7. Reproduction PrepU
A 35-year-old African American woman who smokes regularly and had diabetes visits the health care unit with sustained elevated blood levels and is diagnosed with essential hypertension. Which contraceptive method is best for this client? Menotropins therapy Cervical cap Clomiphene therapy Placement of an etonogestrel/ethinyl estradiol vaginal ring
Cervical cap Explanation: Women who smoke and are 35 years of age or older should not take oral contraceptives because of an increased risk of cardiovascular disease. Mechanical barriers like cervical caps do not use hormonal therapy and are appropriate in this case. Menotropins, a combination of follicle-stimulating hormone and luteinizing hormone, may be used to stimulate the ovaries to produce eggs. An etonogestrel/ethinyl estradiol vaginal ring is a combination hormonal contraceptive that releases estrogen and progestin and is contraindicated for this client.
The nurse is assessing a 16-year-old female on a routine well-child visit. Which assessment finding will the nurse predict this healthy female will report concerning her menstrual cycles? Flow usually lasts 4 to 6 days. The usual cycle is 36 days. There's abundant clear mucus at the beginning Menstruation began at age 15.
Flow usually lasts 4 to 6 days. Explanation: The average menstrual flow is 4 to 6 days in length. The cycle usually lasts 28 days. There should be no mucus during the menstrual cycle, with clear mucus being noted at the time of ovulation or approximately day 14. Menstruation usually begins at the age of 12 to 14 years.
A 28-year-old client who has just conceived arrives at a health care facility for her first prenatal visit to undergo a physical examination. Which intervention should the nurse perform to prepare the client for the physical examination? Instruct the client to keep taking deep breaths. Ensure that the client's family is present. Instruct the client to empty her bladder. Ensure that the client is lying down.
Instruct the client to empty her bladder. Explanation: When preparing the client for a physical examination, the nurse should instruct the client to empty her bladder; the nurse should then collect the urine sample so that it can be sent for laboratory tests to detect possibilities of a urinary tract infection. The client need not lie down, take deep breaths, or have the family present; however, it is important for the nurse to ensure that the client feels comfortable.
Which statement is true regarding hormonal contraception? Fetal anomalies are a concern. It increases risk for uterine cancer. It increases risk for benign breast cancer. It increases risk for venous thromboembolism.
It increases risk for venous thromboembolism. Explanation: Clients taking hormonal contraception have an increased risk for venous thromboembolism but a decreased risk for benign breast cancer and uterine cancer. Fetal anomalies are not a concern.
Which hormone is responsible for ovulation? Luteinizing hormone Follicle stimulating hormone Estrogen Progesterone
Luteinizing hormone Explanation: The surge of luteinizing hormone causes one of the developing follicles to burst and be released. This release of the ovum is called ovulation. Follicle stimulating hormone stimulates follicular growth and development. Rising estrogen levels causes the surge of luteinizing hormone, which results in ovulation. Progesterone is produced by the graafian follicles and retained in the follicle.
A 21-year-old woman is prescribed an oral contraceptive pill to prevent pregnancy. The nurse should inform the client of which adverse effects of this medication? Weight loss Nausea Cessation of bleeding and/or spotting Reduction of breast tissue
Nausea Explanation: Taking combination oral contraceptives is commonly accompanied by nausea. The nurse should tell the client to anticipate this adverse effect. Breakthrough bleeding or spotting is likely with the medication. The nurse would be incorrect to inform the client that bleeding with cease completely. More commonly, clients taking oral contraceptives experience mild to moderate weight gain, not loss. Breast swelling and tenderness is common with this medication, not a reduction in breast tissue.
The nurse is reviewing the functions of the ovaries, uterus, clitoris, and vagina with a group of nursing students. What would be the best response by a nursing student about the function of the uterus? Receives sperm, provides an exit for menstrual flow, and serves as the birth canal Receives the fertilized ovum and provides housing and nourishment for a fetus Small erectile structure that responds to sexual stimulation Produces female gametes or ova and secretes female sex hormones
Receives the fertilized ovum and provides housing and nourishment for a fetus Explanation: The uterus's functions are to receive the fertilized ovum and provide housing and nourishment for a fetus. The ovaries' functions are to produce female gametes or ova and secrete female sex hormones. The vagina's functions are to receive sperm, provide an exit for menstrual flow, and serve as the birth canal. The clitoris is a small erectile structure that responds to sexual stimulation.
A woman who has sickle cell anemia asks the nurse if her infant will develop sickle cell disease. The nurse would base the answer on which information? Sickle cell anemia is recessively inherited. Sickle cell anemia has more than one polygenic inheritance pattern. Sickle cell anemia is dominantly inherited. Sickle cell anemia is not inherited; it occurs following a malaria infection.
Sickle cell anemia is recessively inherited. Explanation: Sickle cell anemia is an autosomal recessive disease requiring that the person have two genes for the disease, one from each parent. If one parent has the disease and the other is free of the disease and trait, the chance of the child inheriting the disease is zero. If the woman has the disease and her partner has the trait, there is a 50% chance that the child will be born with the disease. If both parents have the disease, then all of their children also will have the disease.
Erectile dysfunction would not be characterized as the inability to: achieve or maintain an erection that is sufficiently rigid for sexual activity. sustain erection for a satisfactory period of time. achieve an erection. achieve an erection after sexual activity.
achieve an erection after sexual activity. Explanation: The ability to achieve an erection after sexual activity varies and depends on the man's age, health, and sexual excitement. There must be multiple or persistent incidences of failed erection for the disorder to be considered pathologic.
When counseling the young adult considering pregnancy, what does the nurse teach the client about nutrition? foods high in folic acid help to prevent neural tube defects adding salt to foods will make you gain too much weight you need to start eating for two so the fetus will have enough nutrients eating fast foods once a day is okay during pregnancy
foods high in folic acid help to prevent neural tube defects Explanation: The client considering pregnancy should start eating foods high in folic acid to prevent neural tube defects. Salt will not make the client gain too much weight even though some salt is necessary for iodine. The client does not need to eat for two or eat fast foods. This can lead to excessive weight gain. The dietary focus is eating a good nutritious diet.
A novice nurse asks to be assigned to the least complex antepartum client. Which condition would necessitate the least complex care requirements? preecalmpsia abruptio placenta placenta previa gestational hypertension
gestational hypertension Explanation: Hypertensive disorders represent the most common complication of pregnancy. Gestational hypertension is elevated blood pressure without proteinuria, other signs of preeclampsia, or preexisting hypertension. Abruptio placenta (separation of the placenta from the uterine wall), placenta previa (placenta covering the cervical os), and preeclampsia are high-risk, potentially life-threatening conditions for the fetus and mother during labor and birth.
The nurse is providing care to a client with abnormal uterine bleeding. Treatment with medications has been unsuccessful, and surgical intervention is being considered. The nurse identifies which technique as being the last resort? endometrial ablation dilation and curretage uterine artery embolization hysterectomy
hysterectomy Explanation: If the client does not respond to medical therapy, surgical intervention might include dilation and curettage (D&C;), endometrial ablation, uterine artery embolization, or hysterectomy. Of these, hysterectomy is considered a last resort.
A nurse is caring for a pregnant client who is in labor. Which maternal physiologic responses should the nurse monitor for in the client as the client progresses through birth? Select all that apply. increase in heart rate increase in blood pressure increase in respiratory rate increase in gastric emptying and pH slight decrease in body temperature
increase in heart rate increase in blood pressure increase in respiratory rate Explanation: When caring for a client in labor, the nurse should monitor for an increase in the heart rate by 10 to 20 bpm, an increase in blood pressure by as much as 35 mm Hg, and an increase in respiratory rate. During labor, the nurse should monitor for a slight elevation in body temperature as a result of an increase in muscle activity. The nurse should also monitor for decreased gastric emptying and gastric pH, which increases the risk of vomiting with aspiration.
A nursing student has learned that precipitous labor is when the uterus contracts so frequently and with such intensity that a very rapid birth will take place. This means the labor will be completed in which span of time? less than 4 hours less than 8 hours less than 5 hours less than 3 hours
less than 3 hours Explanation: Precipitous labor is completed in less than 3 hours.
During a routine prenatal visit, a client is found to have proteinuria and a blood pressure rise to 140/90 mm Hg. The nurse recognizes that the client has which condition? eclampsia severe preeclampsia gestational hypertension mild preeclampsia
mild preeclampsia Explanation: A woman is said to have gestational hypertension when she develops an elevated blood pressure (140/90 mm Hg) but has no proteinuria or edema. If a seizure from gestational hypertension occurs, a woman has eclampsia, but any status above gestational hypertension and below a point of seizures is preeclampsia. A woman is said to be mildly preeclamptic when she has proteinuria and a blood pressure rise to 140/90 mm Hg, taken on two occasions at least 6 hours apart. A woman has passed from mild to severe preeclampsia when her blood pressure rises to 160 mm Hg systolic and 110 mm Hg diastolic or above on at least two occasions 6 hours apart at bed rest (the position in which blood pressure is lowest) or her diastolic pressure is 30 mm Hg above her prepregnancy level. Marked proteinuria, 3+ or 4+ on a random urine sample or more than 5 g in a 24-hour sample, and extensive edema are also present. A woman has passed into eclampsia when cerebral edema is so acute a grand-mal seizure (tonic-clonic) or coma has occurred.
The nurse is educating the parents of a premature newborn diagnosed with retinopathy of prematurity. Which comment will be part of the information provided? "This is caused by silver nitrate." "The liquid inside the eye can't drain." "This can be genetic or acquired." "It's an overgrowth of retinal blood vessels."
"It's an overgrowth of retinal blood vessels." Explanation: The pathophysiology of ROP is one of injury to the developing blood vessels and tissues of the retina, and the healing process of regrowth or overgrowth of retinal vessels. Cataracts may be caused by genetics or may be acquired after birth. The inability of the aqueous humor to drain from the eye is a result of glaucoma. Silver nitrate 1% is an antibacterial prophylaxis that may cause conjunctivitis.
The nurse is reviewing client data following a regular monthly appointment at 6 months' gestation. Which fundal height requires no further intervention? 30 cm 18 cm 32 cm 24 cm
24 cm Explanation: An anticipated fundal height for 24 weeks' gestation (6 months) is 24 cm. Between 18 and 32 weeks gestation, the fundal height in centimeters should match the gestational age. All of the other measurements would require further intervention.
During an exam, the nurse notes that the blood pressure of a client at 22 weeks' gestation is lower, and her heart rate is 12 beats per minute higher than at her last visit. How should the nurse interpret these findings? Combined, both of these findings are very concerning and warrant further investigation. Both findings are normal at this point of the pregnancy. The heart rate increase may indicate that the client is experiencing cardiac overload. The blood pressure should be higher since the cardiac volume is increased.
Both findings are normal at this point of the pregnancy. Explanation: A pregnant woman will normally experience a decrease in her blood pressure during the second trimester. An increase in the heart rate of 10 to 15 beats per minute on average is also normal, due to the increased blood volume and increased workload of other organ systems. Hormonal changes cause the blood vessels to dilate, leading to a lowering of blood pressure.
A pregnant woman's ultrasound reveals intrauterine growth retardation (IUGR) and a TORCH agent is thought to be the cause. Which nursing action is appropriate? Facilitate serum testing for hepatitis and obtain the client's immunization history. Arrange for the client to be immunized against cholera (Vibrio cholerae). Determine whether the client has been immunized against rubella. Assess whether the client has been exposed to tetanus since becoming pregnant.
Determine whether the client has been immunized against rubella. Explanation: TORCH stands for toxoplasmosis, other, rubella (i.e., German measles), cytomegalovirus, and herpes. Hepatitis, tetanus, and cholera are not included among lists of TORCH agents.
The nurse would question the prescription for a fetal scalp electrode on which client? client with a prolonged second stage of labor client with an HIV infection client with late decelerations client with significant meconium stained fluid
client with an HIV infection Explanation: Placement of a fetal scalp electrode should be avoided when a client has HIV because it increases the risk of transmission to the fetus. The use of a fetal scalp electrode is indicated when precise tracing are needed to monitor changes associated with fetal hypoxia and satisfactory tracing cannot be obtained with external methods.
A nurse is caring for a 16-year-old pregnant client taking an iron supplement. Which instruction should the nurse include when teaching the adolescent about ferrous sulfate? Select all that apply. Avoid chewing the extended-release form of the drug. Take the supplement with food. Avoid taking the supplement with milk. Report black stools to the physician immediately. Avoid taking the supplement with antacids.
Avoid taking the supplement with milk. Avoid taking the supplement with antacids. Avoid chewing the extended-release form of the drug. Explanation: Because food delays absorption, the nurse should instruct the client to take the supplement between meals to increase absorption. The client should take the supplement with juice (preferably orange juice) or water, but not with milk or antacids. The nurse should also tell the client not to crush or chew extended-release forms of the drug.
Which of the following is a positive sign of pregnancy? Fetal movement felt by examiner Positive pregnancy test Uterine contractions Hegar's sign
Fetal movement felt by examiner Explanation: The positive signs of pregnancy are fetal image on sonogram, hearing a fetal heart rate, and examiner feeling fetal movement.
Early in pregnancy, frequent urination results mainly from which of the following? Pressure on the bladder from the uterus Increased concentration of urine Addition of fetal urine to maternal urine Decreased glomerular selectivity
Pressure on the bladder from the uterus Explanation: Early in pregnancy, the expanding uterus presses on the bladder. Later, it rises above the bladder so pressure is relieved.
A nurse is describing the use of Rho(D) immune globulin as the therapy of choice for isoimmunization in Rh-negative women and for other conditions to a group of nurses working at the women's health clinic. The nurse determines that additional teaching is needed when the group identifies which situation as an indication for Rho(D) immune globulin? STIs maternal trauma amniocentesis molar pregnancy
STIs Explanation: Indications for Rho(D) immune globulin include isoimmunization, ectopic pregnancy, chorionic villus sampling, amniocentesis, prenatal hemorrhage, molar pregnancy, maternal trauma, percutaneous umbilical sampling, therapeutic or spontaneous abortion, fetal death, or fetal surgery.
When a man cannot achieve an erection, the phase of the sexual response in which the man is experiencing difficulty is: excitement phase. obligatory phase. orgasmic phase. refractory phase.
excitement phase. Explanation: The excitement phase is characterized by rapid erection of the penis with tensing and thickening of the scrotal skin and elevation of the scrotal sac.
A couple is inquiring about vasectomy as a permanent method of contraception. Which teaching statement would the nurse include in the teaching plan? "Another method of contraception is needed until the sperm count is 0." "Vasectomy is contraindicated in males with prior history of cardiac disease." "Vasectomy is easily reversed if children are desired in the future." "Vasectomy requires only a yearly follow-up once the procedure is completed."
"Another method of contraception is needed until the sperm count is 0." Explanation: Another method of contraception is needed until all sperm has been cleared from the body. The number of ejaculates for this to occur varies with the individual, and laboratory analysis is required to determine when that has been accomplished. Vasectomy is considered a permanent sterilization procedure and requires microsurgery for anastomosis of the vas deferens to be completed. Studies have shown that there is no connection between cardiac disease in males and vasectomy. There is no need for follow-up after verification there is no sperm in the system.
The nurse is assessing the past medical history of an infant with a suspected cardiovascular disorder. Which response by the mother warrants further investigation? "I was really nauseous throughout my whole pregnancy." "His Apgar score was an 8." "I had the flu during my last trimester." "I am on a low dose of steroids."
"I am on a low dose of steroids." Explanation: Some medications, like corticosteroids, taken by pregnant women may be linked with the development of congenital heart defects. Reports of nausea during pregnancy and an Apgar score of 8 would not trigger further questions. Febrile illness during the first trimester, not the third, may be linked to an increased risk of congenital heart defects.
A 32-year-old woman with epilepsy mentions to the nurse during a routine well-visit that she would like to have children and asks the nurse for advice. Which response is most appropriate from the nurse? "You should talk to the doctor about that; the medications you're on can damage the fetus." "Do you want to talk to a counselor who can help you weigh the pros and cons of having your own child rather than adopting?" "I'll let the doctor know so you can discuss your medications. In the meantime, I'll give you a list of folate-rich foods you can add to your diet." "That's great. I've got a 4-year-old and a 2-year-old myself."
"I'll let the doctor know so you can discuss your medications. In the meantime, I'll give you a list of folate-rich foods you can add to your diet." Explanation: Any woman with epilepsy needs to discuss the medication management with her provider. The current research indicates the medications used for epileptic management are the major cause of birth defects for these patients. The nurse should be careful about mentioning that some epileptics are teratogenic; some women may stop taking their medications in order to get pregnant. Suggesting adoption is inappropriate as the mother has given no indication she is interested in adoption; also, the mother needs to discuss this with the physician so that she can get accurate information about being on anti-seizure medications and being pregnant. The nurse should not share personal information as it does not assist this client in making a serious decision. The client should be referred to the health care provider to help the client make the best decision.
After assessing a woman who has come to the clinic, the nurse suspects that the woman is experiencing abnormal uterine bleeding. Which statement by the client would support the nurse's suspicions? "I get sharp pain in my lower abdomen usually starting soon after my period comes." "I get really irritable and moody about a week before my period." "I've been having bleeding off and on that's irregular and sometimes heavy." "My periods have been unusually long and heavy lately with a lot of bleeding."
"I've been having bleeding off and on that's irregular and sometimes heavy." Explanation: Abnormal uterine bleeding is defined as irregular, abnormal bleeding that occurs with no identifiable anatomic pathology. It is frequently associated with anovulatory cycles, which are common for the first year after menarche and later in life as a woman approaches menopause. Pain occurring with menses refers to dysmenorrhea. Although mood swings may be associated with dysfunctional uterine bleeding, irritability and mood swings are more commonly associated with premenstrual syndrome. Unusually long and heavy periods with prolonged bleeding reflect menorrhagia.
A couple who are pregnant with their first child have made an appointment with a clinical geneticist to discuss prenatal screening. The man states that they, "just want to make sure that there is nothing wrong with our baby." How could the clinician best respond to this statement? "You need to be aware that if abnormalities are detected, termination is normally required." "Testing the umbilical blood and performing amniocentesis can give us some information, but not a guarantee." "Prenatal screening is not usually necessary unless you are among a high-risk group." "We can't rule out all abnormalities, but a routine fetal tissue biopsy can yield useful information."
"Testing the umbilical blood and performing amniocentesis can give us some information, but not a guarantee." Explanation: Prenatal screening provides a useful, but incomplete, picture of fetal health; umbilical sampling and amniocentesis are common methods of screening. Fetal tissue biopsy is a rarely-used screening method, and a couple need not belong to a high-risk group to benefit from prenatal screening. Abnormalities do not usually necessitate termination.
The community health nurse is conducting a presentation on labor and delivery. When illustrating the birth process, the nurse should point out zero station refers to which sign? "This is just a way of determining your progress in labor." "The presenting part is at the true pelvis and is engaged." "This indicates that you start labor within the next 24 hours." "This means +1 and the baby is entering the true pelvis."
"The presenting part is at the true pelvis and is engaged." Explanation: Zero station is when the fetus is engaged in the pelvis, or has dropped. This is an encouraging sign for the client. This sign is indicative that labor may be beginning, but there is no set time frame regarding when it will start. Labor has not started yet, and the fetus has not begun to move out of the uterus.
The grandmother of a child born at 32 'gestation to a teen mother is tearful. She worries her grandchild will have developmental problems. What response by the nurse is most appropriate? "We can't know the outcomes for your grandchild at this point in time." "The risks of developmental concerns are heightened for your grandchild." "Premature children often have problems." "Children born to teen mothers will likely have developmental delays."
"The risks of developmental concerns are heightened for your grandchild." Explanation: Children born to teen mothers and those who are born at a gestation of 33 weeks or less have an increased risk for experiencing developmental delays. The child's grandmother is expressing concerns. It is most appropriate to explain to her that there are risks involved. The most appropriate response by the nurse is one that personalizes and responds to her question.
A pregnant client reports an increase in a thick, whitish vaginal discharge. Which response by the nurse would be most appropriate? "You should refrain from any sexual activity." "You need to be assessed for a fungal infection." "This discharge is normal during pregnancy." "Use a local antifungal agents regularly."
"This discharge is normal during pregnancy." Explanation: During pregnancy, the vaginal secretions become more acidic, white, and thick. Most women experience an increase in a whitish vaginal discharge, called leukorrhea, during pregnancy. The nurse should inform the client that the vaginal discharge is normal except when it is accompanied by itching and irritation, possibly suggesting Candida albicans infection, a monilial vaginitis, which is a very common occurrence in this glycogen-rich environment. Monilial vaginitis is a benign fungal condition and is treated with local antifungal agents. The client need not refrain from sexual activity when there is an increase in a thick, whitish vaginal discharge.
The nurse performs a routine prenatal assessment on a client at 35 weeks' gestation and finds vital signs: blood pressure 138/88 mm Hg, pulse 82/min, respirations 18/min, temperature 99.1° F (37.3° C). Which statement is most appropriate for the nurse to make at this time? "Your blood pressure is slightly high. I will check it again before you leave." "Your vital signs are all normal. I will document them on your chart." "You have a slight temperature. Do you feel hot?" "Your pulse is low. Do you exercise a lot?"
"Your blood pressure is slightly high. I will check it again before you leave." Explanation: A blood pressure reading of 138/88 mm Hg is nearing hypertension range and could be a sign of developing gestational hypertension. Conversely, the client may be experiencing "white coat" syndrome or could be anxious during the prenatal visit. In order to obtain an accurate blood pressure reading, the nurse should allow the woman to rest for a period of time and recheck the blood pressure in the same arm and while the woman is in the same position. This blood pressure is considered approaching high. All other vital signs are within normal range.
A client states that "she thinks" her water has broken. Which best provides confirmation of the rupture of membranes? A positive Nitrazine test A positive bacterial culture Greenish fluid noted on the client's underwear Leakage from the perineum when the client coughs.
A positive Nitrazine test Explanation: A confirmation that the client has a rupture of membranes includes a positive Nitrazine test. A positive test is when the Nitrazine paper turns a dark blue indicating that the fluid is alkaline. Urine also leaks when a client coughs. Greenish fluid on the underwear is not confirmation of the rupture of membranes. A positive bacterial culture is not indicative of the rupture of membranes.
The triage nurse is giving a telephone report to the receiving nurse in the labor and birth unit. The multigravida client is 8 cm dilated and is being transferred to the labor and birth unit. How should the labor and birth nurse manage the next ten minutes with the client? Select all that apply. Assess comfort needs of the client. Determine support systems for the client. Prepare to give an early report to the nurse arriving on the next shift. Call other staff to set up the birthing table. Begin fetal monitoring.
Begin fetal monitoring. Call other staff to set up the birthing table. Assess comfort needs of the client. Determine support systems for the client. Explanation: Assuring the safety of this client is the top priority. The nurse should begin either intermittent or continuous fetal and contraction monitor depending on the client's risk status. Since the client is 8 cm dilated and a multigravid client, asking other staff members to set up the birthing table would be in order. This client is not a candidate for medication as this may have an influence on the baby. This client is past the point of offering an epidural as she may have given birth by the time the medication is in effect, but comfort measures such as warm or cool cloths, back rubs, etc. may be helpful. The support system is an important aspect of the birthing process and is an easily settled situation. Preparing to give an early report to the oncoming nurse does not apply in this situation.
Which term refers to painful menstruation? Amenorrhea Dysmenorrhea Ovulation Dyspareunia
Dysmenorrhea Explanation: Dysmenorrhea is painful menstruation. Amenorrhea is the absence of menstrual flow. Ovulation is the discharge of mature ovum from the ovary. Dyspareunia is difficult or painful sexual intercourse.
Which term refers to difficult or painful sexual intercourse? Amenorrhea Dyspareunia Dysmenorrhea Endometriosis
Dyspareunia Explanation: Dyspareunia is a common problem in older women. Amenorrhea refers to the absence of menstrual flow. Dysmenorrhea refers to painful menstruation. Endometriosis is a condition in which endometrial tissue seeds in other areas of the pelvis. Reference:
The ovarian follicle becomes luteinized once ovulation has taken place. As the corpus luteum, the now empty follicle produces what? Glycogen and testosterone Follicle-stimulating hormone and luteinizing hormone Testosterone and estrogen Estrogen and progesterone
Estrogen and progesterone Explanation: After ovulation, the follicle becomes luteinized; as the corpus luteum, it produces estrogen and progesterone to support the endometrium until conception occurs or the cycle begins again. The other answers are incorrect.
A gravida 4 para 4 mother calls the nurse's station reporting uterine pain following delivery. When the nurse responds to the call, the mother reports that she is having what feels like labor pains again off and on. What would be the nurse's response? Recommend that the client ambulate more to help relieve the pain. Encourage the mother to breast-feed to help relax the uterus. Tell her that you will notify the doctor of the unusual pain and see what he wants to do. Explain to her that women who have had several babies prior to this delivery often experience afterpains, which is where the uterus is contracting and relaxing at intervals.
Explain to her that women who have had several babies prior to this delivery often experience afterpains, which is where the uterus is contracting and relaxing at intervals. Explanation: Afterpains occur most commonly in multipara mothers and occur when the uterus contracts and relaxes at intervals. Breast-feeding also can cause afterpains, increasing both the duration and the intensity of the pains. Ambulation will not affect the incidence of afterpains; afterpains are a very common postpartum event so there is no need to call the doctor.
The nursing instructor is illustrating the various positions the fetus may utilize during the passage through the vaginal canal at birth. The instructor determines the session is successful when the students correctly identify the ROA position, indicating which presentation by the fetus? Presenting with the face as the presenting part Facing the right anterior pelvic quadrant In a common breech birth position In a longitudinal lie facing the left posterior
Facing the right anterior pelvic quadrant Explanation: ROA (right occiput anterior) means the occiput of the fetal head points toward the mother's right anterior pelvis; the head is the presenting part.
A 13-year-old who started her menstrual cycle at age 12 asks the nurse practitioner how frequently her "period" should come. The nurse takes a calendar and has the girl circle the date of her last period, which started on January 7. The nurse then circles when her next period should start based on the average number of days in a normal cycle. What date did the nurse circle? February 5 February 8 January 27 January 30
February 5 Explanation: February 5 is 28 days from the start of the last cycle, based on the average number of days in a normal cycle. However, cycles can vary from 21 to 42 days, depending on a variety of factors. Reference:
How does a woman who feels in control of the situation during labor influence her pain? There is no association between the two factors. Decreased feeling of control helps during the third stage. Feelings of control are inversely related to the client's report of pain. Feeling in control shortens the overall length of labor.
Feelings of control are inversely related to the client's report of pain. Explanation: Studies reveal that women who feel in control of their situation are apt to report less pain than those who feel they have no control.
The nurse has received the results of a client's postpartum hemoglobin and hematocrit. Review of the client's history reveals a prepartum hemoglobin of 14 gm/dL and hematocrit of 42%. Which result should the nurse prioritize? Hemoglobin 13 gm/dL and hematocrit 40 percent in a woman who has given birth vaginally Hemoglobin 12 gm/dL and hematocrit 38 percent in a woman who has given birth vaginally Hemoglobin 11 gm/dL and hematocrit 34 percent in a woman who has given birth by cesarean Hemoglobin 9 gm/dL and hematocrit 32 percent in a woman who has given birth by cesarean
Hemoglobin 9 gm/dL and hematocrit 32 percent in a woman who has given birth by cesarean Explanation: First, the nurse needs to determine the amount of blood loss during the delivery. For every 250 mL of blood lost during the delivery process, the hemoglobin should decrease by 1 gm/dL and the hematocrit by 2 percent. The acceptable amount of blood loss during a normal vaginal delivery is approximately 300 mL to 500 mL and for a cesarean delivery approximately 500 mL to 1000 mL. The loss of hemoglobin from 14 gm/dL to 9 gm/dL is 5 and for the hematocrit from 42% to 32% is 10. This would indicate the client lost approximately 1250 mL of blood during the cesarean delivery (5 x 250 = 1250); this is too much and should be reported to the health care provider immediately. The other choices would be considered to be within normal range.
The nurse is obtaining a health history on a woman of child-bearing age who wants to become pregnant. What information in her health history places her at high risk for having a child with a myelomeningocele? History of a previous abdominal surgery History of asthma taking montelukast History of scoliosis History of a seizure disorder and taking phenobarbital
History of a seizure disorder and taking phenobarbital Explanation: Maternal consumption of certain drugs that antagonize folic acid, such as anticonvulsants (carbamazepine and phenobarbital), places her at high risk for having a child with neural tube defect such as a myelomeningocele. A history of taking montelukast, previous abdominal surgery, or a history of scoliosis does not pose a risk for having a child with a myelomeningocele.
What happens with the hormones associated with pregnancy once the fetus and the placenta have been expelled from the uterus? Hormone levels remain constant. Hormone levels decrease significantly. Hormone levels increase slightly. Hormone levels decrease slightly.
Hormone levels decrease significantly. Explanation: Once the fetus and the placenta have been expelled from the uterus, the hormone levels plummet toward the nonpregnant state.
The nurse is monitoring a client who is in labor and notes the client is happy, cheerful, and "ready to see the baby." The nurse interprets this to mean the client is in which stage or phase of labor? Latent phase Stage three Stage two Transition phase
Latent phase Explanation: The woman in labor undergoes numerous psychological adaptations during labor. During the latent phase, she is often talkative and happy, and yet anxious. During transition, the client may show fear and anger. During stage two she may remain positive, but the work of labor is very intense.
Which hormone is responsible for ovulation? Progesterone Estrogen Follicle-stimulating hormone Luteinizing hormone
Luteinizing hormone Explanation: A massive release of luteinizing hormone or its surge causes one of the developing follicles to burst and release the ovum. This is called ovulation.
When conducting health education sessions for young adults, the nurse explains that a hormone produced by the anterior pituitary gland is responsible for triggering ovulation. The nurse identifies this hormone as the: Follicle-stimulating hormone. Thyroid-stimulating hormone. Luteinizing hormone. Human chorionic gonadotropin hormone.
Luteinizing hormone. Explanation: An acute rise in luteinizing hormone, called a "surge," occurs just before ovulation, about day 14 of a 28-day cycle.
A postpartum client's husband calls the nurse and says, "My wife feels funny." The nurse enters the room and notes blood gushing from the client's vagina, pallor, and a rapid, thready pulse. What should be the nurse's first intervention? Call the physician. Massage the fundus. Pack the vagina with sterile gauze. Insert an indwelling catheter.
Massage the fundus. Explanation: Postpartum hemorrhage results in excessive vaginal bleeding and signs of shock, such as pallor and a rapid, thready pulse. Placental separation causes a sudden gush or trickle of blood from the vagina, rise of the fundus in the abdomen, increased umbilical cord length at the introitus, and a globe-shaped uterus. Uterine involution causes a firmly contracted uterus, which cannot occur until the placenta is delivered. Cervical lacerations produce a steady flow of bright red blood in a client with a firmly contracted uterus. The priority measure to correct postpartum hemorrhage is to massage the fundus. Packing the uterus with sterile gauze is contraindicated. The physician will have to be called but the nurse must first intervene.
Which situation would require the nurse to use critical thinking and decision-making skills in providing genetics-related nursing care? Providing education related to lead poisoning to a single parent of a 4-year-old child Providing family counseling to a same-sex couple that just adopted a 5-year-old with attention deficit hyperactivity disorder (ADHD) Providing fertility counseling to a young family with a 2-year-old child with cystic fibrosis Providing education related to growth and development to a blended family with children of different ages
Providing fertility counseling to a young family with a 2-year-old child with cystic fibrosis Explanation: Cystic fibrosis is an autosomal recessive genetic disorder. Parents of a child diagnosed with cystic fibrosis have a 50% chance of having another child with cystic fibrosis. Once the nurse assesses the family history, it is appropriate nursing action to for the nurse to make a referral for genetic testing or counseling. Although ADHD may have a genetic component, there is no genetics-related issue in this situation. Lead poisoning is not a genetic disorder. There is no indication that any of the children in the blended family have a genetics-related problem.
An anxious young adult is brought to the interviewing room of a crisis shelter, sobbing and saying that she thinks she is pregnant but does not know what to do. Which nursing intervention is most appropriate at this time? Ask the client about the type of things that she had thought of doing. Give the client some ideas about what to expect to happen next. Recommend a pregnancy test after acknowledging the client's distress. Question the client about her feelings and possible parental reactions.
Recommend a pregnancy test after acknowledging the client's distress. Explanation: Before any interventions can occur, knowing whether the client is pregnant is crucial in formulating a plan of care. Asking the client about what things she had thought about doing, giving the client some ideas about what to expect next, and questioning the client about her feelings and possible parental reactions would be appropriate after it is determined that the client is pregnant.
Assessment of a primigravid client in active labor reveals cervical dilation at 9 cm with complete effacement and the fetus at +1 station. What is the most appropriate action for the nurse to take when the health care provider (HCP) prescribes morphine 2 mg IM for the client? Refuse to administer the medication to the client. Administer the medication in the left ventrogluteal muscle. Be certain that naloxone is at the client's bedside. Ask the HCP to validate the dosage of the drug.
Refuse to administer the medication to the client. Explanation: The nurse should refuse to administer the medication to the client because of the risk of respiratory depression in the neonate. Morphine, given IM, peaks in 30 to 60 minutes and lasts 4 hours. Based on the assessment findings, the client most likely will be delivering within that time frame, increasing the risk of respiratory depression in the neonate, a serious consequence. Therefore, the nurse should not administer the drug. Naloxone should be readily available whenever opioids that can result in respiratory depression are used. Asking the HCP to validate the dosage is not necessary.
The nurse is caring for a client at 39 weeks' gestation and whose fetal station is noted as a 0 (zero). The nurse is correct to document which? The fetus has descended down the birth canal. The fetus is floating high in the pelvis. The client is fully effaced. The fetus is in the true pelvis and engaged.
The fetus is in the true pelvis and engaged. Explanation: When the fetus is at a 0 (zero) station, it is at the level of the ischial spines and said to be engaged. Determining the station does not mean that the client's cervix is fully effaced. If the fetus is floating high in the pelvis, its station is noted as a negative number. Descending into the pelvis or birth canal is documented as a positive number.
At a health education class for teenagers, the nurse discusses the sexually transmitted infection chlamydia trachomatis. Which information would the nurse most likely include? The new recombinant human papillomavirus vaccine will prevent the infection. This infection is lifelong as it cannot be treated with medication. This infection is the most common infectious cause of infertility. Antiviral drug regimes will cure this infection.
This infection is the most common infectious cause of infertility. Explanation: The young have the most to lose from acquiring STIs, since they may not reach their full reproductive potential. In women, chlamydia is linked with cervicitis, salpingitis, ectopic pregnancy, pelvic inflammatory disease, and infertility. It is likely the most common infectious cause of infertility in women. Recombinant human papillomavirus vaccine is for the HPV STI. Antibiotics will cure this STI only.
The laboring client who is at 3 cm dilation and 25% effaced is asking for analgesia. The nurse explains the analgesia usually is not administered prior to the establishment of the active phase. What is the appropriate rationale for this practice? The effects would wear off before birth. This can lead to maternal hypertension. This may prolong labor and increase complications. This would cause fetal depression in utero.
This may prolong labor and increase complications. Explanation: Administration of pharmacologic agents too early in labor can stall the labor and lengthen the entire labor. The client should be offered nonpharmacologic options at this point until she is in active labor.
Which pregnant woman should consult with her obstetric provider before continuing an exercise program? a 33-year-old G5 P1 with a history of incompetent cervix a 40-year-old G1 P0 who does 30 to 60 minutes of aerobic exercise a day a 25-year-old G2 P1 with history of heavy periods due to endometriosis a 17-year-old G1 P0 used birth control pills prior to becoming pregnant
a 33-year-old G5 P1 with a history of incompetent cervix Explanation: Women who know they have an incompetent cervix or have had cerclage to correct this should consult with their obstetric provider before beginning or continuing an exercise program. The other pregnant females can continue their exercise programs with the routine precautions outlined.
Down syndrome may occur because of a translocation defect. This means the: infant inherits chromosomal material from only one parent. parents have a chromosomal pattern that is exactly alike. additional chromosome was inherited because it was attached to a normal chromosome. parents are such close relatives that their genes are incompatible.
additional chromosome was inherited because it was attached to a normal chromosome. Explanation: A translocation defect causes Down syndrome when a 21st chromosome is attached to another chromosome, so dysjunction results in an abnormal distribution of chromosomes.
Cystic fibrosis is an example of which type of inheritance? multifactorial autosomal recessive X-linked recessive autosomal dominant
autosomal recessive Explanation: Cystic fibrosis is an autosomal recessive inherited condition. Huntington disease would be an example of an autosomal dominant inherited condition. Hemophilia is an X-linked recessive inherited condition. Cleft lip is a multifactorial inherited condition.
A nurse is monitoring the vital signs of a client 24 hours after birth. She notes that the client's blood pressure is 100/60 mm Hg. Which postpartum complication should the nurse most suspect in this client, based on this finding? bleeding postpartal gestational hypertension infection diabetes
bleeding Explanation: Blood pressure should also be monitored carefully during the postpartal period because a decrease in this can also indicate bleeding. In contrast, an elevation above 140 mm Hg systolic or 90 mm Hg diastolic may indicate the development of postpartal gestational hypertension, an unusual but serious complication of the puerperium. An infection would best be indicated by an elevated oral temperature. Diabetes would be indicated by an elevated blood glucose level.
Many clients experience a slight fever after birth especially during the first 24 hours. To what should the nurse attribute this elevated temperature? infection change in the temperature from the birth room dehydration fluid volume overload
dehydration Explanation: Many women experience a slight fever (100.4° F [38° C]) during the first 24 hours after birth. This results from dehydration because of fluid loss during labor. With the replacement of fluids the temperature should return to normal after 24 hours.
When caring for a woman in her sixth month of pregnancy, the client reports her plans to nurse her baby for at least 2 to 3 years like the rest of the women in her family. Based upon the nurse's knowledge, the nurse should: advise her to be careful who she discusses this with as many will consider that a type of reportable child mistreatment. document her report but do nothing as this is a cultural belief that should be respected. encourage her to start the baby on formula after the first year as recommended by many health care providers. discuss how painful this will be once the baby has teeth.
document her report but do nothing as this is a cultural belief that should be respected. Explanation: Culturally specific decisions should be respected and incorporated into the plan of care.
A client in the second stage of labor who planned an unmedicated birth is in severe pain because the fetus is in the ROP position. The nurse should place the client in which position for pain relief? tailor sitting lithotomy right lateral hands and knees
hands and knees Explanation: Placing the client in the hands and knees position pulls the fetal head away from the sacral promontory (relieving pain) and facilitates rotation of the fetus to the anterior position. Lithotomy is the position preferred by some health care providers (HCP) for delivery but does not facilitate rotation. The right lateral position will perpetuate the ROP position. Tailor sitting facilitates descent in OA positions.
The nurse is providing care to a neonate. Review of the maternal history reveals that the mother is suspected of heroin use disorder. The nurse would be alert for which finding when assessing the neonate? low, feeble cry vigorous sucking easy consolability hypertonicity
hypertonicity Explanation: Newborns of mothers with heroin or other narcotic use disorder display irritability, hypertonicity, a high-pitched cry, vomiting, diarrhea, respiratory distress, disturbed sleeping, sneezing, diaphoresis, fever, poor sucking, tremors, and seizures.
The nurse is reviewing the role of the mammary glands in the reproductive process with a birth class. What should the nurse tell the class is the name of the ducts in the mammary glands that form a small reservoir for milk? areola nipple lactiferous lobules
lactiferous Explanation: Each breast is divided into 15 to 20 lobes of glandular tissue, covered by adipose (fat) tissue, which gives the breast its shape. The lobes are made up of lobules, which consist of milk-secreting cells in glandular alveoli. From the alveoli, small lactiferous ducts converge toward each nipple like the spokes of a wheel. Each lactiferous duct forms a small reservoir for milk. The structures of the breast include the nipple, the areola, and the areolar glands. The nipple is a circular projection containing some erectile tissue. It is surrounded by the pigmented areola. Areolar glands, which are close to the skin's surface, make the areola appear rough.
A woman is taking vaginal progesterone suppositories during her first trimester because her body does not produce enough of it naturally. She asks the nurse what function this hormone has in her pregnancy. What should the nurse explain is the primary function of progesterone? maintains the endometrial lining of the uterus during pregnancy ensures the corpus luteum of the ovary continues to produce estrogen contributes to mammary gland development regulates maternal glucose, protein, and fat levels
maintains the endometrial lining of the uterus during pregnancy Explanation: Progesterone is necessary to maintain the endometrial lining of the uterus during pregnancy. It is human chorionic gonadotropin (hCG) that acts to ensure the corpus luteum of the ovary continues to produce estrogen and progesterone. Estrogen contributes to mammary gland development, and human placental lactogen regulates maternal glucose, protein, and fat levels.
A 19-year-old pregnant adolescent who experienced a rape has arrive in the emergency department in active labor with no prenatal care. The nurse caring for the client should assess for which potential adverse health problem? gestational diabetes hypertension caused by preeclampsia sexually transmitted infections (STIs) alcohol withdraw symptoms
sexually transmitted infections (STIs) Explanation: Any pregnant female who arrives in the emergency department without any prenatal care may be at increased risk for adverse health conditions, which may include STIs. It is rare for a younger client to develop gestational diabetes or preeclampsia. There is no indication that the client was intoxicated and at risk for alcohol withdraw.
During the inital history and physical of a 30-year-old primapara client, the nurse has identified some teratogens the fetus is being exposed to at this phase of the pregnancy. Which lifestyle data could result in teratogenic exposure to the fetus? Select all that apply. smoking 2 packs of cigarettes a day snorting cocaine once or twice a month drinking alcoholic beverages 3 times a week painting pictures as a hobby working as a receptionist in a busy office where she copies documents
smoking 2 packs of cigarettes a day drinking alcoholic beverages 3 times a week snorting cocaine once or twice a month Explanation: Often, helping a woman plan to avoid teratogens is challenging because a total change in lifestyle and environment, such as not smoking, not drinking alcohol, or avoiding the use of recreational drugs may be difficult. Fortunately, most women are highly motivated to complete a pregnancy satisfactorily, so they are usually willing to make changes for the health of the unborn fetus. Working in an office as a receptionist does not expose this client to teratogens. Women are encouraged to continue with their hobbies as long as teratogens are not involved. Painting pictures should not pose a threat to the fetus.
A nurse is conducting a health class for a group of adolescents about male and female reproduction. When describing the testes, the nurse would explain that these organs are important for manufacturing which hormone? estrogen luteinizing hormone progesterone testosterone
testosterone Explanation: The testes serve two functions: production of sperm and synthesis of testosterone, the primary male sex hormone. Estrogen is secreted by the ovaries; progesterone is secreted by the corpus luteum. Luteinizing hormone is secreted by the anterior pituitary gland and is responsible for both the final maturation of the preovulatory follicles and luteinization of the ruptured follicle.
A nurse decides to perform fundal massage based on findings that support which condition? uterine atony uterine prolapse uterine subinvolution uterine contraction
uterine atony Explanation: Fundal massage is performed for uterine atony, which is failure of the uterus to contract and retract after birth. The nurse would place the gloved dominant hand on the fundus and the gloved nondominant hand on the area just above the symphysis pubis. Using a circular motion, the nurse massages the fundus with the dominant hand. Then the nurse checks for firmness and, if firm, applies gentle downward pressure to express clots that may have accumulated. Finally the nurse assists the woman with perineal care and applying a new perineal pad.