Optional Prep U Chapter Rationales:

A woman is to undergo chorionic villus sampling as part of a risk assessment for genetic disorders. What statement would the nurse include when describing this test to the woman?

"A small piece of tissue from the fetal placenta will be removed and analyzed."

A client is scheduled for a cesarean section under spinal anesthesia. After instruction is given by the anesthesiologist, the nurse determines the client has understood the instructions when the client states:

"I may end up with a severe headache from the spinal anesthesia." Cerebrospinal fluid (CSF) leakage from the needle insertion site and irritation caused by a small amount of air that enters at the injection site and shifts the pressure of the CSF causes strain on the cerebral meninges, initiating headache pain.

A nurse is teaching a client how to use a pessary. The nurse determines that the teaching was successful based on which statement?

"I need to clean the pessary with soap and water."

A nurse is conducting a class for nursing students on genetic inheritance and is focusing specifically on X-linked recessive disorders. Which statement by a nursing student would indicate appropriate learning has occurred?

"If the female is the carrier, the daughter can be too."

A nurse is educating a client on the basal body temperature method as a form of contraception. Which statement by the client indicates and understanding of when she can expect to see a rise in her temperature?

"Immediately following ovulation my temperature will increase." The basal body temperature dips immediately prior to ovulation; when ovulation occurs there will be an increase in temperature.

The nurse working in a free health clinic assess a 17-year-old client interested in contraceptives. Which statement, if said by the client, would indicate that female or male condoms would be the appropriate recommendation for this client?

"Last year I was diagnosed with HPV." The client has already contracted HPV; to prevent further spread of it—or contracting others—the nurse should recommend the client use male or female condoms.

Which statement would be most appropriate when explaining endometriosis as a cause of a woman's infertility?

"Ovulation does take place; however, the misplaced endometrial tissue interferes with transport of the ovum."

A pregnant woman recently diagnosed with the genital herpes virus asks the nurse for more information on the virus. Which responses by the nurse would be appropriate? Select all that apply.

"The virus remains quiet until a stressful event occurs to reactivate it." "Transmission is through contact of infected mucous membranes." "Infections may be transmitted by individuals unaware that they have it."

A nurse is preparing a teaching plan for a female client diagnosed with genital ulcers. Which instructions would the nurse include in this teaching plan? Select all that apply.

"Use a condom when having sexual intercourse with any noninfected partner." "Avoid having sex when any ulcers are present." "Air dry any lesions with a hair dryer on the low setting." Teaching a client with genital ulcers includes avoiding extremes of temperature such as ice packs or hot packs, using a condom with all new or uninfected sexual partners, avoiding sex during the prodromal period and when lesions are present, using lukewarm sitz baths for discomfort, and air-drying lesions with a hair dryer on the low setting.

A client would like some information about the use of a cervical cap. Which information should the nurse include in the teaching plan of this client? Select all that apply.

-Inspect the cervical cap before insertion. -Wait for 30 minutes after insertion before engaging in intercourse. -Do not use the cervical cap during menses.

An obstetrical nurse is conducting a program for pregnant women who are in their first trimester. The program focuses on the changes occurring in the woman's body as a result of the pregnancy. When describing the effect of changing hormonal levels, which information would the nurse most likely include? Select all that apply.

-Maintenance of the endometrium so that the embryo can implant -Maternal metabolic changes to make nutrients available for mother and fetus -Relaxation of the ligaments that connect the pelvic bones, allowing them to spread slightly -preparing the breasts for lactation, keeping the milk from coming in until birth occurs

When discussing the many changes the woman's body undergoes during pregnancy, the nurse may include that the woman's total blood volume will increase by approximately how much by the 30th week gestation?

1,500 mL.

The nursing student correctly identifies that ovarian cancer occurs more frequently in which age group?

55 to 75 years of age.

After finding a breast mass on a routine examination and undergoing diagnostic studies, a woman is diagnosed with a fibroadenoma. The treatment plan focuses on watchful waiting. When would the nurse instruct the client to return for reevaluation?

6 months; A client with fibroadenoma being treated with watchful waiting should return for a reevaluation in 6 months, perform monthly self-breast exams, and return annually for a clinical breast exam.

A student nurse is reviewing newborn physical measurements and asks the charge nurse if her client's weight of 2800 g and length of 51 cm falls within normal parameters. The charge nurse would respond to the student nurse in which manner?

A birth weight of 2800 g falls within the normal weight parameters for a full-term newborn. Average birth weight for a newborn is between 5 lb, 8 oz (2500 g) and 8 lb, 13 oz. (4000 g). Average length at birth for a newborn is between 19 and 21 inches (48 to 53 cm).

Which contraceptive should the nurse say is a mechanical barrier contraceptive?

A cervical cap is a mechanical barrier contraceptive that interferes with conception by physically preventing sperm from fertilizing ova.

A client has been admitted with primary syphilis. Which signs or symptoms should the nurse expect to see with this diagnosis?

A painless genital ulcer is a symptom of primary syphilis. Macules on the palms and soles after fever are indicative of secondary syphilis, as is patchy hair loss.

A nurse is preparing a client for intrauterine device (IUD) insertion. What should the nurse inform the client when educating her on IUDs?

A regular check of threads must be done. Menstrual flow may be heavier, or last longer than normal, after IUD insertion. It will not decrease. The client may feel a sharp pain when the IUD is inserted. The client may have cramps for a few days, but these should not continue.

What is the medication of choice for early syphilis?

A single dose of penicillin G benzathine intramuscular injection is the medication of choice for early syphilis or early latent syphilis of less than 1 year's duration. Clients who are allergic to penicillin are usually treated with doxycycline or tetracycline. Ceftriaxone is not the medication of choice for syphilis.

A client prescribed COC has presented for a routine visit. Which finding upon assessment should the nurse prioritize?

Abdominal pain; The warning signs to report for a client on oral contraceptives are severe abdominal or chest pain, dyspnea, headache, weakness, numbness, blurred or double vision, speech disturbances, or severe leg pain and edema.

A nurse is working at a cancer treatment center and is developing programs for specific ethnic groups related to breast cancer. The nurse would target which ethnic group because it has the highest breast cancer mortality rate in the United States?

African American

What is a disadvantage of the female condom?

Can slip into the vagina during vigorous intercourse; Reported disadvantages are that the condom may be difficult to apply, make noise, cause vaginal or penile irritation, or slip into the vagina during vigorous intercourse, a condition that decreases its effectiveness.

A nurse is monitoring a woman in labor. When interpreting the assessment findings, the nurse incorporates which information about the changes that are occurring?

Cardiac output increases by 50% during the first stage; As the woman progresses through birth, numerous physiologic responses occur that assist her to adapt to the laboring process. Some of these changes include heart rate increasing by 10 to 20 beats per minute; cardiac output increasing by 12% to 31% during the first state and by 50% by the second stage; blood pressure increases by up to 35 mm Hg; and respiratory rate increases as more oxygen is consumed.

She asks the nurse about cervical changes during ovulation. What information should the nurse give the client?

Cervix is high or deep in the vagina; The os is slightly open during ovulation. Under the influence of estrogen during ovulation, the cervical mucus is copious and slippery and can be stretched between two fingers without breaking. It becomes thick and dry after ovulation, under the influence of progesterone.

Many changes occur in the body of a pregnant woman. Some of these are changes in the integumentary system. What is one change in the integumentary system called?

Cholasma.

A pregnant client is concerned she may develop preeclampsia, so she has stopped adding any salt to her food and is now questioning the nurse about avoiding prepared foods. The nurse should point out some salt is very beneficial and can help prevent which negative outcome for her baby?

Congenital hypothyroidism.

The nurse is performing Leopold's maneuvers as part of the initial assessment. Which action would the nurse do first?

Feel for the fetal buttocks or head while palpating the abdomen.

What is the most common viral infection?

HPV infection is the most common viral infection. Millions of Americans are infected with HPV, many unaware that they carry the virus.

Interventions for HPV

Immunization regimes such as the recombinant human papillomavirus quadrivalent vaccine are for HPV prevention not cure. Cryosurgery will eliminate HPV warts but not cure it. Antibiotics will not be effective for a virus.

What is an indication of benign breast conditions?

Induced discharge.

Which nursing interventions align with the outcome of preventing maternal and fetal injury in the latent phase of the first stage of labor? Select all that apply.

Monitor maternal and fetal vital statistics every hour. Report an elevated temperature over 38 ℃ (100.4 ℉). Answer questions and encourage verbalization of fears.

For PMS what treatment options are necessary?

NSAIDS, reduction of caffeine intake and vitamin/mineral supplements.

The nurse is caring for a client who is late in her pregnancy. What assessment finding should the nurse attribute to the role of prostaglandins?

The cervix is softening.

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; The sponge provides protection for up to 12 hours but should not be left in place for more than 30 hours after insertion to avoid the risk of toxic shock syndrome.

A 30-year-old woman reports that she has not had a menstrual period for the last 4 or 5 months. Pregnancy is ruled out and she is experiencing no endocrine symptoms. What factors could be contributing to her amenorrhea? Select all that apply.

Working out at the gym 3 hours per day Hypothyroidism Endometrial adhesions

A client is using high-dose estrogen oral contraceptives. The nurse would assess the client for which finding?

Yeast infections.

A nurse is providing education to a woman about screening for breast cancer. The woman has no symptoms and no family history of breast cancer. Which recommendation would the nurse make based on the guidelines from the American Cancer Society?

annual mammogram beginning at age 40.

Papillomas and palpable mobile cysts are

are characteristics of fibroadenomas, intraductal papilloma, and mammary duct ectasia, which are benign breast conditions and are noncancerous.

The nurse is assessing a 52-year-old perimenopausal female who is concerned about the changes occurring in her body. When questioned about the most serious changes, which effect should the nurse point out?

bone mineral density decreases; As women age, the decrease in hormone levels place women at increased risk for osteoporosis. This is a potential concern which can impact life, and bone mineral density should be monitored.

The nurse has just administered morphine 2 mg IV to a laboring client. Which change in the fetal heart rate pattern would the nurse prioritize?

decreased variability

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 exercise

infertility

failure to achieve pregnancy after 1 year of unprotected intercourse.

After teaching a local woman's community group about cervical cancer, the nurse understands that teaching has been successful when the group identifies which condition as a risk factor for cervical cancer?

genital herpes.

The nurse is assessing a postpartum woman and is concerned the client may be hemorrhaging. Which assessment finding is the nurse finding most concerning?

increased heart rate; Tachycardia in the postpartum woman warrants further investigation as it can indicate postpartum hemorrhage. Typically the postpartum woman is bradycardic for the first 2 weeks. In most instances of postpartum hemorrhage, blood pressure and cardiac output remain increased because of a compensatory increase in heart rate.

The client who has a uterine prolapse has been given a pessary. When teaching the client about the use of this device, the nurse should teach the client to monitor which common side effects? Select all that apply.

increased vaginal discharge UTI vaginitis odor

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; Medroxyprogesterone acetate is an injectable form of a progesterone-only contraceptive that is given every 12 weeks. It works by suppressing ovulation and the production of FSH and LH by the pituitary gland.

A nurse is providing a client with information on hormonal contraception. Which could the nurse use as an example of hormonal contraception?

medroxyprogesterone.

Syphillis

must be reported by law.

The nurse determines the session is successful after the participates correctly choose which items will be on matching identification bracelets?

newborn's sex and date and time of birth

A female client has the Huntington's disease gene. She and her husband want to have a child but are apprehensive about possibly transmitting the disease to their newborn child. They have strong views against abortion. They would also like to have their "own" child and would consider adopting only as a last resort. Which action would be most appropriate in this situation?

opting for a preimplantation genetic diagnosis.

A nursing student is studying gynecological cancers and is excited when she reads that birth control pills can have a positive effect on preventing which disease?

ovarian cancer.

The nurse notes a newborn has a temperature of 97.4oF (36.3oC) on assessment. The nurse takes action to prevent which complication first?

respiratory distress.

A pregnant client requires administration of an epidural block for management of pain during labor. For which conditions should the nurse check the client before administering the epidural block? Select all that apply.

spinal abnormality hypovolemia coagulation defects

Cancer involves

spontaneous nipple discharge; Nipple retraction, enlarged lymph nodes, and skin dimpling are commonly associated with breast cancer.

An assessment done in the neonatal intensive care unit reveals a small-for-gestational age newborn. Which findings would the nurse connect with this gestational age variation? Select all that apply.

sunken abdomen decreased amount of breast tissue poor muscle tone

Oral contraceptive

temporary contraceptive that may also relieve dysmenorrhea.

The nurse is providing education to the parents of an infant who was just diagnosed with transposition of the great arteries. The parents ask, "Which vessels were involved?" The nurse is correct to educate about:

the aorta and pulmonary artery.

A young woman says she needs a temporary contraceptive but has a latex allergy. She mentions that she has a papillomavirus infection. Also, she says she is terrible about remembering to take pills. Which method should the nurse recommend?

transdermal contraception; The fact that this woman has a latex allergy rules out the female condom, cervical cap, and diaphragm. Moreover the diaphragm is contraindicated in her case, due to her papillomavirus infection. The best choice for her is the transdermal contraception, which involves wearing a patch for a week at a time and does not require taking pills daily.

A nurse is caring for a 25-year-old woman suspected of having follicular cysts. Which finding is not a clinical manifestation?

typically occur after menopause; typically appear in women of reproductive age.

A group of nursing students are analyzing the fetal circulation. After the session, the students correctly point out which fetal structure contains the highest concentration of oxygen?

umbilical vein.

Which finding would alert the nurse to suspect that a client has a yeast infection?

vulvar burning and itching.

A client with large uterine fibroids is scheduled to undergo a hysterectomy. Which intervention should the nurse perform as a part of the preoperative care for the client?

Teach turning, deep breathing, and coughing. The nurse should teach the client turning, deep breathing, and coughing prior to the surgery to prevent atelectasis and respiratory complications such as pneumonia. Reducing activity level and the need for pelvic rest are instructions related to discharge planning after the client has undergone a hysterectomy.

A nurse is instructing a client on birth control methods. The client asks about the cervical mucus method. When should the nurse tell the client she is fertile in relation to her mucus?

The cervical mucus method relies on the changes that occur naturally with ovulation. Before ovulation, cervical mucus is thick and does not stretch when pulled. With ovulation, the mucus becomes thin, copious, watery, transparent, and stretchy.

A young woman presents with vaginal itching and irritation of recent onset. Her labia are swollen, and she has a frothy yellowish discharge with an unpleasant smell and a pH of 6.8. She has been celibate during the last six months and has been taking antibiotics for a throat infection. Which medication is most likely to clear her symptoms?

The character of the discharge, lack of recent sexual activity, and current antibiotic treatment point to infection with Trichomonas vaginalis, which can exist asymptomatically and flare up only if conditions, such as an imbalance in normal vaginal flora resulting from antibiotic treatment, enable the protozoan to proliferate. Trichomoniasis responds well to treatment with metronidazole.

A newborn is suspected of having gastroschisis at birth. How would the nurse differentiate this problem from other congenital defects?

The intestines appear reddened and swollen and have no sac around them.

The nurse is assessing a pregnant client in her third trimester who is reporting a first-time occurrence of constipation. When asked why this is happening, what is the best response from the nurse?

The intestines are displaced by the growing fetus.

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

The medication should absorb slowly from the muscle, so the nurse supervisor should remind the nurse not to rub the injection site following administration.

Which structure is cut during a vasectomy?

The two vas deferens or ductus deferentia are ligated and cut in the male sterilization procedure, called a vasectomy.

A young woman comes to the walk-in clinic seeking treatment for chronic chlamydia trachomatis. Which finding is most likely because it often correlates with this diagnosis?

There is a common co-infection of chlamydia and gonorrhea when chlamydia is not treated with the necessary antibiotic medication combination.

A mother asks the nurse about having her son circumcised. The nurse understands that circumcision is contraindicated under which circumstances? Select all that apply.

There is a family history of hemophilia. The infant is at 33 weeks' gestation.

Copious amounts of frothy, greenish vaginal discharge would be a symptom of which infection?

Trichomoniasis; The discharge associated with infection caused by Trichomonas organisms is homogenous, greenish gray, watery, and frothy or purulent.

A client with liver disease is seen in the clinic wanting to begin contraception. The nurse recognizes that which type of contraception is best for this client?

Vaginal estrogen/progestin ring.

A 27-year-old lactating client presents with the report of a solid, painless lump in her left breast. On examination, the nurse notes that the lump is mobile and slightly tender to pressure. The nurse suspects this is:

a fibroadenoma.

A 40-year-old woman with gray, runny vaginal discharge that has a foul, fishy odor has been told that she most likely has vaginosis. What most likely contributed to her present condition?

a sharp reduction in the number of lactobacilli in the client's vaginal flora; Vaginosis is a disorder characterized by a shift in the vaginal flora from one dominated by hydrogen peroxide-producing lactobacillus to one with greatly reduced numbers of lactobacillus species and an overgrowth of other organisms.

A nurse in the sexual health clinic is assessing a male adolescent client, who is homosexual, for sexually transmitted infection (STI) risk factors. Which factor would the nurse identify as presenting the highest risk for STIs?

age of the client; Adolescents tend to think they are invincible and deny the risks of their behavior. This risky behavior exposes them to STIs. Adolescents frequently have unprotected intercourse and they engage in partnerships of limited duration. The other options are all risk factors, but just the fact he is a teenager places him more at risk for a STI as he will engage in risky sexual behaviors with a larger number of sexual partners without considering his risks.

During pregnancy, one of progesterone's actions is to allow sodium to be "wasted" or lost in the urine. The nurse would expect to see which hormone increased to help counteract this loss?

aldosterone.

The nurse is teaching a young couple, who desire to start their family, the various methods for determining fertility. After discovering the woman regulary travels internationally for work, deals with a lot of job anxiety and frequently uses an electric blanket at home, the nurse will discourage the use of which method?

basal body temperature method; BBT is a method where the body temperature should be checked first thing in the morning and recorded, immediately after waking and before getting out of bed. It is important for the patient to maintain a normal bedtime routine. Use of the electric blanket, stress, and anxiety can cause a false elevation in the BBT.

A client expresses interest in having an intrauterine device (IUD) placed for contraception. Which finding noted in the health history would indicate to the nurse that this would not be an appropriate contraceptive option?

bicornate uterus; The client has an abnormally shaped uterus, which could be a contraindication for the use of an IUD due to increased risk for uterine wall perforation.

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.

A client is being treated for gonorrhea. Which agent would the nurse expect the primary care provider to prescribe?

ceftriaxone

A client with a family history of cervical cancer is to undergo a Pap test. During the client education, what group should the nurse include as at risk for cervical cancer?

clients with genital warts.

A client is diagnosed with bacterial vaginosis and is prescribed medication therapy. The nurse would anticipate which drugs as being prescribed?

clindamycin and metronidazole.

A young woman is seen in the GYN clinic for a follow-up visit and is told that her recent Pap smear has come back abnormal. Which test can the nurse expect the primary care provider to prescribe for this client?

colposcopy.

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.

A nurse is assessing a pregnant client for the possibility of preexisting conditions that could lead to complications during pregnancy. The nurse suspects that the woman is at risk for hydramnios based on which preexisting condition?

diabetes

A client is being discharged from the gynecological unit after treatment for an acute pelvic inflammatory disease (PID). What priority instruction regarding disease management should the nurse include?

discuss the necessity of finishing the antibiotic therapy; It is the priority that the client understands the need to finish the antibiotic therapy required to treat PID in order to eradicate the offending bacterial infection.

The nursing student is preparing a presentation which will illustrate the various stages of fetal development. The student will label which stage as the time when the various tissues of the growing embryo begin to assume specific functions?

embryonic.

Which action would the nurse include in the plan of care for a client diagnosed with breast cancer who has undergone a mastectomy?

encouraging to perform arm exercises.

The nurse is providing care to a postpartum woman who has given birth vaginally to a healthy term neonate about 4 hours ago. While assessing the client, the client tells the nurse, "I've really been urinating a lot in the past hour." The nurse interprets this finding as suggestive of a decrease in which hormone?

estrogen; The endocrine system rapidly undergoes several changes after birth. Levels of circulating estrogen and progesterone drop quickly with delivery of the placenta. Decreased estrogen levels are associated with breast engorgement and with the diuresis of excess extracellular fluid accumulated during pregnancy.

The newborn nursery nurse suspects a newborn of having neonatal abstinence syndrome. What assessment findings would most correlate with the diagnosis?

frequent yawning and sneezing; Manifestations of neonatal abstinence syndrome include: CNS dysfunction such as hyperactive reflexes resulting in exaggerated Babinski and Moro reflexes; hypertonic muscle tone and constant movement; metabolic, vasomotor, and respiratory disturbances with frequent yawning and sneezing; gastrointestinal dysfunction, including poor feeding; and frantic sucking or rooting.

Screening for this most common birth defect is required by law in most states. Each nurse should know the law for his or her state and the requirements for screening. The nurse would expect a newborn to be screened for which defect as the most common?

hearing

A nurse is preparing for a presentation about breast cancer to a local women's group. Which type of breast cancer would the nurse describe as being the most common type?

invasive ductal carcinoma; By far the most common breast cancer is invasive ductal carcinoma, accounting for 85% of all cases. Invasive lobular carcinoma accounts for 10% of all cases of breast cancer. Other invasive less common types are tubular carcinoma and colloid carcinoma.

A client has been diagnosed with in situ breast carcinoma. The nurse explains that this means:

it is noninvasive and has not extended beyond the point of origin.

The nurse is preparing to assist with a pudendal block. The nurse predicts the client is at which point in the labor process?

just before birth; Pudendal block is a local block in the perineal area and is used to numb for birth. Application before labor begins or while labor is in its early stages would be counterproductive, as the client would not have proper feeling and would have a harder time pushing.

During an initial newborn assessment, the nurse recognizes certain signs need to be reported to the primary care provider as they indicate potential problems. Which signs might indicate a problem? Select all that apply.

labored breathing generalized cyanosis flaccid body posture

A 52-year-old client is seeking treatment for menopause. She is not very active and has a history of cardiac problems. Which therapy option should the nurse recognize as contraindicated for this client?

long-term hormone replacement therapy; Because the client has a history of cardiac problems, long-term hormone replacement therapy is contraindicated. This is because there is an increased risk of heart attacks and strokes. The client should instead be asked to consider options with minimized risk, such as lipid-lowering agents, or nonhormonal therapies, such as bisphosphonates and selective estrogen receptor modulators.

During the initial prenatal visit, the client reveals to the nurse that she "drinks socially." The nurse recommends the woman abstain from all alcoholic beverages because alcohol can lead to damage primarily to which fetal system?

neurological

A pregnant woman has been diagnosed with pica since she eats lead pain chips for their sweetness. The nurse educating this woman should strongly encourage her to abandon this practice because it may have which consequence to the fetus?

neurological changes.

Which occupation may expose a fetus to environmental hazards? Select all that apply.

nurse anesthetist working in a busy oral surgeon's office oncology nurse working in an outpatient chemotherapy unit nurse working for a pulmonologist who administers inhalation ribavirin routinely to the client population

A nurse is conducting an in-service program for a group of oncology nurses. The nurse explains that which nursing intervention is most important when assisting clients who are diagnosed with any form of carcinoma?

offering emotional support.

A pregnant client is complaining of a large amount of malodorous vaginal discharge that is foamy and yellow-green in color, vaginal itching and painful intercourse. When asked, she also reports that urination is somewhat painful. She is diagnosed with trichomoniasis. What treatment would the nurse anticipate the client receiving?

oral metronidazole; Trichomoniasis is caused from a protozoan infection, which can cause preterm labor, low birth weight and premature rupture of membranes. Treatment is oral metronidazole because it is more effective in treating the infection than the suppository or creams.

When the nurse is applying a skin temperature probe to a newborn who is lying on his side, which location would be most appropriate?

over the liver; To obtain accurate assessment of whole body temperature, a skin temperature probe should be placed over the liver if the newborn is supine or in the side-lying position.

A woman who is pregnant for the first time has arrived to the labor department thinking she was in labor only to be diagnosed with Braxton Hicks contractions and sent home. Prior to leaving ther unit, the woman asks, "How will I know when it is 'true' labor?" Which signs/symptoms should the woman assoicate with true labor? Select all that apply.

pain in back that wraps across the abdomen that increases in frequency and intensity pink-tinged blood and mucus mixture on underwear sudden gush of clear fluid coming from the vagina

During the fourth stage of labor, the nurse assesses the client's fundal height and tone. When completing this assessment, the nurse performs which action to prevent prolapse or inversion of the uterus?

places a gloved hand just above the symphysis pubis.

During the discharge planning for new parents, what would the case manager do to help provide the positive reinforcement and ensure multiple assessments are conducted?

provide home visits for high-risk clients.

Which description best explains the hysterosalpingogram procedure?

radiograph of the uterus and fallopian tubes following introduction of a radiopaque medium through the cervix.

The nurse is reviewing information with a client who was just diagnosed with endometrial cancer. Which treatment option should the nurse review for this diagnosis?

removal of uterus, fallopian tubes, and ovaries.

The newborn nursery nurse is admitting a large-for-gestational age infant with a fractured clavicle. What laboratory tests would the nurse expect to monitor? Select all that apply.

serum calcium total bilirubin hematocrit

In assessing the dietary intake over the last 24 hours of a pregnant client, which food would be most concerning to the nurse?

smoked salmon and bagels.

A nurse is describing the many changes a newborn will go through during his or her first couple of weeks after birth. The nurse explains how the functions of the placenta are taken over by which organ?

the liver.

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.

A nurse is caring for a woman who has just been diagnosed with uterine prolapse. Which symptoms may interfere with her daily activities? Select all that apply.

urinary frequency pelvic pressure low back pain

While conducting an interview with a 38-year-old client, the nurse recognizes which factor as putting the client at the greatest risk for endometrial cancer?

use of estrogen without progestin for hormone replacement therapy.

A postpartum woman is experiencing subinvolution. When reviewing the client's history for factors that might contribute to this condition, which factors would the nurse identify? Select all that apply.

uterine infection prolonged labor hydramnios

Chemical barrier contraceptives include:

vaginal foams and spermicidal jelly or creams.

A client in her third trimester reports sleeping poorly: sleeping on her back results in lightheadedness and dizziness and lying on her side results in no sleep. Which suggestion for sleeping should the nurse prioritize for this client?

with a pillow under her right hip.

A woman with uterine prolapse has undergone a vaginal hysterectomy and is being discharged home with an indwelling urinary catheter in place. The client will be using a leg bag during the day. Which instructions would the nurse most likely include in the client's discharge teaching plan? Select all that apply.

"Clean your perineal area each day with a mild soap and water." "Be sure to empty your leg bag frequently throughout the day."

A pregnant client reports frequent urination and tells the health care provider that she has stopped drinking water during the day since she cannot take many breaks during work. Which statement by the nurse is most appropriate at this time?

"Fluids are necessary so your blood volume can double, which is normal in pregnancy."

A nursing mother calls the nurse and is upset. She states that her newborn son just bit her when he was nursing. Upon examining the newborn's mouth, two precocious teeth are noted on the lower central portion of the gums. What would be the nurse's best response?

"Precocious teeth can occur at birth but we may need to remove them to prevent aspiration."

A client has been recently diagnosed with genital herpes and asks, "Why am I having so many recurring outbreaks of the infection?" What is the nurse's best response?

"Stress-reducing strategies may help prevent the outbreaks." Recurrent genital herpes outbreaks are triggered by precipitating factors such as emotional stress and stress-reducing exercises may help. No cure exists, but antiviral drug therapy not antibiotics helps to reduce or suppress symptoms, shedding, and recurrent episodes. Genital herpes is a recurrent, lifelong "viral" not bacterial infection.

A client is scheduled to have in vitro fertilization (IVF) in 1 week. Which statement made by the client indicates that she needs further teaching?

"The primary care provider will transfer the egg and sperm into the fallopian tube where the egg will become fertilized."

The student nurse is attending their first cesarean delivery and is asked by the mentor what should be carefully assess in this infant. After responding "Respiratory status" the student is asked "Why?" What would be the best response?

"There is more fluid present in the lungs at birth after a cesarean delivery than after a vaginal delivery."

A client has been given instructions about a scheduled sonohysterosalpingogram. Which statement, if made by the client, should indicate to a nurse that the client has an adequate understanding of the instructions?

"They will place a catheter in my uterus and use an ultrasound to see what the problem is." A nurse would recognize that this procedure is a sonographic procedure that includes the insertion of a contrast agent into the uterus and fallopian tubes. This procedure can be used as both diagnostic and therapeutic to break up adhesion within the fallopian tubes.

The nurse is teaching a female client about early-stage pelvic organ prolapse. Which statement that centers on dietary and lifestyle changes will promote pelvic relaxation and decrease chronic problems later in life?

"You will need to increase fiber in your diet."

The client is being rushed into the labor and delivery unit. At which station would the nurse document the fetus immediately prior to birth?

+4

A nurse is assigned to educate a group of women on cancer awareness. Which risk factors for breast cancer are modifiable? Select all that apply.

-postmenopausal use of estrogen and progestins -failing to breastfeed for up to a year after pregnancy -not having children until after age 30

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.

-vaginal dryness -increased abdominal fat - hot flashes -decreased bone density

A woman carries a recessive gene for sickle cell anemia. If her sexual partner also has this recessive gene, the chance that her first child will develop sickle cell anemia is:

1 in 4.

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

12 months;

A nurse is caring for a client with pelvic organ prolapse. As part of the client's workup, the nurse obtains a postvoid residual urine specimen via catheterization. Which specimen amount would lead the nurse to suspect that additional testing will be needed?

120 ML

If a delivering mother weighed 140 pounds at the time of delivery, how much weight should she have lost when she goes home 2 days later, based upon the average pattern?

17-29 pounds; Normal expected weight loss is approximately 12-14 pounds with the delivery of the fetus, placenta and amniotic fluid then an additional 5-15 pounds in the early postpartum period from fluid loss.

A nurse is counseling a couple who have a 5-year-old daughter with Down syndrome. The nurse recognizes that their daughter's genome is represented by which chromosone combination?

47XX21+

Following the birth, the nurse is responsible for assessing the cord pH. The nurse recognizes that which value would be considered a normal pH?

7.2; Umbilical cord blood acid-base analysis is considered the most reliable indication of fetal oxygenation and acid-base condition at birth. The normal mean pH value range is 7.2 to 7.3.

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; Individuals aged 15 to 24 years represent almost half of all cases of new STIs.

Transdermal contraceptives

Application of transdermal contraceptive patches to the skin would most likely be the option for this couple. These patches will not hamper the sexual experience nor cause side effects such as those caused by oral contraceptives.

The nurse is checking on a newborn who was circumcised 2 hours ago using a Plastibell. What interventions would be inappropriate for this client?

Apply petroleum gauze to the penis with each diaper change.

A client with breast cancer is scheduled to undergo chemotherapy with aromatase inhibitors. Which explanation best reflects the rationale for using this group of drugs?

Aromatase inhibitors lower the level of estrogen in the body, thereby interfering with the ability of hormone-sensitive tumors to use estrogen for growth.

A client has just had an epidural placed. Before the procedure, her vital signs were as follows: BP 120/70, P90 bmp, R18 per min, and O2 sat 98%. Now, 3 minutes after the procedure, the client says she feels lightheaded and nauseous. Her vital signs are BP 80/40, P100 bmp, R20 per min, and O2 sat 96%. Which interventions should the nurse perform?

Assist the client to semi-Fowler's position, assess the fetal heart rate, start an IV bolus of 500 mL, and administer oxygen via face mask.

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

Avoid alcohol; The nurse should counsel the client taking metronidazole to avoid alcohol during the treatment because mixing the two causes severe nausea and vomiting.

A full-term infant with spontaneous respiration at birth begins exhibiting signs of respiratory distress syndrome (RDS) at 22 hours of age. Which condition would the nurse assess for in this infant?

B-hemolytic, group B streptococcal infection

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

Bacterial vaginosis causes a "stale fish" vaginal odor.

The parents are concerned their newborn appears to be cold all the time. The nurse should point out the infant is best helped by which primary method in the first few days?

Brown fat store usage

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

Burning on urination; may be a sign of gonorrhea or a urinary tract infection.

A nurse is teaching a female client who is unable to conceive how to monitor her basal body temperature. Which instruction would the nurse prioritize for this client?

Chart body temperature for at least a month; The nurse should instruct the client to record her temperature each morning immediately upon awakening (at rest) using the same thermometer. The nurse should also instruct the client to record her menses, any events that would alter her temperature (e.g., infections, insomnia), and when she has intercourse. To maintain a basal body temperature chart, the client has to monitor her basal body temperature for several months. It is not necessary to record body weight along with the temperature.

The nurse is preparing a presentation for a local community group about sexually transmitted infections (STIs). Which most common STI in the United States would the nurse expect to include?

Chlamydia is the most common and fastest-spreading bacterial STI in the United States, with 2.8 million new cases occurring each year. Gonorrhea is the second most frequently reported communicable disease in the U.S. The incidence of syphilis had been increasing for the past 6 years. One in five people older than age 12 is infected with the virus that causes genital herpes.

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

Currently three intrauterine contraceptives are available in the United States: the copper ParaGard-TCu-380A, the levonorgestrel-releasing intrauterine system (LNG-IUS) marketed as Mirena, and another LNG-IUD marketed as Skyla. The ParaGard-TCu-380A is approved for 10 years of use and is nonhormonal. Its mechanism of action is based on the release of copper ions, which alone are spermicidal. Additionally, the device causes an inflammatory action leading to a hostile uterine environment.

The nursing instructor is presenting a class on the various classifications of twins. The instructor determines the session is successful after the students correctly choose which classification that indicates twins have separate amniotic sacs and placentas?

Diamniotic-dichorionic.

Which nursing action is applied throughout all stages of labor?

Do not allow the client to lay flat on her back for long periods.

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; E. coli is the most common causative organism for urinary tract infections. S. aureus is the most common causative organism for mastitis. G. vaginalis is a common cause of metritis. K. pneumoniae is a common cause of metritis, but some species of Klebsiella may cause urinary tract infections.

The nurse is monitoring a client who is in the second stage of labor, at 2+ station, and anticipating birth within the hour. The client is now reporting the epidural has stopped working and is begging for something for pain. Which action should the nurse prioritize?

Encourage her through the contractions, explaining why she cannot receive any pain medication.

A client is exhibiting signs of engorgement, but her milk is still flowing easily. Which suggestion should the nurse prioritize?

Ensure the baby empties the breasts at each feeding.

From which pair of metabolic disorders must the nurse instruct the parents to eliminate breast and cow's milk from the diet?

Galactosemia and phenylketonuria.

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

Gonorrhea can be transmitted to the newborn in the form of ophthalmia neonatorum during birth by direct contact with gonococcal organisms in the cervix.

A nurse is evaluating a female client's risk for cervical cancer and reviewing the client's history. The nurse would be especially alert if the client reported which infection?

HPV.

Which laboratory test results would the nurse consider as a normal finding in a newborn soon after birth?

Hemoglobin typically ranges from 17 to 20 g/dL. White blood cells are initially elevated soon after birth as a result of birth trauma, typically ranging from 10,000 to 30,000/mm3. The newborn's platelet count is the same as that for an adult, ranging between 100,000 and 300,000/uL. After birth, the red blood cell count gradually increases as the cell size decreases. Normal count ranges from 5,100,000 to 5,800,000/uL.

The mother of four small children comes to the clinic and has just been diagnosed with an enterocele. What should the nurse teach the client about her diagnosis?

Her small intestine and peritoneum are jutting downward between the uterus and the rectum.

The nurse explains to the parents of a 2-day-old newborn that decreased life span of neonatal red blood cells has contributed to which complication?

Hyperbilirubinemia; Neonatal red blood cells have a life span of 80 to 100 days and normally have a higher count at birth. This combination leads to an increased hemolysis. Complications of this process include hyperbilirubinemia.

Condom use

If external lubricants are used, use only water-based lubricants with latex condoms. Oil-based or petroleum-based lubricants, such as body lotion, massage oil, or cooking oil, can weaken latex condoms. Latex condoms are the best protection from STIs. Condoms are applied before any genital contact because sperm is present in preejactulate fluid. Condoms also should be stored in a cool, dry place away from direct sunlight to prevent deterioration.

The primary care provider suspects inflammatory breast cancer. For which symptom of inflammatory breast cancer should the nurse assess?

Increased warmth of the breast; Skin edema, redness, and warmth of the breast are symptoms of inflammatory breast cancer.

What measures can a nurse take to reduce the risk of hypoglycemia in a newborn? Select all that apply.

Initiate early and frequent breast-feeding. Dry the newborn off immediately after birth to prevent chilling. Begin kangaroo care for the newborn.

What is the best description of dyspareunia that the nurse can share with the nursing student?

Intercourse may become painful (dyspareunia) as the vaginal mucosal wall becomes thinner and vaginal secretions decrease.

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

Latency; A period of latency occurs when the infected person has no signs or symptoms of syphilis. Secondary syphilis occurs when the hematogenous spread of organisms from the original chancre leads to generalized infection. Primary syphilis occurs 2 to 3 weeks after initial inoculation with the organism. Tertiary syphilis presents as a slowly progressive inflammatory disease with the potential to affect multiple organs.

gonadotropin-releasing hormone antagonists:

Leuprolide, nafarelin, and goserelin.

A nurse is meeting with a group of pregnant clients who are in their last trimester to teach them the signs that may indicate they are going into labor. The nurse determines the session is successful after the clients correctly choose which signs as an indication of starting labor? Select all that apply.

Lightening, backache, bloody show.

A nurse is providing care to a client with uterine fibroids who is prescribed a progestin antagonist. Which medication would the nurse most likely expect the client to receive?

Mifepristone is a progestin antagonist used to treat uterine fibroids.

A nurse is provding care to a pregnant woman in her first trimester who has come to the clinic for a follow up visit. During the visit, the nurse teaches the woman about some of the changes that she will be experiencing during her pregnancy. Which information would the nurse include when describing changes in the breast?

Montgomery's tuburcles become prominent.

A female client with genital herpes is prescribed acyclovir as treatment. After teaching the client about this treatment, which statement by the client indicates effective teaching?

No cure exists, but antiviral drug therapy helps to reduce or suppress symptoms, shedding, and recurrent episodes. Advances in treatment with acyclovir 400 mg orally three times daily for 7 to 10 days, famciclovir 250 mg orally three times daily for 7 to 10 days, or valacyclovir 1 g orally twice daily for 7 to 10 days have resulted in an improved quality of life for those infected with HSV. However, according to the CDC, these drugs neither eradicate latent virus nor affect the risk, frequency, or severity of recurrences after the drug is discontinued.

A nurse is teaching a woman how to use the basal body temperature method of contraception. the nurse determines that the teaching was successful when the woman identifies that she should refrain from having sexual intercourse at which time?

Ovulation occurs after a slight drop in temperature followed by an increase. The ovum has a life span of 3 days. As soon as a woman notices a slight dip in temperature followed by an increase, she knows she has ovulated. She refrains from having coitus (sexual relations) for the next 3 days (the possible life of the discharged ovum).

A nurse is educating a 25-year-old client with a family history of cervical cancer. Which test should the nurse inform the client about to detect cervical cancer at an early stage?

Papanicolaou test.

Which nursing suggestions are options for the client experiencing intense pain in the active phase of labor? Select all that apply.

Patterned breathing Hypnosis Pain medication Massage Acupressure

The nurse is assessing a newborn by auscultating the heart and lungs. Which natural phenomenon will the nurse explain to the parents is happening in the cardiovascular system?

Pressure changes occur and result in closure of the ductus arteriosus.

A client is scheduled to start taking tadalafil for erectile dysfunction. A nurse should teach the client to observe for side effects and notify a health care provider immediately if what occurs?

Priapism; (erection lasting longer than 4 hours) is a side effect of tadalafil that warrants notifying a health care provider immediately.

A nurse is caring for a newborn with transient tachypnea. What nursing interventions should the nurse perform while providing supportive care to the newborn? Select all that apply.

Provide oxygen supplementation. Ensure the newborn's warmth. Observe respiratory status frequently.

An 18-year-old client has given birth in the 28th week of gestation, and her newborn is showing signs of respiratory distress syndrome (RDS). Which statement is true for a newborn with RDS?

RDS is caused by a lack of alveolar surfactant.

A nurse should instruct a client who has premenstrual syndrome (PMS) to make which of these lifestyle modifications?

Reduce caffeine, walk several times a week, use relaxation techniques, and maintain a regular sleep schedule.

A nurse is caring for a 32-year-old client for whom pessary usage is recommended for uterine prolapse. Which instruction should the nurse include in the teaching plan for the client concerning the pessary?

Report any discomfort with urination and defecation.

A client with abnormal uterine bleeding is diagnosed with small ovarian cysts. The nurse has to educate the client on the importance of routine check-ups. Which assessment is most appropriate for this client's condition?

Schedule an ultrasound every 3 to 6 months.

A client in her third trimester of pregnancy wishes to formula feed her baby. What instruction should the nurse provide?

Serve the formula at room temperature.

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 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; The estrogen content of birth control pills may lead to increased blood clotting, leading to an increased incidence of thromboembolism. Women who already are prone to this should not increase their risk further.

Which information would the nurse emphasize in the teaching plan for a postpartal woman who is reluctant to begin taking warm sitz baths?

Sitz baths increase the blood supply to the perineal area.

A nurse is providing discharge teaching to a client who needs Kegel exercises to strengthen the pelvic floor muscles. Which guideline would be appropriate to teach the client?

Squeeze the muscles in your rectum as when you are trying to prevent passing flatus.

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." Diaphragms should be refitted after pregnancy, abdominal or pelvic surgery, or weight loss or gain of 10 pounds (4.5 kilograms) or more. A diaphragm usually is replaced every 1 to 2 years. A diaphragm should remain in place for at least 6 hours after intercourse. A contraceptive sponge, not a diaphragm, should be wetted with water before insertion.

A client who has had a mastectomy is to undergo breast reconstruction with augmentation. After teaching the client about the procedure, the nurse determines that the teaching was successful based on which client statement?

"I'll use the same technique for breast self-exam as before."

A pregnant client who is planning to have genetic testing asks the nurse when she should schedule her amniocentesis. What should the nurse tell the client?

16 weeks.

Cervical cancer

Clinical studies have confirmed that HPV is the cause of essentially all cases of cervical cancer, which is the fourth most common cancer in women in the United States. Up to 95% of cervical squamous cell carcinomas and nearly all preinvasive cervical neoplasms are caused by the HPV.

A client is to take clomiphene citrate for infertility. Which outcome should the nurse explain is the expected action of this medication?

Clomiphene citrate stimulates the release of FSH and LH which is responsible for the maturity and release of ovum from the ovary.

At which time in a client's labor process would the nurse encourage effleurage?

During the early labor phase.

Which laboratory result would be most important for a nurse to monitor for a client who has recently started letrozole?

FSH.

All options are characteristics of malignant breast disease except:

Malignant breast disease is generally characterized by immobile, fixed lumps that may cause skin dimpling and nipple retraction. They are generally painless and not tender. They usually are not smooth and have poorly delineated edges.

The following are nursing measures commonly offered to women in labor. Which nursing intervention probably would be most effective in applying the gate-control theory for relief of labor pain?

Massage the woman's back.

A 24-year-old woman has presented to an inner city free clinic because of the copious, foul vaginal discharge that she has had in recent days. Microscopy has confirmed the presence of Trichomonas vaginalis. What is the woman's most likely treatment and prognosis?

Oral antibiotics can prevent complications such as infertility and pelvic inflammatory disease.

Stages of uterine prolapse

The extent of uterine prolapse is classified in terms of stages: stage 0: no descent of pelvic structure during straining; stage I: prolapsed descending organ is >1 cm above the hymenal ring; stage II: the prolapsed organ extends approximately 1 cm below the hymenal ring; stage III: prolapse extends to 2 cm to 3 cm below the hymenal ring; and stage IV: vagina is completely everted or prolapsed organ is >3 cm below the hymenal ring.

What physiologic changes occur after birth when the cord is cut and clamped?

The infant takes its first breath and the lungs expand to increase blood oxygen levels.

An instructor is teaching a group of students about the incidence of sexually transmitted infections (STIs) and those that must be reported by law. The instructor determines that the students have understood the information when they state that which STI must be reported?

The law mandates reporting of syphilis, chlamydia, gonorrhea, chancroid, and HIV/AIDS. Genital herpes, hepatitis B, venereal warts (condylomata acuminata), granuloma inguinale, and lymphoma venereum are not reportable by law.

Which medication is the most effective treatment for trichomoniasis?

The most effective treatment for trichomoniasis is metronidazole and tinidazole.

While monitoring the EFM tracing the nurse notes decelerations with each contraction. The nurse knows that for a deceleration to be classified as early it has to meet three criteria. What is one of these criteria?

The nadir of the deceleration coincides with the acme of the contraction.

The nurse is preparing a teaching session for a client considering tubal ligation. Which factor should the nurse prioritize in this session?

The procedure is considered permanent and irreversible. This is a procedure not for routine birth control but for permanent birth control. If the women elects for this procedure, it can be done immediately following the birth of the child, lessening the inconvenience or hospitalization of the client. The procedure is not painless, nor easy. A consent form from the partner is not always required.

A pregnant client has been diagnosed with gonorrhea. Which nursing interventions should be performed to prevent gonococcal ophthalmia neonatorum in the baby?

To prevent gonococcal ophthalmia neonatorum in the baby, the nurse should instill a prophylactic agent in the eyes of the newborn. Cephalosporins are administered to the mother during pregnancy to treat gonorrhea but not to prevent infection in the newborn. Performing a cesarean birth will not prevent gonococcal ophthalmia neonatorum in the newborn.

As the nurse examines the birth records, which newborn would the nurse expect to monitor closely for respiratory distress syndrome (RDS)?

a term male newborn, born by a repeat cesarean birth, whose mother has diabetes mellitus.

A nurse is assisting with the pelvic exam of a woman who has come to the clinic with reports of abnormal vaginal bleeding. The client is diagnosed with an endocervical polyp. The nurse understands that the pelvic exam most likely revealed a polyp appearing as:

cherry-red; Most endocervical polyps are cherry red; most cervical polyps are grayish-white.

A woman calls the prenatal clinic and says that she thinks she might be in labor. She shares her symptoms over the phone with the nurse and asks what to do. The nurse determines that she is likely in true labor and that she should head to the hospital. Which symptom is an indicator of true labor?

contractions beginning in the back and sweeping forward across the abdomen.

A nurse assesses and suspects vulvar cancer based on which assessment finding?

fleshy, ulcerated mass on the labia majora.

Diaphragm

is an example of a mechanical barrier. It is a circular rubber disk placed over the cervix before intercourse.

A woman dilated to 10 centimeters and feeling the urge to "have a bowel movement" is refusing to push and is screaming, "It hurts down there too much to push." What option should the nurse suggest at this point for pain management to facilitate pushing?

pudendal block.

Which finding would the nurse expect when assessing the breasts of a client with fibrocystic breast disease?

soft mass; The characteristic breast mass of fibrocystic disease is soft to firm, movable, and unlikely to cause nipple retraction.

The nurse is assessing a pregnant woman on a routine prenatal visit. Which breast assessment finding will the nurse document as a normal and expected finding?

tingling sensations and tenderness.

During an assessment, the nurse notes that the client has been unable to urinate properly since she gave birth and is still bleeding more than expected. The nurse suspects which condition?

uterine atony; Urinary retention is a major cause of uterine atony, which allows excessive bleeding. Urinary retention and bladder distention can cause displacement of the uterus from the midline to the right and can inhibit the uterus from contracting properly, which increases the risk of postpartum hemorrhage. The client will have increased diaphoresis as the body works to decrease the blood volume that was necessary during the pregnancy.

A client who had a vaginal birth 2 days ago asks the nurse when she will be able to breathe normally again. Which response by the nurse is accurate?

"Within 1 to 3 weeks, your diaphragm should return to normal, and your breathing will feel like it did before your pregnancy."

A couple comes to the clinic and states to the nurse, "I don't think we are ever going to be able to have children. We have been trying but have had no luck." What assessments does the nurse anticipate will be performed for this couple? Select all that apply.

-ovulation monitoring -semen analysis -tubal patency

At her 16-week checkup, a client's blood pressure is slightly decreased from her prepregnancy level. The nurse evaluates this change based on which statements concerning blood pressure during pregnancy?

A decrease in the second trimester may occur because of placental growth.

A group of nursing students are preparing a presentation depicting the fetal circulation. The instructor determines the presentation is successful when the students correctly illustrate which route for the ductus arteriosus?

The pulmonary artery to the aorta.

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?

They can be assured vasectomy does not interfere with the production of sperm; the testes continue to produce sperm as always, but the sperm simply do not pass beyond the plugged vas deferens and are absorbed at that point. The man will still have full erection capacity and continue to produce testosterone. Because he also continues to form seminal fluid, he will ejaculate seminal fluid; it will just not contain sperm.

A 45-year-old client and her spouse are present in the clinic. Results of fertility testing indicate that the client has damage to her fallopian tubes. Which would be the most appropriate infertility option for this client?

This client has damage to her fallopian tubes, so any procedure would need to bypass this structure. In vitro fertilization fertilizes an ovum and then inserts it into a women's uterus.

During a follow-up visit, a female client who underwent a mastectomy asks the nurse if she can work in her backyard or at least do some household work. Which suggestion would be most appropriate?

Wear gloves and protective clothing to avoid any injuries. The nurse should recommend that the client wear gloves when doing backyard work or housework to prevent injuries that may heal slowly or become infected.

A woman is 40 years old and a heavy smoker. She has a single sexual partner but has very irregular menstrual cycles. She wants a highly reliable contraceptive. Which method would be the best recommendation?

a diaphragm and spermicide; Women over 40 who smoke should not take ovulation suppressants; irregular menstrual cycles make natural methods difficult; women over 40 may have vaginal dryness, so a spermicidal suppository would not be activated.

The nurse is concerned that a client is not obtaining enough folic acid. Which test would the nurse anticipate being used to evaluate the fetus for potential neural tube defects?

alpha-fetoprotein test

While obtaining the history, a client reports that her mother was treated with diethylstilbestrol (DES) during her pregnancy. The nurse determines that this client is at risk for which cancer?

cervical cancer.

A nurse is caring for a woman who has just been diagnosed with cancer (CIS) of the cervix. The nurse should prepare the women for which treatment?

cervical conization with follow-up Pap smears and colposcopy.

A 67-year-old Caucasian female comes into the clinic and reports to the nurse that she has started her periods again after 15 years of menopause. After discussing the situation with her, the nurse recognizes that her symptoms are suspicious for:

endometrial cancer.

A client has moved into the active phase of labor and is now at 6 cm dilated and +1 station. The nurse is prepared to monitor the contraction pattern how often?

every 30 mins; Active labor is a phase in the first stage of labor when the cervix dilates from 4 to 8 cm. The contractions are progressing and occur every 2 to 5 minutes and last 45 to 60 seconds. The nurse needs to evaluate the labor pattern every 30 minutes. During the latent phase of the first stage, the labor pattern should be evaluated every hour. During the transition phase of the first stage, the contraction pattern should also be evaluated every 30 minutes. During the second stage of labor, the contraction pattern should be evaluated every 15 minutes.

A nurse is caring for a client who has just received an episiotomy. The nurse observes that the laceration extends through the perineal area and continues through the anterior rectal wall. How does the nurse classify the laceration?

fourth degree; The nurse should classify the laceration as fourth degree because it continues through the anterior rectal wall. First-degree laceration involves only skin and superficial structures above muscle; second-degree laceration extends through perineal muscles; and third-degree laceration extends through the anal sphincter muscle but not through the anterior rectal wall.

The nurse is creating an educational pamphlet for pregnant mothers. Which is the best description of fetal development for the nurse to emphasize?

gestational age, length, weight, and systems developed.

A client has been admitted with abruptio placentae. She has lost 1,200 mL of blood, is normotensive, and ultrasound indicates approximately 30% separation. The nurse documents this as which classification of abruptio placentae?

grade 2; The classifications for abruptio placentae are: grade 1 (mild) - minimal bleeding (less than 500 mL), 10% to 20% separation, tender uterus, no coagulopathy, signs of shock or fetal distress; grade 2 (moderate) - moderate bleeding (1,000 to 1,500 mL), 20% to 50% separation, continuous abdominal pain, mild shock, normal maternal blood pressure, maternal tachycardia; grade 3 (severe) - absent to moderate bleeding (more than 1,500 mL), more than 50% separation, profound shock, dark vaginal bleeding, agonizing abdominal pain, decreased blood pressure, significant tachycardia, and development of disseminated intravascular coagulopathy. There is no grade 4.

A client who is in her sixth week of gestation is being seen for a routine prenatal care visit. The client asks the nurse about changes in her eating habits that she should make during her pregnancy. The client informs the nurse that she is a vegetarian. The nurse knows that she has to monitor the client for which risks arising from her vegetarian diet? Select all that apply.

iron-deficiency anemia decreased mineral absorption low gestational weight gain

The nurse is caring for a client who is sent to the obstetric unit for evaluation of fetal well-being. At which location is the nurse correct to place the tocodynamometer?

on the uterine fundus.

The nurse working in the genitourinary clinic understands that the most common cause for women suffering from urinary incontinence is:

pelvic organ prolapse.

A woman who has a history of cocaine abuse gives birth to a newborn. Which findings would the nurse expect to assess in the newborn? Select all that apply.

piercing cry poor sucking inconsolable

A young couple have presented to the office with concerns of possible infertility. A physical examination and complete history of the woman reveals type 2 diabetes mellitus, obesity, sleep apnea, and hypertension. The nurse would suspect:

polycystic ovary syndrome; Polycystic ovary syndrome (PCOS) involves the presence of multiple inactive follicle cysts within the ovary that interfere with ovarian function. It is the most common cause of medically treatable infertility and is responsible for 70% of cases of anovulatory subfertility and up to 20% of couples' infertility cases.

A client diagnosed with uterine prolapse is to undergo surgery. The nurse would prepare a preoperative teaching plan for which surgery?

vaginal hysterectomy

A client is suspected of having herpes simplex viral infection. The nurse would expect to prepare the client for which diagnostic test to confirm the infection?

viral culture of vesicular fluid; Diagnosis of HSV is often based on clinical signs and symptoms and is confirmed by viral culture of fluid from the vesicles. The IgG/IgM antibody testing is frequently done for screening purposes.

A nurse is teaching personal hygiene care techniques to a client with genital herpes. Which statement by the client indicates the teaching has been effective?

"I will wear loose cotton underwear." Wearing loose cotton underwear promotes drying and helps avoid irritation of the lesions. The use of lubricants is contraindicated because they can prolong healing time and increase the risk of secondary infection. Lesions should not be rubbed or scratched because of the risk of tissue damage and additional infection. Cool, wet compresses can be used to soothe the itch.

A nurse is working with a community group to foster early detection of breast cancer. Which components would the group address? Select all that apply.

-breast self-examination -clinical breast examination -mammography

The nurse educator describes the key changes that happen to the newborn's heart and lungs at birth. Which information would the nurse likely include? Select all that apply.

-With the newborn's first breaths, the lungs inflate, increasing blood flow to the lungs. -The foramen ovale closes within 1 to 2 hours after birth and permanently by 6 months. -The ductus venosus closes with the clamping of the umbilical cord. -The ductus arteriosus closes in response to the increase in oxygen levels with the first breaths.

During a prenatal visit a pregnant client asks the nurse how to tell whether the contractions she is having are true contractions or Braxton Hicks contractions. Which description should the nurse mention as characteristic of true contractions?

-begin irregularly but become regular and predictable -felt first in lower back and sweep around to the abdomen in a wave -increase in duration, frequency, and intensity

A nurse is assisting with a pelvic exam on a client who is suspected of having trichomoniasis. Which findings would the nurse note as helping to confirm this diagnosis? Select all that apply.

-cervical bleeding when touched -cervical petechiae -vaginal erythema

The nurse correctly recognizes that which clients are likely not candidates for corrective surgery for pelvic organ prolapse? Select all that apply.

-client at high risk of recurrent prolapse after surgery -client who is morbidly obese before surgery -client who has chronic obstructive pulmonary disease

What would the nurse suspect as a cause of meconium aspiration syndrome (MAS) after reviewing the maternal history of a client whose newborn is diagnosed with MAS?

Maternal hypertension; The nurse would review prenatal and birth records to identify newborns that may be at high risk for meconium aspiration. Predisposing factors for meconium aspiration syndrome include maternal drug abuse, maternal hypertension or diabetes; oligohydramnios; fetal growth restriction; prolapsed cord; or acute or chronic placental insufficiency.

A female client with metastatic breast disease is receiving trastuzumab as part of her immunotherapy. The client has nausea, fatigue, diarrhea, appears jaundice, and has a distended abdomen. What would the nurse do next?

Notify the HCP; Adverse effects of trastuzumab include cardiac toxicity, vascular thrombosis, hepatic failure, fever, chills, nausea, vomiting, and pain with first infusion. The nurse should monitor for these adverse effects with the first infusion of trastuzumab. The nurse would notify the health care provider since the client is showing signs of hepatic failure.

A female client is diagnosed with breast abscess. Although she has been allowed to breastfeed her newborn, she decides to terminate breastfeeding. Which action would be most appropriate in this situation?

Assist the client to pump the breasts to remove breast milk.