Adaptive Quizzing
A client tells the nurse that the first day of her last menstrual period was July 22. What is the estimated date of birth (EDB)? a. May 7 b. April 29 c. April 22 d. March 6
b. April 29 Her EDB is April 29. The Nägele rule is an indirect, noninvasive method for estimating the date of birth: EDB = last menstrual period + 1 year - 3 months + 7 days. May 7 is beyond the expected date of birth. April 22 and March 6 are both before the EDB.
A client at 42 weeks' gestation is admitted for a nonstress test. The nurse concludes that this test is being done because of what possible complication related to a prolonged pregnancy? a. Polyhydramnios b. Placental insufficiency c. Postpartum infection d. Subclinical gestational diabetes
b. Placental insufficiency Placental function peaks at 37 weeks and declines slowly thereafter; therefore continuation of the pregnancy past term (42 weeks) places the fetus at risk because of placental insufficiency. Oligohydramnios (decreased amniotic fluid volume), not polyhydramnios (increased amniotic fluid volume), may occur in postterm gestations. A prolonged pregnancy does not present a risk for a postpartum infection. A prolonged pregnancy is unrelated to gestational diabetes.
A nurse who promotes freedom of choice for clients in decision-making best supports which principle? a. Justice b. Autonomy c. Beneficence d. Paternalism
b. Autonomy The principle of autonomy relates to the freedom of a person to form his or her own judgments and actions. The nurse promotes autonomy nonjudgmentally so as not to infringe on the decisions or actions of others. Justice means to be righteous, equitable, and to act or treat fairly. Beneficence relates to the state or act of doing good and being kind and charitable. It also includes promotion of well-being and abstaining from injuring others. Paternalism encompasses the practice of governing people in a fatherly manner, especially by providing for their needs without infringing on their rights or responsibilities.
A registered nurse is educating a nursing student about the process of resolving an ethical dilemma. What information should the nurse provide regarding negotiation of outcomes? a. "A nurse should provide a personal point of view." b. "Negotiations should be held in formal settings only." c. "Negotiation takes place immediately after gathering information." d. "The group agrees to a statement of the problem during the negotiation process."
a. "A nurse should provide a personal point of view." During the process of negotiating outcomes, the nurse is required to provide a personal point of view. Negotiations may take place informally at the client's bedside or in a formal setting. After gathering relevant information regarding an ethical dilemma, the nurse is required to examine his or her own values and formulate an opinion regarding the matter. When verbalizing the problem, the group agrees to a statement of the problem to begin discussions. This step is performed before negotiating outcomes. Negotiations take place after determining all possible courses of action.
A client who is pregnant for the first time attends the prenatal clinic. She tells the nurse, "I'm worried about gaining too much weight, because I've heard that it's unhealthy." How should the nurse respond? a. "Yes, too much weight gain results in complications during pregnancy." b. "You'll have to follow a low-calorie diet if you gain more than 15 lb." c. "We're more concerned that you won't gain enough weight to ensure adequate growth of your baby." d. "A 25-lb (11.3-kg) weight gain is recommended; however, the pattern of weight gain is more important than the total amount."
d. "A 25-lb (11.3-kg) weight gain is recommended; however, the pattern of weight gain is more important than the total amount." A sudden sharp increase in weight may indicate fluid retention related to preeclampsia. Weight gain is necessary to ensure adequate nutrition for the fetus. The term "too much" is vague; complications are rare when weight gain is more than 25 to 30 lb (11.3 kg to 13.6 kg) in an uncomplicated pregnancy. There is no specific number of pounds that the client should gain, but a low-calorie diet is contraindicated. Telling the client that the staff is more concerned that she won't gain enough weight to ensure adequate growth of her baby closes off communication and does not allow the client to ask more questions about weight gain.
A client who suspects that she is 6 weeks pregnant appears mildly anxious as she is waiting for her first obstetric appointment. What symptom of mild anxiety does the nurse expect this client to experience? a. Dizziness b. Breathlessness c. Abdominal cramps d. Increased alertness
d. Increased alertness Increased alertness is an expected common behavior that occurs in new or different situations when a person is mildly anxious. Dizziness, breathlessness, and abdominal cramps are all common signs of moderate to severe anxiety.
After 5 years of unprotected intercourse, a childless couple comes to the fertility clinic. The husband tells the nurse that his parents have promised to make a down payment on a house for them if his wife gets pregnant this year. What is the nurse's best response to this comment? a. "This must be very difficult for you with this added pressure." b. "Having a child is a decision you should make without your parents' input." c. "You're lucky. It's nice that your parents are making such a generous offer." d. "Five years without a pregnancy is a long time. You were right to come to the fertility clinic."
a. "This must be very difficult for you with this added pressure." Stating that the situation must be difficult encourages the clients to verbalize their feelings. The clients are not seeking advice concerning their relationship with their parents; the focus should be on them. Stating that five years without a pregnancy is a long time is an insensitive statement and cuts off further communication.
A nurse is counseling a pregnant client who maintains a vegetarian diet. What should the nurse plan to do to ensure optimal nutrition during the pregnancy? a. Refer the client to a dietitian to help plan her daily menu. b. Encourage the client to join a group that teaches nutrition. c. Explain that she needs to include meat in her diet at least once a day. d. Advise the client that it is unhealthy to continue a vegetarian diet during pregnancy.
a. Refer the client to a dietitian to help plan her daily menu. The dietitian can give the client specific information that would help her plan nutritious meals. Specific foods, such as nuts and soy products, may be substituted for meat or animal-related products. The client may know healthy nutrition; she needs help to adapt the vegetarian diet to meet pregnancy needs. Explaining that she needs to include meat in her diet at least once a day or advising the client that it is unhealthy to continue a vegetarian diet during pregnancy ignores the client's beliefs and lifestyle; a nutritious vegetarian diet is available during pregnancy.
During the postpartum period a client with heart disease and type 2 diabetes asks a nurse, "Which contraceptives will I be able to use to prevent pregnancy in the near future?" How should the nurse respond? a. "You may use oral contraceptives—they're almost completely effective in preventing pregnancy." b. "You should use foam with a condom to prevent pregnancy—this is the safest method for women with your illnesses." c. "You'll find that the intrauterine device is best for you, because it prevents a fertilized ovum from implanting in the uterus." d. "You have little to worry about regarding becoming pregnant in the near future, because women with your illnesses usually become infertile."
b. "You should use foam with a condom to prevent pregnancy—this is the safest method for women with your illnesses." Some type of barrier contraceptive (condom with foam or jelly or a diaphragm) is usually recommended for the client with diabetes and heart disease. Oral contraceptives are not recommended for this client because of their tendency to alter glucose tolerance. An intrauterine device is not recommended, because it may predispose this client to infection. Clients with heart disease and diabetes can become pregnant again in the future.
A primary healthcare provider notes that all conventional treatment procedures have proved to be ineffective in managing a client's disorder. The primary healthcare provider decides to try an experimental treatment. The nurse ensures that the client has understood the implications of the new treatment plan thoroughly and then signs the client's consent form as a witness. Which basic healthcare ethic does the nurse follow in this situation? a. Justice b. Autonomy c. Beneficence d. Nonmaleficence
b. Autonomy Autonomy refers to the commitment to include clients in decisions about all aspects of care as a way of acknowledging and protecting their independence. In the given situation, the nurse ensures that the client has thoroughly understood the new treatment plan before gaining written consent. This ensures that the client is involved in the decision-making process appropriately. Justice refers to fairness. The given situation does not deal with fairness. Beneficence refers to taking positive actions to help others. This involves keeping the interests of the client before self-interest. Nonmaleficence is the avoidance of harm or hurt. Weighing the pros and cons of the new treatment plan would involve nonmaleficence.
A client who is at 20-weeks' gestation visits the prenatal clinic for the first time. Assessment reveals temperature of 98.8° F (37.1° C), pulse of 80 beats per minute, blood pressure of 128/80 mm Hg, weight of 142 lb (64.4 kg) (pre-pregnancy weight was 132 lb (59.9 kg), fetal heart rate (FHR) of 140 beats per minute, urine that is negative for protein, and fasting blood glucose level of 92 mg/dL (5.2 mmol/L). What should the nurse do after making these assessments? a. Report the findings because the client needs immediate intervention. b. Document the results because they are expected at 20-weeks' gestation. c. Record the findings in the medical record because they are not within the norm but are not critical. d. Prepare the client for an emergency admission because these findings may represent jeopardy to the client and fetus.
b. Document the results because they are expected at 20-weeks' gestation. All data presented are expected for a client at 20-weeks' gestation and should be documented. There is no need for immediate intervention or an emergency admission because all findings are expected.
A client asks a nurse for contraceptive information regarding a number of different methods available. What information should the nurse include as part of the teaching plan? a. Sperm cannot reach the ovum if the male uses coitus interruptus. b. The rim of a condom must be held in place while the penis is withdrawn from the vagina. c. Diaphragms are equally effective even if the partners choose not to use spermicidal creams. d. Individuals who use periodic abstinence should have intercourse on days when the woman has an increase in temperature.
b. The rim of a condom must be held in place while the penis is withdrawn from the vagina. Unless the condom is held firmly, it can be displaced, allowing the sperm to enter the vagina. Sperm may be deposited at the beginning of intercourse, without the man's knowledge. Spermicidal cream is needed because the diaphragm may be displaced in some positions. When the woman has an increase rise in her basal temperature, she is most fertile and should avoid intercourse.
After an uneventful 8-hour labor a client gives birth. Once the airway has been ensured and the neonate has been dried and wrapped in a blanket, the nurse places the newborn in the mother's arms. The mother asks, "Is my baby normal?" What is the best response by the nurse? a. "Most babies are normal; of course your baby is." b. "Your baby must be all right; listen to that strong cry." c. "Let's unwrap your baby so you can see for yourself." d. "Yes, because your entire pregnancy has been so normal."
c. "Let's unwrap your baby so you can see for yourself." Mothers need to explore their infants visually and tactilely to assure themselves that their infants are healthy. Telling the client that most babies are normal closes off communication with the mother at an opportune moment. A strong cry is not indicative of a healthy newborn. The "normalcy" of the mother's pregnancy is not necessarily correlated with the good health of the newborn.
A 16-year-old high school student is referred to a community health center by a local hotline because of the fear of having contracted herpes. The teenager is upset and shares this information with the community health center nurse. What should the nurse's initial response be? a. "Let me get a brief health history now." b. "Try not to worry until you know whether you have herpes." c. "You sound worried. Let me make arrangements to have you examined." d. "Herpes has received too much attention in the media; let's be realistic."
c. "You sound worried. Let me make arrangements to have you examined." Telling the client that she sounds worried and offering to arrange an examination immediately identifies the client's fear as real and offers a service to meet the need for information about the client's physical status. Obtaining the health history ignores the client's concern and focuses on the nurse's need to complete the task of obtaining a history. Telling the client not to worry minimizes the client's concern about having a sexually transmitted infection. Saying that herpes has received too much attention in the media minimizes the client's concern and implies that the client is being unrealistic.
A woman comes into the clinic and states that she is thinking about becoming pregnant. What can the woman do to improve the health of her baby before she becomes pregnant? a. Go buy maternity clothes. b. Start running 3 miles (4.8 km) a day. c. Start taking prenatal vitamins. d. Buy a crib for the baby to sleep in.
c. Start taking prenatal vitamins. Folic acid is important for the pregnant woman; a lack of folic acid can result in neural tube defects, including spina bifida. The time during fetal development when this occurs is very early in the pregnancy, when the woman may not even realize that she is pregnant. Taking prenatal vitamins with adequate folic acid can greatly reduce this birth defect. Although exercise is good for the pregnant woman and infant, it is not necessary to start running 3 miles (4.8 km) a day, especially if this is something the client has never done before. Running may not be healthy for the soon-to-be mother and infant if it is a new activity; however, if this is what the woman normally does, she will be encouraged to continue. Buying maternity clothes or a crib is not necessary at this stage, and neither of these directly affects the health of the baby.
After the client gives birth, her vital signs are temperature 99.3° F (37.4° C); pulse 80 beats/min, regular and strong; respirations 16/min, slow and even; and blood pressure 148/92 mm Hg. Which vital sign should the nurse check more frequently? a. Pulse b. Respirations c. Temperature d. Blood pressure
d. Blood pressure This blood pressure is higher than anticipated; therefore intervention may be necessary. A pulse of 80 beats/min is within expected limits. A respiratory rate of 16/min is within expected limits. The temperature of 99.3° F (37.4° C) is slightly high but consistent with the physiology of the birthing process.
A pregnant client with diabetes is referred to the dietitian in the prenatal clinic for nutritional assessment and counseling. What should the nurse emphasize when reinforcing the client's dietary program? a. The need to increase high-quality protein and decrease fats b. The need to increase carbohydrates to meet energy demands and prevent ketosis c. The need to eat a low-calorie diet that maintains the current insulin coverage and helps prevent hyperglycemia d. The need to eat a pregnancy diet that meets increased dietary needs and to adjust the insulin dosage as necessary
d. The need to eat a pregnancy diet that meets increased dietary needs and to adjust the insulin dosage as necessary Increased metabolic demands on the body during pregnancy require increased ingestion of calories; appropriate doses of insulin must be provided to permit glucose utilization by the body. The quantities of carbohydrates and fats, as well as of protein, are increased, not decreased, during pregnancy. Simply increasing carbohydrate intake is not sufficient to prevent ketosis. A low-calorie diet is contraindicated; it will not meet the demands of pregnancy on the client's body or the needs of the growing fetus.
A client at 16 weeks' gestation arrives at the prenatal clinic for a routine visit. During the examination the nurse notes bruises on the client's face and abdomen. There are no bruises on her legs and arms. Further assessment is required to confirm what? a. Domestic abuse b. Hydatidiform mole c. Excessive exercise d. Thrombocytopenic purpura
a. Domestic abuse Domestic abuse is likely to intensify during pregnancy, and attacks are usually directed toward the pregnant woman's abdomen. A hydatidiform mole manifests as an unusually enlarged uterus for gestational age accompanied by hypertension, nausea and vomiting, and vaginal bleeding, not bruises on the face and abdomen. Excessive exercise may cause cardiovascular or pulmonary problems. It will not result in bruising. Thrombocytopenic purpura and other bleeding disorders manifest as bruises and petechiae on many areas of the body's surface, not just the face and abdomen.
A pregnant woman asks the nurse when she may expect her baby to be born. She tells the nurse that her last menstrual period began on April 14. According to Nägele's rule, what is the client's expected date of birth (EDB)? a. February 1 b. January 7 c. January 21 d. February 7
c. January 21 To use Naegele's rule to calculate the EDB, subtract 3 months and add 7 days to the date of the last menstrual period. January 7 is too early. February 1 is too late, as is February 7.
A nurse explains to a nursing class that the efficiency of the basal body temperature method of contraception depends on fluctuation of the basal body temperature. Which factor can alter the effectiveness of this method? a. Stress b. Length of abstinence c. Age of those involved d. Frequency of intercourse
a. Stress Stress or infection can alter the body's metabolism, causing an elevation in temperature; a rise in temperature from these causes may be misinterpreted as ovulation. Length of abstinence may increase sperm volume, but does not affect the female's basal temperature. Age is not a factor in the efficiency of the basal body temperature method of contraception in premenopausal woman. Frequency of intercourse may affect the volume of sperm, but does not alter the female's basal temperature.
A client is visiting the prenatal clinic for the first time. While giving the nursing history the client states that her last menstrual period started on June 10. What is her expected date of birth (EDB), according to Nägele's rule? a. March 3 b. March 10 c. March 17 d. March 24
c. March 17 The date is March 17 of the following year. Using Nägele's rule, subtract 3 months from the first day of the last menstrual period and add 7 days. March 3 and March 10 are too early. March 24 is too late.
A pregnant client tells the nurse that she thinks she has developed an allergy because her nose is often very congested and she has difficulty breathing. How should the nurse reply? a. "Use a nasal decongestant at least twice a day." b. "It is common for allergies to develop during pregnancy." c. "That is not normal; you may have a chronic respiratory infection." d. "That is an expected occurrence; the increased hormones are responsible for the congestion."
d. "That is an expected occurrence; the increased hormones are responsible for the congestion." Increased estrogen and progesterone levels during pregnancy cause increased vascularization and resultant congestion of mucous membranes. Nasal decongestants are not advised during pregnancy. The pregnant client should consult her healthcare provider before using any medication. It is not common for allergies to develop during pregnancy if the client did not experience allergy symptoms before conception.
Which client care activity may a nurse safely delegate to an unlicensed health care worker? a. Assessing a client's mastectomy incision for signs of inflammation b. Assisting a client who is recovering from an abdominal hysterectomy to the bathroom c. Providing information about side effects to a client receiving chemotherapy for breast cancer d. Evaluating the effectiveness of an antiemetic that was administered to a client to relieve nausea
b. Assisting a client who is recovering from an abdominal hysterectomy to the bathroom An unlicensed health care worker is taught how to safely ambulate clients; this activity does not require extensive nursing knowledge or expert clinical judgment. Assessment, teaching, and evaluation of client responses to care all require clinical judgment and a license to practice nursing.
A 16-year-old client has a steady boyfriend with whom she is having sexual relations. She asks the nurse how she can protect herself from contracting human immunodeficiency virus (HIV). Which guidance is most appropriate for the nurse to provide? a. Ask her partner to withdraw before ejaculating. b. Make certain their relationship is monogamous. c. Insist that her partner use a condom when having sex. d. Seek counseling about various contraceptive methods.
c. Insist that her partner use a condom when having sex. A condom covers the penis and contains the semen when it is ejaculated; semen contains a high percentage of HIV in infected individuals. Preejaculatory fluid carries HIV in an infected individual, so withdrawing before ejaculation is not effective. Although a monogamous relationship is less risky than having multiple sexual partners, if one partner is HIV positive, the other person is at risk for acquiring HIV. The client is not asking about various contraceptive methods. Most contraceptives do not provide protection from HIV.
A client in labor is having an indwelling urinary catheter inserted. What should the nurse plan to do to prevent late decelerations of the fetal heart rate during this procedure? a. Position both the client's legs simultaneously. b. Urge the client to take deep breaths frequently. c. Place a rolled towel under the client's right hip. d. Loosen the transducer belts around the client's abdomen.
c. Place a rolled towel under the client's right hip. Elevating the right hip during catheter insertion displaces the uterus to the left. This action improves placental perfusion and prevents supine hypotension caused by pressure on the vena cava with its associated late fetal heart rate decelerations. Placing the feet in stirrups simultaneously helps prevent trauma to ligaments at the time of birth; it is not done when a urinary catheter is inserted. Breathing frequently is contraindicated because hyperventilation may result. Adjusting the belts around the client's abdomen does not affect the fetal heart rate.
A 47-year-old client comes to the clinic for a Papanicolaou (Pap) smear. She tells the nurse that she has been experiencing hot flashes and that her periods have been occurring at longer, less regular intervals, with a scanty flow. What does the nurse conclude is the most likely cause of these changes? a. Uterine cancer b. Lack of estrogen c. Early cervical carcinoma d. Expected menopausal changes
d. Expected menopausal changes The adaptations described, along with the client's age, suggest that the client is experiencing menopause. Irregular spotting and bleeding occur with uterine cancer and are not associated with the menstrual cycle. Estrogen is reduced, not eliminated, during and after menopause; the adrenal glands produce a small amount of estrogen throughout life. Early cervical cancer is asymptomatic; an irregular bloody vaginal discharge is a late sign of cervical cancer.
A client who menstruates regularly every 30 days asks a nurse on what day she is most likely to ovulate. Because the client's last menses started on January 1, the nurse should tell her that ovulation should occur on which day in January? a. 7 b. 16 c. 24 d. 29
b. 16 Ovulation should occur on January 16. The time between ovulation and the next menstruation is relatively constant. In a 30-day cycle the first 15 days are preovulatory, ovulation occurs on day 16, and the next 14 days are postovulatory. January 7, January 24, and January 29 all reflect inaccurate calculation of the date of ovulation.
