OB/PEDS (Pre-Quiz) 22 & 4
A nurse is assessing the perineum of several postpartum clients using the REEDA score. The nurse initiates interventions to minimize the risk for postpartum infection for the client with which score?
9
_____ is a common cause of metritis
G. vaginalis
A nurse is working with a couple who is dealing with infertility. Which aspect would be most important for the nurse to consider?
culture
Every postpartum client has the potential of hemorrhage. While assessing a client's status, which finding would be of little benefit in identifying the possibility of hemorrhage?
signs of shock
_____ is the most common causative organism for mastitis
S. aureus
____ is the most common causative organism for urinary tract infections
E. coli
After teaching a class of pregnant women on ways to decrease the postpartum complication of thrombotic conditions, the nurse recognizes more teaching is needed when one of the participants states:
"At least I don't have to give up smoking for this one"
A woman opts to use a diaphragm for contraception. Which instruction would be most important for the nurse to provide?
"Have your diaphragm refitted if you lose 10 pounds (4.5 kilograms) or more."
A nurse is making a follow up visit to a new parent and 3-month-old infant. The nurse is talking with the client about her role as a mother and caring for her infant. Which statement by the client would lead the nurse to immediately call the health care provider?
"I am so angry with myself, I just want to give up my life right now"
A postpartum client with a history of deep vein thrombosis is being discharged on anticoagulant therapy. The nurse teaches the client about the therapy and measures to reduce her risk for bleeding. Which statement by the client indicates the need for additional teaching?
"I should brush my teeth vigorously to stimulate the gums"
A nurse is reading a journal article about premenstrual syndrome (PMS) and the millions of women affected by it during their reproductive years. The nurse would expect to find approximately what percentage of women meeting the ACOG criteria for PMS?
75%
During a routine health visit for an 11-year-old girl, her mother asks the nurse, "My daughter just got her period about 4 months ago, but they haven't been very regular so far. How long might it take until she gets regular?" Which response by the nurse would be most appropriate?
"It can take up to 2 years once she starts the periods to become regular"
A young adult woman comes to the clinic for an evaluation. During the visit, the woman tells the nurse that she suffers from painful cramps during her menses. She states, "It is worse the first couple of days and then it gets better. I take ibuprofen and it helps. Is there anything else I can do?" Which information would the nurse incorporate into the response? Select all that apply.
"Limit the amount of salty foods you eat." "Try to exercise." "Take warm showers to help relax."
After the nurse teaches a local woman's group about postpartum affective disorders, which statement by the group indicates that the teaching was successful
"Postpartum depression develops gradually, appearing within the first 6 weeks"
A couple is deciding about contraceptive measures. The male partner has decided to undergo a vasectomy. After teaching the client about this procedure, which client statement indicates the need for additional teaching?
"Right after surgery, my semen will be sperm-free"
A woman is diagnosed with primary dysmenorrhea and is prescribed ibuprofen as part of her treatment plan. When teaching the woman about using this medication, which instruction would be important for the nurse to emphasize?
"Start taking the medication when you first get your period"
Which instruction would the nurse include in the teaching plan for a postpartum woman with mastitis?
"Try applying warm compresses to your breasts to encourage the milk to be released."
The client has heard of extended-cycle oral contraceptive regimens and desires more information. The nurse explains that these regimens consist of active combination pills, followed by placebo pills. How many days of active combination pills and placebo pills are contained in these regimens?
84 active; 7 placebo
The nurse determines that a woman is experiencing postpartum hemorrhage after a vaginal birth when the blood loss is greater than which amount?
1,000 mL
A postpartum woman is being treated for hemorrhage and is to receive a blood transfusion. The nurse understands that this treatment is being instituted based on which amount of estimated blood loss?
1,500 mL
Once estimates of blood loss reach _______, transfusion of blood products should be instituted immediately.
1,500 mL to 2000 mL
The sponge provides protection for up to ____ but should not be left in place for more than 30 hours after insertion to avoid the risk of toxic shock syndrome.
12 hours
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
A client arrives in the emergency department accompanied by her husband and new 10-week-old infant, crying, confused, and with possible hallucinations. The nurse recognizes this could possibly be postpartum psychosis as it can appear within which time frame after birth?
3 months
The nurse collects a urine specimen for culture from a postpartum woman with a suspected urinary tract infection. Which organism would the nurse expect the culture to reveal?
E. coli
A client presents at the clinic and is interested in obtaining emergency contraception (EC). The nurse explains that EC must be used within 72 hours of unprotected sex to be effective. This is because:
ECs simply prevent embryo creation and uterine implantation from occurring in the first place
The client presents reporting irregular menstrual cycles, bleeding between periods, mood swings, hot flashes and vaginal tenderness. After an examination, the nurse suspects abnormal uterine bleeding. Which approach would be inappropriate?
Tell the client she will need to learn to live with the problems
A young couple is exploring their contraceptive options and are curious about using an intrauterine contraceptive device. The nurse explains that there are two types, one that uses hormones and one that uses:
copper
A nurse is teaching a couple who has chosen condoms as their means of contraception. The nurse determines that the teaching was successful when the couple makes which statements? Select all that apply.
We will use a new condom each time we have sexual intercourse.", "We'll keep the condom in its wrapper until we're ready to use it.", "The penis needs to be erect before putting on the condom."
When assessing a client with symptoms of premenstrual syndrome (PMS), the nurse uses the ACDHO tool. The nurse questions the client about which symptom when addressing the "C" in the tool?
cravings
The _____ is used to monitor the effectiveness of intravenous anticoagulant therapy, most commonly heparin
activated partial thromboplastin time
What would the nurse use to monitor the effectiveness of intravenous anticoagulant therapy for a postpartum woman with deep vein thrombosis?
activated partial thromboplastin time
A 25-year-old nulliparous client presents in active labor. She has had no prenatal care, and her coagulation status is determined. Which result would the nurse identify as placing the client at risk for postpartum hemorrhage?
activated partial thromboplastin time 60 seconds
A nurse is assessing a client and suspects that the client may be experiencing premenstrual dysphoric disorder (PMDD). Applying the American Psychiatric Association criteria, the nurse would assess which symptoms? Select all that apply
affective lability, diarrhea, sleep difficulties
The Postpartum Depression Predictor Scale (PDSS) is a self-report, 35-item Likert-type response scale divided into seven conceptual domains:
anxiety/insecurity sleep/eating disturbance emotional lability loss of self-esteem guilt/shame cognitive impairment suicidal thoughts
A 16-year-old girl is brought to the clinic by her mother because she has not had a menstrual period for the past 8 months. Which findings might alert the nurse to the possibility that anorexia nervosa may be contributing to the client's amenorrhea? Select all that apply.
bradycardia reduced subcutaneous fat hypotension
Flushing and headache are adverse effects of
carboprost
Various medications are available to help control hemorrhage in the postpartum client. When reviewing the client's history, the nurse notes she has a history of asthma. Which medication if prescribed would the nurse question?
carboprost
___ is contraindicated with asthma due to the risk of bronchial spasms
carboprost
A woman is to receive methotrexate and misoprostol to terminate a first-trimester pregnancy. When preparing the teaching plan for this client, the nurse understands that misoprostol works by:
causing uterine contractions to expel the uterine contents
Techniques used to determine fertility include the
cervical mucus ovulation method, the basal body temperature (BBT) method, the symptothermal method, standard days method, and 2-day method
A 17-year-old nulliparous client presents in active labor. It is discovered that she received no prenatal care. Which information would be important to collect first?
coagulation studies
Activated partial thromboplastin time of 60 seconds is increased and suggestive of a
coagulopathy
The public health nurse is teaching a community class of couples on fertility awareness-based methods. The nurse determines that additional teaching is needed when one of the couples states that they will be using which method?
coitus interruptus method
A nurse is conducting a class for a group of young adults at the health clinic about contraceptive options. The nurse determines that the teaching was successful when the group identifies which type as protective against sexually transmitted infections?
condom
The nurse reviews the history of a postpartum woman, G3, P3 and notes it is positive for obesity and smoking. The nurse would be especially alert for the development of signs and symptoms of which complication in this client?
deep vein thrombosis
The nurse recognizes that the postpartum period is a time of rapid changes for each client. What is believed to be the cause of postpartum affective disorders?
drop in estrogen and progesterone levels after birth
A nurse is reviewing the history and physical examination of a client diagnosed with secondary dysmenorrhea for possible associated causes. Which etiology would the nurse need to keep in mind as being the most common?
endometriosis
The nurse is assessing a couple who have come to the health care facility because they have been unable to conceive a child. When assessing the woman, the nurse would identify which factor as increasing the woman's risk for infertility?
endometriosis
The nurse is planning to speak at a local community center to a group of middle-aged women about osteoporosis. Which measure would the nurse be sure to include as effective in reducing the risk for osteoporosis?
engaging in daily weight-bearing exercises
is an implantable form contraceptive
etonogestrel
The mental health clinical nurse specialist is teaching a postpartum nurse how to use the Postpartum Depression Predictor Scale (PDSS) to assess for postpartum depression. The nurse specialist determines the need for additional teaching when the nurse identifies which component as being screened with the scale?
family and social support system
Which findings would lead the nurse to suspect that a postpartum woman has developed endometritis? Select all that apply.
foul-smelling lochia pain on both sides of the abdomen leukocytosis
A nurse is preparing for a class to teach pregnant women and their partners about postpartum complications. Which measure would be most important for the nurse to emphasize as helping to prevent postpartum infection?
handwashing
A nurse is preparing a presentation for a local community women's group about menopause. When describing the body system changes that occur, the nurse would include which changes? Select all that apply.
hot flashes increased abdominal fat decreased bone density vaginal dryness
Menopause may be associated with
hot flashes, increased abdominal fat, vaginal dryness, decreased bone density, dry, thinning skin, and increased waist size
The nurse is providing care to a client with abnormal uterine bleeding. Treatment with medications has been unsuccessful, and surgical intervention is being considered. The nurse identifies which technique as being the last resort?
hysterectomy
The nurse is conducting a review class for a group of perinatal nurses about factors that place a pregnant woman at risk for infection in the postpartum period. The nurse determines that additional teaching is needed when the group identifies which factor?
increased vaginal acidity leading to growth of bacteria
While assessing a postpartum woman, the nurse palpates a contracted uterus. Perineal inspection reveals a steady stream of bright red blood trickling out of the vagina. The woman reports mild perineal pain. She just voided 200 mL of clear yellow urine. Which condition would the nurse suspect?
lacerations
A client presents to her postpartum appointment with vague reports. The nurse suspects postpartum depression based on which assessment finding?
lack of pleasure
____ is an oral contraceptive that uses a 365-day combination dosing
levonorgestrel/ethinyl estradiol
A middle-aged woman with a history of hypertension and high cholesterol levels asks the nurse about ways to reduce her risk for heart disease as she approaches menopause. Which area would the nurse emphasize as most important?
lifestyle modification
The client is interested in using an injectable contraceptive that works by suppressing pituitary secretions. The nurse provides the client with literature and discusses which contraceptive with her?
medroxyprogesterone acetate
_____ is an injectable form of a progesterone-only contraceptive that is given every 12 weeks.
medroxyprogesterone acetate
works by suppressing ovulation and the production of FSH and LH by the pituitary gland
medroxyprogesterone acetate
_____ should not be given to a woman who is hypertensive
methylergonovine
A nurse is conducting a class for nurses working in the postpartum unit about ways to reduce the risk of postpartum infections. The nurse determines that the teaching was effective when the group identifies which preventive measure as essential?
meticulous handwashing
_____ should not be given to women with active CVD, pulmonary or hepatic disease
misoprostol
Fertility awareness refers to any _____ that does not require hormones, pharmaceutical compounds, physical barriers, or surgery to prevent pregnancy
natural contraceptive method
____ is a patch-type contraceptive
norelgestromin/ethinyl estradiol
A client is diagnosed with endometriosis. As part of the teaching plan, the nurse is explaining the condition, including the ways that the diagnosis would be confirmed. The nurse determines that the teaching was successful when the client states that which test would confirm the diagnosis?
pelvic laparoscopy
A mother presents to the clinic with her 15-year-old daughter who is reporting amenorrhea. The girl's menarche was at age 12. When conducting the health history and physical exam, which findings might the nurse identify as suggesting the underlying cause? Select all that apply.
pregnancy, extreme rapid weight gain, emotional distress, hypothyroidism
_____ is used to monitor the effectiveness of the oral anticoagulant warfarin.
prothrombin time
Methylergonovine is prescribed for a woman experiencing postpartum hemorrhage. The nurse monitors the woman closely for which adverse effects?
seizures, hypertension, uterine cramping, nausea, vomiting, and palpitations
Disseminated intravascular coagulation is a life-threatening condition that the nurse recognizes can occur as a complication secondary to which primary conditions? Select all that apply.
septicemia, severe preeclampsia, abruptio placenta
A nurse is preparing a presentation for a client who is considering contraception. When discussing oral contraceptives, the nurse would identify which advantages? Select all that apply.
shortening of the menstrual period reduction in risk for osteoporosis reduction in severe cramping
Effective nursing management involves many aspects and being aware of subtle changes in the client. Which finding should alert the nurse to a potential infection in the client?
temperature of 38 C or higher after the first 24 hours after birth
A couple has chosen fertility awareness as their method of contraception. The nurse explains that the unsafe period for them during the menstrual cycle would be at which time?
three days before and three days after ovulation
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 fundal massage is sometimes performed on a postpartum woman. The nurse would perform this procedure to address which condition?
uterine atony
