Women's Health NCO

A client asks a nurse about the most common problem associated with the use of an intrauterine device (IUD). What answer should the nurse provide? 1. Perforation of the uterus 2. Spontaneous device expulsion 3. Discomfort associated with coitus 4. Development of vaginal infections

2. spontaneous device expulsion Rationale: The IUD may cause irritability of the myometrium, inducing contraction of the uterus and expulsion of the device. Perforation of the uterus is a rare, rather than a common, occurrence. Clients do not report discomfort during coitus when an IUD is in place. Increased incidence of vaginal infections is not reported with the use of an IUD.

A client in labor is receiving an oxytocin (Pitocin) infusion. Which intervention is a priority for the nurse when repetitive late decelerations of the fetal heart rate are observed? 1. Administer oxygen. 2. Place the client on the left side. 3. Discontinue the oxytocin infusion. 4. Check the client's blood pressure

3. discontinue the oxytocin infusion Rationale: The infusion should be stopped because it is the likely source of fetal compromise. Administering oxygen may not be necessary if late decelerations cease with other interventions. Placing the client on the left side should be done after the oxytocin infusion is discontinued. The client's blood pressure may be checked, but this is not the priority.

A 28-year-old woman is scheduled to undergo a laparoscopic bilateral salpingo-oophorectomy. What does a nurse expect the client's priority concern will be? 1. Acute pain 2. Risk for hemorrhage 3. Fear of chronic illness 4. Loss of childbearing potential

4. loss of childbearing potential Rationale: The nurse must determine the client's feelings concerning loss of fertility; if she is childless, the client must cope with the knowledge that unless ova are removed and frozen before the surgery, her genes will not be passed to the next generation, even with in vitro fertilization. Laparoscopic surgery is relatively painless. Because the abdominal cavity is not entered, there is minimal risk of hemorrhage. There is no evidence to indicate that a chronic illness is related to the need for the surgery.

During a routine prenatal office visit at 26 weeks' gestation, a client states that she is getting fat all over and that she even needed to buy bigger shoes. What is the next nursing action? 1. Obtaining the client's weight and blood pressure 2. Reassuring the client that weight gain is expected 3. Supporting the client's decision to buy comfortable shoes 4. Teaching the client about the importance of limiting fatty foods and sweets

1. obtaining the client's weight and blood pressure Rationale: The client's weight and blood pressure help the nurse determine whether an unusual weight gain or an increase in blood pressure has occurred; both of these findings are early signs of preeclampsia. The data suggest a greater-than-expected weight gain. Supporting the client's decision to buy comfortable shoes ignores the possibility that the edema and weight gain are related to preeclampsia. The weight gain may not be caused by inappropriate dietary intake but rather by an underlying pathologic condition.

At her first prenatal clinic visit a primigravida has blood drawn for a rubella antibody screening test, and the results are positive. Which intervention is important when the nurse discusses this finding with the client? 1. Asking her whether she has ever had German measles and when she had the disease 2. Arranging for her to receive the rubella booster vaccine after the birth 3. Planning for her to receive the rubella booster vaccine at her next visit 4. Informing her that the result was expected and that treatment will not be needed

1. asking her whether she has ever had German measles and when she had the disease Rationale: The positive result indicates that the client has had rubella or was vaccinated. The nurse should determine whether she has had the disease, because it is important to know whether it was before or after she became pregnant; if she had rubella at the start of her pregnancy, the fetus is at risk. A rubella booster, either at the next visit or after the birth, is not necessary because the client has active immunity. More information is needed before the client can be told that no treatment will be needed.

While performing shallow, rapid breathing during transition, a client in labor experiences tingling and numbness of her fingertips. The nurse encourages her to breathe into what? 1. A paper bag 2. An oxygen mask 3. A compressed air mask 4. An incentive spirometer

1. a paper bag Rationale: The client is hyperventilating. Using a paper bag allows the client to rebreathe carbon dioxide, which corrects respiratory alkalosis. The client needs to increase the level of carbon dioxide, not oxygen. Compressed air does not enhance the rebreathing of carbon dioxide. An incentive spirometer is used to improve lung expansion, not to rebreathe carbon dioxide.

A 40-year-old primigravida is scheduled to have her first ultrasound. What should the nurse's instructions include? 1. Postponing breakfast until after the test 2. Drinking eight glasses of water before the test 3. Emptying the bladder immediately before the test 4. Inserting a suppository after arising on the day of the test

2. drinking eight glasses of water before the test Rationale: A full bladder raises the uterus above the pelvis, providing better visualization of its contents. It is not necessary to arrive for the test with an empty stomach. The bladder should not be emptied until after the test. It is not necessary to evacuate the bowels before the test.

A client undergoes anterior and posterior surgical repair of a cystocele and rectocele and returns from the postanesthesia care unit with an indwelling catheter in place. What should the nurse tell the client about the primary reasons for the catheter? Select all that apply. 1. Discomfort is minimized. 2. Bladder tone is maintained. 3. Retention of urine is prevented. 4. Pressure on the suture line is relieved. 5. Hourly urine output can be easily measured.

1. discomfort is minimized 3. retention of urine is prevented 4. pressure on the suture line is relieved Rationale: Distention causes discomfort; this is prevented because the catheter prevents urinary retention. The effects of anesthesia and the inflammatory process may impede voiding, leading to urine retention; an indwelling catheter empties the bladder. Distention places pressure on the suture line; this is prevented because the indwelling catheter prevents retention. Because the bladder is continually empty when an indwelling catheter is in place, it loses tone; this is an expected side effect. Hourly urine output can be easily measured, but this is not necessary; hourly urine output is a reflection of kidney function.

A nurse is implementing a teaching plan for a pregnant client who is noncompliant with maintaining bed rest. What is the most appropriate short-term goal? 1. Carrying the fetus to term 2. Remaining in bed as prescribed 3. Listing four reasons to stay in bed 4. Asking her husband to do the cooking

2. remaining in bed as prescribed Rationale: Remaining in bed as prescribed is related to the immediate goal of maintaining bed rest. This is an objective measurement. Carrying the fetus to term is a long-term goal. Also, it is not related to the teaching associated with the treatment regimen. Clients are often able to explain and list reasons why they should follow a proposed plan, even though they may not comply. Clients may not admit failure to adhere to the treatment regimen; demonstration of the desired behavior is an objective measurement. The goal focuses on what the client does in regard to maintaining bed rest. The client could be noncompliant with other activities, such as cooking.

The nurse is providing information to a couple about the assisted reproductive technique of in vitro fertilization (IVF). What information should the nurse include in the teaching session? 1. The sperm will need to come from an unknown donor. 2. Supplemental progesterone is given to promote implantation. 3. The fertilized ova are implanted in the woman's fallopian tube. 4. After implantation, a sign that pregnancy has occurred is an absence of a menstrual period

2. supplemental progesterone is given to promote implantation Rationale: Supplemental progesterone is given to the woman undergoing IVF to promote implantation and support the early pregnancy. The primary healthcare provider removes the ova by means of ultrasound-guided transvaginal retrieval and mixes them with prepared sperm from the woman's partner or a donor. In IVF the fertilized ova are placed in the uterus, not in the fallopian tubes. Because of the supplemental progesterone, the woman will not have a menstrual period even if she is not pregnant, so the absence of menses does not mean that pregnancy has occurred.

During her first visit to the prenatal clinic a client is found to be obese. During the ensuing 5 months, the client has been unsuccessful in adhering to her nutritional plan. Which finding indicates to the nurse that the client has been successful during the sixth month? 1. Weight loss of 1 lb (0.45 kg) 2. Weight gain of 2 lb (0.91 kg) 3. No change in weight from last month 4. The client's statement that she lost weight last week

2. weight gain of 2 lb Rationale: Although obese, the client must gain some weight to meet the fetus's nutritional needs, and a 2-lb (0.91 kg) weight gain is appropriate. Weight loss is contraindicated during pregnancy because it may interfere with fetal growth and development. Maintaining the same weight from last month to this month may indicate that the nutritional needs of the fetus are not being met. The client's statement that she lost weight last week does not constitute objective data.

A nurse caring for a client who has had a hysterectomy is concerned about the client's risk for postoperative thrombosis. The nurse remembers that the majority of pulmonary emboli begin as deep vein thromboses in what area? 1. Calf 2. Thoracic cavity 3. Pelvis and thighs 4. Extremities and abdomen

3. pelvis and thighs Rationale: Most pulmonary emboli after surgery of the pelvic floor originate in the deep veins of the pelvis and thighs because of the extensive vascular network in the region. The calf, thoracic cavity, extremities, and abdomen are not where most pulmonary emboli originate after surgery involving the pelvic floor.

A client at the women's health clinic tells the nurse that she has endometriosis. What factors associated with endometriosis does the nurse anticipate the client will report? Select all that apply. 1. Insomnia 2. Ecchymosis 3. Rectal pressure 4. Abdominal pain 5. Skipped periods 6. Pelvic infections

3. rectal pressure 4. abdominal pain Rationale: Endometriosis is the presence of aberrant endometrial tissue outside the uterus. The tissue responds to ovarian stimulation and bleeds during menstruation, which causes rectal pressure and abdominal pain. Insomnia, ecchymoses, and skipped periods are not related to endometriosis. Pelvic infections are not caused by endometriosis; most frequently they are sexually transmitted.

What is the safest and most reliable birth control method for the nurse to recommend to a client with type 1 diabetes? 1. Vaginal sponge 2. Oral contraceptive 3. Rhythm method with a condom 4. Diaphragm with a spermicidal gel

4. diaphragm with a spermicidal gel Rationale: A diaphragm with a spermicidal gel, if used correctly, offers a low risk of conception and a high degree of reliability, and it is the safest contraceptive method for a person with type 1 diabetes. A vaginal sponge may be used by a woman with type 1 diabetes, but it is less reliable than the diaphragm with spermicidal gel. Even a low-dose oral contraceptive increases the risk for vascular complications, and women with type 1 diabetes are already at risk for vascular complications. The rhythm method is not reliable because menses during the postpartum and lactation periods are often irregular; condoms can fail and must be used correctly and consistently throughout sexual intercourse.

A nurse is preparing a pregnant 39-year-old client for an amniocentesis. Which factor increases the risk of problems after an amniocentesis? 1. The client's blood type is known to be Rh positive. 2. Ultrasonography is done before the amniocentesis. 3. The procedure is done at the twenty-second week of gestation. 4. Several punctures are needed to obtain amniotic fluid.

4. several punctures are needed to obtain amniotic fluid Rationale: Repeated needle punctures inflicted in an attempt to obtain fluid increase the chance of amnionitis or fetal injury. The risk is greater if the client is Rh negative. Ultrasound is used to guide the needle into a pocket of fluid; it decreases the risk of puncturing the placenta or fetus. There is no increased risk associated with performing an amniocentesis during the twenty-second week of gestation.

A woman has made the decision to have breast augmentation surgery, and the procedure is to be performed on an outpatient basis. As part of the preoperative protocol, the nurse provides teaching regarding the discharge instructions. Which instructions apply to this type of surgery? Select all that apply. 1. "Avoid taking aspirin or nonsteroidal antiinflammatory drugs (such as ibuprofen ) for pain relief." 2. "Sleep with your head and torso elevated for at least 1 week." 3. "Sleep on your back or sides but not on your stomach." 4. "Begin slowly raising your arms over your head after the first week." 5. "Take your temperature daily and notify the clinic if it goes above 99.6° F (37.6° C)."

1. avoid taking aspirin or nonsteroidal antiinflammatory drugs (such as ibuprofen) for pain relief 2. sleep with your head and torso elevated for at least 1 week 5. take your temperature daily and notify the clinic if it goes above 99.6 F Rationale: Nonsteroidal antiinflammatory drugs (NSAIDs) should be avoided because of their anticoagulant effects. Elevating the head and torso will reduce edema at the surgical site. This is necessary to help identify the presence of infection. The side-lying position may be traumatic to the surgical area; the client should sleep on her back. Raising the arms above the head may cause movement of the pectoralis muscle and could result in trauma to the surgical area; the arms should not be raised above the head for a minimum of 3 weeks.

The nurse reviews the history of a neonate admitted to the nursery and discovers that the infant's mother was listed as gravida 1 para 1 before the baby was born. How should the nurse utilize these data in order to gather more information? 1. To determine whether there were previous fetal losses 2. To determine whether there are twins at home 3. To consider that someone recorded the gravida and para incorrectly 4. To consider that the current birth means that there were two pregnancies

3. to consider that someone recorded the gravida and para incorrectly Gravida refers to pregnancies, including this one, and para refers to pregnancies terminated (by whatever means) after the age of viability. If this is the client's only pregnancy (gravida 1), she could not have had a previous pregnancy that ended after the age of fetal viability. Para will not exceed gravida. One pregnancy is gravida 1. A twin pregnancy is still one pregnancy terminated after the age of viability. Because the documentation of the client indicates that she is gravida 1, it cannot be assumed that it is the woman's second pregnancy.

What nursing intervention should be implemented routinely after a client has a vacuum aspiration abortion? 1. Giving the client the prescribed oxytocic medication 2. Preparing the client for discharge within 30 minutes 3. Teaching the client about the various methods of birth control 4. Encouraging the client to take the prescribed antibiotic medication

4. encouraging the client to take the prescribed antibiotic medication Rationale: Prophylactic antibiotics after a vacuum extraction abortion decrease the incidence of infection. Oxytocics are not used routinely after an abortion unless there is excessive vaginal bleeding. The client is usually observed for 1 to 3 hours before being discharged. Birth control instructions should be given before the abortion; a client is not receptive to teaching immediately after the procedure.

The nurse is caring for a client who is in the taking-in phase of the postpartum period. What area of health teaching will the client be most responsive to? 1. Perineal care 2. Infant feeding 3. Infant hygiene 4. Family planning

1. perineal care Rationale: During the taking-in phase a woman is primarily concerned with self-care needs and being cared for. The taking-in phase generally occurs during the first 24 hours after delivery and may last up to 2 days. Infant feeding and infant hygiene are best taught during the taking-hold phase of postpartum adjustment. Family planning is not a primary concern during the immediate postpartum period.

A nurse is planning care for a client who gave birth to a preterm male infant. Which response does the nurse anticipate that this mother may experience? 1. Feelings of failure and loss of control 2. Thoughts related to guilt and withdrawal 3. Fear of forming a healthy relationship with her son until he is out of danger 4. Need for increased attachment behaviors because of her son's life-threatening condition

1. feelings of failure and loss of control Rationale: Attachment theory states that the experience of the birth of a preterm infant carries with it feelings of loss of control for the mother. Withdrawal from the situation is maladaptive and requires special help. A healthy relationship may develop regardless of the infant's health. There is no basis to believe that increased attachment behaviors are necessary.

At 22 weeks' gestation a client visits the prenatal clinic for the first time. As part of the prenatal workup, the client has blood work performed. The nurse concludes that further assessment is indicated when the laboratory findings show what? 1. Hemoglobin of 10 g/dL (100 mmol/L) 2. Sedimentation rate of 15 mm/hr 3. Blood glucose level of 115 mg/dL (2.98 mmol/L) 4. White blood cell (WBC) count of 9000/mm 3

1. hemoglobin of 10 g/dL Rationale: A hemoglobin reading below 11 g/dL (110 mmol/L) suggests true anemia rather than physiologic anemia; this occurs because the plasma volume increases more than the red blood cell count during pregnancy, especially during the second trimester. The normal sedimentation rate in women is up to 20 mm/hr; no further assessment is necessary because this is an expected value. The normal blood glucose level ranges from 70 to 105 mg/dL (4.0-6.0 mmol/L); a slightly increased level is common during pregnancy. A WBC count of 5000 to 10,000/mm 3 is within expected limits; no further assessment is necessary.

A woman presents in labor with her baby in frank breech, left sacral anterior position. Where should the nurse listen for the fetal heart? 1. Mother's left side, above the umbilicus 2. Mother's left side, below the umbilicus 3. Mother's right side, above the umbilicus 4. Mother's right side, below the umbilicus

1. mother's left side, above the umbilicus Rationale: The nurse should listen for the fetal heart on the mother's left side above the umbilicus. The baby's body is positioned so that the heart is on the left side of the mother's abdomen. Heart tones in a fetus in the breech position are heard above the mother's umbilicus. The nurse would be unable to ascertain the fetal heart rate below the umbilicus if the fetus was in a frank breach position. The heart rate would be inaudible on the right side.

What should a nurse include in the discharge instructions for a woman who has undergone breast-conserving surgery (lumpectomy) for breast cancer? 1. Assuring her that a supportive brassiere is unnecessary 2. Emphasizing the importance of breast self-examination 3. Instructing her to return the next day for removal of the drain 4. Explaining why it is unnecessary to exercise the arm on the unaffected side

2. emphasizing the importance of breast self-examination Rationale: A client who has cancer of one breast is at risk for the development of cancer in the remaining breast; therefore breast self-examination is important. Wearing a supportive brassiere limits incisional discomfort. There may or may not be a wound drainage system in place, and the timing of its removal is individualized. With the removal of breast tissue specific exercises are needed to prevent muscle atrophy and contractures; the right and left arms should be exercised at the same time.

A nurse is discussing informed consent with a client who is scheduled for a hysterectomy. What components should the informed consent include? Select all that apply. 1. Duplicate of the Patient's Bill of Rights 2. Explanation of available alternative treatments 3. Answers to questions and concerns about the procedure 4. Complete description of the possible dangers and discomforts 5. Countersignature by the person designated in the client's living will

2. explanation of available alternative treatments 3. answers to questions and concerns about the procedure 4. complete description of the possible dangers and discomforts Rationale: Alternative treatment regimens should be discussed so that the client may make an informed choice about which course of treatment to pursue. All questions should be answered honestly and in terms that the client can understand. A description of all potential complications is required for a client to give informed consent. A copy of the Patient's Bill of Rights is not necessary for informed consent for treatment. A countersignature is not necessary if the client is an independent adult.

When teaching a client about using a diaphragm as a form of contraception, what instructions should the nurse provide about the diaphragm? 1. It may or may not be used with a spermicidal lubricant. 2. It should remain in place for at least 6 hours after intercourse. 3. It must be inserted with the dome facing down to be maximally effective. 4. It often appears puckered but this will not interfere with its effectiveness.

2. it should remain in place for at least 6 hours after intercourse Rationale: The diaphragm should remain in place for at least 6 hours after intercourse because the spermicidal jelly or cream requires this amount of time to be effective. The diaphragm must always be used with a spermicide to be effective. The diaphragm may be inserted with the dome facing either up or down and still be effective. Puckering, especially near the rim, may indicate thin spots that could rupture during intercourse; the diaphragm should be replaced if puckering is found.

A 24-year-old woman wants to use her basal body temperature (BBT) in natural family planning but is unsure when to take her temperature. When should the nurse explain is the best time for accurate BBT assessment? 1. Each night right before bed 2. On the first day of her next menstrual cycle 3. Each morning before getting out of bed or increasing her activity 4. At bedtime beginning on day 14 of her menstrual cycle and continuing until her next period

3. each morning before getting out of bed or increasing her activity Rationale: The most accurate BBT is taken before a woman gets out of bed and begins any type of activity that could increase the body's temperature even slightly. BBT should be charted daily on a calendar to permit interpretation of temperature fluctuations. A BBT taken in the evening may be increased after a day of activity. Daily assessment and recording of BBT during the first half of the menstrual cycle is also crucial, because a woman's BBT is lower then than during the second half of her cycle. The BBT temperature may rise slightly with ovulation.

A 32-year-old woman is admitted to the unit with a history of fibroids and menorrhagia. Which findings does the nurse expect to encounter during assessment of the client? Select all that apply. 1. Fluid overload 2. Intermittent diarrhea 3. Pale mucous membranes 4. Difficulty emptying the bladder 5. High hemoglobin and hematocrit levels

3. pale mucous membranes 4. difficulty emptying the bladder Rationale: Menorrhagia (heavy menstrual bleeding) can cause anemia (acute or chronic). Because this client has a history of menorrhagia, the nurse can anticipate chronic anemia. Urinary frequency, urgency, and incontinence are symptoms of fibroids, which can cause menorrhagia. Constipation, not diarrhea, is a common symptom of fibroids, which can cause menorrhagia. Menorrhagia would cause hypovolemia, not hypervolemia. Menorrhagia would cause the hemoglobin and hematocrit levels to decrease, not increase.

A primipara about to be discharged with her newborn asks the nurse many questions regarding infant care. What phase of maternal adjustment does this behavior illustrate? 1. Let-down 2. Taking-in 3. Taking-hold 4. Early parenting

3. taking hold Rationale: The taking-hold phase, which begins around the second or third postpartum day, involves concern about being a "good" mother; the new mother is most receptive to teaching at this time. The behavior described refers to the taking-hold phase of bonding. Let-down is not related to bonding. The let-down reflex refers to the flow of milk in response to suckling and is caused by the release of oxytocin from the posterior pituitary. The taking-in phase is the first period of adjustment to parenthood. It includes the first 2 postpartum days; the mother is passive and dependent and preoccupied with her own needs. Early parenting involves many behaviors, of which taking-hold is only one.

On the third postpartum day after a cesarean birth a client tells the nurse that her breasts feel warm, firm, and tender. The skin is shiny and taut. What does the nurse suspect as the cause of the client's breast discomfort? 1. Stasis of milk in the mammary ducts 2. Overdistention and edema of the acini 3. Inadequate release of milk during each feeding 4. Extended vascular and lymphatic circulation in the breasts

4. extended vascular and lymphatic circulation in the breasts Increased circulation in the breasts causes engorgement, which immediately precedes milk production on the third to fifth postpartum day. Milk production has not yet begun; this is engorgement, which precedes milk production. Acinar cells do not become overdistended because of the supply-and-demand nature of milk production; in addition, milk production is not yet established. Inadequate release of milk is impossible because the breasts have not yet filled with milk; engorgement is occurring.

A nurse is obtaining a health history from a primigravida on her first visit to the prenatal clinic. Before discussing the client's health habits with her, what does the nurse consider the most important factor in the survival of the client's newborn? 1. Reproductive history 2. Adequacy of prenatal care 3. Health habits and social class 4. Gestational age and birth weight

4. gestational age and birth weight Rationale: Adaptation to the extrauterine environment is dependent on the functional capacity of vital organ systems, which is established during intrauterine development; this is measurable in terms of the newborn's gestational age and weight. Although reproductive history, adequacy of prenatal care, and health habits and social class may all influence health, none is the most critical to neonatal survival.