Exam 5 OB

A parent at an educational session on sexually transmitted infections (STIs) asks the nurse if there are vaccines available to prevent STIs. How should the nurse respond?

"A vaccine has been approved to prevent the human papillomavirus."

A nurse is preparing a client for intrauterine device (IUD) insertion. Which education will the nurse provide to the client?

"Checking the strings is recommended following insertion."

A nurse is completing an informed consent on a client preparing for a tubal ligation. Which statement by the client would require the nurse to notify the health care provider?

"I will be able to have my third child in about a year from now."

A woman is going to have in vitro fertilization. When preparing her for this, the nurse would make which statement?

"It can be done with frozen donor sperm."

A couple is seeking guidance for their inability to conceive a child after trying for 15 months. They are morbidly obese but state they have friends with the same weight problem who have had no difficulty conceiving. What education can the nurse provide this couple to increase their chances of success?

"Obesity may interfere with effective penetration and deposition of sperm. We will look at several factors to discover what issues you may be encountering."

The nurse has provided information to a client about oral contraceptive pills (OCPs). Which statement by the client would indicate a need for further education?

"Some oral contraceptive pills protect against STIs."

The nurse educates a 15-year-old female client on ways to prevent pregnancy. Which statement will the nurse include in the teaching?

"The use of a condom is a method often recommended to prevent pregnancy for people your age."

A 20-year-old female comes to the sexual health clinic for follow up related to a positive test for the human papillomavirus (HPV). The client asks the nurse, "Is there anything I can do to get rid of this?" What is the nurse's best response?

"There is currently no medical treatment to cure HPV."

Pelvic infection is most commonly caused by:

*Sexual transmission* But, can also occur with invasive procedures such as: *Endometrial biopsy, surgical abortion, hysteroscopy, or insertion of an IUD*

A nurse is assigned to educate a pregnant client regarding the changes in the structures of the respiratory system taking place during pregnancy. Which conditions are associated with such changes?

-nasal and sinus stuffiness -nosebleeds -thoracic rather than abdominal breathing

A 35 week client says " I'm feeling tightening in my groin every 5 min". What should nurse say? 1. "Please lie down and drink about four full glasses of water." 2. "You are having false labor pains so you need not to worry." 3. "It is essential that you get to the hospital immediately." 4. "That is very normal for someone who is on her feet all day."

1. "Please lie down and drink about four full glasses of water."

Subfertility/infertility is said to exist when a couple has failed to achieve pregnancy after how many months of unprotected sexual intercourse?

12

In analyzing the need for health teaching in a client, G5P4004 with gestational diabetes, the nurse should ask which of the following questions? 1. "How old were you at your first pregnancy?" 2. "Do you exercise regularly?" 3. "Is your partner diabetic?" 4. "Do you work outside of the home?"

2. "Do you exercise regularly?" The likelihood of developing gestational or type 2 diabetes is reduced when clients exercise regularly.

A client is G813P4AOL6. during prenatal teaching, the nurse teaches the woman to notify Dr if. 1. Change in fetal movement 2. S/Sx of labor 3. Swelling of feet and ankles 4. Appearance of spider veins

2. S/Sx of labor

The nurse is giving a presentation about chlamydia to a group of adult women. The nurse would emphasize the need for annual screening for this infection in all sexually active women younger than which age?

25

A woman has opted to use medroxyprogesterone injections for birth control. The client receives the first injection today. The nurse instructs the woman to return to the clinic in how many months for the next injection?

3

Nagele's Rule

A method of determining the estimated date of birth (EDB): after obtaining the first day of the last menstrual period, subtract 3 months and add 7 days.

Empiric therapy

A method of treating disease based on observations and experience, rather than a knowledge of the precise cause for the disorder.

A woman uses a diaphragm for contraception. The nurse would instruct her to return to the clinic to have her diaphragm fit checked after which occurrence?

A weight gain of 10 lb (4.5 kg).

What are the risk factors for gestational diabetes? *Select all that apply.* A. Obesity, BMI > 30 B. Past GDM history C. Glycosuria D. First time pregnancy

A. Obesity, BMI > 30 B. Past GDM history C. Glycosuria Conditions such as obesity, past GDM hx, and glucose in the urine are all risk factors for GDM as well as having a strong family hx of DM, and having a prior poor obstetrical outcome (stillbirth).

A nurse is preparing for a class discussion on sexually transmitted infections (STIs) to be given at a local high school. Which would the nurse include as a discussion priority?

Adolescents and young adults are the largest age group diagnosed with an STI.

Biophysical Profile (BPP)

Assessment of five variables in the fetus that help to evaluate fetal risk: breathing movement, body movement, tone, amniotic fluid volume, and fetal heart rate reactivity.

A patient who is 34 weeks pregnant is suspected of having placental abruption. Which of the following would put this patient at risk for this condition? *Select all that apply." A. IUGR B. Cocaine use C. Abdominal trauma D. Cigarette smoking

B. Cocaine use C. Abdominal trauma D. Cigarette smoking ^ can all put a pregnant woman at risk for placental abruption as well as elevated blood pressure.

Probable signs of pregnancy (objective)

Braxton Hicks contractions (16-28 weeks) Positive Pregnancy test (4-12 weeks) Abdominal Enlargement (14 weeks) Ballottement (16-28 weeks) Goodell's Sign (5 weeks) Chadwick's Sign (6-8 weeks) Hegar's Sign (6-12 weeks)

A nurse is caring for a client in the clinic. Which sign or symptom may indicate that the client has gonorrhea?

Burning on urination.

A client has presented reporting symptoms that suggest a gonorrheal infection. After laboratory testing confirms this diagnosis, the nurse anticipates that the client will also be treated for which infection?

Chlamydia.

Clients who have had PID are prone to which complication?

Ectopic pregnancy.

A contraction stress test (CST) is commonly performed in place of a biophysical profile. T or F

FALSE

At 12 weeks gestation, the uterine fundus can be palpated at the umbilicus. T or F

FALSE

Presumptive signs of pregnancy are a positive indicator of pregnancy. T or F

FALSE

Elevated hCG levels are a positive sign of pregnancy. T or F

FALSE Elevated hCG levels can also indicate signs of an underlying health problem.

A nurse is assessing a pregnant client. The nurse understands that hormonal changes occur during pregnancy. Which hormones would the nurse most likely identify as being inhibited during the pregnancy?

FSH and LH

The school nurse is counseling a sexually active 16-year-old adolescent about the various forms of contraception. She is afraid of getting pregnant or contracting a sexually transmitted infection because her boyfriend refuses to use a condom. In answering the client's questions as to which option will be best suit her needs, which form should the nurse recommend?

Female condom.

A client in her 39th week of gestation arrives at the maternity clinic stating that earlier in her pregnancy, she experienced shortness of breath. However, for the past few days, she has been able to breathe easily, but she has also begun to experience increased urinary frequency. A nurse is assigned to perform the physical examination of the client. Which observation is most likely?

Fundal height has dropped since the last recording.

After teaching a group of students about sexually transmitted infections (STIs), the instructor determines that additional teaching is necessary when the students identify which STI as curable with treatment?

Genital herpes.

A newborn is diagnosed with ophthalmia neonatorum. The nurse understands that this newborn was exposed to which infection?

Gonorrhea.

A client with syphilis did not receive treatment and has now progressed into the tertiary stage of the disorder. Which symptoms would the nurse expect the client to exhibit?

Heart disease and inflammation of the aorta, eyes, brain, central nervous system, and skin.

A clinic nurse explains to a client who is undergoing an infertility workup that the patency of her fallopian tubes will be checked. Which test is currently used to do this?

Hysterosalpingography

A client presents with vulvar itching and diffuse green vaginal discharge. Upon evaluation, she is prescribed metronidazole. What is the paramount nursing intervention in discharge planning?

Instruct the client not to drink alcohol with this treatment.

Which statement best explains the action of the lactational amenorrhea method (LAM) of fertility control?

LAM causes suppression of the ovulation process.

The nurse is preparing a presentation for a group of adolescents and young adults about sexually transmitted infections and the use of condoms. Which information will the nurse include?

Leave space at the tip of the condom.

Which medication is the most effective treatment for trichomoniasis?

Metronidazole.

A healthy 28-year-old female client who has a sedentary lifestyle and is a chain smoker is seeking information about contraception. The nurse informs this client of the various options available and the benefits and the risks of each. Which should the nurse recognize as contraindicated in the case of this client?

Oral contraceptive pills (OCPs)

A nurse supervisor observes a nurse massage a client's injection site after giving a dose of depot medroxyprogesterone acetate (Depo-Provera). What is the priority response by the nurse supervisor?

Remind the nurse that this injection should absorb slowly.

A couple in their mid-30s are at their primary care provider's office because they have been unable to conceive for 3 years. They already have one child who is 4 years of age. The care provider explains to them that they are dealing with what kind of infertility?

Secondary infertility

A 40-year-old woman is being discharged from the walk-in health care clinic after a diagnosis of pelvic inflammatory disease (PID). Which health teaching topic should the nurse address?

Sexually transmitted infections (STIs)

A woman visits the family planning clinic to request a prescription for birth control pills. Which factor would indicate that an ovulation suppressant would not be the best contraceptive method for her?

She has a family history of thromboembolism.

Why is fertility testing initiated with sperm analysis of the male partner?

Sperm analysis is one of the easiest tests to complete.

During late pregnancy, the nurse teaches a pregnant woman to lay on her left side to avoid what condition?

Supine hypotension syndrome

A couple is considering vasectomy as a contraception option. However, the husband is nervous about how such a procedure would affect his sexual functioning. Which information should the nurse mention to the man?

The man will still have full erection capacity.

A client desires protection from unwanted pregnancies. However, the client does not enjoy sex when her partner wears a male condom. Also, the client experiences breast tenderness, headache, and nausea after taking oral contraceptive pills (OCPs). Which method would be the most likely choice for the couple to help them enhance their sexual experience as well as prevent any side effects?

Transdermal contraceptive.

The nurse is assessing a 15-year-old female who reports extreme itching in the genital area, dysuria, and foul-smelling, yellow, foamy, vaginal discharge. What would most likely be responsible for these symptoms?

Trichomoniasis.

A nurse is assessing a client diagnosed with bacterial vaginosis. What is a symptom of bacterial vaginosis?

Vaginal odor smelling of fish.

A nurse is engaged in primary prevention activities for human papillomavirus (HPV). The nurse would be most likely involved with which activity?

administering HPV vaccine.

The nurse is assessing a pregnant client at her 20-week visit. Which breast assessment should the nurse anticipate documenting?

darkened breast aerolae

The nurse should carefully screen a client who insists on using only oral contraceptive pills (OCPs) for which contraindication?

deep vein thrombosis

The nurse discusses various contraceptive methods with a client and her partner. Which method would the nurse explain as being available only by prescription?

diaphragm

Urinary frequency is a common complaint during the __________ and __________ trimesters.

first and third

Varicosities of the rectum, or ________, result from progesterone-induced vasodilation and the pressure of the enlarging uterus.

hemorrhoids

A client comes to the clinic and tells the nurse, "I think I might be pregnant." After completing the history and physical examination, the nurse obtains a blood specimen for pregnancy testing. When explaining this test to the client, which hormone will the nurse identify as being measured by this test?

human chorionic gonadotropin

A nurse is asked to teach a woman to take her basal body temperature daily to assess the time of ovulation. She can detect her day of ovulation, following ovulation, because her temperature will:

increase a degree.

A nurse who has been caring for a pregnant client understands that the client has pica and has been regularly consuming soil. For which condition should the nurse monitor the client?

iron-deficiency anemia

Food allergies are ______________ likely to develop in a breast-fed baby.

less

The nurse informs the client that a diaphragm is an example of which type of contraception?

mechanical barrier

The nurse is preparing to teach a community class to a group of first-time parents. Which information should the nurse include concerning what the pregnant woman's partner may experience as a normal response?

physical symptoms similar to the mother

The compulsive ingestion of nonfood substances is termed ________.

pica

The ____________ is a unique endocrine gland with the ability to form protein and steroid hormones.

placenta

The client at 18 weeks' gestation states, "I feel a fluttering sensation, kind of like gas." The nurse understands that the client is describing what occurrence?

quickening

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

should be applied to the abdomen, buttocks, or back.

The heat associated with saunas and hot tubs may cause fetal ___________________.

tachycardia

When teaching the client how to use a contraceptive sponge, the nurse must tell the client that leaving the sponge in place longer than 30 hours may lead to:

toxic shock syndrome.

A client is being admitted to the antepartum unit for hypovolemia secondary to hyperemesis gravidarum. Which of the following factors predisposes a client to the development of this? 1. Trophoblastic disease 2. Maternal age > 35 y/o 3. Malnourished or underweight clients 4. Low levels of hCG

1. Trophoblastic disease Trophoblastic disease is associated with hyperemesis gravidarum. Obesity and maternal age younger than 20y/o are risk factors too. High levels of estrogen and hCG have also been associated with the development.

The recommended amount of weight gain (for a person of normal weight) is 25 to ____.

35

Cell-free fetal DNA testing can be completed at: 1. 22-24 weeks 2. 30-32 weeks 3. 16-18 weeks 4. 8-9 weeks

4. 8-9 weeks

Dr needs to rule out ectopic pregnancy, which order is the most important for the nurse to do? 1. Take client's temp 2. Document the time of client's last meal 3. Obtain urine for urinalysis and culture 4. Assess for complaint of dizziness or weakness

4. Assess for complaint of dizziness or weakness

Neonates born to women infected with hepatitis B should undergo which Tx regimen 1. Hep B vaccine at birth and 1 month 2. Hep B immune globulin at birth, no hepatitis B vaccine 3. Hepatitis B immune globulin within 48 hours of birth and Hep B vaccine at 1 month 4. Hep B immune globulin within 12 hrs of birth and Hep B vaccine at birth, 1 month, and 6 months

4. Hep B immune globulin within 12 hrs of birth and Hep B vaccine at birth, 1 month, and 6 months Hep B immune globulin should be given as soon as possible after birth but within 12 hours. Neonates should at least receive hep b vaccine at regularly scheduled intervals. This sequence of care has been determined as superior to the others.

Before becoming pregnant, a woman's heart rate averaged 72 beats per minute. The woman is now 15 weeks' pregnant. The nurse would expect this woman's heart rate to be approximately:

85 beats per minute. -Explanation: During pregnancy, heart rate increases by 10 to 15 beats per minute between 14 and 20 weeks of gestation, and this elevation persists to term. Therefore, a prepregnancy heart rate of 72 would increase by 10 to 15 beats per minute to a rate of 82 to 87 beats per minute.

Which medication is used to suppress viral load of the HSV-2 infection?

Acyclovir.

Pregnant women commonly experience the emotional response of _________________ during the first trimester of pregnancy.

Ambivalence

What important assessments should be done on a patient diagnosed with Hyperemesis Gravidarum? *Select all that apply.* A. Fetal heart tones B. Electrolytes C. Intake and Output D. Maternal weight

B. Electrolytes C. Intake and Output D. Maternal weight Monitor VS, electrolytes (CMP, Mag, Phos), I&O, urine for ketones, weight, calorie counts.

A patient who is 32 weeks pregnant gets scheduled for a biophysical profile. What is this exam assessing? A. Cervical insufficiency B. Fetal size C. Maternal HTN D. Fetal well being

D. Fetal well being

Presumptive signs of pregnancy (subjective)

Fatigue (12 weeks) Breast tenderness (3-4 weeks) Nausea and vomiting (4-14 weeks) Amenorrhea (4 weeks) Urinary frequency (6-12 weeks) Hyperpigmentation of skin (16 weeks) Fetal movements (quickening) (16-20 weeks) Uterine enlargement (7-12 weeks) Breast enlargement (6 weeks)

A client is admitted in the health care facility with pelvic inflammatory disease (PID). When reviewing the client's history, what would the nurse identify as a risk factor?

Frequent douching. *Avoid douching and doucheb^gs ;)*

The _______________ method of preparing for labor involves the use of specific breathing and relaxation techniques.

Lamaze

Which stage or period of syphilis occurs when the infected person has no signs or symptoms of syphilis?

Latency.

What is the medication of choice for early syphilis?

Penicillin G benzathine

A couple who is in for fertility testing ask the nurse what tests are commonly performed to assess fertility. The nurse replies that there are only three primary tests that are used. What are these tests?

Semen analysis, ovulation monitoring, and tubal patency assessment.

A couple consults with the nurse regarding their infertility issues. The female says "I don't know what I have done so bad that God would punish me like this." What would be the most appropriate nursing diagnosis for this couple?

Spiritual distress related to inability to conceive.

Increased vaginal discharge during the first trimester is a normal finding. T or F

TRUE

Nagele's rule to determine the expected date of birth is inaccurate for women with irregular menstrual cycles. T or F

TRUE

The influence of progesterone leads to decreased peristalsis in the pregnant woman. T or F

TRUE

Positive signs of pregnancy (fetal)

Ultrasound verification of embryo or fetus (4-6 weeks) Fetal movements felt by experienced clinician (20 weeks) Auscultation of fetal heart tones via doppler (10-12 weeks)

Oxytocin, responsible for uterine contractions, is released from the ________ pituitary gland.

posterior

A woman who's 36 week preg comes into L&D with mild contractions. Which of the following complications should the nurse watch for when the client informs her that she has placenta previa? 1. Sudden ROM 2. Vaginal bleeding 3. Emesis 4. Fever

2. Vaginal bleeding Contractions may disrupt the microvascular network in the placenta of the client with placenta previa and result in bleeding. If the separation of the placenta occurs in the margin of the placenta, the blood will escape vaginally.

When is the maternal serum alpha-fetoprotein (MSAFP) screen done? A. 10-12 weeks gestation B. 15-22 weeks gestation C. 6-8 weeks gestation D. 24-28 weeks gestation

B. 15-22 weeks gestation

Which of the following statements describes a reactive nonstress test? A. No increase in fetal heart rate with fetal activity. B. No more than one fetal heart rate acceleration of 15 bpm with fetal activity during a 20min period. C. At least 2 fetal heart rate accelerations of at least 15bpm and lasting at least 15secs during a 20min period. D. Variable decelerations of at least 15bpm and lasting at least 15secs occurring with fetal activity during a 20min period.

C. At least 2 fetal heart rate accelerations of at least 15bpm and lasting at least 15secs during a 20min period.

A woman provides the nurse with the following obstetrical history: Delivered a son, now 7 y/o, at 28 wks gestation; delivered a daughter, now 5 y/o, at 39 wks gestation; had a miscarriage 3 yrs ago; and had a first-trimester abortion 2 yrs ago. She is currently pregnant. Which accurately portrays a picture of this woman's gravidity and parity? 1. G4 P2 1 2 1 2. G4 P1 2 1 2 3. G5 P1 1 2 2 4. G5 P2 2 1 1

G5 P1 1 2 2 or 5 1 1 2 2

A group of students is reviewing class material on sexually transmitted infections in preparation for a test. The students demonstrate understanding of the material when they identify which cause of condylomata?

Human papillomavirus (HPV)

A young woman is newly married and is seeking advice on contraception. She is in a monogamous relationship and would like a temporary contraceptive, as she plans to have children in the future. Her husband dislikes the feel of condoms. Also, she mentions that she typically experiences dysmenorrhea and has a history of recurrent urinary tract infections. Which method should the nurse recommend?

Oral contraceptive pills (OCPs).

A female client with an anal gonorrheal infection experiences painful bowel elimination and a purulent rectal discharge. The nurse would expect which finding once the microorganism disseminates throughout the body?

Painful joints.

A client is receiving ceftriaxone as treatment for gonorrhea. What would be most important for the nurse to emphasize to the client?

Avoid alcohol consumption.

A female client is prescribed metronidazole for the treatment of trichomoniasis. Which instruction should the nurse give the client undergoing treatment?

Avoid alcohol.

When are ALL pregnant women screened for GBS? A. 12-15 weeks B. 35-37 weeks C. 24-28 weeks D. 8-10 weeks

B. 35-37 weeks

An antenatal client is informing the nurse of her prenatal signs and symptoms. Which of the following findings would the nurse determine are presumptive signs of pregnancy? *Select all that apply.* 1. Amenorrhea. 2. Breast tenderness. 3. Quickening. 4. Frequent urination. 5. Uterine growth.

1. Amenorrhea 2. Breast tenderness 3. Quickening 4. Frequent urination

After being diagnosed with placental abruption, the patient starts to bleed from her IV sites and has increased vaginal bleeding. What life-threatening condition is the patient having? A. Disseminated intravascular coagulation(DIC) B. Shock C. Renal failure D. Congestive Heart Failure

A. Disseminated intravascular coagulation (DIC) Its presence in a pregnant patient almost invariably is evidence of an underlying obstetric disorder such as abruptio placentae, eclampsia, retention of a dead fetus, amniotic fluid embolism, placental retention, or bacterial sepsis.

A client who delivered her baby 3 months ago is seen in the clinic and tells the nurse that she and her husband have yet to resume a sexual relationship. The nurse notes that no contraception is currently being used. What is the most appropriate nursing diagnosis for this client?

Altered sexual pattern related to fear of pregnancy.

A patient who is 36 weeks pregnant with placenta previa, asks her nurse how she will deliver. What is the most appropriate response from the nurse? A. "You should call your husband to bring you to the hospital." B. "Your doctor will schedule you for a c/section, before you go into labor." C. "You will be in early labor for a long time so stay home as long as possible." D. "That will be decided once you start contracting."

B. "Your doctor will schedule you for a c/section, before you go into labor." In all cases of placenta previa, patients are scheduled for a cesarean delivery prior to the patient going into labor.

A gestational diabetic who requires insulin therapy to control her blood glucose levels telephones the triage nurse complaining of dizziness and headache. Which of the following actions should the nurse take at this time? A. Have the client proceed to the office to see her physician. B. Advise the client to drink a glass of juice and then call back. C. Instruct the client to inject herself with regular insulin. D. Tell the client immediately to telephone her medical doctor.

B. Advise the client to drink a glass of juice and then call back.

The nurse is educating a client who has been diagnosed with gestational diabetes on how to perform home blood glucose testing. Which of the following information should be included in the teaching session? A. When pricking the fingertip, always prick the center of the fingertip. B. One-hour postprandial glucose values should be 146mg/dL or lower. C. Blood glucose testing should be performed 2 times per day -- before breakfast and before bedtime. D. All blood glucose results should be kept in a log for evaluation by the nurse and primary healthcare provider.

D. All blood glucose results should be kept in a log for evaluation by the nurse and primary healthcare provider. All blood glucose results should be kept in a log for evaluation by the nurse and primary healthcare provider. If the results are off, the MD may order dietary changes or the addition of oral hypoglycemic meds.

During the first few months of pregnancy, estrogen stimulates uterine growth. T or F

TRUE

Fundal height is not a reliable indicator of gestational weeks after 36 week' gestation. T or F

TRUE

The optimal time for alpha-fetoprotein screening is 16 to 18 weeks of gestation. T or F

TRUE

A 30-year-old client would like to try using basal body temperature (BBT) as a fertility awareness method. Which instruction should the nurse provide the client?

Take temperature before rising, and record it on a chart.

A gravid client, 27 weeks of gestation, has been diagnosed with gestational diabetes. Which of the following therapies will most likely be ordered for this client? A. Oral hypoglycemic agents B. Diet control with exercise C. Regular insulin injections D. Inhaled insulin

B. Diet control with exercise About 95% of gestational diabetic clients are managed with diet and exercise alone.