NU271 PrepU: Reproduction (week 9)

A nurse is conducting a class geared toward changes in early pregnancy and self-care items like perineal hygiene. A woman shares that she douches at least once a day since she has "so much discharge" from her vagina. Which response by the nurse is most appropriate at this time?

"During pregnancy, you should not douche because it can cause fluid to enter the cervix resulting in an infection." - Even if vaginal discharge seems excessive, douching is contraindicated because the force of the irrigating fluid could cause the solution to enter the cervix, leading to a uterine infection. In addition, douching alters the pH of the vagina, leading to an increased risk of vaginal bacterial growth. Stating that douching will keep the client clean does not provide the client with the information she needs. Boiling water for a douche will not prevent development of infection. The nurse is capable of responding to the client directly without referring the client to the health care provider.

The nurse is obtaining blood for a human chorionic gonadotropin (hCG) level from a newly pregnant woman. What does the nurse teach this woman about the purpose of the hormone and why levels are evaluated?

"Elevated hCG levels indicate the endometrial lining is being prepared for implantation of the embryo." - The hormone hCG is produced as early as three days after conception from the trophoblasts. It preserves the corpus luteum and its progesterone production so the endometrial lining is ready for implantation. The increased progesterone production then maintains the endometrium. hCG is the basis for the pregnancy tests because it is the first hormone to be detected. The levels continue to rise until the placenta is fully functional, then the levels begin to decline as other hormones take over. Myometrial contractility is caused by estrogen. The trophoblasts differentiate into all the cells that form the placenta.

During a routine health visit for an 11-year-old girl, her mother asks the nurse, "My daughter just got her period about 4 months ago, but they haven't been very regular so far. How long might it take until she gets regular?" Which response by the nurse would be most appropriate?

"It can take up to 2 years once she starts for the periods to become regular." - Once menarche has occurred, cycles may take up to 2 years to become regular, ovulatory cycles. Telling the mother that her daughter's periods would get regular in 2 to 3 months or that she should be having regular periods by now is incorrect. Also, telling the mother that her daughter's periods will continue to be irregular is untrue and inappropriate.

A client who has been treated for infertility is now pregnant. During a routine ultrasound at 8 weeks' gestation, she learns that five fetuses are visualized. The client's husband is concerned that five infants will not survive and that his wife may not be able to handle the stress of the pregnancy, so he asks the nurse about selective reduction. What is the nurse's best response?

"It has been used to decrease the possibility of complications." - Stating the facts about selective reduction and coordinating a discussion with the healthcare provider are part of the nurse's responsibility to ensure that clients receive all information needed to make informed decisions. It isn't the role of the nurse to make judgments or to impart their own beliefs. Nurses must respect that clients need to be autonomous in decision making. Stating that the husband should be glad his wife conceived is using guilt and not addressing the problem. Infertility carries a large burden for couples. Decisions need to be made together because the pregnancy affects everyone.

A client has an autosomal-dominant disorder. His wife is unaffected. When explaining the risk for inheritance of the disorder in their offspring, which statement by the nurse would be most appropriate?

"There is a 50% chance that each of your children will have the condition." - When a client has an autosomal-dominant disorder and the spouse is unaffected, each of that person's offspring has a 50% chance of inheriting the gene mutation for the condition and a 50% chance of inheriting the normal version of the gene. Offspring who do not inherit the mutation do not develop the condition and do not have an increased chance for having children with the same condition. The affected individual, regardless of that person's gender, determines the inheritance pattern.

A pregnant client reports an increase in a thick, whitish vaginal discharge. Which response by the nurse would be most appropriate?

"This discharge is normal during pregnancy." - During pregnancy, vaginal secretions become more acidic, white, and thick. Most women experience an increase in a whitish vaginal discharge, called leukorrhea, during pregnancy. The nurse should inform the client that the vaginal discharge is normal except when it is accompanied by itching and irritation, possibly suggesting Candida albicans infection (a monilial vaginitis), which is a very common occurrence in this glycogen-rich environment. Monilial vaginitis is a benign fungal condition and is treated with local antifungal agents. The client need not refrain from sexual activity when there is an increase in a thick, whitish vaginal discharge.

In an ideal 28-day menstrual cycle, the secretory phase occurs during which days?

15 to 28 - In an ideal 28-day menstrual cycle, the secretory phase occurs during days 15-28.

The nurse is explaining ovulation to a female client. The nurse explains that follicle-stimulating hormone (FSH) and luteinizing hormone (LH) are important hormones needed to ovulate and are secreted by which gland?

Anterior pituitary - After puberty, the anterior pituitary secretes follicle-stimulating hormone (FSH) and luteinizing hormone (LH).

A client who is 2 months' pregnant has become more introverted, stopping most social activities. What action would the nurse take upon learning this information?

Assess the client for depression using an approved depression screening tool. - Psychosocial adaptation to pregnancy can follow some predictable courses through the trimesters but will be highly individualized. Often, in the first trimester women can become more withdrawn and introverted. However, the nurse should not assume this is the reason for the change in the client's behavior. Instead, the nurse should rule out possible depression as a contributing factor as this is the most serious potential cause of the change. Simple bedside assessment tools for depression exist that the nurse can perform quickly. Based on the results, the nurse could then explore additional actions required, such as seeking counseling or psychiatric consults. Making assumptions about the reasons for client symptoms (whether physical or behavioral) instead of conducting the relevant assessments to rule out more serious causes of these symptoms would be negligent on the part of the nurse.

The nurse is performing an assessment on a 2-day postpartum client and discovers a boggy fundus at the umbilicus and slightly to the right. The nurse determines that this is most likely related to which situation?

Bladder distention - Most often the cause of a displaced uterus is a distended bladder. Ask the client to void and then reassess the uterus. According to the scenario described, the most likely cause of the uterine findings would not be uterine atony. A full bowel or poor bladder tone would not cause a boggy and displaced fundus.

Which of these reflects a positive outcome to interventions provided for a 20-year-old woman undergoing treatment for anorexia nervosa?

Client has monthly menses. - The individual with anorexia nervosa is expected to maintain a minimally normal body weight (e.g., at least 85% of minimal expected weight). The individual has an excessive concern over gaining weight and how the body is perceived in terms of size and shape, and amenorrhea (in girls and women after menarche). A positive outcome is reflected in less obsession over weight or appearance, and return of menses.

Teaching for women of childbearing years who are receiving antipsychotic medications includes which statement?

Continue previous contraceptive use even if you're experiencing amenorrhea. - Women may experience amenorrhea, which is reversible, while taking antipsychotics. Because amenorrhea doesn't indicate cessation of ovulation, the client who experiences amenorrhea can still become pregnant. She should be instructed to continue contraceptive use even when experiencing amenorrhea. Dysmenorrhea isn't an adverse effect of antipsychotics, and the depressant effect generally decreases libido.

During a lecture on stem cells, the professor mentions that the first few cells produced after fertilization are totipotent and divide into which types of cells? Select all that apply.

Embryonic cells, Extraembryonic cells - Totipotent stem cells are those produced by a fertilized ovum. The first few cells produced after fertilization are totipotent and can differentiate into embryonic and extraembryonic cells. Neurons, which are highly specialized cells, lose their ability to proliferate once development of the nervous system is complete. The cells in permanent tissues do not proliferate. The cells in these tissues are considered to be terminally differentiated and do not undergo mitotic division in postnatal life.

Where is the final site for sperm maturation?

Epididymis - The final site of sperm maturation is in the epididymis. The bladder, urethra, and bulbourethral gland do not store sperm.

When describing the process of fertilization, the nurse would explain that it normally occurs in which structure?

Fallopian tube - Fertilization normally occurs in the fallopian tube. Once fertilized the ovum proceeds down the uterus and attaches itself in the endometrium. The vagina and cervix are not involved in fertilization.

Gonadotropin-releasing hormone (GnRH) stimulates the anterior pituitary to release which hormones? (Select all that apply.)

Follicle-stimulating hormone (FSH), Luteinizing hormone (LH) - GnRH stimulates the anterior pituitary to release FHS and LH. FHS and LH stimulate the follicles on the outer surface of the ovaries to grow and develop.

A pregnant mother may experience constipation and the increased pressure in the veins below the uterus can lead to development of what problem?

Hemorrhoids - The displacement of the intestines and possible slowed motility of the intestines can lead to constipation in the pregnant woman. This, along with elevated venous pressure, can lead to development of hemorrhoids.

Which cells in the testes produce testosterone?

Leydig cells - The interstitial or Leydig cells produce testosterone. Sertoli cells produce estrogens and inhibin, an estrogen-like molecule.

A nurse is conducting a presentation at a local prenatal clinic for pregnant women in their first trimester. The nurse is describing the growth and development of the fetus. When describing the embryonic period, which event would the nurse include? Select all that apply.

Organs taking on their basic shape, Some features becoming recognizable, Bone tissue beginning to form - The embryonic stage occurs from the 4th through the 8th week. Rapid growth and differentiation of the cell layers take place. By the end of this stage, all basic organs have been established, the bones have begun to ossify, and some human features are recognizable. The cell layers are formed during the pre-embryonic stage. The heartbeat can be heard by Doppler during the fetal stage, usually about the end of the first trimester (12 weeks).

At the beginning of prenatal care, the goal for the client was to gain 25 lb (11.25 kg) by the end of the pregnancy. At 30 weeks of pregnancy, the client has only gained 1 lb (0.45 kg). Which statemen(s) would help the nurse most appropriately interpret these data?

The client is not achieving the goal. The nurse should determine the reasons the client has not been gaining weight. - The client is not achieving the goal. The nurse should determine what the causes are in order to revise the plan of care. It is important to determine as early as possible if the plan of care is working. This will allow sufficient time to revise the plan of care. It is unrealistic to think the client will achieve the goal in the next 10 weeks. The client may not achieve the goal, but the priority at this time is to determine the reasons and revise the plan of care.

Which client outcome during active and transitional labor is best?

The client will practice breathing techniques during contractions. - The nurse identifies a priority during the active and transitional stage of labor as working with the contractions to give birth. Being tense works against cervical dilation (dilatation) and fetal descent. For that reason, the client is encouraged to practice breathing techniques. It may be unrealistic to state that the pain level is under 7 in the active and transitional phases. Walking in the hall and tolerating liquids also depends on the client.

When describing the role of a doula to a group of pregnant women, the nurse would include which information?

The doula primarily focuses on providing continuous labor support. - Doulas provide the woman with continuous support throughout labor. The doula is a laywoman trained to provide women and families with encouragement, emotional and physical support, and information through late pregnancy, labor, and birth. A doula does not perform any clinical procedures and is not trained to handle high-risk births and emergencies.

The health care provider has prescribed a karyotype for a newborn. The mother questions the type of information that will be provided by the test. What information should be included in the nurse's response?

The karyotype will assess the baby's chromosomal makeup. - The pictorial analysis of the number, form, and size of an individual's chromosomes is referred to as a karyotype. This analysis commonly uses white blood cells and fetal cells in amniotic fluid. The chromosomes are numbered from the largest to the smallest, 1 to 22, and the sex chromosomes are designated by the letter X or the letter Y. The severity and related complications of a disorder are not determined by the karyotype. Condition management is not determined by the karyotype.

Before World War II women moved from home to hospital births. What was the primary reason for that shift in maternity care?

They were convinced that setting would improve birth outcomes. - Prior to World War II, American women moved from home to the hospital for birth in part because they were convinced that setting would improve birth outcomes. Women who labored and gave birth at home were traditionally attended to by relatives and midwives. Many women were attracted to hospitals because this showed affluence and hospitals provided pain management, which was not available in home births.

A client is 9 days postpartum and breast-feeding her neonate. The client experiences pain, redness, and swelling of her left breast and is diagnosed with mastitis. The nurse teaching the client how to care for her infected breast should include which information?

Use a warm moist compress over the painful area. - Warm, moist compresses will reduce inflammation and edema of the infected breast tissue. The woman with mastitis should wear a proper fitting bra with good support. Breast-feeding does not have to be interrupted. The client will also need to pump the breast to keep the breast empty of milk and to ensure an adequate milk supply. Adequate emptying of the affected breast helps prevent more bacteria from collecting in the breast and may shorten the duration of the infection. Antibiotics must be taken for the full course of therapy and not stopped when symptoms subside.

Which condition is an example of physiologic hyperplasia?

Uterine enlargement in pregnancy - Two common types of physiologic hyperplasia are hormonal and compensatory. Breast and uterine enlargements during pregnancy are examples of a physiologic hyperplasia. The other examples are nonphysiologic hyperplasia.

A client asks the nurse when during embryonic growth the nervous system develops. The best response would be:

Week 3 - The nervous system appears very early in week 3 of embryonic development, around 22 to 23 days' gestation. This early development is essential because it influences the development and organization of many other body systems, including the axial skeleton, skeletal muscles, and sensory organs (such as the eyes and ears).

A charge nurse is completing client assignments for the nursing staff on the pediatric unit. Which client would the nurse refrain from assigning to a pregnant staff member?

an 8-year-old with Rubella - Rubella (German measles) has a teratogenic effect on the fetus. An infected child must be isolated from pregnant women. Ringworm is caused by a fungal infection on the skin. Standard hand hygiene is necessary. Kawasaki's disease is an autoimmune disease in which blood vessels become inflamed. Roseola is a virus transferred by oral secretions.

A nurse is assigned to assist with the admission of a laboring client. Which of the following actions are appropriate? Select all that apply.

asking about the estimated date of childbirth, asking about the amount of time between contractions, taking maternal and fetal vital signs - The nurse should ask about the estimated date of childbirth and then compare the response to the information in the prenatal record. If the fetus is preterm, special precautions and equipment are necessary. Maternal and fetal vital signs should be obtained to evaluate the well-being of the client and fetus. Determining how far apart the contractions are provides the healthcare team with valuable baseline information. The physician estimates the size of the fetus. It would not be appropriate for the nurse to ask about the client's last menses. This information is collected at the first prenatal visit. It would be premature to administer an analgesic, which could slow or stop labor contractions.

The nurse is assessing a woman at 37 weeks' gestation who has presented with possible signs of labor. The nurse determines the membranes have ruptured based on which color of the nitrazine paper?

blue - If the fluid in the vaginal canal is amniotic fluid, the nitrazine paper will turn a dark blue, the color of an alkaline fluid, and this is a positive nitrazine test for rupture of membranes.

A nurse is reviewing the history and physical examination of a client diagnosed with secondary dysmenorrhea for possible associated causes. Which etiology would the nurse need to keep in mind as being the most common?

endometriosis - Secondary dysmenorrhea is painful menstruation due to pelvic or uterine pathology. Endometriosis is the most common cause of secondary dysmenorrhea. Other recognized causes include adenomyosis, fibroids, pelvic infection, an intrauterine device, cervical stenosis, or congenital uterine or vaginal abnormalities.

Which pregnant woman likely faces the greatest risk of developing gestational diabetes? A client who:

is morbidly obese (defined as greater than 100 pounds over ideal weight). - Obesity is among the risk factors for gestational diabetes mellitus (GDM). Obstetric complications, multiple pregnancies, high triglycerides, and hypertension are not specific risk factors for GDM.

The nurse is assessing a client in labor for pain and notes she is currently not doing well handling the increased pain. Which opioid can the nurse offer to the client to assist with pain control?

meperidine - Meperidine is an opioid that is commonly used during labor and birth. Secobarbital and thiopental are barbiturates. Hydroxyzine hydrochloride is a tranquilizer which can be used to supplement the opioid or reduce anxiety.

The nurse knows that which structures are a part of the male reproductive system? Select all that apply.

pair of gonads, seminiferous tubules, and prostate glands - The male reproductive system consists of a pair of gonads (i.e., testes), a system of excretory ducts (i.e., seminiferous tubules and efferent ducts), the accessory organs (i.e., epididymis, seminal vesicles, prostate, and Cowper glands), and the penis.

A nurse is conducting a presentation for a local women's group about pelvic organ prolapse. When describing the different types, which information would the nurse incorporate into the description of a cystocele?

protrusion of the bladder wall through the anterior vaginal wall - A cystocele occurs when the posterior bladder wall protrudes downward through the anterior vaginal wall. A rectocele occurs when the rectum sags and pushes into or against the posterior vaginal wall. An enterocele occurs when the small intestine bulges through the posterior vaginal wall. Uterine prolapse occurs when the uterus descends through the pelvic floor and into the vaginal canal.

A nurse is explaining to a pregnant client about the changes occurring in the body in preparation for labor. Which hormone would the nurse include in the explanation as being responsible for causing the pelvic connective tissue to become more relaxed and elastic?

relaxin - As the pregnancy progresses, the hormones relaxin and estrogen cause the connective tissues to become more relaxed and elastic and cause the joints to become more flexible to prepare the mother's pelvis for birth. Progesterone, oxytocin, and prolactin are not involved.

When using the contraceptive patch, a client should understand that it:

should be applied to the abdomen, buttocks, or back. - The patch should be applied only to the buttocks, back, abdomen, or torso (never the breasts). The patch is safe for wearing during swimming and bathing. The patch requires application for 1 week before becoming effective.

It has been 8 hours since a woman gave birth vaginally to a healthy newborn. When assessing the woman's fundus, the nurse would expect to find it at:

the level of the umbilicus. - Approximately 6 to 12 hours after birth, the fundus is usually at the level of the umbilicus. The fundus is between the umbilicus and symphysis pubis 1 to 2 hours after birth. The fundus typically is 1 cm below the umbilicus on the first postpartum day and 2 cm below the umbilicus on the second postpartum day.

A primigravida 21-year-old client at 24 weeks' gestation has a 2-year history of HIV. As the nurse explains the various options for delivery, which factor should the nurse point out will influence the decision for a vaginal birth?

the viral load - A woman who has HIV during pregnancy is at risk for transmitting the infection to the fetus during pregnancy or childbirth and to the newborn while breastfeeding. The type of birth, vaginal or cesarean, depends on several factors, including the woman's viral load, use of ART during pregnancy (not waiting until the birth), length of time membranes have been ruptured, and gestational age (not mother's age). With prenatal ART and prophylactic treatment of the newborn, there is a reduced risk of perinatal HIV transmission. The amniocentesis results would not be a factor in preventing the spread of HIV to the infant and may actually lead to the fetus being infected through the puncture site and bleeding into the amniotic sac.

Which factor puts a multiparous client on her first postpartum day at risk for developing hemorrhage?

uterine atony - Multiparous women typically experience a loss of uterine tone due to frequent distentions of the uterus from previous pregnancies. As a result, this client is also at higher risk for hemorrhage. Thrombophlebitis does not increase the risk of hemorrhage during the postpartum period. The hemoglobin level and lochia flow are within acceptable limits.