WOMEN'S HEALTH - YOUNGKIN MIDTERM

The postpartum nurse is educating a patient who is preparing to go home from the hospital. Which statements made by the patient indicate understanding of contraceptive use after childbirth?

"Just because I am breastfeeding does not mean I cannot get pregnant."

A 38-year-old widow consults you 2 years after her husband's accidental death. She is planning to remarry and asks about the possibility of resuming the low-dose oral contraceptives she took before she was widowed. Which one of the following may contraindicate resumption of oral contraceptives? (check one) A. Her 42-year-old sister has breast cancer B. Her blood pressure is 135/88 mm Hg C. She smokes a pack of cigarettes each day D. She has a history of migraines resistant to triptans E. Her LDL/HDL ratio is 2.8

C Oral contraceptives increase the risk of venous thromboembolic phenomena. The combination of oral contraceptives and smoking substantially increases the risk of cardiovascular disease. Caution should be exercised in prescribing oral contraceptives for women older than 35 years of age who smoke. In general, oral contraceptive use is considered absolutely contraindicated in women older than 35 who are heavy smokers. Women who smoke fewer than 15 cigarettes a day and patients with mildly elevated blood pressure and elevated lipid levels are not at increased risk for cardiovascular disease when oral contraceptives are used. Ref: Seibert C, Barbouche E, Fagan J, et al: Prescribing oral contraceptives for women older than 35 years of age. Ann Intern Med 2003;138:54-64.

What are high risk types of HPV? a) 6 & 11 b) 8 & 21 c) 16 & 18 d) 23 & 48

C) 16 & 18 (also 33, 35, 39, 45, 51, 52, 56, 58, and 59) Types 6 & 11 are low-risk strains of HPV and cause warts.

Which client statement indicates the need for further teaching? A."I won't change the cat's litter box during the pregnancy." B."It's important to exercise during my pregnancy." C."I will schedule my next appointment as soon as I leave." D."I will not eat sushi during my pregnancy."

C. "I will schedule my next appointment as soon as I leave." The nurse is teaching a woman who is 8 weeks pregnant to avoid teratogens.

A client asks the nurse about the importance of preconception counseling. In responding, the nurse states that preconception counseling helps women lessen risky behaviors and eliminate exposure to harmful substances. Which statement made by the nurse about contraception cessation would be included in the preconception counseling? A. "Women taking contraception up to a month before pregnancy will be better able to conceive and date the pregnancy." B. "Women using hormonal contraception need to discontinue its use at least one menstrual period before conception." C. "It may take several months or up to a year to conceive after discontinuing Depo-Provera." D. "Women using an intrauterine device (IUD) will have it removed during labor."

C. "It may take several months or up to a year to conceive after discontinuing Depo-Provera."

A nurse is providing prenatal education to a group of primigravida clients with gestational diabetes. Which is the nurse's best explanation for increased maternal insulin needed during the second trimester? A. "Placental hormone human chorionic gonadotropin (hCG) causes maternal insulin resistant." B. "Placental hormone progesterone causes maternal insulin resistant." C. "Placental hormone human chorionic somatomammotropin (hCS) causes maternal insulin resistant." D. "Placental hormone oxytocin causes maternal insulin resistant."

C. "Placental hormone human chorionic somatomammotropin (hCS) causes maternal insulin resistant."

A nurse is reviewing the care plan for a woman in the third trimester of her first pregnancy. Which action by the patient best indicates positive adaptation to the pregnancy and impending motherhood? A. Attended three prenatal classes with her partner to learn about labor B. Continues to exercise, maintains a healthy diet, quit smoking recently C. Educated about pregnancy, fetal growth and development, and motherhood D. Has prepared a well-stocked nursery complete with stimulating toys

C. Educated about pregnancy, fetal growth and development, and motherhood Attending prenatal classes, maintaining a healthy lifestyle, and having a prepared space for the baby are all tasks that indicate some degree of positive adaptation to a pregnancy. However, the best indicator of positive adaptation is when the woman can be described as well educated on pregnancy, growth and development of the fetus, and motherhood. This is much more inclusive than the other individual tasks

In general, women are encouraged to be screened for breast cancer a) Every 1-2 years after age 40 b) Every 3 years after age 50 c) Every 5 years after age 40 d) Every year after age 50

A) Every 1-2 years after age 40(USPSTF, ACOG, ACS) ACNM Prep Workbook, P. 88

Which finding is significant for breast cancer? a) Peau d'Orange b) Enlarged lymph nodes c) Rubbery, movable mass d) Spontaneous nipple discharge

A) Peau d'Orange Sign of Paget's disease, inflammatory breast cancer

A 25 yo woman presents to your clinic for a follow-up visit with a cervical cytology result of ASCUS. What is your next step in management? a) Test for HPV b) Conduct co-testing in 12 months c) Repeat cytology in 1 year d) Routine cytology in 3 years as per age-specific guidelines

A) Test for HPV Since she is <30 yo, HPV testing was not done, if HPV is positive (+), she should go for colposcopy.If HPV test is negative (-), she should continue routine testing as per age-specific guidelines (cytology-only in 3 years) ASCCP 2012 Guidelines(http://www.asccp.org/asccp-guidelines)

A perinatal clinic nurse educated a pregnant woman about basic prenatal exercises. On a return visit, which statement by the patient indicates that teaching goals have been met? A. "I have learned to isolate the right muscle for Kegel exercises." B. "It's hard to find 30 minutes a day for exercise, but I have done it." C. "Jumping rope is great exercise and keeps my weight in control." D. "When I get fatigued with these exercises, I just push through it."

A. "I have learned to isolate the right muscle for Kegel exercises." Kegel exercises are among the basic prenatal exercises taught to all pregnant women. In order to do them correctly, the woman needs to learn to isolate the pubococcygeal (PC) muscle. Women can obtain benefits from exercising as little as 10 minutes a day; jumping rope should be avoided because it involves too much bouncing; and when the pregnant woman is fatigued, she should rest.

A gravid patient with severe asthma asks the nurse if she should stop taking her asthma medications because she is worried they may harm her fetus. Which response by the nurse is most appropriate? A."Medications commonly used for asthma management are considered safe during pregnancy. Let's talk with your provider about them." B."You should take your bronchodilators, but do not take any steroid medications while pregnant." C."If you can't breathe, the baby can't breathe, so you should take the medicine." D."There is really no medication that is safe during pregnancy."

A. "Medications commonly used for asthma management are considered safe during pregnancy. Let's talk with your provider about them."

A woman in the clinic complains of severe hot flashes associated with perimenopause. Her past medical history includes deep vein thrombosis (DVT) 10 years ago. The nurse can anticipate teaching the woman about what treatment?

A. A trial of a selective serotonin reuptake inhibitor Rational: Selective serotonin reuptake inhibitors, such as fluoxetine (Prozac), citalopram (Celexa), and sertraline (Zoloft), have been used to reduce vasomotor symptoms such as hot flashes. The anticonvulsant gabapentin (Neurontin) has also been used. This woman is not a candidate for estrogen-only hormone replacement therapy for two reasons: she has not had a hysterectomy and she has a history of DVT. She is not a candidate for estrogen-progestin therapy because of her previous history of DVT.

The nurse is obtaining a 24-hour diet history from a pregnant client. which food consumed by the client would indicate the need for further teaching by the nurse? A. Alfalfa Sprouts B. Fruits C. Soy products D. Nuts

A. Alfalfa Sprouts Raw sprouts of any kind should be avoided during pregnancy

The prenatal clinic nurse meets with a 30-year-old woman who is experiencing her first pregnancy. The patient's quadruple-marker screen result is positive at 17 weeks of gestation. Which action by the nurse is most important? A. Call the social worker for a consultation. B. Document the findings in the woman's chart. C. Facilitate a referral to a genetics counselor. D. Prepare the woman for intrauterine death

C. Facilitate a referral to a genetics counselor All women should be offered screening with maternal serum markers. The triple-marker screen and the quadruple-marker screen test for the presence of alpha-fetoprotein, estradiol, human chorionic gonadotropin, and other markers. These tests screen for potential neural tube defects, Down syndrome, and trisomy 18. If the screen is positive, the woman should be referred to a genetics specialist for counseling and further testing, such as chorionic villus sampling or amniocentesis, should be performed (ACOG, 2007). There is no indication that the woman needs a social work consult or that she will experience intrauterine death. Documentation should be complete, but is not the most important action for the nurse to take

An 18-year-old woman at 18 weeks' gestation is being seen in the prenatal clinic. Her weight gain is 25 pounds over her prepregnant weight. Which is the perinatal nurse's best approach to care at this visit? A. Ask the patient to complete a 3-day dietary recall while she is in the clinic. B. Explain the possible concerns related to excessive weight gain in pregnancy C. Explain to the patient that weight gain is not a concern in pregnancy. D. Teach the patient about the expected normal weight gain during pregnancy.

A. Ask the patient to complete a 3-day dietary recall while she is in the clinic This woman has gained much more than the average weight gain in the first trimester (1-2.5 kg). Nutrition and weight management play an essential role in the development of a healthy pregnancy. Not only does the patient need to have an understanding of the essential nutritional elements, she must also be able to assess and modify her diet for the developing fetus and her own nutritional maintenance. To facilitate this process, it is the nurse's responsibility to provide education and counseling concerning dietary intake, weight management, and potentially harmful nutritional practices. The nurse should facilitate this process while the woman is at her appointment. After assessment and mutually planning nutritional goals, the nurse can educate the woman about the possible concerns related to excessive weight gain and teach about the normal trajectory of weight gain during pregnancy. This series of actions follows the nursing process best.

A patient has undergone an extensive evaluation to confirm that she is pregnant. Which of the following would constitute a positive sign of pregnancy in this patient? (Select all that apply) A. Auscultation of a fetal heart beat using a Doppler device B. Amenorrhea C. Observation and palpation of fetal movement by the nurse D. Chadwick's sign E. Sonographic visualization of the fetus

A. Auscultation of a fetal heart beat using a Doppler device C. Observation and palpation of fetal movement by the nurse E. Sonographic visualization of the fetus Auscultation of a fetal heart beat using a Doppler device constitutes a positive sign of pregnancy because it is objective, meaning that the examiner can verify it, and that it can only be attributed to the fetus.Feedback 2: Amenorrhea is a presumptive, not positive, sign of pregnancy, because it is subjective, meaning it is perceived only by the woman herself.Feedback 3: Observation and palpation of fetal movement by the nurse constitute a positive sign of pregnancy because they are objective, meaning that the examiner can verify them, and that they can only be attributed to the fetus.Feedback 4: Chadwick's sign, which is a bluish-purple coloration of the vaginal mucosa, cervix, and vulva seen at 6 to 8 weeks, is a probable, not positive, sign of pregnancy, because it can be caused by factors other than pregnancy.Feedback 5: Sonographic visualization of the fetus constitutes a positive sign of pregnancy because it is objective, meaning that the examiner can verify it, and that it can only be attributed to the fetus.

The nurse teaches the prenatal class attendees about herbal medications that may cause uterine contractions and preterm labor. Which of the following herbal preparations should be avoided because they act as uterine stimulants? (Select all that apply.) A. Black cohosh B. Dong quai C. Ephedra D. Mugwort E. Senna

A. Black cohosh D. Mugwort During preconception counseling and pregnancy, nurses should educate couples to avoid the following common uterine stimulants that may cause preterm labor: barberry, black cohosh, feverfew, goldenseal, mugwort, pennyroyal leaf, and yarrow root. Dong quai is an anticoagulant, ephedra is a cardiac stimulant, and senna can overstimulate digestion and metabolism, causing fluid and electrolyte imbalances.

For which diseases does the prenatal nurse recommend a newly pregnant woman be screened? (Select all that apply.) A. Chlamydia B. Hepatitis A C. Mumps D. Rubella E. Varicella

A. Chlamydia D. Rubella E. Varicella Pregnant women should be screened for sexually transmitted infections, hepatitis B, HIV, rubella, and varicella. When contracted during the first trimester, rubella causes a number of fetal deformities. Varicella (chickenpox) is another common childhood disease that may cause problems in the developing embryo and fetus. Therefore, all pregnant women are screened for rubella and varicella.

The community health nurse is preparing information for women on healthcare coverage available through the Affordable Care Act. Which items does the nurse include in this information? Select all that apply. A. Contraception B. Pregnancy care C. Breastfeeding support D. Coverage for children up to age 29 E. Screening for breast and cervical cancers

A. Contraception B. Pregnancy care C. Breastfeeding support E. Screening for breast and cervical cancers

A 17-year-old female is brought to the family practice clinic by her mother, who is worried that her daughter has not yet developed secondary sex characteristics. Which action by the nurse is best? A. Get a family pedigree B. Inform them her daughter needs a pregnancy test C. Inform them that the daughter will be tested for estrogen deficiency. D. Get information on family history

C. Inform them that the daughter will be tested for estrogen deficiency. Rational: Estrogen is the primary female hormone and is responsible for the development of secondary sex characteristics. Physical changes associated with puberty usually begin between ages 11 and 13. A 17-year-old female who has not yet developed these features may have an estrogen deficiency. A family pedigree may be beneficial, but not as the first step. A pregnancy test would not illustrate the cause of the problem.

A patient who has a previous diagnosis of round ligament pain is in the clinic for a follow-up visit. Which statement by the patient would indicate that teaching objectives for this problem have been met? A. "I have been supporting my uterus with a pillow when resting." B. "I have been trying all sorts of over-the-counter medications." C. "I haven't had any black, tarry stools at all since I was here." D. "That black cohosh has really helped with my abdominal pain."

A. I have been supporting my uterus with a pillow when resting Round ligament pain is a common discomfort of pregnancy and the nurse can teach self-care measures such as supporting the uterus with a pillow when resting, warm baths, applying heat, and wearing a pregnancy girdle. Pregnant women should be taught to avoid all medications (both prescription and over the counter) without consulting with their health-care provider. Black, tarry stools are not related to round ligament pain. Black cohosh is a uterine stimulant and should be avoided during pregnancy.

The nurse is preparing to measure a client's fundal height. which would the nurse do to obtain the most accurate measurement? A. Instruct the client to empty her bladder. B. Place the measuring tape just below the umbilicus. C. Use the millimeter markings on the measuring tape to record fundal height. D. Instruct the client to take a deep breath and hold it during the measurement.

A. Instruct the client to empty her bladder.

A student nurse asks the faculty about the importance of preconception counseling. Which response by the faculty is best? A. "It is the best time to find any conditions that could have a negative effect on a pregnancy." B. "It's a good time to educate women about birth control options before they need them." C. "Reproductive care is an important part of any woman's health care." D. "The Centers for Disease Control mandates that all women get preconception care."

A. It is the best tie to find any conditions that could have a negative effect on a pregnancy Preconception counseling is an ideal time to identify conditions (physical, psychosocial, environmental, or social) that could lead to a future negative pregnancy outcome. The patient can be educated about the risks and assist in developing a plan to mitigate or avoid them. Providing birth control options can be an important part of preconception care, but this answer is too limited to be the best choice. Stating that reproductive care is important is vague. A goal of Healthy People 2020 is to increase the number of women getting preconception and prenatal care.

Using Naegele's Rule, calculate the estimated due date (EDD) if the woman's last menstrual period (LMP) was June 11. A. March 18 B. March 10 C. March 20 D. March 15

A. March 18 Using Naegele's Rule, subtract 3 months and add 7 days to the LMP.

What are the pros of estrogen replacement therapy for older women? (select all that apply) A. Prevent bone loss if started early B. Reduced the risk of Alzheimer's disease C. Reduce cholesterol levels D. Reduce heart attack risk E. Reduce the risk for some forms of cancer

A. May help prevent bone loss if started early B. May reduced the risk of Alzheimer's disease C. May reduce cholesterol levels D. Reduce heart attack risk

The nurse obtains a fundal height measurement of 32 cm on a client experiencing a healthy, low-risk pregnancy. How does the nurse interpret this measurement? A. The client is approximately 32-week gestation. B. The weight of the fetus is approximately 3200 grams. C. The amniotic fluid volume is 3.2 cm. D. The distance from the fundus to the xiphoid process is 32 cm.

A. The client is approximately 32-week gestation.

A nurse in a fertility clinic is caring for a client who has been trying to conceive. Which symptoms does the nurse teach the client to note as presumptive signs of pregnancy? Select all that apply. A.Amenorrhea B.Nausea and vomiting C.Skin hyperpigmentation D.Positive urine test E.Breast changes

A.Amenorrhea B.Nausea and vomiting E.Breast changes

A client with a history of amenorrhea lasting more than a month was booked to have an ultrasound examination done for the purpose of diagnosing her pregnancy. Which other data in the client's history should the nurse use to determine the need for this procedure? Select all that apply. A.Having an ectopic pregnancy 1 year ago B.Vaginal bleeding since 2 days ago C.Having a regular menstrual cycle D.Palpating fetal movement E.Complaint of constipation

A.Having an ectopic pregnancy 1 year ago B.Vaginal bleeding since 2 days ago

A nurse is volunteering for the local chapter of the cancer society and is planning breast cancer screening and educational activities in the community. In order to have the most impact on this disease, which women should the nurse target? A. African Americans B. Asian Americans C. Caucasian Americans D. Native Americans

ANS: A African American women are more likely to die from breast cancer because of late diagnosis, and in women under 45 in this group, breast cancer is more common. To have the greatest impact, the nurse should target this group of women. Asian, Hispanic, and Native American women have a lower risk of developing and dying from breast cancer. Caucasian women tend to develop breast cancer more frequently than African American women, but they die less often.

A patient in the high-risk OB unit has suffered a seizure and is now postictal. She is on oxygen at 2L/minute. Which assessment by the nurse warrants immediate intervention? A. Fetal heart rate is 98 beats/minute on electronic fetal monitor strip. B. Maternal oxygen saturation is 94% by pulse oximetry. C. Mother is sleeping soundly and is difficult to arouse. D. Mother's respiratory rate is 12 breaths/minute.

ANS: A After a seizure, all fetuses must be checked and accounted for. Fetal heart rate may show variability or bradycardia. A fetal heart rate of 98 is bradycardic, and the nurse should intervene immediately. Oxygen saturation of 94% is normal, a postictal patient will be drowsy and difficult to arouse, and a respiratory rate of 12 breaths/minute is normal.

A nurse is assessing a woman in the perinatal clinical with diagnosed cervical insufficiency. The woman is in her 18th week of a viable pregnancy. Which action by the nurse is most appropriate? A. Assist with obtaining informed consent for a cerclage. B. Draw blood to assess the maternal Rh status. C. Facilitate a transvaginal and abdominal ultrasound. D. Refer the woman to a perinatal grief specialist.

ANS: A Because the woman has diagnosed cervical insufficiency, a cerclage is appropriate therapy. This purse-string suture closes the cervix so the uterus can contain the pregnancy. It is usually removed in the 37th week to allow for vaginal delivery. Because it is an invasive procedure, informed consent is required. The other options are not necessary in this situation, although if the woman has unresolved grief following prior spontaneous abortions, a referral would be appropriate.

A nurse is planning breast education for women. What information does the nurse plan to provide about breast cancer screening recommendations? A. Annual screening after age 40 B. MRI to replace mammography C. No routine screening after age 65 D. Periodic screening if high risk

ANS: A Breast cancer screening is the subject of controversy. The American College of Obstetricians and Gynecologists (ACOG) recommends annual screening with mammography and clinical breast examinations every year starting at age 40.

The prenatal clinic nurse assesses a woman at 15 weeks' gestation. The patient's blood pressure, measured twice at intervals 1 hour apart with a cuff that fits appropriately, is 146/96 mm Hg. The nurse understands the patient has which condition? A. Chronic hypertension B. Gestational hypertension C. Preeclampsia D. Transient hypertension

ANS: A Chronic hypertension is defined as hypertension that is present and observable prior to pregnancy, or hypertension that is diagnosed before the 20th week of gestation. Hypertension is defined as a blood pressure greater than 140/90 mm Hg. Hypertension for which a diagnosis is confirmed for the first time during pregnancy and that persists beyond the 84th day postpartum is also classified as chronic hypertension. Gestational hypertension occurs after 28 weeks without proteinuria and is a temporary diagnosis used until more diagnostic testing can be accomplished. Preeclampsia is an increased blood pressure seen after 20 weeks' gestation accompanied by proteinuria. Transient hypertension describes women who develop gestational hypertension but have no preeclampsia and whose blood pressure returns to normal within 12 weeks postpartum. This diagnosis is used only after pregnancy.

A practicing nurse tells a student nurse that beyond the World Health Organization's definition of health, providers must also consider which of the following factors when determining the health of a community? A. The definition of health as described by the community B. The incidence of preventable health problems in the group C. The morbidity caused by genetically related health problems D. The mortality rates that could be lowered with primary prevention

ANS: A The World Health Organization (WHO) defines health as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity." According to Purnell and Paulanka (2008), one must also consider the definition of health as it is described by people within their own ethnocultural group. The other options are not part of this consideration.

A student nurse is working in the OB clinic as part of a preceptorship. The student is counseling a woman in her first trimester who complains of insomnia due tonasal congestion. Which action by the student warrants intervention by the student's preceptor? A. Advises the woman to use over-the-counter nasal saline spray B. Assesses the patient for other allergy and cold symptoms C. Instructs the woman to use decongestants and antihistamines D. Suggests the woman take a hot, steamy bath at bedtime

C. Instructs the woman to use decongestants and anti histamines Congestion is a common complaint in pregnancy. Self-care measures include occasional saline drops; hot, steamy showers; increasing fluids;, and using a vaporizer or humidifier. It is important to rule out upper respiratory infections such as colds or allergies when a woman complains of nasal congestion. Women should avoid decongestants in the first trimester.

A woman at 32 weeks' gestation is admitted to the high-risk OB unit with a diagnosis of preterm labor. On assessment the nurse finds the following: blood pressure, 182/96 mm Hg; pulse, 106 beats/minute; respirations, 16 breaths/minute; regular uterine contractions of 5 in 10 minutes; and fetal heart rate of 145 beats/minute. She is dilated to 8 cm. Which action by the nurse is best? A. Administer the ordered dose of betamethasone (Celestone). B. Call for an immediate electrocardiogram (EKG). C. Document the findings and prepare for emergent delivery. D. Prepare to administer magnesium sulfate (Sulfamag).

ANS: A The administration of antenatal corticosteroids (betamethasone) is the most beneficial intervention for improvement of neonatal outcomes among women who give birth preterm. A single course of corticosteroids is recommended for pregnant women between 24 and 34 weeks of gestation who are at risk of preterm delivery within 7 days. Although the woman is mildly tachycardic, there is no need for an EKG without further information. There is no indication that delivery is imminent. Magnesium sulfate is a tocolytic drug used to stop labor, but it is contraindicated in women with advanced cervical dilation.

What are the cons of estrogen replacement therapy for older women? A. There are no contraindications B. Increases bone loss C. May increase the risk for some forms of cancer D. Increases cholesterol levels, increasing the risk of heart attacks

C. May increase the risk for some forms of cancer, especially when progestin isn't given with it

The nurse explains to the student that the development of the lining of the uterus is mediated by which hormone? A. Follicle-stimulating hormone (FSH) B. Luteinizing hormone (LH) C. Progesterone D. Prostaglandins

C. Progesterone Rational:Estrogen and progesterone are responsible for mediating the development of the uterine lining. Follicle-stimulating hormone stimulates growth of the graafian follicle. Luteinizing hormone stimulates the development of the corpus luteum. Prostaglandins modulate hormonal activity and affect ovulation, fertility, and cervical mucus viscosity.

A 24-year-old lactating woman asks about contraceptive options. The family planning clinic nurse recommends an oral contraceptive formulated with which ingredients? A. Prescribe a estrogen-containing contraceptive B. Estrogen only C. Progestin only D. Estrogen and progestin contraceptive

C. Progestin only Rational: Low-dose progestin-only contraceptive pills are often referred to as the mini-pill because they contain no estrogen. The mini-pill may be used during breastfeeding because it does not interfere with milk production.

During preconception counseling, the nurse is teaching a client about diagnosing pregnancy. Which signs are considered probable signs of pregnancy? Select all that apply. A. Fetal heart tones B. Quickening C. Uterine growth D. Frequent urination E. Positive home pregnancy test

C. Uterine growth E. Positive home pregnancy test

The jail nurse is interviewing a woman who has been brought to the clinic for prenatal care. Which of the following are appropriate actions for the nurse to perform? (Select all that apply.) A. Assess the woman for drug and alcohol abuse and possible withdrawal. B. Assess the woman's health knowledge and health literacy. C. Ask if the woman has other children and who is caring for them. D. Determine if the woman has risk factors for pregnancy complications. E. Inquire about the woman's criminal history and background.

ANS: A, B, C, D A nurse who is able to deliver culturally competent care to incarcerated women quickly becomes cognizant of the challenges of caring for this population. These women tend to have many health problems, including substance abuse and dependency. They frequently have not had access to health-related knowledge. Because nearly 1.3 million children of incarcerated women have no mother figure in their lives, women in prison or jail are often deeply concerned about their welfare. This demonstrates caring and can often be the motivation for making changes. The nurse needs to complete a thorough obstetrical history, including determining risk factors for high-risk pregnancy. The nurse does not need to know about the woman's criminal history.

A perinatal nurse is working with a woman who has had four perinatal losses in the first 20 weeks of pregnancy. The nurse should anticipate orders for which of the following diagnostic tests? (Select all that apply.) A. Cervical cultures B. Hysterosalpingogram C. Maternal/paternal karyotype D. Sickle cell screening E. Thyroid-stimulating hormone (TSH) levels

ANS: A, B, C, E Patients who experience habitual (three or more) spontaneous abortions may be offered these tests as part of the diagnostic workup: a karyotype obtained from the products of conception and from both parents and an examination of the maternal anatomy, beginning with a hysterosalpingogram. Additional testing may include hysteroscopy or laparoscopy; screening tests for maternal hypothyroidism, diabetes mellitus, antiphospholipid syndrome (APS), and systemic lupus erythematosus (SLE); testing of the serum progesterone level during the luteal phase of the menstrual cycle; cultures of the cervix, vagina, and endometrium; and endometrial biopsy during the luteal phase of the menstrual cycle. Sickle cell screening would not be part of this workup.

A pregnant woman in her second trimester arrives at the labor unit triage station with complaints of lower abdominal cramping and urinary frequency. Appropriate nursing actions include which of the following? (Select all that apply.) A. Assess the fetal heart rate. B. Assess the patient's pulse rate. C. Insert an indwelling Foley catheter. D. Obtain a urine sample for culture and sensitivity. E. Palpate the patient's abdomen for contractions.

ANS: A, B, D, E Women who experience preterm labor may complain of backache, pelvic aching, menstrual-type cramps, increased vaginal discharge, pelvic pressure, urinary frequency, and intestinal cramping with or without diarrhea. A urinalysis and urine culture and sensitivity should be obtained on all patients with symptoms of preterm labor, and the nurse must remember that symptoms of urinary tract infection often mimic normal pregnancy complaints (e.g., urgency, frequency). The patient's abdomen should be palpated to assess for contractions, and the fetal heart rate should be monitored. It is not necessary to insert a Foley catheter at this time.

A nurse is assessing all patients in the perinatal clinic for culturally related increased risk for gestational diabetes mellitus. Which patients would the nurse assess as being in the highest risk groups? (Select all that apply.) A. African American B. Caucasian C. Chinese D. Hispanic E. Native American

ANS: A, C, D, E Ethnic groups with a higher incidence of gestational diabetes mellitus include African Americans, Asian Americans, Hispanics, and Native Americans. Pacific Islanders also have increased risk. Caucasians do not have an increased risk.

A nurse is conducting an educational class for expectant couples. What information about preterm birth does the nurse include in the discussion? (Select all that apply.) A. A diagnosis of preterm labor requires cervical changes. B. African Americans have the lowest rate of preterm birth of all ethnic groups. C. The vast majority of infants born at 29 weeks' gestation survive. D. Today, 1 in 25 babies are born prematurely in America. E. Worldwide, preterm birth is the leading cause of neonatal morbidity and mortality.

ANS: A, C, E Although many pregnant women experience preterm contractions, only those with cervical changes are diagnosed with preterm labor. More than 90% of infants born at 28-29 weeks' gestation survive today. Worldwide, premature birth is the leading cause of infant morbidity and mortality. According to the March of Dimes (2012), the rate of preterm birth is highest for African American infants (18.4 %). In the United States, more than 1 in 8 babies are born too soon.

A postmenopausal woman asks the nurse about reducing her breast cancer risk. The woman is overweight, consumes one alcoholic drink daily, does not smoke, and works at a desk. What response by the nurse is best? A. Exercise regularly. B. Lose weight. C. Stop drinking. D. Take aspirin daily.

ANS: B Alcohol intake, smoking, and weight maintenance all affect breast health. However, this woman's highest risk factor is being overweight. After menopause, estrogen is produced in body fat cells. The combination of estrogen and dietary fat significantly increases the chance of breast cancer development. Exercise can be part of a weight-loss regimen, but this is not the most comprehensive answer. Drinking one drink a day is not linked to increased breast cancer risk, although drinking two to five drinks a day is associated with an increased risk. Taking an aspirin daily is for promotion of heart health.

A pregnant patient is brought to the emergency department after a roll-over motor vehicle crash. After assessing and stabilizing the patient's airway, breathing, and circulation, which of the following actions should the nurse perform next? A. Assess the woman for further injuries. B. Attach continuous fetal monitoring leads. C. Determine the date of the patient's last tetanus booster. D. Prepare to transfer the woman to the delivery suite.

ANS: B Maternal trauma accounts for about 50% of fetal deaths. Seemingly minor injuries to the woman may cause serious injury or death to the fetus. Because the fetal heart rate is one of the first signs to change in fetal distress, all pregnant trauma patients need continuous fetal monitoring. Assessing the woman for further injuries and determining the date of the woman's last tetanus booster are both appropriate actions; however, they do not take priority over fetal monitoring. The woman may or may not need to be transferred to the delivery suite.

A woman presents to the perinatal clinic with abdominal pain. She has missed one period and, following a transvaginal ultrasound, pregnancy is confirmed. However, implantation has occurred in the right fallopian tube. The ectopic mass is 3 cm and has not ruptured. The nurse prepares the patient for which therapy? A. Laparoscopic salpingostomy B. Methotrexate C. Partial salpingectomy D. Salpingectomy by laparotomy

ANS: B Methotrexate, a chemotherapeutic drug and folic acid inhibitor that stops cell production and destroys remaining trophoblastic tissue, is used in the management of uncomplicated, non-life-threatening ectopic pregnancies. Patients are considered to be eligible for methotrexate therapy if the ectopic mass is unruptured and measures 4 cm or less on ultrasound examination. The other options would not be needed.

A nurse reads in a patient's chart that the Bethesda system terminology used to describe her cervical cytology and histology is AIS. What can the nurse conclude about this woman's treatment? A. Follow-up in 1 month B. Possible chemotherapy C. Repeat test in 3 months D. Use of luprolide (Lupron)

ANS: B The Bethesda System terminology describes categories of epithelial cell abnormalities. The categories are ASC (atypical squamous cells), LSIL (low-grade squamous intraepithelial lesions), HSIL (high-grade squamous intraepithelial lesions), AGC (atypical glandular cells), and AIS (adenocarcinoma in situ). Treatment for cancer of the cervix includes surgery, chemotherapy, radiation, or a combination of these. The other options are not appropriate for this situation.

A woman is admitted to the high-risk OB unit with the diagnosis of preterm labor. Orders include bedrest with continuous fetal monitoring, administration of magnesium sulfate (Sulfamag) and betamethasone (Celestone), and laboratory work. In reviewing the patient's record, the nurse notes a history of hypertension that is well controlled with nifedipine (Procardia) and diet-controlled diabetes mellitus type 2. Which action by the nurse is best? A. Assist the woman to choose appropriate food items from the menu. B. Call the physician to question the orders and document the conversation. C. Order a pressure-relieving mattress overlay and perform a skin assessment. D. Prepare to give the magnesium sulfate and betamethasone as ordered.

ANS: B The combination of nifedipine and magnesium sulfate can cause sudden cardiac death. The nurse should contact the health-care provider to question the orders. The nurse should also document all aspects of this communication clearly. The woman may or may not need assistance in choosing food items appropriate for her diabetes. All patients need a full skin assessment and, depending on how long bedrest is anticipated, a pressure-relieving mattress overlay might be appropriate. The nurse should not give the medications without further clarification.

A college nurse offers screening programs for students. At what age should the nurse encourage women to have their first Pap test? A. At age 19 B. At age 21 C. Before sexual activity D. No specific age

ANS: B Women should have their first Pap test at age 21.

Which of the following activities should the perinatal nurse encourage women who come for preconceptional counseling to consider? (Select all that apply.) A. Choosing breastfeeding or bottle feeding B. Decreasing risk for exposure to toxoplasmosis C. Decreasing fetal risks related to the work environment D. Ensuring folic acid supplementation E. Ensuring iron supplementation

ANS: B, C, D Folic acid supplementation helps to prevent certain birth defects. A fetus's exposure to harm could potentially be prevented if a woman were counseled prior to pregnancy about the adverse effects of alcohol, tobacco, toxoplasmosis, and other teratogens in her home or workplace. During the preconception period, it is too early for the woman to take iron supplements (unless she is anemic), and debating infant feeding methods is not the priority at this time

A nurse is caring for a pregnant 16-year-old who is homeless and occasionally spends time in a homeless shelter. She has been seen in the clinic before for sexually transmitted infections (STIs). She weighs 92 lb (41.8 kg) and occasionally uses crack cocaine. Which risk factors does this patient have for a negative pregnancy outcome? (Select all that apply.) A. Age of 16 years B. Being homeless C. Crack cocaine use D. History of STIs E. Low weight

ANS: B, C, D, E According to Barry (2011) and Porter and Holness (2011), prenatal medical and behavioral risks for the adolescent population include preterm labor and birth—especially when combined with low socioeconomic status, being a single parent, being a smoker, using illicit drugs, prepregnant weight less than 100 lb (45.5 kg), poor weight gain during pregnancy, and inadequate prenatal care. Other factors include anemia; preeclampsia-eclampsia; repeated exposure to sexually transmitted infections; chronic or asymptomatic urinary tract infections; acute pyelonephritis; intrauterine growth restriction/low-birth-weight infants (< 2,500 g); and social issues such as poverty, unmarried status, low educational levels, smoking, and drug use. After age 15 years, the adolescent does not experience any more problems than does the general population.

A nurse is conducting a nonstress test on a pregnant woman. The nurse understands that which of the following conditions can lead to loss of fetal heart rate reactivity? A. Central nervous system irritability B. Certain congenital abnormalities C. Fetal acid-base disturbance D. Fetal hypoxia E. Fetal sleep cycle

ANS: B, C, D, E The most common cause of loss of fetal heart rate reactivity is a fetal sleep cycle. Other causes are related to central nervous system depression (not irritability) and can include fetal acidosis, hypoxia, and certain congenital abnormalities.

Which of the following does the nurse recognize as complications of premature birth? (Select all that apply.) A. Osteoporosis B. Cerebral palsy and mental retardation C. Diabetes mellitus type 1 D. Intraventricular hemorrhage E. Retinopathy of prematurity

ANS: B, D, E Some short-term neonatal morbidities associated with preterm birth include respiratory distress syndrome, intraventricular hemorrhage, periventricular leukomalacia, necrotizing enterocolitis, bronchopulmonary dysplasia, sepsis, and patent ductus arteriosus. Long-term morbidities include cerebral palsy, mental retardation, and retinopathy of prematurity. Osteoporosis and diabetes are not known complications of premature birth.

A pregnant patient in the second trimester is in the emergency department after a motor vehicle crash. She has a severe laceration of her arm resulting in a large blood loss. Which assessment should the nurse perform first? A. Blood pressure B. Fetal heart tones C. Pulse D. Respiratory rate

ANS: C Because a woman's blood volume can increase dramatically during pregnancy, blood pressure is an unreliable indicator of a volume deficit. Maternal pulse and fetal heart rate are much more accurate indicators. Because the priority in care of the pregnant trauma patient is care of the mother, the nurse should assess the mother's blood pressure first.

A nurse wants to know the trend concerning death due to cardiovascular disease. What source should the nurse consult? A. Epidemiology data B. Morbidity data C. Mortality data D. Primary prevention data

ANS: C Mortality refers to death. Government agencies keep both mortality and morbidity records on public health threats. Morbidity refers to illness. Epidemiology is the statistical analysis of factors related to disease in populations over time. Primary prevention includes activities designed to keep health problems from happening. It often includes education.

The perinatal nurse is caring for a woman at 26 weeks' gestation who has a history of hypertension that has been well controlled. Today she presents with a blood pressure of 156/102 mm Hg and she has 2+ protein on urine dipstick. Which initial action by the nurse is most appropriate? A. Arrange admission to the high-risk OB unit. B. Instruct the woman on strict bedrest. C. Obtain a clean-catch urine sample. D. Prepare to administer IV anti-hypertensives.

ANS: C Preeclampsia can occur in a woman who has chronic hypertension. This woman has the characteristics of hypertension after a period of good control and proteinuria of at least 2+ on dipstick (100 mg/dL). The nurse needs to ensure protein levels are assessed in two samples at least 4 hours apart and ensure the woman has no signs of a urinary tract infection, as protein can occur in a sample of infected urine. The nurse should obtain a clean-catch urine sample to send to the laboratory for analysis. Asymptomatic UTI can occur in up to 11% of pregnant women, so assessing for signs and symptoms may not be accurate. The woman does not need admission to the high-risk OB unit, strict bedrest, or IV anti-hypertensives at this point.

The mother of a 5-month-old baby complains that her child seems hungry even after breastfeeding 10 times a day. What assessment question would help the nurse plan anticipatory teaching? A. "Are you sure your breasts are emptying?" B. "Does the baby put everything in his mouth?" C. "Does your baby sit in a high chair yet?" D. "Is your baby using the pincer grasp yet?"

ANS: C The child may be ready for solid foods so the nurse should assess for readiness. Signs of readiness to eat solids include being able to hold the head up, being able to sit in a high chair, and being able to move the tongue around without pushing food out of the mouth. Other signs include appropriate weight gain, teething, and remaining hungry after breastfeeding 8-10 times a day or bottle feeding 40 oz of formula. Asking about emptying the breasts is irrelevant if the baby is gaining weight. Putting objects in the mouth and using the pincer grasp are indicative of being ready for finger foods.

A young couple is in the clinic for a prenatal exam. The woman expresses concern that her husband continues to binge drink and use drugs on weekends. What action by the nurse is best? A. Assess the father for reasons why he continues to abuse alcohol and illicit drugs at his age. B. Explain that if there are drugs in a house with a baby, the baby can be taken away. C. Help the husband see how his drug and alcohol use is inconsistent with the father role. D. Warn the husband that he will be putting the baby at risk unless he stops this activity.

ANS: C The most reliable theory on drug use focuses on role development. As young adults take on the roles of spouse and parent, illicit drug use can interfere with performing those roles. Also, when assuming adult roles is seen as incompatible with illicit drug use, substance use declines. The nurse's best action is to help the husband see how binge drinking and drug use are not compatible with the father and role model roles. The nurse could assess the father for reasons he continues to abuse substances, but this will not help him diminish his use. Stating that the baby can be taken away may be seen as a threat and will probably cut off communication. Likewise, telling the father he will be putting his baby at risk may sound judgmental and threatening as well.

A woman suffering from severe vasomotor menopausal symptoms wants to use complementary or alternative therapies instead of hormone therapy. What advice by the nurse is best? A. "Acupuncture has been shown to work better than other body therapies." B. "Herbs are a great option as they do not typically have side effects." C. "Mind-body, manipulative, or traditional Chinese medicine are safer than herbs." D. "Research shows that black cohosh significantly reduces hot flashes."

ANS: C There is no evidence that either herbal preparations or complementary approaches such as acupuncture, mind-body therapies, or manipulative therapies significantly reduce the symptoms of menopause. However, body-related therapies are considered safer because they do not have the side effects of herbal preparations. The nurse's best answer is to explain this to the patient.

A woman presents to the family practice clinic complaining of abdominal pain, pain during ovulation, and heavy periods. What action by the nurse is best? A. Facilitate a vaginal ultrasound. B. Obtain consent for a laparoscopy. C. Prepare the woman for a pelvic exam. D. Provide education on ibuprofen (Motrin).

ANS: C This woman has manifestations of endometriosis. Diagnosis can be made via a pelvic exam, although it is often difficult to do so. Some physicians will order ultrasounds or laparoscopy with biopsy. The first step, however, is the pelvic exam, so the nurse should prepare the woman for this to occur. After making a diagnosis of endometriosis, the nurse can educate the woman on medical management, which includes using ibuprofen for pain.

A nurse has admitted a woman pregnant in her third trimester with moderate vaginal bleeding and severe abdominal pain. After assessing maternal vital signs, obtaining the fetal heart rate, and starting an IV line, which action should the nurse do next? A. Administer betamethasone (Celestone) just prior to delivery. B. Discuss pros and cons of continuous fetal monitoring. C. Facilitate laboratory work, including blood type and screen. D. Obtain informed consent for emergent delivery.

ANS: C Women who present with third-trimester vaginal bleeding should be examined carefully for placenta previa or abruptio placentae. Bleeding accompanied by abdominal pain is the classic sign of placental abruption. Care includes obtaining maternal vital signs, assessing fetal heart rate, and starting an IV for fluid resuscitation or transfusion if needed. Blood work should be obtained for CBC, type and screen, coagulation studies, and a Kleihauer Betke determination, Betamethasone is given if delivery is not imminent. Continuous electronic fetal monitoring is the standard of care, and although the nurse should educate the patient on its use, this discussion does not take priority over obtaining diagnostic laboratory studies. An emergent delivery is a possible (not certain) outcome, but obtaining consent does not take priority over the diagnostic blood work.

A pregnant woman is HIV-positive. She is asking about ways to decrease the risk of vertical transmission to her baby. Which option given by the nurse would confer the least risk to the baby? A. Antiretroviral medications (zidovudine [ZDV]) B. Cesarean delivery C. Cesarean delivery plus antiretroviral medications for the newborn D. Vaginal delivery plus antiretroviral medications for the newborn

ANS: C Women with HIV should be counseled that the risk of vertical transmission (mother to child) is 25% without antiretroviral medication. With ZDV, the rate is 5 to 8%. When both options are combined, the risk drops to around 2%, so this is the best option.

A nurse is evaluating several patients for possible hormone therapy to reduce severe symptoms of menopause. For which patient would hormone therapy be recommended? A. 53 years old, smoker, estrogen-progestin therapy B. 54 years old, history of endometrial cancer 10 years ago, estrogen only C. 55 years old, history of hysterectomy 4 years ago, estrogen only D. 76 years old, went through menopause 16 years ago, estrogen-progestin

ANS: C 55 years old, history of hysterectomy 4 years ago, estrogen only Estrogen therapy for women who have had a hysterectomy or estrogen-progestin therapy offers the greatest benefit and smallest risk to those who are within 10 years of menopause. The patient who is 55 and has had a hysterectomy would be the best candidate. The 53-year-old smoker has a double risk for venous thromboembolism (VTE) because smoking increases the risk along with the combination hormone therapy. Estrogen-only therapy increases the risk of endometrial cancer, so it is not used in patients who have a history of endometrial cancer. The smallest risk is seen in women within 10 years of menopause, so the 76-year-old woman is too far removed from menopause to receive hormone therapy.

The clinic nurse is interviewing a woman and her daughter who describe their address as"temporary." The mother appears thin, pale, and tired. Her blood work confirms anemia and pregnancy. What actions by the nurse would be most helpful? (Select all that apply.) A. Call the Department of Children and Family Services. B. Discuss nutrition needs for pregnancy. C. Facilitate the woman's opportunity to return for prenatal care. D. Determine if the family is in a safe location. E. Provide shelter information for this family.

ANS: C, D, E A priority for this family is to provide information regarding shelters, to facilitate follow-up clinic visits for the mother to address her pregnancy and anemia, and to determine if the family is currently in a safe place or if the family is vulnerable to violence. Nutrition in pregnancy should be discussed, but it is not the priority intervention at this point. There is no reason to call the Department of Children and Family Services unless abuse is suspected.

The clinic nurse educates young adults that the most common infectious health risks associated with tattoos include which of the following? (Select all that apply.) A. Chlamydia infection B. Gonorrhea C. Hepatitis D. Human papilloma virus (HPV) E. Staphylococcus infection

ANS: C, D, E Infectious health risks related to tattooing include viral, bacterial, and fungal diseases, most commonly infections caused by viruses and bacteria. The most common infections associated with tattooing and body piercing include hepatitis, human immunodeficiency virus (HIV), and human papilloma virus (HPV). Bacterial infections may be caused by Staphylococcus, Streptococcus, Pseudomonas, Clostridium, and Mycobacterium.

The clinic nurse educates young adults that the most common infectious health risks associated with tattoos include which of the following? (Select all that apply.) A. Chlamydia infection B. GonorrheaC. Hepatitis D. Human papilloma virus (HPV) E. Staphylococcus infection

ANS: C, D, E Infectious health risks related to tattooing include viral, bacterial, and fungal diseases, most commonly infections caused by viruses and bacteria. The most common infections associated with tattooing and body piercing include hepatitis, human immunodeficiency virus (HIV), and human papilloma virus (HPV). Bacterial infections may be caused by Staphylococcus, Streptococcus, Pseudomonas, Clostridium, and Mycobacterium.

A nurse in the perinatal clinic explains to a student nurse that which of the following patients are at highest risk of developing gestational diabetes? (Select all that apply.) A. A17-year-old in her second pregnancy B. A 24-year-old pregnant woman with placenta previa C. A 32-year-old woman with a BMI of 40 D. A woman whose first baby weighed 10.5 lb (4.7 kg) E. A woman whose mother and sister had gestational diabetes

ANS: C, D, E The risk factors for developing gestational diabetes include age older than 25; obesity; insulin resistance; polycystic ovary syndrome; history of pregnancy-related diabetes mellitus; history of a large-for-gestational age infant; hydramnios, stillbirth, miscarriage, or an infant with congenital anomalies during a previous pregnancy; family history of type 2 diabetes (first-degree relative); and ethnicity. Being young does not confer additional risk, nor does placenta previa. The 32-year-old is obese, the 10.5-lb baby is large for gestational age, and the mother and sister are first-degree relatives.

A clinic nurse sees adolescent girls frequently. Many of the girls should be screened for gonorrhea and Chlamydia infection, but they balk at having a pelvic exam. What option can the nurse offer these girls? A. Blood draw B. Limited pelvic exam C. No alternative D. Urine collection

ANS: D A urine sample can be used for gonorrhea and Chlamydia testing and is a good alternative for patients aged 13-18. The other options are incorrect.

A nurse is caring for a pregnant woman admitted to the high-risk OB unit. Which finding indicates to the nurse that outcomes for a priority nursing diagnosis have been met? A. Patient can list community resources available for her after childbirth. B. Patient describes skills she and partner use for dealing with stress. C. Patient states that with next pregnancy, she will obtain consistent prenatal care. D. Patient's blood pressure is 128/62 mm Hg without orthostatic changes.

ANS: D All options show that outcomes for important nursing diagnoses for a high-risk pregnancy have been met. However, physical needs take priority over psychosocial needs, so describing community resources and coping skills are not the most important. Prenatal care is important to help prevent adverse outcomes, but the patient is describing actions she intends to take for a subsequent, not current, pregnancy. For physical needs, airway, breathing, and circulation take priority. A stable blood pressure without orthostatic changes demonstrates hemodynamic stability and shows that outcomes for the diagnosis of risk for deficient fluid volume have been met.

The family clinic nurse encourages a patient to continue breastfeeding her 8-month-old infant to facilitate maturation of the infant's immune system. When does this occur? A. 12 months B. 16 months C. 18 months D. 24 months

ANS: D Because an infant's immune system does not become fully mature until 2 years of age, the maternal transfer of antibodies and immune factors enhances development of the immune system and facilitates the neonate's immune system response. The longer the time that an infant is breastfed, the stronger the protection again infection and the earlier the maturation of the infant's immune system.

A new nurse is caring for a woman previously diagnosed with preeclampsia who was admitted to the high-risk OB unit after suffering a seizure in the perinatal clinic. The new nurse is preparing to administer a dose of magnesium sulfate (Sulfamag). Which action by the nurse warrants intervention by the unit manager? A. Explains to the patient that her vital signs and EKG will be monitored frequently B. Piggybacks the Sulfamag into a main line using an infusion pump C. Places 10% calcium gluconate in a secure location in the patient's room D. Runs the Sulfamag as the main IV line through an infusion pump

ANS: D Magnesium sulfate should be infused on an infusion pump piggybacked into the main line, not as the primary IV line. The other actions are appropriate.

The perinatal nurse is assessing a woman who is at 35 weeks' gestation in her first pregnancy. She is worried about having her baby "too soon," and she is experiencing uterine contractions every 10 to 15 minutes. The fetal heart rate is 136 beats/minute. A vaginal examination performed by the health-care provider reveals no cervical changes since her last examination. Ultrasound examination reveals the presence of V-shaped cervical funneling. Which action by the nurse is most appropriate? A. Educate the woman on benefits of corticosteroids. B. Facilitate admission to the high-risk OB unit. C. Prepare to administer a dose of magnesium sulfate. D. Reassure the woman that she is not in preterm labor.

ANS: D Preterm labor is defined as regular uterine contractions and cervical changes before the end of the 37th week of gestation. Many patients present with preterm contractions but only those who demonstrate changes in the cervix are diagnosed with preterm labor. Because this woman has no demonstrated cervical changes, she does not have the diagnosis. Also reassuring is the infrequency of her contractions; a defining characteristic of preterm labor is persistent uterine contractions (4 every 20 minutes or 8 per hour). Another reassuring finding is the presence of V-shaped cervical funneling ; a change to U-shaped cervical funneling in a woman with a shortened cervix is associated with preterm labor in high-risk women with a prior spontaneous preterm birth. The woman does not require corticosteroids or magnesium sulfate or admission to the high-risk OB unit.

A nurse reads in the paper that the death rate for women overall has declined substantially. To what does the nurse correlate this finding? A. Abundant new choices in contraception B. Better detection and treatment of breast cancer C. Greater access to sources of fresh produce D. Improved diagnosis of heart disease in women

ANS: D The leading cause of death in women overall is heart disease. Women face significant barriers to timely diagnosis and treatment of heart disease than do men. The nurse can conclude that this has improved, leading to the significant decrease in the female death rate. Contraception choices would not lead to a significant decrease in mortality, as childbirth is not a common fatal event, although the number of perinatal deaths has not declined in recent years. And even with multiple choices in contraception, at least half of all pregnancies are unintended or mistimed. Access to fresh produce could improve many health conditions for women. Cancer is the second leading cause of death in women.

A nurse works with many older patients and provides information about safer sexual practices and risks. What physical factors increase an older woman's risk for acquiring human immunodeficiency virus (HIV) infection? (Select all that apply.) A. Increased promiscuity B. Isotonic dehydration C. Decreased vaginal pH D. Loss of vaginal elasticity E. Vaginal dryness

ANS: D, E Physical changes in the older woman that increase susceptibility to HIV infection include loss of vaginal elasticity and vaginal dryness. Increased promiscuity is not a physical factor (and is not known to be a characteristic of the older adult). Mild isotonic dehydration is often seen in older adults, but is not related. Vaginal pH is not related.

A nurse works with many older patients and provides information about safer sexual practices and risks. What physical factors increase an older woman's risk for acquiring human immunodeficiency virus (HIV) infection? (Select all that apply.) A. Increased promiscuity B. Isotonic dehydration C. Decreased vaginal pH D. Loss of vaginal elasticityE. Vaginal dryness

ANS: D, E Physical changes in the older woman that increase susceptibility to HIV infection include loss of vaginal elasticity and vaginal dryness. Increased promiscuity is not a physical factor (and is not known to be a characteristic of the older adult). Mild isotonic dehydration is often seen in older adults, but is not related. Vaginal pH is not related.

The nurse providing health promotion to a group of young adult women would plan to offer which services as a priority? (Select all that apply.) A. Aspirin prophylaxis B. Breast cancer screen C. Colorectal cancer screen D. Influenza vaccine E. Tobacco and alcohol screen

ANS: D, E Priority health services for the young adult population include influenza vaccination and tobacco, alcohol, and drug screens, among other things. Aspirin prophylaxis and breast cancer screen are more appropriate for middle-aged adults.

When should a woman start being routinely screened for HPV along with cervical cytology? a) 21 years old b) 30 years old c) 35 years old d) One year after becoming sexually active

B) 30 years old Ages 21-29, cytology alone q 3 yearsAges 30+, cytology and HPV (co-testing) q 5 years is PREFERRED, cytology alone q 3 years is acceptable ASCCP 2012 Guidelines(http://www.asccp.org/asccp-guidelines)

Breast cancer is most commonly found in which location? a) Left, upper quadrant b) Right, upper quadrant c) Left, lower quadrant d) Right, lower quadrant

B) Right, upper quadrant

A woman comes to the clinic for her 24-week prenatal visit. This is her second pregnancy. The patient does not wish to know her weight and when her clinic record is reviewed, her total weight gain for this pregnancy is 5 pounds. She is very concerned about her changing body shape. What disorder does the nurse suspect? A. Anemia B. Anorexia nervosa C. Gestational diabetes D. Gestational hypertension

B. Anorexia nervosa Anorexia nervosa is characterized by a distorted body image and an intense fear of becoming obese. Patients with anorexia nervosa lose weight either by excessive dieting or by purging themselves of calories they have ingested. Because this woman has gained very little weight and has concerns about her body shape, the nurse should suspect anorexia and assess the patient further. Anemia, gestational diabetes, and gestational hypertension do not manifest with these symptoms.

The prenatal nurse has reviewed a patient's 3-day diet recall and notes that the patient typically eats a deli meat sandwich or hot dog, chips, and an apple for lunch. Breakfast consists of cereal, milk, and juice; and dinner contains meat, a starch, vegetables, and a salad. What action by the nurse is most important? A. Advise the woman to obtain more calories from protein. B. Assess the woman's knowledge of proper food handling. C. Discuss adding fish such as tuna or swordfish to the diet. D. Weigh the woman and document her weight in the chart.

B. Assess the woman's knowledge of proper food handling Pregnant women should be taught proper food handling to prevent foodborne illnesses. Deli meats, hot dogs, and luncheon meats should be stored at 40° or less, heated before eating, and consumed within 4 days. Tuna should be eaten in moderation and fish such as shark, swordfish, king mackerel, and tilefish should be avoided in pregnancy because of mercury poisoning. Promoting safety is a priority. The woman may or may not need more calories from protein. Obtaining the patient's weight and documentation are important prenatal activities, but are not the best answer because the nurse needs to assess the woman's knowledge and practice of safe food handling first.

A woman in her third trimester complains of heartburn. Which of the following recommendations should the nurse make to the patient to help prevent this condition? A. Eating one or two large meals daily B. Increasing intake of fluids during meals C. Avoiding fatty or fried foods D. Lying down for 30 to 45 minutes after eating

B. Avoiding fatty or fried foods The patient should eat small, frequent meals rather than large less-frequent ones.The patient should avoid fluid intake with meals, not increase it.The patient should avoid fatty or fried foods.The patient should remain upright for 30 to 45 minutes after eating, not lie down.

The nurse prepares to offer health screening and promotion activities for women aged 40-60. Which activity does the nurse plan to include as a priority for this group? A. Alzheimer's disease screening B. Breast cancer screening C. Gardasil vaccinations D. Influenza vaccinations

B. Breast cancer screening Rational:Breast cancer is the second leading cause of cancer death in women in the United States and is the leading cause of death in women aged 40-55. The priority screening activity is for breast cancer. Alzheimers disease screening is typically done in the older patient. Gardasil is recommended for females aged 9-26. Influenza vaccinations are important for all ages.

A nurse is instructing a patient on how to avoid nausea and vomiting during her first trimester. Which of the following should the nurse mention? A. Take vitamins first thing in the morning B. Drink ginger ale C. Brush teeth before eating D. Eat at a rapid pace

B. Drink ginger ale The patient should take vitamins at bedtime with a snack, not in the morning.The patient should drink cold, clear carbonated beverages such as ginger ale.The patient should brush her teeth after, not before, eating. The patient should eat at a slow, not rapid, pace.

A nurse is teaching a nonsmoking pregnant woman about the iron tablets she was just prescribed. What information is most important for the nurse to teach the patient? A. Calling the doctor right away for dark, tarry stools B. Drinking at least one glass of orange juice a day C. Stopping the prenatal vitamins while taking iron D. Taking the medication between meals and with milk

B. Drinking at least one glass of orange juice a day Vitamin C enhances the absorption of iron, and a nonsmoking woman should be able to get sufficient iron from a glass of citrus juice daily. Iron tablets should be taken between meals, using a beverage other than tea, coffee, or milk. Dark, tarry stools are a known side effect of iron. Women on iron should also be on prenatal vitamins.

The clinic nurse is assessing a woman in her 30th week of pregnancy. Her fundal height is 23 centimeters. What other assessment finding would the nurse correlate with this condition? A. Blood glucose 112 mg/dL B. Hemoglobin 9.2 g/dL C. Leukorrhea D. Platelet count elevated

B. Hemoglobin 9.2 g/dL True anemia, or iron-deficiency anemia, occurs when the hemoglobin level drops below 10 g/dL. The blood's decreased oxygen-carrying capacity causes a reduction in oxygen transport to the developing fetus. Decreased fetal oxygen transport has been associated with intrauterine growth restriction and preterm birth. The patient's lower-than-expected fundal height measurement could also be indicative of intrauterine growth restriction. The blood glucose, although slightly high, is not related, nor is leukorrhea (a common finding in pregnancy) or an elevated platelet count.

To avoid supine hypotensive syndrome while measuring fundal height, where would a nurse position a pillow under a client? A. Head B. Hip C. Feet D. Knees

B. Hip

A patient in the prenatal clinic had a negative rubella titer. Which action by the nurse is most appropriate? A. Have the laboratory draw rubella titers as a double-check. B. Instruct the woman to avoid anyone who may have the disease. C. Prepare to administer a rubella vaccination to the woman. D. Reassure the woman that rubella has few fetal consequences.

B. Instruct the woman to avoid anyone who may have the disease Rubella (German measles) can cause fetal abnormalities if the pregnant woman contracts it during the first trimester, so all pregnant women are screened for immunity. A positive test means the woman is immune to the disease, whereas a negative test indicates susceptibility to it. The woman needs to avoid people who may be ill with rubella and be immunized after her delivery. There is no need for a double check of the results.

A postmenopausal woman asks the nurse about reducing her breast cancer risk. The woman is overweight, consumes one alcoholic drink daily, does not smoke, and works at a desk. What response by the nurse is best? A. Stop drinking all alcohol B. Lose weight C. Exercise more D. Take aspirin daily

B. Lose weight. Rational:Alcohol intake, smoking, and weight maintenance all affect breast health. However, this womans highest risk factor is being overweight. After menopause, estrogen is produced in body fat cells. The combination of estrogen and dietary fat significantly increases the chance of breast cancer development. Exercise can be part of a weight-loss regimen, but this is not the most comprehensive answer. Drinking one drink a day is not linked to increased breast cancer risk, although drinking two to five drinks a day is associated with an increased risk. Taking an aspirin daily is for promotion of heart health.

A nurse is calculating a patient's estimated date of delivery (EDD) using Naegele's rule. Given that the patient's first day of her last normal menstrual period (LMP) was January 11, which of the following should the nurse determine is the woman's EDD? A. October 11 B. October 18 C. October 4 D. October 25

B. October 18 Naegele's rule, which is the standard formula for determining EDD based on the LMP, is calculated as follows: first day of LMP - 3 months + 7 days = EDD. Thus, in this case, the equation would be as follows: January 11 - 3 months + 7 days = October 18.

The nurse is monitoring a patient who is receiving magnesium sulfate for preeclampsia. Which assessment findings might indicate magnesium toxicity? Select all that apply. A.Deep Tendon Reflex (DTR) +4 B.Respiratory rate 10 breaths/minute C.Urine output 15 mL/hour D.Patient reports nausea E.Patient reports feeling flushed

B. Respiratory rate 10 breaths/minute C.Urine output 15 mL/hour

The nurse used Naegele's rule to calculate the expected date of delivery (EDD) for a primigravida whose last menstrual period (LMP) was September 7. How did the nurse arrive at June 14? A. The nurse subtracted 3 months from September 7 and then added 14 days. B. The nurse subtracted 3 months from September 7 and then added 7 days. C. The nurse added 3 months to September 7 and then subtracted 14 days. D. The nurse added 3 months to September 7 and then subtracted 7 days

B. The nurse subtracted 3 months from September 7 and then added 7 days.

In patients with breast cancer, the most reliable predictor of survival is (check one) A. estrogen receptor status B. cancer stage at the time of diagnosis C. tumor grade D. histologic type E. lymphatic or blood vessel involvement

B. cancer stage at the time of diagnosis The most reliable predictor of survival in breast cancer is the stage at the time of diagnosis. Tumor size and lymph node involvement are the main factors to take into account. Other prognostic parameters (tumor grade, histologic type, and lymphatic or blood vessel involvement) have been proposed as important variables, but most microscopic findings other than lymph node involvement correlate poorly with prognosis. Estrogen receptor (ER) status may also predict survival, with ER-positive tumors appearing to be less aggressive than ER-negative tumors. Ref: Abeloff MD, Armitage JO, Niederhuber JE, et al (eds): Clinical Oncology, ed 3. Elsevier Churchill Livingstone, 2004, pp 2399-2401.

A 60-year-old female has been on conjugated equine estrogens/medroxyprogesterone (Prempro) since she went through menopause at age 52. She still has her uterus and ovaries. She is having no side effects that she is aware of and is experiencing no vaginal bleeding. She is worried about the health effects of her hormone replacement therapy and asks your advice about risks versus benefits. Which one of the following would be accurate advice regarding these risks and benefits? (check one) A. The incidence of stroke is decreased B. The incidence of myocardial infarction is decreased C. The incidence of pulmonary embolus is decreased D. The incidence of breast cancer is increased E. The incidence of colorectal cancer is increased

D The Women's Health Initiative Randomized Controlled Trial concluded that the health risks of hormone replacement therapy with combined estrogen plus progestin exceeded the benefits. Absolute risk reductions per 10,000 person-years attributable to estrogen plus progestin were 6 fewer colorectal cancers and 5 fewer hip fractures. However, absolute excess risks per 10,000 person-years included 7 more coronary heart disease events, 8 more strokes, 8 more pulmonary emboli, and 8 more invasive breast cancers. Ref: Rossouw JE, Anderson GL, Prentice RL, et al: Risks and benefits of estrogen plus progestin in healthy postmenopausal women: Principal results from the Women's Health Initiative randomized controlled trial. JAMA 2002;288(3):321-333.

A 38 yo woman presents to your clinic for a follow-up visit with a cervical cytology result of ASCUS and HPV+. What is the next step in management? a) Repeat cytology-only in 3 years b) Immediate HPV genotyping c) Repeat cotesting in 12 months d) Refer for colposcopy

D) Refer for colposcopyAbnormal cervical cells and presence of high-risk HPV present high likelihood for cervical cancer and should be referred for colposcopy. ASCCP 2012 Guidelines(http://www.asccp.org/asccp-guidelines)

A woman in preterm labor has an order for nifedipine (Procardia). Which assessment finding should alert the nurse to withhold the medication? A.Fetal heart rate (FHR) 155 beats per minute B.Breath sounds clear to auscultation C.The patient reports nausea D.Blood pressure 88/50 mm Hg

D. Blood pressure 88/50 mm Hg

The prenatal clinic nurse visits with a 32-year-old man. His partner is pregnant with her first child and is now at 12 weeks of gestation. The man states that he has been experiencing nausea and vomiting, fatigue, and weight gain. Which action by the nurse is most appropriate? A. Ask the woman's health-care provider to prescribe the man anti-nausea medication. B. Assess for cancer risk factors, as weight gain and vomiting are unusual together. C. Encourage the man to make an appointment with his primary health-care provider. D. Explain that these symptoms are normal and often seen in men with pregnant partners.

D. Explain that these symptoms are normal and often seen in men with pregnant partners Couvade syndrome is when a male partner experiences the same maternal signs and symptoms as the woman. The nurse should reassure the man that this is an often-occurring finding. The nurse would not need to encourage the man to make an appointment with his health-care provider unless the symptoms became severe. The woman's primary health-care provider does not need to prescribe anti-emetics, nor does the nurse need to assess the man further for cancer risk factors.

Which does the nurse assess that best reflects an understanding of maternal health? A. History of breast cancer B. Desire to physically exercise C. Feelings about domestic partner D. Knowledge of prenatal vitamin benefit

D. Knowledge of prenatal vitamin benefit

The nurse explains to the prenatal class attendees that at full term about 10 to 11% of the maternal weight gain is attributed to which of the following? A. Blood, uterine, and breast tissue B. Fetal tissue C. Maternal reserves D. Placental fluid

D. Placental fluid During early pregnancy, maternal weight gain is related to an increased blood volume, which is necessary to supply the enlarging uterus and to support fetal growth and development. As the pregnancy progresses, enlargement of the placenta and fetal body add to the woman's increase in weight. By term, maternal extracellular fluid, blood, uterine tissue, and breast tissue comprise 35% of the gestational weight gain; the maternal reserves comprise 27%; fetal tissue comprises 27%; and placental fluid comprises 11% of the total maternal weight gain (Cunningham et al., 2010).

A perinatal nurse is assessing a pregnant woman's medications and finds that one of them is categorized as Category D. What information should the nurse provide this patient? A. "Studies have not found human fetal risk, although animal fetuses are harmed by it." B. "There are no associated fetal risks with this drug and it is safe to take in pregnancy." C. "There haven't been any studies of this drug in human fetuses; I wouldn't take it." D. "We have to decide if the benefits of this drug outweigh the risk, as it can harm the fetus."

D. We have to decide if the benefits of this drug outweigh the risk, as it can harm the fetus There are five categories of drugs based on fetal risk: Category A: no associated fetal risk, safe to take during pregnancy; Category B: no associated fetal risk in animals, fetal risk in humans not identified; Category C: evidence of adverse effects in animal fetuses, fetal risk in humans not identified; Category D: evidence of adverse effects and fetal risk in humans, benefits and risks must be considered before prescribing; and Category X: evidence of fetal risk and congenital anomalies in humans, risks outweigh the benefits, should not be prescribed during pregnancy.