OB Exam #1

Which symptom is considered a first-trimester warning sign and should be reported immediately by the pregnant woman to her health care provider? a. Nausea with occasional vomiting c. Urinary frequency b. Fatigue d. Vaginal bleeding

d

The nurse should know that once human immunodeficiency virus (HIV) enters the body, seroconversion to HIV positivity usually occurs within: a. 6 to 10 days. c. 6 to 8 weeks. b. 2 to 4 weeks. d. 6 months

ANS: C Seroconversion to HIV positivity usually occurs within 6 to 8 weeks after the virus has entered the body.

A woman is 6 weeks pregnant. She has had a previous spontaneous abortion at 14 weeks of gestation and a pregnancy that ended at 38 weeks with the birth of a stillborn girl. What is her gravidity and parity using the GTPAL system?

3-1-0-1-0

The placenta allows exchange of oxygen, nutrients, and waste products between the mother and fetus by: a. Contact between maternal blood and fetal capillaries within the chorionic villi. b. Interaction of maternal and fetal pH levels within the endometrial vessels. c. A mixture of maternal and fetal blood within the intervillous spaces. d. Passive diffusion of maternal carbon dioxide and oxygen into the fetal capillaries.

a

Which behavior indicates that a woman is "seeking safe passage" for herself and her infant? a. She keeps all prenatal appointments. c. She drives her car slowly. b. She eats for two. d. She wears only low-heeled shoes.

a

Which statement about pregnancy is accurate? a. A normal pregnancy lasts about 10 lunar months. b. A trimester is one third of a year. c. The prenatal period extends from fertilization to conception. d. The estimated date of confinement (EDC) is how long the mother will have to be bedridden after birth.

a

A woman complains of severe abdominal and pelvic pain around the time of menstruation that has gotten worse over the last 5 years. She also complains of pain during intercourse and has tried unsuccessfully to get pregnant for the past 18 months. These symptoms are most likely related to: a. Endometriosis. c. Primary dysmenorrhea. b. PMS. d. Secondary dysmenorrhea

ANS: A Symptoms of endometriosis can change over time and may not reflect the extent of the disease. Major symptoms include dysmenorrhea and deep pelvic dyspareunia (painful intercourse). Impaired fertility may result from adhesions caused by endometriosis. Although endometriosis may be associated with secondary dysmenorrhea, it is not a cause of primary dysmenorrhea or PMS. In addition, this woman is complaining of dyspareunia and infertility, which are associated with endometriosis, not with PMS or primary or secondary dysmenorrhea.

What important, immediate postoperative care practice should the nurse remember when caring for a woman who has had a mastectomy? a. The blood pressure (BP) cuff should not be applied to the affected arm. b. Venipuncture for blood work should be performed on the affected arm. c. The affected arm should be used for intravenous (IV) therapy. d. The affected arm should be held down close to the womans side.

ANS: A The affected arm should not be used for BP readings, IV therapy, or venipuncture. The affected arm should be elevated with pillows above the level of the right atrium

Which patient is most at risk for fibroadenoma of the breast? a. A 38-year-old woman c. A 16-year-old girl b. A 50-year-old woman d. A 27-year-old woman

ANS: C Although it may occur at any age, fibroadenoma is most common in the teenage years. Ductal ectasia and intraductal papilloma become more common as a woman approaches menopause. Fibrocystic breast changes are more common during the reproductive years

A patient has been prescribed adjuvant tamoxifen therapy. What common side effect might she experience? a. Nausea, hot flashes, and vaginal bleeding b. Vomiting, weight loss, and hair loss c. Nausea, vomiting, and diarrhea d. Hot flashes, weight gain, and headaches

ANS: A Common side effects of tamoxifen therapy include hot flashes, nausea, vomiting, vaginal bleeding, menstrual irregularities, and rash. Weight loss, hair loss, diarrhea, weight gain, and headaches are not common side effects of tamoxifen

Fibrocystic changes in the breast most often appear in women in their 20s and 30s. The etiology is unknown, but it may be an imbalance of estrogen and progesterone. The nurse who cares for this client should be aware that treatment modalities are conservative. One proven modality that may provide relief is: a. Diuretic administration. b. Including caffeine daily in the diet. c. Increased vitamin C supplementation. d. Application of cold packs to the breast as necessary

ANS: A Diuretic administration plus a decrease in sodium and fluid intake are recommended. Although not supported by research, some advocate eliminating dimethylxanthines (caffeine) from the diet. Smoking should also be avoided, and alcohol consumption should be reduced. Vitamin E supplements are recommended; however, the client should avoid megadoses because this is a fat-soluble vitamin. Pain relief measures include applying heat to the breast, wearing a supportive bra, and taking nonsteroidal antiinflammatory drugs

A benign breast condition that includes dilation and inflammation of the collecting ducts is called: a. Ductal ectasia. c. Chronic cystic disease. b. Intraductal papilloma. d. Fibroadenoma

ANS: A Generally occurring in women approaching menopause, ductal ectasia results in a firm irregular mass in the breast, enlarged axillary nodes, and nipple discharge. Intraductal papillomas develop in the epithelium of the ducts of the breasts; as the mass grows, it causes trauma or erosion within the ducts. Chronic cystic disease causes pain and tenderness. The cysts that form are multiple, smooth, and well delineated. Fibroadenoma is evidenced by fibrous and glandular tissues. They are felt as firm, rubbery, and freely mobile nodules

Examples of sexual risk behaviors associated with exposure to a sexually transmitted infection (STI) include (Select all that apply): a. Fellatio. b. Unprotected anal intercourse. c. Multiple sex partners. d. Dry kissing. e. Abstinence.

ANS: A, B, C Engaging in these sexual activities increases the exposure risk and the possibility of acquiring an STI. Dry kissing and abstinence are considered safe sexual practices

There is little consensus on the management of premenstrual dysphoric disorder (PMDD). However, nurses can advise women on several self-help modalities that often improve symptoms. The nurse knows that health teaching has been effective when the client reports that she has adopted a number of lifestyle changes, including (Select all that apply): a. Regular exercise. b. Improved nutrition. c. A daily glass of wine. d. Smoking cessation. e. Oil of evening primrose

ANS: A, B, D, E These modalities may provide significant symptom relief in 1 to 2 months. If there is no improvement after these changes have been made, the patient may need to begin pharmacologic therapy. Women should decrease both their alcohol and caffeinated beverage consumption if they have PMDD.

The exact cause of breast cancer remains undetermined. Researchers have found that there are many common risk factors that increase a womans chance of developing a malignancy. It is essential for the nurse who provides care to women of any age to be aware of which of the following risk factors (Select all that apply)? a. Family history b. Late menarche c. Early menopause d. Race e. Nulliparity or first pregnancy after age 30

ANS: A, D, E Family history, race, and nulliparity are known risk factors for the development of breast cancer. Other risk factors include age, personal history of cancer, high socioeconomic status, sedentary lifestyle, hormone replacement therapy, recent use of oral contraceptives, never having breastfed a child, and drinking more than one alcoholic beverage per day. Early menarche and late menopause are risk factors for breast malignancy, not late menarche and early menopause.

The drug of choice for treatment of gonorrhea is: a. Penicillin G. c. Ceftriaxone. b. Tetracycline. d. Acyclovir.

ANS: C Ceftriaxone is effective for treatment of all gonococcal infections. Penicillin is used to treat syphilis. Tetracycline is prescribed for chlamydial infections. Acyclovir is used to treat herpes genitalis

When evaluating a patient for sexually transmitted infections (STIs), the nurse should be aware that the most common bacterial STI is: a. Gonorrhea. c. Chlamydia. b. Syphilis. d. Candidiasis

ANS: C Chlamydia is the most common and fastest spreading STI among American women, with an estimated 3 million new cases each year. Gonorrhea and syphilis are bacterial STIs, but they are not the most common ones among American women. Candidiasis is caused by a fungus, not by bacteria

The nurse providing education regarding breast care should explain to the woman that fibrocystic changes in breasts are: a. A disease of the milk ducts and glands in the breasts. b. A premalignant disorder characterized by lumps found in the breast tissue. c. Lumpiness with pain and tenderness found in varying degrees in the breast tissue of healthy women during menstrual cycles. d. Lumpiness accompanied by tenderness after menses.

ANS: C Fibrocystic changes are palpable thickenings in the breast usually associated with pain and tenderness. The pain and tenderness fluctuate with the menstrual cycle. Fibrocystic changes are not premalignant changes

A woman has a breast mass that is not well delineated and is nonpalpable, immobile, and nontender. This is most likely: a. Fibroadenoma. c. Intraductal papilloma. b. Lipoma. d. Mammary duct ectasia

ANS: C Intraductal papilloma is the only benign breast mass that is nonpalpable. Fibroadenoma is well delineated, palpable, and movable. Lipoma is palpable and movable. Mammary duct ectasia is not well delineated and is immobile, but it is palpable and painful

After a mastectomy a woman should be instructed to perform all of the following except: a. Emptying surgical drains twice a day and as needed. b. Avoiding lifting more than 4.5 kg (10 lb) or reaching above her head until given permission by her surgeon. c. Wearing clothing with snug sleeves to support the tissue of the arm on the operative side. d. Reporting immediately if inflammation develops at the incision site or in the affected arm.

ANS: C The woman should not be advised to wear snug clothing. Rather, she should be advised to avoid tight clothing, tight jewelry, and other causes of decreased circulation in the affected arm. As part of the teaching plan, the woman should be instructed to empty surgical drains, to avoid lifting more than 10 lb or reaching above her head, and to report the development of incision site inflammation

A nurse practitioner performs a clinical breast examination on a woman diagnosed with fibroadenoma. The nurse knows that fibroadenoma is characterized by: a. Inflammation of the milk ducts and glands behind the nipples. b. Thick, sticky discharge from the nipple of the affected breast. c. Lumpiness in both breasts that develops 1 week before menstruation. d. A single lump in one breast that can be expected to shrink as the woman ages.

ANS: D Fibroadenomas are characterized by discrete, usually solitary lumps smaller than 3 cm in diameter. Fibroadenomas increase in size during pregnancy and shrink as the woman ages. Inflammation of the milk ducts is associated with mammary duct ectasia, not fibroadenoma. A thick, sticky discharge is associated with galactorrhea, not fibroadenoma. Lumpiness before menstruation is associated with fibrocystic changes of the breast.

The nurse must watch for what common complications in a patient who has undergone a transverse rectus abdominis myocutaneous (TRAM) flap? a. Axillary edema and tissue necrosis b. Delayed wound healing and muscle contractions c. Delayed wound healing and axillary edema d. Delayed wound healing and hematoma

ANS: D Postoperative care focuses on monitoring the skin flap for signs of decreased capillary refill, hematoma, infection, and necrosis. Axillary edema and muscle contractions are not common complications of TRAM flaps

The nurse providing care in a womens health care setting must be aware regarding which sexually transmitted infection that can be successfully treated and cured? a. Herpes b. Acquired immunodeficiency syndrome (AIDS) c. Venereal warts d. Chlamydia

ANS: D The usual treatment for infection by the bacterium Chlamydia is doxycycline or azithromycin. Concurrent treatment of all sexual partners is needed to prevent recurrence. There is no known cure for herpes, and treatment focuses on pain relief and preventing secondary infections. Because there is no known cure for AIDS, prevention and early detection are the primary focus of care management. Condylomata acuminata are caused by human papillomavirus. No treatment eradicates the virus

A healthy 60-year-old African-American woman regularly receives her health care at the clinic in her neighborhood. She is due for a mammogram. At her previous clinic visit, her physician, concerned about the 3- week wait at the neighborhood clinic, made an appointment for her to have a mammogram at a teaching hospital across town. She did not keep her appointment and returned to the clinic today to have the nurse check her blood pressure. What would be the most appropriate statement for the nurse to make to this patient? a. Do you have transportation to the teaching hospital so that you can get your mammogram? b. Im concerned that you missed your appointment; let me make another one for you. c. Its very dangerous to skip your mammograms; your breasts need to be checked. d. Would you like me to make an appointment for you to have your mammogram here?

ANS: D This statement is nonjudgmental and gives the patient options as to where she may have her mammogram. Furthermore, it is an innocuous way to investigate the reasons the patient missed her previous appointment. African-American women often have the perception that they are treated with prejudice by health care providers. Questioning the potential lack of transportation may promote this perception. African-American women report not participating in early breast cancer screening because breast cancer comes by chance and getting it is determined by a higher power. Expressing concern and offering to schedule another appointment is a reflection of the nurses beliefs, not those of the client. Suggesting that it is dangerous to skip a mammogram can be perceived as judgmental and derogatory. It may alienate and embarrass the patient

While teaching the expectant mother about personal hygiene during pregnancy, maternity nurses should be aware that: a. Tub bathing is permitted even in late pregnancy unless membranes have ruptured. b. The perineum should be wiped from back to front. c. Bubble bath and bath oils are permissible because they add an extra soothing and cleansing action to the bath. d. Expectant mothers should use specially treated soap to cleanse the nipples.

a

Many parents to be have questions about multiple births. Maternity nurses should be able to tell them that: 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 white families. d. Fraternal twins are same gender, usually male.

a

Prenatal testing for human immunodeficiency virus (HIV) is recommended for: a. All women, regardless of risk factors. b. A woman who has had more than one sexual partner. c. A woman who has had a sexually transmitted infection. d. A woman who is monogamous with her partner.

a

The mucous plug that forms in the endocervical canal is called the: a. Operculum. c. Funic souffle. b. Leukorrhea. d. Ballottement.

a

The multiple marker test is used to assess the fetus for which condition? a. Down syndrome c. Congenital cardiac abnormality b. Diaphragmatic hernia d. Anencephaly

a

The nurse is assessing the knowledge of new parents with a child born with maple syrup and urine disease (MSUD). This is an autosomal recessive in here to disorder, which means that: a. Both genes of a pair must be abnormal for the disorder to be expressed. b. Only one copy of the abnormal gene is required for the disorder to be expressed. c. The disorder occurs in males and heterozygous females. d. The disorder is carried on the X chromosome.

a

The nurse must be cognizant that an individual's genetic make up is known as his or her: a. Genotype. c. Karyotype. b. Phenotype. d. Chromotype.

a

A first-time mother at 18 weeks of gestation comes for her regularly scheduled prenatal visit. The client tells the nurse that she is afraid that she is going into premature labor because she is beginning to have regular contractions. The nurse explains that this is the Braxton Hicks sign and teaches the client that this type of contraction: a. Is painless. c. Causes cervical dilation. b. Increases with walking. d. Impedes oxygen flow to the fetus.

a

A key finding from the human Genome project is: a. Approximately 20,000 genes make up the genome. b. All human beings are 80.99% identical at the DNA level. c. Human genes produce only one protein per gene; other mammals produce three proteins per gene. d. Single gene testing will become a standardized test for all pregnant clients in the future.

a

A new mother asks the nurse about the "white substance" covering her infant. The nurse explains that the purpose of vernix caseosa is to: a. Protect the fetal skin from amniotic fluid. b. Promote normal peripheral nervous system development. c. Allow transport of oxygen and nutrients across the amnion. d. Regulate fetal temperature.

a

A woman at 10 weeks of gestation who is seen in the prenatal clinic with presumptive signs and symptoms of pregnancy likely will have: a. Amenorrhea. c. Chadwicks sign. b. Positive pregnancy test. d. Hegars sign.

a

A woman is in her seventh month of pregnancy. She has been complaining of nasal congestion and occasional epistaxis. The nurse suspects that: a. This is a normal respiratory change in pregnancy caused by elevated levels of estrogen. b. This is an abnormal cardiovascular change, and the nosebleeds are an ominous sign. c. The woman is a victim of domestic violence and is being hit in the face by her partner. d. The woman has been using cocaine intranasally.

a

A woman who has completed one pregnancy with a fetus (or fetuses) reaching the stage of fetal viability is called a: a. Primipara. c. Multipara. b. Primigravida. d. Nulligravida.

a

Appendicitis may be difficult to diagnose in pregnancy because the appendix is: a. Displaced upward and laterally, high and to the right. b. Displaced upward and laterally, high and to the left. c. Deep at McBurney point. d. Displaced downward and laterally, low and to the right.

a

As relates to the father's acceptance of the pregnancy and preparation for childbirth, the maternity nurse should know that: a. The father goes through three phases of acceptance of his own. b. The fathers attachment to the fetus cannot be as strong as that of the mother because it does not start until after birth. c. In the last 2 months of pregnancy, most expectant fathers suddenly get very protective of their established lifestyle and resist making changes to the home. d. Typically men remain ambivalent about fatherhood right up to the birth of their child.

a

During a client's physical examination the nurse notes that the lower uterine segment is soft on palpation. The nurse would document this finding as: a. Hegars sign c. Chadwicks sign b. McDonalds sign d. Goodells sign

a

With regard to medications, herbs, shots, and other substances normally encountered by pregnant women, the maternity nurse should be aware that: a. Both prescription and over-the-counter (OTC) drugs that otherwise are harmless can be made hazardous by metabolic deficiencies of the fetus. b. The greatest danger of drug-caused developmental deficits in the fetus is seen in the final trimester. c. Killed-virus vaccines (e.g., tetanus) should not be given during pregnancy, but live-virus vaccines (e.g., measles) are permissible. d. No convincing evidence exists that secondhand smoke is potentially dangerous to the fetus.

a

With regard to prenatal genetic testing, nurses should be aware that: a. Maternal serum screening can determine whether a pregnant woman is at risk of carrying a fetus with Down syndrome. b. Carrier screening tests look for gene mutations of people already showing symptoms of a disease. c. Predisposition testing predicts with near certainty that symptoms will appear. d. Presymptomatic testing is used to predict the likelihood of breast cancer.

a

A woman is in for a routine prenatal checkup. You are assessing her urine for proteinuria. Which findings are considered normal (Select all that apply)? a. Dipstick assessment of trace to +1 c. Dipstick assessment of +2 b. <300 mg/24 hours d. >300 mg/24 hours

a,b

Signs and symptoms that a woman should report immediately to her health care provider include (Select all that apply): (a. Vaginal bleeding. b. Rupture of membranes. c. Heartburn accompanied by severe headache. d. Decreased libido. e. Urinary frequency.) a. a,b,d b. c,b,d c. a,b,c d. c,d,e

a,b,c

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 just Station period for the nurse to be able to conduct a complete assessment of the newly pregnant client, she should understand the significance of exposure to known human teratogens. These include: a. Infections. b. Radiation. Test Bank - Maternal Child Nursing Care by Perry (6th Edition, 2017) 96 c. Maternal conditions. d. Drugs. e. Chemicals.

a,b,c,d,e

Which congenital malformations result from multi-factorial inheritance? a. Cleft lip b. Congenital heart disease c. Cri du chat syndrome d. Anencephaly e. Pyloric stenosis

a,b,d,e

A woman has just moved to the United States from Mexico. She is 3 months pregnant and has arrived for her first prenatal visit. During her assessment interview, you discover that she has not had any immunizations. Which immunizations should she receive at this point in her pregnancy (Select all that apply)? (a. Tetanus b. Diphtheria c. Chickenpox d. Rubella e. Hepatitis B) a. a,b,c,d b. a,b,e c. c,d,e d. a,b,c,e

a,b,e

The diagnosis of pregnancy is based on which positive signs of pregnancy (Select all that apply)? a. Identification of fetal heartbeat b. Palpation of fetal outline c. Visualization of the fetus d. Verification of fetal movement e. Positive hCG test

a,c,d

A 3-year-old girl's mother is 6 months pregnant. What concern is this child likely to verbalize? a. How the baby will get out c. Whether her mother will die b. What the baby will eat d. What color eyes the baby has

b

A 31-year-old woman believes that she may be pregnant. She took an OTC pregnancy test 1 week ago after missing her period; the test was positive. During her assessment interview, the nurse inquires about the woman's last menstrual period and asks whether she is taking any medications. The woman states that she takes medicine for epilepsy. She has been under considerable stress lately at work and has not been sleeping well. She also has a history of irregular periods. Her physical examination does not indicate that she is pregnant. She has an ultrasound scan, which reveals that she is not pregnant. What is the most likely cause of the false-positive pregnancy test result? a. She took the pregnancy test too early. b. She takes anticonvulsants. c. She has a fibroid tumor. d. She has been under considerable stress and has a hormone imbalance.

b

A patient in her first trimester complains of nausea and vomiting. She asks, "Why does this happen?" The nurse's best response is: a. It is due to an increase in gastric motility. b. It may be due to changes in hormones. c. It is related to an increase in glucose levels. d. It is caused by a decrease in gastric secretions.

b

A pregnant woman at 18 weeks of gestation calls the clinic to report that she has been experiencing occasional backaches of mild-to-moderate intensity. The nurse would recommend that she: a. Do Kegel exercises. c. Use a softer mattress. b. Do pelvic rock exercises. d. Stay in bed for 24 hours.

b

A woman is at 14 weeks of gestation. The nurse would expect to palpate the fundus at which level? a. Not palpable above the symphysis at this time b. Slightly above the symphysis pubis c. At the level of the umbilicus d. Slightly above the umbilicus

b

A woman who is 32 weeks' pregnant is informed by the nurse that a danger sign of pregnancy could be: a. Constipation. b. Alteration in the pattern of fetal movement. c. Heart palpitations. d. Edema in the ankles and feet at the end of the day.

b

A woman's obstetric history indicates that she is pregnant for the fourth time and all of her children from previous pregnancies are living. One was born at 39 weeks of gestation, twins were born at 34 weeks of gestation, and another child was born at 35 weeks of gestation. What is her gravidity and parity using the GTPAL system? a. 3-1-1-1-3 c. 3-0-3-0-3 b. 4-1-2-0-4 d. 4-2-1-0-3

b

Cardiovascular system changes occur during pregnancy. Which finding would be considered normal for a woman in her second trimester? a. Less audible heart sounds (S1, S2) b. Increased pulse rate c. Increased blood pressure d. Decreased red blood cell (RBC) production

b

During the first trimester, a woman can expect which of the following changes in her sexual desire? a. An increase, because of enlarging breasts b. A decrease, because of nausea and fatigue c. No change d. An increase, because of increased levels of female hormones

b

In understanding and guiding a woman through her acceptance of pregnancy, a maternity nurse should be aware that: a. Nonacceptance of the pregnancy very often equates to rejection of the child. b. Mood swings most likely are the result of worries about finances and a changed lifestyle as well as profound hormonal changes. c. Ambivalent feelings during pregnancy usually are seen only in emotionally immature or very young mothers. d. Conflicts such as not wanting to be pregnant or childrearing and career-related decisions need not be addressed during pregnancy because they will resolve themselves naturally after birth

b

Physiologic anemia often occurs during pregnancy as a result of: a. Inadequate intake of iron. b. Dilution of hemoglobin concentration. c. The fetus establishing iron stores. d. Decreased production of erythrocytes.

b

The maternity nurse understands that vascular volume increases 40% to 60% during pregnancy to: a. Compensate for decreased renal plasma flow. b. Provide adequate perfusion of the placenta. c. Eliminate metabolic wastes of the mother. d. Prevent maternal and fetal dehydration.

b

The musculoskeletal system adapts to the changes that occur during pregnancy. A woman can expect to experience what change? a. Her center of gravity will shift backward. b. She will have increased lordosis. c. She will have increased abdominal muscle tone. d. She will notice decreased mobility of her pelvic joints.

b

The nurse caring for a newly pregnant woman would advise her that ideally prenatal care should begin: a. Before the first missed menstrual period. b. After the first missed menstrual period. c. After the second missed menstrual period. d. After the third missed menstrual period.

b

The nurse should have knowledge of the purpose of the pinch test. It is used to: a. Check the sensitivity of the nipples. b. Determine whether the nipple is everted or inverted. c. Calculate the adipose buildup in the abdomen. d. See whether the fetus has become inactive.

b

The nurse teaches a pregnant woman about the presumptive, probable, and positive signs of pregnancy. The woman demonstrates understanding of the nurse's instructions if she states that a positive sign of pregnancy is: a. A positive pregnancy test. b. Fetal movement palpated by the nurse-midwife. c. Braxton Hicks contractions. d. Quickening.

b

To reassure and educate pregnant clients about changes in the uterus, nurses should be aware that: a. Lightening occurs near the end of the second trimester as the uterus rises into a different position. b. The womans increased urinary frequency in the first trimester is the result of exaggerated uterine antireflexion caused by softening. c. Braxton Hicks contractions become more painful in the third trimester, particularly if the woman tries to exercise. d. The uterine souffle is the movement of the fetus.

b

To reassure and educate pregnant clients about changes in their cardiovascular system, maternity nurses should be aware that: a. A pregnant woman experiencing disturbed cardiac rhythm, such as sinus arrhythmia requires close medical and obstetric observation, no matter how healthy she otherwise may appear. b. Changes in heart size and position and increases in blood volume create auditory changes from 20 weeks to term. c. Palpitations are twice as likely to occur in twin gestations. d. All of the above changes likely will occur.

b

To reassure and educate pregnant clients about the functioning of their kidneys in eliminating waste products, maternity nurses should be aware that: a. Increased urinary output makes pregnant women less susceptible to urinary infection. b. Increased bladder sensitivity and then compression of the bladder by the enlarging uterus results in the urge to urinate even if the bladder is almost empty. c. Renal (kidney) function is more efficient when the woman assumes a supine position. d. Using diuretics during pregnancy can help keep kidney function regular.

b

What type of cultural concern is the most likely deterrent to many women seeking prenatal care? a. Religion c. Ignorance b. Modesty d. Belief that physicians are evil

b

Which finding in the urine analysis of a pregnant woman is considered a variation of normal? a. Proteinuria c. Bacteria in the urine. b. Glycosuria d. Ketones in the urine.

b

Which statement about multifetal pregnancy is inaccurate? a. The expectant mother often develops anemia because the fetuses have a greater demand for iron. b. Twin pregnancies come to term with the same frequency as single pregnancies. c. The mother should be counseled to increase her nutritional intake and gain more weight. d. Backache and varicose veins often are more pronounced.

b

Which time-based description of a stage of development in pregnancy is accurate? a. Viability22 to 37 weeks since the last menstrual period (LMP) (assuming a fetal weight >500 g) b. Termpregnancy from the beginning of week 38 of gestation to the end of week 42 c. Pretermpregnancy from 20 to 28 weeks d. Postdatepregnancy that extends beyond 38 weeks

b

With regard to chromosome abnormal tees, nurses should be aware that: a. They occur in approximately 10% of newborns. b. Abnormalities of number are the leading cause of pregnancy loss. c. Down syndrome is a result of an abnormal chromosome structure. d. Unbalanced translocation results in a mild abnormality that the child will outgrow.

b

With regard to the initial physical examination of a woman beginning prenatal care, maternity nurses should be cognizant of: a. Only women who show physical signs or meet the sociologic profile should be assessed for physical abuse. b. The woman should empty her bladder before the pelvic examination is performed. c. The distribution, amount, and quality of body hair are of no particular importance. d. The size of the uterus is discounted in the initial examination.

b

You are a maternal newborn nurse caring for her mother who just delivered a baby born with down syndrome. What nursing diagnosis is most essential in caring for the mother of this infant? a. Disturbed body image c. Anxiety b. Interrupted family processes d. Risk for injury

b

care managementof a women diagnosed with acute pelvic inflammatory disease most likely would include a. oral antiviral therapy b. bed rest in semi fowlers position c. antibiotic regimen continued untill symptoms subside d. frequent pelvic exam

b. bed rest in semi fowlers position

A woman eight months pregnant asked the nurse, "Does my baby have any antibodies to fight infection?" The most appropriate response by the nurse is: a. Your baby has all the immune globulins necessary: IgG, IgM, and 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.

d

A couple has been counseled for genetic anomalies. They ask you, what is karyotyping? Your best response is: a. Karyotyping will reveal if the babys lungs are mature. b. Karyotyping will reveal if your baby will develop normally. c. Karyotyping will provide information about the gender of the baby and the number and structure of the chromosomes. d. Karyotyping will detect any physical deformities the baby has.

c

A father and mother are carriers of phenylketonuria (PKU). Their 2-year-old daughter has PKU. The couple tells the nurse that they are planning to have a second baby. Because their daughter has PKU, they are sure that their next baby wont be affected. What response by the nurse is most accurate? a. Good planning; you need to take advantage of the odds in your favor. b. I think youd better check with your doctor first. c. You are both carriers, so each baby has a 25% chance of being affected. d. The ultrasound indicates a boy, and boys are not affected by PKU.

c

A patient at 24 weeks of gestation contacts the nurse at her obstetric provider's office to complain that she has cravings for dirt and gravel. The nurse is aware that this condition is known as ________ and may indicate anemia. a. Ptyalism c. Pica b. Pyrosis d. Decreased peristalsis

c

A pregnant woman at 10 weeks of gestation jogs three or four times per week. She is concerned about the effect of exercise on the fetus. The nurse should inform her: a. You dont need to modify your exercising any time during your pregnancy. b. Stop exercising because it will harm the fetus. c. You may find that you need to modify your exercise to walking later in your pregnancy, around the seventh month. d. Jogging is too hard on your joints; switch to walking now.

c

A pregnant woman at 25 weeks just station 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.

c

A woman is 3 months pregnant. At her prenatal visit, she tells the nurse that she doesn't know what is happening; one minute she's happy that she is pregnant, and the next minute she cries for no reason. Which response by the nurse is most appropriate? a. Dont worry about it; youll feel better in a month or so. b. Have you talked to your husband about how you feel? c. Perhaps you really dont want to be pregnant. d. Hormonal changes during pregnancy commonly result in mood swings.

d

In response to requests by the U.S. Public Health Service for new models of prenatal care, an innovative new approach to prenatal care known as centering pregnancy was developed. Which statement would accurately apply to the centering model of care? a. Group sessions begin with the first prenatal visit. b. At each visit, blood pressure, weight, and urine dipsticks are obtained by the nurse. c. Eight to 12 women are placed in gestational-age cohort groups. d. Outcomes are similar to those of traditional prenatal care.

c

Some pregnant clients may complain of changes in their voice and impaired hearing. The nurse can tell these clients that these are common reactions to: a. A decreased estrogen level. b. Displacement of the diaphragm, resulting in thoracic breathing. c. Congestion and swelling, which occur because the upper respiratory tract has become more vascular. d. Increased blood volume.

c

The nurse should be aware that the partner's main role in pregnancy is to: a. Provide financial support. b. Protect the pregnant woman from old wives tales. c. Support and nurture the pregnant woman. d. Make sure the pregnant woman keeps prenatal appointments.

c

To provide the patient with accurate information about dental care during pregnancy, maternity nurses should be aware that: a. Dental care can be dropped from the priority list because the woman has enough to worry about and is getting a lot of calcium anyway. b. Dental surgery, in particular, is contraindicated because of the psychologic stress it engenders. c. If dental treatment is necessary, the woman will be most comfortable with it in the second trimester. d. Dental care interferes with the expectant mothers need to practice conscious relaxation.

c

To reassure and educate pregnant clients about changes in their breasts, nurses should be aware that: a. The visibility of blood vessels that form an intertwining blue network indicates full function of Montgomerys tubercles and possibly infection of the tubercles. b. The mammary glands do not develop until 2 weeks before labor. c. Lactation is inhibited until the estrogen level declines after birth. d. Colostrum is the yellowish oily substance used to lubricate the nipples for breastfeeding.

c

With regard to a woman's reordering of personal relationships during pregnancy, the maternity nurse should understand that: a. Because of the special motherhood bond, a womans relationship with her mother is even more important than with the father of the child. b. Nurses need not get involved in any sexual issues the couple has during pregnancy, particularly if they have trouble communicating them to each other. c. Women usually express two major relationship needs during pregnancy: feeling loved and valued and having the child accepted by the father. d. The womans sexual desire is likely to be highest in the first trimester because of the excitement and because intercourse is physically easier.

c

With regard to follow-up visits for women receiving prenatal care, nurses should be aware that: a. The interview portions become more intensive as the visits become more frequent over the course of the pregnancy. b. Monthly visits are scheduled for the first trimester, every 2 weeks for the second trimester, and weekly for the third trimester. c. During the abdominal examination, the nurse should be alert for supine hypotension. d. For pregnant women, a systolic blood pressure (BP) of 130 and a diastolic BP of 80 is sufficient to be considered hypertensive.

c

With regard to the initial visit with a client who is beginning prenatal care, nurses should be aware that: a. The first interview is a relaxed, get-acquainted affair in which nurses gather some general impressions. b. If nurses observe handicapping conditions, they should be sensitive and not inquire about them because the client will do that in her own time. c. Nurses should be alert to the appearance of potential parenting problems, such as depression or lack of family support. d. Because of legal complications, nurses should not ask about illegal drug use; that is left to physicians

c

During pregnancy, many changes occur as a direct result of the presence of the fetus. Which of these adaptations meet this criteria? a. Leukorrhea b. Development of the operculum c. Quickening d. Ballottement e. Lightening

c,d,e

A woman who is 14 weeks pregnant tells the nurse that she always had a glass of wine with dinner before she became pregnant. She has abstained during her first trimester and would like to know if it is safe for her to have a drink with dinner now. The nurse would tell her: a. Since youre in your second trimester, theres no problem with having one drink with dinner. b. One drink every night is too much. One drink three times a week should be fine. c. Since youre in your second trimester, you can drink as much as you like. d. Because no one knows how much or how little alcohol it takes to cause fetal problems, the best course is to abstain throughout your pregnancy.

d

For what reason would breastfeeding be contraindicated? a. Hepatitis B b. Everted nipples c. History of breast cancer 3 years ago d. Human immunodeficiency virus (HIV) positive

d

Human chorionic gonadotropin (hCG) is an important biochemical marker for pregnancy and the basis for many tests. A maternity nurse should be aware that: a. hCG can be detected 2.5 weeks after conception. b. The hCG level increases gradually and uniformly throughout pregnancy. c. Much lower than normal increases in the level of hCG may indicate a postdate pregnancy. d. A higher than normal level of hCG may indicate an ectopic pregnancy or Down syndrome.

d

In her work with pregnant women of various cultures, a nurse practitioner has observed various practices that seemed strange or unusual. She has learned that cultural rituals and practices during pregnancy seem to have one purpose in common. Which statement best describes that purpose? a. To promote family unity b. To ward off the evil eye c. To appease the gods of fertility d. To protect the mother and fetus during pregnancy

d

Numerous changes in the integumentary system occur during pregnancy. Which change persists after birth? a. Epulis c. Telangiectasia b. Chloasma d. Striae gravidarum

d

The nurse caring for the pregnant client must understand that the hormone essential for maintaining pregnancy is: a. Estrogen. b. Human chorionic gonadotropin (hCG). c. Oxytocin. d. Progesterone.

d

The phenomenon of someone other than the mother-to-be experiencing pregnancy-like symptoms such as nausea and weight gain applies to the: a. Mother of the pregnant woman. c. Sister of the pregnant woman. b. Couples teenage daughter. d. Expectant father.

d

To reassure and educate pregnant clients about changes in the cervix, vagina, and position of the fetus, nurses should be aware that: a. Because of a number of changes in the cervix, abnormal Papanicolaou (Pap) tests are much easier to evaluate. b. Quickening is a technique of palpating the fetus to engage it in passive movement. c. The deepening color of the vaginal mucosa and cervix (Chadwicks sign) usually appears in the second trimester or later as the vagina prepares to stretch during labor. d. Increased vascularity of the vagina increases sensitivity and may lead to a high degree of arousal, especially in the second trimester.

d

To reassure and educate their pregnant clients about changes in their blood pressure, maternity nurses should be aware that: a. A blood pressure cuff that is too small produces a reading that is too low; a cuff that is too large produces a reading that is too high. b. Shifting the clients position and changing from arm to arm for different measurements produces the most accurate composite blood pressure reading at each visit. c. The systolic blood pressure increases slightly as pregnancy advances; the diastolic pressure remains constant. d. Compression of the iliac veins and inferior vena cava by the uterus contributes to hemorrhoids in the later stage of term pregnancy.

d

What represents a typical progression through the phases of a woman's establishing a relationship with the fetus? a. Accepts the fetus as distinct from herselfaccepts the biologic fact of pregnancyhas a feeling of caring and responsibility b. Fantasizes about the childs gender and personalityviews the child as part of herselfbecomes introspective c. Views the child as part of herselfhas feelings of well-beingaccepts the biologic fact of pregnancy d. I am pregnant.I am going to have a baby.I am going to be a mother.

d

When discussing work and travel during pregnancy with a pregnant patient, nurses should instruct them that: a. Women should sit for as long as possible and cross their legs at the knees from time to time for exercise. b. Women should avoid seat belts and shoulder restraints in the car because they press on the fetus. c. Metal detectors at airport security checkpoints can harm the fetus if the woman passes through them a number of times. d. While working or traveling in a car or on a plane, women should arrange to walk around at least every hour or so.

d

Which statement about a condition of pregnancy is accurate? a. Insufficient salivation (ptyalism) is caused by increases in estrogen. b. Acid indigestion (pyrosis) begins early but declines throughout pregnancy. c. Hyperthyroidism often develops (temporarily) because hormone production increases. d. Nausea and vomiting rarely have harmful effects on the fetus and may be beneficial.

d

While you are assessing the vital signs of a pregnant woman in her third trimester, the patient complains of feeling faint, dizzy, and agitated. Which nursing intervention is appropriate? a. Have the patient stand up and retake her blood pressure. b. Have the patient sit down and hold her arm in a dependent position. c. Have the patient lie supine for 5 minutes and recheck her blood pressure on both arms. d. Have the patient turn to her left side and recheck her blood pressure in 5 minutes.

d

With regard to the estimation and interpretation of the recurrence of risks for genetic disorders, nurses should be aware that: a. With a dominant disorder, the likelihood of the second child also having the condition is 100%. b. An autosomal recessive disease carries a one in eight risk of the second child also having the disorder. c. Disorders involving maternal ingestion of drugs carry a one in four chance of being repeated in the second child. d. The risk factor remains the same no matter how many affected children are already in the family.

d

With regard to the development of the respiratory system, maternity nurses should understand that: a. The respiratory system does not begin developing until after the embryonic stage. b. The infants lungs are considered mature when the lecithin/sphingomyelin (L/S) ratio is 1:1, at about 32 weeks. 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.

c

A woman has a thick, white, lumpy, cottage cheeselike discharge, with patches on her labia and in her vagina. She complains of intense pruritus. The nurse practitioner would order which preparation for treatment? a. Fluconazole c. Clindamycin b. Tetracycline d. Acyclovir

ANS: A Fluconazole, metronidazole, and clotrimazole are the drugs of choice to treat candidiasis. Tetracycline is used to treat syphilis. Clindamycin is used to treat bacterial vaginosis. Acyclovir is used to treat genital herpes

In vitro fertilization-embryo transfer (IVF-ET) is a common approach for women with blocked fallopian tubes or unexplained infertility and for men with very low sperm counts. A husband and wife have arrived for their preprocedural interview. The husband asks the nurse to explain what the procedure entails. The nurses most appropriate response is: a. IVF-ET is a type of assisted reproductive therapy that involves collecting eggs from your wifes ovaries, fertilizing them in the laboratory with your sperm, and transferring the embryo to her uterus. 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 sperm, and transferred to her uterus after normal embryonic development has occurred. The statement, A donor embryo will be transferred into your wifes uterus describes therapeutic donor insemination. Donor sperm will be used to inseminate your wife describes the procedure for a donor embryo. Dont worry about the technical stuff; thats what we are here for discredits the clients need for teaching and is an inappropriate response. PTS: 1 DIF: Cognitive Level: Application REF: 118 OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

As relates to dysfunctional uterine bleeding (DUB), the nurse should be aware that: a. It is most commonly caused by anovulation. b. It most often occurs in middle age. c. The diagnosis of DUB should be the first considered for abnormal menstrual bleeding. d. The most effective medical treatment is steroids

ANS: A Anovulation may occur because of hypothalamic dysfunction or polycystic ovary syndrome. DUB most often occurs when the menstrual cycle is being established or when it draws to a close at menopause. A diagnosis of DUB is made only after all other causes of abnormal menstrual bleeding have been ruled out. The most effective medical treatment is oral or intravenous estrogen

Postcoital contraception with Ovral: a. Requires that the first dose be taken within 72 hours of unprotected intercourse. b. Requires that the woman take second and third doses at 24 and 36 hours after the first dose. c. Must be taken in conjunction with an IUD insertion. d. Is commonly associated with the side effect of menorrhagia.

ANS: A Emergency contraception is most effective when used within 72 hours of intercourse; however, it may be used with lessened effectiveness 120 hours later. Insertion of the copper IUD within 5 days of intercourse may also be used and is up to 99% effective. The most common side effect of postcoital contraception is nausea. PTS: 1 DIF: Cognitive Level: Comprehension REF: 132 OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

On vaginal examination of a 30-year-old woman, the nurse documents the following findings: profuse, thin, grayish white vaginal discharge with a fishy odor; complaint of pruritus. On the basis of these findings, the nurse suspects that this woman has: a. Bacterial vaginosis (BV). c. Trichomoniasis. b. Candidiasis. d. Gonorrhea

ANS: A Most women with BV complain of a characteristic fishy odor. The discharge usually is profuse; thin; and white, gray, or milky in color. Some women also may have mild irritation or pruritus. The discharge associated with candidiasis is thick, white, and lumpy and resembles cottage cheese. Trichomoniasis may be asymptomatic, but women commonly have a characteristic yellowish-to-greenish, frothy, mucopurulent, copious, and malodorous discharge. Women with gonorrhea are often asymptomatic. They may have a purulent endocervical discharge, but discharge usually is minimal or absent.

Which symptom described by a patient is characteristic of premenstrual syndrome (PMS)? a. I feel irritable and moody a week before my period is supposed to start. b. I have lower abdominal pain beginning the third day of my menstrual period. c. I have nausea and headaches after my period starts, and they last 2 to 3 days. d. I have abdominal bloating and breast pain after a couple days of my period.

ANS: A PMS is a cluster of physical, psychologic, and behavioral symptoms that begin in the luteal phase of the menstrual cycle and resolve within a couple of days of the onset of menses. Complaints of lower abdominal pain, nausea and headaches, and abdominal bloating all are associated with PMS. However, the timing reflected is inaccurate.

A woman has chosen the calendar method of conception control. During the assessment process, it is most important that the nurse: a. Obtain a history of 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 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 it is not the most important aspect to assess for discussion of the calendar method. PTS: 1 DIF: Cognitive Level: Analysis REF: 121 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

A physician prescribes clomiphene citrate (Clomid, Serophene) for a woman experiencing infertility. She is very concerned about the risk of multiple births. The nurses most appropriate response is: a. This is a legitimate concern. Would you like to discuss this further before your treatment begins? b. No one has ever had more than triplets with Clomid. c. Ovulation will be monitored with ultrasound so that this 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 significantly increased. The patients 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 is inaccurate and negates the patients concerns. Ultrasound cannot ensure that a multiple pregnancy will not occur. The percentage quoted in this statement is inaccurate. The comment dont worry discredits the patients concern. PTS: 1 DIF: Cognitive Level: Application REF: 116 OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

Which viral sexually transmitted infection is characterized by a primary infection followed by recurrent episodes? a. Herpes simplex virus (HSV)-2 b. Human papillomavirus (HPV) c. Human immunodeficiency virus (HIV) d. Cytomegalovirus (CMV)

ANS: A The initial HSV genital infection is characterized by multiple painful lesions, fever, chills, malaise, and severe dysuria; it may last 2 to 3 weeks. Recurrent episodes of HSV infection commonly have only local symptoms that usually are less severe than the symptoms of the initial infection. With HPV infection, lesions are a chronic problem. HIV is a retrovirus. Seroconversion to HIV positivity usually occurs within 6 to 12 weeks after the virus has entered the body. Severe depression of the cellular immune system associated with HIV infection characterizes acquired immunodeficiency syndrome (AIDS). AIDS has no cure. In most adults, the onset of CMV infection is uncertain and asymptomatic. However, the disease may become a chronic, persistent infection.

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. Dilation and evacuation (D&E). b. Instillation of hypertonic saline into the uterine cavity. c. Intravenous administration of Pitocin. d. Vacuum aspiration.

ANS: A The most common technique for medical termination of a pregnancy in the second trimester is D&E. It is usually performed between 13 and 16 weeks. Hypertonic solutions injected directly into the uterus account for less than 1% of all abortions because other methods are safer and easier to use. Intravenous 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. PTS: 1 DIF: Cognitive Level: Comprehension REF: 137 OBJ: Nursing Process: Implementation MSC: Client Needs: Physiologic Integrity

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

ANS: A The standard days variation on the calendar method has a failure rate of 12%. The periodic abstinence method has a failure rate of 25% or greater. The postovulation method has a failure rate of 25% or greater. The coitus interruptus method has a failure rate of 27% or greater. PTS: 1 DIF: Cognitive Level: Knowledge REF: 121 OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

An essential component of counseling women regarding safe sex practices includes discussion regarding avoiding the exchange of body fluids. The physical barrier promoted for the prevention of sexually transmitted infections and human immunodeficiency virus is the condom. Nurses can help motivate clients to use condoms by initiating a discussion related to a number of aspects of condom use. The most important of these is: a. Strategies to enhance condom use. b. Choice of colors and special features. c. Leaving the decision up to the male partner. d. Places to carry condoms safely

ANS: A When the nurse opens discussion on safe sex practices, it gives the woman permission to clear up any concerns or misapprehensions that she may have regarding condom use. The nurse can also suggest ways that the woman can enhance her condom negotiation and communications skills. These include role-playing, rehearsal, cultural barriers, and situations that put the client at risk. Although women can be taught the differences among condoms, such as size ranges, where to purchase, and price, this is not as important as negotiating the use of safe sex practices. Women must address the issue of condom use with every sexual contact. Some men need time to think about this. If they appear reluctant, the woman may want to reconsider the relationship. Although not ideal, women may safely choose to carry condoms in shoes, wallets, or inside their bra. They should be taught to keep the condom away from heat. This information is important; however, it is not germane if the woman cannot even discuss strategies on how to enhance condom use

Nurses should be aware that 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 Of cases with an identifiable cause, about 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. PTS: 1 DIF: Cognitive Level: Comprehension REF: 114 OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

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

ANS: A Women with a history of TSS should not use a cervical cap. Condoms, vaginal films, and vaginal sheaths are not contraindicated for a woman with a history of TSS. PTS: 1 DIF: Cognitive Level: Comprehension REF: 127 OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

You (the nurse) are reviewing the educational packet provided to a client about tubal ligation. What is an important fact you should point out (Select all that apply)? a. It is highly unlikely that you will become pregnant after the procedure. b. This is an effective form of 100% permanent sterilization. You wont be able to get pregnant. c. Sterilization offers some form of protection against sexually transmitted infections (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, although it is not 100% effective. Sterilization offers no protection against STIs. The menstrual cycle typically remains the same after a tubal ligation. PTS: 1 DIF: Cognitive Level: Application REF: 134 OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

The U.S. Centers for Disease Control and Prevention (CDC) recommends that HPV be treated with client applied: a. Miconazole ointment. b. Topical podofilox 0.5% solution or gel. c. Penicillin given intramuscularly for two doses. d. Metronidazole by mouth

ANS: B Available treatments are imiquimod, podophyllin, and podofilox. Miconazole ointment is used to treat athletes foot. Intramuscular penicillin is used to treat syphilis. Metronidazole is used to treat bacterial vaginosis.

Which contraceptive method best protects against sexually transmitted infections (STIs) and human immunodeficiency virus (HIV)? a. Periodic abstinence b. Barrier methods c. Hormonal methods d. They all offer about the same protection.

ANS: B Barrier methods such as condoms best protect against STIs and HIV. Periodic abstinence and hormonal methods (the pill) offer no protection against STIs or HIV. PTS: 1 DIF: Cognitive Level: Application REF: 125 OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

A woman who has a seizure disorder and takes barbiturates and phenytoin sodium daily asks the nurse about the pill as a contraceptive choice. The nurses most appropriate response would be: a. This is a highly effective method, but it has some side effects. b. Your current medications will reduce the effectiveness of the pill. c. The pill will reduce the effectiveness of your seizure medication. d. This is a good choice for a woman of your age and personal history.

ANS: B Because the liver metabolizes oral contraceptives, their effectiveness is reduced when they are taken simultaneously with anticonvulsants. The statement Your current medications will reduce the effectiveness of the pill is true, but it is not the most appropriate response. The anticonvulsant will reduce the effectiveness of the pill, not the other way around. The statement This is a good choice for a woman of your age and personal history does not teach the client that the effectiveness of the pill may be reduced because of her anticonvulsant therapy. PTS: 1 DIF: Cognitive Level: Application REF: 130 OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

Which of the following statements about the various forms of hepatitis is accurate? a. A vaccine exists for hepatitis C but not for hepatitis B. b. Hepatitis A is acquired by eating contaminated food or drinking polluted water. c. Hepatitis B is less contagious than human immunodeficiency virus (HIV). d. The incidence of hepatitis C is decreasing.

ANS: B Contaminated milk and shellfish are common sources of infection with hepatitis A. A vaccine exists for hepatitis B but not for hepatitis C. Hepatitis B is more contagious than HIV. The incidence of hepatitis C is increasing.

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). The nurses most appropriate response is: a. The IUD does not interfere with sex. b. The risk of pelvic inflammatory disease (PID) will be higher for you. c. The IUD will protect you from sexually transmitted infections (STIs). d. Pregnancy rates are high with IUDs.

ANS: B Disadvantages of IUDs include an increased risk of PID in the first 20 days after insertion and the risks of bacterial vaginosis and uterine perforation. The IUD offers no protection against STIs or human immunodeficiency virus. Because this woman has multiple sex partners, she is at higher risk of developing a STI. The IUD does not protect against infection, as does a barrier method. Although the statement The IUD does not interfere with sex may be correct, it is not the most appropriate response. The IUD offers no protection from STIs. The typical failure rate of the IUD in the first year of use is 0.8%. PTS: 1 DIF: Cognitive Level: Application REF: 133 OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

During her gynecologic checkup, a 17-year-old girl states that recently she has been experiencing cramping and pain during her menstrual periods. The nurse would document this complaint as: a. Amenorrhea. c. Dyspareunia. b. Dysmenorrhea. d. Premenstrual syndrome (PMS).

ANS: B Dysmenorrhea is pain during or shortly before menstruation. Amenorrhea is the absence of menstrual flow. Dyspareunia is pain during intercourse. PMS is a cluster of physical, psychologic, and behavioral symptoms that begin in the luteal phase of the menstrual cycle and resolve within a couple of days of the onset of menses

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 Endometrial biopsy is scheduled after ovulation, during the luteal phase of the menstrual cycle. 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. Laparoscopy usually is 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. PTS: 1 DIF: Cognitive Level: Knowledge REF: 111 OBJ: Nursing Process: Planning MSC: Client Needs: Physiologic Integrity

With regard to the use of intrauterine devices (IUDs), nurses should be aware that: 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 sexually transmitted infections (STIs) as the diaphragm. d. Consent forms are not needed for IUD insertion.

ANS: B The woman has up to 8 days to insert the IUD after unprotected sex. Return to fertility is immediate after removal of the IUD. IUDs offer no protection for STIs. A consent form is required for insertion, as is a negative pregnancy test. PTS: 1 DIF: Cognitive Level: Comprehension REF: 132 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

A married couple is discussing alternatives for pregnancy prevention and has asked about fertility awareness methods (FAMs). The nurses most appropriate reply is: a. Theyre not very effective, and its very likely youll get pregnant. b. They can be effective for many couples, but 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 adherence to coitus intervals. They are effective if used correctly by a woman with a regular menstrual cycle. The typical failure rate for all FAMs is 25% 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. PTS: 1 DIF: Cognitive Level: Application REF: 121 OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

With regard to the assessment of female, male, and couple infertility, nurses should be aware that: a. The couples religious, cultural, and ethnic backgrounds provide emotional clutter that does not affect the clinical scientific diagnosis. b. The investigation takes 3 to 4 months and a significant financial investment. c. The woman is assessed first; if she is not the problem, 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 impact on diagnosis and assessment. Both partners are assessed systematically and simultaneously, as individuals and as a couple. Semen analysis is for men, but the postcoital test is for the couple. PTS: 1 DIF: Cognitive Level: Application REF: 112 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

The viral sexually transmitted infection (STI) that affects most people in the United States today is: a. Herpes simplex virus type 2 (HSV-2). b. Human papillomavirus (HPV). Test Bank - Maternal Child Nursing Care by Perry (6th Edition, 2017) 50 c. Human immunodeficiency virus (HIV). d. Cytomegalovirus (CMV).

ANS: B HPV infection is the most prevalent viral STI seen in ambulatory health care settings. HSV-2, HIV, and CMV all are viral STIs but are not the most prevalent viral STIs.

A woman inquires about herbal alternative methods for improving fertility. Which statement by the nurse is the most appropriate when instructing the client in 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.

ANS: B Herbs that a woman should avoid while trying to conceive include licorice root, yarrow, wormwood, ephedra, fennel, golden seal, lavender, juniper, flaxseed, pennyroyal, passionflower, wild cherry, cascara, sage, thyme, and periwinkle. Nettle leaf, dong quai, and vitamin E all promote fertility. Vitamin E, calcium, and magnesium may promote fertility and conception. All supplements and herbs should be purchased from trusted sources. PTS: 1 DIF: Cognitive Level: Application REF: 114 OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

A 25-year-old single woman comes to the gynecologists office for a follow-up visit related to her abnormal Papanicolaou (Pap) smear. The test revealed that the patient has human papillomavirus (HPV). The client asks, What is that? Can you get rid of it? Your best response is: a. Its just a little lump on your cervix. We can freeze it off. b. HPV stands for human papillomavirus. It is a sexually transmitted infection (STI) that may lead to cervical cancer. c. HPV is a type of early human immunodeficiency virus (HIV). You will die from this. d. You probably caught this from your current boyfriend. He should get tested for this.

ANS: B It is important to inform the patient about STIs and the risks involved with HPV. The health care team has a duty to provide proper information to the patient, including information related to STIs. HPV and HIV are both viruses that can be transmitted sexually, but they are not the same virus. The onset of HPV can be insidious. Often STIs go unnoticed. Abnormal bleeding frequently is the initial symptom. The client may have had HPV before her current boyfriend. You cannot make any deductions from this limited information

While interviewing a 31-year-old woman before her routine gynecologic examination, the nurse collects data about the clients recent menstrual cycles. The nurse should collect additional information with which statement? a. The woman says her menstrual flow lasts 5 to 6 days. b. She describes her flow as very heavy. c. She reports that she has had a small amount of spotting midway between her periods for the past 2 months. d. She says the length of her menstrual cycle varies from 26 to 29 days

ANS: B Menorrhagia is defined as excessive menstrual bleeding, in either duration or amount. Heavy bleeding can have many causes. The amount of bleeding and its effect on daily activities should be evaluated. A menstrual flow lasting 5 to 6 days is a normal finding. Mittlestaining, a small amount of bleeding or spotting that occurs at the time of ovulation (14 days before onset of the next menses), is considered normal. During her reproductive years, a woman may have physiologic variations in her menstrual cycle. Variations in the length of a menstrual cycle are considered normal

To detect human immunodeficiency virus (HIV), most laboratory tests focus on the: a. virus. c. CD4 counts. b. HIV antibodies. d. CD8 counts.

ANS: B The screening tool used to detect HIV is the enzyme immunoassay, which tests for the presence of antibodies to the virus. CD4 counts are associated with the incidence of acquired immunodeficiency syndrome (AIDS) in HIV-infected individuals.

A male client asks the nurse why it is better to purchase condoms that are not lubricated with nonoxynol-9 (a common spermicide). The nurses most appropriate response is: a. The lubricant prevents vaginal irritation. b. Nonoxynol-9 does not provide protection against sexually transmitted infections, as originally thought; it has also been linked to an increase in the transmission of human immunodeficiency virus and can cause genital lesions. c. The additional lubrication improves sex. d. Nonoxynol-9 improves penile sensitivity.

ANS: B The statement Nonoxynol-9 does not provide protection against sexually transmitted infections, as originally thought; it has also been linked to an increase in the transmission of human immunodeficiency virus and can cause genital lesions is true. Nonoxynol-9 may cause vaginal irritation, has no effect on the quality of sexual activity, and has no effect on penile sensitivity. PTS: 1 DIF: Cognitive Level: Application REF: 125 OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

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 take first when meeting with a new client to discuss contraception? a. Obtain data about the frequency of coitus. b. Determine the womans level of knowledge about contraception and 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 This 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 sexually transmitted infections, and a 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 partners objections. Assessing the womans willingness to touch herself is a key factor for the nurse to discuss should the client express 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. PTS: 1 DIF: Cognitive Level: Analysis REF: 119 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

Injectable progestins (DMPA, Depo-Provera) are a good contraceptive choice for women who: a. Want menstrual regularity and predictability. b. Have a history of thrombotic problems or breast cancer. c. Have difficulty remembering to take oral contraceptives daily. d. Are homeless or mobile and rarely receive health care.

ANS: C Advantages of DMPA include a contraceptive effectiveness comparable to that of combined oral contraceptives with the requirement of only four injections a year. Disadvantages of injectable progestins are prolonged amenorrhea and uterine bleeding. 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. PTS: 1 DIF: Cognitive Level: Comprehension REF: 131 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

When evaluating a patient whose primary complaint is amenorrhea, the nurse must be aware that lack of menstruation is most often the result of: a. Stress. c. Pregnancy. b. Excessive exercise. d. Eating disorders

ANS: C Amenorrhea, or the absence of menstrual flow, is most often a result of pregnancy. Although stress, excessive exercise, and eating disorders all may be contributing factors, none is the most common factor associated with amenorrhea.

When assessing a patient for amenorrhea, the nurse should be aware that this is unlikely to be caused by: a. Anatomic abnormalities. c. Lack of exercise. b. Type 1 diabetes mellitus. d. Hysterectomy

ANS: C Lack of exercise is not a cause of amenorrhea. Strenuous exercise may cause amenorrhea. Anatomic abnormalities, type 1 diabetes mellitus, and hysterectomy all are possible causes of amenorrhea

Management of primary dysmenorrhea often requires a multifaceted approach. The nurse who provides care for a client with this condition should be aware that the optimal pharmacologic therapy for pain relief is: a. Acetaminophen. b. Oral contraceptives (OCPs). c. Nonsteroidal antiinflammatory drugs (NSAIDs). d. Aspirin

ANS: C NSAIDs are prostaglandin inhibitors and show the strongest research results for pain relief. Often if one NSAID is not effective, another one can provide relief. Approximately 80% of women find relief from NSAIDs. Preparations containing acetaminophen are less effective for dysmenorrhea because they lack the antiprostaglandin properties of NSAIDs. OCPs are a reasonable choice for women who also want birth control. The benefit of OCPs is the reduction of menstrual flow and irregularities. OCPs may be contraindicated for some women and have numerous potential side effects. NSAIDs are the drug of choice. If a woman is taking a NSAID, she should avoid taking aspirin

While instructing a couple regarding birth control, the nurse should be aware that the method called natural family planning: a. Is the same as coitus interruptus, or pulling out. b. Uses the calendar method to align the womans cycle with the natural phases of the moon. c. Is the only contraceptive practice acceptable to the Roman Catholic church. d. Relies on barrier methods during fertility phases.

ANS: C 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. 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. PTS: 1 DIF: Cognitive Level: Comprehension REF: 121 OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

Which statement concerning cyclic perimenstrual pain and discomfort (CPPD) is accurate? a. Premenstrual dysphoric disorder (PMDD) is a milder form of premenstrual syndrome (PMS) and more common in younger women. b. Secondary dysmenorrhea is more intense and medically significant than primary dysmenorrhea. c. Premenstrual syndrome is a complex, poorly understood condition that may include any of a hundred symptoms. d. The causes of PMS have been well established.

ANS: C PMS may manifest with one or more of a hundred or so physical and psychologic symptoms. PMDD is a more severe variant of PMS. Secondary dysmenorrhea is characterized by more muted pain than that seen in primary dysmenorrhea; the medical treatment is much the same. The cause of PMS is unknown. It may be a collection of different problems

With regard to endometriosis, nurses should be aware that: a. It is characterized by the presence and growth of endometrial tissue inside the uterus. b. It is found more often in African-American women than in white or Asian women. c. It may worsen with repeated cycles or remain asymptomatic and disappear after menopause. d. It is unlikely to affect sexual intercourse or fertility

ANS: C Symptoms vary among women, ranging from nonexistent to incapacitating. With endometriosis, the endometrial tissue is outside the uterus. Symptoms vary among women, ranging from nonexistent to incapacitating. Endometriosis is found equally in white and African-American women and is slightly more prevalent in Asian women. Women can experience painful intercourse and impaired fertility

A 36-year-old woman has been given a diagnosis of uterine fibroids. When planning care for this patient, the nurse should know that: a. Fibroids are malignant tumors of the uterus that require radiation or chemotherapy. b. Fibroids increase in size during the perimenopausal period. c. Menorrhagia is a common finding. d. The woman is unlikely to become pregnant as long as the fibroids are in her uterus

ANS: C The major symptoms associated with fibroids are menorrhagia and the physical effects produced by large myomas. Fibroids are benign tumors of the smooth muscle of the uterus, and their etiology is unknown. Fibroids are estrogen sensitive and shrink as levels of estrogen decline. Fibroids occur in 25% of women of reproductive age and are seen in 2% of pregnant women.

A couple comes in for an infertility workup, having attempted to get pregnant for 2 years. The woman, 37, 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 test is needed? a. Testicular biopsy b. Antisperm antibodies c. Follicle-stimulating hormone (FSH) level d. Examination for testicular infection

ANS: C The woman has irregular menstrual cycles. The scenario does not indicate that she has had any testing related to this irregularity. Hormone analysis is performed to assess endocrine function of the hypothalamic-pituitaryovarian axis when menstrual cycles are absent or irregular. Determination of blood levels of prolactin, FSH, luteinizing hormone (LH), estradiol, progesterone, and thyroid hormones may be necessary to diagnose the cause of irregular menstrual cycles. A testicular biopsy would be indicated only in cases of azoospermia (no sperm cells) or severe oligospermia (low number of sperm cells). Antisperm antibodies are produced by a man against his own sperm. This is unlikely to be the case here because the man has already produced children. Examination for testicular infection would be done before semen analysis. Infection would affect spermatogenesis. PTS: 1 DIF: Cognitive Level: Analysis REF: 112 OBJ: Nursing Process: Diagnosis MSC: Client Needs: Health Promotion and Maintenance

A woman will be taking oral contraceptives using a 28-day pack. The nurse should advise this woman to protect against pregnancy by: a. Limiting sexual contact for one cycle after starting the pill. b. Using condoms and foam instead of the pill for as long as she takes an antibiotic. c. Taking one pill at the same time every day. d. Throwing away the pack and using a backup method if she misses two pills 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 abortion, 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 hormone levels in oral contraceptive users. If the client misses two pills during week 1, she should take two pills a day for 2 days, finish the package, and use a backup method the next 7 consecutive days. PTS: 1 DIF: Cognitive Level: Application REF: 131 OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

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 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. Emergency contraception is used within 72 hours of unprotected intercourse to prevent pregnancy. Postcoital contraceptive use is 74% to 90% effective at preventing pregnancy. Oral emergency contraceptive regimens may include progestin-only and estrogenprogestin pills. Women with contraindications to estrogen use should use progestin-only pills. PTS: 1 DIF: Cognitive Level: Analysis REF: 132 OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

A couple is trying to cope with an infertility problem. They want to know what they can do to preserve their emotional equilibrium. The nurses most appropriate response is: a. Tell your friends and family so 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 it is very difficult to obtain an infant.

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, but depending on where the other couple is in their own recovery process, this may or may not help them. The statement about adoption proceedings is not supportive of the psychosocial needs of this couple and may be detrimental to their well-being. PTS: 1 DIF: Cognitive Level: Application REF: 114 OBJ: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

Which diagnostic test is used to confirm a suspected diagnosis of breast cancer? a. Mammogram c. Fine-needle aspiration (FNA) b. Ultrasound d. CA 15.3

ANS: C When a suspicious mammogram is noted or a lump is detected, diagnosis is confirmed by FNA, core needle biopsy, or needle localization biopsy. Mammography is a clinical screening tool that may aid early detection of breast cancers. Transillumination, thermography, and ultrasound breast imaging are being explored as methods of detecting early breast carcinoma. CA 15.3 is a serum tumor marker that is used to test for residual disease

The two primary areas of risk for sexually transmitted infections (STIs) are: a. Sexual orientation and socioeconomic status. b. Age and educational level. c. Large number of sexual partners and race. d. Risky sexual behaviors and inadequate preventive health behaviors

ANS: D Risky sexual behaviors and inadequate preventive health behaviors put a person at risk for acquiring or transmitting an STI. Although low socioeconomic status may be a factor in avoiding purchasing barrier protection, sexual orientation does not put one at higher risk. Younger individuals and individuals with less education may be unaware of proper prevention techniques; however, these are not the primary areas of risk for STIs. Having a large number of sexual partners is a risk-taking behavior, but race does not increase the risk for STIs

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 so couples can make informed decisions about their choice of treatment. Which issue would not need to be addressed by an infertile couple 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. Risk of 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 there may be a need for multifetal reduction. Nurses can provide anticipatory guidance on this matter. Depending on the therapy chosen, there may be a need for donor oocytes, sperm, embryos, or a surrogate mother. 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. PTS: 1 DIF: Cognitive Level: Application REF: 111 OBJ: Nursing Process: Implementation MSC: Client Needs: Safe and Effective Care Environment

Which statement is true about the term contraceptive failure rate? a. It refers to the percentage of users expected to have an accidental pregnancy over a 5-year span. b. It refers to the minimum level that must be achieved to receive a government license. c. It 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. PTS: 1 DIF: Cognitive Level: Knowledge REF: 120 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

When a nurse is counseling a woman for primary dysmenorrhea, which nonpharmacologic intervention might be recommended? a. Increasing the intake of red meat and simple carbohydrates b. Reducing the intake of diuretic foods such as peaches and asparagus c. Temporarily substituting physical activity for a sedentary lifestyle d. Using a heating pad on the abdomen to relieve cramping

ANS: D Heat minimizes cramping by increasing vasodilation and muscle relaxation and minimizing uterine ischemia. Dietary changes such as eating less red meat may be recommended for women experiencing dysmenorrhea. Increasing the intake of diuretics, including natural diuretics such as asparagus, cranberry juice, peaches, parsley, and watermelon, may help ease the symptoms associated with dysmenorrhea. Exercise has been found to help relieve menstrual discomfort through increased vasodilation and subsequent decreased ischemia.

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

ANS: D Medical abortions are performed through the use of medications (rather than surgical procedures). They are mostly done in the first trimester, and they can be either elective (the womans choice) or therapeutic (for reasons of maternal or fetal health). PTS: 1 DIF: Cognitive Level: Comprehension REF: 135 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

One of the alterations in cyclic bleeding that occurs between periods is called: a. Oligomenorrhea. c. Leiomyoma. b. Menorrhagia. d. Metrorrhagia

ANS: D Metrorrhagia is bleeding between periods. It can be caused by progestin injections and implants. Oligomenorrhea is infrequent or scanty menstruation. Menorrhagia is excessive menstruation. Leiomyoma is a common cause of excessive bleeding

Nafarelin is currently used as a treatment for mild-to-severe endometriosis. The nurse should tell a woman taking this medication that the drug: a. Stimulates the secretion of gonadotropin-releasing hormone (GnRH), thereby stimulating ovarian activity. b. Should be sprayed into one nostril every other day. c. Should be injected into subcutaneous tissue BID. d. Can cause her to experience some hot flashes and vaginal dryness

ANS: D Nafarelin is a GnRH agonist, and its side effects are similar to effects of menopause. The hypoestrogenism effect results in hot flashes and vaginal dryness. Nafarelin is a GnRH agonist that suppresses the secretion of GnRH and is administered twice daily by nasal spray

In their role of implementing a plan of care for infertile couples, nurses should: a. Be comfortable with their sexuality and nonjudgmental about others to counsel their clients effectively. 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 the above plus be knowledgeable about potential drug and surgical remedies.

ANS: D Nurses should be open to and ready to help with a variety of medical and nonmedical approaches. PTS: 1 DIF: Cognitive Level: Comprehension REF: 109 OBJ: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

With regard to dysmenorrhea, nurses should be aware that: a. It is more common in older women. b. It is more common in leaner women who exercise strenuously. c. Symptoms can begin at any point in the ovulatory cycle. d. Pain usually occurs in the suprapubic area or lower abdomen

ANS: D Pain is described as sharp and cramping or sometimes as a dull ache. It may radiate to the lower back or upper thighs. Dysmenorrhea is more common in women 17 to 24 years old, women who smoke, and women who are obese. Symptoms begin with menstruation or sometimes a few hours before the onset of flow.

The recommended treatment for the prevention of human immunodeficiency virus (HIV) transmission to the fetus during pregnancy is: a. Acyclovir. c. Podophyllin. b. Ofloxacin. d. Zidovudine

ANS: D Perinatal transmission of HIV has decreased significantly in the past decade as a result of prophylactic administration of the antiretroviral drug zidovudine to pregnant women in the prenatal and perinatal periods. Acyclovir is an antiviral treatment for HSV. Ofloxacin is an antibacterial treatment for gonorrhea. Podophyllin is a solution used in the treatment of human papillomavirus.

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. The nurses most appropriate response is: 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 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 would most likely cause an increase in BBT. PTS: 1 DIF: Cognitive Level: Application REF: 122 OBJ: Nursing Process: Assessment MSC: Client Needs: Health Promotion and Maintenance

A woman currently uses a diaphragm and spermicide for contraception. She asks the nurse what the major differences are between the cervical cap and diaphragm. The nurses most appropriate response is: 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 safely be 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. No additional spermicide is required for repeated acts of intercourse. 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. PTS: 1 DIF: Cognitive Level: Application REF: 127 OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

With regard to the noncontraceptive medical effects of combined oral contraceptive pills (COCs), nurses should be aware that: a. COCs can cause toxic shock syndrome if the prescription is wrong. b. Hormonal withdrawal bleeding usually is a bit more profuse than in normal menstruation and lasts a week. c. COCs increase the risk of endometrial and ovarian cancer. d. The 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. Toxic shock syndrome can occur in some diaphragm users, 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. PTS: 1 DIF: Cognitive Level: Comprehension REF: 130 OBJ: Nursing Process: Planning MSC: Client Needs: Health Promotion and Maintenance

The nurse who is teaching a group of women about breast cancer would tell the women that: a. Risk factors identify more than 50% of women who will develop breast cancer. b. Nearly 90% of lumps found by women are malignant. c. One in 10 women in the United States will develop breast cancer in her lifetime. d. The exact cause of breast cancer is unknown.

ANS: D The exact cause of breast cancer is unknown. Risk factors help to identify less than 30% of women in whom breast cancer eventually will develop. Women detect about 90% of all breast lumps. Of this 90%, only 20% to 25% are malignant. One in eight women in the United States will develop breast cancer in her lifetime

Informed consent concerning contraceptive use is important because some of the methods: a. Are invasive procedures that require hospitalization b. Require a surgical procedure to insert c. May not be reliable d. Have potentially dangerous side effects

ANS: D To make an informed decision about the use of contraceptives, it is important for couples to be aware of potential side effects. The only contraceptive method that is a surgical procedure and requires hospitalization is sterilization. Some methods have greater efficacy than others, and this should be included in the teaching. PTS: 1 DIF: Cognitive Level: Comprehension REF: 134 OBJ: Nursing Process: Assessment MSC: Client Needs: Safe and Effective Care Environment

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. The nurses most appropriate response is: a. Your sperm count seems to be okay in the first semen analysis. b. Only marijuana cigarettes affect sperm count. c. Smoking can give you lung cancer, even though it has no effect on sperm. d. Smoking can reduce the quality of your sperm.

ANS: D Use of tobacco, alcohol, and marijuana may affect sperm counts. Your sperm count seems to be okay in the first semen analysis is inaccurate. Sperm counts vary from day to day and depend on emotional and physical status and sexual activity. A single analysis may be inconclusive. A minimum of two analyses must be performed several weeks apart to assess male fertility. PTS: 1 DIF: Cognitive Level: Application REF: 111 OBJ: Nursing Process: Diagnosis MSC: Client Needs: Health Promotion and Maintenance

A maternity nurse should be aware of which fact about the amniotic fluid? a. It serves as a source of oral fluid and 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

A woman asked the nurse, "what protects my babies umbilical cord from being squashed while the babies inside of me?" The nurses best response is: a. Your babys umbilical cord is surrounded by connective tissue called Wharton jelly, which prevents compression of the blood vessels and ensures continued nourishment of your baby. b. Your babys umbilical floats around in blood anyway. c. You dont need to worry about things like that. d. The umbilical cord is a group of blood vessels that are very well protected by the placenta.

a

The nurse caring for a pregnant client knows that her health teaching regarding fetal circulation has been effective when the client reports that she has been sleeping: a. In a side-lying position. b. On her back with a pillow under her knees. c. With the head of the bed elevated. d. On her abdomen.

a

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

a

Along with gas exchange and nutrient transfer, The placenta produces many hormones necessary for normal pregnancy. These include: a. Human chorionic gonadotropin (hCG) b. Insulin c. Estrogen d. Progesterone e. Testosterone

a,c,d

A mans wife is pregnant for the third time. One child was born with cystic fibrosis, and the other child is healthy. The man wonders what the chance is that this child will have cystic fibrosis. This type of testing is known as: a. Occurrence risk. b. Recurrence risk. c. predictive risk d. Predisposition testing

b

A woman is 15 weeks pregnant with her first baby. She asks how long it will be before she feels the baby move. The best answer is: 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.

b

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?" The best answer is: a. A babys sex is determined as soon as conception occurs. b. The baby has developed enough that we can determine the sex by examining the genitals through ultrasound. c. Boys and girls look alike until about 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.

b

As relates 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.

b

In presenting to obstetric nurses interested in genetics, the genetic nurse identifies the primary risk(s) associated with genetic testing as: a. Anxiety and altered family relationships. b. Denial of insurance benefits. c. High false-positive results associated with genetic testing. d. Ethnic and socioeconomic disparity associated with genetic testing.

b

A woman's cousin gave birth to an infant with a congenital heart anomaly. The woman ask 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. They occur between the third and fifth weeks of development. d. They usually occur in the first 2 weeks of development.

c

Approximately _____ weeks gestation, lecithin is forming on the alveolar surfaces, the eyelids open, the fetus measures approximately 27 cm crown to rump and weighs approximately 1110 g. a. 20 c. 28 b. 24 d. 30

c

In practical terms regarding genetic health care, nurses should be aware that: a. Genetic disorders affect people of all socioeconomic backgrounds, races, and ethnic groups equally. b. Genetic health care is more concerned with populations than individuals. c. The most important of all nursing functions is providing emotional support to the family during counseling. d. Taking genetic histories is the province of large universities and medical centers.

c

Sally comes in for first prenatal examination. This is her first child. She asked the nurse, " how does my baby get air inside my uterus?" The correct response is: 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.

c

The measurement of lecithin in relation to sphingomyelin (LS ratio) is used to determine fetal lung maturity. What ratio reflects maturity of the Longs? a. 1.4:1 c. 2:1 b. 1.8:1 d. 1:1

c

The nurse is providing genetic counseling for an expectant couple who already have a child with trisomy 18. The nurse should: a. Tell the couple they need to have an abortion within 2 to 3 weeks. b. Explain that the fetus has a 50% chance of having the disorder. c. Discuss options with the couple, including amniocentesis to determine whether the fetus is affected. d. Refer the couple to a psychologist for emotional support.

c

Some of the embryos intestines remain with and then Belco cord during the embryonic period because the: 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.

d

The ___ Is/are responsible for oxygen and carbon dioxide transport to and from the maternal blood stream. a. Decidua basalis c. Germ layer b. Blastocyst d. Chorionic villi

d

The most basic information a maternity nurse should have concerning conception is that: 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.

d