Sexuality/Reproduction
What is the most widely used off-label drug for cervical ripening and the enhancement of uterine muscle tone? 1 Misoprostol 2 Mifepristone 3 Dinopristone 4 Methylergonovine
1 Misoprostol Misoprostol is the most widely used off-label drug for cervical ripening and the enhancement of uterine muscle tone because it is relatively affordable. Mifepristone is used to induce labor. Dinoprostone is used for cervical ripening but is not an off-label drug for cervical ripening. Methylergonovine is used to enhance myometrial tone but is not used to augment labor.
A client with recurrent episodes of nausea, vomiting, and abdominal pain arrives at the hospital. Assessments by the primary healthcare provider reveal that the cremasteric reflex is absent, and emergency surgery is performed. What is the likely diagnosis? 1 Varicocele 2 Epididymitis 3 Penile neoplasia 4 Testicular torsion
4 Testicular torsion Nausea, vomiting, and abdominal pain are symptoms of testicular torsion. The cremasteric reflex is absent in cases of torsion. Emergency surgery may be performed in cases of torsion as a means of preserving the testicle. Varicocele is characterized by elongation, dilation, and tortuosity of the veins of the spermatic cord superior to the testicle. Urethral discharge, dysuria, fever, and pyuria are signs of epididymitis. Penile neoplasia is associated with human papillomavirus type 16 infection
While caring for a woman who has had a positive contraction stress test (CST), what complication does the nurse suspect? 1 Preeclampsia 2 Placenta previa 3 Imminent preterm birth 4 Uteroplacental insufficiency
4 Uteroplacental insufficiency A positive contraction stress test (CST) indicates a compromised fetus with late decelerations during contractions. This finding is associated with uteroplacental insufficiency. Preeclampsia does not result in a positive CST unless the fetus is compromised. Ultrasonography demonstrates placenta previa; a CST is contraindicated because it may induce labor. A CST is contraindicated for a woman with a suspected preterm birth or a pregnancy of less than 33 weeks' gestation, because it may induce labor
A client had a cesarean birth 3 days ago. Where should the nurse, while palpating the client's fundus, expect to locate the fundus if each line represents 1 cm? a. b. c. d.
C. Three days after birth, the fundus should be located 3 cm below the umbilicus; 12 hours after birth it should be located about 1 cm above the umbilicus; each following day it drops 1 to 2 cm. Location a is too high; the fundal height is 1 cm below the umbilicus on day 1. Location b is too high; the fundal height is 2 cm below the umbilicus on day 2. Location d is too low; the fundal height is 4 cm below the umbilicus on day 4.
A pregnant adolescent reports discomfort in her lower abdomen and watery-to-purulent vaginal discharge. The adolescent is diagnosed with a herpes simplex virus infection. Which medication would the nurse expect the primary healthcare provider to prescribe? 1 Acyclovir 2 Penciclovir 3 Famciclovir 4 Valacyclovir
1 Acyclovir Of the drugs used to treat herpes simplex virus, acyclovir is the drug of choice. Penciclovir is used for herpes labialis. Famciclovir and valacyclovir are not prescribed for pregnant adolescents due to their potentially teratogenic effects.
Which condition should be suspected in a 17-year-old client in whom secondary sexual characteristics and menarche have failed to occur? 1 Amenorrhea 2 Endometriosis 3 Dysmenorrhea 4 Premenstrual syndrome
1 Amenorrhea Amenorrhea is the absence of menstruation or development of secondary sexual characteristics even after late adolescence. Endometriosis is characterized by the presence and growth of endometrial tissue outside of the uterus. Dysmenorrhea is pain during or shortly before menstruation. Mood swings and somatic symptoms that occur with the menstrual cycle are considered components of premenstrual syndrome.
An unmarried female adolescent arrives at a hospital with her parents. She complains of a delay in her regular menstrual cycle and wants to confirm her health status. Which strategies should be employed while interviewing the adolescent? Select all that apply. 1 Gaining the client's trust 2 Asking close-ended questions 3 Explaining the limits of confidentiality 4 Starting the interview with more sensitive issues 5 Interviewing the adolescent along with her parents
1 Gaining the client's trust 3 Explaining the limits of confidentiality Gaining the client's trust would help the nurse get more information from a client. Explaining the limits of confidentiality helps to obtain reports on physical or sexual abuse. According to nursing care guidelines, the interview should include open-ended questions in order to obtain detailed information about the client. The interview should begin with less sensitive issues. In order to ensure privacy, the adolescent should be interviewed without her parents present.
A woman has been administered clomiphene as part of a treatment for infertility. What assessments indicate that the drug is working effectively? Select all that apply. 1 Increased estrogens 2 Increased ovarian stimulation 3 Increased luteinizing hormone 4 Decreased follicle-stimulating hormone 5 Decreased gonadotropin-releasing hormone
1 Increased estrogens 2 Increased ovarian stimulation 3 Increased luteinizing hormone Clomiphene acts by stimulating the hypothalamus in the treatment for infertility. This drug indirectly increases the levels of estrogens, which causes ovarian stimulation due to the increase in the levels of luteinizing hormone. Stimulation of the hypothalamus by clomiphene indirectly increases the level of follicle-stimulating hormone via the increased production of gonadotropin-releasing hormone from the hypothalamus.
Which condition contraindicates the use of ginseng herbal therapy? 1 Pregnancy 2 Schizophrenia 3 Bipolar depression 4 Alzheimer disease
1 Pregnancy Pregnancy is contraindicated for ginseng herbal therapy. Schizophrenia, bipolar depression, and Alzheimer disease are contraindicated for St. John's Wort herbal therapy.
A female client has severe cramping, pain, backache, and a migraine headache that presents with anxiety and mood swings. Which medication does the nurse think will be prescribed first to reduce the symptoms? 1 Sertraline 2 Buspirone 3 Ibuprofen 4 Spironolactone
1 Sertraline A client with severe cramps, backache, and a migraine with anxiety and mood swings likely has premenstrual syndrome (PMS). Selective serotonin reuptake inhibitors (SSRIs) such as sertraline are effective in relieving the symptoms of severe PMS. Buspirone is useful only to relieve anxiety in the client with PMS. Ibuprofen is used to reduce physiologic symptoms. Diuretics such as spironolactone are effective in reducing fluid overload.
A registered nurse teaches a nursing student about the effects of aspirin in pregnant women. Which statement made by the nursing student indicates a need for further teaching? 1 "Aspirin may reduce a fever." 2 "Aspirin may cause Reye syndrome." 3 "Aspirin may increase the risk of bleeding." 4 "Aspirin may suppress labor contractions."
2 "Aspirin may cause Reye syndrome." Aspirin does not cause Reye syndrome in pregnant clients. Aspirin may reduce fever, increase the risk of bleeding, and suppress labor contractions.
An adolescent reports scrotal pain, redness, dysuria, and fever. Which condition does this adolescent have? 1 Varicocele 2 Epididymitis 3 Testicular torsion 4 Testicular cancer
2 Epididymitis Epididymitis is a condition associated with scrotal pain, dysuria, redness, and fever. Varicocele can be palpated as a worm-like mass situated above the testicles. Manifestations of testicular torsion include nausea, vomiting, and abdominal pain. The presence of a heavy, hard mass that is palpable accompanied by back pain and shortness of breath is associated with testicular cancer.
The nurse is teaching a prenatal breathing and relaxation class. What intervention does the nurse suggest to ease back discomfort during labor? 1 Alternating lying on the back and side 2 Having support persons use back massage techniques 3 Using distraction techniques such as abdominal effleurage 4 Maintaining the knee-chest position before and after assessments of the fetal heart rate
2 Having support persons use back massage techniques The fetus exerts pressure against the spine during labor; back massage provides counterpressure, which eases the discomfort. The back-lying position is contraindicated because the weight of the fetus compresses the vena cava, decreasing the flow of blood to the placenta. Although abdominal effleurage can serve as a distraction during labor, it will not relieve back discomfort. The knee-chest position will also not relieve back pain during labor.
A client is admitted to a long-term care facility and placed in a semiprivate room. After the second night on the unit, the client's roommate reports that the client is masturbating at night and demands another room. What is the most appropriate intervention by the nurse? 1 Moving the roommate who made the report to another room 2 Providing the client who was masturbating with periods of private time 3 Telling the roommate that this is acceptable behavior and that the client has the right to engage in it 4 Informing the client who is masturbating that this behavior is inappropriate and should not continue
2 Providing the client who was masturbating with periods of private time Masturbating is a healthy human sexual behavior. The client should be provided with private time. Moving the roommate to another room could be ineffective because this may happen with the client's future roommate. Telling the roommate that this is acceptable behavior and that the client has the right to engage in it does not address either client's needs. The client has the right to meet physical needs but should not impose the behavior on others.
The cervix of a client in labor is fully dilated and effaced. The head of the fetus is at +2 station. What should the nurse encourage the client to do during contractions? 1 Relax by closing her eyes 2 Push with her glottis open 3 Blow to slow the birth process 4 Pant to prevent cervical edema
2 Push with her glottis open The contractions in the second stage of labor are expulsive in nature; having the client push or bear down with the glottis open will hasten expulsion. Contractions are now intense and the client will be unable to relax; relaxation occurs between contractions. Having the client close her eyes, blow, or pant will prevent pushing and should not be encouraged until the fetal head crowns (+4 station) and a controlled birth is desired.
A laboring client is to have a pudendal block. What should a nurse teach the client about the effects of the pudendal block? 1 Bladder sensation may be lost. 2 She will not feel an episiotomy. 3 She may lose the ability to push. 4 Contractions will no longer be felt.
2 She will not feel an episiotomy. A pudendal block provides anesthesia to the perineum. This block affects only the perineum, not the bladder. It does not affect muscle control, and it anesthetizes only the perineum, not the cervix or body of the uterus.
A client seeks help for dealing with incontinence. A nursing intervention is to teach Kegel exercises. Which type of incontinence is the client most likely experiencing? 1 Reflex incontinence 2 Stress incontinence 3 Overflow incontinence 4 Functional incontinence
2 Stress incontinence Stress incontinence [1] [2] [3] is the involuntary loss of urine during coughing, laughing, or sneezing. In women, this is often seen after having children. Kegel exercises increase the perineal muscle tone, helping to control involuntary voiding. Overflow incontinence is caused by overdistention of the bladder, and exercises will not help. Reflex incontinence is preceded by abnormal detrusor contractions from neurologic abnormalities. Functional incontinence is associated with environmental or cognitive factors due to which the client is unable to get to the toilet or does not have the necessary cognitive abilities to use the toilet.
A nurse is assessing a primigravida who was admitted in early labor after her membranes have ruptured. She is at 41 weeks' gestation. Her contractions are irregular, and her cervix is dilated 3 cm. The fetal head is at station 0, and the fetal heart rate tracing is reactive. How can the nurse help the client facilitate labor? 1 Encourage her to watch television. 2 Take a walk around the unit with her. 3 Ask her to maintain a left-lateral position. 4 Promote the patterned, paced breathing technique.
2 Take a walk around the unit with her Walking may increase the frequency and intensity of the contractions. Although watching TV may be a relaxing activity, it will not help stimulate labor. At this time there is no indication that the client should assume the left-lateral position. During early labor, slow chest or abdominal breathing helps the client relax; the patterned, paced breathing technique is more appropriate for the transition phase of labor.
A contraction stress test (CST) is performed on a client at 40 weeks' gestation. The findings are interpreted as negative. What does the nurse conclude from this interpretation? 1 Testing will be repeated in 24 hours because the results indicate hyperstimulation. 2 There will be weekly retesting because, at this time, the fetus has adequate oxygen reserves. 3 Emergency birth will be considered because the fetal heart rate has early decelerations with uterine contractions. 4 Induction of labor will be performed because fetal heart rate accelerations with movement is indicative of a false result.
2 There will be weekly retesting because, at this time, the fetus has adequate oxygen reserves. A negative test result implies that placental support is adequate; it is associated with a low fetal death rate within 1 week. A negative test result does not indicate hyperstimulation. This is a negative test result; if there were persistent late decelerations with contractions, the test would be positive and intervention would be required. Fetal heart rate accelerations with movement are reassuring; an expeditious birth is not indicated.
During a childbirth class, several participants have questions about the elective induction of labor. One participant states that it is more convenient for a woman with a busy schedule. What evidence-based information should the nurse provide to the participant? 1 "Elective induction rates are dropping nationwide." 2 "Elective induction is recommended if the client has a classic uterine incision." 3 "The widespread use of elective induction increases the risk of unfavorable outcomes." 4 "There is no evidence that elective induction makes any difference in the labor experience."
3 "The widespread use of elective induction increases the risk of unfavorable outcomes." Elective induction significantly increases the risk of cesarean birth, instrumented delivery, use of epidural analgesia, and neonatal intensive care unit admission, all of which may or may not produce a favorable outcome. Elective induction rates are increasing on a national basis. There are some very important reasons, including convenience for the client, obstetrician, or both, that some women should have labor induced. A classic (vertical) uterine incision would be a contraindication to any type of vaginal delivery, whether spontaneous or induced. Rupture of the uterus and possible death would be dangerous side effect, so cesarean section would be scheduled in advance of labor.
A client admitted with preeclampsia is receiving magnesium sulfate. Which assessment finding indicates that a therapeutic level of the medication has been reached? 1 Increased fetal activity 2 Decreased urine output 3 Deep tendon reflexes of +2 4 Respiratory rate of 10 breaths/min
3 Deep tendon reflexes of +2 Hyperreflexia of severe preeclampsia is +3 to +4; therefore a deep tendon reflex of +2, which is an active, expected reflex, indicates that a therapeutic level of the drug has been reached. A diminished reflex or absence of the reflex indicates that the serum magnesium level is too high. Because magnesium sulfate is a central nervous system depressant, a respiratory rate of at least 12 breaths/min should be maintained. Alterations in fetal activity are not indicators of a therapeutic magnesium sulfate level. Oliguria is a sign of severe preeclampsia; diuresis is a therapeutic effect of magnesium sulfate administration.
Which drug is used to manage nonmetastatic gestational trophoblastic disease? 1 Oxytocin 2 Mifepristone 3 Dinoprostone 4 Methylergonovine
3 Dinoprostone Dinoprostone is a synthetic drug derived from naturally occurring prostaglandins. This drug is used to manage nonmetastatic gestational trophoblastic disease. Methylergonovine is used to treat postpartum hemorrhage. Oxytocin is used for labor induction. Mifepristone is used to induce an abortion.
A nurse is assessing a client at 16 weeks' gestation. Where does the nurse expect the fundal height to be located? 1 Above the umbilicus 2 At the level of the umbilicus 3 Half the distance to the umbilicus 4 Slightly above the symphysis pubis
3 Half the distance to the umbilicus Considering the growth of the fetus, this is the expected height of the fundus at 16 weeks' gestation. The height of the fundus in centimeters is approximately the same as the number of weeks of gestation if the woman's bladder is empty at the time of measurement. Above the umbilicus is where the fundus should be palpated from after 24 weeks' gestation until term. At the level of the umbilicus is where the fundus should be palpated at 22 to 24 weeks' gestation. Between 12 and 14 weeks' gestation, the uterus outgrows the pelvic cavity and can be palpated just above the symphysis pubis.
Shortly after giving birth, a client says she feels as though she is bleeding excessively. When checking the fundus, a nurse observes a steady trickle of blood from the vagina. What is the nurse's initial action? 1 Calling the primary healthcare provider 2 Checking the blood pressure and pulse 3 Holding the fundus firmly and gently massaging it 4 Explaining that the trickling blood is a common occurrence
3 Holding the fundus firmly and gently massaging it A relaxed uterus is the most common cause of bleeding in the early postpartum period. The uterus may be returned to a state of firmness with the use of intermittent gentle fundal massage. Immediate action is directed toward the client's safety; the primary healthcare provider is called if nursing intervention does not control the bleeding. The vital signs are checked after another intervention that addresses the client's immediate needs. Steady bleeding is a complication that must be attended to immediately.
A 16-year-old client has a steady boyfriend with whom she is having sexual relations. She asks the nurse how she can protect herself from contracting human immunodeficiency virus (HIV). Which guidance is most appropriate for the nurse to provide? 1 Ask her partner to withdraw before ejaculating. 2 Make certain their relationship is monogamous. 3 Insist that her partner use a condom when having sex. 4 Seek counseling about various contraceptive methods.
3 Insist that her partner use a condom when having sex. A condom covers the penis and contains the semen when it is ejaculated; semen contains a high percentage of HIV in infected individuals. Preejaculatory fluid carries HIV in an infected individual, so withdrawing before ejaculation is not effective. Although a monogamous relationship is less risky than having multiple sexual partners, if one partner is HIV positive, the other person is at risk for acquiring HIV. The client is not asking about various contraceptive methods. Most contraceptives do not provide protection from HIV.
A client seeking advice regarding contraception asks a nurse to explain how an intrauterine device (IUD) prevents pregnancy. How should the nurse respond? 1 "It covers the entrance to the cervical os." 2 "The openings to the fallopian tubes are blocked." 3 "The sperm are kept from reaching the vagina." 4 "It produces a spermicidal intrauterine environment."
4 "It produces a spermicidal intrauterine environment." Intrauterine devices produce a spermicidal intrauterine environment. A copper IUD inflames the endometrium, damaging or killing sperm and preventing fertilization and/or implantation. A levonorgestrel-releasing IUD damages sperm and causes the endometrium to atrophy, thus preventing fertilization and/implantation. A diaphragm blocks the cervical os. The IUD does not act by blocking the openings to the fallopian tubes. Preventing sperm from reaching the vagina is the function of a condom.
At 39 weeks' gestation a client asks the nurse about the difference between true and false labor. Which information regarding true labor contractions should the nurse include in a response to the client's question? 1 Usually fluctuate in length 2 Continuous, without relaxation 3 Related to time of membrane rupture 4 Accompanied by progressive cervical dilation
4 Accompanied by progressive cervical dilation Progressive cervical dilation is the only positive sign of true labor; the cervix dilates in response to regular, coordinated uterine contractions. The contractions of true labor increase in length and intensity. A continuous contraction may have an adverse effect on the fetus; immediate intervention is required. The membranes may rupture before contractions begin; more frequently they rupture after true labor is established
The nurse is caring for a postpartum client who has experienced an abruptio placentae. Which assessment indicates that disseminated intravascular coagulation (DIC) is occurring? 1 Boggy uterus 2 Hypovolemic shock 3 Multiple vaginal clots 4 Bleeding at the venipuncture site
4 Bleeding at the venipuncture site Bleeding at the venipuncture site indicates afibrinogenemia; massive clotting in the area of the separation has resulted in a decrease in the circulating fibrinogen level. A boggy uterus indicates uterine atony. Although hypovolemic shock may occur with DIC, there are other causes of hypovolemic shock, not just DIC. Blood clots indicate an adequate fibrinogen level; however, vaginal clots may indicate a failure of the uterus to contract and should be explored further.
A nurse in the women's health clinic is counseling clients about family planning. What should the nurse consider when discussing the effects of a high concentration of estrogen in the blood? 1 It causes ovulation. 2 Lactation is stimulated. 3 It prompts secretion of oxytocin. 4 It inhibits secretion of follicle-stimulating hormone (FSH).
4 It inhibits secretion of follicle-stimulating hormone (FSH). A high level of plasma estrogen inhibits anterior pituitary secretion of FSH; this effect appears to be mediated by the hypothalamus and its releasing factors. Luteinizing hormone, not estrogen, causes ovulation. Lactogenic hormone (prolactin) stimulates lactation. Putting the infant to the breast prompts the release of oxytocin, which is secreted by the posterior pituitary gland, resulting in the let-down reflex.
A nurse in the clinic is obtaining a health history of a 16-year-old boy with a complaint of a thick urethral discharge. What is the most appropriate nursing action to help confirm a tentative diagnosis of gonorrhea? 1 Assessing the temperature for fever 2 Collecting a urine sample for a urinalysis 3 Drawing blood for a complete blood count 4 Obtaining a urethral specimen for a culture
4 Obtaining a urethral specimen for a culture When the Gonococcus organism is present in the genitourinary tract of a male client, a culture of the urethral exudate provides a definitive diagnosis. Fever is not a specific diagnostic tool, because it occurs with other infections. Although urine may contain Gonococcus organisms, the urine dilutes the concentration; the organisms are more concentrated in the urethral discharge. The Gonococcus organism is in the genitourinary tract, not the blood; a complete blood count will not provide information with which to diagnose gonorrhea.
