OB Chapter 14 - Before Conception (Exam 2)
A woman comes in for her annual gynecological examination and informs the nurse that she is going to try and become pregnant. She asks the nurse when the best time in the month is to become pregnant. What is the best response by the nurse?
"3 days before until 2 days after ovulation."
A female client is concerned about the rate of fertility because the client is older than age 35 years. The client states, "Have I given up the chance to be a parent?" Which response from the nurse is accurate?
"A woman's fertility peaks in the 20s, declines gradually until age 35, and then rapidly declines until it ends."
The nurse is teaching an adolescent client about fertility and the various phases of the menstrual cycle. The client has a 28-day menstrual cycle. Which statement is a priority for the nurse to include in the teaching?
"Day 14 of your menstrual cycle is normally when you will ovulate."
Which question would be most important for a nurse to ask a G2P1 client who has a child with sickle cell anemia?
"Did you and your partner get genetic testing?"
An obviously pregnant woman appears for her first prenatal visit. She reports a headache and generalized abdominal pain which has persisted over the past couple months. Which question should the nurse prioritize after determining the client is approximately 24 weeks' gestation, appears nervous, and is reluctant to have a full physical assessment?
"Do you feel safe at home?"
The nurse is conducting an initial history and assessment on a client at 10 weeks' gestation who is pregnant with her first child. Which question is a priority for the nurse to ask the client at this time?
"Does anyone in your or the father's family have any genetic disorders?"
A 45-year-old man has just been diagnosed with Huntington disease. He and his spouse are concerned about their four children. Based on the knowledge of patterns of inheritance, how will the nurse respond?
"Each of your children will have a 50% chance of inheriting the disease."
A woman who is planning to become pregnant comes to the clinic for a visit. During the visit, the woman tells the nurse that she is planning to use a home pregnancy test to check if she is pregnant. After teaching the woman about this type of test, the nurse determines that additional teaching is needed based on which client statement?
"I can test my urine a day or two before the date of my expected period.
The nurse is seeing a client who is going to be married in a month. This client has a history of Huntington disease in her family. The genetic testing has come back, and the client has just been told she carries the gene for Huntington disease and will develop the disease when she gets older. The client asks the nurse if this information is confidential and if it will remain that way. The nurse explains to the client that her family should be told and so should her fiancé. The client forcefully tells the nurse "no." She is not going to tell either her family or her fiancé. What is the nurse's best response?
"I will respect your wishes and keep your information confidential. I do wish you would reconsider though."
The nurse is providing teaching to an adolescent girl on the function of the female reproductive system. Which statement by the client best reflects understanding of the material presented?
"My menstrual cycle lasts about 28 days each month but varies sometimes, which is normal."
The nurse educates a client who is confused about her ovarian cycle. Which client statement would best validate her understanding of the education?
"Two hormones control my ovulation, follicle-stimulating hormone (FSH) and luteinizing hormone (LH)."
The nurse is caring for several families enrolled in Medicaid in the prenatal setting. Which statement by an expectant mother would alert the nurse to assess the family further?
"We just moved here from another state and I am still getting used to the new town."
When providing preconception care to a client, which instruction will the nurse to provide about medications during pregnancy?
"You need to talk with your health care provider about using all prescription, over-the-counter, and herbal medications."
Utilize the GTPAL system to classify a woman who is currently 18 weeks pregnant. This is her 4th pregnancy. She gave birth to one baby vaginally at 26 weeks who died, experienced a miscarriage, and has one living child who was delivered at 38 weeks gestation.
4, 1, 1, 1, 1
The nurse cares for multiple clients planning to have children. Which client will the nurse identify as priority for needing a referral for prenatal genetic testing?
A male client with family history of sickle cell disease
A client is at the clinic for her annual pelvic exam and asks the nurse about ovulation and where the eggs come from. What educational information would the nurse share with this client?
A woman is born with all the ova that she will ever have and they are stored within the ovaries.
The nurse is reviewing the structure and function of various organs in the female reproductive system. Which information should the nurse include about the ovum in the review with the client?
All the ova a female will ever have are present at birth.
A woman tells the nurse that she is going to use a home pregnancy test to determine whether she is pregnant. Which precautions should the nurse give her?
Arrange for prenatal care if the test is positive.
A client asks the nurse about cervical mucus changes that occur during the menstrual cycle. Which statement should the nurse expect to include in the client's teaching plan?
As ovulation approaches, cervical mucus is abundant and stretchable.
You see a 3-year-old girl in an ambulatory clinic because she has a bad cold. Her mother tells you the girl's problem was caused by her being affected by "mal de ojo." Which of the following would be the best action?
Ask her mother what symptoms her daughter is experiencing.
What instruction should a nurse offer to a pregnant client or a client who wishes to become pregnant to help her avoid exposure to teratogenic substances?
Avoid medications.
Which information provided by a client would be considered a presumptive sign of pregnancy?
Breast tenderness
A woman has come to the clinic for her first prenatal visit. Which method would be the most effective way for the nurse to initiate data gathering for a health history?
Conduct an interview in a private room to obtain her health history.
A young married woman says that she is planning a tubal ligation because intellectual disability runs in her husband's family and she does not want any children with this problem. Which nursing diagnosis would best apply to this couple?
Deficient knowledge of genetically inherited disorders
A group of nursing students are preparing a presentation for a health fair illustrating what happens to the body during pregnancy. Which structure will the students point out is influenced the most by hormones to prepare for conception?
Endometrium
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
A couple comes to the clinic asking questions regarding getting pregnant. The nurse explains that fertilization normally occurs in what structure of the woman's body?
Fallopian tube
An adolescent describes her menstrual pattern to the nurse. Which observation is typical of a usual menstrual pattern?
Flow usually lasts 4 to 6 days.
The nurse is assessing a 16-year-old female on a routine well-child visit. Which assessment finding will the nurse predict this healthy female will report concerning her menstrual cycles?
Flow usually lasts 4 to 6 days.
The nurse is teaching a group of women about the hormone that makes the ovum within the ovaries mature each month. Which hormone is responsible for stimulating the ovum?
Follicle-stimulating hormone
A nurse is collecting data during an admission assessment of a client who is pregnant with twins. The client has a 4-year-old child who was delivered at 38 weeks' gestation and tells the nurse that she does have a history of spontaneous abortion (miscarriage) within the first trimester. The nurse is correct to document the history as:
G = 3, T = 1, P = 0, A = 1, L = 1
A multigravida client is pregnant for the third time. Her previous two pregnancies ended in an abortion in the first and third month of pregnancy. How will the nurse classify her pregnancy history?
G3 P0020
A pregnant client arrives for her first prenatal appointment. She reports her previous pregnancy ended at 19 weeks, and she has 3-year-old twins born at 30 weeks' gestation. How will the nurse document this in her records?
G3 T0 P1 A1 L2
A pregnant woman comes to the clinic for a prenatal visit for her third pregnancy. She reveals she had a previous miscarriage at 12 weeks and her 3-year-old son was born at 32 weeks. How should the nurse document this woman's obstetric history?
G3, T0, P1, A1, L1
As part of the first prenatal visit, the nurse is assessing a pregnant woman's obstetrical history, which includes an 18-month-old daughter, born 2 days after her estimated date of birth; a 3-year-old son born at 35 weeks' gestation; and two lost pregnancies, one at 12 weeks and one at 21 weeks. How should the nurse document this history?
G5 T1 P2 A1 L2
A nurse is classifying the pregnancy history of a woman who has had five pregnancies: three full-term, one preterm, and one abortion, with four children still living. How would the nurse document this information on the client's chart using the GTPAL system?
G5 T3 P1 A1 L4
A 28-year-old client states that she has not had her menstrual period for the past 3 months and suspects she is pregnant. Which should the nurse do next?
Have the client take a pregnancy test.
A client who is trying not to get pregnant calls the nurse on Saturday at 11 a.m. reporting that she had unprotected sex on Thursday at 10 p.m. She believes she has just ovulated and wants to verify that she has no risk of pregnancy. What can the nurse tell her?
If she ovulated on Saturday around 11 a.m., the egg could be fertilized any time before about 11 a.m. on Sunday.
The clinic nurse is obtaining baseline information for the medical record which will be sent to the hospital. When asking the client about religious preference, the client says, "Why? What difference does that make?" How will the nurse respond?
It is to identify religious beliefs that may affect you or the fetus during your stay.
The nurse is reviewing the functions of the ovaries, uterus, clitoris, and vagina with a group of nursing students. What would be the best response by a nursing student about the function of the uterus?
It receives the fertilized ovum and provides housing and nourishment for a fetus.
As part of caring for childbearing families, the nurse must be able to educate families regarding which topic?
Knowledge of reproductive anatomy and physiology
Which vaccines are contraindicated during pregnancy since they may transmit a viral infection to the fetus? Select all that apply.
MEASLES, MUMPS, RUBELLA
A nurse is assessing a female client. When obtaining the client's history, the client tells the nurse that her menstrual cycle is usually 30 days and that she expects her next menstruation on March 20. Based on the client's information and the nurse's understanding of the female reproductive cycle, the nurse would identify ovulation as most likely occurring at which time?
March 6
A girl comes from a large family that you analyze as being extended. In planning hospital care for her, which factor would be most important for you to consider?
Organizing nursing care at times other than visiting hours.
The nurse is assessing a client who believes she is pregnant. The nurse points out a more definitive assessment is necessary due to which sign being considered a probable sign of pregnancy?
Positive home pregnancy test
A newly married female is talking to the nurse about her desire to get pregnant soon. Which suggestion would the nurse make to assist this client?
Sexual intercourse should occur between Day 13 and 15 of her menstrual cycle
An adolescent client asks the nurse about how the ovaries work. The nurse would include which information in her reply?
Storage of ova and maturation of them is one of the main functions of the ovaries.
A 15-year-old adolescent arrives at the office with a report of flu symptoms, including nausea and vomiting and recent weight loss. A pregnancy test is done and is positive. The client begins crying and tells the nurse her mother will be furious with her. What can the nurse do to assist this adolescent at this point?
Support her by respecting her right to privacy and confidentiality.
A recently married couple come to the prenatal clinic because they are concerned about genetic testing. The husband is of Jewish heritage. The nurse should recommend the couple undergo genetic testing to determine if the fetus has which disorder common among Ashkenazi Jews (Jews of Eastern European lineage)?
Tay-Sachs disease
Hormonal regulation of reproductive functions in both the male and the female are complicated processes. In the male, where are the sex hormones produced?
Testes
A 14-year-old you see in an ambulatory clinic is asking about menstruation. Which of the following would be an important point to teach her about menstrual health?
The average menstrual flow last 3 to 7 days.
A client is attempting to become pregnant and is using varied methods to identify ovulation. What assessment finding would most clearly suggest that the client is ovulating?
The client has clear, thin cervical mucus
The nurse is caring for a client who desires to become pregnant within a few months. Which outcome regarding folic acid intake would be appropriate for this client?
The client will begin taking 400 μg of folic acid every day.
Which statement best expresses the role of the corpus luteum?
The corpus luteum secretes progesterone to promote the preparation of the endometrium for implantation.
The student nurse cares for a child from a large extended family. Considering the child's family structure, which way might the child view the student nurse as "poor"?
The student is unmarried and lives alone.
A pregnant woman asks the nurse about using herbal remedies while she is pregnant. The nurse recommends that the woman talk with her health care provider about their use based on which understanding?
They are not rated with regard to safety during pregnancy.
The nurse is reviewing the functions of the ovaries, uterus, clitoris, and vagina with a group of nursing students. What would be the correct response by a nursing student about the function of the ovaries?
They produce female gametes or ova and secrete female sex hormones.
The nurse is explaining the phases of the uterine cycle to a client. What action during the proliferative phase of the uterine cycle should the nurse include in the teaching session with the client?
While the ovarian follicles are producing increased amounts of estrogen, the endometrium prepares for possible fertilization with pronounced growth.
You care for a woman in a prenatal clinic who thinks she might be pregnant. Which of the following assessments is a probable sign of pregnancy?
a positive pregnancy test
A client makes an appointment at the prenatal clinic because the client thinks the client might be pregnant. Which assessment would the nurse identify as a presumptive sign of pregnancy?
amenorrhea
When a woman is admitted to the labor and delivery unit, her husband says he is going to work and asks you to call when the baby is born. Your best response to this husband would be to:
ask him if he knows that he can stay with his wife during labor.
What does the genetic analysis always include?
assessment for any other potentially inherited condition
The nurse is examining a woman who came to the clinic because she thinks she is pregnant. Which data collected by the nurse are presumptive signs of her pregnancy? Select all that apply.
breast changes, amenorrhea, morning sickness
A group of nursing students are comparing male and female reproductive organs. The instructor determines the class is successful when the students correctly deduce the male glans penis is complementary to which female structure?
clitoris
The nursing instructor is preparing a class presentation covering the various hormones and their functions during pregnancy. The instructor determines the class is successful when the class correctly matches which function with hCG?
continues progesterone production by corpus luteum
Which disease process would the nurse screen for under potential genetic disorders?
cystic fibrosis
While conducting the first prenatal health history visit, the nurse learns that a pregnant client is taking various herbal remedies and over-the-counter medications for minor ailments. Which nursing diagnosis should the nurse identify as being appropriate for the client at this time?
deficient knowledge regarding exposure to teratogens during pregnancy
Which assessment finding in the pregnant woman at 12 weeks' gestation should the nurse find most concerning? The inability to:
detect fetal heart sounds with a Doppler.
When caring for a woman in her sixth month of pregnancy, she reports her plans to nurse for at least two to three years like the rest of the women in her family. Based upon your knowledge, you:
document her report but do nothing, as this is a cultural belief that should be respected.
During which stage of fetal development is exposure to teratogens most damaging?
embryonic stage
A woman is 10 weeks' pregnant and tells the nurse that this pregnancy was unplanned and she has no real family support. The nurse's most therapeutic response would be to:
encourage her to identify someone that she can talk to and share the pregnancy experience.
A school nurse who is teaching a health course at the local high school is presenting information on human development and sexuality. When talking about the role of hormones in sexual development, which hormone does the nurse teach the class is the most important for developing and maintaining the female reproductive organs?
estrogen
The nurse is conducting an annual examination on a young female who reports her last menses was 2 months ago. The client insists she is not pregnant due to a negative home pregnancy test. Which assessment should the nurse use to assess confirm the pregnancy?
fetal heartbeat
A client arrives to the clinic very excited and reporting a positive home pregnancy test. The nurse cautions that the home pregnancy test is considered a probable sign and will assess the client for which sign to confirm pregnancy?
fetal movement felt by examiner
What is a positive sign of pregnancy?
fetal movement felt by examiner
Which of the following is a positive sign of pregnancy?
fetal movement felt by the examiner
After teaching a health education class on the female reproductive cycle, the nurse determines that the teaching was effective when the group identifies which phase as belonging to the ovarian cycle?
follicular phase
A client questions the nurse about how her fetus's gender is determined. The nurse's most accurate reply would be that gender of the fetus is determined when:
gametes from the mother and gametes from the father are joined during meiosis.
When providing counseling to a couple who have just found out they will be having a daughter, the nurse will identify this chromosome abbreviation as:
genome 46xx.
A nurse is preparing a program for a group of parents of prepubertal children about the changes to expect with puberty. When describing the sequence of events that occur, the nurse would identify which hormone as initiating the cycle?
gonadotropin-releasing hormone
A pregnant woman needs an update in her immunizations. Which vaccination would the nurse ensure that the woman receives?
hepatitis B
To assess the sociocultural aspects of the family of an adolescent in an ambulatory clinic, which of the following would you ask?
his family structure
A nurse is putting together educational material for clients who desire to learn about how to get pregnant. Part of this information will explain that fertilization occurs:
in the fallopian tubes.
A nurse is caring for a pregnant adolescent client, who is in her first trimester, during a visit to the maternal child clinic. Which important area should the nurse address during assessment of the client?
knowledge of child development
A woman suspecting she is pregnant asks the nurse about which signs would confirm her pregnancy. The nurse would explain that which sign would confirm the pregnancy?
palpable fetal movement
The nurse is assessing a woman who is pregnant for the first time. Which of the following terms applies to this client?
primigravida
A nurse is preparing a teaching plan for a woman who is planning to become pregnant. Which hormone secreted by the corpus luteum would the nurse include in the discussion when describing how the endometrium is prepped for egg implantation?
progesterone
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
Which client immunization titer is most important to assess and document in the prenatal record of the pregnant woman?
rubella
After teaching a class on the female reproductive system, the nurse determines that the teaching was successful when the class identifies which action as the primary function of the ovaries?
secreting estrogen and progesterone
An adult client currently has low levels of estrogen and progesterone. At this point in the menstrual cycle, the client will likely:
shed her uterine lining.
The nurse is assessing a pregnant client's family history at the first prenatal visit. The client states that heart disease, diabetes and breast cancer are in the family and that a niece has spinal bifida. Which instruction is most important at this time?
taking a folic acid supplement
Most cultures have their own beliefs surrounding pregnancy and prenatal care of the woman. A nurse is assigned to a family that is newly immigrated and alone in the community. The client needs bed rest and help with her activities of daily living. One cultural issue that needs to be assessed is:
the role of the male partner in giving care to his wife.
In preparing for a preconception class, the nurse plans to include a discussion of potential risk factors. Which risk factor would be most important to include?
the use of OTC drugs with teratogens
A school nurse is talking to an adolescent who asks about why she has monthly menstrual cycles. The best explanation that the nurse can offer regarding the menstrual phase is to tell her that:
the uterine lining is being shed due to lowering of hormone levels.
A nurse is teaching a group of women at the local health clinic about reproduction. After describing the various internal structures involved, the nurse determines that the teaching was successful when the group identifies which structure as connecting the external structures with the cervix?
vagina
