappropriate response? a. This probably means that youre pregnant. b. Dont worry; its probably nothing. c. Have you been sick this month? d. You probably didnt ovulate during this cycle.

ANS: D The absence of a temperature decrease most likely is the result of a lack of ovulation. Pregnancy cannot occur without ovulation, which is being measured using the BBT method. A comment such as, Dont worry; its probably nothing, discredits the clients concerns. Illness is most likely the cause of an increase in BBT.

6. A client currently uses a diaphragm and spermicide for contraception. She asks the nurse to explain the major differences between the cervical cap and the diaphragm. What is the most appropriate response by the nurse? a. No spermicide is used with the cervical cap, so its less messy. b. The diaphragm can be left in place longer after intercourse. c. Repeated intercourse with the diaphragm is more convenient. d. The cervical cap can be safely used for repeated acts of intercourse without adding more spermicide later.

ANS: D The cervical cap can be inserted hours before sexual intercourse without the need for additional spermicide later. Spermicide should be used inside the cap as an additional chemical barrier. The cervical cap should remain in place for 6 hours after the last act of intercourse. Repeated intercourse with the cervical cap is more convenient because no additional spermicide is needed.

10. A blind woman has arrived for an examination. Her guide dog assists her to the examination room. She appears nervous and says, Ive never had a pelvic examination. What response from the nurse would be most appropriate? a. Dont worry. It will be over before you know it. b. Try to relax. Ill be very gentle, and I wont hurt you. c. Your anxiety is common. I was anxious when I first had a pelvic examination. d. Ill let you touch each instrument that Ill use during the examination as I tell you how it will be used.

ANS: D The client who is visually impaired needs to be oriented to the examination room and needs a full explanation of what the examination entails before the nurse proceeds. Telling the client that the examination will be over quickly diminishes the clients concerns. The nurse should openly and directly communicate with sensitivity. Women who have physical disabilities should be respected and involved in the assessment and physical examination to the full extent of their abilities. Telling the client that she will not be hurt does not reflect respect or sensitivity. Although anxiety may be common, the nurse should not discuss her own issues nor compare them to the clients concerns.

22. While working in the prenatal clinic, nurses care for a very diverse group of clients. Which cultural factor related to health is most likely to drive acceptance of planned interventions? a. Educational achievement b. Income level c. Subcultural group d. Individual beliefs

ANS: D The clients beliefs are ultimately the key to the acceptance of health care interventions. However, these beliefs may be influenced by factors such as educational level, income level, and ethnic background. Educational achievement, income level, and being part of a subcultural group all are important factors. However, the nurse must understand that a womans concerns from her own point of view will have the most influence on her compliance and acceptance of health care interventions.

14. Which part of the menstrual cycle includes the stimulated release of gonadotropin-releasing hormone (GnRH) and follicle-stimulating hormone (FSH)? a. Menstrual phase b. Endometrial cycle c. Ovarian cycle d. Hypothalamic-pituitary cycle

ANS: D The cyclic release of hormones is the function of the hypothalamus and pituitary glands. The menstrual cycle is a complex interplay of events that simultaneously occur in the endometrium, hypothalamus, pituitary glands, and ovaries. The endometrial cycle consists of four phases: menstrual phase, proliferative phase, secretory phase, and ischemic phase. The ovarian cycle remains under the influence of FSH and estrogen.

19. Nurses should be cognizant of what information with regard to the noncontraceptive medical effects of combination oral contraceptives (COCs)? a. COCs can cause TSS if the prescription is wrong. b. Hormonal withdrawal bleeding is usually a little more profuse than in normal menstruation and lasts a week for those who use COCs. c. COCs increase the risk of endometrial and ovarian cancers. d. Effectiveness of COCs can be altered by some over-the-counter medications and herbal supplements.

ANS: D The effectiveness of COCs can be altered by some over-the-counter medications and herbal supplements. TSS can occur in some who use the diaphragm, but it is not a consequence of taking oral contraceptive pills. Hormonal withdrawal bleeding usually is lighter than in normal menstruation and lasts a couple of days. Oral contraceptive pills offer protection against the risk of endometrial and ovarian cancers.

16. While obtaining a detailed history from a woman who has recently immigrated from Somalia, the nurse realizes that the client has undergone female genital mutilation. What is the nurses most appropriate response in this situation? a. This is a very abnormal practice and rarely seen in the United States. b. Are you aware of who performed this mutilation so that it can be reported to the authorities? c. We will be able to restore fully your circumcision after delivery. d. The extent of your circumcision will affect the potential for complications.

ANS: D The extent of the circumcision is important. The client may experience pain, bleeding, scarring, or infection and may require surgery before childbirth. Although this practice is not prevalent in the United States, it is very common in many African and Middle Eastern countries for religious reasons. Mentioning that the practice is abnormal and rarely seen in the United States is culturally insensitive. The infibulation may have occurred during infancy or childhood; consequently, the client will have little to no recollection of the event. She would have considered this to be a normal milestone during her growth and development. The International Council of Nurses has spoken out against this procedure as harmful to a womans health.

30. What is the most dangerous effect on the fetus of a mother who smokes cigarettes while pregnant? a. Genetic changes and anomalies b. Extensive central nervous system damage c. Fetal addiction to the substance inhaled d. Intrauterine growth restriction

ANS: D The major consequences of smoking tobacco during pregnancy are low-birth-weight infants, prematurity, and increased perinatal loss. Cigarettes will not normally cause genetic changes or extensive central nervous system damage. Addiction to tobacco is not usually a concern related to the neonate.

21. In what form do families tend to be the most socially vulnerable? a. Married-blended family b. Extended family c. Nuclear family d. Single-parent family

ANS: D The single-parent family tends to be economically and socially vulnerable, creating an unstable and deprived environment for the growth potential of children. The married-blended family, the extended family, and the nuclear family are not the most socially vulnerable.

23. What is the goal of a long-term treatment plan for an adolescent with an eating disorder? a. Managing the effects of malnutrition b. Establishing sufficient caloric intake c. Improving family dynamics d. Restructuring client perception of body image

ANS: D The treatment of eating disorders is initially focused on reestablishing physiologic homeostasis. Once body systems are stabilized, the next goal of treatment for eating disorders is maintaining adequate caloric intake. Although family therapy is indicated when dysfunctional family relationships exist, the primary focus of therapy for eating disorders is to help the adolescent cope with complex issues. The focus of treatment in individual therapy for an eating disorder involves restructuring cognitive perceptions about the individuals body image.

4. Which action would be inappropriate for the nurse to perform before beginning the health history interview? a. Smile and ask the client whether she has any special concerns. b. Speak in a relaxed manner with an even, nonjudgmental tone. c. Make the client comfortable. d. Tell the client her questions are irrelevant.

ANS: D The woman should be assured that all of her questions are relevant and important. Beginning any client interaction with a smile is important and assists in putting the client at ease. If the nurse speaks in a relaxed manner, then the client will likely be more relaxed during the interview. The clients comfort should always be ensured before beginning the interview.

19. What information should the nurse be aware of regarding telephonic nursing care such as warm lines? a. Were developed as a reaction to impersonal telephonic nursing care b. Were set up to take complaints concerning health maintenance organizations (HMOs) c. Are the second option when 9-1-1 hotlines are busy d. Refer to community service telephone lines designed to provide new parents with encouragement and basic information

ANS: D Warm lines are one aspect of telephonic nursing care specifically designed to provide new parents with encouragement and basic information. Warm lines and similar services sometimes are set up by HMOs to provide new parents with encouragement and basic information. The name, warm lines, may have been suggested by the term hotlines, but these are not emergency numbers but are designed to provide new parents with encouragement and basic information.

A nurse is planning care for a client with a different cultural background. What is an appropriate goal? a. Strive to keep the clients cultural background from influencing health needs. b. Encourage the continuation of cultural practices in the hospital setting. c. In a nonjudgmental way attempt to change the clients cultural beliefs. d. As necessary adapt the clients cultural practices to her health needs.

ANS: D Whenever possible, the nurse should facilitate the integration of cultural practices into health needs. The cultural background is part of the individual. It would be very difficult to eliminate The cultural practices need to be evaluated within the context of the health care setting to determine if they are conflicting. It is not appropriate to attempt to change someones cultural practices.

____________________ twins is another term for fraternal twins. These twins may be the same or different sexes and genetically are no more alike than siblings born at different times.

ANS: Dizygotic Monozygotic twins are those that develop from one fertilized ovum which then divides. These are also known as identical twins.

Normally a fertile couple has approximately a 50% chance of conception each ovulatory cycle. Is this statement true or false?

ANS: F In the healthy fertile couple, a 20% chance of conception occurs during each ovulatory cycle.

Very fine hairs, called ____________________, appear first at 12 weeks of gestational age on the fetuss eyebrows and upper lip. By 20 weeks they cover the entire body. By 28 weeks, the scalp hair is longer than these fine hairs, which thin and may disappear by term gestation.

ANS: Lanugo By 20 weeks of gestation the eyelashes, eyebrows, and scalp hair also begin to grow.

The ___________________ __________ is one method used to evaluate the adequacy of coital technique, cervical mucous, sperm quality and penetration.

ANS: Postcoital test This test is performed within several hours after ejaculation of semen into the vagina and is used to study a number of factors affecting fertility.

The fetal concentration of glucose is lower than the glucose level in the maternal blood because of its rapid metabolism by the fetus. Is this statement true or false?

ANS: T This fetal requirement demands larger concentrations of glucose than simple diffusion can provide. Therefore, maternal glucose moves into the fetal circulation by active transport.

Obesity is associated with infertility as well as poorer outcomes for assisted reproductive technologies. Is this statement true or false?

ANS: T Women who are overweight or obese have a reduced chance of pregnancy following in vitro fertilization (IVF) and a significantly greater risk of spontaneous abortion following infertility treatment. Infertility treatment may be deferred until the body mass index (BMI) is less than 30 kg/m2, with no other risk factors.

The ability of the fetus to survive outside the uterus is called ____________________.

ANS: Viability In the past the earliest age at which fetal survival could be expected was 28 weeks after conception. With modern technology and advancements in maternal and neonatal care, viability is now possible at 20 weeks after conception (22 weeks after last menstrual period [LMP], fetal weight of 500 g or more).

The nurse-midwife is teaching a group of women who are pregnant about Kegel exercises. Which statement by a participant would indicate a correct understanding of the instruction? A. "I will see results only if I perform 100 Kegel exercises each day." B. "I should hold the Kegel exercise contraction for 10 seconds and rest for 10 seconds between exercises." C. "I should perform Kegel exercises only in the sitting position." D. "I will perform daily Kegel exercises during the last trimester of my pregnancy to achieve the best results."

B. Guidelines suggest that women perform between 30 and 80 Kegel exercises daily. The correct technique is to hold the contraction for at least 10 seconds and to rest for 10 seconds in between so the muscles can have time to recover and each contraction can be as strong as the woman can make it. The exercises are best performed in a supine position with the knees bent. Kegel exercises should be performed throughout the pregnancy to achieve the best results.

Which time span delineates the appropriate length for a normal pregnancy? A. 9 lunar months, 8.5 calendar months, 39 weeks, 272 days B. 10 lunar months, 9 calendar months, 40 weeks, 280 days C. 9 calendar months, 10 lunar months, 42 weeks, 294 days D. 9 calendar months, 38 weeks, 266 days

B. Pregnancy lasts approximately 10 lunar months, 9 calendar months, 40 weeks, 280 days. Length of pregnancy is computed from the first day of the last menstrual period (LMP) until the day of birth. Nine lunar months is just short of a term pregnancy, and 294 days is longer than the average length of a pregnancy and would be considered postterm. Because conception occurs approximately 2 weeks after the first day of the LMP, the length described in D represents the postconception age of 266 days or 38 weeks. Postconception age is used in the discussion of fetal development.

In the 1970s rape-trauma syndrome (RTS) was identified as a cluster of characteristics, symptoms, and related behaviors seen in the weeks and months after a rape. Which pattern of responses would not apply to a victim of rape? A. Acute phase: disorganization B. Acute phase: rearranging C. Outward adjustment phase D. Long-term process: reorganization phase

B. Reorganization is not a phase of RTS. Disorganization is the first phase of RTS, which can last for several days up to 3 weeks. Reactions such as shock, denial, and disbelief are common. The rape survivor feels embarrassed, degraded, angry, and vengeful. The outward adjustment phase is next. The survivor appears to have resolved her crisis. She needs to regain control over her life and may return to work, move, or buy a weapon to defend herself. The third phase is reorganization. Suppression of feelings and emotions starts to deteriorate, and the woman may become depressed and anxious.

The nurse's best measure when evaluating the care of a woman in an abusive situation is based on the: A. Woman's decision to leave her partner. B. Woman's declaration of a safety plan. C. Couple's follow-through on a referral for counseling. D. Woman's gratitude to the nurse for the helpful information.

B. Safety is the most significant part of the intervention. A decision to leave the partner would be a positive step for the woman, but it is not the most significant part of the intervention. In addition, many women choose to return to the relationship. The woman may express her gratitude to the nurse in an effort to end the conversation; this does not indicate the woman's readiness to leave the relationship or to make a plan for safety. Couples counseling generally is not recommended. Initially, individual counseling would be more beneficial. Neither would be a measure of success in the evaluation of the care plan of an abused woman.

What would a breastfeeding mother who is concerned that her baby is not getting enough to eat find most helpful and most cost-effective on the day after discharge? A. Visiting a pediatric screening clinic at the hospital B. Placing a call to the hospital nursery warm line C. Calling the pediatrician for a lactation consult referral D. Requesting a home visit

B. The first course of action should be to call a warm line for advice from a nurse. Warm lines are telephone lines offered as a community service, in this case to provide new parents with support, encouragement, and basic parenting education.

Which of the following lab tests would be indicated for a victim of sexual assault? Select all that apply. A. Chemistry profile and complete blood count B. Screening test for hepatitis B C. Fecal occult blood testing D. Oral swab DNA testing E. Serum blood pregnancy test F. Gonorrhea culture

B., D., E. Testing for Hepatitis B would be warranted because of blood transmission. Testing for confirmation of DNA would be indicated in a sexual assault case. Testing for pregnancy, urine or blood would be indicated in a sexual assault case. Typically, gonorrhea cultures would not be indicated because treatment would be given prophylactically to a sexual assault victim and therefore the results would not affect clinical practice. There is no need for fecal occult blood testing unless there is some other presenting clinical indication. Unless there is evidence of blood loss, a chemistry profile and complete blood count may not be needed.

When caring for pregnant women, the nurse should keep in mind that violence during pregnancy: A. Affects more than 25% of pregnant women in the United States. B. Increases a pregnant woman's risk for gestational hypertension. C. May be associated with substance abuse by both the pregnant woman and her partner. D. Has decreased in incidence as a result of better assessment techniques and record-keeping.

C. Approximately 8% of pregnant women are battered; the incidence of battering increases during pregnancy. Violence itself has no correlation with the incidence of gestational hypertension. Alcoholism and substance abuse by the woman or her abuser are associated with violence. The rates of violence have actually increased, possibly because of better assessment and reporting mechanisms.

If used consistently and correctly, which of the barrier methods of contraception has the lowest failure rate? A. Spermicides B. Female condoms C. Male condoms D. Diaphragms

C. For typical users, the failure rate for male condoms may approach 15%; however, if condoms are used correctly, the failure rate is only 2%. Failure rates are about 29% for spermicides, about 21% for female condoms, and 16% for diaphragms with spermicides.

Another name for human sex trafficking is: A. Sex games. B. Licensed sexual act. C. Modern-day slavery. D. Prostitution.

C. Human sex trafficking has been referred to as "modern-day slavery" according to current literature. It is performed with coercion, and "licensure" does not apply. Sex games refers to "sexual game playing" during the course of sexual activity. Prostitution refers to the trade whereby an individual provides sexual activity for monetary remuneration.

A nursing student is reviewing information relative to cultural beliefs about infertility. Which statement, if made by a patient, would require intervention? A. A patient states that she wants to consult her Rabbi before going any further with an infertility workup. B. "I will not be able to use IVF therapies as it is against my religion; I am a Roman Catholic." C. "I have to take full responsibility for my failure to conceive." D. "I may consider having infertility treatments but I have to talk this over with my husband first."

C. In certain cultures, women are viewed as being responsible for all fertility problems, but the fact that this statement acknowledges complete fault would require the nursing student to intervene in order to provide compassion and decrease the psychologic stress of the patient. Statements about consulting the partner are expected, because both partners should discuss and explore available fertility options. Consultation about infertility treatments with a spiritual leader, regardless of religion, requires no intervention. Certain religions, such as Roman Catholicism, do not allow IVF therapy.

A woman taking an oral contraceptive pill (OCP) as her birth control method of choice should notify her health care provider immediately if she notes: A. Breast tenderness and swelling B. Weight gain C. Swelling and pain in one of her legs D. Mood swings

C. Leg pain and swelling (edema) may indicate thrombophlebitis and should be reported immediately. Breast tenderness and weight gain are expected side effects of OCPs, and mood swings are a common side effect.

A pregnant woman has been diagnosed with oligohydramnios. Which presentation would the nurse suspect to find on physical examination? A. Fetus is in a breech position B. FHR baseline is within normal range C. Fetus with possible renal problems D. Increased fundal height

C. Oligohydramnios reflects a decrease in the amount of amniotic fluid and is associated with renal abnormalities in the fetus and compromised fetal well-being. The position of the fetus is due to gestational age and the maternal uterine environment. FHR may be within normal range because it is affected by gestational age and fetal well-being. An increase in fundal height would be associated with polyhydramnios and/or gestational age assessment.

Which of the following actions, if demonstrated by a nursing student, could lead to dismissal from the health program? Select all that apply. A. A student nurse offers her phone number to a patient so that they can remain in touch. B. Nursing students go out for lunch following a clinical rotation to a local restaurant while still in uniform. C. A nursing student posts pictures of clinical site experiences on her Facebook page. D. Student nurses share their thoughts about their clinical site experiences on Twitter.

C. D. Although a nursing student can provide a phone number to a patient so that they remain in touch, the student should be aware of the limits of the relationship while in nursing school. Nursing students going out to lunch following a clinical experience while in uniform would not pose a problem as long as they maintained their professional demeanor and did not discuss clinical events. Posting of images related to clinical experiences on a Facebook page would make the student liable for violation of privacy. Sharing of thoughts related to clinical experiences on social media may result in dismissal from a health program if a student nurse provides information that results in violation of the HIPAA (Health Insurance Portability and Accountability Act) Privacy Rule.

When assessing women it is important for a nurse to keep in mind the possibility that they are victims of violence. The nurse should: A. Use an abuse assessment screen during the assessment of every woman B. Recognize that abuse rarely occurs during pregnancy C. Assess a woman's legs and back as the most commonly injured areas D. Notify the woman's partner immediately if abuse is suspected

Choice A is correct; all women should be screened because abuse can happen to any woman; abuse can begin or escalate during pregnancy; the most commonly injured sites are head, neck, chest, abdomen, breasts, and upper extremities. If abuse is suspected, the nurse needs to assess further to encourage disclosure and then assist the woman to take action and formulate a safety plan. Nurses should follow the laws of their state with regard to reporting instances of abuse.

Which statement is most accurate regarding persons who should participate in preconception counseling? A. All women and their partners as they make decisions about their reproductive future, including becoming parents B. Women older than 40 years of age who wish to become pregnant C. Sexually active women who do not use birth control D. Women with chronic illnesses such as diabetes who are planning to get pregnant

Choice A is correct; all women-not just specific groups-should participate in preconception care approximately 1 year before planning to become pregnant.

After teaching a group of pregnant women about the hazards of cigarette smoking during pregnancy, a woman answers a question by listing the hazards. Which hazard, if included by the woman in her list, indicates the need for further teaching? A. Intrauterine growth restriction B. Congenital anomalies C. Low birth weight D. Premature labor and birth

Choice B is correct; smoking is not associated with anomalies; because smoking adversely affects circulation and thus placental perfusion, choices A, C, and D are all possible complications of smoking.

Lifestyle and sexual practices can affect fertility. Which of the following practices could enhance a couple's ability to conceive? A. Use balanced nutrition and exercise to achieve a normal body mass index (BMI). B. Abstain from alcohol. C. Avoid the use of lubricants during intercourse. D. Relax in a hot tub every day before going to bed.

Choice A is correct; both male and female obesity can adversely affect fertility; water-soluble lubricants can be safely used; daily hot tubs or saunas may increase scrotal temperature enough to interfere with spermatogenesis; although excessive alcohol use can cause erectile dysfunction, abstention from alcohol is not necessary.

A family with open boundaries: A. Uses available support systems to meet its needs B. Is more prone to crisis, related to increased exposure to stressors C. Discourages family members from setting up channels D. Strives to maintain family stability by avoiding outside influences

Choice A is correct; choices B, C, and D reflect the characteristics of families with closed boundaries. they are more prone to crises because they have a narrow network to help them in times of stress.

When caring for pregnant women, the nurse would recognize that a woman with which disorder has the greatest risk for giving birth to a macrosomic newborn? A. Diabetes B. Anemia C. Hyperthyroidism D. Hypertension

Choice A is correct; if a woman's diabetes is uncontrolled, maternal hyperglycemia will produce fetal hyperglycemia and stimulate hyperinsulinemia, resulting in increased fetal growth (macrosomia or large for gestational age); lung maturation is inhibited and neonatal hypoglycemia can occur; strict control of maternal glucose levels before and during pregnancy will reduce the risk.

A single young-adult woman received instructions from the nurse regarding the use of an oral contraceptive. The woman demonstrates a need for further instruction if she: A. Stops asking her sexual partners to use condoms with spermicide B. States that her menstrual periods should be shorter with less blood loss C. Takes a pill every morning D. Uses a barrier method of birth control if she misses two or more pills

Choice A is correct; oral contraception provides no protection from STIs; therefore a condom and spermicide are still recommended to prevent transmission; choices B, C, and D reflect appropriate actions and recognition of the effects of oral contraceptive pills (OCPs).

A 36-year-old woman has chosen depot medroxyprogesterone acetate (DMPA, Depo-Provera) as the method of contraception most suitable for her lifestyle. Which statement made by the woman indicates a lack of understanding and a need for further instruction by the nurse? A. "I will need to receive another injection every 4 weeks." B. "I am going to watch my diet and exercise, because weight gain is common." C. "If I plan to continue with the Depo-Provera, I should have my bone density assessed." D. "This method will result in a smaller amount of thicker cervical mucus."

Choice A is correct; the injection is repeated every 11 to 13 weeks (four times per year); choices B, C, and D are accurate.

A woman with an IUD should confirm its placement by checking the IUD's string: A. After menses ceases B. After intercourse C. Two days after ovulation D. During menstrual bleeding

Choice A is correct; the string should be checked after menses, before intercourse, at the time of ovulation, and if expulsion is suspected; a missing string or one that becomes longer or shorter should be checked by a health care professional.

Which of the following women is most likely to seek assistance when battered? A. A woman with a career B. A woman who has been battered for the first time C. A woman who, as a child, saw her mother being abused by her father D. A woman who was abused as a child

Choice A is correct; women who experience repeated and severe abuse, have never witnessed or experienced abuse in their own families, and have alternatives such as a job or career are more likely to seek assistance.

Oral contraception in the form of a combination of low-dose estrogen and progesterone: A. Reduces the pH of cervical mucus, thereby destroying sperm B. Protects against iron deficiency anemia by reducing menstrual blood loss C. Prevents the transmission of sexually transmitted infections D. Is 90% effective in preventing pregnancy when used correctly

Choice B is correct; benefits of low dose pills are decreased menstrual blood loss and iron deficiency anemia; cervical mucus is thickened, thereby inhibiting sperm penetration; ovulation and the development of the endometrium are also inhibited; there is no protection from STIs; the overall effectiveness rate is nearly 100% if used correctly.

A 52-year-old woman asks the nurse practitioner about how often she should be assessed for the common health problems that women of her age could experience. The nurse recommends: A. An endometrial biopsy every 3 to 4 years B. A fecal occult blood test annually C. A mammogram every other year D. Bone mineral density testing annually

Choice B is correct; bone mineral density testing should be initiated at 65 years of age or older unless risk factors are present; endometrial biopsies are not recommended on a routine basis for most women but women at risk for endometrial cancer should have one done at menopause; mammograms should be done annually for women 50 years of age and older.

A women's health nurse practitioner is going to perform a pelvic examination on a female client. Which nursing action would be least effective in enhancing the client's comfort and relaxation during the examination? A. Encourage the client to ask questions and express feelings and concerns before and after the examination. B. Ask the client questions as the examination is performed. C. Allow the client to keep her shoes and socks on when placing her feet in the stirrups. D. Instruct the client to place her hands over her diaphragm and take deep, slow breaths.

Choice B is correct; do not ask questions during the examination because it may distract the client, interfering with relaxation measures she may be using; offer explanations only as needed during the examination.

Which nursing action is most likely to reduce a woman's anxiety and enhance her personal security as it relates to the concept of personal space needs? A. Touching the woman before and during procedures B. Providing explanations when performing tasks C. Making eye contact as much as possible D. Reducing the need for the woman to make decisions

Choice B is correct; providing explanations, especially when performing tasks that require close contact, can help to avoid misunderstandings; touching the client, putting the client in proximity to others, overuse of eye contact, and taking away the right to make decisions can be interpreted by clients in some cultures as invading their personal space and thereby increase the level of anxiety and stress experienced.

When using a cervical cap (FemCap), the woman bould be taught to: A. Apply spermicide only to the outside of the cap and around the rim B. Leave it in place for a minimum of 6 hours after the last act of coitus C. Continue to use the cap during menstrual periods D. Check the position of the cap and insert additional spermicide before each act of coitus

Choice B is correct; spermicide should be applied inside the cap but not around the rim because a seal will not form to keep the cap in place; use during menses increases the risk for toxic shock syndrome (TSS); checking the cap's position is all that is required before each subsequent act of coitus.

A woman must assess herself for signs that ovulation is occurring. Which of the following is a sign associated with ovulation? A. Reduction in level of luteinizing hormone (LH) in the urine 12 to 24 hours prior to ovulation B. Spinnbarkeit C. Drop in basal body temperature (BBT) following ovulation D. Increased thickness of cervical mucus

Choice B is correct; spinnbarkeit refers to stretchiness of cervical mucus at ovulation to facilitate passage of sperm; there is an LH surge prior to ovulation; BBT rises in response to increased progesterone after ovulation; cervical mucus becomes thinner and more abundant with ovulation.

The results of an amniocentesis show that the pregnant woman's lecithin-sphingomyelin (LIS) ratio is 2: 1. This result indicates that: A. The woman is in her second trimester of pregnancy B. The newborn should be able to maintain effective respiration after birth C. The fetus most likely has developed a renal problem D. An open neural tube defect is present

Choice B is correct; the LIS ratio is a test to determine the presence of the surfactants lecithin and sphingomyelin; it becomes 2:1, indicating lung maturity, at approximately 35 weeks of gestation; an elevated alpha-fetoprotein level is an indicator for an open neural tube defect; renal disorders usually are indicated by a decreased amount of amniotic fluid.

A nurse manager of a prenatal clinic should recognize that the most significant barrier encountered by pregnant women in accessing health care is: A. Lack of transportation to the clinic B. Child care responsibilities C. Inability to pay D. Deficient knowledge related to the benefits of prenatal care

Choice C is correct; although the other options are important, inability to pay, which relates to inadequate or lack of health care insurance, is the most significant barrier.

A student nurses' association is planning a health fair that will emphasize secondary-level prevention activities. Which activity would the faculty adviser tell them to eliminate because it does not fit into their stated focus? A. Teaching participants how to check their radial pulse for rate and regularity B. Blood glucose monitoring C. Demonstration of relaxation measures to manage stress D. Breast models that participants can use to learn breast palpation techniques

Choice C is correct; because it represents the primary level of prevention.

A nurse instructed a female client regarding vulvar self-examination (VSE). Which statement made by the client indicates that further instruction is needed? A. "I will perform this examination at least once a month, especially if I change sexual partners or am sexually active." B. "I will become familiar with how my genitalia look and feel so that I will be able to detect changes." C. "I will use the examination to determine when I should get medications at the pharmacy for infections." D. "I will wash my hands thoroughly before and after I examine myself."

Choice C is correct; self-examination should not be used for self-diagnosis but rather to detect early changes, which would call for the guidance of a health care provider.

If a pregnant woman's intake of iron is sufficient, her newborn will have enough iron stored in its liver to last approximately how many months after birth? A. 1 month B. 3 months C. 5 months D. 9 months

Choice C is correct; the healthy newborn of a well-nourished mother will not need iron sources until about 5 months of age; iron-fortified cereal is usually introduced at this time.

A student nurse is planning to communicate with her postpartum client using an interpreter. Her instructor should provide further guidance if the student: A. Arranges for a female from the woman's country of origin to act as interpreter B. Stops periodically during the interaction to ask the interpreter how things are going C. Asks the woman questions while looking at the interpreter D. Gathers culturally appropriate learning aids and reading materials to use during the interaction

Choice C is correct; the student should be looking at the woman while speaking and asking questions through the interpreter; a normal tone of voice should be used.

A woman taking human menopausal gonadotropins for infertility should understand which of the following regarding this medication? A. She should take the medication orally, once a day after breakfast. B. The medication stimulates the pituitary gland to produce the follicle-stimulating hormone (FSH) and the luteinizing hormone (LH). C. She must report for ultrasound testing as scheduled to monitor follicular development. D. Progesterone should be administered after seven doses of the gonadotropins have been taken.

Choice C is correct; this medication provides LH and FSH, causing a powerful ovulation stimulation that can result in multiple pregnancy; therefore regular ovarian ultrasound and monitoring of estradiol levels are required to prevent hyperstimulation. It is administered intramuscularly and is used when clomiphene fails to induce ovulation; it is followed by administration of human chorionic gonadotropin (hCG)

Both worldwide and in the United States, the leading cause of maternal mortality is: A. Hemorrhage B. Infection or sepsis C. Diabetes D. Cardiovascular disease, including hypertensive disorders

Choice D is correct.

When making a home visit, it is essential that the nurse use appropriate infection control measures. Of the measures listed below, which one is the most important? A. Including personal protective equipment in the home care bag B. Designating a dirty area with a trash bag to collect soiled equipment and supplies C. Wearing clean vinyl gloves for procedures that involve touching the client D. Performing hand hygiene using either soap and running water or a self-drying antiseptic solution

Choice D is correct; although choices A and B are appropriate, they are not the most important; gloves are not needed unless the possibility of contacting body substances is present.

A characteristic of women in abusive relationships is which of the following? A. Masochism B. Willingness to take a stand no matter what the cost C. Absence of typical feminine characteristics such as nurturing and compassion D. Tendency to isolate themselves from social relationships

Choice D is correct; battered women are often isolated as a result of fear, the stigma that society places on them because of the false belief that they must enjoy being abused, and restrictions on their activities by their partner; typical feminine characteristics are more apparent in women in abusive relationships whereas assertiveness, independence, and willingness to take a stand are more characteristic of women who are in nonviolent relationships.

Pregnant women who are obese are more likely to develop one or both of the two most frequently reported maternal risk factors. These factors are: A. Premature labor and infection B. Hemorrhage and hypertension associated with pregnancy C. Infection and diabetes D. Diabetes and hypertension associated with pregnancy

Choice D is correct; both diabetes and hypertension associated with pregnancy are the risk factors most commonly reported with obesity.

A Native-American woman gave birth to a girl 12 hours ago. The nurse notes that the woman keeps her baby in the bassinet except for feeding and states that she will wait until she returns home to begin breastfeeding. The nurse recognizes that this behavior is most likely a reflection of: A. Embarrassment B. Delayed attachment C. Disappointment that the baby is a girl D. Cultural beliefs regarding the best way to care for newborns

Choice D is correct; choices A, B, and C are incorrect interpretations based on the woman's culture and customs; Native Americans may use cradleboard and avoid handling their newborn often; newborn should not be fed colostrum.

When palpating the small breasts of a young, slender woman the nurse should: A. Wear clean gloves B. Lift the hands when moving from one segment of the breast to another C. Use both hands D. Follow a systematic, overlapping pattern

Choice D is correct; clean gloves are required only if open lesions are present and when compressing the nipple if discharge is anticipated; fingers should not be lifted; two hands are used for women with large, pendulous breasts.

When teaching women about the effective use of chemical barriers, the nurse should tell them to: A. Insert at least 2 hours prior to intercourse B. Use nonoxynol-9 (N-9) to inhibit the transmission of HIV C. Douche immediately after the last act of intercourse D. Reapply before each act of coitus

Choice D is correct; spermicide should be inserted no longer than 1 hour prior to intercourse; douching or rinsing should not occur for at least 6 hours after the last act of coitus; frequent use of N-9, especially for anal intercourse, may disrupt mucosa, increasing rather than decreasing the risk of HIV transmission.

When caring for a woman who is scheduled for a hysterosalpingogram, the nurse should do which of the following? A. Ensure that the woman is in the secretory phase of her menstrual cycle. B. Explain to the woman that the procedure will allow her to conceive. C. Report any uterine cramping immediately because it may indicate that the woman's uterus was perforated during the procedure. D. Change the woman's position if she complains of shoulder pain following the procedure.

Choice D is correct; with passage of radiopaque dye, this test could straighten or unblock the uterine tube if that is the cause of the infertility but it is not a guarantee she will conceive; it is performed 4 to 5 days after menstruation (proliferative phase); uterine cramping and referred pain to the shoulder are expected findings and are treated with mild analgesics and position changes.

A 20-year-old woman tells the nurse that she performs breast self-examination (BSE) on a regular basis. The nurse evaluates the woman's understanding of BSE and ability to perform the technique correctly. Which actions by the woman indicate that she needs further instruction regarding BSE? (Circle all that apply.) A. Performs BSE every month on the first day of her menstrual cycle. B. Observes the size of her breasts, direction of her nipples, and appearance of her skin, including the presence of dimpling, when looking at her breasts in the mirror. C. Lies down on a bed and puts a pillow under the shoulder of the breast she is going to palpate. Then she places the arm on that side under her head. D. Uses the tips of two fingers to palpate her breast. E. Palpates her breast, using an overlapping circular pattern around her entire breast. F. Palpates her breasts again, including up into her axillae, while taking a shower.

Choices A and D are correct; a woman should perform BSE every month at the end of menstruation when the breasts are the least tender; she should use the fingerpads of her three middle fingers for palpation.

Men who are likely to abuse their female partners often exhibit which of the following characteristics? (Circle all that apply.) A. Low self-esteem B. Assertiveness C. Ability to express feelings verbally D. Intense interest in spending all of his time doing things with his partner E. Tolerance for frustration

Choices A and D are correct; characteristics of a potential batterer include deficits in assertiveness, low tolerance for frustration, inadequate verbal skills especially with regard to expressing feelings, and an unusual amount of jealousy leading to often expecting his partner to spend all of her time with him.

A 40-year-old male has elected to have a vasectomy because he no longer wants to worry that a sexual partner will become pregnant. The nurse describes the procedure along with care requirements before and after the procedure. Which statements by the client indicate the need for further instruction? (Circle all that apply.) A. "I am glad I will not need to use a condom. I hate them!" B. "I will use ice packs for a few hours after I get home to reduce swelling and discomfort." C. "I will wear a scrotal support for a few days to reduce discomfort." D. "I will need to wait about 3 weeks before resuming sexual intercourse." E. "I should not expect to see a decrease in the amount of semen I ejaculate."

Choices A and D are correct; condoms are still needed to reduce risk for STIs and to prevent pregnancy until two consecutive sperm counts are at zero; he may become sexually active when desired but needs to use a condom since sperm may still be in the ejaculate.

Regarding pregnancy and childbirth, European-American women are likely to believe that: (Circle all that apply.) A. The father of the baby should be actively involved in the labor and birth B. Pregnancy requires medical attention, so prenatal care should begin early in pregnancy C. Birthing at home should be valued D. Pregnant women should participate in childbirth education E. The doctor is the head of the obstetric care team F. Mothers should not begin to breastfeed until milk comes in

Choices A, B, D, and E are correct; birthing in an institutional setting is valued and breastfeeding should start as soon as possible after birth.

Knowledge of trends in fertility and birth rates and infant mortality rates can guide nurses in targeting health care resources to those areas and clients in most need of intervention. Which statements accurately reflect current trends in the United States? (Circle all that apply.) A. Women between ages 20 and 29 years have the highest birth rate. B. The incidence of LBW (low birth weight) is highest among non-Hispanic African-American women. C. The leading cause of neonatal death is premature birth. D. The infant mortality rate is a common indicator of the adequacy of prenatal care and the health of a nation as a whole. E. Hispanic women are twice as likely as non-Hispanic Caucasian women to die as a result of pregnancy.

Choices A, B, and D are correct; African-American women have a maternal mortality rate that is three times higher than Caucasian women whereas the rate for Hispanic women is the lowest; the leading cause of neonatal death is congenital anomalies.

A woman must assess herself for signs that ovulation is occurring. Which signs are associated with ovulation? (Circle all that apply.) A. Increase in the level of LH in her urine 12 to 24 hours before ovulation B. Spinnbarkeit C. Drop in BBT during the luteal phase of her menstrual cycle D. Softened moist cervix, which opens and rises in the vagina E. Decreased libido

Choices A, B, and D are correct; BBT rises during the luteal phase and libido increases.

When caring for a pregnant woman who is Hispanic, the nurse should recognize that the woman may be guided by which of the following cultural beliefs and practices during her pregnancy? (Circle all that apply.) A. Cool air currents can be dangerous during pregnancy. B. Prenatal care should begin very early in pregnancy. C. Milk should be avoided because it results in big babies and difficult births. D. Drinking chamomile tea should be avoided because it can cause preterm labor. E. The advice of both mothers and mothers-in-law should be followed during pregnancy. F. Pelvic examinations should not be performed by a male health care provider.

Choices A, C, E, and F are correct; prenatal care should begin late in pregnancy and chamomile tea is thought to ensure effective labor.

Joyce has chosen the diaphragm as her method of contraception. Which actions indicate that Joyce is using the diaphragm effectively? (Circle all that apply.) A. Joyce came to be refitted after healing was complete following the term vaginal birth of her son. B. Joyce applies a spermicide only to the rim of the diaphragm just before insertion. C. Joyce empties her bladder before inserting the diaphragm and after intercourse. D. Joyce applies more spermicide for each act of intercourse. E. Joyce removes the diaphragm within 1 hour of intercourse. F. Joyce always uses the diaphragm during her menstrual periods.

Choices A, C, and D are correct; spermicide should be spread on both surfaces of the diaphragm; it should not be removed for at least 6 hours after intercourse nor should it be used during menses because of the risk for TSS.

A woman suspects that she has been raped by her date and that he put a "roofie" (flunitrazepam [Rohypnol]) in the wine she was drinking. What signs would she describe to the sexual assault nurse examiner (SANE) to help confirm that her suspicions are correct? (Circle all that apply.) A. Remembering what happened clearly B. Severe headache in the morning C. Feeling as if sex has occurred D. Feeling more intoxicated than usual with a similar amount of alcohol E. Feeling fuzzy or woozy on awakening

Choices C, D, and E are correct; there is no recall after taking a drink laced with the drug; severe headache is not characteristic of having been drugged but feeling fuzzy when waking up is characteristic.

The nurse who provides preconception care understands that it: A. Is designed for women who have never been pregnant. B. Includes risk factor assessments for potential medical and psychologic problems but by law cannot consider finances or workplace conditions. C. Avoids teaching about safe sex to avoid political controversy. D. Could include interventions to reduce substance use and abuse.

D. Preconception care is designed for all women of childbearing potential. Risk factor assessment includes financial resources and environmental conditions at home and work. Health promotion can include teaching about safe sex. If assessments indicate a drug problem, treatment can be suggested or arranged.

A married couple is discussing male and female sterilization with the nurse. Which statement is most appropriate for the nurse to make? A. "Male and female sterilization methods are 100% effective." B. "A vasectomy may have a slight effect on sexual performance." C. "Tubal ligation can be easily reversed if you change your mind in the future." D. "Major complications after sterilization are rare."

D. Sterilization procedures can be safely done on an outpatient basis. Complications are uncommon and usually not serious. The average failure rate for female sterilization is 0.5% and for male sterilization is 0.15%. A vasectomy has no effect on potency or volume of ejaculate. Sterilization reversal is costly, difficult, and uncertain.

Which developmental finding is accurate with regard to fetal growth? A. Heart starts beating at 12 weeks. B. Lungs take shape by 8 weeks. C. Brain configuration is complete by 8 weeks. D. Main blood vessels form by 8 weeks.

D. The heart starts beating by 4 weeks, the lungs take shape by 12 weeks, and brain configuration is complete by 12 weeks.

A woman has had a ParaGard T380A IUD inserted. The nurse should recognize that the woman needs further teaching if she makes which of the following statements? (Circle all that apply.) a. "I should check the string before each menstrual period." b. "The IUD remains effective for 10 years." c. "It is normal to experience an increase in bleeding and cramping within the first year after it has been inserted." d. "My IUD works by releasing progesterone." e. "I should avoid using NSAIDs like Motrin if I have cramping." f. "I must use safer sex measures including maintaining a monogamous relationship to prevent infections in my uterus."

a, d, and e; the string should be checked after menses, before intercourse, at the time of ovulation, and if expulsion is suspected; a missing string or one that becomes longer or shorter should be checked by a health care professional; ParaGard is a copper IUD— it contains no hormone; NSAIDs are safe to use for discomfort.