Maternity Exam 3 NCLEX Qs

The hormone responsible for the maturation of the graafian follicle is: A- Follicle stimulating hormone B- Progesterone C- Estrogen D- Luteinizing hormone

ANS A : The hormone that stimulates the maturation if the of the graafian follicle is the Follicle Stimulating Hormone which is released by the anterior pituitary gland.

For the client who is using oral contraceptives, the nurse informs the client about the need to take the pill at the same time each day to accomplish which of the following? A- Decrease the incidence of nausea B- Maintain hormonal levels C- Reduce side effects D- Prevent drug interactions

ANS B Regular timely ingestion of oral contraceptives is necessary to maintain hormonal levels of the drugs to suppress the action of the hypothalamus and anterior pituitary leading to inappropriate secretion of FSH and LH. Therefore, follicles do not mature, ovulation is inhibited, and pregnancy is prevented. The estrogen content of the oral site contraceptive may cause the nausea, regardless of when the pill is taken. Side effects and drug interactions may occur with oral contraceptives regardless of the time the pill is taken.

Oral contraceptive pills are of different types. Which type is most appropriate for mothers who are breastfeeding? A- Estrogen only B- Progesterone only C- Mixed type- estrogen and progesterone D- 21-day pills mixed type

ANS B : If mother is breastfeeding, the progesterone only type is the best because estrogen can affect lactation.

What is the approximate time that the blastocyst spends traveling to the uterus for implantation? A- 2 days B- 7 days C- 10 days D- 14 weeks

ANS B : The blastocyst takes approximately 1 week to travel to the uterus for implantation.

Which of the following are signs of ovulation? Select all that apply: A- Mittelschmerz; B- Spinnbarkeit; C- Thin watery cervical mucus; D- Elevated body temperature of 4.0 degrees centigrade

ANS: A B C: Mittelschmerz, spinnbarkeit and thin watery cervical mucus are signs of ovulation. When ovulation occurs, the hormone progesterone is released which can cause a slight elevation of temperature between 0.2-0.4 degrees centigrade and not 4 degrees centigrade.

Which of the following are the functions of amniotic fluid? Select all that apply. A- Cushions the fetus from abdominal trauma B- Serves as the fluid for the fetus C- Maintains the internal temperature D- Facilitates fetal movement

All the four functions enumerated are true of amniotic fluid.

Which of the following signs will distinguish threatened abortion from imminent abortion? A- Severity of bleeding B- Dilation of the cervix C- Nature and location of pain D- Presence of uterine contraction

Ans B In imminent abortion, the pregnancy will definitely be terminated because the cervix is already open unlike in threatened abortion where the cervix is still closed.

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 client 12 weeks' pregnant come to the emergency department with abdominal cramping and moderate vaginal bleeding. Speculum examination reveals 2 to 3 cms cervical dilation.The nurse would document these findings as which of the following? A- Threatened abortion B- Imminent abortion C- Complete abortion D- Missed abortion

ANS B Cramping and vaginal bleeding coupled with cervical dilation signifies that termination of the pregnancy is inevitable and cannot be prevented. Thus, the nurse would document an imminent abortion. In a threatened abortion, cramping and vaginal bleeding are present, but there is no cervical dilation. The symptoms may subside or progress to abortion. In a complete abortion all the products of conception are expelled. A missed abortion is early fetal intrauterine death without expulsion of the products of conception.

When talking with a pregnant client who is experiencing aching swollen, leg veins, the nurse would explain that this is most probably the result of which of the following? A- Thrombophlebitis B- Pregnancy-induced hypertension C- Pressure on blood vessels from the enlarging uterus D- The force of gravity pulling down on the uterus

ANS C Pressure of the growing uterus on blood vessels results in an increased risk for venous stasis in the lower extremities. Subsequently, edema and varicose vein formation may occur. Thrombophlebitis is an inflammation of the veins due to thrombus formation. Pregnancy-induced hypertension is not associated with these symptoms. Gravity plays only a minor role with these symptoms.

Which of the following is a positive sign of pregnancy? A- Fetal movement felt by mother B- Enlargement of the uterus C- (+) pregnancy test D- (+) ultrasound.

Ans D A positive ultrasound will definitely confirm that a woman is pregnant since the fetus in utero is directly visualized

Which of the following would the nurse identify as a presumptive sign of pregnancy? A- Hegar sign B- Nausea and vomiting C- Skin pigmentation changes D- Positive serum pregnancy test

ANS B Presumptive signs of pregnancy are subjective signs. Of the signs listed, only nausea and vomiting are presumptive signs. Hegar sign,skin pigmentation changes, and a positive serum pregnancy test are considered probably signs, which are strongly suggestive of pregnancy.

An anemic woman, 34 weeks pregnant, is taking iron supplements. Which of the following foods should the patient take with iron? A- Carrots B- Orange juice C- Yogurt D- Fortified milk

B • Consuming vitamin C-rich foods, like orange juice, will increase the absorption of iron. • Incorrect: Avoid calcium-containing foods such as milk and yogurt, which will decrease the absorption of iron. • Incorrect: Carrots have no effect on iron absorption.

The nurse is providing teaching to a newly pregnant patient. The nurse advises her to take calcium and what vitamin to increase calcium absorption? A- Vitamin A B- Vitamin D C- Vitamin C D- Vitamin E.

B • Vitamin D increases calcium absorption in the GI tract. • The recommended amount of calcium during pregnancy is 1,200-1,500 mg. Women under age 24 should aim for the higher end. • The skeleton and teeth constitute a major portion of the fetus. Initial calcification of the teeth occurs around 14 weeks. Bones begin to calcify at 12 weeks. To supply adequate calcium and phosphorus for bone formation, pregnant women need to eat food high in calcium and vitamin D

Which of the following refers to the single cell that reproduces itself after conception? A- Chromosome B- Blastocyst C- Zygote D- Trophoblast

ANS C : The zygote is the single cell that reproduces itself after conception. The chromosome is the material that makes up the cell and is gained from each parent. Blastocyst and trophoblast are later terms for the embryo after zygote.

Which finding(s) is (are) of most concern to the nurse when caring for a woman in the first trimester of pregnancy? (Select all that apply.) A. Cramping with bright red spotting B. Extreme tenderness of the breast C. Lack of tenderness of the breast D. Increased amounts of discharge E. Increased right-side flank pain

A,C,E Rationale: A and C) are signs of a possible miscarriage. Cramping with bright red bleeding is a sign that the client's menstrual cycle is about to begin. A decrease of tenderness in the breast is a sign that hormone levels have declined and that a miscarriage is imminent. (E) could be a sign of an ectopic pregnancy, which could be fatal if not discovered in time before rupture. (B and D) are normal signs during the first trimester of a pregnancy.

Which of the following can lead to infertility in adult males? A- German measles B- Orchitis C- Chicken pox D- Rubella

Ans B Orchitis is a complication that may accompany mumps in adult males. This condition is characterized by unilateral inflammation of one of the testes which can lead to atrophy of the affected testis. About 20-30% of males who gets mumps after puberty may develop this complication.

Which of the following instructions should be included in the nurse's teaching regarding oral contraceptives? a. Weight gain should be reported to the physician. b. An alternate method of birth control is needed when taking antibiotics. c. If the client misses one or more pills, two pills should be taken per day for 1 week. d. Changes in the menstrual flow should be reported to the physician.

Answer: B When the client is taking oral contraceptives and begins antibiotics, another method of birth control should be used. Antibiotics decrease the effectiveness of oral contraceptives. Approximately 5-10 pounds of weight gain is not unusual, so answer A is incorrect. If the client misses a birth control pill, she should be instructed to take the pill as soon as she remembers the pill. Answer C is incorrect. If she misses two, she should take two; if she misses more than two, she should take the missed pills but use another method of birth control for the remainder of the cycle. Answer D is incorrect because changes in menstrual flow are expected in clients using oral contraceptives. Often these clients have lighter menses.

A adult female patient is using the rhythm (calendar-basal body temperature) method of family planning. In this method, the unsafe period for sexual intercourse is indicated by; a. Return preovulatory basal body temperature b. Basal body temperature increase of 0.1 degrees to 0.2 degrees on the 2nd or 3rd day of cycle c. 3 full days of elevated basal body temperature and clear, thin cervical mucus d. Breast tenderness and mittelschmerz

Answer: C Ovulation (the period when pregnancy can occur) is accompanied by a basal body temperature increase of 0.7 degrees F to 0.8 degrees F and clear, thin cervical mucus. A return to the preovulatory body temperature indicates a safe period for sexual intercourse. A slight rise in basal temperature early in the cycle is not significant. Breast tenderness and mittelschmerz are not reliable indicators of ovulation.

The nurse is assessing the knowledge of new parents with a child born with maple syrup urine disease (MSUD). This is an autosomal recessive inherited disorder, which means that: a. Both genes of a pair must be abnormal for the disorder to be expressed. b. Only one copy of the abnormal gene is required for the disorder to be expressed. c. The disorder occurs in males and heterozygous females. d. The disorder is carried on the X chromosome.

a. Both genes of a pair must be abnormal for the disorder to be expressed. MSUD is a type of autosomal recessive inheritance disorder in which both genes of a pair must be abnormal for the disorder to be expressed. MSUD is not an X-linked dominant or recessive disorder or an autosomal dominant inheritance disorder.

The chief function of progesterone is the: A- Development of the female reproductive system B- Stimulation of the follicles for ovulation to occur C- Preparation of the uterus to receive a fertilized egg D- Establishment of secondary male sex characteristics

Ans C: Progesterone stimulates differentiation of the endometrium into a secretory type of tissue.

Courtney, a 34-year-old, suspects that she is pregnant. A serologic immunoassay test is performed to determine if she is pregnant. Which of the following statements is true about the test? A- This is an over-the-counter test which can give false negatives. B- It is highly accurate by 8-10 days after conception. C- A blood specimen must be used. D- It is highly accurate by 26 days after conception. E- This test can be used to indicate how developed the embryo or fetus is. F- First morning urine should be used, if possible.

B C F • All serology pregnancy tests are designed to detect human chorionic gonadotropin (hCG), which is a glycoprotein hormone secreted by the developing placenta shortly after fertilization. In a normal pregnancy, a qualitative serologic test detects the presence of the hCG hormone found in the serum and urine of pregnant women just 7-10 days following fertilization. • The appearance of hCG in urine soon after conception and its subsequent rise in concentration during early gestational growth make it an excellent marker for the early detection of pregnancy. Even some over the counter home pregnancy urine tests can detect as little as 6.3 mIU/mL of hCG in urine, an amount which varies widely, but may be present anywhere from 3-9 days before a missed period. • A quantitative immunoassay test measures the concentration of hCG, indicating the age of the baby. This test also screens for abnormalities that would give an abnormal hCG level like ectopic pregnancies, molar pregnancies, or possible miscarriages. • Random urine specimens are appropriate for urine hCG testing (not serologic), but the first-morning urine is optimal because it generally contains the highest concentration of hCG. • Serologic tests require a blood sample, not urine. • Over-the-counter urine tests (not serologic tests) can give false negatives because any low result will be negative, which can mean simply that the embryo has not yet implanted or developed enough to produce the minimum amount of hCG to meet the sensitivity requirements of the test.

Icon correct question header Correct 12/33 A patient with oligohydramnios presents to the hospital with intense contractions. Which of the following complications is associated with this condition? A- Hypospadias B- Renal malformations C- Lesin of CN VI D- Skeletal malformations E- Cord compression

B D E • Oligohydramnios is a condition characterized by amniotic fluid deficiency. • Complications include cord compression, skeletal malformations, renal malformations, facial distortion, pulmonary hypoplasia, and intrauterine growth restriction. • CN VI lesion and hypospadias are not associated with oligohydramnios.

In presenting to obstetric nurses interested in genetics, the genetic nurse identifies the primary risk(s) associated with genetic testing as: a. Anxiety and altered family relationships. b. Denial of insurance benefits. c. High false positives associated with genetic testing. d. Ethnic and socioeconomic disparity associated with genetic testing.

b. Denial of insurance benefits. Decisions about genetic testing are shaped by socioeconomic status and the ability to pay for the testing. Some types of genetic testing are expensive and are not covered by insurance benefits. Anxiety and altered family relationships, high false positives, and ethnic and socioeconomic disparity are factors that may be difficulties associated with genetic testing, but they are not risks associated with testing.

The diet that is appropriate in normal pregnancy should be high in A- Protein, minerals and vitamins B- Carbohydrates and vitamins C- Proteins, carbohydrates and fats D- Fats and minerals

ANS A : In normal pregnancy there is a higher demand for protein (body building foods), vitamins (esp. vitamin A, B, C, folic acid) and minerals (esp. iron, calcium, phosphorous, zinc, iodine, magnesium) because of the need of the growing fetus.

A female adult patient is taking a progestin-only oral contraceptive, or mini pill. Progestin use may increase the patient's risk for: A- Endometriosis B- Female hypogonadism C- Premenstrual syndrome D- Tubal or ectopic pregnancy

ANS D : Women taking the minipill have a higher incidence of tubal and ectopic pregnancies, possibly because progestin slows ovum transport through the fallopian tubes. Endometriosis, female hypogonadism, and premenstrual syndrome are not associated with progestin-only oral contraceptives.

In a lecture on sexual functioning, the nurse plans to include the fact that ovulation occurs when the: A- Oxytocin is too high B- Blood level of LH is too high C- Progesterone level is high D- Endometrial wall is sloughed off.

Ans B : It is the surge of LH secretion in mid cycle that is responsible for ovulation.

A client at 36 weeks gestation is schedule for a routine ultrasound prior to an amniocentesis. After teaching the client about the purpose for the ultrasound, which of the following client statements would indicate to the nurse in charge that the client needs further instruction? A- The ultrasound will help to locate the placenta B- The ultrasound identifies blood flow through the umbilical cord C- The test will determine where to insert the needle D- The ultrasound locates a pool of amniotic fluid

Ans B Before amniocentesis, a routine ultrasound is valuable in locating the placenta, locating a pool of amniotic fluid, and showing the physician where to insert the needle. Color Doppler imaging ultrasonography identifies blood flow through the umbilical cord. A routine ultrasound does not accomplish this.

A gravidocardiac mother is advised to observe bed rest primarily to A- Allow the fetus to achieve normal intrauterine growth B- Minimize oxygen consumption which can aggravate the condition of the compromised heart of the mother C- Prevent perinatal infection D- Reduce incidence of premature labor

Ans B : Activity of the mother will require more oxygen consumption. Since the heart of a gravido-cardiac is compromised, there is a need to put a mother on bedrest to reduce the need for oxygen.

A patient comes to the clinic stating that she may be pregnant. The nurse knows that a pregnancy can be confirmed by A- a positive urine test B- ultrasound fetal visualization C- hCG blood test D- quickening

B • There are only three positive signs that are used to confirm pregnancy: fetal heart sounds heard by doppler ultrasound, ultrasound visualization of the fetus, or fetal movements palpated by the examiner. • Presumptive signs of pregnancy are those that are least indicative of pregnancy. Taken as single entities, they could indicate other conditions. They are largely subjective in that they are experienced by the woman. Presumptive signs include amenorrhea and quickening. • Probable signs of pregnancy can be objectively seen and documented by the examiner. Although they are more than the presumptive signs, they still are not positive or true diagnostic findings. An example is a positive home pregnancy test or serum hCG test.

A woman in the first trimester of her pregnancy is attending childbirth classes. What topics are most likely to be covered during this trimester? A- False and true labor B- Fetal development C- Anatomy of pregnancy D- Fetal movements E- Nutrition F- Complications and warning signs

B C E F • During the early stages of pregnancy, childbirth classes should cover topics such as warning signs of complications, nutrition, anatomy, and fetal development. • Fetal movements begin between weeks 16-20 (second trimester). False labor and signs of labor (third timester) are usually covered in later childbirth classes as well.

A woman who is two months pregnant complains of nausea after taking her prenatal vitamin. The nurse should instruct the patient to do which of the following to alleviate this side effect? A- Take the vitamin in the morning. B- Crush the vitamin and mix it with orange juice. C- Try the generic brand. D- Take the vitamin at night. E- Take the vitamin with food.

D E • Taking a prenatal vitamin with food can help reduce nausea. Also, taking the vitamin before bedtime can help. • Using a different brand of prenatal vitamins may not help. • The acidity of orange juice can worsen nausea.

A patient was recently discovered to have an ectopic pregnancy. The nurse should tell the patient which of the following? A- "Most women who have an ectopic pregnancy have normal pregnancies and births in the future." B- "Ectopic pregnancy can be either medically or surgically treated." C- "She will have a continuous nagging pain through the rest of pregnancy." D- "If she must have a fallopian tube removed, she will be sterile afterward." E- "Most ectopic pregnancies go to completion, although the newborn is usually small."

A B Explanation• Ectopic pregnancies can be managed either surgically or medically. Ectopic pregnancies are rarely viable. A ruptured ectopic pregnancy requires surgery to repair or remove the affected fallopian tube. If the ectopic pregnancy is unruptured, medical intervention is done to minimize damage and prevent rupture. • Most women go on to have uncomplicated pregnancies and births in the future, though around 10% may have another ectopic pregnancy. After surgical treatment, most physicians will recommend waiting 3-6 months before trying to conceive again. • An ectopic pregnancy is one in which implantation occurs outside the uterine cavity. Immediately after the union of ovum and spermatozoon, the zygote begins to divide and grow normally. Unfortunately, the zygote does not travel the length of the tube to reach the uterus. It implants into the lining of the fallopian tube instead of the uterine wall. • Medical treatment involves oral administration of Methotrexate followed by leucovorin. Methotrexate, a folic acid antagonist chemotherapeutic agent, attacks and destroys rapidly-dividing, fast-growing cells. • As the fetus grows in the fallopian tube, there is a tendency to rupture. If a tube is removed, the woman's fertility is reduced because while she will still ovulate, the eggs released from the affected side cannot be fertilized or reach the uterus without a fallopian tube. Ovulation alternates between the left and right ovaries, so pregnancy can only take place every other month when an egg is released from the unaffected side.

A maternity nurse should be aware of which fact about the 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

When developing a plan of care for a client newly diagnosed with gestational diabetes, which of the following instructions would be the priority? A- Dietary intake B- Medication C- Exercise D- Glucose monitoring.

ANS A Although all of the choices are important in the management of diabetes, diet therapy is the mainstay of the treatment plan and should always be the priority. Women diagnosed with gestational diabetes generally need only diet therapy without medication to control their blood sugar levels. Exercise, is important for all pregnant women and especially for diabetic women, because it burns up glucose, thus decreasing blood sugar. However, dietary intake, not exercise, is the priority. All pregnant women with diabetes should have periodic monitoring of serum glucose. However, those with gestational diabetes generally do not need daily glucose monitoring. The standard of care recommends a fasting and 2-hour postprandial blood sugar level every 2 weeks

During a nonstress test (NST), the electronic tracing displays a relatively flat line for fetal movement, making it difficult to evaluate the fetal heart rate (FHR). To mark the strip, the nurse in charge should instruct the client to push the control button at which time? A- At the beginning of each fetal movement B- At the beginning of each contraction C- After every three fetal movements D- At the end of fetal movement:

ANS A An NST assesses the FHR during fetal movement. In a healthy fetus, the FHR accelerates with each movement. By pushing the control button when a fetal movement starts, the client marks the strip to allow easy correlation of fetal movement with the FHR. The FHR is assessed during uterine contractions in the oxytocin contraction test, not the NST. Pushing the control button after every three fetal movements or at the end of fetal movement wouldn't allow accurate comparison of fetal movement and FHR changes.

A client in the first trimester of pregnancy arrives at a health care clinic and reports that she has been experiencing vaginal bleeding. A threatened abortion is suspected, and the nurse instructs the client regarding management of care. Which statement, if made by the client, indicates a need for further education? A- "I will maintain strict bedrest throughout the remainder of pregnancy." B- "I will avoid sexual intercourse until the bleeding has stopped, and for 2 weeks following the last evidence of bleeding." C- "I will count the number of perineal pads used on a daily basis and note the amount and color of blood on the pad." D- "I will watch for the evidence of the passage of tiSsue

ANS A Strict bed rest throughout the remainder of pregnancy is not required. The woman is advised to curtail sexual activities until the bleeding has ceased, and for 2 weeks following the last evidence of bleeding or as recommended by the physician. The woman is instructed to count the number of perineal pads used daily and to note the quantity and color of blood on the pad. The woman also should watch for the evidence of the passage of tissue.

When preparing a woman who is 2 days postpartum for discharge, recommendations for which of the following contraceptive methods would be avoided? A- Diaphragm B- Female condom C- Oral contraceptives D- Rhythm method

ANS A The diaphragm must be fitted individually to ensure effectiveness. Because of the changes to the reproductive structures during pregnancy and following delivery, the diaphragm must be refitted, usually at the 6 weeks' examination following childbirth or after a weight loss of 15 lbs or more. In addition, for maximum effectiveness, spermicidal jelly should be placed in the dome and around the rim. However, spermicidal jelly should not be inserted into the vagina until involution is completed at approximately 6 weeks. Use of a female condom protects the reproductive system from the introduction of semen or spermicides into the vagina and may be used after childbirth. Oral contraceptives may be started within the first postpartum week to ensure suppression of ovulation . For the couple who has determined the female's fertile period, using the rhythm method, avoidance of intercourse during this period, is safe and effective.

When describing dizygotic twins to a couple, on which of the following would the nurse base the explanation? A- Two ova fertilized by separate sperm B- Sharing of a common placenta C- Each ova with the same genotype D- Sharing of a common chorion

ANS A : Dizygotic (fraternal) twins involve two ova fertilized by separate sperm. Monozygotic (identical) twins involve a common placenta, same genotype, and common chorion.

The nursing intervention to relieve "morning sickness" in a pregnant woman is by giving A- Dry carbohydrate food like crackers B- Low sodium diet C- Intravenous infusion D- Antacid

ANS A : Morning sickness maybe caused by hypoglycemia early in the morning thus giving carbohydrate food will help.

Which of the following statements is TRUE of conception? A- Within 2-4 hours after intercourse conception is possible in a fertile woman B- Generally, fertilization is possible 4 days after ovulation C- Conception is possible during menstruation in a long menstrual cycle D- To avoid conception, intercourse must be avoided 5 days before and 3 days after menstruation

ANS A : The sperms when deposited near the cervical os will be able to reach the fallopian tubes within 4 hours. If the woman has just ovulated (within 24 hours after the rupture of the graafian follicle), fertilization is possible.

A client at 8 weeks' gestation calls complaining of slight nausea in the morning hours. Which of the following client interventions should the nurse question? A- Taking 1 teaspoon of bicarbonate of soda in an 8-ounce glass of water B- Eating a few low-sodium crackers before getting out of bed C- Avoiding the intake of liquids in the morning hours D- Eating six small meals a day instead of thee large meals

ANS A : Using bicarbonate would increase the amount of sodium ingested, which can cause complications. Eating low-sodium crackers would be appropriate. Since liquids can increase nausea avoiding them in the morning hours when nausea is usually the strongest is appropriate. Eating six small meals a day would keep the stomach full, which often decrease nausea

After the first four months of pregnancy, the chief source of estrogen and progesterone is the: A- Placenta B-Adrenal cortex C- Corpus luteum D- Anterior hypophysis

ANS A : When placental formation is complete, around the 16th week of pregnancy; it produces estrogen and progesterone.

When preparing to listen to the fetal heart rate at 12 weeks' gestation, the nurse would use which of the following? A- Stethoscope placed midline at the umbilicus B- Doppler placed midline at the suprapubic region C- Fetoscope placed midway between the umbilicus and the xiphoid process D- External electronic fetal monitor placed at the umbilicus

ANS B At 12 weeks gestation, the uterus rises out of the pelvis and is palpable above the symphysis pubis. The Doppler intensifies the sound of the fetal pulse rate so it is audible. The uterus has merely risen out of the pelvis into the abdominal cavity and is not at the level of the umbilicus. The fetal heart rate at this age is not audible with a stethoscope. The uterus at 12 weeks is just above the symphysis pubis in the abdominal cavity, not midway between the umbilicus and the xiphoid process. At 12 weeks the FHR would be difficult to auscultate with a fetoscope. Although the external electronic fetal monitor would project the FHR, the uterus has not risen to the umbilicus at 12 weeks.

A nurse is reviewing a basal body temperature chart with a couple. Which change would indicate probable ovulation? a) An increase in temperature followed by a decrease for several days b) A decrease in temperature followed by an increase for several days c) A decrease in temperature that remains until menses begins d) A steadily increasing temperature over seven days

ANS B At ovulation body temperature drops, then rises sharply and remains elevated for several days.

Before advising a 24-year-old client desiring oral contraceptives for family planning, the nurse would assess the client for signs and symptoms of which of the following? A) Anemia. B) Hypertension. C) Dysmenorrhea. D) Acne vulgaris.

ANS B Before advising a client about oral contraceptives, the nurse needs to assess the client for signs and symptoms of hypertension. Clients who have hypertension, thrombophlebitis, obesity, or a family history of cerebral or cardiovascular accident are poor candidates for oral contraceptives. In addition, women who smoke, are older than 40 years of age, or have a history of pulmonary disease should be advised to use a different method. Iron-deficiency anemia, dysmenorrhea, and acne are not contraindications for the use of oral contraceptives. Iron-deficiency anemia is a common disorder in young women. Oral contraceptives decrease the amount of menstrual flow and thus decrease the amount of iron lost through menses, thereby providing a beneficial effect when used by clients with anemia. Low-dose oral contraceptives to prevent ovulation may be effective in decreasing the severity of dysmenorrhea (painful menstruation). Dysmenorrhea is thought to be caused by the release of prostaglandins in response to tissue destruction during the ischemic phase of the menstrual cycle. Use of oral contraceptives often improves facial acne

A 23-year-old nulliparous client visiting the clinic for a routine examination tells the nurse that she desires to use the basal body temperature method for family planning. The nurse should instruct the client to do which of the following? A) Check the cervical mucus to see if it is thick and sparse. B) Take her temperature at the same time every morning. C) Document ovulation when the temperature decreases at least 1°F. D) Avoid coitus for 10 days after a slight rise in temperature.

ANS B The basal body temperature method requires that the client take her temperature each morning before arising, preferably at the same time each day before eating or any other activity. Just before the day of ovulation, the temperature falls by 0.5°F. At the time of ovulation, the temperature rises 0.4° to 0.8°F because of increased progesterone secretion in response to the luteinizing hormone. The temperature remains higher for the rest of the menstrual cycle. The client should keep a diary of about 6 months of menstrual cycles to calculate "safe" days. There is no mucus for the first 3 or 4 days after menses, and then thick, sticky mucus begins to appear. As estrogen increases, the mucus changes to clear, slippery, and stretchy. This condition, termed spinnbarkeit, is present during ovulation. After ovulation, the mucus decreases in amount and becomes thick and sticky again until menses. Because the ovum typically survives about 24 hours and sperm can survive up to 72 hours, couples must avoid coitus when the cervical mucus is copious and for about 3 to 4 days before and after ovulation to avoid a pregnancy.

Which of the following would the nurse include in the teaching plan for a 32-year-old female client requesting information about using a diaphragm for family planning? A) Douching with an acidic solution after intercourse is recommended. B) Diaphragms should not be used if the client develops acute cervicitis. C) The diaphragm should be washed in a weak solution of bleach and water. D) The diaphragm should be left in place for 2 hours after intercourse.

ANS B The teaching plan should include a caution that diaphragms should not be used if the client develops acute cervicitis, possibly aggravated by contact with the rubber of the diaphragm. Some studies have also associated diaphragm use with increased incidence of urinary tract infections. Douching after use of a diaphragm and intercourse is not recommended because pregnancy could occur. The diaphragm should be inspected and washed with mild soap and water after each use. A diaphragm should be left in place for at least 6 hours but no longer than 24 hours after intercourse. More spermicidal jelly or cream should be used if intercourse is repeated during this period.

Cervical softening and uterine souffle are classified as which of the following? A- Diagnostic signs B- Presumptive signs C- Probable signs D- Positive signs

ANS B Cervical softening (Goodell sign) and uterine soufflé are two probable signs of pregnancy. Probable signs are objective findings that strongly suggest pregnancy. Other probable signs include Hegar sign, which is softening of the lower uterine segment; Piskacek sign, which is enlargement and softening of the uterus; serum laboratory tests; changes in skin pigmentation; and ultrasonic evidence of a gestational sac. Presumptive signs are subjective signs and include amenorrhea; nausea and vomiting; urinary frequency; breast tenderness and changes; excessive fatigue; uterine enlargement; and quickening.

Nutritional planning for a newly pregnant woman of average height and weighing 145 pounds should include: A- A decrease of 200 calories a day B- An increase of 300 calories a day C- An increase of 500 calories a day D- A maintenance of her present caloric intake per day

ANS B This is the recommended caloric increase for adult women to meet the increased metabolic demands of pregnancy.

Lactation Amenorrhea Method(LAM) can be an effective method of natural birth control if A- The mother breast feeds mainly at night time when ovulation could possibly occur B- The mother breastfeeds exclusively and regularly during the first 6 months without giving supplemental feedings C- The mother uses mixed feeding faithfully D- The mother breastfeeds regularly until 1 year with no supplemental feedings

ANS B : A mother who breastfeeds exclusively and regularly during the first 6 months benefits from lactation amenorrhea. There is evidence to support the observation that the benefits of lactation amenorrhea lasts for 6 months provided the woman has not had her first menstruation since delivery of the baby

The nurse is developing a teaching plan for a patient who is 8 weeks pregnant. The nurse should tell the patient that she can expect to feel the fetus move at which time? A- Between 10 and 12 weeks' gestation B- Between 16 and 20 weeks' gestation C- Between 21 and 23 weeks' gestation D- Between 24 and 26 weeks' gestation

ANS B : A pregnant woman usually can detect fetal movement (quickening) between 16 and 20 weeks' gestation. Before 16 weeks, the fetus is not developed enough for the woman to detect movement. After 20 weeks, the fetus continues to gain weight steadily, the lungs start to produce surfactant, the brain is grossly formed, and myelination of the spinal cord begins.

The nurse in-charge is reviewing a patient's prenatal history. Which finding indicates a genetic risk factor? A- The patient is 25 years old B- The patient has a child with cystic fibrosis C- The patient was exposed to rubella at 36 weeks' gestation D- The patient has a history of preterm labor at 32 weeks' gestation

ANS B : Cystic fibrosis is a recessive trait; each offspring has a one in four chance of having the trait or the disorder. Maternal age is not a risk factor until age 35, when the incidence of chromosomal defects increases. Maternal exposure to rubella during the first trimester may cause congenital defects. Although a history or preterm labor may place the patient at risk for preterm labor, it does not correlate with genetic defects.

Which of the following would be the priority nursing diagnosis for a client with an ectopic pregnancy? A- Risk for infection B- Pain C- Knowledge Deficit D- Anticipatory Grieving

ANS B : For the client with an ectopic pregnancy, lower abdominal pain, usually unilateral, is the primary symptom. Thus, pain is the priority. Although the potential for infection is always present, the risk is low in ectopic pregnancy because pathogenic microorganisms have not been introduced from external sources. The client may have a limited knowledge of the pathology and treatment of the condition and will most likely experience grieving, but this is not the priority at this time.

The following are important considerations to teach the woman who is on low dose (mini-pill) oral contraceptive EXCEPT: A- The pill must be taken everyday at the same time B- If the woman fails to take a pill in one day, she must take 2 pills for added protection C- If the woman fails to take a pill in one day, she needs to take another temporary method until she has consumed the whole pack D- If she is breastfeeding, she should discontinue using mini-pill and use the progestin-only type

ANS B : If the woman fails to take her usual pill for the day, taking a double dose does not give additional protection. What she needs to do is to continue taking the pills until the pack is consumed and use at the time another temporary method to ensure that no pregnancy will occur. When a new pack is started, she can already discontinue using the second temporary method she employed.

A client makes a routine visit to the prenatal clinic. Although she is 14 weeks pregnant, the size of her uterus approximates that in an 18- to 20-week pregnancy. Dr. Charles diagnoses gestational trophoblastic disease and orders ultrasonography. The nurse expects ultrasonography to reveal: A- an empty gestational sac. B- grapelike clusters. C- a severely malformed fetus. D- an extrauterine pregnancy.

ANS B : In a client with gestational trophoblastic disease, an ultrasound performed after the 3rd month shows grapelike clusters of transparent vesicles rather than a fetus. The vesicles contain a clear fluid and may involve all or part of the decidual lining of the uterus. Usually no embryo (and therefore no fetus) is present because it has been absorbed. Because there is no fetus, there can be no extrauterine pregnancy. An extrauterine pregnancy is seen with an ectopic pregnancy.

When teaching a group of adolescents about male hormone production, which of the following would the nurse include as being produced by the Leydig cells? A- Follicle-stimulating hormone B- Testosterone C- Luteinizing hormone D- Gonadotropin releasing hormone

ANS B : Testosterone is produced by the Leydig cells in the seminiferous tubules. Follicle-stimulating hormone and luteinizing hormone are released by the anterior pituitary gland. The hypothalamus is responsible for releasing gonadotropin-releasing hormone.

A patient has undergone an amniocentesis for evaluation of fetal well-being. Which intervention would be included in the nurse's plan of care after the procedure? Select all that apply. A- Perform ultrasound to determine fetal positioning. B- Observe the patient for possible uterine contractions. C- Administer RhoGAM to the patient if she is Rh negative. D- Perform a mini catheterization to obtain a urine specimen to assess for bleeding.

ANS B C Ultrasound is used prior to the procedure as a visualization aid to assist with insertion of transabdominal needle. There is no need to assess the urine for bleeding as this is not considered to be a typical presentation or complication.

When involved in prenatal teaching, the nurse should advise the clients that an increase in vaginal secretions during pregnancy is called leukorrhea and is caused by increased: A- Metabolic rates B- Production of estrogen C- Functioning of the Bartholin glands D- Supply of sodium chloride to the cells of the vagina

ANS B: The increase of estrogen during pregnancy causes hyperplasia of the vaginal mucosa, which leads to increased production of mucus by the endocervical glands. The mucus contains exfoliated epithelial cells.

A client at 24 weeks gestation has gained 6 pounds in 4 weeks. Which of the following would be the priority when assessing the client? A- Glucosuria B- Depression C- Hand/face edema D- Dietary intake

ANS C After 20 weeks' gestation, when there is a rapid weight gain, preeclampsia should be suspected, which may be caused by fluid retention manifested by edema, especially of the hands and face. The three classic signs of preeclampsia are hypertension, edema, and proteinuria. Although urine is checked for glucose at each clinic visit, this is not the priority. Depression may cause either anorexia or excessive food intake, leading to excessive weight gain or loss. This is not, however, the priority consideration at this time. Weight gain thought to be caused by excessive food intake would require a 24-hour diet recall. However, excessive intake would not be the primary consideration for this client at this time.

For which of the following clients would the nurse expect that an intrauterine device would not be recommended? A- Woman over age 35 B- Nulliparous woman C- Promiscuous young adult D- Postpartum client

ANS C An IUD may increase the risk of pelvic inflammatory disease, especially in women with more than one sexual partner, because of the increased risk of sexually transmitted infections. An UID should not be used if the woman has an active or chronic pelvic infection, postpartum infection, endometrial hyperplasia or carcinoma, or uterine abnormalities. Age is not a factor in determining the risks associated with IUD use. Most IUD users are over the age of 30. Although there is a slightly higher risk for infertility in women who have never been pregnant, the IUD is an acceptable option as long as the risk-benefit ratio is discussed. IUDs may be inserted immediately after delivery, but this is not recommended because of the increased risk and rate of expulsion at this time.

. A 19-year-old nulligravid client visiting the clinic for a routine examination asks the nurse about cervical mucus changes that occur during the menstrual cycle. Which of the following statements would the nurse expect to include in the client's teaching plan? a) About midway through the menstrual cycle, cervical mucus is thick and sticky. b) During ovulation, the cervix remains dry without any mucus production. c) As ovulation approaches, cervical mucus is abundant and clear. d) Cervical mucus disappears immediately after ovulation, resuming with menses.

ANS C As ovulation approaches, cervical mucus is abundant and clear, resembling raw egg white. Ovulation generally occurs 14 days (plus or minus 2 days) before the beginning of menses. During the luteal phase of the cycle, which occurs after ovulation, the cervical mucus is thick and sticky, making it difficult for sperm to pass. Changes in the cervical mucus are related to the influences of estrogen and progesterone. Cervical mucus is always present

When teaching a client about contraception. Which of the following would the nurse include as the most effective method for preventing sexually transmitted infections? A- Spermicides B- Diaphragm C- Condoms D- Vasectomy

ANS C Condoms, when used correctly and consistently, are the most effective contraceptive method or barrier against bacterial and viral sexually transmitted infections. Although spermicides kill sperm, they do not provide reliable protection against the spread of sexually transmitted infections, especially intracellular organisms such as HIV. Insertion and removal of the diaphragm along with the use of the spermicides may cause vaginal irritations, which could place the client at risk for infection transmission. Male sterilization eliminates spermatozoa from the ejaculate, but it does not eliminate bacterial and/or viral microorganisms that can cause sexually transmitted infections.

A pregnant client states that she "waddles" when she walks. The nurse's explanation is based on which of the following as the cause? A- The large size of the newborn B- Pressure on the pelvic muscles C- Relaxation of the pelvic joints D- Excessive weight gain

ANS C During pregnancy, hormonal changes cause relaxation of the pelvic joints, resulting in the typical "waddling" gait. Changes in posture are related to the growing fetus. Pressure on the surrounding muscles causing discomfort is due to the growing uterus. Weight gain has no effect on gait.

Heartburn and flatulence, common in the second trimester, are most likely the result of which of the following? A- Increased plasma HCG levels B- Decreased intestinal motility C- Decreased gastric acidity D- Elevated estrogen levels

ANS C During the second trimester, the reduction in gastric acidity in conjunction with pressure from the growing uterus and smooth muscle relaxation, can cause heartburn and flatulence. HCG levels increase in the first, not the second, trimester. Decrease intestinal motility would most likely be the cause of constipation and bloating. Estrogen levels decrease in the second trimester.

Assessment of a 16-year-old nulligravid client who visits the clinic and asks for information on contraceptives reveals a menstrual cycle of 28 days. The nurse formulates a nursing diagnosis of Deficient Knowledge related to ovulation and fertility management. Which of the following would be important to include in the teaching plan for the client? A) The ovum survives for 96 hours after ovulation, making conception possible during this time. B) The basal body temperature falls at least 0.2°F after ovulation has occurred. C) Ovulation usually occurs on day 14, plus or minus 2 days, before the onset of the next menstrual cycle. D) Most women can tell they have ovulated because of severe pain and thick, scant cervical mucus.

ANS C For a client with a menstrual cycle of 28 days, ovulation usually occurs on day 14, plus or minus 2 days, before the onset of the next menstrual cycle. Stated another way, the menstrual period begins about 2 weeks after ovulation has occurred. Ovulation does not usually occur during the menses component of the cycle when the uterine lining is being shed. In most women, the ovum survives for about 12 to 24 hours after ovulation, during which time conception is possible. The basal body temperature rises 0.5° to 1.0°F when ovulation occurs. Although some women experience some pelvic discomfort during ovulation (mittelschmerz), severe or unusual pain is rare. After ovulation, the cervical mucus is thin and copious.

The hormone responsible for a positive pregnancy test is: A- Estrogen B- Progesterone C- Human Chorionic Gonadotropin D- Follicle Stimulating hormone

ANS C Human chorionic gonadotropin (HCG) is the hormone secreted by the chorionic villi which is the precursor of the placenta. In the early stage of pregnancy, while the placenta is not yet fully developed, the major hormone that sustains the pregnancy is HCG.

A client, 30 weeks pregnant, is scheduled for a biophysical profile (BPP) to evaluate the health of her fetus. Her BPP score is 8. What does this score indicate? A- The fetus should be delivered within 24 hours. B- The client should repeat the test in 24 hours. C- The fetus isn't in distress at this time. D- The client should repeat the test in 1 week.

ANS C The BPP evaluates fetal health by assessing five variables: fetal breathing movements, gross body movements, fetal tone, reactive fetal heart rate, and qualitative amniotic fluid volume. A normal response for each variable receives 2 points; an abnormal response receives 0 points. A score between 8 and 10 is considered normal, indicating that the fetus has a low risk of oxygen deprivation and isn't in distress. A fetus with a score of 6 or lower is at risk for asphyxia and premature birth; this score warrants detailed investigation. The BPP may or may not be repeated if the score isn't within normal limits

A 20-year-old woman desiring to use a cervical cap for family planning is instructed on its use. Which of the following client statements would indicate to the nurse that the client needs further instruction? A) "Cervical caps can be left in place longer than a diaphragm." B) "Using a cervical cap may increase the risk of irritation." C) "Cervical caps usually fit better than a diaphragm." D) "Many women are unable to use cervical caps."

ANS C The client needs further instruction when she says that cervical caps fit better than the diaphragm. Many women are unable to use cervical caps because their cervix is too short for the cap to fit the cervix properly. A cervical cap may remain in place for up to 48 hours after intercourse, whereas it is recommended that a diaphragm be left in place for only 24 hours. The cervical cap is associated with cervical irritation.

The nurse recognizes that an expected change in the hematologic system that occurs during the 2nd trimester of pregnancy is: A- A decrease in WBC's B- In increase in hematocrit C- An increase in blood volume D- A decrease in sedimentation rate

ANS C : The blood volume increases by approximately 40-50% during pregnancy. The peak blood volume occurs between 30 and 34 weeks of gestation. The hematocrit decreases as a result of the increased blood volume.

A adult female patient is using the rhythm (calendar-basal body temperature) method of family planning. In this method, the unsafe period for sexual intercourse is indicated by: A- Return preovulatory basal body temperature B- Basal body temperature increase of 0.1 degrees to 0.2 degrees on the 2nd or 3rd day of cycle C- 3 full days of elevated basal body temperature and clear, thin cervical mucus D- Breast tenderness and mittelschmerz

ANS C Ovulation (the period when pregnancy can occur) is accompanied by a basal body temperature increase of 0.7 degrees F to 0.8 degrees F and clear, thin cervical mucus. A return to the preovulatory body temperature indicates a safe period for sexual intercourse. A slight rise in basal temperature early in the cycle is not significant. Breast tenderness and mittelschmerz are not reliable indicators of ovulation.

A prenatal nurse is providing instructions to a group of pregnant client regarding measures to prevent toxoplasmosis. Which statement if made by one of the clients indicates a need for further instructions? A- "I need to cook meat thoroughly." B- "I need to avoid touching mucous membranes of the mouth or eyes while handling raw meat." C- "I need to drink unpasteurized milk only." D- "I need to avoid contact with materials that are possibly contaminated with cat feces."

ANS C: All pregnant women should be advised to do the following to prevent the development of toxoplasmosis. Women should be instructed to cook meats thoroughly, avoid touching mucous membranes and eyes while handling raw meat; thoroughly wash all kitchen surfaces that come into contact with uncooked meat, wash the hands thoroughly after handling raw meat; avoid uncooked eggs and unpasteurized milk; wash fruits and vegetables before consumption, and avoid contact with materials that possibly are contaminated with cat feces, such as cat litter boxes, sandboxes, and garden soil.

After being examined and fitted for a diaphragm, a 24-year-old client receives instructions about its use. Which of the following client statements indicates a need for further teaching? A) "I can continue to use the diaphragm for about 2 to 3 years if I keep it protected in the case." B) "If I get pregnant, I will have to be refitted for another diaphragm after the delivery." C) "Before inserting the diaphragm I should coat the rim with contraceptive jelly." D) "If I gain or lose 20 pounds, I can still use the same diaphragm."

ANS D A client would need additional instructions when she says that she can still use the same diaphragm if she gains or loses 20 pounds. Gaining or losing more than 15 pounds can change the pelvic and vaginal contours to such a degree that the diaphragm will no longer protect the client against pregnancy. The diaphragm can be used for 2 to 3 years if it is cared for and well protected in its case. The client should be refitted for another diaphragm after pregnancy and delivery of a newborn because weight changes and physiologic changes of pregnancy can alter the pelvic and vaginal contours, thus affecting the effectiveness of the diaphragm. The client should use a spermicidal jelly or cream before inserting the diaphragm.

A 40-year-old woman with a high body mass index (BMI) is 10 weeks pregnant. Which diagnostic tool is appropriate to suggest to her at this time? a- Biophysical profile B- Amniocentesis C- Maternal serum alpha-fetoprotein (MSAFP) D- Transvaginal ultrasound

ANS D An ultrasound is the method of biophysical assessment of the infant that is performed at this gestational age. Transvaginal ultrasound is especially useful for obese women, whose thick abdominal layers cannot be penetrated adequately with the abdominal approach. A biophysical profile is a method of biophysical assessment of fetal well-being in the third trimester. An amniocentesis is performed after the fourteenth week of pregnancy. A MSAFP test is performed from week 15 to week 22 of the gestation (weeks 16 to 18 are ideal).

A couple who wants to conceive but has been unsuccessful during the last 2 years has undergone many diagnostic procedures. When discussing the situation with the nurse, one partner states, "We know several friends in our age group and all of them have their own child already, Why can't we have one?". Which of the following would be the most pertinent nursing diagnosis for this couple? A-Fear related to the unknown B-Pain related to numerous procedures. c-Ineffective family coping related to infertility. d-Self-esteem disturbance related to infertility.

ANS D Based on the partner's statement, the couple is verbalizing feelings of inadequacy and negative feelings about themselves and their capabilities. Thus, the nursing diagnosis of self-esteem disturbance is most appropriate. Fear, pain, and ineffective family coping also may be present but as secondary nursing diagnoses.

On which of the following areas would the nurse expect to observe chloasma? A- Breast, areola, and nipples B- Chest, neck, arms, and legs C- Abdomen, breast, and thighs D- Cheeks, forehead, and nose

ANS D Chloasma, also called the mask of pregnancy, is an irregular hyperpigmented area found on the face. It is not seen on the breasts, areola, nipples, chest, neck, arms, legs, abdomen, or thighs.

Which of the following common emotional reactions to pregnancy would the nurse expect to occur during the first trimester? A- Introversion, egocentrism, narcissism B- Awkwardness, clumsiness, and unattractiveness C- Anxiety, passivity, extroversion D- Ambivalence, fear, fantasies

ANS D During the first trimester, common emotional reactions include ambivalence, fear, fantasies, or anxiety. The second trimester is a period of well-being accompanied by the increased need to learn about fetal growth and development. Common emotional reactions during this trimester include narcissism, passivity, or introversion. At times the woman may seem egocentric and self-centered. During the third trimester, the woman typically feels awkward, clumsy, and unattractive, often becoming more introverted or reflective of her own childhood.

Which of the following would the nurse expect to include in the teaching plan for a 30-year-old multiparous client who will be using an intrauterine device (IUD) for family planning? a) Amenorrhea is a common side effect of IUDs. b) The client needs to use additional protection for conception. c) IUDs are more costly than other forms of contraception. d) Severe cramping may occur when the IUD is inserted.

ANS D Severe cramping and pain may occur as the device is passed through the internal cervical os. The insertion of the device is generally done when the client is having her menses, because it is unlikely that she is pregnant at that time. Common side effects of IUDs are heavy menstrual bleeding and subsequent anemia, not amenorrhea. Uterine infection or ectopic pregnancy may occur. The IUD has an effectiveness rate of 98%. Therefore, additional protection is not necessary to prevent pregnancy. IUDs generally are less costly than other forms of contraception because they do not require additional expense. Only one insertion is necessary, in comparison to daily doses of oral contraceptives or the need for spermicides in conjunction with diaphragm use.

The nurse observes that an antepartum client who is on bed rest for preterm labor is eating ice rather than the food on her breakfast tray. The client states that she has a craving for ice and then feels too full to eat anything else. Which is the best response by the nurse? A. Remove all ice from the client's room. B. Ask the client what foods she might consider eating. C. Remind the client that what she eats affects her baby. D. Notify the health care provider.

ANS D The health care provider should be notified (D) when a client practices pica (craving for and consumption of nonfood substances). The practice of pica may displace more nutritious foods from the diet, and the client should be evaluated for anemia. (A) is overreacting and may be perceived as punishment by the patient. (B) allows the dietary department to customize the client's tray but fails to address physiologic problems associated with not consuming nutritious foods in pregnancy. (C) is judgmental and blocks further communication.

A multigravid client will be using medroxyprogesterone acetate (Depo-Provera) as a family planning method. After the nurse instructs the client about this method, which of the following client statements indicates effective teaching? a) "This method of family planning requires monthly injections." b) "I should have my first injection during my menstrual cycle." c)"This drug will be given by subcutaneous injections." d) "One possible side effect is absence of a menstrual period.

ANS D With medroxyprogesterone acetate, irregular menstrual cycles and amenorrhea are common side effects. Other side effects include weight gain, breakthrough bleeding, headaches, and depression. This method requires deep intramuscular injections every 3 months. The first injection should occur within 5 days after menses.

During a prenatal visit at 4 months gestation, a pregnant client asks whether tests can be done to identify fetal abnormalities. Between 18 and 40 weeks gestation, which procedure is used to detect fetal anomalies? A- Amniocentesis B- Chorionic villi sampling C- Fetoscopy D- Ultrasound

ANS D : Ultrasound is used between 18 and 40 weeks' gestation to identify normal fetal growth and detect fetal anomalies and other problems. Amniocentesis is done during the third trimester to determine fetal lung maturity. Chorionic villi sampling is performed at 8 to 12 weeks' gestation to detect genetic disease. Fetoscopy is done at approximately 18 weeks' gestation to observe the fetus directly and obtain a skin or blood sample.

FHR can be auscultated with a fetoscope as early as which of the following? A- 5 weeks gestation B- 10 weeks gestation C- 15 weeks gestation D- 20 weeks gestation

ANS D The FHR can be auscultated with a fetoscope at about 20 week's gestation. FHR usually is ausculatated at the midline suprapubic region with Doppler ultrasound transducer at 10 to 12 week's gestation. FHR, cannot be heard any earlier than 10 weeks' gestation.

A nurse is providing instructions to a client in the first trimester of pregnancy regarding measures to assist in reducing breast tenderness. The nurse tells the client to: A- Avoid wearing a bra B- Wash the nipples and areola area daily with soap, and massage the breasts with lotion. C- Wear tight-fitting blouses or dresses to provide support D- Wash the breasts with warm water and keep them dry

ANS D: The pregnant woman should be instructed to wash the breasts with warm water and keep them dry. The woman should be instructed to avoid using soap on the nipples and areola area to prevent the drying of tissues. Wearing a supportive bra with wide adjustable straps can decrease breast tenderness. Tight-fitting blouses or dresses will cause discomfort.

Vasectomy is a procedure done on a male for sterilization. The organ involved in this procedure is A- Prostate gland B- Seminal vesicle C- Testes D- Vas deferens

ANS D: Vasectomy is a procedure wherein the vas deferens of the male is ligated and cut to prevent the passage of the sperms from the testes to the penis during ejaculation.

Estrogen, one of the hormones regulating cyclic activities in female reproductive system is responsible for which effect? a. Increases the quantity and pH of cervical mucus, causing it to become thin and watery and can be stretched to a distance of 10-13 cm. b. Inhibits the production of LH c. Increases endometrial tortuosity d. All of the above

ANS: A Effects of estrogen: • Inhibits the production of FSH • Causes hypertrophy of the myometrium • Increases the quantity and pH of cervical mucus, causing it to become thin and watery and can be stretched to a distance of 10-13 cm. Effects of Progesterone • Inhibits the production of LH • Increases endometrial tortuosity • Increased endometrial secretions • Facilitates transport of the fertilized ovum through the fallopian tubes

A 22-year-old nulligravid client tells the nurse that she and her husband have been considering using condoms for family planning. Which of the following instructions would the nurse include about the use of condoms as a method for family planning? A) Using a spermicide with the condom offers added protection against pregnancy. B) Natural skin condoms protect against sexually transmitted diseases. C) The typical failure rate for couples using condoms is about 25%. D) Condom users frequently report penile gland sensitivity

ANS: A The typical failure rate of a condom is approximately 12% to 14%. Adding a spermicide can decrease this potential failure rate because it offers additional protection against pregnancy. Natural skin condoms do not offer the same protection against sexually transmitted diseases caused by viruses as latex condoms do. Unlike latex condoms, natural skin (membrane) condoms do not prevent the passage of viruses. Most condom users report decreased penile gland sensitivity. However, some users do report an increased sensitivity or allergic reaction (such as a rash) to latex, necessitating the use of another method of family planning or a switch to a natural skin condom.

A nurse is assisting in performing an assessment on a client who suspects that she is pregnant and is checking the client for probable signs of pregnancy. Select all probable signs of pregnancy. A- Uterine enlargement B- Fetal heart rate detected by nonelectric device C- Outline of the fetus via radiography or ultrasound D- Chadwick's sign E- Braxton Hicks contractions F- Ballottement

ANS: A D E F: The probable signs of pregnancy include: >Uterine Enlargement >Hegar's sign or softening and thinning of the uterine segment that occurs at week 6. >Goodell's sign or softening of the cervix that occurs at the beginning of the 2nd month >Chadwick's sign or bluish coloration of the mucous membranes of the cervix, vagina and vulva. Occurs at week 6. >Ballottement or rebounding of the fetus against the examiner's fingers of palpation >Braxton-Hicks contractions Positive pregnancy test measuring for hCG. >Positive signs of pregnancy include: >Fetal Heart Rate detected by electronic device (doppler) at 10-12 weeks >Fetal Heart rate detected by nonelectronic device (fetoscope) at 20 weeks AOG >Active fetal movement palpable by the examiners >Outline of the fetus via radiography or ultrasound

Smoking is contraindicated in pregnancy because A- Nicotine causes vasodilation of the mother's blood vessels B- Carbon monoxide binds with the hemoglobin of the mother reducing available hemoglobin for the fetus C- The smoke will make the fetus and the mother feel dizzy D- Nicotine will cause vasoconstriction of the fetal blood vessels

Ans B : Carbon monoxide is one of the substances found in cigarette smoke. This substance diminishes the ability of the hemoglobin to bind with oxygen thus reducing the amount of oxygenated blood reaching the fetus.

The developing cells are called a fetus from the: A- Time the fetal heart is heard B- Eighth week to the time of birth C- Implantation of the fertilized ovum D- End of the second week to the onset of labor

Ans B : In the first 7-14 days the ovum is known as a blastocyst; it is called an embryo until the eighth week; the developing cells are then called a fetus until birth.

Which of the following findings in a woman would be consistent with a pregnancy of two months duration? A- Weight gain of 6-10 lbs. and presence of striae gravidarum B- Fullness of the breast and urinary frequency C- Braxton Hicks contractions and quickening D- Increased respiratory rate and ballottement

Ans B. Fullness of the breast is due to the increased amount of progesterone in pregnancy. The urinary frequency is caused by the compression of the urinary bladder by the gravid uterus which is still within the pelvic cavity during the first trimester.

A 26-year old multigravida is 14 weeks' pregnant and is scheduled for an alpha-fetoprotein test. She asks the nurse, "What does the alpha-fetoprotein test indicate?" The nurse bases a response on the knowledge that this test can detect: A- Kidney defects B- Cardiac defects C- Neural tube defects D- Urinary tract defects

Ans C The alpha-fetoprotein test detects neural tube defects and Down syndrome.

Which of the following is the most likely effect on the fetus if the woman is severely anemic during pregnancy? A- Large for gestational age (LGA) fetus B- Hemorrhage C- Small for gestational age (SGA) baby D- Erythroblastosis fetalis

Ans C : Anemia is a condition where there is a reduced amount of hemoglobin. Hemoglobin is needed to supply the fetus with adequate oxygen. Oxygen is needed for normal growth and development of the fetus.

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.

The student nurse is giving a presentation about milestones in embryonic development. Which information should he or she include? 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.

The nurse is counseling a client who wants to become pregnant. She tells the nurse that she has a 36-day menstrual cycle and the first day of her last menstrual period was January 8. When will the client's next fertile period occur? A. January 14 to 15 B. January 22 to 23 C. January 29 to 30 D.February 6 to 7

C. Rationale: This client can expect her next period to begin 36 days from the first day of her last menstrual period. Her next period would begin on February 12. Ovulation occurs 14 days before the first day of the menstrual period. The client can expect ovulation to occur January 29 to 30 (C). (A, B, and D) are incorrect.

A pregnant woman is attending a checkup at the physician's office. The mother discovers that her child has chromosomal abnormalities and will be mentally and physically handicapped. The mother is crying and says she feels overwhelmed. Which of the following interventions would be appropriate? A- Tell the patient it is selfish to feel upset about this. B- Recommend a second opinion. C- Suggest an elective termination of the pregnancy. D- Sit with the patient and allow her to cry and express her feelings. E- Contact the social worker for a referral by the end of shift. Explanation

D E The mother is overwhelmed with the unexpected news. The nurse should provide comfort and support. •The nurse should contact the social worker after allowing the mother time to express her feelings. Social support and resources will be important for this family. •Recommending a second opinion at this time may be premature. Let the patient adjust to the news. •The nurse should not tell the patient what to do or how to feel.

A woman planning on becoming pregnant is receiving education from the nurse. Which statement by the patient suggests that she understands fetal alcohol syndrome? A- "I can have a glass of wine with meals since food absorbs the alcohol." B- "Beer is okay, since it is low in alcohol." C- "I have to drink a lot of alcohol to cause significant harm to my child." D- "If I consume alcohol, the baby can be harmed before I even know I'm pregnant." E- "Alcohol affects my baby more than me, so even a little alcohol can be dangerous." Explanation

D E • The first few weeks of fetal development is the period of highest risk for alcohol's teratogenic effects. • Alcohol causes higher blood alcohol concentrations in a developing baby than in the mother because of slower fetal metabolism. Alcohol interferes with oxygen delivery to developing tissues and organs. • Women planning to become pregnant should avoid alcohol. • All alcohol consumption should be discouraged, even with meals.

A 28-year-old primigravida goes to the clinic for a prenatal visit. Which of the following is not included as part of the initial prenatal assessment? A-Family history B- HIV testing C- Nutritional status D- Pelvimetry E- Complete blood count (CBC) F- HgbA1c

D F • Pelvimetry is not routinely included in the prenatal assessment unless the patient is at high risk. Pelvimetry involves the manual assessment of the female pelvis usually through the vagina to help in determining the risk for cephalo-pelvic disproportion during vaginal birth. • The HgbA1c test provides an indication of blood sugar control over the last 3 months and would not be administered unless the patient was determined to be at risk for diabetes. • HIV testing is routinely done as part of risk screening for all prenatal patients. • Nutritional counseling is initiated early in prenatal care and addressed at each visit. • Family history provides information which helps to direct care planning and identify risk factors during pregnancy and birth. • Anemia is common during pregnancy and a CBC is routinely performed to assess for this condition early in care.

A mother who is HIV-positive delivers a full-term newborn and asks the nurse if her baby will become HIV-infected. Which explanation should the nurse provide? A. Most infants of HIV-positive women will continue to test positive for HIV antibodies. B. Infants who have HIV-positive mothers carry the virus and will eventually develop the disease. C. Medication taken during pregnancy to reduce the mother's viral load ensures that the infant is HIV-negative. D. HIV infection is determined at 18 months of age, when maternal HIV antibodies are no longer present.

D. Rationale: All newborns of HIV-positive mothers receive passive HIV antibodies from the mother, so the evaluation of an infant for the HIV virus is determined at 18 months of age, when all the maternal antibodies are no longer in the infant's blood (D). Passive HIV antibodies disappear in the infant within 18 months of age (A). (B) is inaccurate. Although administration of HIV medication during pregnancy (C) can significantly reduce the risk of vertical transmission, treatment does not ensure that the virus will not become manifest in the infant.

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.