RNSG 1538

A client in her first trimester arrives at the emergency room with reports of severe cramping and vaginal spotting. On examination, the health care provider informs her that no fetal heart sounds are evident and orders a dilatation and curettage (D&C). The client looks frightened and confused and states that she does not believe in induced abortion (medical abortion). Which statement by the nurse is best?

"Unfortunately, the pregnancy is already lost. The procedure is to clear the uterus to prevent further complications." Explanation: The nurse should not inform the client what she must do but supply information about what has happened and teach the client about the treatments that are used to correct the situation. A threatened spontaneous abortion (miscarriage) becomes an imminent (inevitable) miscarriage if uterine contractions and cervical dilation (dilatation) occur. A woman who reports cramping or uterine contractions is asked to seek medical attention. If no fetal heart sounds are detected and an ultrasound reveals an empty uterus or nonviable fetus, her health care provider may perform a dilatation and curettage (D&C) or a dilation and evacuation (D&E) to ensure all products of conception are removed. Be certain the woman has been told the pregnancy was already lost and all procedures, such as suction curettage, are to clear the uterus and prevent further complications such as infection, not to end the pregnancy. This scenario does not involve an abortion (elective termination of pregnancy) or an incomplete miscarriage.

The nurse is preparing a teaching plan for a pregnant woman about the signs and symptoms to be reported immediately to her health care provider. Which signs and symptoms would the nurse include? Select all that apply.

* Headache with visual changes in the third trimester * Sudden leakage of fluid during the second trimester * Lower abdominal pain with should pain in the first trimester Explanation:

After attending a preconception workshop, a young woman asks the educator to explain neural tube defects (NTD). Which conditions are examples of neural tube defects? Select all that apply.

* Spina bifida * Anencephaly * Encephalocele Explanation:

A neonate has been placed on cardiac and apnea monitoring in the neonatal nursery. The nurse notes that the apnea alarm repeatedly triggers. Place the following actions in the order they would be completed by the nurse. All options must be used.

1. Perform a focused assessment on the neonate 2. Count the respiratory rate for 60 sec 3. Silence the alarm to decrease environmental stimuli 4. Check all connections on the apnea monitor. 5. Document the assessment findings, interventions, and neonate's response. Explanation: The priority action is to perform a focused assessment on the neonate. Afterward, the nurse would evaluate the respiratory rate by counting respirations for 60 seconds. Afterward, the nurse would silence the alarm, check all connections on the apnea monitor, and, finally, document the information. Remember to "nurse the client," not the equipment.

The nurse recognizes that documenting accurate blood pressures is vital in the diagnosing of preeclampsia, severe preeclampsia and eclampsia. The nurse suspects preeclampsia based on which finding?

BP of 140/90 mm Hg last week and at current visit after 20 weeks' gestation Explanation: Gestational hypertension is diagnosed when systolic blood pressure is over 140 mm Hg and/or diastolic pressure is over 90 mm Hg on at least two occasions at least 4 to 6 hours apart after the 20th week of gestation in women known to be normotensive prior to this time and prior to pregnancy. Severe preeclampsia (i.e., preeclampsia with severe features) may develop suddenly or within days and bring with it high blood pressure of more than 160/110 mm Hg, cerebral and visual symptoms, and pulmonary edema.

The nurse is monitoring a laboring client with continuous fetal monitoring and notes a decrease in FHR with variable deceleration to 75 bpm. Which intervention should the nurse prioritize?

Change the position of the client. Explanation:

The male reproductive system is composed of two systems. The nurse knows that which system is responsible for the transportation and storage of sperm?

Ductile System Explanation: The ductile system (epididymis, vas deferens, and ejaculatory ducts) transports and stores sperm, and assists in their maturation. The accessory glands (seminal vesicles, prostate gland, and bulbourethral glands) prepare the sperm for ejaculation.

The nurse is counseling a newly pregnant woman who is concerned about developing infections during her pregnancy. The pregnant woman states, "I'm so afraid something will happen to my baby. My friend developed an infection while she was pregnant and the baby died." Which of the following responses by the nurse would be most appropriate?

Early prenatal care like you are receiving is very beneficial in reducing chances of infection Explanation: Informing the client that early prenatal care is important in decreasing the incidence of maternal infection is both accurate and reassuring to the client, addressing the client's fear. Telling the client that there is nothing to worry about is providing false hope, as there is no guarantee that the mother or baby will not experience some complication. The client's chances of developing an infection depend in part on measures the client takes to prevent infection, so the statement that the chances of developing an infection are very small is not completely accurate. The type and cause of the friend's infection are not relevant to the client's situation, and asking about them is more likely to upset or offend the client than reassure her.

The nurse is doing a presentation for a group of nursing students about the topic of menstrual disorders. After discussing the disorder secondary amenorrhea, the students make the following statements. Which statement made by the nursing students is the most accurate regarding the cause of secondary amenorrhea?

Emotional stress can be a cause of this disorder. Explanation: Secondary amenorrhea can be the result of discontinuing contraceptives, a sign of pregnancy, the result of physical or emotional stress, or a symptom of an underlying medical condition. A complete physical examination, including gynecologic screening, is necessary to help determine the cause. Primary amenorrhea occurs when a girl has had no previous menstruation. A spontaneous abortion (miscarriage) does not cause secondary amenorrhea.

Which hormone triggers the positive feedback mechanism that controls the secretion of luteinizing hormone (LH) levels?

Estrogen Explanation: An example of positive feedback is the preovulatory surge in luteinizing hormone (LH) levels that trigger ovulation. At that time, an increase in estrogen levels exerts a positive feedback effect on the anterior pituitary secretion of LH. The other hormones are not associated with LH in this manner.

Fetal circulation differs from the circulatory path of the newborn infant. In utero the fetus has a hole connecting the right and left atria of the heart. This allows oxygenated blood to quickly pass to the major organs of the body. What is this hole called?

Foramen Ovale Explanation: The foramen ovale is a hole that connects the right and left atria so the majority of oxygenated blood can quickly pass into the left side of the fetal heart, go to the brain, and move to the rest of the fetal body.

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 Explanation:

The nurse is providing care to a neonate. Review of the maternal history reveals that the mother is suspected of having a heroin use disorder. The nurse would be alert for which finding when assessing the neonate?

Hypertonicity Explanation: Newborns of mothers with heroin or other opioid use disorder display irritability, hypertonicity, a high-pitched cry, vomiting, diarrhea, respiratory distress, disturbed sleeping, sneezing, diaphoresis, fever, poor sucking, tremors, and seizures.

A mother is talking to the nurse and is concerned about managing her asthma while she is pregnant. Which response to the nurse's teaching indicates that the woman needs further instruction?

I need to begin taking allergy shots like my friend to prevent me from having an allergic reaction this spring. Explanation: A pregnant woman with a history of asthma needs to be proactive, taking her inhalers and other asthma medications to prevent an acute asthma attack. She needs to understand that it is far more dangerous to not take the medications and have an asthma attack. She also needs to monitor her peak flow for decreases, be aware of triggers, and avoid them if possible. However, a pregnant woman should never begin allergy shots if she has not been taking them previously, due to the potential of an adverse reaction.

A nurse caring for a 43-year-old client explains to the client that ovarian functions gradually decrease around this age. What is the implication of decreased ovarian function?

Inability to become pregnant Explanation: Because of the decrease in ovarian functions, the client loses the ability to become pregnant. Loss of estrogen makes the client susceptible to fractures and also increases the risk of heart disease. Changes in sexual response are usually related to physical changes in the vagina.

Which statement is true regarding hormonal contraception?

It increases the risk for venous thromboembolism Explanation : Clients taking hormonal contraception have an increased risk for venous thromboembolism, but their risk for benign breast cancer and uterine cancer is decreased. Fetal anomalies are not a concern.

Performing chorionic villi sampling prior to 10 weeks' gestation is not recommended because of the danger of:

Limb reduction defects in the fetus Explanation: Sampling of the chorionic villi usually is done after 10 weeks of gestation. Performing the test before 10 weeks is not recommended because of the danger of limb reduction defects in the fetus. The other options are not defects caused by this procedure.

Which results would indicate to the nurse the possibility that a neonate has congenital hypothyroidism?

Low T4 level and high TSH level Explanation: Screening results that show a low T4 level and a high TSH level indicate congenital hypothyroidism and the need for further tests to determine the cause of the disease.

The nurse is explaining the latest laboratory results to a pregnant client who is in her third trimester. After letting the client know she is anemic, which heme iron-rich foods should the nurse encourage her to add to her diet?

Meats Explanation: Meats are the best source of heme-rich iron and should be included in her diet if she is not following a vegetarian diet. Grains and legumes are non-heme iron sources. Dairy products will add various vitamins and calcium to the diet.

The physician knows the client, G1P0, has correctly understood the prenatal education regarding sexually transmitted infection as evidenced by which statement listed below?

My baby could become infected either across the placenta or during the birth itself Explanation:

A woman who just gave birth tells the obstetrical nurse that her mother has noticed that so much has changed in maternity care in recent years. One change she could likely be referring to is:

Newborn stay at the mother's bedside as long the infant is well. Explanation: There has been increased access to care for all women (regardless of their ability to pay) and many hospital redesigns of labor, birth, and recovery rooms and postpartum spaces aimed at keeping families together during the birth experience and minimizing interruptions. Rooming-in and liberal visiting policies allow parents and other family members to participate in the child's care. Births happen in birthing suites/rooms as opposed to sterile birth rooms. Family is allowed to visit at most times of the day and night. Rooming in with the newborn is considered standard care now.

Which of a client's cells are most likely to reproduce by meiosis?

Ova Explanation: Ova and other sex cells reproduce by meiosis. All of the other tissues are made up of somatic cells, which reproduce by mitosis.

The nurse is caring for a pregnant client. What hormone must be secreted to cause uterine contractions?

Oxytocin Explanation: The pituitary is made up of three lobes: anterior, intermediate, and posterior. The posterior lobe stores two hormones produced by the hypothalamus, ADH, and oxytocin. Oxytocin stimulates uterine smooth muscle contraction in late phases of pregnancy and also causes milk release or "let down" reflex in lactating women. The posterior lobe does not store estrogen or enkephalins. Prolactin stimulates milk production, not the onset of labor.

Which is the first step in establishing a patter of inheritance?

Pedigree Explanation: A pedigree is a first step in establishing the pattern of inheritance. A genotype consists of the genes and variations therein that a person inherits from his or her parents. Transcription is the process of transforming information from DNA into new strands of messenger RNA. Mutation is a heritable alteration in genetic material.

A client who is 14 weeks' pregnant mentions that she has been having difficulty moving her bowels since she became pregnant. Which hormone is responsible for this common discomfort during pregnancy?

Progesterone Explanation:

A 32-year-old woman presents to the labor and birth suite in active labor. She is multigravida, relaxed, and talking with her husband. When examined by the nurse, the fetus is found to be in a cephalic presentation. His occiput is facing toward the front and slightly to the right of the mother's pelvis, and he is exhibiting a flexed attitude. How does the nurse document the position of the fetus?

ROA Explanation: The nurse should document the fetal position in the clinical record using abbreviations. The first letter describes the side of the maternal pelvis toward which the presenting part is facing ("R" for right and "L" for left). The second letter indicates the reference point ("O" for occiput, "Fr" for frontum, etc.). The last part of the designation specifies whether the presenting part is facing the anterior (A) or the posterior (P) portion of the pelvis, or whether it is in a transverse (T) position.

A nurse has been asked to present information to a group of civic leaders concerning women's health issues. In preparing the information, the nurse includes what goal from Healthy People 2030?

Reduce the rate of cesarean births among low-risk births Explanation: Healthy People 2030 has the goal of reducing the rate of cesarean births among low-risk women with no prior births.

Sperm production occurs in the seminiferous tubules. The nurse understands the anatomy of the testes and knows that as the tubules lead into the efferent ducts, the seminiferous tubules become which structure?

Rete Testis Explanation: The testes are composed of several hundred compartments, or lobules. Each lobule contains one or more coiled seminiferous tubules. These tubules are the site of sperm production. As the tubules lead into the efferent ducts, the seminiferous tubules become the rete testis, which are multiple interconnecting channels in the mediastinum.

On a client's second postpartum visit, a health care provider reviews the chart. What's the best term for the lochia described?

Rubra

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

Secondary Infertility Explanation: There are two main types of infertility: primary and secondary. A couple who has never been able to conceive has primary infertility, whereas a couple who has been able to conceive in the past but is currently unable to do so has secondary infertility.

Which statement is correct regarding spermatogenesis?

Spermatogenesis and sperm maturation takes approximately 90 days. Explanation: Spermatogenesis and sperm maturation takes approximately 90 days. It begins when the spermatogonia undergo rapid mitotic division. Meiosis is a unique form of cell division that occurs only in the gonads. Each sperm contains 23 chromosomes.

A pregnant woman has arrived to the office reporting vaginal bleeding. Which finding during the assessment would lead the nurse to suspect an inevitable spontaneous abortion (miscarriage)?

Strong abdominal cramping Explanation: Strong abdominal cramping is associated with an inevitable spontaneous abortion (miscarriage). Slight vaginal bleeding early in pregnancy and a closed cervical os are associated with a threatened abortion. With an inevitable abortion, passage of the products of conception may occur. No fetal tissue is passed with a threatened abortion.

The nurse is caring for a client in active labor. Which assessment finding should the nurse prioritize and report to the team?

Sudden shortness of breath Explanation: Sudden shortness of breath can be a sign of amniotic fluid embolism and requires emergent intervention. This can occur suddenly during labor or immediately after. The woman usually develops symptoms of acute respiratory distress, cyanosis, and hypotension. It must be reported to the care team so proper interventions may be taken. Other symptoms can include hypotension, cyanosis, hypoxemia, uterine atony, seizures, tachycardia, coagulation failure, DIC, and pulmonary edema

A nurse is monitoring a woman in labor. Which assessment finding is most concerning to the nurse?

Temperature is 101.6 F (38.7 C) Explanation: Although slight temperature elevations are normal during labor, a temperature of 101.6°F (38.7°C) indicates an infection and should be reported to the health care provider. 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; blood pressure increases by up to 35 mm Hg; and respiratory rate increases as more oxygen is consumed. Nausea and vomiting are common during labor, especially during the transition phase, due to decreased gastric motility.

During a nonstress test (NST), a nurse notes three fetal heart rate (FHR) increases of 15 beats/minute, each lasting 15 seconds. These increases occur only with fetal movement. How should the nurse interpret this finding?

The fetus is not in distress at this time Explanation: The NST provides an indirect measurement of uteroplacental function. An electronic fetal monitoring device is used to measure fetal movement and increases in the fetal heart rate. The mother is given a button to push when she feels fetal movement so it can be recorded on the tracing. Prior to starting the testing, the nurse should obtain a baseline fetal monitor strip. Once testing starts, what is important is the acceleration of the fetal heart rate. A reactive NST includes at least two fetal heart rate accelerations from the baseline of at least 15 bpm for at least 15 seconds within a 20-minute testing time. If the test does not meet this criterion after 40 minutes, it is considered nonreactive.

A woman diagnosed with uterine fibroids is scheduled for a myomectomy. After reviewing this procedure with the client, the nurse determines that the client understands this procedure based on which statement?

The fibroid will be removed but new ones may grow. Explanation: A myomectomy involves removing the fibroid alone and leaves the healthy areas of the uterus intact to preserve fertility. Fertility is not jeopardized because this procedure leaves the uterine muscle walls intact. Myomectomy relieves symptoms but does not affect the underlying process; thus, fibroids grow back and further treatment will be needed in the future. Hormones are used to reduce the size of fibroids. Uterine artery embolization (UAE) is an option in which polyvinyl alcohol pellets are injected into selected blood vessels via a catheter to block circulation to the fibroid, causing it to shrink and producing symptom resolution. This procedure can affect fertility. A hysterectomy involves the removal of the uterus and loss of fertility.

Which statement by the high school nurse is most accurate in terms of the function/purpose of female ovaries?

The ovaries contain a fixed number of ova at birth which decreases throughout one's life. Explanation: The ovaries, like the male testes, have a dual function: to store female germ cells/ova, and produce the female sex hormones. Unlike the male gonads, which produce sperm throughout a man's reproductive life, the female gonads contain a fixed number of ova at birth that diminishes throughout a woman's life.

A client recently gave birth. Two minutes before breast-feeding the baby, she administers one nasal spray (40 units/ml) of oxytocin into each nostril. Why is the client using this drug?

To stimulate lactation Explanation: Oxytocin is administered as a nasal spray before breast-feeding to stimulate lactation. When oxytocin is used to treat eclampsia, reduce postpartum bleeding, or treat erythroblastosis fetalis, the drug is administered parenterally.

A client in her third trimester reports to the nurse shortness of breath when sleeping. The nurse informs the client that this is normal and occurs because the growing fetus puts pressure on the diaphragm. Which measure should the nurse suggest to help alleviate this problem?

Use extra pillows Explanation: The nurse should instruct the client to use extra pillows at night to keep her more upright. The nurse can instruct the client to use a firmer mattress if the client is experiencing backache. The nurse can ask the client to avoid overeating and ingesting spicy food in case the client is experiencing heartburn.

A male child asks the nurse what chromosomes he would receive from his father. The best best response would be:

Y Explanation: Males (XY) get an X chromosome from their mother, and a Y chromosome from their father. If the father transmits an X chromosome, then the fetus would develop into a female (XX).