Evolve Maternal exam 1 review

List the time span in lunar months, calendar months, weeks, and days that indicates the appropriate length for a normal pregnancy. ________

10 lunar months, 9 calendar months, 40 weeks, 280 days.

A woman is 6 weeks pregnant. She has had a previous spontaneous abortion at 14 weeks of gestation and a pregnancy that ended at 38 weeks with the birth of a stillborn girl. What is her gravidity and parity using the GTPAL system? _______

3-1-0-1-0

A pregnant woman is the mother of two children. Her first pregnancy ended in a still birth at 32 weeks of gestation, her second pregnancy with the birth of her daughter at 36 weeks, and her third pregnancy with the birth of her son at 41 weeks. Using the 5-digit system to describe this woman's current obstetric history, the nurse would record: __________

4-1-2-0-2

What laboratory results would be a cause for concern if exhibited by a woman at her first prenatal visit during the second month of her pregnancy? A. Hematocrit 38%, hemoglobin 13 g/dL B. White blood cell count 6000/mm3 C. Platelets 300,000/mm3 D. Rubella titer 1:6

A. Hematocrit 38%, hemoglobin 13 g/dL

During the preconception phase, the nurse should teach about which infectious diseases as risk factors for maternal complications? A. Diabetes B. Rubella C. Hepatitis B D. Anemia E. HIV/AIDS

B, C, E Rubella, Hepatitis B, and HIV/AIDS are all infectious diseases. Diabetes and anemia are chronic diseases.

Which presumptive signs (felt by the woman) or probable sign (observed by the examiner) of pregnancy is not matched with another possible cause? A. Amenorrhea: Stress, endocrine problems B. Quickening: Gas, peristalsis C. Goodell sign: Cervical polyps D. Chadwick sign: Pelvic congestion

C. Goodell sign: Cervical polyps Amenorrhea sometimes can be caused by stress, vigorous exercise, early menopause, or endocrine problems. Quickening can be gas or peristalsis. Goodell sign might be the result of pelvic congestion, not polyps. Chadwick sign might be the result of pelvic congestion.

A Native American woman gave birth to a baby girl 12 hours ago. The nurse notes that the woman keeps her baby in the bassinet except for feeding and states that she will wait until she gets home to begin breastfeeding. The nurse recognizes that this behavior is most likely a reflection of: A. delayed attachment B. embarassment C. disappointment the baby is a girl D. a belief that babies should not receive colustrum

D Delayed attachment is a cultural belief, not a delay in attachment. Embarrassment is a cultural belief, not an expression of embarrassment. This cultural belief does not indicate that there is disappointment regarding the sex of the baby. Native Americans often use cradle boards and avoid handling their newborn often; they believe that the infant should not be fed colostrum.

A pregnant woman experiencing nausea and vomiting should: A. drink a glass of water with a fat-free carbohydrate before getting out of bed in the morning. B. eat small, frequent meals (every 2 to 3 hours). C. increase her intake of high-fat foods to keep the stomach full and coated. D. limit fluid intake throughout the day.

eat small, frequent meals (every 2 to 3 hours). A pregnant woman experiencing nausea and vomiting should avoid consuming fluids early in the day or when nauseated. This is a correct suggestion for a woman experiencing nausea and vomiting. A pregnant woman experiencing nausea and vomiting should reduce her intake of fried foods and other fatty foods. A pregnant woman experiencing nausea and vomiting should avoid consuming fluids early in the morning or when nauseated but should compensate by drinking fluids at other times.

Which hematocrit (Hct) and hemoglobin (Hgb) results represent(s) the lowest acceptable values for a woman in the third-trimester of pregnancy? A. 38% Hct; 14 g/dL Hgb B. 35% Hct; 13 g/dL Hgb C. 33% Hct; 11 g/dL Hgb D. 32% Hct; 10.5 g/dL Hgb

33% Hct; 11 g/dL Hgb

A mother's household consists of her husband, his mother, and another child. She is living in a/an: A. an extended fmaily B. single-parent family C. married-blended family D. trinuclear family

A An extended family includes blood relatives living with the nuclear family. Both parents and a grandparent are living in this extended family. Married-blended refers to families reconstructed after divorce. Both parents and a grandparent make up an extended family.

With regard to dysfunctional uterine bleeding (DUB), the nurse should be aware that: A. it is most commonly caused by anovulation. B. it most often occurs in middle age. C. the diagnosis of DUB should be the first considered for abnormal menstrual bleeding. D. the most effective medical treatment involves steroids.

A Anovulation may occur because of hypothalamic dysfunction or polycystic ovary syndrome. DUB most often occurs when the menstrual cycle is being established or when it draws to a close at menopause. A diagnosis of DUB is made only after all other causes of abnormal menstrual bleeding have been ruled out. The most effective medical treatment is oral or intravenous estrogen.

The term used to describe a situation in which a cultural group loses its identity and becomes part of the dominant culture is called: A. assimilation B. cultural relativism C. acculturation D. ethnocentrisim

A Assimilation is the process by which groups "melt" into the mainstream. Cultural relativism refers to learning about and applying the standards of another person's culture to activities within that culture. Acculturation refers to changes that occur within one group or among several groups when people from different cultures come in contact with one another. Ethnocentrism is a belief in the rightness of one's culture's way of doing things.

The nurse is assessing a woman's breast self-examination (BSE) technique. Which action indicates that a woman needs further instruction regarding BSE? A. Performs every month on the first day of her menstrual period B. Uses the pads of her fingers when palpating each breast C. Inspects her breasts while standing before a mirror and changing arm positions D. Places a folded towel under right shoulder and right hand under head when palpating right breast

A BSE should be performed once a month after the menstrual period has ended. The following are correct actions for performing a BSE.

The CDC-recommended medication for the treatment of chlamydia would be: A. doxycycline. B. podofilox. C. acyclovir. D. penicillin.

A Doxycycline is effective for treating chlamydia, but it should be avoided if the woman is pregnant. Podofilox is a recommended treatment for nonpregnant women diagnosed with human papilloma virus infection. Acyclovir is recommended for genital herpes simplex virus infection. Penicillin is not a CDC-recommended medication for chlamydia; it is the preferred medication for syphilis.

From the nurse's perspective, what measure should be the focus of the health care system to reduce the rate of infant mortality further? A. implementing programs to ensure women's early participation in ongoing prenatal care B. increasing the length of stay in a hospital after a vaginal birth from 2 to 3 days C. expanding the number of neonatal intensive care units (NICUs) D. mandating that all pregnant women receive care from an obstetrician

A Early prenatal care allows for early diagnosis and appropriate interventions to reduce the rate of infant mortality. An increased length of stay has been shown to foster improved self-care and parental education. However, it does not prevent the incidence of leading causes of infant mortality rates, such as low birth weight. Early prevention and diagnosis reduce the rate of infant mortality. NICUs offer care to high risk infants after they are born. Expanding the number of NICUs would offer better access for high risk care, but this is not the primary focus for further reduction of infant mortality rates. A mandate that all pregnant women receive obstetric care would be nearly impossible to enforce. Furthermore, certified nurse-midwives (CNMs) have demonstrated reliable, safe care for pregnant women.

A woman is giving birth to her third child in a setting that allows her husband and other two children to be actively involved in the process. The nurse caring for the woman must also consider the husband and family as patients and work to meet their needs. This type of setting is termed: A. family-centered care B. emergency care C. hospice care D. individual care

A Family-centered care is any setting in which the pregnant woman and family are treated as one unit. The nurse assumes a major role in teaching, counseling, and supporting the family. In emergency care settings, the nurse deals primarily with the patient who is having difficulty. In hospice care settings, the nurse deals with patients who have terminal illnesses. Individual care deals only with the patient and does not include the family.

What symptom described by a woman is characteristic of premenstrual syndrome (PMS)? A. "I feel irritable and moody a week before my period is supposed to start." B. "I have lower abdominal pain beginning the third day of my menstrual period." C. "I have nausea and headaches after my period starts, and they last 2 to 3 days." D. "I have abdominal bloating and breast pain after a couple days of my period."

A PMS is a cluster of physical, psychologic, and behavioral symptoms that begin in the luteal phase of the menstrual cycle and resolve within a couple of days of the onset of menses. PMS begins in the luteal phase and resolves as menses occurs. It does not start after menses has begun. This complaint is associated with PMS. However, the timing reflected in this statement is inaccurate. PMS begins in the luteal phase and resolves as menses occurs. It does not start after menses has begun. Abdominal bloating and breast pain are likely to occur a few days prior to menses, not after it has begun.

A 42-year-old woman asks the nurse about mammograms, now that she is "getting older." The nurse should tell her that: A. the American Cancer Society recommends mammograms every 1 to 2 years for women ages 40 to 49. B. the best time to perform a mammogram is just before a menstrual period. C. regular mammograms reduce the need to perform breast self-examination (BSE). D. mammograms can confirm the diagnosis for breast cancer.

A The current guidelines indicate that a mammogram should be performed every 1 to 2 years on women between the ages of 40 and 49. Mammograms are best performed beginning at about 1 week after menstruation when the breasts are the least tender. Mammograms are not a substitute for BSE, which should still be performed every month. A biopsy of cells from suspicious lesions is required to confirm a diagnosis of cancer.

What has had the greatest impact on reducing infant mortality in the United States? A. improvements in perinatal care B. decreased incidence of congenital abnormalities C. better maternal nutrition D. improved funding for health care

A The improvements in perinatal care, particularly care of the mother-baby dyad before birth, have had the greatest impact. There has been a decrease in some congenital anomalies, such as spina bifida, but this has not had the greatest impact. This has had a positive influence but not the greatest overall impact. Changes in funding have not had the greatest impact.

The two most frequently reported maternal risk factors are: A. hypertension associated with pregnancy and diabetes B. drug use and alcohol abuse C. homelessness and lack of insurance D. behaviors and lifestyles

A These are the most frequently reported maternal risk factors. Both are associated with obesity. Approximately 20% of U.S. women who give birth are obese. Obesity in pregnancy is associated with the use of increased health care services and longer hospital stays. Both drug and alcohol use continue to increase in the maternal population. These are associated with low-birth-weight infants, mental retardation, and birth defects. The number of these clients are increasing; however, these are not the most common risks. Behavior and lifestyle choices do contribute to the health of the mother and fetus.

Which statement made by the nurse would indicate that he or she is practicing appropriate family-centered care techniques? A. the nurse encourages the mother and father to make choices whenever possible B. the nurse updates the family about what is going to happen but instructs the client's sister that she cannot be present in the room during the birth C. the nurse believes that he or she is acting in the best interest of the client and commands her what to do throughout the labor D. the father is discouraged from accompanying his wife during a cesarean birth

A With family-centered maternity care it is important to allow for choices for the couple and to include the partner in the care process. Unless there is an institutional policy prohibiting the number of attendees at a birth, the client should be allowed to have whomever she desires with her (unless of course the birth is emergent and guests may be requested to leave). FCMC involves collaboration between the health care team and the client. In a family-centered care model, the partner, or even a grandparent may be present for a cesarean birth.

Which is correct concerning the performance of a Papanicolaou (Pap) smear? A. The woman should not douche, use vaginal medications, or have intercourse for at least 24 hours before the test. B. It should be performed once a year beginning with the onset of puberty. C. A lubricant such as Vaseline should be used to ease speculum insertion. D. The specimen for the Pap smear should be obtained after specimens are collected for cervical infection.

A Women should not douche, use vaginal medications, or have sexual intercourse for 24 hours before the examination so as not to alter the cytology results. Pap smears are performed annually for sexually active women or by age 18, especially if risk factors for cervical cancer or reproductive tract infections are present. Pap smears may be performed every 3 years in low risk women after three negative results on annual examination. Only warm water should be used on the speculum so as not to alter the cytology results. The cytologic specimen should be obtained first.

The nurse is developing a dietary teaching plan for a patient on a vegetarian diet. The nurse should provide the patient with which examples of protein containing foods? (Select all that apply.) Select all that apply. A. Dried beans B. Seeds C. Peanut butter D. Bagel E. Eggs

A, B, C, E

The nurse should teach a pregnant woman that which substances are teratogens? (Select all that apply.) A. Cigarette smoke B. Isotretinoin (Retin A) C. Vitamin C D. Salicylic acid E. Rubella

A, B, C, E

Which suggestions should the nurse include when teaching about appropriate weight gain in pregnancy? (Select all that apply.) A. Underweight women should gain 12.5 to 18 kg. B. Obese women should gain at least 7 to 11.5 kg. C. Adolescents are encouraged to strive for weight gains at the upper end of the recommended scale. D. In twin gestations, the weight gain recommended for a single fetus pregnancy should simply be doubled. E. Normal weight women should gain 11.5 to 16 kg.

A, B, C, E Underweight women need to gain the most. Obese women need to gain weight during pregnancy to equal the weight of the products of conception. Adolescents are still growing; therefore, their bodies naturally compete for nutrients with the fetus. Women bearing twins need to gain more weight (usually 16 to 20 kg) but not necessarily twice as much. Normal weight women should gain 11.5 to 16 kg.

The women's health nurse knows which statements regarding sexual response are accurate? A. Women and men are more alike than different in their physiologic response to sexual arousal and orgasm. B. Vasocongestion is the congestion of blood vessels. C. The orgasmic phase is the final state of the sexual response cycle. D. Facial grimaces and spasms of hands and feet are often part of arousal. E. Sexual difficulties should be disregarded in the postpartum period.

A, B, D Men and women are surprisingly alike. Vasocongestion causes vaginal lubrication and engorgement of the genitals. The final state of the sexual response cycle is the resolution phase after orgasm. Arousal is characterized by increased muscular tension (myotonia). Sexual difficulties should be addressed during the postpartum period.

The hospital risk management nurse is providing annual in-service training at the obstetrical unit staff meeting. The risk management nurse should discuss which conditions included on the National Quality Forum list that pertain to maternity nursing? (Select all that apply) A. falls and trauma B. decreased incidence of urinary tract infections with catheter use C. air embolism D. foreign objects retained after surgey E. blood incompatibility

A, C, D, E Catheter use should be minimized to decreased urinary tract infections. Five of the conditions are also on the National Quality Forum list. Conditions that might pertain to maternity nursing include a foreign object retained after surgery, air embolism, blood incompatibility, falls and trauma, and catheter-associated urinary tract infections. Almost 1300 U.S. hospitals waive (do not bill for) costs associated with serious reportable events.

Healthy People 2020 goals include (select all that apply): A. promoting quality of life B. promoting healthy behaviors in middle adulthood C. attaining high-quality, longer lives D. eliminating health disparities E. creating social and physical environments the promote health

A, C, D, E Healthy People 2020 promotes healthy behaviors across all life stages. Healthy People provides science-based 10-year national objectives for improving the health of all Americans. It has four overarching goals: (1) attaining high-quality, longer lives free of preventable disease, disability, injury, and premature death; (2) achieving health equity, eliminating disparities, and improving the health of all groups; (3) creating social and physical environments that promote good health for all; and (4) promoting quality of life, healthy development, and healthy behaviors across all life stages. The goals of Healthy People 2020 are based on assessments of major risks to health and wellness, changes in public health priorities, and issues related to the health preparedness and prevention of our nation.

Which statements about multifetal pregnancy are most appropriate? (Select all that apply.) A. The expectant mother often develops anemia because the fetuses have a greater demand for iron. B. Twin pregnancies come to term with the same frequency as single pregnancies. C. The mother should be counseled to increase her nutritional intake and gain more weight. D. Backache and varicose veins are often more pronounced. E. Spontaneous rupture of membranes before term is uncommon.

A, C, D. The expectant mother often develops anemia because the fetuses have a greater demand for iron. The mother should be counseled to increase her nutritional intake and gain more weight. Backache and varicose veins are often more pronounced.

Which statement made by the nurse would indicate that she or he is practicing appropriate family-centered care techniques? (Select all) A. the nurse allows the mother and father to make choices whenever possible B. the nurse informs the family what is going to happen she/he instructs the client's sister, who is a nurse, that she cannot be in the room during the birth C. the nurse commands the mother what to do D. the nurse provides time for the partner to ask questions

A, D It is important to allow for choices for the couple and to include the partner in the care process. Unless there is an institutional policy prohibiting the number of attendees at a birth, the patient should be allowed to have whomever she desires with her (unless the birth is emergent and the guests are requested to leave). Family-centered care involves collaboration between the health care team and the patient.

A pregnant woman reports that she is still playing tennis at 32 weeks of gestation. The nurse would be most concerned if this woman consumes which food during and after tennis matches? A. 64 ounces of fluid B. Extra protein sources, such as peanut butter C. Salty foods to replace lost sodium D. Easily digested sources of carbohydrate

A. 64 ounces of fluid If no medical or obstetric problems contraindicate physical activity, pregnant women should get 30 minutes of moderate physical exercise daily. Liberal amounts of fluid should be consumed before, during, and after exercise, because dehydration can trigger premature labor. Also the woman's calorie intake should be sufficient to meet the increased needs of pregnancy and the demands of exercise. All pregnant women should consume the necessary amount of protein in their diet, regardless of level of activity. Many pregnant women of this gestation tend to retain fluid. This may contribute to hypertension and swelling. An adequate fluid intake prior to and after exercise should be sufficient. The woman's calorie and carbohydrate intake should be sufficient to meet the increased needs of pregnancy and the demands of exercise.

A maternity nurse should be aware of which fact about amniotic fluid? A. It serves as a source of oral fluid and as a repository for waste from the fetus. B. The volume remains about the same throughout the term of a healthy pregnancy. C. A volume of less than 300 mL is associated with gastrointestinal malformations. D. A volume of more than 2 L is associated with fetal renal abnormalities.

A. It serves as a source of oral fluid and as a repository for waste from the fetus. Amniotic fluid also cushions the fetus and helps maintain a constant body temperature. The volume of amniotic fluid changes constantly. Too little amniotic fluid (oligohydramnios) is associated with renal abnormalities. Too much amniotic fluid (hydramnios) is associated with gastrointestinal and other abnormalities.

A key finding from the Human Genome Project is: A. approximately 20,000 to 25,000 genes make up the genome. B. all human beings are 80.99% identical at the DNA level. C. human genes produce only one protein per gene; other mammals produce three proteins per gene. D. single-gene testing will become a standardized test for all pregnant women in the future.

A. approximately 20,000 to 25,000 genes make up the genome. Approximately 20,500 genes make up the human genome; this is only twice as many as make up the genomes of roundworms and flies. Human beings are 99.9% identical at the DNA level. Most human genes produce at least three proteins. Single-gene testing (e.g., alpha-fetoprotein) is already standardized for prenatal care.

With regard to protein in the diet of pregnant women, nurses should be aware that: A. many protein-rich foods are also good sources of calcium, iron, and B vitamins. B. many women need to increase their protein intake during pregnancy. C. as with carbohydrates and fat, no specific recommendations exist for the amount of protein in the diet. D. high-protein supplements can be used without risk by women on macrobiotic diets.

A. many protein-rich foods are also good sources of calcium, iron, and B vitamins. Good protein sources such as meat, milk, eggs, and cheese have a lot of calcium and iron. Most women already eat a high-protein diet and do not need to increase their intake. Protein is sufficiently important that specific servings of meat and dairy are recommended. High-protein supplements are not recommended because they have been associated with an increased incidence of preterm births.

With regard to medications, herbs, immunizations, and other substances normally encountered, the maternity nurse should be aware that: A. prescription and over-the-counter (OTC) drugs that otherwise are harmless can be made hazardous by metabolic deficiencies of the fetus. B. the greatest danger of drug-caused developmental deficits in the fetus is seen in the final trimester. C. killed-virus vaccines (e.g., tetanus) should not be given during pregnancy, but live-virus vaccines (e.g., measles) are permissible. D. no convincing evidence exists that secondhand smoke is potentially dangerous to the fetus.

A. prescription and over-the-counter (OTC) drugs that otherwise are harmless can be made hazardous by metabolic deficiencies of the fetus. This is especially true for new medications and combinations of drugs. The greatest danger of drug-caused developmental defects exists in the interval from fertilization through the first trimester, when a woman may not realize that she is pregnant. Live-virus vaccines should be part of postpartum care; killed-virus vaccines may be administered during pregnancy. Secondhand smoke is associated with fetal growth restriction and increases in infant mortality.

When planning a diet with a pregnant woman, the nurse's FIRST action would be to: A. review the woman's current dietary intake. B. teach the woman about the food pyramid. C. caution the woman to avoid large doses of vitamins, especially those that are fat-soluble. D. instruct the woman to limit the intake of fatty foods.

A. review the woman's current dietary intake. Reviewing the women's dietary intake as the first step will help to establish if she has a balanced diet or if changes in the diet are required. These are correct actions on the part of the nurse, but the first action should be to assess the patient's current dietary pattern and practices since instruction should be geared to what she already knows and does.

During a client's physical examination, the nurse notes that the lower uterine segment is soft on palpation. The nurse would document this finding as: A. Hegar sign. B. McDonald sign. C. Chadwick sign. D. Goodell sign.

A. Hegar sign. At approximately 6 weeks of gestation, softening and compressibility of the lower uterine segment occur; this is called the Hegar sign. The McDonald sign indicates a fast-food restaurant. The Chadwick sign is a blue-violet cervix caused by increased vascularity; this occurs around the fourth week of gestation. Softening of the cervical tip is called the Goodell sign, which may be observed around the sixth week of pregnancy.

A woman at 35 weeks of gestation has had an amniocentesis. The results reveal that surface-active phospholipids are present in the amniotic fluid. The nurse is aware that this finding indicates: A. the fetus is at risk for Down syndrome. B. the woman is at high risk for developing preterm labor. C. lung maturity. D. meconium is present in the amniotic fluid.

A. lung maturity. The presence of surface-active phospholipids is not an indication of Down syndrome. This result reveals the fetal lungs are mature and in no way indicates risk for preterm labor. The detection of the presence of pulmonary surfactants, surface-active phospholipids, in amniotic fluid has been used to determine fetal lung maturity, or the ability of the lungs to function after birth. This occurs at approximately 35 weeks of gestation. Meconium should not be present in the amniotic fluid.

A woman who has completed one pregnancy with a fetus (or fetuses) reaching the stage of fetal viability is called a: A. primipara. B. primigravida. C. multipara. D. nulligravida.

A. primipara. A primipara is a woman who has completed one pregnancy with a viable fetus. To remember terms, keep in mind that gravida is a pregnant woman; para comes from parity, meaning a viable fetus; primi means first; multi means many; and null means none. A primigravida is a woman pregnant for the first time. A multipara is a woman who has completed two or more pregnancies with a viable fetus. A nulligravida is a woman who has never been pregnant.

The nurse must evaluate a male patient's knowledge regarding the use of a condom. The nurse would recognize the need for further instruction if the patient states that he: A. lubricates the condom with a spermicide containing nonoxynol-9. B. leaves an empty space at the tip of the condom. C. leaves a small amount of air in the tip. D. removes his still-erect penis from the vagina while holding onto the base of the condom.

A. lubricates the condom with a spermicide containing nonoxynol-9. Nonoxynol-9 is no longer recommended. Recent data suggest that frequent use of nonoxynol-9 may increase human immunodeficiency virus transmission and can cause genital lesions. An empty space at the tip of the condom is the correct instruction. Leaving a small amount of air at the tip of the condom is the correct instruction. Removing the condom while holding the base is the correct instruction.

When providing care to a young single woman just diagnosed with acute pelvic inflammatory disease, the nurse should: A. point out that inappropriate sexual behavior caused the infection. B. position the woman in a semi-Fowler position. C. explain to the woman that infertility is a likely outcome of this type of infection. D. tell her that antibiotics need to be taken until pelvic pain is relieved.

B Although sexual behavior may have contributed to the infection, the nurse must discuss these practices in a nonjudgmental manner and provide information about prevention measures. The position of comfort is the semi-Fowler position. In addition, the foot of the bed could be elevated to keep the uterus in a dependent position and reduce discomfort. Until treatment is complete and healing has occurred, the outcome is unknown and should not be suggested. The nurse should emphasize that medication must be continued until follow-up assessment indicates that the infection has been treated successfully.

What is descriptive of the family systems theory? A. the family is viewed as the sum of individual members B. when the family system is disrupted, change can occur at any point in the system C. change in one family member cannot create change in other members D. individual family members are readily identified as the source of the problem

B Although the family is the sum of the individual members, the family systems theory focuses on the number of dyad interactions that can occur. The family systems theory describes an interactional model. Any change in one member will create change in others. Change in any family member will affect other members of the family. The interactions are considered to be the problem, not the individual family members.

With regard to the diagnosis and management of amenorrhea, nurses should be aware that: A. it probably is the result of a hormone deficiency that can be treated with medication. B. it may be caused by stress or excessive exercise or both. C. it likely will require the client to eat less and exercise more. D. it often goes away on its own.

B Amenorrhea may be the result of a decrease in follicle-stimulating hormone (FSH) and luteinizing hormone (LH). This is usually caused by stress, body fat to lean ratio, and in rare occurrences a pituitary tumor. It cannot be treated by medication. Amenorrhea usually is the result of stress and/or an inappropriate ratio of body fat to lean tissue, possibly as a result of excessive exercise. Management includes counseling and education about the causes and possible lifestyle changes. In most cases a client will need to decrease her amount of exercise and increase her body weight in order to resume menstruation. Management of stress and eating disorders is usually necessary to manage this condition.

The nurse-midwife is teaching a group of women who are pregnant, including instruction on Kegel exercises. Which statement by a participant would indicate a correct understanding of the instruction? A. I will only see results if I perform 100 Kegel exercises each day. B. I should hold the Kegel exercise contraction for 10 seconds and rest for 10 seconds between exercises. C. I should only perform Kegel exercises in the sitting position. D. I will perform daily Kegel exercises during the last trimester of my pregnancy to achieve the best results.

B Guidelines suggest that women perform between 30 and 80 Kegel exercises. The correct technique for Kegel exercises is to hold the contraction for at least 10 seconds and rest for 10 seconds in between so the muscles can have time to recover and each contraction can be as strong as the woman can make it. Kegel exercises are best performed in a supine position with the knees bent. Kegel exercises should be performed throughout the pregnancy to achieve the best results.

When providing health education to the client, the nurse understands that an example of the secondary level of prevention is: A. approved infant car seats B. breast self-examination (BSE) C. immunizations D. support groups for parents of children with Down syndrome

B Infant car seats are an example of primary prevention. BSE is an example of secondary prevention, which includes health screening measures for early detection of health problems. Immunizations are an example of primary prevention. Support groups are an example of tertiary prevention, which follows the occurrence of a defect or disability (e.g., Down syndrome).

What would a breastfeeding mother who is concerned that her baby is not getting enough to eat find most helpful and most cost-effective on the day after discharge? A. visiting a pediatric screening clinic at the hosopital B. placing a call to the hospital nursery "warm line" C. calling the physician for a lactation consult referral D. requesting a home visit

B This action would not necessarily be cost-effective. The first course of action should be to call a warm line for advice from a nurse. Warm lines are telephone lines offered as a community service to provide new parents with support, encouragement, and basic parenting education. This action would not necessarily be cost-effective. The first course of action should be to call a warm line for advice from a nurse. This action would not necessarily be cost-effective. The first course of action should be to call a warm line for advice from a nurse.

During a health history interview, a woman states that she thinks that she has "bumps" on her labia. She also states that she is not sure how to check herself. The correct response would be to: A. reassure the woman that the examination will not reveal any problems. B. explain the process of vulvar self-examination to the woman and reassure her that she will become familiar with normal and abnormal findings during the examination. C. reassure the woman that "bumps" can be treated. D. reassure her that most women have "bumps" on their labia.

B This statement is inappropriate and may be untrue. During assessment and evaluation the responsibility for self-care, health promotion, and enhancement of wellness is emphasized. The pelvic examination provides a good opportunity for the practitioner to emphasize the need for regular vulvar self-examination. Because the nurse is unsure of the cause of this client's discomfort, this comment would be incorrect. This statement is not accurate and should not be used in this situation.

A nurse counseling a client with endometriosis understands which statements regarding the management of endometriosis is accurate? (Select all that apply) A. Bone loss from hypoestrogenism is not reversible. B. Side effects from the steroid danazol include masculinizing traits. C. Surgical intervention often is needed for severe or acute symptoms. D. Women without pain and who do not want to become pregnant need no treatment. E. Women with mild pain who may want a future pregnancy may take nonsteroidal antiinflammatory drugs (NSAIDs).

B, C, D Bone loss is mostly reversible within 12 to 18 months after the medication is stopped. Such masculinizing traits as hirsutism, a deepening voice, and weight gain occur with danazol but are reversible. Surgical intervention often is needed when symptoms are incapacitating. The type of surgery is influenced by the woman's age and desire to have children. Treatment is not needed for women without pain or the desire to have children. In women with mild pain who may desire a future pregnancy, treatment may be limited to use of NSAIDs during menstruation.

A community women's health nurse knows that which groups of people are considered vulnerable populations? A. caucasian americans B. adolescent girls C. women with underlying health conditions D. refugee women E. incarcerated women

B, C, D, E All of these groups are considered vulnerable populations except for Caucasian Americans.

A married woman has made the decision to use a diaphragm as her primary method of birth control. The clinic nurse should provide which instructions regarding care of, insertion, and removal of the diaphragm? (Select all that apply.) Select all that apply. A. Remove the diaphragm by catching the rim from below the dome. B. Avoid using mineral oil body products. C. On insertion, direct the diaphragm down toward the space below cervix. D. Wash diaphragm monthly with mild soap and water. E. A dusting of cornstarch is appropriate after drying the diaphragm.

B, C, D, E. Avoid using mineral oil body products.The diaphragm should not be removed by trying to catch the rim from below the dome. Oil-based products can cause the breakdown of the rubber. The diaphragm should be inserted into the vagina, directing it inward and downward as far as it will go to the space behind and below the cervix. The diaphragm should be washed after each use with mild soap and water. Cornstarch may be used. Avoid use of scented talc, body powder, and baby powder because they can weaken the rubber. On insertion, direct the diaphragm down toward the space below cervix.The diaphragm should not be removed by trying to catch the rim from below the dome. Oil-based products can cause the breakdown of the rubber. The diaphragm should be inserted into the vagina, directing it inward and downward as far as it will go to the space behind and below the cervix. The diaphragm should be washed after each use with mild soap and water. Cornstarch may be used. Avoid use of scented talc, body powder, and baby powder because they can weaken the rubber. Wash diaphragm monthly with mild soap and water.The diaphragm should not be removed by trying to catch the rim from below the dome. Oil-based products can cause the breakdown of the rubber. The diaphragm should be inserted into the vagina, directing it inward and downward as far as it will go to the space behind and below the cervix. The diaphragm should be washed after each use with mild soap and water. Cornstarch may be used. Avoid use of scented talc, body powder, and baby powder because they can weaken the rubber. A dusting of cornstarch is appropriate after drying the diaphragm.The diaphragm should not be removed by trying to catch the rim from below the dome. Oil-based products can cause the breakdown of the rubber. The diaphragm should be inserted into the vagina, directing it inward and downward as far as it will go to the space behind and below the cervix. The diaphragm should be washed after each use with mild soap and water. Cornstarch may be used. Avoid use of scented talc, body powder, and baby powder because they can weaken the rubber.

The nurse should include which information when teaching a 15-year-old about genital tract infection prevention? A. Wear nylon undergarments. B. Avoid tight-fitting jeans. C. Use floral scented bath salts. D. Decrease sugar intake. E. Do not douche. F. Limit time spent wearing a wet bathing suit.

B, D, E, F Patient teaching for the prevention of genital tract infections in women includes the following guidelines:•Practice genital hygiene.•Choose underwear or hosiery with a cotton crotch.• Avoid tight-fitting clothing (especially tight jeans).• Select cloth car seat covers instead of vinyl.• Limit the time spent in damp exercise clothes (especially swimsuits, leotards, and tights).•Limit exposure to bath salts or bubble bath.•Avoid colored or scented toilet tissue.•If sensitive, discontinue use of feminine hygiene deodorant sprays.•Use condoms.•Void before and after intercourse.•Decrease dietary sugar.•Drink yeast-active milk and eat yogurt (with lactobacilli).•Do not douche.

A woman is 8 months pregnant. She tells the nurse that she knows her baby listens to her, but her husband thinks she is imagining things. Which response by the nurse is most appropriate? A. "Many women imagine what their baby is like." B. "A baby in utero does respond to the mother's voice." C. "You'll need to ask the doctor if the baby can hear yet." D. "Thinking that your baby hears will help you bond with the baby."

B. "A baby in utero does respond to the mother's voice." Although this statement is accurate, it is not the most appropriate response. Fetuses respond to sound by 24 weeks. The fetus can be soothed by the sound of the mother's voice. This statement is not appropriate. The mother should be instructed that her fetus can hear at 24 weeks and can respond to the sound of her voice. The statement is not appropriate. It gives the impression that her baby cannot hear her. It also belittles the mother's interpretation of her fetus's behaviors

A woman inquires about herbal alternative methods for improving fertility. Which statement by the nurse is the most appropriate when instructing the woman in which herbal preparations to avoid while trying to conceive? A. "You should avoid nettle leaf, dong quai, and vitamin E while you are trying to get pregnant." B. "You may want to avoid licorice root, lavender, fennel, sage, and thyme while you are trying to conceive." C. "You should not take anything with vitamin E, calcium, or magnesium. They will make you infertile." D. "Herbs have no bearing on fertility."

B. "You may want to avoid licorice root, lavender, fennel, sage, and thyme while you are trying to conceive." Nettle leaf, dong quai, and vitamin E promote fertility. Herbs that a woman should avoid while trying to conceive include: licorice root, yarrow, wormwood, ephedra, fennel, goldenseal, lavender, juniper, flaxseed, pennyroyal, passionflower, wild cherry, cascara, sage, thyme, and periwinkle. Vitamin E, calcium, and magnesium may promote fertility and conception. Although most herbal remedies have not been proven clinically to promote fertility, women should avoid the following herbs while trying to conceive: licorice root, yarrow, wormwood, ephedra, fennel, goldenseal, lavender, juniper, flaxseed, pennyroyal, passionflower, wild cherry, cascara, sage, thyme, and periwinkle.

A pregnant woman with a body mass index (BMI) of 22 asks the nurse how she should be gaining weight during pregnancy. The nurse's BEST response would be to tell the woman that her pattern of weight gain should be approximately: A. a pound a week throughout pregnancy. B. 2 to 5 lbs during the first trimester, then a pound each week until the end of pregnancy. C. a pound a week during the first two trimesters, then 2 lbs per week during the third trimester. D. a total of 25 to 35 lb

B. 2 to 5 lbs during the first trimester, then a pound each week until the end of pregnancy. A pound a week is not the correct guideline during pregnancy. A BMI of 22 represents a normal weight. Therefore, a total weight gain for pregnancy would be about 25 to 35 lbs or about 2 to 5 lbs in the first trimester and about 1 lb/week during the second and third trimesters. These are not accurate guidelines for weight gain during pregnancy. The total is correct, but the pattern needs to be explained.

If exhibited by an expectant father, what would be a warning sign of ineffective adaptation to his partner's first pregnancy? A. Views pregnancy with pride as a confirmation of his virility. B. Consistently changes the subject when the topic of the fetus/newborn is raised. C. Expresses concern that he might faint at the birth of his baby. D. Experiences nausea and fatigue, along with his partner, during the first trimester.

B. Consistently changes the subject when the topic of the fetus/newborn is raised. This is an expected view for an expectant father. Persistent refusal to talk about the fetus-newborn may be a sign of a problem and should be assessed further. This is an expected feeling for an expectant father. This is an expected finding with expectant fathers.

What best describes the pattern of genetic transmission known as autosomal recessive inheritance? A.Disorders in which the abnormal gene for the trait is expressed even when the other member of the pair is normal. B. Disorders in which both genes of a pair must be abnormal for the disorder to be expressed. C. Disorders in which a single gene controls the particular trait. D. Disorders in which the abnormal gene is carried on the X chromosome.

B. Disorders in which both genes of a pair must be abnormal for the disorder to be expressed. Autosomal dominant inheritance occurs when the abnormal gene for the trait is expressed, even when the other member of the pair is normal, such as Huntington disease or Marfan syndrome. An autosomal recessive inheritance disorder occurs when both genes of the pair are abnormal, such as phenylketonuria or sickle cell anemia. Disorders in which a single gene controls the particular trait describe the unifactorial inheritance. X-linked recessive inheritance occurs when the abnormal gene is carried on the X chromosome, such as hemophilia or Duchenne muscular dystrophy.

With regard to nutritional needs during lactation, a maternity nurse should be aware that: A. the mother's intake of vitamin C, zinc, and protein now can be lower than during pregnancy. B. caffeine consumed by the mother accumulates in the infant, who therefore may be unusually active and wakeful. C. critical iron and folic acid levels must be maintained. D. lactating women can go back to their prepregnant calorie intake.

B. caffeine consumed by the mother accumulates in the infant, who therefore may be unusually active and wakeful. Vitamin C, zinc, and protein levels need to be moderately higher during lactation than during pregnancy. A lactating woman needs to avoid consuming too much caffeine. The recommendations for iron and folic acid are somewhat lower during lactation. Lactating women should consume about 500 kcal more than their prepregnancy intake, at least 1800 kcal daily overall.

A pregnant woman at 7 weeks of gestation complains to her nurse midwife about frequent episodes of nausea during the day with occasional vomiting. She asks what she can do to feel better. The nurse midwife could suggest that the woman: A. drink warm fluids with each of her meals. B. eat a high-protein snack before going to bed. C. keep crackers and peanut butter at her bedside to eat in the morning before getting out of bed. D. schedule three meals and one midafternoon snack a day.

B. eat a high-protein snack before going to bed. Fluids should be taken between (not with) meals to provide for maximum nutrient uptake in the small intestine. A bedtime snack of slowly digested protein is especially important to prevent the occurrence of hypoglycemia during the night that would contribute to nausea. Dry carbohydrates such as plain toast or crackers are recommended before getting out of bed. Eating small, frequent meals (about 5 or 6 each day) with snacks helps to avoid a distended or empty stomach, both of which contribute to the development of nausea and vomiting.

A nurse teaches a pregnant woman about the presumptive, probable, and positive signs of pregnancy. The woman demonstrates an understanding of the nurse's instructions if she states that a positive sign of pregnancy is: A. a positive pregnancy test. B. fetal movement palpated by the nurse-midwife. C. Braxton Hicks contractions. D. quickening.

B. fetal movement palpated by the nurse-midwife. A positive pregnancy test is a probable sign of pregnancy. Positive signs of pregnancy are those that are attributed to the presence of a fetus, such as hearing the fetal heartbeat or palpating fetal movement. Braxton Hicks contractions are a probable sign of pregnancy. Quickening is a presumptive sign of pregnancy.

Women with an inadequate weight gain during pregnancy are at higher risk of giving birth to an infant with: A. spina bifida. B. intrauterine growth restriction. C. diabetes mellitus. D. Down syndrome.

B. intrauterine growth restriction. Spina bifida is not associated with inadequate maternal weight gain. An adequate amount of folic acid has been shown to reduce the incidence of this condition. Both normal-weight and underweight women with inadequate weight gain have an increased risk of giving birth to an infant with intrauterine growth restriction. Diabetes mellitus is not related to inadequate weight gain. A gestational diabetic mother is more likely to give birth to a large-for-gestational age infant. Down syndrome is the result of a trisomy 21, not inadequate maternal weight gain.

Semen analysis is a common diagnostic procedure related to infertility. In instructing a male patient regarding this test, the nurse would tell him to: A. ejaculate into a sterile container. B. obtain the specimen after a period of abstinence from ejaculation of 2 to 5 days. C. transport specimen with container packed in ice. D. ensure that the specimen arrives at the laboratory within 30 minutes of ejaculation.

B. obtain the specimen after a period of abstinence from ejaculation of 2 to 5 days. The male must ejaculate into a clean container or a plastic sheath that does not contain a spermicide. An ejaculated sample should be obtained after a period of abstinence to get the best results. He should avoid exposing the specimen to extremes of temperature, either heat or cold. The specimen should be taken to the laboratory within 2 hours of ejaculation.

A male client asks the nurse why it is better to purchase condoms that are not lubricated with nonoxynol-9 (a common spermicide). The nurse's most appropriate response is: A. "The lubricant prevents vaginal irritation." B."Nonoxynol-9 does not provide protection against sexually transmitted infections, as originally thought; also it has been linked to an increase in the transmission of human immunodeficiency virus (HIV) and can cause genital lesions." C. "The additional lubrication improves sex." D. "Nonoxynol-9 improves penile sensitivity."

B. "Nonoxynol-9 does not provide protection against sexually transmitted infections, as originally thought; also it has been linked to an increase in the transmission of human immunodeficiency virus (HIV) and can cause genital lesions." Nonoxynol-9 may cause vaginal irritation. This is a true statement. Nonoxynol-9 has no effect on the quality of sexual activity. Nonoxynol-9 has no effect on penile sensitivity.

Cardiovascular system changes occur during pregnancy. Which finding would be considered normal for a woman in her second trimester? A. Less audible heart sounds (S1, S2) B. Increased pulse rate C. Increased blood pressure D. Decreased red blood cell (RBC) production

B. Increased pulse rate Splitting of S1 and S2 is more audible. Between 14 and 20 weeks of gestation, the pulse increases about 10 to 15 beats/min, which persists to term. In the first-trimester blood pressure usually remains the same as the prepregnancy level, but it gradually decreases up to about 20 weeks of gestation. During the second trimester both the systolic and diastolic pressures decrease by about 5 to 10 mm Hg. Production of RBCs accelerates during pregnancy.

With regard to abnormalities of chromosomes, nurses should be aware that: A. they occur in approximately 10% of newborns. B. abnormalities of number are the leading cause of pregnancy loss. C. down syndrome is a result of an abnormal chromosomal structure. D unbalanced translocation results in a mild abnormality that the child will outgrow.

B. abnormalities of number are the leading cause of pregnancy loss. Chromosomal abnormalities occur in less than 1% of newborns. Aneuploidy is an abnormality of number that also is the leading genetic cause of intellectual disability. Down syndrome is the most common form of trisomal abnormality, an abnormality of chromosome number (47 chromosomes). Unbalanced translocation is an abnormality of chromosome structure that often has serious clinical effects.

When assessing the fetal heart rate (FHR) of a woman at 30 weeks of gestation, the nurse counts a rate of 82 beats/min. Initially the nurse should: A. recognize that the rate is within normal limits and record it. B. assess the woman's radial pulse. C. notify the physician. D. allow the woman to hear the heartbeat.

B. assess the woman's radial pulse. The expected fetal heart rate (FHR) is 120 to 160 beats/min. The nurse may have inadvertently counted the uterine souffle, the beat-like sound of blood flowing through the uterine blood vessels, which corresponds to the mother's heartbeat. The physician should be notified if the FHR is confirmed to be 82 beats/min. Allow the woman to hear the heartbeat as soon as a full assessment is made.

In order to reassure and educate pregnant clients about changes in their blood pressure, maternity nurses should be aware that: A. a blood pressure cuff that is too small produces a reading that is too low; a cuff that is too large produces a reading that is too high. B. shifting the client's position and changing from arm to arm for different measurements produces the most accurate composite blood pressure reading at each visit. C. the systolic blood pressure increases slightly as pregnancy advances; the diastolic pressure remains constant. D. compression of the iliac veins and inferior vena cava by the uterus contributes to hemorrhoids in the latter stage of term pregnancy.

B. shifting the client's position and changing from arm to arm for different measurements produces the most accurate composite blood pressure reading at each visit. The tightness of a cuff that is too small produces a reading that is too high; similarly, the looseness of a cuff that is too large results in a reading that is too low. Because maternal positioning affects readings, blood pressure measurements should be obtained in the same arm and with the woman in the same position. The systolic blood pressure generally remains constant but may decline slightly as pregnancy advances. The diastolic blood pressure first drops and then gradually increases. This compression also leads to varicose veins in the legs and vulva.

A woman who is 32 weeks pregnant is informed by the nurse that a danger sign of pregnancy could be: A. constipation. B. alteration in the pattern of fetal movement. C. heart palpitations. D. edema in the ankles and feet at the end of the day.

B. alteration in the pattern of fetal movement. Constipation is a normal discomfort of pregnancy that occurs in the second and third trimesters. An alteration in the pattern or amount of fetal movement may indicate fetal jeopardy. Heart palpitations are a normal change related to pregnancy. This is most likely to occur during the second and third trimesters. As the pregnancy progresses, edema in the ankles and feet at the end of the day is not uncommon.

In which culture is the father more likely to be expected to participate in the labor and delivery? A. asian-american B. african-american C. european-american D. hispanic

C Asian-American fathers do not actively participate in labor or birth. African-American men view pregnancy as a sign of virility; however, they may be less likely to participate actively in labor or birth.

Self-care instructions for a woman following a modified radical mastectomy would include that she: A. wears clothing with snug sleeves to support her affected arm. B. use depilatory creams instead of shaving the axilla of her affected arm. C. expect a decrease in sensation or tingling in her affected arm as her body heals. D. empty surgical drains once a day or every other day.

C Loose clothing should be worn since tight clothing could impede circulation in the affected arm. The axilla of the affected arm should not be shaved nor should depilatory creams or strong deodorants be used. A decrease in sensation and tingling in the affected arm and in the incision are expected for weeks to months after the surgery. Drains should be emptied at least twice a day and more often if necessary.

The nurse should include questions regarding sexuality when gathering data for a reproductive health history of a female patient. Which principle should guide the nurse when interviewing the patient? A. An in-depth exploration of specific sexual practices should be included for every patient. B. Sexual histories are optional if the patient is not currently sexually active. C. Misconceptions and inaccurate information expressed by the patient should be corrected promptly. D. Questions regarding the patient's sexual relationship are unnecessary if she is monogamous.

C More in-depth assessments are required if the patient is sexually active or if problems or concerns are raised during general questions. Sexuality should be included on every reproductive health history whether or not the patient is sexually active. To obtain the most accurate reproductive health history, the nurse needs to correct misconceptions and inaccurate information. The relationship and sexual partner should be discussed even if the patient is monogamous.

Several noted health risks are associated with menopause. These risks include all except: A. osteoporosis. B. coronary heart disease. C. breast cancer. D. obesity.

C Osteoporosis is a major health problem in the United States. It is associated with an increase in hip and vertebral fractures in postmenopausal women. A woman's risk of developing and dying of cardiovascular disease increases significantly after menopause. Breast cancer may be associated with the use of hormone replacement therapy for women who have a family history of breast cancer. Women tend to become more sedentary in midlife. The metabolic rate decreases after menopause, which may require an adjustment in lifestyle and eating patterns.

Providing treatment and rehabilitation for people who have developed disease is part of: A. primary preventative care B. secondary preventative care C. tertiary preventative care D. primordial preventative care

C Primary preventive care involves promoting healthy lifestyles. Secondary preventive care involves targeting populations at risk. Tertiary preventive care is the treatment or rehabilitation of those who already have a specific disease. Primordial preventive care refers to prevention of the risk factors themselves at either the social or environmental level.

A 65-year-old woman, G6 P6006, is complaining of increasing stress incontinence and pelvic pressure and fullness. Pelvic examination reveals a bulging in the anterior vaginal wall. This woman is most likely experiencing: A. uterine prolapse. B. rectocele. C. cystocele. D. vesicovaginal fistula.

C Prolapse or downward displacement of the uterus could result in protrusion of the uterus through the vagina. Rectocele would result in herniation of the rectal wall through the posterior vagina. Clinical manifestations would relate to alterations in bowel elimination. This is the classic clinical manifestations of cystocele. A vesicovaginal fistula is an abnormal passage between the bladder and the vagina, resulting in urinary incontinence and excoriation of the vaginal mucosa.

An effective relief measure for primary dysmenorrhea would be to: A. reduce physical activity level until menstruation ceases. B. begin taking prostaglandin synthesis inhibitors on the first day of the menstrual flow. C. decrease intake of salt and refined sugar about 1 week before menstruation is about to occur. D. use barrier methods rather than the oral contraceptive pill (OCP) for birth control.

C Staying active is helpful since it facilitates menstrual flow and increases vasodilation to reduce ischemia. Prostaglandin inhibitors should be started a few days before the onset of menstruation. Decreasing intake of salt and refined sugar can reduce fluid retention. OCPs are beneficial in relieving primary dysmenorrhea as a result of inhibition of ovulation and prostaglandin synthesis.

Which personal safety precaution should guide the nurse working in home care? A. do not carry personal items, such as extra car keys or a cellular phone B. avoid making a visit with another nurse C. schedule visits during daylight hours D. never wear a nametag

C The nurse should carry keys and a cell phone in the event the keys must be used for self-defense or the cell phone is needed to call for help. Making a visit in pairs is a good personal strategy for nurses visiting families with a history of violence or substance abuse. For the nurse's personal safety, all home visits should be conducted during daylight hours. Dress should be casual but professional and should include a name tag.

A couple has been counseled for genetic anomalies. They ask you, "What is karyotyping?" Your best response is: A. "Karyotyping will reveal if the baby's lungs are mature." B. "Karyotyping will reveal if your baby will develop normally." C. "Karyotyping will provide information about the gender of the baby, and the number and structure of the chromosomes." D. "Karyotyping will detect any physical deformities the baby has."

C. "Karyotyping will provide information about the gender of the baby, and the number and structure of the chromosomes." The lecithin/sphingomyelin ratio, not karyotyping, reveals lung maturity. Although karyotyping can detect genetic anomalies, the range of normal is nondescriptive. Karyotyping provides genetic information, such as gender and chromosomal structure. Although karyotyping can detect genetic anomalies, not all such anomalies display obvious physical deformities. The term deformities is a nondescriptive word. Furthermore, physical anomalies may be present that are not detected by genetic studies (e.g., cardiac malformations).

Which minerals and vitamins usually are recommended as a supplement a pregnant woman's diet? A. Fat-soluble vitamins A and D B.Water-soluble vitamins C and B6 C. Iron and folate D. Calcium and zinc

C. Iron and folate Fat-soluble vitamins should be supplemented as a medical prescription, as vitamin D might be for lactose-intolerant women. Water-soluble vitamin C sometimes is consumed in excess naturally; vitamin B6 is prescribed only if the woman has a very poor diet. Iron generally should be supplemented, and folic acid supplements often are needed because folate is so important. Zinc sometimes is supplemented. Most women get enough calcium.

A nurse is providing genetic counseling for an expectant couple who already have a child with trisomy 18. The nurse should: A. tell the couple they need to have an abortion within 2 to 3 weeks. B. explain that the fetus has a 50% chance of having the disorder. C. discuss options with the couple, including amniocentesis to determine whether the fetus is affected. D. refer the couple to a psychologist for emotional support.

C. discuss options with the couple, including amniocentesis to determine whether the fetus is affected. The couple should be given information about the likelihood of having another baby with this disorder so that they can make an informed decision. A genetic counselor is the best source for determining genetic probability ratios. Genetic testing, including amniocentesis, would need to be performed to determine whether the fetus is affected. The couple eventually may need emotional support, but the status of the pregnancy must be determined first.

An expectant father confides in the nurse that his pregnant wife, 10 weeks of gestation, is driving him crazy. "One minute she seems happy, and the next minute she is crying over nothing at all. Is there something wrong with her?" The nurse's BEST response would be: A. "This is normal behavior and should begin to subside by the second trimester." B. "She may be having difficulty adjusting to pregnancy; I will refer her to a counselor that I know." C. "This is called emotional lability and is related to hormone changes and anxiety during pregnancy. The mood swings will eventually subside as she adjusts to being pregnant." D. "You seem impatient with her. Perhaps this is precipitating her behavior."

C. "This is called emotional lability and is related to hormone changes and anxiety during pregnancy. The mood swings will eventually subside as she adjusts to being pregnant."Although this statement is appropriate, it does not answer the father's question. Mood swings are a normal finding in the first trimester; the woman does not need counseling. This is the most appropriate response since it gives an explanation and a time frame for when the mood swings may stop. This statement is judgmental and not appropriate.

A pregnant woman at 10 weeks of gestation jogs 3 or 4 times per week. She is concerned about the effect of exercise on the fetus. The nurse should inform her: A. "You do not need to modify your exercising any time during your pregnancy." B. "Stop exercising, because it will harm the fetus." C. "You may find that you need to modify your exercise to walking later in your pregnancy, around the seventh month." D. "Jogging is too hard on your joints; switch to walking now."

C. "You may find that you need to modify your exercise to walking later in your pregnancy, around the seventh month." The nurse should inform the woman that she may need to reduce her exercise level as the pregnancy progresses. Physical activity promotes a feeling of well-being in pregnant women. It improves circulation, promotes relaxation and rest, and counteracts boredom. Typically, running should be replaced with walking around the seventh month of pregnancy. Simple measures should be initiated to prevent injuries, such as warm-up and stretching exercises to prepare the joints for more strenuous exercise.

The student nurse is giving a presentation about milestones in embryonic development. Which information should be included? A. At 8 weeks of gestation, primary lung and urethral buds appear. B. At 12 weeks of gestation, the vagina is open or the testes are in position for descent into the scrotum. C. At 20 weeks of age, the vernix caseosa and lanugo appear. D. At 24 weeks of age, the skin is smooth, and subcutaneous fat is beginning to collect.

C. At 20 weeks of age, the vernix caseosa and lanugo appear. The primary lung and urethral buds appear at 6 weeks of gestation. The vagina is open or the testes are in position for descent into the scrotum at 16 weeks. Two milestones that occur at 20 weeks are the appearance of the vernix caseosa and lanugo. The appearance of smooth skin occurs at 28 weeks, and subcutaneous fat begins to collect at 30 to 31 weeks.

A nurse is reviewing information related to home pregnancy tests so as to prepare for a patient teaching session. Which statement by the patient indicates that additional instruction is needed following the teaching session? A. The patient states that she will follow directions as listed on the testing package. B. The patient indicates that a positive result will be seen if there is a color change on the applicator. C. The patient states there is no need for concern as home pregnancy test results are 100% correct. D. The patient can perform the test without any assistance in the home setting.

C. The patient states there is no need for concern as home pregnancy test results are 100% correct.Home pregnancy testing while reliable does not provide 100% correct results. There are other variables such as medication history as well as timing of specimen, collection and interpretation that may lead to inaccurate results. Following directions, noting a color change as a positive result and being able to perform the test without any assistance in the home setting all indicate that the patient has an understanding of the process.

A woman's cousin gave birth to an infant with a congenital heart anomaly. The woman asks the nurse when such anomalies occur during development. Which response by the nurse is most accurate? A. "We don't really know when such defects occur." B. "It depends on what caused the defect." C. "They occur between the third and fifth weeks of development." D. "They usually occur in the first 2 weeks of development."

C. They occur between the third and fifth weeks of development." This is an inaccurate statement. Regardless of the cause, the heart is vulnerable during its period of development, the third to fifth weeks. The cardiovascular system is the first organ system to function in the developing human. Blood vessel and blood formation begins in the third week, and the heart is developmentally complete in the fifth week. This is an inaccurate statement.

A pregnant woman demonstrates understanding of the nurse's instructions regarding relief of leg cramps if she: A. wiggles and points her toes during the cramp. B. applies cold compresses to the affected leg. C. extends her leg and dorsiflexes her foot during the cramp. D. avoids weight bearing on the affected leg during the cramp.

C. extends her leg and dorsiflexes her foot during the cramp. Pointing toes can aggravate rather than relieve the cramp. Application of heat is recommended. Extending the leg and dorsiflexing the foot is the appropriate relief for a leg cramp. Bearing weight on the affected leg can help to relieve the leg cramp, so it should not be avoided.

During the first trimester the pregnant woman would be most motivated to learn about: A. fetal development. B. impact of a new baby on family members. C. measures to reduce nausea and fatigue so she can feel better. D. location of childbirth preparation and breastfeeding classes.

C. measures to reduce nausea and fatigue so she can feel better. Fetal development concerns are more apparent in the second trimester when the woman is feeling fetal movement. Impact of a new baby on the family would be appropriate topics for the second trimester when the fetus becomes "real" as its movements are felt and its heartbeat heard. During this trimester a woman works on the task of, "I am going to have a baby." During the first trimester a woman is egocentric and concerned about how she feels. She is working on the task of accepting her pregnancy. Motivation to learn about childbirth techniques and breastfeeding is greatest for most women during the third trimester as the reality of impending birth and becoming a parent is accepted. A goal is to achieve a safe passage for herself and her baby.

An infertile woman is about to begin pharmacologic treatment. As part of the regimen, she will take purified follicle-stimulating hormone (FSH) (urofollitropin [Metrodin]). The nurse instructs her that this medication is administered in the form of a/an: A.intranasal spray. B. vaginal suppository. C. intramuscular injection. D. tablet.

C. intramuscular injection. Intranasal spray is not the appropriate route for urofollitropin. Vaginal suppository is not the correct route for urofollitropin. Urofollitropin is given by IM injection; the dosage may vary. Urofollitropin cannot be given by tablet; it is given only by IM injection.

A 26-year-old woman is considering Depo-Provera as the form of contraception that is best for her since she does not like to worry about taking a pill every day. To assist this woman with decision making concerning this method of contraception, the nurse would tell her that Depo-Provera: A. is a combination of progesterone and estrogen. B. is a small adhesive hormonal birth control patch that is applied weekly. C. thickens and decreases cervical mucus, thereby inhibiting sperm penetration and ovulation. D. has an effectiveness rate in preventing pregnancy of 99% when used correctly.

C. thickens and decreases cervical mucus, thereby inhibiting sperm penetration and ovulation. Depo-Provera is a progestin-only form of hormonal contraception. Depo-Provera is administered as an intramuscular injection. In addition to the changes in the cervical mucus, some but not all ovulatory cycles are suppressed, and formation of an endometrium capable of supporting implantation is inhibited. The effectiveness rate is 99% or greater over 5 years.

When a nurse is unsure about how to perform a client care procedure, the BEST action would be to: A. ask another nurse B. discuss the procedure with the client's physician C. look up the procedure in a nursing textbooks D. consult the agency procedure manual and follow the guidelines for the procedure

D Each nurse is responsible for his or her own practice. Relying on another nurse may not always be safe practice. Each nurse is obligated to follow the standards of care for safe client care delivery. Physicians are responsible for their own client care activity. Nurses may follow safe orders from physicians, but they are also responsible for the activities that they as nurses are to carry out. Information provided in a nursing textbook is basic information for general knowledge and may not reflect the current standard of care or individual state or hospital policies. It is always best to follow the agency's policies and procedures manual when seeking information on correct client procedures. These policies should reflect the current standards of care and state guidelines.

The nurse should refer the patient for further testing if she noted this on inspection of the breasts of a 55-year-old woman: A. left breast slightly smaller than right breast. B. eversion (elevation) of both nipples. C. bilateral symmetry of venous network, which is faintly visible. D. small dimple located in the upper outer quadrant of the right breast.

D In many women, one breast is smaller than the other. Eversion of both nipples is a normal finding. Faintly visible venous network is a normal finding. A small dimple is an abnormal finding and should be further evaluated.

A 23-year-old African-American woman is pregnant with her first child. Based on the statistics for infant mortality, which plan is most important for the nurse to implement? A. perform a nutrition assessment B. refer the woman to a social worker C. advise the woman to see an obstetrician, not a midwife D. explain to the woman the importance of keeping her prenatal care appointments

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

When obtaining a reproductive health history from a female patient, the nurse should: A. limit the time spent on exploration of intimate topics. B. avoid asking questions that may embarrass the patient. C. use only accepted medical terminology when referring to body parts and functions. D. explain the purpose for the questions asked and how the information will be used.

D Sufficient time must be spent on gathering relevant data. All questions should be asked, even if it may be embarrassing for the patient or the nurse, or if it involves intimate topics. Always use terms the patient can understand. Explanation of the purpose for the questions asked while obtaining a reproductive health history will help to gather honest and relevant data.

The nurse is planning care for a patient with a different cultural background. What would be an appropriate goal? A. strive to keep the patient's cultural background from influencing health needs B. encourage the continuation of cultural practices in the hospital setting C. in a nonjudgmental way attempt to change the patient's cultural beliefs D. as necessary adapt the patient's cultural practices to her health needs

D The cultural background is part of the individual. It would be very difficult to eliminate the influence of the patient's background. The cultural practices need to be evaluated within the context of the health care setting to determine if they are conflicting. It is not appropriate to attempt to change someone's cultural practices. Whenever possible, the nurse should facilitate the integration of cultural practices into health needs.

Evidence-based practice is best described as: A. gathering evidence of mortality and morbidity in children B. meeting physical and psychosocial needs of the family in all areas of practice C. using a professional code of ethics as a means of professional self-regulation D. providing care based on evidence gained through research and clinical trial

D This will assist the nurse in determining areas of concern and potential involvement. It is not possible to meet all needs of the patient and family in all areas of practice. The nurse is an advocate for the family. This is part of professional role and licensure. Evidence-based practice is providing care based on evidence gained through research and clinical trials. Practitioners must use the best available information on which to base their interventions.

Discharge instructions after tubal ligation should include: (Select all that apply.) Select all that apply. A. being prepared for significant mood swings due to hormonal influences. B. expecting heavier menstrual periods. C. using two forms of birth control to prevent pregnancy. D. not expecting change in sexual functioning; may enjoy more. E. using condoms to prevent sexually transmitted infections.

D, E. not expecting change in sexual functioning; may enjoy more.Patient teaching regarding what to expect after tubal ligation includes: You should expect no change in hormones and their influence.Your menstrual period will be about the same as before the sterilization.You may feel pain at ovulation.The ovum disintegrates within the abdominal cavity.It is highly unlikely that you will become pregnant.You should not have a change in sexual functioning; you may enjoy sexual relations more because you will not be concerned about becoming pregnant.Sterilization offers no protection against sexually transmitted infections. Therefore, you may need to use condoms. using condoms to prevent sexually transmitted infections.Patient teaching regarding what to expect after tubal ligation includes: You should expect no change in hormones and their influence.Your menstrual period will be about the same as before the sterilization.You may feel pain at ovulation.The ovum disintegrates within the abdominal cavity.It is highly unlikely that you will become pregnant.You should not have a change in sexual functioning; you may enjoy sexual relations more because you will not be concerned about becoming pregnant.Sterilization offers no protection against sexually transmitted infections. Therefore, you may need to use condoms.

A woman is using the basal body temperature (BBT) method of contraception. She calls the clinic and tells the nurse, "My period is due in a few days, and my temperature has not gone up." The nurse's most appropriate response is: A. "This probably means you're pregnant." B. "Don't worry; it's probably nothing." C. "Have you been sick this month?" D. "You probably did not ovulate during this cycle."

D. "You probably did not ovulate during this cycle." Pregnancy cannot occur without ovulation (which is being measured using the basal body temperature (BBT) method). A comment such as this discredits the client's concerns. Illness would most likely cause an increase in BBT. The absence of a temperature decrease most likely is the result of lack of ovulation.

When counseling a client about getting enough iron in her diet, the maternity nurse should tell her that: A. milk, coffee, and tea aid iron absorption if consumed at the same time as iron. B. iron absorption is inhibited by a diet rich in vitamin C. C. iron supplements are permissible for children in small doses. D. constipation is common with iron supplements.

D. constipation is common with iron supplements. These beverages inhibit iron absorption when consumed at the same time as iron. Vitamin C promotes iron absorption. Children who ingest iron can get very sick and even die. Constipation can be a problem.

An expectant couple asks the nurse about intercourse during pregnancy and if it is safe for the baby. The nurse should tell the couple that: A. intercourse should be avoided if any spotting from the vagina occurs afterward. B. intercourse is safe until the third trimester. C. safer-sex practices should be used once the membranes rupture. D. intercourse and orgasm are often contraindicated if a history or signs of preterm labor are present.

D. intercourse and orgasm are often contraindicated if a history or signs of preterm labor are present. Some spotting can normally occur as a result of the increased fragility and vascularity of the cervix and vagina during pregnancy. Intercourse can continue as long as the pregnancy is progressing normally. Safer-sex practices are always recommended; rupture of the membranes may require abstaining from intercourse. Uterine contractions that accompany orgasm can stimulate labor and would be problematic if the woman were at risk for or had a history of preterm labor.

A woman who is 14 weeks pregnant tells the nurse that she always had a glass of wine with dinner before she became pregnant. She has abstained during her first trimester and would like to know if it is safe for her to have a drink with dinner now. The nurse tells her: A. Because you are in your second trimester, there is no problem with having one drink with dinner. B. One drink every night is too much. One drink 3 times a week should be fine. C. Because you are in your second trimester, you can drink as much as you like. D. Because no one knows how much or how little alcohol it takes to cause fetal problems, the best course is to abstain throughout your pregnancy.

D. Because no one knows how much or how little alcohol it takes to cause fetal problems, the best course is to abstain throughout your pregnancy. Regardless of which trimester the woman has reached, no amount of alcohol during pregnancy has been deemed safe for the fetus. Neither one drink per night nor three drinks per week is a safe recommendation. Although the first trimester is a crucial period of fetal development, pregnant women of all gestations are counseled to eliminate all alcohol from their diet. A safe level of alcohol consumption during pregnancy has not yet been established. Although the consumption of occasional alcoholic beverages may not be harmful to the mother or her developing fetus, complete abstinence is strongly advised.

If exhibited by a pregnant woman, what represents a positive sign of pregnancy? A. Morning sickness B. Quickening C. Positive pregnancy test D. Fetal heartbeat auscultated with Doppler/fetoscope

D. Fetal heartbeat auscultated with Doppler/fetoscope Morning sickness and quickening, along with amenorrhea and breast tenderness, are presumptive signs of pregnancy; subjective findings are suggestive but not diagnostic of pregnancy. Other probable signs include changes in integument, enlargement of the uterus, and Chadwick sign. A positive pregnancy test is still considered to be a probable sign of pregnancy (objective findings are more suggestive but not yet diagnostic of pregnancy) since error can occur in performing the test or in rare cases human chorionic gonadotropin (hCG) may be detected in the urine of nonpregnant women. Chances of error are less likely to occur today since pregnancy tests used are easy to perform and are very sensitive to the presence of the hCG associated with pregnancy. Detection of a fetal heartbeat, palpation of fetal movements and parts by an examiner, and detection of an embryo/fetus with sonographic examination would be positive signs diagnostic of pregnancy.

A 22-year-old woman pregnant with a single fetus has a preconception body mass index (BMI) of 24. When she was seen in the clinic at 14 weeks of gestation, she had gained 1.8 kg (4 lbs) since conception. How would the nurse interpret this? A. This weight gain indicates possible gestational hypertension. B. This weight gain indicates that the woman's infant is at risk for intrauterine growth restriction (IUGR). C. This weight gain cannot be evaluated until the woman has been observed for several more weeks. D. The woman's weight gain is appropriate for this stage of pregnancy.

D. The woman's weight gain is appropriate for this stage of pregnancy. Although this is an accurate statement, it does not apply to this client. The desirable weight gain during pregnancy varies among women. The primary factor to consider in making a weight gain recommendation is the appropriateness of the prepregnancy weight for the woman s height. A commonly used method of evaluating the appropriateness of weight for height is body mass index (BMI). This woman has gained the appropriate amount of weight for her size at this point in her pregnancy.Weight gain should take place throughout the pregnancy. The optimal rate of weight gain depends on the stage of the pregnancy. This is an accurate statement. This woman's BMI is within the normal range. During the first trimester, the average total weight gain is only 1 to 2.5 kg.

A maternal serum alpha-fetoprotein (MSAFP) test is performed at 16 to 18 weeks of gestation. An elevated level has been associated with: A. Down syndrome. B. sickle cell anemia. C. cardiac defects. D. open neural tube defects such as spina bifida.

D. open neural tube defects such as spina bifida.

The nurse advises the woman who wants to have a nurse-midwife provide obstetric care that: A. she will have to give birth at home. B. she must see an obstetrician as well as the midwife during pregnancy. C. she will not be able to have epidural analgesia for labor pain. D. she must be having a low risk pregnancy.

D. she must be having a low risk pregnancy. Most nurse-midwife births are managed in hospitals or birth centers; a few may be managed in the home. Nurse-midwives may practice with physicians or independently with an arrangement for physician backup. They must refer clients to physicians for complications. Care in a midwifery model is noninterventional, and the woman and family usually are encouraged to be active participants in the care. This does not imply that medications for pain control are prohibited. Midwives usually see low risk obstetric clients. Care is often noninterventional with active involvement from the woman and her family. Nurse-midwives must refer clients to physicians for complications.

With regard to the estimation and interpretation of the recurrence of risks for genetic disorders, nurses should be aware that: A. with a dominant disorder, the likelihood of the second child also having the condition is 100%. B. an autosomal recessive disease carries a one in eight risk of the second child also having the disorder. C. disorders involving maternal ingestion of drugs carry a one in four chance of being repeated in the second child. D. the risk factor remains the same no matter how many affected children are already in the family.

D. the risk factor remains the same no matter how many affected children are already in the family. In a dominant disorder, the likelihood of recurrence in subsequent children is 50% (one in two). An autosomal recessive disease carries a one in four chance of recurrence. Subsequent children would be at risk only if the mother continued to use drugs; the rate of risk would be difficult to calculate. Each pregnancy is an independent event. The risk factor (e.g., one in two, one in four) remains the same for each child, no matter how many children are born to the family.

A pregnant woman at 32 weeks of gestation complains of feeling dizzy and light-headed while her fundal height is being measured. Her skin is pale and moist. The nurse's initial response would be to: A. assess the woman's blood pressure and pulse. B. have the woman breathe into a paper bag. C. raise the woman's legs. D. turn the woman on her side.

D. turn the woman on her side. Vital signs can be assessed next. Breathing into a paper bag is the solution for dizziness related to respiratory alkalosis associated with hyperventilation. Raising her legs will not solve the problem since pressure will still remain on the major abdominal blood vessels, thereby continuing to impede cardiac output. During a fundal height measurement the woman is placed in a supine position. This woman is experiencing supine hypotension as a result of uterine compression of the vena cava and abdominal aorta. Turning her on her side will remove the compression and restore cardiac output and blood pressure.

A pregnant woman's last menstrual period began on April 8, 2009, and ended on April 13. Using Nägele's rule, her estimated date of birth would be _____?

January 15, 2010.

Most of the genetic tests now offered in clinical practice are tests for: A. single-gene disorders. B. carrier screening. C. predictive values. D. predispositional testing.

single-gene disorders.Most tests now offered are tests for single-gene disorders in clients with clinical symptoms or who have a family history of a genetic disease. Carrier screening is used to identify individuals who have a gene mutation for a genetic condition but do not display symptoms. Predictive testing is used only to clarify the genetic status of asymptomatic family members. Predispositional testing differs from the other types of genetic screening in that a positive result does not indicate a 100% chance of developing the condition.