Test 1: Maternity by Lowdermilk & Perry: Chapters 1, 2, 3, 4, 12, 13, 14, 15, 26

An ultrasound of a fetus' heart shows that "normal fetal circulation is occurring." Which of the following statements is consistent with the finding?

. A right to left shunt is seen between the atria. This is correct. The foramen ovale is a duct between the atria. In fetal circulation, there is a right to left shunt through the duct.

A couple who has sought infertility counseling has been told that the man's sperm count is very low. The nurse advises the couple that spermatogenesis is impaired when which of the following occur?

. The testes are overheated. Spermatogenesis occurs in the testes. High temperatures harm the development of the sperm.

During preconception counseling, the clinic nurse explains that the time period when the fetus is most vulnerable to the effects of teratogens occurs from:

2 to 8 weeks The period of organogenesis lasts from approximately the second until the eighth week of gestation during which time the embryo undergoes rapid growth and differentiation. During organogenesis, the embryo is extremely vulnerable to teratogens such as medications, alcohol, tobacco, caffeine, illegal drugs, radiation, heavy metals, and maternal (TORCH) infections. Structural fetal defects are most likely to occur during this period because exposure to teratogens either before or during a critical period of development of an organ can cause a malformation.

A clinic nurse explains to the pregnant woman that the amount of amniotic fluid present at 24 weeks' gestation is approximately

800 mL Amniotic fluid first appears at about 3 weeks. There are approximately 30 mL of amniotic fluid present at 10 weeks' gestation, and this amount increases to approximately 800 mL at 24 weeks' gestation. After that time, the total fluid volume remains fairly stable until it begins to decrease slightly as the pregnancy reaches term.

Chapter 05: Violence Against Women Historically, what was the justification for the victimization of women? A) Women were regarded as possessions. B) Women were the "weaker sex." C) Control of women was necessary to protect them. D) Women were created subordinate to men.

A) Women were regarded as possessions. - Misogyny, patriarchy, devaluation of women, power imbalance, a view of women as property, gender-role stereotyping, and acceptance of aggressive male behaviors as appropriate contributed and continue to contribute to the subordinate status of women in many of the world's societies. Viewing women as the "weaker sex" is a cultural and modern stereotype that contributes to the victimization of women. Control of women to protect them is another cultural and modern stereotype that contributes to the victimization of women. Yet another cultural stereotype that contributes to the victimization of women is the idea that women were created as subordinate to men.

COMPLETION 1. Nurses who are part of a collaborative team that cares for victims of sexual assault and who have special education and training in forensic nursing are called ______________.

ANS: SANE (nurses) Sexual assault nurse examiners

COMPLETION 1. In order to effectively screen a client at risk for an eating disorder, the nurse should use the ________________ questionnaire.

ANS: SCOFF A screening tool developed specifically for identification of eating disorders uses the acronym SCOFF. Each question scores 1 point. A score of 2 or more indicates that the client may have anorexia nervosa or bulimia. The letters represent the following questions: a. Do you make yourself Sick because you feel too full? b. Do you worry about loss of Control over the amount that you eat? c. Have you recently lost more than One stone (14 pounds) in a 3-month period? d. Do you think that you are too Fat, even if others think you are thin? e. Does Food dominate your life?

A young woman arrives at the emergency department and states that she thinks she has been raped. She is sobbing and expresses disbelief that this could happen because the man was her best friend. In an effort to calm the client in order to perform a thorough assessment and physical examination, the nurse acknowledges the client's fear and anxiety and tells her: a. "Rape is not limited to strangers and frequently occurs by someone who is known to the victim." b. "I would be very upset if my best friend did that to me; that is very unusual." c."You must feel very betrayed. In what way do you think you might have led him on?" d."This does not sound like rape. Didn't you just change your mind about having sex after the fact?"

ANS: A Acquaintance rape involves individuals who know one another. Sexual assault occurs when the trust of a relationship is violated. Victims may be less prone to recognize what is happening to them because the dynamics are different from those of stranger rape. It is not at all unusual for the victim to know and trust the perpetrator. Stating that the woman might have led the man to attack her indicates that the sexual assault was somehow the victim's fault. This type of mentality is not constructive. Nurses must first reflect on their own feelings and learn to be unbiased when dealing with victims. A statement of this type can be very psychologically damaging to the victim. Nurses must display compassion by first believing what the victim states. The nurse is not responsible for deciphering the facts involving the victim's claim.

Individual irregularities in the ovarian (menstrual) cycle are most often caused by: a.Variations in the follicular (preovulatory) phase b.An intact hypothalamic-pituitary feedback mechanism c. A functioning corpus luteum d. A prolonged ischemic phase

ANS: A Almost all variations in the length of the ovarian cycle are the result of variations in the length of the follicular phase. An intact hypothalamic-pituitary feedback mechanism would be regular, not irregular. The luteal phase begins after ovulation. The corpus luteum is dependent on the ovulatory phase and fertilization. During the ischemic phase the blood supply to the functional endometrium is blocked, and necrosis develops. The functional layer separates from the basal layer, and menstrual bleeding begins.

Which statement indicates that a client requires additional instruction about breast self-examination? a. "Yellow discharge from my nipple is normal if I'm having my period." b. "I should check my breasts at the same time each month, after my period." c. "I should also feel in my armpit area while performing my breast exam." d. "I should check each breast in a set way, such as in a circular motion."

ANS: A Discharge from the nipples requires further examination from a health care provider. The breasts should be checked at the same time each month. The armpit should also be examined. A circular motion is the best method in which to ascertain any changes in the breast tissue.

Chapter 01: 21st Century Maternity and Women's Health 1. To assess a mother's risk of having a low-birth-weight (LBW) infant, what is the most important factor for the nurse to consider? a. African-American race b. Cigarette smoking c. Poor nutritional status d. Limited maternal education

ANS: A For African-American births, the incidence of LBW infants is twice that of Caucasian births. Race is a nonmodifiable risk factor. Cigarette smoking is an important factor in potential infant mortality rates, but it is not the most important. Additionally, smoking is a modifiable risk factor. Poor nutrition is an important factor in potential infant mortality rates, but it is not the most important. Additionally, nutritional status is a modifiable risk factor. Maternal education is an important factor in potential infant mortality rates, but it is not the most important. Additionally, maternal education is a modifiable risk factor.

13. The level of practice a reasonably prudent nurse provides is called: a. The standard of care b. Risk management c. A sentinel event d. Failure to rescue

ANS: A Guidelines for standards of care are published by various professional nursing organizations. Risk management identifies risks and establishes preventive practices, but it does not define the standard of care. Sentinel events are unexpected negative occurrences. They do not establish the standard of care. Failure to rescue is an evaluative process for nursing, but it does not define the standard of care.

Kegel exercises, or pelvic muscle exercises: a. Were developed to control or reduce incontinent urine loss b. Are the best exercises for a pregnant woman because they are so pleasurable c. Help to manage stress d. Are ineffective without sufficient calcium in the diet

ANS: A Kegel exercises help control the urge to urinate. Kegel exercises may be fun for some, but the most important matter is the control they provide over incontinence. Kegel exercises help manage urination, not stress. Calcium in the diet is important but is not related to Kegel exercises.

10. A nurse caring for a pregnant client should be aware that the U.S. birth rate shows what trend? a. Births to unmarried women are more likely to have less favorable outcomes. b. Birth rates for women 40 to 44 years of age are declining. c. Cigarette smoking among pregnant women continues to increase. d. The rates of pregnancy and abortion among teens are lower in the United States than in any other industrialized country.

ANS: A Low-birth-weight infants and preterm birth are more likely because of the large number of teenagers in the unmarried group. Birth rates for women in their early 40s continue to increase. Fewer pregnant women smoke. Teen pregnancy and abortion rates are higher in the United States than in any other industrial country.

17. Maternity nurses can enhance communication among health care providers by utilizing the SBAR technique. This acronym stands for: a. Situation, Background, Assessment, Recommendation b. Situation, Baseline, Assessment, Recommendation c. Subjective, Background, Analysis, Recommendation d. Subjective, Background, Analysis, Review

ANS: A SBAR is an easy to remember, useful, concrete mechanism for communicating important information that requires a clinician's immediate attention. Baseline is not discussed as part of SBAR. Subjective and analysis are not specific to the SBAR acronym. Subjective, analysis, and review are not specific to the SBAR acronym.

The transition phase during which ovarian function and hormone production decline is called: a. The climacteric b. Menarche c. Menopause d. Puberty

ANS: A The climacteric is a transitional phase during which ovarian function and hormone production decline. Menarche is the term that denotes the first menstruation. Menopause refers only to the last menstrual period. Puberty is a broad term that denotes the entire transitional stage between childhood and sexual maturity.

When the nurse is alone with a battered client, the client seems extremely anxious and says, "It was all my fault. The house was so messy when he got home, and I know he hates that." What is the most suitable response by the nurse? a."No one deserves to be hurt. It's not your fault. How can I help you?" b."What else do you do that makes him angry enough to hurt you?" c."He will never find out what we talk about. Don't worry. We're here to help you." d."You have to remember that he is frustrated and angry so he takes it out on you."

ANS: A The nurse should stress that the client is not at fault. Asking what the client did to make her husband angry is placing the blame on the woman and would be an inappropriate statement. The nurse should not provide false reassurance. To assist the woman, the nurse should be honest. Often the batterer will find out about the conversation.

2. Because of the effect of cyclic ovarian changes on the breast, the best time for breast self-examination (BSE) is: a. Five to 7 days after menses ceases b. Day 1 of the endometrial cycle c. Midmenstrual cycle d. Any time during a shower or bath

ANS: A The physiologic alterations in breast size and activity reach their minimal level about 5 to 7 days after menstruation stops. Therefore, BSE is best performed during this phase of the menstrual cycle. Day 1 of the endometrial cycle is too early to perform an accurate BSE. After the midmenstrual cycle breasts are likely to become tender and increase in size. This is not the ideal time to perform BSE. Lying down after a shower or bath with a small towel under the shoulder of the side being examined is appropriate teaching for BSE. A secondary BSE may be performed while in the shower.

The female reproductive organ(s) responsible for cyclic menstruation is/are the: a. Uterus b. Ovaries c.Vaginal vestibule d. Urethra

ANS: A The uterus is responsible for cyclic menstruation. It also houses and nourishes the fertilized ovum and the fetus. The ovaries are responsible for ovulation and production of estrogen; the uterus is responsible for cyclic menstruation. The vaginal vestibule is an external organ that has openings to the urethra and vagina; the uterus is responsible for cyclic menstruation. The urethra is not a reproductive organ, although it is found in the area; the uterus is responsible for cyclic menstruation.

A thorough abuse assessment screen should be completed on all female clients. This screen should include which components? (Select all that apply.) a.Asking the client if she has ever been slapped, kicked, punched, or physically hurt by her partner b.Asking the client if she is afraid of her partner c.Asking the client if she has been forced to perform sexual acts d.Diagramming the client's current injuries on a body map e.Asking the client what she did wrong to elicit the abuse

ANS: A, B, C, D Asking the client if she has been slapped, kicked, punched, or physically hurt by her partner, if she is afraid of her partner, or if she has been forced to perform sexual acts are questions that should be posed to all clients. If any physical injuries are present, then they should be marked on a form that indicates their locations on the body. Implying that a client did something wrong can be very emotionally damaging. Many victims of violence are not aware that they are in an abusive relationship. They may not respond to questions about abuse. Using general descriptive words such as "slap," "kick," or "punch" to elicit information is best.

2. Which methods help alleviate the problems associated with access to health care for the maternity client? Choose all that apply. a. Provide transportation to prenatal visits. b. Provide child care so that a pregnant woman may keep prenatal visits. c. Increase the number of providers that will care for Medicaid clients. d. Provide low-cost or no-cost health care insurance. e. Provide job training.

ANS: A, B, C, D Lack of transportation to visits, lack of child care, access to skilled obstetric providers, and lack of affordable health insurance are prohibitive factors associated with lack of prenatal care. Although job training may result in employment and income, the likelihood of significant changes during the time frame of the pregnancy is remote.

Which nursing diagnosis would be most applicable for battered women? Choose all that apply. a. Loss of trust b. Ineffective family coping c. Situational low self-esteem d. Risk for self-directed violence e. Enhanced communication

ANS: A, B, C, D Loss of trust, ineffective family coping, situational low self-esteem, and risk for self-directed violence are potential nursing diagnoses associated with battered women. A more appropriate nursing diagnosis for this client would be impaired communication.

Which nursing diagnoses would be most applicable for battered women? (Select all that apply.) a.Loss of trust b.Ineffective family coping c.Situational low self-esteem d.Risk for self-directed violence e.Enhanced communication

ANS: A, B, C, D Loss of trust, ineffective family coping, situational low self-esteem, and risk for self-directed violence are potential nursing diagnoses associated with battered women. A more appropriate nursing diagnosis for a battered woman would be impaired communication

MULTIPLE RESPONSE 1. Women of all ages will receive substantial and immediate benefits from smoking cessation. This is not an easy process and most people have to attempt quitting numerous times before achieving success. Smoking cessation programs and self-help materials are available from a number of organizations including: a. Association of Women's Health, Obstetric and Neonatal Nurses b. March of Dimes c. American Cancer Society d. American Lung Association e. American College of Obstetricians and Gynecologists (ACOG)

ANS: A, B, C, D, E AWHONN provides a smoking cessation counseling program for pregnant women. The March of Dimes, the American Lung Association, and the American Cancer Society have self-help materials available. ACOG recommends a five-step individualized program and offers resources for health care providers.

MULTIPLE RESPONSE 1. The nurse who is evaluating the client for potential abuse should be aware that intimate partner violence includes (choose all that apply): a. Physical abuse b. Sexual abuse c. Emotional abuse d. Psychologic abuse e. Economic abuse

ANS: A, B, C, D, E Physical, sexual, emotional, psychologic, and economic abuse can be factors in intimate partner violence.

SATA 1. Examples of alternative healing modalities include (choose all that apply): a. Acupuncture b. Meditation c. Yoga d. Antibiotics e. Chelation therapy

ANS: A, B, C, E Acupuncture, meditation, yoga, and chelation therapy are examples of alternative healing modalities. Western medicine uses antibiotics. Macrobiotics are commonly used as an alternative therapy.

The nurse who is evaluating the client for potential abuse should be aware that IPV includes a number of different forms of abuse, including which of the following? (Select all that apply.) a.Physical b.Sexual c.Emotional d.Psychologic e.Financial

ANS: A, B, D, E Physical, sexual, financial, and psychologic abuse can all be components in a relationship with IPV. Emotional abuse is a form of psychologic abuse.

Concerning the use and abuse of legal drugs or substances, nurses should be aware that: a. Although cigarette smoking causes a number of health problems, it has little direct effect on maternity-related health b. Women ages 21 to 34 have the highest rates of specific alcohol-related problems c. Coffee is a stimulant that can interrupt body functions and has been related to birth defects d. Prescription psychotherapeutic drugs taken by the mother do not affect the fetus; otherwise, they would not have been prescribed

ANS: B Although a very small percentage of childbearing women have alcohol-related problems, alcohol abuse during pregnancy has been associated with a number of negative outcomes. Cigarette smoking impairs fertility and is a cause of low birth weight. Caffeine consumption has not been related to birth defects. Psychotherapeutic drugs have some effect on the fetus, and that risk must be weighed against their benefit to the mother.

Which statement regarding human trafficking is correct? a.Human trafficking is a multibillion-dollar business that primarily exists in the United States. b.Victims often experience the Stockholm syndrome. c.Vast majority of the victims are young boys and girls. d.Human trafficking primarily refers to commercial sex work.

ANS: B Although victims of sex trafficking can be young boys and girls, the vast majority are women and girls. They are often lured by false promises, such as a job or marriage, sold by their parents, or kidnapped by traffickers. These individuals are forced into sex work, hard labor, and organ donation. This $32 billion business exists in the United States and internationally. The Stockholm syndrome occurs when the slaves become attached to their enslavers. Health care professionals may interact with victims who are in captivity should they require emergent health care. The nurse is challenged to find an opportunity to speak with the client alone and assess for victimization.

The nurse suspects that a client who comes to the maternity clinic for a pregnancy test is in an abusive relationship. The nurse includes the abuse assessment screen as part of the assessment. Although the woman was very emotional and hesitant in responding to the questions, verbally she denied abuse as being a problem. While waiting for the results of the pregnancy test, the nurse decides to teach the client about partner abuse anyway. The rationale for the nurse's decision is that all women should be informed about: a. The nurse's ethical responsibility to protect clients b. The cycle of violence, which continues and escalates over time once it begins c. Women's legal right not to be controlled by men d. The masochistic nature of women who stay in abusive relationships

ANS: B Because of the cycle of violence and the loving respite phase, denial is a coping mechanism often used by battered women. During pregnancy the nurse should assess for abuse at each prenatal visit and on admission to labor. Although the nurse may feel an ethical responsibility to protect the client, it is not the best rationale for the nurse's behavior. Although women have a right not to be controlled by men, it is not the reason the nurse should continue the teaching with this client. The belief that women are masochistic is simply a myth.

5. Intimate partner violence (IPV) is seen in all races, ethnicities, religions, and socioeconomic backgrounds. Which statement is most accurate regarding the reporting of IPV in the United States? a. Asian women report more IPV than do other minority groups. b. Caucasian women report less IPV than do non-Caucasians. c. Native-American women report IPV at a rate similar to other groups. d. African-American women are less likely to report IPV than Caucasian women.

ANS: B Caucasian women report less IPV than other ethnic groups. Asian women report significantly less IPV than do other racial groups. Native-American and Alaska Native women report significantly more IPV than do women of any other racial background. African-American women tend to report violence at a slightly higher rate than Caucasian women.

3. The nurse should be aware that a statistic widely used to compare the health status of different populations is the: a. Incidence of specific infections, such as acquired immunodeficiency syndrome (AIDS) and tuberculosis b. Infant mortality rate c. Maternal morbidity rate d. Incidence of low-birth-weight (LBW) infants

ANS: B City, county, and state health departments provide annual reports of births and deaths. Maternal and infant death rates are particularly important because they reflect health outcomes that may be preventable. Infant mortality continues to be a concern in all populations. AIDS and tuberculosis may be the target of research studies; however, maternal and infant mortality rates are particularly important in the evaluation of the health of a population. The number of maternal deaths in the United States is small; however, worldwide many women die each year from problems related to pregnancy and childbirth. The incidence of LBW infants is monitored in order to determine risk factors such as racial disparity. It is not as widely used as infant mortality.

6. Contemporary maternity nursing is exemplified by: a. The use of midwives for all vaginal deliveries b. Family-centered care c. Free-standing birth clinics d. Physician-driven care

ANS: B Contemporary maternity nursing focuses on the family's needs and desires. Midwives and physicians both perform vaginal deliveries. Free-standing clinics are an example of alternative birth options. Contemporary maternity nursing is driven by the relationship between nurses and their clients.

Which trait is least likely to be displayed by a woman experiencing intimate partner violence (IPV)? a.Socially isolated b.Assertive personality c.Struggling with depression d.Dependent partner in a relationship

ANS: B Every segment of society is represented among women who are suffering abuse. However, traits of assertiveness, independence, and willingness to take a stand have been documented as more characteristic of women who are in nonviolent relationships. Women who are financially more dependent have fewer resources and support systems, exhibit symptoms of depression, and are more often seen as victims.

12. Maternity nursing care that is based on knowledge gained through research and clinical trials is: a. Derived from the Nursing Intervention Classification b. Known as evidence-based practice c. At odds with the Cochrane School of traditional nursing d. An outgrowth of telemedicine

ANS: B Evidence-based practice is based on knowledge gained from research and clinical trials. The Nursing Intervention Classification is a method of standardizing language and categorizing care. Dr. Cochrane systematically reviewed research trials and is part of the evidence-based practice movement. Telemedicine uses communication technologies to support health care.

In 1979, Lenore Walker pioneered the cause of women as victims of violence when she published her book The Battered Woman. While Walker conducted her research she found a similar pattern of abuse among many of the women. This concept is now referred to as the Cycle of Violence. Which phase does not belong in this three-cycle pattern of violence? a. Tension-building state b. Frustration followed by violence c. Acute battering incident d. Kindness and contrite, loving behavior

ANS: B Frustration followed by violence is not part of the Cycle of Violence. Tension-building state is also known as phase I of the cycle. The batterer expresses dissatisfaction and hostility with violent outbursts. The woman senses anger and anxiously tries to placate him. Acute battering incident is phase II of the cycle. It results in the man's uncontrollable discharge of tension toward the woman. Outbursts can last from several hours to several days and may involve kicking, punching, slapping, choking, burns, broken bones, and the use of weapons. Sometimes referred to as the honeymoon, kindness and contrite, loving behavior is the third phase of the cycle. The batterer feels remorseful and apologizes profusely. He tries to help the woman and often showers her with gifts.

9. An important development that concerns maternity nursing is integrative health care, which: a. Seeks to provide the same health care for all racial and ethnic groups b. Blends complementary and alternative therapies with conventional Western treatment c. Focuses on the disease or condition rather than the client's background d. Has been mandated by Congress

ANS: B Integrative health care tries to mix the old with the new at the discretion of the client and health care providers. Integrative health care is a blending of new and traditional practices. Integrative health care focuses on the whole person, not just the disease or condition. U.S. law supports complementary and alternative therapies but does not mandate them.

During the past 20 years the prevalence of obesity has doubled in the United States, with 25% of women older than 20 years of age being obese. Body mass index (BMI) is defined as the measure of an adult's weight in relation to his or her height. This is the most accurate measure of weight. This is an important part of the health screening process because obesity is closely associated with: a. The non-Hispanic Caucasian population b. A large number of chronic conditions c. Mostly acute illnesses d. Improved mental well-being

ANS: B Overweight and obesity are known risk factors for diabetes, heart disease, dyslipidemia, stroke, hypertension, arthritis, osteoporosis, and some types of cancer. In the United States the prevalence of obesity is highest among non-Hispanic black women, followed by Hispanic women, and non-Hispanic Caucasian women. Overweight and obesity are most frequently linked to chronic conditions. Improved mental well-being is a myth. In fact, obesity is associated with depression and increased stress.

Certain fatty acids classified as hormones that are found in many body tissues and have roles in many reproductive functions are known as: a. Gonadotropin-releasing hormone (GnRH) b. Prostaglandins (PGs) c. Follicle-stimulating hormone (FSH) d. Luteinizing hormone (LH)

ANS: B PGs affect smooth muscle contraction and changes in the cervix. GnRH is part of the hypothalamic-pituitary cycle, which responds to the rise and fall of estrogen and progesterone. FSH is part of the hypothalamic-pituitary cycle, which responds to the rise and fall of estrogen and progesterone. LH is part of the hypothalamic-pituitary cycle, which responds to the rise and fall of estrogen and progesterone.

Physiologically, sexual response can be characterized by: a. Coitus, masturbation, and fantasy b. Myotonia and vasocongestion c. Erection and orgasm d. Excitement, plateau, and orgasm

ANS: B Physiologically, according to Masters (1992), sexual response can be analyzed in terms of two processes: vasocongestion and myotonia. Coitus, masturbation, and fantasy are forms of stimulation for the physical manifestation of the sexual response. Erection and orgasm occur in two of the four phases of the sexual response cycle. Excitement, plateau, and orgasm are three of the four phases of the sexual response cycle.

16. The body part that both protects the pelvic structures and accommodates the growing fetus during pregnancy is the: a. Perineum b. Bony pelvis c. Vaginal vestibule d. Fourchette

ANS: B The bony pelvis protects and accommodates the growing fetus. The perineum covers the pelvic structures; the bony pelvis protects and accommodates the growing fetus. The vaginal vestibule contains openings to the urethra and vagina; the bony pelvis protects and accommodates the growing fetus. The fourchette is formed by the labia minor; the bony pelvis protects and accommodates the growing fetus.

A woman who is 6 months pregnant has sought medical attention, saying she fell down the stairs. What scenario would cause an emergency department nurse to suspect that the woman has been a victim of IPV? a.The woman and her partner are having an argument that is loud and hostile. b.The woman has injuries on various parts of her body that are in different stages of healing. c.Examination reveals a fractured arm and fresh bruises. D.She avoids making eye contact and is hesitant to answer questions

ANS: B The client may have multiple injuries in various stages of healing that indicates a pattern of violence. An argument is not always an indication of battering. A fractured arm and fresh bruises could be caused by the reported fall and do not necessarily indicate IPV. It may be normal for the woman to be reticent and have a dull affect.

Nurses must remember that pregnancy is a time of risk for all women. Which condition is likely the biggest risk for the pregnant client? a. Preeclampsia b. Intimate partner violence (IPV) c. Diabetes d. Abnormal Pap test

ANS: B The prevalence of IPV during pregnancy is estimated at 4% to 8% of all pregnant women. The risk for IPV and even IPV-related homicide is more common than all of the other pregnancy-related conditions. Although preeclampsia poses a risk to the health of the pregnant client, it is less common than IPV. Gestational diabetes continues to be a complication of pregnancy; however, it is less common than IPV during pregnancy. Some women are at risk for an abnormal Pap screening during pregnancy. This finding is not as common as IPV.

14. During a prenatal intake interview, the client informs the nurse that she would prefer a midwife to provide both her care during pregnancy and deliver her infant. What information is most appropriate for the nurse to share with this client? a. Midwifery care is only available to clients who are uninsured because their services are less expensive than an obstetrician. Costs are often lower than an obstetric provider. b. The client will receive fewer interventions during the birth process. c. She should be aware that midwives are not certified. d. Her delivery can take place only at home or in a birth center.

ANS: B This client will be able to participate actively in all decisions related to the birth process and is likely to receive fewer interventions during the birth process. Midwifery services are available to all low risk pregnant women, regardless of the type of insurance they have. Midwifery care in all developed countries is strictly regulated by a governing body that ensures that core competencies are met. In the United States, this body is the American College of Nurse-Midwives (ACNM). Midwives can provide care and delivery at home, in freestanding birth centers, and in community and teaching hospitals.

What are the responsibilities of the nurse who suspects or confirms any type of violence against a woman? (Select all that apply.) a.Report the incident to legal authorities. b.Provide resources for domestic violence shelters. c.Call a client advocate who can assist in the client's decision about what actions to take. d.Accurately and concisely document the incident (or findings) in the client's record. e.Reassure and support the client.

ANS: B, C, D, E Domestic violence is considered a crime in all states; however, mandatory reporting remains controversial. Nurses must become knowledgeable on the laws that apply in the state in which they practice. Caring for a client who may be a victim of domestic abuse is an ideal opportunity to provide the woman with information for safe houses or support groups for herself and her children. The nurse may assist in reaching out to a client advocate, which often occurs when potential legal action is taken or if the woman is seeking shelter. Documentation must be accurate and timely to be useful to the client later in court if she chooses to press charges. The primary functions for the nurse are to reassure the client and to provide her with emotional support.

Documentation of abuse can be useful to women later in court, should they elect to press charges. It is of key importance for the nurse to document accurately at the time that the client is seen. Which entry into the medical record would be the least helpful to the court? a.Photographs of injuries b.Clear and legible written documentation c.Summary of information (e.g., "The client is a battered woman.") d.Accurate description of the client's demeanor

ANS: C A statement such as, "The client is a battered woman" lacks the supporting factual information and will render the report inadmissible. More appropriate documentation would include exact statements from the woman in quotations (e.g., "My husband kicked me in the stomach"). The time and date of the examination should also be included.

A woman arrives at the clinic for her annual examination. She tells the nurse that she thinks she has a vaginal infection, and she has been using an over-the-counter cream for the past 2 days to treat it. The nurse's initial response should be to: a. Inform the woman that vaginal creams may interfere with the Papanicolaou (Pap) test for which she is scheduled b. Reassure the woman that using vaginal cream is not a problem for the examination c. Ask the woman to describe the symptoms that indicate to her she has a vaginal infection d. Ask the woman to reschedule the appointment for the examination

ANS: C An important element of the history and physical examination is the client's description of any symptoms she may be experiencing. Although this statement is true, the best response is for the nurse to inquire about the symptoms the woman is experiencing. Women should not douche, use vaginal medications, or have sexual intercourse for 24 to 48 hours before obtaining a Pap test. Although the woman may need to reschedule a visit for her Pap test, her current symptoms should still be addressed.

4. Alternative and complementary therapies: a. Replace conventional Western modalities of treatment b. Are used by only a small number of American adults c. Allow for more client autonomy d. Focus primarily on the disease an individual is experiencing

ANS: C City, county, and state health departments provide annual reports of births and deaths. Maternal and infant death rates are particularly important because they reflect health outcomes that may be preventable. Infant mortality continues to be a concern in all populations. Alternative and complementary therapies are part of an integrative approach to health care. An increasing number of American adults are seeking alternative and complementary health care options. Alternative healing modalities offer a holistic approach to health, focusing on the whole person and not just the disease.

While preparing a 21-year-old client for her first adult physical examination and Pap test, the nurse is aware of excessive shyness. The young woman states that she will not remove her bra because, "There is something wrong with my breasts; one is way bigger." What is the best response by the nurse in this situation? a."Please reschedule your appointment until you are more prepared." b. "It is okay; the provider will not do a breast examination." c. "I will explain normal growth and breast development to you." d. "That is unfortunate; this must be very stressful for you."

ANS: C During adolescence one breast may grow more quickly than the other. Full development of the breasts is not achieved until after the end of the first pregnancy and period of lactation. The client should be reassured regarding this aspect of growth and development. Female teenagers usually enter the health system for screening (Pap tests begin at age 21 or 3 years after first sexual activity). Situations such as these can produce great stress for the teenager, and the nurse and health care provider should treat her carefully. Asking her to reschedule will likely result in the client not returning for her appointment at all. A breast examination at her age is part of the complete physical examination. Young women should be taught about normal breast development and begin doing breast self-examinations. This response is inappropriate. Although acknowledging the client's stress shows empathy on the part of the nurse, it will not meet the client's need of deficient knowledge related to normal growth and development.

With regard to violence against women, intimate partner violence (IPV) nurses should be aware that: a. Relationship violence usually consists of a single episode that the couple can put behind them b. Violence often declines or ends with pregnancy c. Economic coercion is considered part of IPV d. Battered women generally are poorly educated and come from a deprived social background

ANS: C Economic coercion accompanies physical assault and psychologic attacks. IPV almost always follows an escalating pattern. It rarely ends with a single episode of violence. IPV often begins with and escalates during pregnancy. It may include both psychologic attacks and economic coercion. Race, religion, social background, age, and education level are not significant factors in differentiating women at risk.

The nurse guides a woman to the examination room and asks her to remove her clothes and put on an examination gown with the front open. The woman states, "I have special undergarments that I do not remove for religious reasons." The most appropriate response from the nurse would be: a. "You can't have an examination without removing all your clothes." b. "I'll ask the doctor to modify the examination." c. "Tell me about your undergarments. I'll explain the examination procedure, and then we can discuss how you can have your examination comfortably." d. "What? I've never heard of such a thing! That sounds different and strange."

ANS: C Explaining the examination procedure reflects cultural competence by the nurse and shows respect for the woman's religious practices. The nurse must respect the rich and unique qualities that cultural diversity brings to individuals. The examination can be modified to ensure that modesty is maintained. In recognizing the value of cultural differences, the nurse can modify the plan of care to meet the needs of each woman. Telling the client that her religious practices are different or strange is inappropriate and disrespectful to the client.

16. In order to ensure client safety, the practicing nurse must have knowledge of The Joint Commission's current "Do Not Use" list of abbreviations. Which term is acceptable for use regarding medication administration? a. q.o.d. or Q.O.D b. MSO4 or MgSO4 c. International Unit d. Lack of a leading zero

ANS: C I.U. and i.u. are no longer acceptable because they could be misread as "I.V." or the number 10. Q.O.D. should be written out as "every other day." The period after the "Q" could be mistaken for an "I" and the "o" could also be mistaken for an "i." It is too easy to confuse one medication for another. These medications are used for very different purposes and could put a client at risk for an adverse outcome. They should be written as morphine sulfate andmagnesium sulfate. The decimal point should never be missed before a number, to avoid confusion; i.e., 0.4 rather than .4. A leading zero is the preferred term.

Proper documentation of the abuse as reported by the victim is a crucial role of the nurse. Evaluate the following data, which include information from the victim, and choose the best documentation by the nurse. A 34-year-old Caucasian arrives at the emergency department with a black right eye; she also is bleeding from the left side of her head. She reports that her boyfriend has been abusing her physically. The nurse performs a history and physical examination and documents her findings. a. "Client alleges that her boyfriend beat her up." b. "Client reports that her boyfriend hit her in the eye and head." c. "Client is a 34-year-old Caucasian female. Presents with periorbital ecchymosis on right side. Laceration of left parietal area, 3 cm long with tissue bridging. Approximately 1 cm deep. Client states that her boyfriend 'threw a brick from 10 feet away, aiming at my head. The corner of the brick hit the left side of my head.' She reports that he also 'hit me in the eye.' Client indicates that the hit was with her boyfriend's closed left fist." d. "Client presents with a black eye and a cut on the left side of her head. Reports being abused."

ANS: C It is important to list the name of the abuser, if possible, because a defense strategy is to portray the victim as having more than one partner. Listing the name eliminates any confusion as to who the abuser was. In addition, using accurate medical terminology is crucial. If you are unsure of the proper descriptive terms to use in documentation, simply describe what you see without labeling the injury. Photographs should be taken. Documenting only that the client states that her boyfriend beat her lacks specificity and important details related to the event. In addition, improper medical terminology is used. This type of documentation would be detrimental to the victim's case if she were to pursue legal recourse against the abuser. Documenting only that the client states that her boyfriend hit her in the eye and head lacks specificity and important details related to the event. In addition, improper medical terminology is used. This type of documentation would be detrimental to the victim's case if she were to pursue legal recourse against the abuser. Documenting only that the client reports being abused lacks specificity and important details related to the event. In addition, improper medical terminology is used. This type of documentation would be detrimental to the victim's case if she were to pursue legal recourse against the abuser.

5. Prostaglandins are produced in most organs of the body, including the uterus. Other source(s) of prostaglandins is/are: a.Ovaries b. Breast milk c. Menstrual blood d. The vagina

ANS: C Menstrual blood is a potent source of prostaglandins. Prostaglandins are not produced in the ovaries. Breast milk is not a source of prostaglandins. The vagina neither produces nor is a source of prostaglandins.

3. Menstruation is periodic uterine bleeding: a. That occurs every 28 days b. In which the entire uterine lining is shed c. That is regulated by ovarian hormones d. That leads to fertilization

ANS: C Menstruation is periodic uterine bleeding that is controlled by a feedback system involving three cycles: the endometrial cycle, the hypothalamic-pituitary cycle, and the ovarian cycle. The average length of a menstrual cycle is 28 days, but variations are normal. During the endometrial cycle, the functional two thirds of the endometrium is shed. Lack of fertilization leads to menstruation.

7. A 38-year-old Hispanic woman delivered a 9-lb, 6-oz baby girl vaginally after being in labor for 43 hours. The baby died 3 days later from sepsis. On what grounds could the woman have a legitimate legal case for negligence? a. She is Hispanic. b. She delivered a girl. c. If the standards of care were not met. d. She refused fetal monitoring.

ANS: C Not meeting the standards of care is a legitimate factor for a case of negligence. The client's race is not a factor for a case of negligence. The infant's gender is not a factor for a case of negligence. Although fetal monitoring is the standard of care, the client has the right to refuse treatment. This refusal is not a case for negligence, but informed consent should be properly obtained, and the client should sign an against medical advice form for refusal of any treatment that is within the standard of care

5. The nurses working at a newly established birthing center have begun to compare their performance in providing maternal-newborn care against clinical standards. This comparison process, designed to improve the quality of client care, is called: a.. Best practices network b. Clinical benchmarking c. Outcomes-oriented care d. Evidence-based practice

ANS: C Outcomes-oriented care measures effectiveness of interventions and quality of care against benchmarks or standards. The term best practice refers to a program or service that has been recognized for excellence. Clinical benchmarking is a process used to compare one's own performance against the performance of the best in an area of service. The term evidence-based practice refers to the provision of care based on evidence gained through research and clinical trials.

One purpose of preconception care is to: a. Ensure that pregnancy complications do not occur b. Identify women who should not become pregnant c. Encourage healthy lifestyles for families desiring pregnancy d. Ensure that women know about prenatal care

ANS: C Preconception counseling guides couples in how to avoid unintended pregnancies, how to identify and manage risk factors in their lives and their environment, and how to identify healthy behaviors that promote the well-being of the woman and her potential fetus. Preconception care does not ensure that pregnancy complications will not occur. In many cases, problems can be identified and treated and may not recur in subsequent pregnancies. In many instances, counseling can allow behavior modification before damage is done, or a woman can make an informed decision about her willingness to accept potential hazards. If a woman is seeking preconception care, she likely is aware of prenatal care.

Which statement is the most comprehensive description of sexual violence? a.Sexual violence is limited to rape. b.Sexual violence is an act of force during which an unwanted and uncomfortable sexual act occurs. c.Sexual violence encompasses a number of sexual acts. d.Sexual violence includes degrading sexual comments and behaviors.

ANS: C Sexual violence is a broad term that includes a range of sexual victimization including sexual assault, sexual harassment, and rape. It may include but is not limited to rape. Sexual assault includes unwanted or uncomfortable touches, kisses, hugs, petting, intercourse, or other sexual acts. It is a component of sexual violence. Unwelcome or degrading e-mail messages, comments, contact, or behavior, such as exhibitionism, that makes any environment feel unsafe is known as sexual harassment.

In the 1970s, the rape-trauma syndrome (RTS) was identified as a cluster of symptoms and related behaviors observed in the weeks and months after an episode of rape. Researchers identified three phases related to this condition. Which phase is not displayed in a client with RTS? a.Acute Phase: Disorganization b.Outward Adjustment Phase c.Shock/Disbelief: Disorientation Phase d.Long-Term Process: Reorganization Phase

ANS: C Shock, disbelief, or disorientation is a component of the Acute Phase. The rape survivor feels embarrassed, degraded, fearful, and angry. She may feel unclean and want to bathe and douche repeatedly, even though doing so may destroy evidence. The victim relives the scene over and over in her mind, thinking of things she "should have done." During the Outward Adjustment Phase, the victim may appear to have resolved her crisis and return to activities of daily living and work. Other women may move, leave their job, and buy a weapon to protect themselves. Disorientation is a reaction during which the victim may feel disoriented, have difficulty concentrating, or have poor recall. The Long-Term Process is the reorganization phase. This recovery phase may take years and may be difficult and painful.

The microscopic examination of scrapings from the cervix, endocervix, or other mucus membranes to detect premalignant or malignant cells is called: a. Bimanual palpation b. Rectovaginal palpation c. A Papanicolaou (Pap) test d. The four A's procedure

ANS: C The Pap test is a microscopic examination for cancer that should be performed regularly, depending on the client's age. Bimanual palpation is a physical examination of the vagina; the Pap test is a microscopic examination for cancer. Rectovaginal palpation is a physical examination performed through the rectum; the Pap test is a microscopic examination for cancer. The four A's is an intervention procedure to help a client stop smoking. The Pap test is a microscopic examination for cancer.

The primary theme of the feminist perspective on violence against women recognizes the: a. Role of testosterone as the underlying cause of men's violent behavior b. Basic human instinctual drive toward aggression c. Dominance and coercive control over women by men d. Cultural norm of violence in Western society

ANS: C The contemporary social view of violence is derived from the feminist theory. With the primary theme of male dominance and coercive control, this view enhances our understanding of all forms of violence against women, including wife battering, stranger and acquaintance rape, incest, and sexual harassment in the workplace. The role of testosterone as an underlying cause of men's violent behavior is not associated with the feminist perspective of violence against women. The basic human instinctual drive toward aggression is not associated with the feminist perspective. The cultural norm of violence in Western society is not associated with the feminist perspective regarding violence against women.

17. A fully matured endometrium that has reached the thickness of heavy, soft velvet describes the _____ phase of the endometrial cycle. a. Menstrual b. Proliferative c. Secretory d. Ischemic

ANS: C The secretory phase extends from the day of ovulation to approximately 3 days before the next menstrual cycle. During this phase the endometrium becomes fully mature. During the menstrual phase the endometrium is being shed; the endometrium is fully mature again during the secretory phase. The proliferative phase is a period of rapid growth, but the endometrium becomes fully mature again during the secretory phase. During the ischemic phase the blood supply is blocked and necrosis develops. The endometrium is fully mature during the secretory phase.

Intervention for the sexual abuse survivor often is not attempted by maternity and women's health nurses because of the concern about increasing the distress of the woman and the lack of expertise in counseling. What initial intervention is appropriate and most important in facilitating the woman's care? a. Initiating a referral to an expert counselor b. Setting limits on what the client discloses c. Listening and encouraging therapeutic communication skills d. Acknowledging the nurse's discomfort to the client as an expression of empathy

ANS: C The survivor needs support on many different levels, and a women's health nurse may be the first person to whom she relates her story. Therapeutic communication skills and listening are initial interventions. Referring this client to a counselor is an appropriate measure but not the most important initial intervention. A client should be allowed to disclose any information she feels the need to discuss. As a nurse you should provide a safe environment in which she can do so. Either verbal or nonverbal shock and horror reactions from the nurse are particularly devastating. Professional demeanor and professional empathy are essential.

A 20-year-old client calls the clinic to report that she has found a lump in her breast. The nurse's best response is: a. "Don't worry about it. I'm sure it's nothing." b. "Wear a tight bra, and it should shrink." c. "Many women have benign lumps and bumps in their breasts. However, to make sure it's benign you should come in for an examination by your physician." d. "Check it again in 1 month and call me back if it's still there."

ANS: C Try to ease the client's fear but provide a time for a thorough evaluation of the lump, because it may indicate abnormal changes in the breast. Discrediting the client's findings may discourage her from continuing with breast self-examination (BSE). Wearing a tight bra may irritate the skin and will not cause the lump to shrink. Delaying treatment may allow proliferation of abnormal cells.

2. What is the primary role of practicing nurses in the research process? a.Designing research studies b.Collecting data for other researchers c.Identifying researchable problems d.Seeking funding to support research studies

ANS: C When problems are identified, research can be properly conducted. Research of health care issues leads to evidence-based practice guidelines. Designing research studies is only one factor of the research process. Data collection is another factor of research. Financial support is necessary to conduct research, but it is not the primary role of the nurse in the research process.

2. Common characteristics of a potential batterer include (choose all that apply): a. High level of self-esteem b. High frustration tolerance c. Substance abuse problems d. Excellent verbal skills e. Personality disorders

ANS: C, E Substance abuse and personality disorders are often seen in batterers. Typically the batterer has low self-esteem. Batterers usually have a low frustration level (i.e., they lose their temper easily). Batterers characteristically have poor verbal skills and especially can have difficulty expressing their feelings.

8. The National Quality Forum has issued a list of "never events" pertaining specifically to maternal and child health. These include all except: a. Infant discharged to the wrong person b. Kernicterus associated with failure to identify and treat hyperbilirubinemia c. Artificial insemination with wrong donor sperm or egg d. Foreign object retained after surgery

ANS: D Although a foreign object retained after surgery is a never event, this does not pertain specifically to obstetric clients. A client undergoing any type of surgery may be at risk for this event. An infant discharged to the wrong person pertains specifically to postpartum care. Death or serious disability as a result of kernicterus pertains to newborn assessment and care. Artificial insemination affects families seeking care for infertility.

Women with severe and persistent mental illness are likely to be more vulnerable to being involved in controlling and/or violent relationships; however, many women develop mental health problems as a result of long-term abuse. Which condition is unlikely to be a psychologic consequence of continued abuse? a.Substance abuse b.Posttraumatic stress disorder (PTSD) c.Eating disorders d.Bipolar disorder

ANS: D Bipolar disorder is a specific illness (also known as manic depressive disorder) not related to abuse. Substance abuse is a common method of coping with long-term abuse. The abuser is also more likely to use alcohol and other chemical substances. PTSD is the most prevalent mental health sequela of long-term abuse. The traumatic event is persistently re-experienced through distress recollection and dreams. Eating disorders, depression, psychologic-physiologic illness, and anxiety reactions are all mental health problems associated with repeated abuse.

As part of their participation in the gynecologic portion of the physical examination, nurses should: a. Take a firm approach that encourages the client to facilitate the exam by following the physician's instructions exactly b. Explain the procedure as it unfolds and continue to question the client to get information in a timely manner c. Take the opportunity to explain that the trendy vulvar self-examination is only for women at risk for cancer d. Help the woman relax through proper placement of her hands and proper breathing during the exam

ANS: D Breathing techniques are important relaxation techniques that can help the client during the exam. The nurse should encourage the client to participate in an active partnership with the care provider. Explanations during the procedure are fine, but many women are uncomfortable answering questions in the exposed and awkward position of the exam. Vulvar self-examination on a regular basis should be encouraged and taught during the exam.

A 23-year-old African-American woman is pregnant with her first child. Based on the statistics for infant mortality, which plan is most important for the nurse to implement? a.Perform a nutrition assessment. b.Refer the woman to a social worker. c.Advise the woman to see an obstetrician, not a midwife. d.Explain to the woman the importance of keeping her prenatal care appointments.

ANS: D Consistent prenatal care is the best method of preventing or controlling risk factors associated with infant mortality. Nutritional status is an important modifiable risk factor, but it is not the most important action a nurse should take in this situation. The client may need assistance from a social worker at some time during her pregnancy, but a referral to a social worker is not the most important aspect the nurse should address at this time. If the woman has identifiable high-risk problems, then her health care may need to be provided by a physician. However, it cannot be assumed that all African-American women have high-risk issues. In addition, advising the woman to see an obstetrician is not the most important aspect on which the nurse should focus at this time, and it is not appropriate for a nurse to advise or manage the type of care a client is to receive.

4. The primary responsibility of the nurse who suspects or confirms any type of violence against a woman is: a. Report the incident to legal authorities b. Provide information to social services c. Call a client advocate who can assist in the client's decision making about what action to take d. Document the incident (or findings) accurately and concisely in the client's record

ANS: D Documentation can be useful to women later in court if they choose to press charges. Although many states have mandatory reporting laws, the primary responsibility of the nurse is to document the incident and findings. Social services is called only if a child also is a victim of violence or had witnessed the violence. A client advocate usually is notified when legal action is to be taken or if the woman is seeking shelter. The nurse may assist in this endeavor, but it is not the first action to be taken.

The nurse's best measure of evaluating care of a rape victim is that: a. All legal evidence is preserved during the physical examination b. The victim appreciates the legal information but decides not to pursue legal proceedings c. The victim states that she is going to advocate against sexual violence d.The victim leaves the health care facility without feeling revictimized

ANS: D Nurses can assist clients through an examination that is as nontraumatic as possible with kindness, skill, and empathy. The initial care of the victim affects her recovery and decision to receive follow-up care. Preservation of all legal evidence is very important; however, this may not be the best measure in terms of evaluating care of a rape victim. Offering legal information is not the best measure of evaluating the care that this victim received. The victim may well decide not to pursue legal proceedings. Advocating against sexual violence may be extremely therapeutic for the client after her initial recovery. This is not a measure of evaluating her care.

During a prenatal intake interview, the nurse is in the process of obtaining an initial assessment of a 21-year-old Hispanic client with limited English proficiency. Which action is the most important for the nurse to perform? a.Use maternity jargon to enable the client to become familiar with these terms. b.Speak quickly and efficiently to expedite the visit. c.Provide the client with handouts. d.Assess whether the client understands the discussion.

ANS: D Nurses contribute to health literacy by using simple, common words, avoiding jargon, and evaluating whether the client understands the discussion. Speaking slowly and clearly and focusing on what is important will increase understanding. Most client education materials are written at a level too high for the average adult and may not be useful for a client with limited English proficiency.

A blind woman has arrived for an examination. Her guide dog assists her to the examination room. She appears nervous and says, "I've never had a pelvic examination." The nurse's most appropriate response would be: a. "Don't worry. It will be over before you know it." b. "Try to relax. I'll be very gentle, and I won't hurt you." c. "Your anxiety is common. I was anxious when I first had a pelvic examination." d. "I'll let you touch each item that I'll use during the examination as I tell you how it will be used."

ANS: D The client who is visually impaired needs to be oriented to the examination room and needs a full explanation of what the examination entails before the nurse proceeds. Telling the client that the examination will be over quickly diminishes the client's concerns. The nurse should communicate openly and directly with sensitivity. Women who have physical disabilities should be respected and involved in the assessment and physical examination to the full extent of their abilities. Telling the client that she won't be hurt does not reflect respect or sensitivity. Although anxiety may be common, the nurse should not discuss her own issues nor compare them to the client's concerns.

18. The stimulated release of gonadotropin-releasing hormone (GnRH) and follicle-stimulating hormone (FSH) is part of the: a. Menstrual cycle b. Endometrial cycle c. Ovarian cycle d. Hypothalamic-pituitary cycle

ANS: D The cyclic release of hormones is the function of the hypothalamus and pituitary glands. The menstrual cycle is a complex interplay of events that occur simultaneously in the endometrium, hypothalamus, pituitary glands, and ovaries. The endometrial cycle consists of four phases: menstrual phase, proliferative phase, secretory phase, and ischemic phase. The ovarian cycle remains under the influence of FSH and estrogen.

15. While obtaining a detailed history from a woman who has recently immigrated from Somalia, the nurse realizes that the client has undergone female genital mutilation. The nurse's best response to this client is: a. "This is a very abnormal practice and rarely seen in the United States." b. "Are you aware of who performed this so that it can be reported to the authorities?" c. "We will be able to fully restore your circumcision after delivery." d. "The extent of your circumcision will affect the potential for complications."

ANS: D The extent of the circumcision is important. The client may experience pain, bleeding, scarring, or infection and may require surgery prior to childbirth. Although this practice is not prevalent in the United States, it is very common in many African and Middle Eastern countries for religious reasons. Mentioning that the practice is abnormal and rarely seen in the United States is culturally insensitive. The infibulation may have occurred during infancy or childhood. The client will have little to no recollection of the event. She would have considered this to be a normal milestone during her growth and development. The International Council of Nurses has spoken out against this procedure as harmful to a woman's health.

Chapter 4. Assessment and Health Promotion The two primary functions of the ovary are: a. Normal female development and sex hormone release b. Ovulation and internal pelvic support c. Sexual response and ovulation d. Ovulation and hormone production

ANS: D The two functions of the ovaries are ovulation and hormone production. The presence of ovaries does not guarantee normal female development. The ovaries produce estrogen, progesterone, and androgen. Ovulation is the release of a mature ovum from the ovary; the ovaries are not responsible for interval pelvic support. Sexual response is a feedback mechanism involving the hypothalamus, anterior pituitary gland, and the ovaries. Ovulation does occur in the ovaries.

11. The high cost of health care in the United States is most likely a result of: a. Early postpartum discharge policies b. Midwifery care c. The involvement of nurses in the politics of cost containment d. An emphasis on the use of advanced technology in care

ANS: D The use of advanced technology in care increases costs. Caring for the increased number of low-birth-weight infants in neonatal intensive care unit (NICU) settings contributes significantly to increased health care costs. Early discharges reduce costs. Midwifery care reduces costs. Involvement of nurses should ameliorate costs.

Before beginning the health history interview, the nurse should perform all actions except: a. Smile and ask the client whether she has any special concerns b. Speak in a relaxed manner with an even, nonjudgmental tone c. Make the client comfortable d. Tell the client her questions are irrelevant

ANS: D The woman should be assured that all of her questions are relevant and important. It is important to begin any client interaction with a smile. This assists in putting the client at ease. If the nurse speaks in a relaxed manner, the client will likely be more relaxed during the interview. Always ensure the client's comfort prior to beginning the interview.

TRUE/FALSE 1. Violence against women remains a major health care problem in the United States, affecting millions of women annually. Fortunately, during pregnancy violence often stops entirely or diminishes. Is this true or false?

ANS: F Pregnancy is often when violence either begins or escalates. Maternity and women's health nurses, by the nature of their practice are in a unique position to provide sensitive care to women in abusive relationships, engage in prevention, and influence health care and public policy.

TRUE/FALSE 1. Researchers have found that most client education materials used are written at too high a reading level for the average adult. Is this true or false?

ANS: T As a result of the increasing multicultural U.S. population, there is an urgent need to address health literacy as a component of culturally and linguistically competent care. Health care providers contribute to health literacy by using simple common words, avoiding jargon, and developing appropriate written materials.

Which of the following statements by a pregnant woman indicates she needs additional teaching on ways to reduce risks to her unborn child from the potential effects of exposure to toxoplasmosis?a. "I will avoid rare lamb."b. "I will wear a mask when cleaning my cat's litter box."c. "I understand that exposure to toxoplasmosis can cause blindness in the baby."d. "I will avoid rare beef."

ANS: b Feedback a. Exposure occurs when the protozoan parasite found in cat feces and uncooked or rare beef and lamb is ingested. b. Correct. Pregnant women and women who are attempting pregnancy should avoid contact with cat feces. Exposure occurs when the protozoan parasite found in cat feces and uncooked or rare beef and lamb is ingested. Wearing a mask will not decrease the risk through ingestion of the parasite. c. Exposure to toxoplasmosis can cause fetal death, mental retardation, and blindness. d. Exposure occurs when the protozoan parasite found in cat feces and uncooked or rare beef and lamb is ingested.

A client is to take Clomiphene Citrate for infertility. Which of the following is the expected action of this medication? a. Decrease the symptoms of endometriosis b. Increase serum progesterone levels c. Stimulate release of FSH and LH d. Reduce the acidity of vaginal secretions

ANS: c Feedback a. Clomiphene Citrate will not reduce a client's symptoms of endometriosis. b. Clomiphene Citrate will not increase a client's progesterone levels. c. Clomiphene Citrate stimulates release of FSH and LH. d. Clomiphene Citrate will not reduce the acidity of vaginal secretions.

. A diagnostic test commonly used to assess problems of the fallopian tubes is:a. Endometrial biopsyb. Ovarian reserve testingc. Hysterosalpingogramd. Screening for sexually transmitted infections

ANS: c Feedback a. Endometrial biopsy provides information on the response of the uterus to hormonal signals. b. Ovarian reserve testing is used to assess ovulatory functioning. c. Correct. Hysterosalpingogram provides information on the endocervical canal, uterine cavity, and fallopian tubes. d. STIs can cause adhesions within the fallopian tubes, but screening cannot confirm that adhesions are present.

3. The fetal circulatory structure that connects the pulmonary artery with the descending aorta is known as which of the following?a. Ductus venosus b. Foramen ovale c. Ductus arteriosus d. Internal iliac artery

ANS: c Feedback a. The ductus venosus connects the umbilical vein to the inferior vena cava. b. The foramen ovale is the opening between the right and left atria. c. Correct. d. The internal iliac artery connects the external iliac artery to the umbilical artery.

1. The color of a person's hair is an example of which of the following?a. Genomeb. Sex-link inheritancec. Genotyped. Phenotype

ANS: d Feedback a. Genome is an organism's complete set of DNA. b. Sex-link inheritance refers to genes or traits that are located only on the X chromosome. c. Genotype refers to a person's genetic makeup. d. Correct. Phenotype refers to how genes are outwardly expressed, such as eye color, hair color, and height.

A woman at 40 weeks' gestation has a diagnosis of oligohydramnios. Which of the following statements related to oligohydramnios is correct?a. It indicates that there is a 25% increase in amniotic fluid.b. It indicates that there is a 25% reduction of amniotic fluid.c. It indicates that there is a 50% increase in amniotic fluid.d. It indicates that there is a 50% reduction of amniotic fluid.

ANS: d Feedback a. Oligohydramnios is a decrease, not an increase in amniotic fluid. b. Oligohydramnios is a 50% reduction in amniotic fluid. c. Oligohydramnios is a decrease, not an increase in amniotic fluid. d. Correct. Oligohydramnios refers to a decreased amount of amniotic fluid of less than 500 mL at term or 50% reduction of normal amounts.

The ovarian cycle includes which of the following phases? (Select all that apply.

Follicular phase Ovulatory phase Luteal phase Follicular phase, ovulatory phase, and luteal phase are part of the ovarian cycle

A nurse is teaching a woman about her menstrual cycle. The nurse states that __________ is the most important change that happens during the secretory phase of the menstrual cycle.

Proliferation of the endometrium The proliferation of the endometrium occurs during the secretory phase of the menstrual cycle.

The clinic nurse knows that the part of the endometrial cycle occurring from ovulation to just prior to menses is known as the:

Secretory phase The secretory phases occurs from the time of ovulation to the period just prior to menses, or approximately days 15 to 26.

The nurse takes the history of a client, G2 P1, at her first prenatal visit. The client is referred to a genetic counselor, due to her previous child having a diagnosis of __________.

Sickle cell anemia c. Sickle cell anemia is an autosomal recessive illness. This client needs to be seen by a genetic counselor.

A major fetal development characteristic at 16 weeks' gestation is:

Teeth begin to form

A nurse working with an infertile couple has made the following nursing diagnosis: Sexual dysfunction related to decreased libido. Which of the following assessments is the likely reason for this diagnosis?

The couple has established a set schedule for their sexual encounters. Couples who "schedule" intercourse often complain that their sexual relationship is unsatisfying.

Karen, a 26-year-old woman, has come for preconception counseling and asks about caring for her cat as she has heard that she "should not touch the cat during pregnancy." The clinic nurse's best response is:

Toxoplasmosis is a concern during pregnancy, so it is important to have someone else change the cat's litter pan and also to avoid consuming uncooked meat. Women need to be aware that Toxoplasma gondii, a single-celled parasite, is responsible for the infection toxoplasmosis. The majority of individuals who become infected with toxoplasmosis are asymptomatic, although when present, symptoms are described as "flu like" and include glandular pain and enlargement and myalgia. Severe toxoplasmosis infection may cause damage to the fetal brain, eyes, or other organs. Toxoplasmosis is usually acquired by consuming raw or poorly cooked meat that has been contaminated with T. gondii. Toxoplasmosis may also be acquired through close contact with feces from an infected animal (usually cats) or soil that has been contaminated with T. gondii.

A couple who has been attempting to become pregnant for 5 years is seeking assistance from an infertility clinic. The nurse assesses the clients' emotional responses to their infertility. Which of the following responses would the nurse expect to find? (Select all that apply.)

a. Anger at others who have babies. b. Feelings of failure because they cannot make a baby. d. Guilt on the part of one partner because he or she is unable to give the other a baby. a. Infertile couples often feel anger toward couples who have babies. b. Infertile couples often express feelings of personal failure. d. Guilt is often expressed by the couple.

Which of the following places a couple at higher risk for conceiving a child with a genetic abnormality? (Select all that apply.)

a. Maternal age over 35 years b. Partner who has a genetic disorder Fertility decreases after 35 years. A partner contributes half of the chromosomal makeup, and genetic disorders can be inherited. Maternal diabetes can have an effect on the fetus/neonate, such as causing complications such as macrosomia and hypoglycemia, but these are not genetic disorders.

A couple is undergoing an infertility workup. The semen analysis indicates a decreased number of sperm and immature sperm. Which of the following factors can have a potential effect on sperm maturity? (Select all that apply.)

a. The man rides a bike to and from work each day. b. The man takes a calcium channel blocker for the treatment of hypertension. The daily riding of a bike can be the cause of prolonged heat exposure to the testicles. Prolonged heat exposure is a gonadotoxin. A number of medications, such as calcium channel blockers, can have an effect on sperm production.

The clinic nurse recognizes that pregnant women who are in particular need of support are those who (select all that apply):

b. Are awaiting genetic testing results d. Are trying to conceal this pregnancy as long as possible A second pregnancy is not an indication of a woman in need of additional support. A support system may be lacking for women who are trying to conceal a pregnancy or for women who are trying to keep the news of their pregnancy from relatives or friends until results from genetic tests are known

A woman seeks care at an infertility clinic. Which of the following tests may this woman undergo to determine what, if any, infertility problem she may have? (Select all that apply.)

b. Endometrial biopsy c. Hysterosalpingogram d. Serum FSH analysis b. Endometrial biopsy is performed about 1 week following ovulation to detect the endometrium's response to progesterone. c. Hysterosalpingogram is used to determine if fallopian tubes are patent. d. Serum FSH levels are used to assess ovarian function.