Exam #7

A postpartum patient asks the nurse when the subdermal hormone implant for contraception can be inserted. What should the nurse respond to this patient? A) 6 weeks B) In 1 month C) 1 week after your next menstrual cycle D) Before being discharged after this delivery

A) 6 weeks The subdermal hormone implant can be placed 6 weeks after the birth of a baby. One month is too soon for the implant to be placed after the birth of a baby. Typically, the rod is inserted during menses or no later than day 7 of a menstrual cycle to be certain that the patient is not pregnant at the time of insertion. The implant will not be placed immediately after the delivery of a baby.

A nurse is planning care for a client and her husband recently diagnosed with multiple sclerosis and wanting to prevent pregnancy for now. What is the most appropriate nursing diagnosis for this couple? A) Readiness for enhanced knowledge regarding contraception options B) Decisional conflict regarding choice of birth control because of health concerns C) Altered sexuality pattern related to fear of pregnancy D) Risk for ineffective health maintenance related to lack of knowledge

A) Readiness for enhanced knowledge regarding contraception options The nurse should recognize that the couple is ready for enhanced knowledge regarding contraceptive options. By providing education materials on the options available the clients can select the best option for them.

The nurse is assessing the circumstances associated with a client's suspected acquaintance rape at a party. Which is the best question for the nurse to ask? A) "Do you know the assailant well?" B) "Were alcohol and drugs available at the party?" C) "Did you have a prior sexual relationship with the assailant?" D) "Did the assailant express regret after the assault occurred?"

B) "Were alcohol and drugs available at the party?" Although acquaintance rape and date rape do not always involve drugs, a rapist might use alcohol or other drugs to sedate the victim. It a felony to give an unsuspecting person a "date rape drug" with the intent of raping him or her. The other questions are irrelevant to the circumstances of the rape.

Which laboratory result would be most important for a nurse to monitor for a client who has recently started letrozole? A) hCG B) CBC C) TSH D) FSH

D) FSH The nurse will need to monitor FSH levels in the client taking letrozole to increase ovulation.

A nurse is assigned to care for a client who was brought to the emergency department. The client was a victim of human trafficking. When providing care to this client, which intervention would have priority? A) building trust B) promoting privacy C) ensuring safety D) completing documentation

A) building trust Although privacy, safety, and documentation are important, the priority for this client would be to build trust.

A victim of rape is exhibiting symptoms of posttraumatic stress disorder (PTSD) which the nurse interprets as indicative of intrusion. Which symptoms would the client be exhibiting? Select all that apply. A) nightmares B) recurrent thoughts C) flashbacks D) social withdrawal E) emotional numbing

A) nightmares B) recurrent thoughts C) flashbacks

A nursing instructor is teaching about domestic violence. Which of the following should the nurse include as forms of domestic violence? (Select all that apply.) physical violence threats emotional abuse harassment stalking

ALL

A nurse is teaching a group of patients experiencing secondary subfertility. Which of the following would the nurse include as things that can negatively affect spermatogenesis? (Select all that apply.) Increased scrotal heat Trauma to the testes Drug use Excessive alcohol use X-ray exposure Low body temperature

ALL but low body temp

Nurses at an emergency department seek to develop a plan to help clients who are victims of intimate partner violence. Which component is critical to the success of the plan? A) an intimate partner violence (IPV) counselor B) avenues for referral C) a quality of life assessment tool D) educational materials

B) avenues for referral Nurses assume their appropriate role in the effort to screen and treat victims of intimate partner violence through simple screening and having readily available information and avenues for referral.

A nurse is preparing a client for intrauterine device (IUD) insertion. What should the nurse inform the client when educating her on IUDs? A) There is reduced menstrual flow after insertion. B) The insertion procedure is painless. C) A regular check of threads must be done. D) There are continuous cramps after insertion.

C) A regular check of threads must be done. The nurse should instruct the client to check the threads regularly to make sure that the IUD is in place. Menstrual flow may be heavier, or last longer than normal, after IUD insertion. It will not decrease. The client may feel a sharp pain when the IUD is inserted. The client may have cramps for a few days, but these should not continue.

A female client who has chosen the cervical cap as her method of contraception states that she knows how to use it. Which statement by the client would indicate to the nurse that the client does understand this method of contraception? A) "I will remove the cap immediately after every intercourse and reinsert it later." B) "This method will help protect me from getting sexually transmitted infections." C) "I do not need any follow-up procedures for this method." D) "I do not have any spermicidal allergies, so this method is OK for me."

D) "I do not have any spermicidal allergies, so this method is OK for me." Spermicidal allergies are contraindications for the cervical cap. The client should leave the cervical cap in place for at least six hours after intercourse. The cervical cap does not protect against sexually transmitted infections. The woman should have a follow-up Papanicolau test three months after beginning to use the cap.

A woman calls the clinic to report that she has had some cramping and spotting since the insertion of her IUD three days ago. Which instruction would be most appropriate? A) "Come to the clinic as soon as possible." B) "Consider this normal, because your IUD is newly inserted." C) "Take your blood pressure daily for the rest of the month." D) "You'll have to change your method of birth control."

B) "Consider this normal, because your IUD is newly inserted." A woman may notice some spotting or uterine cramping the first 2 or 3 weeks after IUD insertion.. Ibuprofen, a prostaglandin inhibitor, is helpful in relieving the pain.

The nurse is assessing the health history of the male partner. Which of the following data is most likely to be related to an infertility problem? A) 30 years of age B) Employment as a taxi driver C) Intercourse approximately every third day D) Immunization against mumps as a child

B) Employment as a taxi driver Excessive testicular heat, which can occur from long periods of sitting, can limit sperm production and mobility. Male age, frequency of intercourse, and immunizations do not affect sperm production.

Spinnbarkeit mucus

looks like egg whites Occurs as ovulation approaches

sonohysterosalpingogram

the insertion of a contrast agent into the uterus and fallopian tubes

Bicornate uterus

abnormally shaped uterus

A woman arrives at the neighborhood clinic asking for care related to symptoms that include bruising, lacerations and vague reports of perineal discomfort. The nurse assesses and provides care for the client's physical condition, then questions the client. Which is the best question for the nurse to ask? A) "Intimate partner violence is a problem among women in our community. Are you experiencing any type of physical or emotional abuse?" B) "Your injuries suggest that you are experiencing physical and or sexual abuse. Would you like to talk about what's happening?" C) "It appears that your injuries are a result of abuse and violence. Do you feel safe at home?" D) "Physical abuse is not something you have to tolerate. Would you like me to notify the police?"

A) "Intimate partner violence is a problem among women in our community. Are you experiencing any type of physical or emotional abuse?" Often, after a woman is victimized, she will report physical ailments, which gives her the opportunity to visit a health care setting. Opening up the possibility for women to express themselves about their experience of abuse to a nurse sends a clear message that violence should never be tolerated and not kept hidden. Presenting the opportunity in a nonthreatening, nonjudgmental manner will encourage the woman to open up to the problem either immediately or in the future.

A nurse is giving a talk on violence against women to a community group and informs the attendees that violence is growing in the United States today. The nurse informs them of which alarming statistic? A) 1/3 to 1/2 of all U.S. women will experience some form of physical violence in their lifetimes. B) 1/2 to 3/4 of all U.S. women will experience some form of physical violence in their lifetimes. C) 1/4 to 1/3 of all U.S. women will experience some form of physical violence in their lifetimes. D) Fewer then 1/3 of all U.S. women will experience some form of physical violence in their lifetimes.

A) 1/3 to 1/2 of all U.S. women will experience some form of physical violence in their lifetimes. Statistics prove that violence against women is increasing; 1/3 to 1/2 of all U.S. women will experience some form of physical violence in their lifetimes.

A young woman is having trouble conceiving and has come in to the office for fertility testing. She states that she has irregular and unpredictable menstrual cycles. On blood testing, it is found that her ovaries are producing excess testosterone, which is lowering her follicle-stimulating hormone (FSH) and luteinizing hormone (LH) levels. Which of the following is the most likely cause of her subfertility? A) Anovulation B) Endometriosis C) Tubal transport problems D) Stenotic cervical os

A) Anovulation Anovulation is absence of ovulation or release of ova from the ovary. The most frequent cause for anovulation is naturally occurring variations in ovulatory patterns or polycystic ovary syndrome, a condition in which the ovaries produce excess testosterone lowering FSH and LH levels, which then causes irregular and unpredictable menstrual cycles. Based on the woman's symptoms and test results, anovulation is the most likely cause of her subfertility. The other conditions listed would not have the same symptoms and test results.

When working with children and families of children who have been sexually abused, the nurse recognizes which of the following is frequently noted when a child is assaulted or abused by a stranger? A) The occurrence is often reported by the caregivers to authorities promptly. B) The child is usually encouraged by the caregivers to keep the situation a secret. C) The child usually tells no one about the incident D) The offender is usually in early to mid-adulthood

A) The occurrence is often reported by the caregivers to authorities promptly. When a child is sexually assaulted by a stranger, the caregivers usually become aware of the incident, promptly report it, and take the child for a physical examination. Unlike abuse by family members, this type of abuse is more commonly reported rather than kept secret. Abusers may be of widely varying ages.

The nurse is teaching a client about a vasectomy. The nurse determines the session is successful when the client correctly chooses which fact concerning the vasectomy? A) Usually done as an office procedure B) Will no longer ejaculate C) May notice permanent increased scrotal swelling D) Testes will no longer produce sperm.

A) Usually done as an office procedure Vasectomy is an outpatient surgical procedure which is usually performed in the office. It involves ligating and cutting the vas deferens, which stops the flow of sperm from the testes to the outside of the body; however, it does not stop sperm production. There may be short-term swelling immediately after the procedure, but there should not be any permanent swelling. The patient should still have normal sexual function.

A perimenopausal woman asks for help in selecting a contraceptive. She reports vaginal dryness during intercourse and says that her partner does not like the feel of condoms. Which method should the nurse recommend? A) spermicide B) female condom C) cervical cap D) diaphragm

A) spermicide Women older than 35 years have a higher incidence of cystocele or rectocele than younger women, so diaphragms or cervical caps may not be the ideal contraceptive for them. Spermicide foam can help lubricate the vagina to increase sexual enjoyment in women nearing menopause. Her partner's dislike of condoms rules out the female condom.

The nurse is providing education about barrier contraceptives. Which statement by the patient indicates a need for further education? A) "I have to wash my cervical caps after each use." B) "I can leave my diaphragm in for up to 48 hours." C) "I can insert my female condoms up to 8 hours before intercourse." D) "Male latex condoms when used correctly are an effective means of contraceptive and very effective at preventing transmission of STDs."

B) "I can leave my diaphragm in for up to 48 hours." The diaphragm stays in for at least 6 hours after intercourse but no more than 24 hours. The FemCap can stay for 48 hours. Diaphragms and cervical caps are washable and reusable. Female condoms can be inserted up to 8 hours before intercourse to avoid interrupting sexual activity. Male condoms can be made of latex, polyurethane or natural membranes. Male latex condoms when used correctly are an effective means of contraceptive and very effective at preventing transmission of STDs.

A client has been given instructions about a scheduled sonohysterosalpingogram. Which statement, if made by the client, should indicate to a nurse that the client has an adequate understanding of the instructions? A) "I will be put under general anesthesia for the procedure." B) "They will place a catheter in my uterus and use an ultrasound to see what the problem is." C) "This is just an ultrasound procedure, like they do for a baby." D) "They will surgically implant the ovum during the procedure."

B) "They will place a catheter in my uterus and use an ultrasound to see what the problem is." A nurse would recognize that this procedure is a sonographic procedure that includes the insertion of a contrast agent into the uterus and fallopian tubes. This procedure can be used as both diagnostic and therapeutic to break up adhesion within the fallopian tubes.

The experienced nurse working in a fertility clinic understands the stress couples experience when they have to "schedule" sexual relations. Which suggestion would be most helpful to a couple to help prevent further stress on their relationship? A) Try to relax and enjoy it. B) Begin a new activity together. C) Take up new individual hobbies. D) Avoid talking about the cost that is involved.

B) Begin a new activity together. Suggesting that a couple combine involvement with fertility testing with ongoing activities or they begin a new activity together at the same time that they begin fertility testing is a way of helping to reduce the feeling that their entire existence revolves around the testing procedures. It also may help to increase intimacy, helping to compensate for any decreased enjoyment that comes from "scheduled" sexual relations.

A client is requesting information on the various available contraceptives. When explaining a vaginal spermicide, which information should the nurse prioritize? A) Wash with clean water and soap after intercourse. B) Insert the product by applicator in the vagina several hours prior to intercourse. C) Apply the spermicide directly to the glans penis to kill the sperm when they exit the penis. D) Leave the product in place for 24 hours after intercourse.

B) Insert the product by applicator in the vagina several hours prior to intercourse. Vaginal spermicides provide a physical barrier that prevents sperm penetration and a chemical barrier that kills sperm. It is designed to be inserted vaginally immediately before or within a few hours before sexual intercourse. Hygiene is always important and is unrelated to the use of spermicides. Applying the spermicide to the penis would be ineffective as it would rub off. The product is immediately effective and can be removed right after intercourse.

A nurse is conducting a presentation on violence and abuse for a community health program. When describing this concept, which information would the nurse include? Select all that apply. A) Violence against men by women is being significantly addressed. B) Violence against women often goes unrecognized and unreported. C) It ranks low on the scale as a cause for morbidity. D) Violence during pregnancy is rare occurrence. E) In some countries, violence against women is considered acceptable behavior.

B) Violence against women often goes unrecognized and unreported. E) In some countries, violence against women is considered acceptable behavior.

After teaching a woman who has chosen the vaginal ring as her method of contraception, the nurse determines that the client needs additional teaching when she makes which statement? A) "It must be centered on my cervix to be effective ." B) "I'll compress the ring, inserting it as far back as possible." C) "I will insert a new ring at the same time and day of every week." D) "Once I remove the ring, I'll discard it."

C) "I will insert a new ring at the same time and day of every week." The vaginal ring involves a 3-week period of continuous use followed by a ring-free week to allow withdrawal bleeding. The ring is compressed and inserted into the vagina, as far back as possible, but precise placement is not critical. After 3 weeks, the ring is removed and discarded.

A client has been following the conventional 28-day regimen for contraception. She is now considering switching to an extended oral contraceptive (OC) regimen. She is seeking information about specific safety precautions. Which is true for the extended OC regimen? A) It is not as effective as the conventional regimen. B) It prevents pregnancy for 3 months at a time. C) It carries the same safety profile as the 28-day regimen. D) It does not ensure restoration of fertility if discontinued.

C) It carries the same safety profile as the 28-day regimen. Recent studies have shown that the extended use of active OC pills carries the same safety profile as the conventional 28-day regimen. This option helps reduce the number of periods and is as effective as the conventional regimen. There is no evidence to suggest that discontinuation of active OCs will not ensure restoration of fertility. Medroxyprogesterone, not active OC pills, prevents pregnancy for 3 months at a time.

The nurse is preparing to meet with a couple who have requested counseling concerning family planning. The nurse will prioritize which topics for discussion? A) Ensuring the couple is legally married B) Ensuring the correct time frame is followed C) Possible genetic abnormalities D) Preventing STIs

C) Possible genetic abnormalities Family planning consists of two complementary components: planning pregnancy and preventing pregnancy. The nurse may be involved with teaching the families how to avoid unwanted pregnancies, bring about wanted births, and control the intervals between births. Discussing potential genetic anomalies would be involved as the family prepares for children. It would not be proper for the nurse to ignore this couple based on their marriage status. The time frame would be determined by the couple and is flexible. Preventing STIs would also not be a focus of this session.

An intrauterine device has been inserted into a client as a requested birth control method. What is an advantage of intrauterine devices (IUDs)? A) decreased incidence of tubal pregnancies B) decreased incidence of pelvic inflammatory disease C) continuous protection without client's active participation D) protection against sexually transmitted infections

C) continuous protection without client's active participation IUDs provide continuous protection without the need for the client's active participation. IUDs give no protection against sexually transmitted infections and may cause an increased incidence of pelvic inflammatory disease and tubal pregnancies.

A nurse is educating a client on the basal body temperature method as a form of contraception. Which statement by the client indicates and understanding of when she can expect to see a rise in her temperature? A) "My temperature will increase with the start of my menses." B) "If I am pregnant, I will have a temperature spike." C) "There will be an increase in my temperature right before I ovulate." D) "Immediately following ovulation my temperature will increase."

D) "Immediately following ovulation my temperature will increase." The basal body temperature dips immediately prior to ovulation; when ovulation occurs there will be an increase in temperature.

A 35-year-old female client who is unable to conceive is scheduled for a hysterosalpingogram to assess tubal patency. Which of the following would the nurse ensure before the client undergoes the hysterosalpingogram? A) Client has been administered general anesthesia B) Client is in second phase of menstrual cycle C) Client's basal body temperature is recorded D) Client has just completed her menses

D) Client has just completed her menses The nurse should ensure that the client has completed her menses just before undergoing a hysterosalpingogram because a hysterosalpingogram is performed immediately following menses. At this time she is not likely to be pregnant and there is little chance of disrupting a spontaneous pregnancy. General anesthesia is not required before a hysterosalpingogram. The client has to be in the second phase of her menstrual cycle in case of an endometrial biopsy—not a hysterosalpingogram. Basal body temperature monitors the time of ovulation and is required if the client has to undergo postcoital testing, not a hysterosalpingogram.

The nurse is caring for a client at the ambulatory care clinic who questions the nurse for information about contraception. The client reports that she is not comfortable about using any barrier methods and would like the option of regaining fertility after a couple of years. Which method should the nurse suggest to this client? A) basal body temperature (BBT) B) coitus interruptus C) lactational amenorrhea method D) CycleBeads or medroxyprogesterone injection

D) CycleBeads or medroxyprogesterone injection The best option for a client who is not well educated would be the Standard Days Method with CycleBeads, as the 32 color-coded CycleBeads are easy to use and understand. An injection of medroxyprogesterone would also suit this client, as it works by suppressing ovulation and the production of follicle stimulating hormone and leutinizing hormone by the pituitary gland and prevents pregnancy for 3 months at a time. BBT requires the client to take and chart her body temperature; this may be difficult for the client to follow. Coitus interruptus is a method in which the man controls his ejaculation and ejaculates outside the vagina; this suggests that the client rely solely on the cooperation and judgment of her spouse. The lactational amenorrhea method works as a temporary method of contraception only for breastfeeding mothers.

A community health nurse is preparing a presentation for a health fair on the topics of planning for a pregnancy. Which major goal has the nurse determined should be accomplished with this presentation? A) Ensure women are using the correct contraceptive method. B) Ensure couples understand genetic risks. C) Provide one-on-one counseling. D) Decrease the number of unwanted pregnancies.

D) Decrease the number of unwanted pregnancies. Preconception counseling with general health care is a health promotion activity to help prevent unwanted pregnancies. The nurse will be responsible for presenting the basic information to everyone. In this environment it would not be appropriate for the nurse to provide one-on-one counseling due to privacy concerns. The nurse could present various risks but it would be beyond the scope of this event to ensure every participant understands each point.

A nurse is visiting with a couple who has recently completed subfertility assessments and are awaiting the results. Throughout the conversation the wife intermittently begins to cry. What would be the most appropriate nursing diagnosis for this couple? A) Hopelessness related to perception of no viable alternative to usual conception B) Anticipatory grieving related to failure to conceive or sustain a pregnancy C) Situational low self-esteem related to the apparent inability to conceive D) Fear related to possible outcome of subfertility studies

D) Fear related to possible outcome of subfertility studies The nurse should recognize that the client may be expressing fear related to the possible outcomes of the testing. The nurse should address those fears with the client and answer any questions to help reduce fears.

The nurse is working at a clinic that conducts abortions. Which laboratory values would the nurse expect to review for each client? A) Electrolyte levels B) Red blood cell count C) Urine specific gravity D) Rh status

D) Rh status The Rh factor/status is determined because women who are Rh negative will need to receive Rhₒ(D) immune globulin due the blood type of the coceptus not being determined. Electrolytes, urine specific gravity levels and red blood cell count may be obtained but are not specific to a surgical or medical abortion. Anemia would be reason to reschedule the procedure in some cases, but a hemoglobin and hematocrit would be evaluated for this concern.

A client with liver disease is seen in the clinic wanting to begin contraception. The nurse recognizes that which type of contraception is best for this client? A) Oral combination contraception B) Subdermal hormone implant C) Intramuscular injections D) Vaginal estrogen/progestin ring

D) Vaginal estrogen/progestin ring The nurse should recognize that the vaginal estrogen/progestin ring releases hormones into the mucous membranes of the vagina and avoids the "first pass" through the liver.

The estrogen content in the contraceptive pill performs which action? A) decreases the permeability of cervical mucus B) increases the level of luteinizing hormone (LH) C) interferes with endometrial proliferation D) suppresses follicle-stimulating hormone (FSH)

D) suppresses follicle-stimulating hormone (FSH) Estrogen has a direct effect on the pituitary gland suppressing FSH; progesterone increases permeability of cervical mucus and endometrial proliferation.