NCLEX-PN Maternal and Women's Health Nursing EAQ questions and answers

During labor a client begins to experience dizziness and tingling of her hands. What should the nurse instruct the client to do? 1 Breathe into her cupped hands 2 Pant during the next three contractions 3 Hold her breath with the next contraction 4

Dizziness and tingling of the hands are signs of respiratory alkalosis, most likely the result of hyperventilating. Breathing into cupped hands or a paper bag promotes the rebreathing of carbon dioxide. Panting during the next three contractions could cause the client to hyperventilate more. Holding her breath with the next contraction will not improve the client's respiratory alkalosis. Using a fast, deep, or shallow breathing pattern could cause the client to hyperventilate more.

Which drug is derived from a natural source and may be prescribed for the treatment of osteoporosis? 1 Calcitonin 2 Raloxifene 3 Clomiphene 4 Bisphosphonates

Calcitonin is derived from natural sources such as fish; this drug may be prescribed to prevent osteoporosis. Raloxifene is prescribed to prevent postmenopausal osteoporosis. Clomiphene is prescribed to induce ovulation. Bisphosphonates are prescribed to treat osteoporosis; this drug is not derived from natural sources.

Which sleeping position is most recommended during pregnancy? 1 Prone 2 Supine 3 Left side-lying 4 Right side-lying

During pregnancy, the left side-lying position is recommended to promote oxygenation. As the pregnancy progresses, the prone position will become uncomfortable or impossible. The supine position is not recommended because it may place pressure on the aorta and vena cava, possibly resulting in supine hypotensive syndrome and/or decreased circulation to the fetus. Right side-lying position is safe and may be comfortable, but it is not as recommended because it does not promote oxygenation.

What may happen when clomiphene is co-administered with methyldopa to promote ovulation? 1 Impaired fertility 2 Induction of ovulation 3 Reduced blood pressure 4 Increased blood pressure

Clomiphene interacts with methyldopa and may cause infertility. Clomiphene when taken alone induces ovulation. Methyldopa is an antihypertensive drug used to treat hypertension in pregnant women if taken alone. Neither clomiphene nor methyldopa increase blood pressure.

What clinical manifestation requires immediate intervention in a woman with a probable ruptured tubal pregnancy? 1 Abdominal distention 2 Intermittent abdominal contractions 3 Dull, continuous upper -quadrant abdominal pain 4 Sudden onset of knifelike pain in one of the lower quadrants

One symptom of sudden rupture of a fallopian tube is pain on the affected side, usually sudden, excruciating, and radiating over the lower abdomen and to the shoulder; sometimes the pain is associated with nausea, vomiting, and diarrhea. Abdominal distention is not a classic sign of a ruptured fallopian tube. There are no contractions because the pregnancy is not uterine. The pain is exquisite, sharp (not dull) and sudden in the lower abdomen when the fallopian tube ruptures.

What step should a nurse take when preparing to administer Rho(D) immune globulin to a postpartum client? 1 Start a primary intravenous (IV) line so that the drug may be administered via IV piggyback. 2 Ensure that the client is Rh negative and the neonate is Rh positive. 3 Obtain a syringe and needle appropriate for the subcutaneous injection. 4 Determine that the client has not eaten since midnight of the previous night

Rho(D) immune globulin is given to Rh-negative mothers not previously sensitized who have Rh-positive neonates; it prevents Rh incompatibility in the next pregnancy. Rho(D) immune globulin is administered intramuscularly, not intravenously or subcutaneously. There is no need for the client to fast; the client may eat and drink before receiving this medication.

A client gives birth vaginally, with a midline episiotomy, to an infant who weighs 8 lb 13 oz (4000 g). An ice pack is applied to the perineum to ease the swelling and pain. The client complains, "This pain in my vaginal and rectum is excruciating, and my vagina feels so full and heavy." What does the nurse suspect as the cause of the pain? 1 Full bladder 2 Vaginal hematoma 3 Infected episiotomy 4 Enlarged hemorrhoid

A vaginal hematoma caused by fetal head pressure during the birthing process can result in severe pain. Bladder distention causes abdominal, not perineal, discomfort. Although the episiotomy may cause pain, it should not be excruciating; it is too early for an infection to have developed. Although hemorrhoids may cause perineal discomfort, they should not cause the vagina to feel full and heavy.

A pregnant client comes to the emergency department because of vaginal bleeding. The nurse asks the client to estimate how heavy the bleeding is. What is the best gauge for the client to use? 1 Number of clots that were passed 2 Changes in fetal activity when bleeding 3 Increased weakness since bleeding began 4 Amount of blood lost in relation to usual menstrual flow

Determining the amount of blood lost in relation to her usual menstrual flow gives the client a familiar gauge with which to estimate the amount of bleeding she is experiencing. The presence of clots does not indicate the amount of bleeding. Changes in fetal activity may indicate a problem, but there is no relationship to the amount of bleeding. Weakness is a subjective symptom and may not reflect blood loss.

Which drug can be prescribed for the elective termination of a pregnancy? 1 Mifeprex 2 Raloxifene 3 Methylergonovine 4 Clomiphene

Mifeprex helps stimulate uterine contractions; this drug can be used for the elective termination of a pregnancy. Raloxifene may be used to prevent postmenopausal osteoporosis. Methylergonovine may be used to reduce postpartum uterine hemorrhage. Clomiphene may induce ovulation.

A nurse is planning to teach a new mother about breastfeeding. What should the nurse consider before preparing the client to breastfeed? 1 Oxytocin stimulates milk production. Correct 2 Suckling stimulates the release of oxytocin. Incorrect 3 Estrogen stimulates the secretion of lactogenic hormones. 4 Placental separation stimulates the release of progesterone

Suckling or nipple stimulation precipitates the release of oxytocin, which initiates the let-down reflex. The hormone prolactin stimulates milk production. Estrogen inhibits the secretion of lactogenic hormones. Placental separation triggers the hormonal changes of the postpartum period.

A nurse is reviewing the laboratory report of a newborn whose hematocrit level is 45%. What value denotes a healthy infant? 1 Less than 40% 2 More than 75% 3 Between 45% and 65% 4 Between 65% and 75%

The expected hematocrit level for a healthy newborn is between 45% and 65%. Less than 40% is below the expected level and is considered anemia. More than 75% is high and is considered polycythemia. Between 65% and 75% is above the expected range.

The nurse teaches a pregnant client why she needs a folic acid supplement. Which neonatal disorder does folic acid prevent? 1 Phenylketonuria 2 Down syndrome 3 Neural tube defects 4 Erythroblastosis fetalis

A folic acid supplement (0.4 mg/day) greatly reduces the incidence of fetal neural tube defects. Phenylketonuria is a genetic disorder that cannot be prevented by the action of folic acid. Down syndrome is a genetic disorder that cannot be prevented by the action of folic acid. Erythroblastosis fetalis is related to the Rh factor and is not prevented by the action of folic acid.

A client admitted to the high-risk unit with a threatened abortion anxiously asks the nurse, "Could this have happened because I had the flu?" How should the nurse respond? 1 "Tell me why you feel this way. Do you think that you did something to cause the bleeding?" 2 "We know that maternal infection sometimes results in spontaneous abortion. Perhaps the flu did cause it." 3 "I'm sure that there's nothing you could have done to cause this. You shouldn't worry about it." 4 "The primary healthcare provider will be here soon and will be better prepared to answer your questions. Why don't you wait until then?"

Asking the client to talk about how she feels encourages the client to discuss her fears and anxieties. Stating that the flu may have caused the spontaneous abortion gives inaccurate information; this conclusion has not been documented, and this response adds to the guilt felt by the client. Telling the client that there is nothing she could have done to cause the problem does not focus on the client's feelings; it cuts off communication between the nurse and the client. Telling the client to wait until the primary healthcare provider arrives denies the client's feelings, abdicates the nurse's responsibility to the client, and cuts off communication. Also, it may increase anxiety because it implies that the nurse is not adequately prepared to care for the client. Test-Taking Tip: Stay away from other nervous students before the test. Stop reviewing at least 30 minutes before the test. Take a walk, go to the library and read a magazine, listen to music, or do something else that is relaxing. Go to the test room a few minutes before class time so that you are not rushed in settling down in your seat. Tune out what others are saying. Crowd tension is contagious, so stay away from it.

A nurse teaches a nursing student about the effects of aspirin in pregnant women. Which statement made by the nursing student indicates a need for further teaching? Incorrect 1 "Aspirin may reduce a fever." Correct 2 "Aspirin may cause Reye syndrome." 3 "Aspirin may increase the risk of bleeding." 4 "Aspirin may suppress labor contractions.

Aspirin does not cause Reye syndrome in pregnant clients. Aspirin may reduce fever, increase the risk of bleeding, and suppress labor contractions.

A nurse is caring for a client with vaginal bleeding caused by placenta previa. What is the best nursing intervention to delay the birth of the fetus? 1 Maintaining bed rest 2 Planning for an ultrasound test 3 Preparing for a nonstress test 4 Administering oxygen by way of a mask

Gravitational pull on an already stressed placenta may cause further bleeding; bed rest limits stress. Planning for an ultrasound test or a nonstress test provides for fetal assessment; it does not delay the birth. Unless the fetal heart rate is decelerating, oxygen supplementation is not necessary.

A pregnant client at 37 weeks' gestation is taught about signs and symptoms that should be reported immediately to the primary care provider. The nurse determines that the client understands the information presented when she states that she will immediately report what? 1 Lower back pain 2 White vaginal discharge 3 Irregular strong contractions 4 Leakage of fluid from the vagina

Leakage may indicate rupture of the amniotic membranes; the client is at risk for an ascending infection from the vagina if birth does not occur within 24 hours or if early treatment is not instituted. Lower back pain is a common discomfort of pregnancy because the enlarged uterus causes a shift in the client's center of gravity. Leukorrhea is common during pregnancy because of increased vascularity of the cervix and increased production of mucus. Preparatory (Braxton Hicks) contractions occur at irregular intervals throughout pregnancy; they become stronger after the 28th week of gestation.

Which drug is known as an abortion pill? 1 Oxytocin 2 Misoprostol Correct 3 Mifepristone Incorrect 4 Methylergonovine

Mifepristone activates uterine contractions and causes abortion. This drug is used in the voluntary termination of pregnancy and is known as the abortion pill. Pregnant women are sensitive to oxytocin, which causes uterine concentrations and may lead to abortion. Misoprostol is a synthetic prostaglandin usually given with mifepristone. Methylergonovine is an ergot alkaloid used to treat postpartum hemorrhage.

A client in labor is being prepared for a cesarean birth. What is the most important nursing intervention before anesthesia is administered? 1 Preparing the abdomen 2 Obtaining informed consent 3 Initiating an intravenous infusion 4 Inserting an indwelling urinary catheter

Obtaining informed consent is the priority before anesthesia is administered. Anesthesia depresses the central nervous system, and once it has been administered the client cannot participate in decision-making. Inserting an indwelling urinary catheter, initiating an intravenous infusion, and preparing the abdomen may be performed later; they are not the priority.

A client consents to have her newborn son circumcised. Which statement indicates to the nurse that the mother needs additional discharge instructions? 1 "I'll put an ice bag on his penis so it won't swell." 2 "I need to change the dressing four times each day." 3 "I'll call my doctor if I notice any bleeding from the penis." 4 "I need to keep the diaper loose so it won't rub on the penis.

Placing ice on the newborn's penis is contraindicated because the neonate's immature heat-regulating mechanisms could be disturbed. The application of ice is unnecessary because only slight edema is expected after a circumcision. Stating that she will change the dressing four times a day, call the doctor if she notices any bleeding from the penis, and keep the diaper loose to prevent rubbing are all appropriate statements for which no additional instructions are needed.

Which action involving client needs may a nurse delegate to a nursing assistant? 1 Assessing a newly admitted client's contraction pattern 2 Discussing pain management options with a laboring client 3 Providing ice chips to a primigravida in early labor per order 4 Obtaining a sterile urine specimen for a suspected urinary tract infection

Providing ice chips to a primigravida in early labor per order does not require clinical knowledge or judgment for safe, effective care. Assessment, discussion of alternative actions, and the use of sterile technique during an invasive procedure all require clinical knowledge and judgment beyond the scope of practice of a nursing assistant. Test-Taking Tip: Survey the test before you start answering the questions. Plan how to complete the exam in the time allowed. Read the directions carefully and answer the questions you know for sure first

A client who had tocolytic therapy for preterm labor is being discharged. What instructions should the nurse include in the teaching plan? 1 Restrict fluid intake. Correct 2 Limit daily activities. Incorrect 3 Monitor urine for protein. 4 Avoid deep-breathing exercises

Although it has not been proved that bedrest limits preterm labor, it is often recommended; activities are restricted to bathroom privileges and movement to a daytime resting area. Fluid intake should not be restricted; hydration should be maintained. Monitoring of the urinary protein level is included in the care of a client with preeclampsia, not preterm labor. Deep-breathing exercises do not influence preterm labor.

Which adverse effect of heparin may be seen during pregnancy? 1 Osteoporosis 2 Severe bleeding 3 Abnormal uterine contractions 4 Suppression of uterine contractions

Heparin is safe to a fetus but may cause osteoporosis in a pregnant woman. Severe bleeding and abnormal or suppressed uterine contractions are not associated with heparin.

A nurse is teaching a client about the oral contraceptive prescribed by the primary health care provider. Which condition identified by the client indicates understanding of when the drug should be stopped immediately and the health care provider notified? 1 Chest pain 2 Menorrhagia 3 Mittelschmerz 4 Increased leukorrhea

Oral contraceptives should be discontinued with the presence of any symptom related to a pulmonary embolus. Menorrhagia, extremely heavy menstrual flow, is a side effect related to excessive amounts of estrogen; immediate discontinuation of the oral contraceptive is unnecessary. Mittelschmerz, pain at the time of ovulation, does not occur when the client is taking an oral contraceptive. Increased leukorrhea may be a sign of infection, not a side effect of oral contraceptives.

How should the nurse assess a newborn's grasp reflex? 1 By putting direct pressure along the sole of the newborn's foot 2 By jarring the crib and watch the movement of the newborn's hands 3 By pressing the examining fingers against the palms of the newborn's hands 4 By holding the body upright and allowing the newborn's feet to touch a surface

Pressing the examiner's fingers against the palms should elicit the grasp reflex of the newborn's hands. Putting direct pressure along the sole of the newborns' foot will cause the toes to hyperextend with dorsiflexion of the big toe (Babinski reflex). Jarring the crib will elicit symmetric abduction and extension of the arms with the thumb and forefingers forming a C, followed by adduction of the arms and finally a return of the arms to a relaxed position (Moro reflex). Holding the body upright and allowing the newborn's feet to touch a surface will elicit alternating flexion and extension of the feet that simulates walking (stepping reflex).

A 15-year-old emancipated minor gave birth to a boy 36 hours ago and has requested a circumcision. What is the nurse's priority? 1 Getting a physician's prescription for a lidocaine injection 2 Educating the new mother about the circumcision procedure 3 Getting an informed consent signed by the mother of the baby 4 Getting an informed consent signed by the grandmother of the baby

As an emancipated minor, the mother of the baby has the right to make the decision regarding the circumcision and is responsible for signing the informed consent. A nurse does not administer a lidocaine injection into the newborn penis; the physician does. Circumcision is a decision made by the parent(s), often for cultural or religious reasons. Education can be provided as needed, as the nurse obtains a signed consent. Because the mother of the baby is an emancipated minor, the grandmother does not have the authority to sign the consent in this situation.

The nurse is helping a mother breastfeed her newborn. What is the best indication that the newborn has achieved an effective attachment to the breast? 1 The tongue is securely on top of the nipple. 2 The mouth covers most of the areolar surface. 3 Loud sucking sounds are heard during the 15 minutes spent at each breast. 4 Vigorous suckling occurs for the 5 minutes the infant spends at each breast before falling asleep

Effective attachment involves covering most of the areolar surface of the breast with the newborn's mouth; effective attachment helps compress the milk glands. The nipple must be on top of the newborn's tongue. Loud sucking sounds indicate inadequate attachment. The newborn should suckle for a longer period; the newborn may be sucking only on the nipple.

What is the primary responsibility of a LPN re-enforcing teaching for the pregnant adolescent? 1 Instructing her about the care of an infant 2 Informing her of the benefits of breast-feeding 3 Advising her to watch for danger signs of preeclampsia 4 Encouraging her to continue regularly scheduled prenatal care

It is not uncommon for adolescents to avoid prenatal care; many do not recognize the deleterious effect that lack of prenatal care can have on them and their infants. Instruction in the care of an infant can be done in the later part of pregnancy and reinforced during the postpartum period. Informing the client of the benefits of breast-feeding should come later in pregnancy but not before the client's feelings about breast-feeding have been ascertained. Advising the client to watch for danger signs of preeclampsia is necessary, but it is not the priority intervention at this time.

The nurse in the postpartum unit is teaching self-care to a group of new mothers. What color does the nurse teach them that the lochial discharge will be on the fourth postpartum day? 1 Dark red 2 Deep brown 3 Pinkish brown 4 Yellowish white

Lochia serosa is the expected vaginal discharge between the 3rd and 10th postpartum days; it is pinkish to brownish and consists of serous exudate, shreds of degenerating decidua, erythrocytes, leukocytes, cervical mucus, and numerous microorganisms. Lochia rubra is the expected vaginal discharge on the first 2 or 3 postpartum days; it is dark red and consists of epithelial cells, erythrocytes, leukocytes, shreds of decidua, and occasionally fetal meconium, lanugo, and vernix caseosa. Lochia is never dark brown. Lochia alba is the expected vaginal discharge about 10 days postpartum; it persists for 1 to 2 weeks. A creamy or yellowish color, it consists of leukocytes, decidual cells, epithelial cells, fat, cervical mucus, cholesterol crystals, and bacteria.

A young sexually active client at the family planning clinic is advised to have a Papanicolaou (Pap) smear. She has never had a Pap smear before. What should the nurse include in the explanation of this procedure? 1 The Pap smear can detect cancer of the cervix. 2 Vaginal bleeding is expected after a Pap smear. 3 Colposcopy will be used to visualize the cervix. 4 Scraping the cervix is the most uncomfortable part

The Pap smear can detect cancer of the cervix by revealing atypical as well as cancerous cells. Scraping of the cells can cause a few drops of blood to be expelled; vaginal bleeding does not occur. A colposcopy is not part of a routine Pap smear. Insertion of the speculum usually is the most uncomfortable part of the test.

A nurse teaches a nursing student about the physiologic changes that occur during pregnancy and their impact on drug disposition and dosing. Which statement of the nursing student indicates the need for further education? 1 Drug elimination is increased. 2 The hepatic metabolism of a drug is decreased. 3 The intestinal transit time of a drug is increased. 4 The absorption of a drug through the gastrointestinal tract is increased

The hepatic metabolism of the drugs is increased in pregnancy, which increases the drug response. Elimination of the drugs is increased because the renal blood flow doubles in the third trimester. The intestinal transit time of drugs increases because the motility of the bowel decreases in pregnancy. This action also leads to an increase in the drug's gastrointestinal absorption. Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer.

A client is admitted to the birthing unit because fluid is leaking from her vagina. She is unsure whether her "bag of water" has broken. What should the nurse do to help determine whether the fluid is amniotic fluid? 1 Test the fluid with nitrazine paper. 2 Inspect the fluid for its characteristics. 3 Assess the fluid for the presence of protein. 4 Send the fluid to the laboratory for analysis

Amniotic fluid is slightly alkaline and urine is acidic; when moistened with amniotic fluid, nitrazine will turn dark blue, indicating an alkaline substance. Inspecting the fluid is a subjective assessment and may be inaccurate. Protein is not a discriminating factor because it may be present in urine and amniotic fluid (especially in the urine) if the client shows signs of preeclampsia. The fluid need not be sent to the laboratory; it can be tested immediately for alkalinity with nitrazine paper. Test-Taking Tip: Be alert for details. Details provided in the stem of the item, such as behavioral changes or clinical changes (or both) within a certain time period, can provide a clue to the most appropriate response or, in some cases, responses.

The nurse is counseling a client who is pregnant and has type 1 diabetes about medication changes as pregnancy progresses. Which medication will be needed in increased dosages during the second half of her pregnancy? 1 Insulin 2 Antihypertensives 3 Pancreatic enzymes 4 Estrogenic hormones

Usually as pregnancy progresses there are alterations in glucose tolerance and in the metabolism and utilization of insulin. The result is an increased need for exogenous insulin. Antihypertensives are administered only to clients with severe hypertensive preeclampsia. Pancreatic enzymes or hormones other than insulin are not taken by pregnant women with diabetes. Estrogenic hormones are not administered during pregnancy.

The nurse is caring for a client who is admitted to the birthing unit with a diagnosis of abruptio placentae. Which complication associated with a placental abruption should the nurse carefully monitor this client for? 1 Cerebral hemorrhage 2 Pulmonary edema 3 Impending seizures 4 Hypovolemic shock

With abruptio placentae, uterine bleeding can result in massive internal hemorrhage, causing hypovolemic shock. A cerebral hemorrhage may occur with a dangerously high blood pressure; there is no information indicating the presence of a dangerously high blood pressure. Pulmonary edema may occur with severe preeclampsia or heart disease, and seizures are associated with severe preeclampsia; there is no information indicating the presence of these conditions.

A 24-year-old client complains to the nurse in the women's health clinic that her breasts become tender before her menstrual period. What should the nurse recommend that the client do 1 week before an expected menses? 1 Take salt tablets daily 2 Increase protein intake 3 Eliminate daily exercise 4 Decrease caffeine intake

he client is exhibiting one symptom of premenstrual syndrome (PMS); eliminating food and beverages containing caffeine can limit breast swelling. Salt intake should be reduced premenstrually to limit the development of edema. Increased protein intake is unnecessary if the client is eating a nutritious diet. Exercise should be increased before the menstrual period to help ease the symptoms of PMS.

A thin 24-year-old woman who runs 10 miles each week asks the nurse for advice about preventing osteoporosis. Which vitamin and other dietary supplement should the nurse recommend? 1 Vitamin E and ginseng tea 2 Vitamin B and ginkgo biloba 3 Vitamin D and calcium citrate 4 Vitamin C and glucosamine/chondroitin

All women, except those who are pregnant or lactating, should ingest between 1000 and 1300 mg of calcium daily; if the client is unable to ingest enough calcium in food, supplements of calcium and vitamin D are recommended. Vitamin C and glucosamine/chondroitin maintain cartilage and connective tissue integrity but do not help prevent osteoporosis. Vitamins E and B, ginseng, and ginkgo biloba do not help prevent osteoporosis.

What common problem affects the client in labor when an external fetal monitor has been applied to her abdomen? 1 Intrusion on movement 2 Inability to take sedatives 3 Interference with breathing techniques 4 Increased frequency of vaginal examinations

Because the client is attached to a machine and movement may alter the tracings, movement is discouraged. Placement of the external monitor leads does not interfere with the administration of sedatives. An external monitor does not interfere with breathing techniques. An external monitor does not necessitate more frequent vaginal examinations.

The nurse is conducting teaching for a client being discharged after an abdominal hysterectomy. Which statement by the client indicates a need for further teaching? Incorrect 1 "I know not to lift anything heavier than 5 lb." 2 "I'll limit my stair climbing to four times a day." 3 "I'll avoid crossing my legs at the knees when I sit." Correct 4 "I'm glad I'll be able to get back into my jogging routine next week

Discharge instructions after abdominal hysterectomy include avoiding jogging, aerobic exercise, participating in sports, and other any strenuous activity for 2 to 6 weeks after the surgery. The statement indicating that the client plans to start jogging again by next week means that the client requires more teaching. Stair climbing should be limited to fewer than five times per day. Nothing heavier than 5 to 10 lb should be lifted. The client should not cross her legs at the knees when sitting. Those three statements by the client are accurate and indicate understanding of the teaching.

Which chemical may be responsible for Braxton Hicks contractions occurring during the final weeks of pregnancy? Estrogen Oxytocin Progesterone Prostaglandin

During the final weeks of pregnancy, the prostaglandin concentration increases, which causes mild myometrial contractions known as Braxton Hicks contractions. Oxytocin is administered when there are weak contractions to induce labor. Estrogen and progesterone are not involved in causing contractions.

A woman comes into the clinic and states that she is thinking about becoming pregnant. What can the woman do to improve the health of her baby before she becomes pregnant? 1 Go buy maternity clothes 2 Start running 3 miles a day 3 Start taking prenatal vitamins 4 Buy a crib for the baby to sleep in

Folic acid is important for the pregnant woman; a lack of folic acid can result in neural tube defects, including spina bifida. The time during fetal development when this occurs is very early in the pregnancy, when the woman may not even realize that she is pregnant. Taking prenatal vitamins with adequate folic acid can greatly reduce this birth defect. Although exercise is good for the pregnant woman and infant, it is not necessary to start running 3 miles a day, especially if this is something the client has never done before. Running may not be healthy for the soon-to-be mother and infant if it is a new activity; however, if this is what the woman normally does, she will be encouraged to continue. Buying maternity clothes or a crib is not necessary at this stage, and neither of these directly objects affects the health of the baby.

A nurse plans to evaluate a postpartum client's uterine fundus for involution. What should the nurse ask the client to do before this assessment? 1 Drink fluids. 2 Empty her bladder. 3 Perform the Valsalva maneuver. 4 Assume the semi-Fowler position

Having the client empty her bladder will help ensure accurate assessment of fundal height. A full bladder may promote a boggy uterus and may elevate the uterus upward and toward the client's right side. There is no need to drink fluids before this assessment; however, the client should drink at least 2 L of fluid a day during the postpartum period. The Valsalva maneuver has no effect on the assessment of fundal height. Assessing the fundus while the client is in the semi-Fowler position will result in an inaccurate assessment. The bed should be flat, and the client should assume the supine position.

A multigravida in the active phase of labor says, "I feel all wet. I think I wet myself." What should the nurse do first? 1 Give her the bedpan. 2 Change the bed linens. 3 Inspect her perineal area. 4 Take an oral temperature

Inspection of the perineum is performed to determine whether rupture of the membranes has occurred and whether the umbilical cord has prolapsed. Giving the client the bedpan is not a priority. Changing the bed linens is not the priority, although it is done eventually if the membranes have ruptured. An oral temperature should be taken after it has been established that the membranes have ruptured.

A young woman has been using oral contraceptives. When she misses her regular menstrual period, she visits the women's health clinic and tells the nurse that she may be pregnant because she missed taking her contraceptive pills for 1 week when she had the flu. How should the nurse respond? 1 "It's too late to worry about that now. You may want to consider having an abortion." 2 "Contraceptive pills are unpredictable. You probably would've become pregnant even if you had taken them regularly." 3 "You may be right. One of the reasons that an exact schedule is prescribed for birth control pills is that they have to be taken regularly to be effective." 4 "That's the trouble with birth control pills. They're so effective that women tend to believe that they won't get pregnant even if they skip pills for a few days

Monophasic, biphasic, and triphasic oral contraceptives are available; regardless of the type that is prescribed, the regimen should be followed exactly. Interruption in the schedule permits release of luteinizing hormone, resulting in ovulation and possible pregnancy. Telling the client that it is too late to worry about that now is callous, and giving advice such as the client should consider an abortion is inappropriate; all options may be explored after a pregnancy has been confirmed. When taken as prescribed, oral contraceptives have a high rate of success. Stating that some women tend to believe that they won't become pregnant even if the pills are skipped for a few days is judgmental; it is a generalization about women who take the pills and indicates that the nurse assumes that the client is similarly irresponsible.

When discussing future health management with a client who has had a total hysterectomy, the nurse advises regular physical examinations. The client agrees and adds, "It won't be so hard to go now that I won't need the pelvic examination and Pap smear." How should the nurse respond? Incorrect 1 Discuss the need to have pelvic examinations and Pap smears until healing is complete 2 Suggest that the client discuss the need for future pelvic examinations with her practitioner 3 Agree that other components of the physical examination will be more important in the future Correct 4 Explain why regular pelvic examinations and Pap smears of vaginal secretions will be necessary in the future.

Pelvic examinations and Pap smears will always be necessary to screen for atypical changes in vaginal tissue and will always remain a priority for this client. Suggesting that the client talk with her practitioner transfers the nurse's responsibility for client teaching to the practitioner.

A nurse caring for a pregnant woman determines that she is engaging in the practice of pica. Why should the nurse prepare a teaching plan for this client? 1 Inedible items are being ingested. 2 The client has a need for a particular food. 3 Many foods can cause nausea and vomiting. 4 The client has a dislike for an essential group of foods.

Pica is the eating of inedibles such as starch or dirt. There is a cultural influence on this practice, but it may also be related to malnutrition or anemia. Food cravings frequently occur in pregnant women. If many foods are causing nausea and vomiting, the client has morning sickness. If it continues past the first trimester, it may be hyperemesis gravidarum. The dislike for essential food groups does not describe the practice of pica.

A woman is being prepared for a contraction stress test (CST). Which information should the nurse provide the client before the test? 1 "The test will be discontinued after at least six contractions are observed." 2 "You'll need to provide a double-voided urine specimen before the test." 3 "The fetal heart rate will be monitored for about 20 minutes before the test begins." 4 "You'll be placed in a right lateral position that must be maintained throughout the test.

The fetal heart rate (FHR) is measured for about 20 minutes before the CST to determine baseline variability and to detect any FHR alterations without induced stress. The test involves monitoring the fetal heart rate during three to five uterine contractions over a 10-minute period. A urine sample is unnecessary. The semi-Fowler position with a left-sided tilt is the position of choice.

A client making her first visit to the prenatal clinic asks which immunization can be administered safely to a pregnant woman. What should the nurse tell her? 1 Rubella (measles) 2 Rubeola (German measles) Correct 3 Inactive influenza 4 Varicella (chicken pox)

The inactive influenza and diphtheria, tetanus, pertussis (dTAP) immunizations can be safely administered during the first trimester of pregnancy, although dTAP is recommended at 27 to 36 weeks gestation to provide immunity to the mother and infant. The inactivated influenza vaccine may be given because it is a killed virus vaccine and will not have a teratogenic effect. Rubella (measles) and rubeola (German measles) vaccines are both live viruses that should never be administered during pregnancy because they can have teratogenic effects. Varicella (chicken pox) immunization is not given because it may cause birth defects in the fetus.

Phototherapy is prescribed for a neonate with hyperbilirubinemia. Which nursing intervention is appropriate to reduce the potentially harmful side effect of the phototherapy? 1 Covering the trunk to prevent hypothermia 2 Using shields on the eyes to protect them from the light 3 Massaging vitamin E oil into the skin to minimize drying 4 Turning after each feeding to reduce exposure of each surface area

The lights used for phototherapy can damage the infant's eyes, and eye shields are standard equipment. Maximal effectiveness is achieved when the infant's entire skin surface is exposed to the light. Vitamin E oil massage is contraindicated because it can cause burns and result in an overdose of the vitamin. The infant should be turned every 2 hours regardless of feeding times so that all body surfaces are exposed to the light and no single body surface is overexposed.

What does an Apgar score recorded 5 minutes after birth help the nurse evaluate? 1 Gestational age of the newborn 2 Effectiveness of the birthing process 3 Adequacy of the transition to extrauterine life 4 Possibility of respiratory distress syndrome

The score at 5 minutes indicates the adequacy of the cardiac and respiratory systems' response to the environment. The Dubowitz score is related to gestational age. The 5-minute Apgar score represents the neonate's response to the environment and is not related to the actual process of labor and birth. The Apgar score is not a diagnostic tool for respiratory distress syndrome.

A client who is at 10 weeks' gestation returns to the health care provider for her second prenatal visit. She asks why she feels the need to urinate so often. How can the nurse explain the reason for urinary frequency in the first trimester? 1 It is caused by the descent of the baby's head into the uterus. Correct 2 It is influenced by the enlarging uterus, which is still within the pelvis. 3 It is caused by maternal renal filtration of waste products excreted by the growing fetus. 4 It is mostly a psychological phenomenon that results from the knowledge that one is pregnant.

The uterus remains within the pelvis until the second trimester, placing pressure on the bladder. The fetus is in the uterus during the first trimester, but head descent occurs in preparation for delivery in the third trimester; fetal waste products are minimal at this time and do not influence urinary frequency. Frequency is a physiological, not a psychological, sign of early and late pregnancy.

A pregnant client interested in childbirth education asks how the Lamaze method differs from the Read method. What should the nurse explain about the Lamaze method? 1 It is an easier method to teach and learn. 2 It provides relaxation and techniques that can be used during labor. 3 It is a natural approach based on childbirth without pain. 4 It avoids the use of pain-relieving medications during labor

There is much to be learned and practiced so that the client can vary the breathing and relaxation techniques of Lamaze through the stages of labor. The Read method can be quickly taught to an "unprepared" woman in labor. The Read method, not the Lamaze method, focuses on naturalness and denial of pain. Medication use is acceptable, if required, in the Lamaze method.

What is the definition of a tocolytic? 1 A drug that cause harmful effects to the fetus 2 A drug that inhibits labor and maintains a pregnancy 3 A drug that induces abortion when taken during pregnancy 4 A drug that stimulates uterine contractions during pregnancy

Tocolytics are drugs used to inhibit labor and maintain a pregnancy. Abortifacients are drugs taken to terminate a pregnancy or induce an abortion. Oxytocics are used to stimulate the uterine contractions in pregnancy. Teratogens are drugs that cause harmful effects to the fetus.

A 16-year-old client has a steady boyfriend with whom she is having sexual relations. She asks the nurse how she can protect herself from contracting HIV. What should the nurse advise her to do? 1 Ask her partner to withdraw before ejaculating 2 Make certain their relationship is monogamous 3 Insist that her partner use a condom when having sex 4 Seek counseling about various contraceptive methods

A condom covers the penis and contains the semen when it is ejaculated; semen contains a high percentage of HIV in infected individuals. Pre-ejaculatory fluid carries HIV in an infected individual. Although a monogamous relationship is less risky than having multiple sexual partners, if one partner is HIV positive, the other person is at risk for acquiring HIV. The client is not asking about various contraceptive methods. Most contraceptives do not provide protection from the HIV.

After an incomplete abortion, a client tells the nurse that although her primary healthcare provider explained what an incomplete abortion was, she did not understand. What is the best response by the nurse? 1 "I don't think you should focus on this anymore." 2 "It's when the fetus dies but is retained in the uterus for at least 2 months." 3 "It's when the fetus is expelled but other parts of the pregnancy remain in the uterus." 4 "I think it's best for you to ask your primary healthcare provider for the answer to that question.

A correct and simple definition answers the question and fulfills the client's need to know. Telling the client not to focus on the topic any more denies the client's right to know. The definition of a missed abortion is when the fetus dies but is retained in the uterus for at least 2 months. Telling the client to ask her primary healthcare provider for the answer is an abdication of the nurse's responsibility; the nurse can independently reinforce information and correct misconceptions.

An older female client tells the nurse in the clinic that she has a cystocele that was diagnosed a year ago. She has urinary frequency and burning on urination. The client asks, "The primary healthcare provider wanted me to have surgery for the cystocele last year; but, I can manage with peripads. It won't hurt not to have surgery, will it?" How should the nurse respond? 1 "Not really, but it should be done." 2 "Yes, you're risking kidney damage." 3 "Yes, you're risking bowel obstruction." 4 "Not really, but you'll be more comfortable if you have it

A cystocele is a herniation of the bladder through the vaginal wall resulting from weakened pelvic structures. In this condition the herniated bladder does not empty effectively, and urinary stasis, chronic infection, and renal failure may result. The surgery improves bladder function and prevents renal failure; it is necessary at this time. Bowel obstruction is a complication of a rectocele, not a cystocele. Although corrective surgery will reduce perineal pressure, its primary purpose is to improve bladder function and prevent complications.

A pregnant client tells the nurse in the prenatal clinic that although she and her husband do not have the disease, she has a 1-year-old daughter with sickle cell anemia. She asks the nurse, "Will this baby also have sickle cell anemia?" How should the nurse respond? 1 "The chance that another child will have sickle cell anemia is 25%." 2 "Only one child in a family is affected, so the others probably will be all right." 3 "The most likely conclusion is that your children will have sickle cell anemia." 4 "If your partner has the sickle cell gene, 50% of your children will have sickle cell anemia

According to the Mendelian laws of inheritance, the sickle cell gene is recessive. If neither parent has the disease, both of them have the sickle cell trait; there is therefore a 25% chance that a child will have sickle cell anemia, a 50% chance that a child will have the sickle cell trait, and a 25% chance that a child will be unaffected. Saying that only one child in a family is affected and that the others probably will be all right is too vague. Stating that the children will have sickle cell anemia is not an accurate answer. The client should be told the probability of a child's inheriting the disease, but 50% is too high. Test-Taking Tip: Prepare for exams when and where you are most alert and able to concentrate. If you are most alert at night, study at night. If you are most alert at 2 am, study in the early morning hours. Study where you can focus your attention and avoid distractions. This may be in the library or in a quiet corner of your home. The key point is to keep on doing what is working for you. If you are distracted or falling asleep, you may want to change when and where you are studying.

A client in labor, who is at term, is admitted to the birthing room. The fetus is in the left occiput posterior position. The client's membranes rupture spontaneously. What observation requires the nurse to notify the practitioner? 1 Greenish amniotic fluid 2 Shortened intervals between contractions 3 Clear amniotic fluid with specks of mucus 4 Maternal temperature of 99.1° F (37.3° C)

Greenish amniotic fluid indicates the presence of meconium and should be reported to the health care provider. The interval between contractions should shorten as labor progresses. Clear fluid with specks of mucus is the description of normal amniotic fluid. There may be a slight increase in temperature related to the stress of labor, and it should be monitored.

A client at 16 weeks' gestation arrives at the prenatal clinic for a routine visit. During the examination the nurse notes bruises on the client's face and abdomen. There are no bruises on her legs and arms. Further assessment is required to confirm what? 1 Domestic abuse 2 Hydatidiform mole 3 Excessive exercise 4 Thrombocytopenic purpura

Domestic abuse is likely to intensify during pregnancy, and attacks are usually directed toward the pregnant woman's abdomen. A hydatidiform mole manifests as an unusually enlarged uterus for gestational age accompanied by hypertension, nausea and vomiting, and vaginal bleeding, not bruises on the face and abdomen. Excessive exercise may cause cardiovascular or pulmonary problems. It will not result in bruising. Thrombocytopenic purpura and other bleeding disorders manifest as bruises and petechiae on many areas of the body's surface, not just the face and abdomen.

A nurse assesses a 35-year-old multiparous client who is scheduled for a tubal ligation to determine her emotional response to the planned procedure. What factor in the client's history will contribute most to the healthy resolution of any emotional problem associated with sterilization? 1 Belief that surgery will relieve her monthly dysmenorrhea 2 Knowledge that her partner does not want to have any more children 3 Feeling that her family is complete and she now has the children that were planned 4 Recovery from her previous complicated birth and does not want to experience another birth

Many couples in their 30s who feel that their families are complete choose sterilization as their method of contraception. Sterilization by means of tubal ligation should have no effect on dysmenorrhea. The decision for sterilization should not be made by others, only by the woman herself. Decisions regarding sterilization should not be made when the client is under stress.

A 37-year-old client with endometriosis visits the women's health clinic because she has dysmenorrhea and dyspareunia. Which statement is the most accurate description of dysmenorrhea? 1 Pain with menses 2 Endometrial hyperplasia 3 Bleeding between menses 4 Heavy bleeding with menses

Dysmenorrhea is defined as pain with menses. Endometrial hyperplasia results from anovulation and persistent estrogen stimulation. Bleeding between menses is metrorrhagia. Heavy bleeding with menses is menorrhagia. Test-Taking Tip: Do not panic while taking an exam! Panic will only increase your anxiety. Stop for a moment, close your eyes, take a few deep breaths, and resume review of the question.

Which anomaly may be observed when a fetus is exposed to a teratogen during the embryonic development? 1 Death of the fetus 2 Normal growth of the fetus 3 Improper functioning of the fetus 4 Improper development of the organs

Exposure to a teratogen during embryonic development may result in improper development of internal organs. Death of the fetus may occur when the exposure to a teratogen is during the presomite stage. Normal growth of the baby may occur if the exposed teratogen dose is very low. Defect in the functioning of the fetus may occur if the exposure to the teratogen is during the fetal stage.

A nurse from the pediatric clinic who is strongly opposed to any chemical or mechanical method of birth control is asked to work in the family planning clinic. What is the most professional response that this nurse could give to the requesting supervisor? 1 "I will go, but it is against my beliefs and values." 2 "I won't do it, because I do not believe in birth control at all." 3 "I would prefer another assignment that is not contrary to my beliefs." 4 "I will have to stress that the rhythm method is the method of choice.

Expressing a preference for another assignment that is not contrary to the nurse's beliefs is a positive negotiation to be reassigned to an area in which the nurse's personal values will not pose a problem. Fulfilling the request even though it is against the nurse's beliefs is an ineffective way to resolve value conflict; undoubtedly a client would sense this conflict. The nurse may not have the legal, ethical, or professional right to refuse this assignment if employed by the facility. Stressing that the rhythm method is the method of choice is unethical and unprofessional.

During the first hour after a cesarean birth, a nurse notes that the client's lochia has saturated one perineal pad. In light of the knowledge of expected lochial flow, what should the nurse conclude that this indicates? 1 Scant lochial flow 2 Postpartum hemorrhage 3 Retained placental fragments 4 Lochial flow within expected limits

It is expected that as many as two perineal pads will be saturated in the first hour. A scant flow probably would not saturate even one pad. Hemorrhage would saturate more than two pads in an hour. Retained placental fragments would be accompanied by heavy bleeding and require more than two pads during the first hour.

A nurse in the postpartum unit must complete several interventions before a client's discharge from the hospital. The nurse plans to delegate some of the tasks to the nursing assistant. Which activity must be performed by the nurse? 1 Taking the neonate's picture 2 Placing the infant car seat in the car 3 Comparing the identification bands of mother and infant 4 Preparing the discharge gift packages and distributing them to parents

It is the nurse's professional responsibility to compare the mother's and infant's identification bands one last time before discharge. This ensures that the correct infant is discharged with the mother. Taking the neonate's picture, placing the infant seat in the car, and preparing the discharge gift packages and distributing them to parents are all within the role of the nursing assistant and may be delegated safely.

During labor a client tells the nurse that she and her husband are very concerned because the baby will be born 2 months early. How should the nurse respond? 1 "You should be concerned. I feel for you." 2 "If you're concerned, let's talk about it." 3 "Try not to worry about it; just concentrate on your labor." 4 "Don't worry; the care of preterm babies has greatly improved."

Offering to talk with the client encourages her to verbalize concerns, which serves as an outlet for tension. Telling the client that she should be concerned reinforces her fears, and it conveys sympathy, not empathy. Telling the client not to worry about it denies the client's feelings and cuts off communication. Telling the client not to worry because the care of preterm babies has improved denies the client's feelings and represents false reassurance.

A primipara delivered 12 hours ago. Although an ice bag has been applied to her perineal area, the client continues to complain of rectal pressure resulting in excruciating pain in the area of the episiotomy. This has also not been relieved by the administration of analgesics. What does the nurse conclude is the cause of the client's pain? 1 A normal response after delivery 2 Low tolerance of pain 3 Hematoma in the perineal area 4 Infection at the episiotomy site

Pain becomes excruciating with hematoma development at the episiotomy site because of pressure on surrounding nerve endings. This pain is not relieved by the application of ice because ice only reduces edema formation around the incision. There is no data to indicate that the client has a low tolerance for pain. It is too early to assume that an infection has developed; pyrexia and local signs of infection would support this conclusion. STUDY TIP: Laughter is a great stress reliever. Watching a short program that makes you laugh, reading something funny, or sharing humor with friends helps decrease stress.

A mother is concerned that her newborn will be exposed to communicable diseases when she goes home. While teaching the mother ways to decrease the risk of infection, what type of immunity should the nurse explain was transferred to the baby through the placenta? 1 Active natural 2 Passive natural 3 Active artificial 4 Passive artificial

Passive natural immunity is developed from an antigen-antibody response in the mother that is transmitted to the fetus. Active natural immunity is acquired by an individual in response to a disease or an infection. Active artificial immunity is acquired by an individual in response to small amounts of antigenic material (e.g., vaccination). Passive artificial immunity is conferred by the injection of antibodies prepared in another host.

A nurse administers the prescribed intravenous dose of magnesium sulfate to a client with severe preeclampsia. What adverse effect should the nurse address when evaluating the client's response to the medication? 1 Blurred vision 2 Epigastric pain 3 Fetal tachycardia 4 Respiratory depressio

Respiratory depression is a late indicator of magnesium sulfate toxicity; if the respiratory rate decreases below 12 breaths/min the infusion should be discontinued. Blurred vision and epigastric pain are both associated with worsening of preeclampsia, which could lead to a seizure; neither is a toxic effect of the magnesium sulfate. The fetal heart rate is not affected by the infusion of magnesium sulfate.

A nurse explains to a nursing class that the efficiency of the basal body temperature method of contraception depends on fluctuation of the basal body temperature. Which factor can alter the effectiveness of this method? 1 Stress 2 Length of abstinence 3 Age of those involved 4 Frequency of intercourse

Stress or infection can alter the body's metabolism, causing an elevation in temperature; a rise in temperature from these causes may be misinterpreted as ovulation. Length of abstinence may increase sperm volume, but does not affect the female's basal temperature. Age is not a factor in the efficiency of the basal body temperature method of contraception in premenopausal woman. Frequency of intercourse may affect the volume of sperm, but does not alter the female's basal temperature.

A nurse is teaching a primigravida about how she can identify the onset of labor. What clinical indicator of labor would necessitate the client to call her health care provider? 1 Bloody show and back pressure occurring with no contractions 2 Irregular contractions coming 10 minutes apart 3 Rupture of membranes or contractions 5 minutes apart 4 Contractions 12 minutes apart and lasting about 30 seconds

When the membranes rupture the potential for infection is increased, and when the contractions are 5 to 8 minutes apart they are usually of sufficient force to warrant professional supervision. Bloody show and back pressure may be early signs of labor or signs of posterior fetal position, but it is too early to notify the health care provider. The other options indicate that it is too soon in the labor process to call the health care provider; the client should remain with her family and keep moving around at home.

A client is receiving antibiotics and antifungal medications for the treatment of a recurring vaginal infection. What should the nurse encourage the client to do to compensate for the effect of these medications? 1 Eat yogurt daily 2 Avoid spicy foods 3 Drink more fruit juices 4 Take a multivitamin every day

Yogurt contains Lactobacillus acidophilus, which replaces the intestinal flora destroyed by antibiotics. The other options are not relevant to antibiotics or intestinal flora. Test-Taking Tip: You have at least a 25% chance of selecting the correct response in multiple-choice items. If you are uncertain about a question, eliminate the choices that you believe are wrong and then call on your knowledge, skills, and abilities to choose from the remaining responses.