NU375 Exam 1

Which hormone is essential for maintaining pregnancy? a. Estrogen b. hCG c. Oxytocin d. Progesterone

ANS: D Progesterone is essential for maintaining pregnancy; it does so by relaxing smooth muscles, which reduces uterine activity and prevents miscarriage. Estrogen plays a vital role in pregnancy, but it is not the primary hormone for maintaining pregnancy. hCG levels rise at implantation but decline after 60 to 70 days. Oxytocin stimulates uterine contractions.

The practice of the calendar rhythm method is based on the number of days in each menstrual cycle. The fertile period is determined after monitoring each cycle for 6 months. The beginning of the fertile period is estimated by subtracting 18 days from the longest cycle and 11 days from the shortest. If the womans cycles vary in length from 24 to 30 days, then her fertile period would be day _____ through day ______.

ANS: 6; 19 To avoid pregnancy, the couple must abstain from intercourse on days 6 through 19. Ovulation occurs on day 12 (plus or minus 2 days either way).

A client is 5 months pregnant. On a routine ultrasound scan, the physician discovers that the fetus has a diaphragmatic hernia. The woman becomes distraught and asks the nurse what she should do. Which response would be most suitable? A. Talk to the client, and refer her to a genetic counselor. B. Suggest that the client travel to a fetal treatment center for intrauterine surgery. C. Tell her that everything is going to be fine. D. Sit with the client, and calmly suggest that she consider terminating this pregnancy.

ANS: A Before the client makes any decisions, she should discuss this newly discovered information with a genetic counselor. Genetic counselors can help with the diagnosis and management of families affected by genetic conditions. The discussion of potential surgery should be pursuant to genetic counseling. Telling the woman that everything is going to be fine may give her false hope and is not accurate. All options should be discussed with the genetic counselor. Furthermore, the guiding principle for genetic counseling is nondirection, which respects the right of the individual or family who are being counseled to make autonomous decisions.

Which presumptive sign or symptom of pregnancy would a client experience who is approximately 10 weeks of gestation? A. Amenorrhea B. Positive pregnancy test C. Chadwick sign D. Hegar sign

ANS: A Amenorrhea is a presumptive sign of pregnancy. Presumptive signs of pregnancy are those felt by the woman. A positive pregnancy test and the presence of the Chadwick and Hegar signs are all probable signs of pregnancy.

Which information regarding amniotic fluid is important for the nurse to understand? A. Amniotic fluid serves as a source of oral fluid and a repository for waste from the fetus. B. Volume of the amniotic fluid remains approximately the same throughout the term of a healthy pregnancy. C. The study of fetal cells in amniotic fluid yields little information. D. A volume of more than 2 L of amniotic fluid is associated with fetal renal abnormalities.

ANS: A Amniotic fluid serves as a source of oral fluid, serves as a repository for waste from the fetus, cushions the fetus, and helps maintain a constant body temperature. The volume of amniotic fluid constantly changes. The study of amniotic fluid yields information regarding the sex of the fetus and the number of chromosomes. Too much amniotic fluid (hydramnios) is associated with gastrointestinal and other abnormalities.

What kind of fetal anomalies are most often associated with oligohydramnios? a. Renal b. Cardiac c. Gastrointestinal d. Neurologic

ANS: A An amniotic fluid volume of less than 300 ml (oligohydramnios) is often associated with fetal renal anomalies. The amniotic fluid volume has no bearing on the fetal cardiovascular system. Gastrointestinal anomalies are associated with hydramnios or an amniotic fluid volume greater than 2 L. The amniotic fluid volume has no bearing on the fetal neurologic system.

A woman in labor passes some thick meconium as her amniotic fluid ruptures. The client asks the nurse where the baby makes the meconium. What is the correct response by the nurse? A. Fetal intestines B. Fetal kidneys C. Amniotic fluid D. Placenta

ANS: A As the fetus nears term, fetal waste products accumulate in the intestines as dark green-to-black, tarry meconium. Meconium is not produced by the fetal kidneys nor should it be present in the amniotic fluid, which may be an indication of fetal compromise. The placenta does not produce meconium.

A woman is 16 weeks pregnant and has elected to terminate her pregnancy. Which is the most common technique used for the termination of a pregnancy in the second trimester? A. Dilation and evacuation (D&E) B. Methotrexate administration C. Prostaglandin administration D. Vacuum aspiration

ANS: A D&E can be performed at any point up to 20 weeks of gestation. It is more commonly performed between 13 and 16 weeks of gestation. Methotrexate is a cytotoxic drug that causes early abortion by preventing fetal cell division. Prostaglandins are also used for early abortion and work by dilating the cervix and initiating uterine wall contractions. Vacuum aspiration is used for abortions in the first trimester.

A woman is in her seventh month of pregnancy. She has been complaining of nasal congestion and occasional epistaxis. Which statement best describes why this may be happening to this client? A. This respiratory change is normal in pregnancy and caused by an elevated level of estrogen. B. This cardiovascular change is abnormal, and the nosebleeds are an ominous sign. C. The woman is a victim of domestic violence and is being hit in the face by her partner. D. The woman has been intranasally using cocaine.

ANS: A Elevated levels of estrogen cause capillaries to become engorged in the respiratory tract, which may result in edema in the nose, larynx, trachea, and bronchi. This congestion may cause nasal stuffiness and epistaxis. Cardiovascular changes in pregnancy may cause edema in the lower extremities. Domestic violence cannot be determined on the basis on the sparse facts provided. If the woman had been hit in the face, then she most likely would have additional physical findings. Cocaine use cannot be determined on the basis on the sparse facts provided.

7. Which statement regarding emergency contraception is correct? A. Emergency contraception requires that the first dose be taken within 72 hours of unprotected intercourse. B. Emergency contraception may be taken right after ovulation. C. Emergency contraception has an effectiveness rate in preventing pregnancy of approximately 50%. D. Emergency contraception is commonly associated with the side effect of menorrhagia.

ANS: A Emergency contraception should be taken as soon as possible or within 72 hours of unprotected intercourse to prevent pregnancy. If taken before ovulation, follicular development is inhibited, which prevents ovulation. The risk of pregnancy is reduced by as much as 75%. The most common side effect of postcoital contraception is nausea.

The nurse is responsible for providing health teaching regarding the side effects of COCs. These side effects are attributed to estrogen, progesterone, or both. Which side effects are related to the use of COCs? (Select all that apply.) A. Gallbladder disease B. Myocardial infarction and stroke C. Hypotension D. Breast tenderness and fluid retention E. Dry skin and scalp

ANS: A, B, D Serious side effects include stroke, myocardial infarction, hypertension, gallbladder disease, and liver tumors. More common side effects include nausea, breast tenderness, fluid retention, increased appetite, oily skin and scalp, and chloasma.

A woman asks the nurse, What protects my babys umbilical cord from being squashed while the babys inside of me? What is the nurses best response? A. Your babys umbilical cord is surrounded by connective tissue called Whartons jelly, which prevents compression of the blood vessels. B. Your babys umbilical cord floats around in blood and amniotic fluid. C. You dont need to be worrying about things like that. D. The umbilical cord is a group of blood vessels that are very well protected by the placenta.

ANS: A Explaining the structure and function of the umbilical cord is the most appropriate response. Connective tissue called Whartons jelly surrounds the umbilical cord, prevents compression of the blood vessels, and ensures continued nourishment of the embryo or fetus. The umbilical cord does not float around in blood or fluid. Telling the client not to worry negates her need for information and discounts her feelings. The placenta does not protect the umbilical cord.

Which condition or treatment reduces the risk of morbidity in women with the inherited factor V Leiden disorder? A. Anticoagulant therapy B. Pregnancy C. Oral contraceptives D. Hormone replacement therapy

ANS: A Factor V Leiden is the most common inherited risk factor for primary or recurrent venous thromboembolism. It is an autosomal recessive disorder that increases an individuals risk for blood clots in the legs and pulmonary emboli. This risk significantly increases if the woman is pregnant or is taking oral contraceptives or hormone replacement therapy. Prophylactic anticoagulation therapy decreases the risk of comorbidities.

Which term best describes the conscious decision concerning when to conceive or avoid pregnancy as opposed to the intentional prevention of pregnancy during intercourse? A. Family planning B. Birth control C. Contraception D. Assisted reproductive therapy

ANS: A Family planning is the process of deciding when and if to have children. Birth control is the device and/or practice used to reduce the risk of conceiving or bearing children. Contraception is the intentional prevention of pregnancy during sexual intercourse. Assisted reproductive therapy is one of several possible treatments for infertility.

An expectant couple attending childbirth classes have questions regarding multiple births since twins run in the family. What information regarding multiple births is important for the nurse to share? A. Twinning and other multiple births are increasing because of the use of fertility drugs and delayed childbearing. B. Dizygotic twins (two fertilized ova) have the potential to be conjoined twins. C. Identical twins are more common in Caucasian families. D. Fraternal twins are the same gender, usually male.

ANS: A If the parents-to-be are older and have taken fertility drugs, then they would be very interested to know about twinning and other multiple births. Conjoined twins are monozygotic; that is, they are from a single fertilized ovum in which division occurred very late. Identical twins show no racial or ethnic preference, and fraternal twins are more common among African-American women. Fraternal twins can be different genders or the same gender, and identical twins are the same gender.

A nurse is assessing the knowledge of new parents of a child born with Klinefelter syndrome. Which statement accurately describes this genetic disorder? A. Klinefelter syndrome is a sex chromosome abnormality. B. It affects only female children. C. The disorder is expressed as trisomy XYY. D. The child with this disorder will grow to be infertile.

ANS: A Klinefelter syndrome, also known as trisomy XXY, is a sex chromosomal deviation that is expressed in males. Turner syndrome (monosomy X) is displayed in females. Most males with Klinefelter syndrome are tall, may be infertile, and are slow to learn; however, those who have mosaic Klinefelter syndrome may be fertile as adults.

A pregnant client tells her nurse that she is worried about the blotchy, brownish coloring over her cheeks, nose, and forehead. The nurse can reassure her that this is a normal condition related to hormonal changes. What is the correct term for this integumentary finding? A. Melasma B. Linea nigra C. Striae gravidarum D. Palmar erythema

ANS: A Melasma, (also called chloasma, the mask of pregnancy), usually fades after birth. This hyperpigmentation of the skin is more common in women with a dark complexion. Melasma appears in 50% to 70% of pregnant women. Linea nigra is a pigmented line that runs vertically up the abdomen. Striae gravidarum are also known as stretch marks. Palmar erythema is signified by pinkish red blotches on the hands.

Which type of genetic tests in clinical practice are most often offered to clients with a family history of disease? A. Single-gene disorders B. Carrier screening C. Predictive value testing D. Predispositional testing

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

The nurse caring for a pregnant client is evaluating his or her health teaching regarding fetal circulation. Which statement from the client reassures the nurse that his or her teaching has been effective? A. Optimal fetal circulation is achieved when I am in the side-lying position. B. Optimal fetal circulation is achieved when I am on my back with a pillow under my knees. C. Optimal fetal circulation is achieved when the head of the bed is elevated. D. Optimal fetal circulation is achieved when I am on my abdomen.

ANS: A Optimal circulation is achieved when the woman is lying at rest on her side. Decreased uterine circulation may lead to intrauterine growth restriction. Previously, it was believed that the left lateral position promoted maternal cardiac output, enhancing blood flow to the fetus. However, it is now known that the side-lying position enhances uteroplacental blood flow. If a woman lies on her back with the pressure of the uterus compressing the vena cava, then blood return to the right atrium is diminished. Although having the head of the bed elevated is recommended and ideal for later in pregnancy, the woman still must maintain a lateral tilt to the pelvis to avoid compressing the vena cava. Many women find lying on their abdomen uncomfortable as pregnancy advances. Side-lying is the ideal position to promote blood flow to the fetus.

Which congenital malformations result from multifactorial inheritance? (Select all that apply.) A. Cleft lip B. Congenital heart disease C. Cri du chat syndrome D. Anencephaly E. Pyloric stenosis

ANS: A, B, D, E Cleft lip, congenital heart disease, anencephaly, and pyloric stenosis are associated with multifactorial inheritance. Cri du chat syndrome is related to a chromosomal deletion.

23. A new mother asks the nurse about the white substance covering her infant. How should the nurse explain the purpose of vernix caseosa? A. Vernix caseosa protects the fetal skin from the amniotic fluid. B. Vernix caseosa promotes the normal development of the peripheral nervous system. C. Vernix caseosa allows the transport of oxygen and nutrients across the amnion. D. Vernix caseosa regulates fetal temperature.

ANS: A Prolonged exposure to the amniotic fluid during the fetal period could result in the breakdown of the skin without the protection of the vernix caseosa. Normal development of the peripheral nervous system was dependent on nutritional intake of the mother. The amnion was the inner membrane that surrounded the fetus and was not involved in the oxygen and nutrient exchange. The amniotic fluid helped maintain fetal temperature.

Why might it be more difficult to diagnose appendicitis during pregnancy? A. The appendix is displaced upward and laterally, high and to the right. B. The appendix is displaced upward and laterally, high and to the left. C. The appendix is deep at the McBurneys point. D. The appendix is displaced downward and laterally, low and to the right.

ANS: A The appendix is displaced high and to the right, not to the left. It is displaced beyond the McBurneys point and is not displaced in a downward direction.

A woman has chosen the calendar method of conception control. Which is the most important action the nurse should perform during the assessment process? A. Obtain a history of the womans menstrual cycle lengths for the past 6 to 12 months. B. Determine the clients weight gain and loss pattern for the previous year. C. Examine skin pigmentation and hair texture for hormonal changes. D. Explore the clients previous experiences with conception control.

ANS: A The calendar method of conception control is based on the number of days in each cycle, counting from the first day of menses. The fertile period is determined after the lengths of menstrual cycles have been accurately recorded for 6 months. Weight gain or loss may be partly related to hormonal fluctuations, but it has no bearing on the use of the calendar method. Integumentary changes may be related to hormonal changes, but they are not indicators for use of the calendar method. Exploring previous experiences with conception control may demonstrate client understanding and compliancy, but these experiences are not the most important aspect to assess for the discussion of the calendar method.

Nurses who elect to practice in the field of obstetrics must have a basic working knowledge of genetics. What is the correct term used to describe an individuals genetic makeup? a. Genotype b. Phenotype c. Karyotype d. Chromotype

ANS: A The genotype comprises all the genes the individual can pass on to a future generation. The phenotype is the observable expression of an individuals genotype. The karyotype is a pictorial analysis of the number, form, and size of an individuals chromosomes. Genotype refers to an individuals genetic makeup.

The various systems and organs of the fetus develop at different stages. Which statement is most accurate? A. Cardiovascular system is the first organ system to function in the developing human. B. Hematopoiesis originating in the yolk sac begins in the liver at 10 weeks of gestation. C. Body changes from straight to C-shape occurs at 8 weeks of gestation. D. Gastrointestinal system is mature at 32 weeks of gestation.

ANS: A The heart is developmentally complete by the end of the embryonic stage. Hematopoiesis begins in the liver during the sixth week. The body becomes C-shaped at 21 weeks of gestation. The gastrointestinal system is complete at 36 weeks of gestation.

Although reported in small numbers, toxic shock syndrome (TSS) can occur with the use of a diaphragm. If a client is interested in this form of conception control, then the nurse must instruct the woman on how best to reduce her risk of TSS. Which comment by the nurse would be most helpful in achieving this goal? A. You should always remove your diaphragm 6 to 8 hours after intercourse. Dont use the diaphragm during menses, and watch for danger signs of TSS, including a sudden onset of fever over 38.4 C, hypotension, and a rash. B. You should remove your diaphragm right after intercourse to prevent TSS. C. Its okay to use your diaphragm during your menstrual cycle. Just be sure to wash it thoroughly first to prevent TSS. D. Make sure you dont leave your diaphragm in for longer than 24 hours, or you may get TSS.

ANS: A The nurse should instruct the client on the proper use and removal of the diaphragm and include the danger signs of TSS. The diaphragm must remain against the cervix for 6 to 8 hours to prevent pregnancy, but it should not remain in place longer than 8 hours to avoid the risk of TSS. The diaphragm should not be used during menses.

What is the correct term used to describe the mucous plug that forms in the endocervical canal? A. Operculum B. Leukorrhea C. Funic souffle D. Ballottement

ANS: A The operculum protects against bacterial invasion. Leukorrhea is the mucus that forms the endocervical plug (the operculum). The funic souffle is the sound of blood flowing through the umbilical vessels. Ballottement is a technique for palpating the fetus.

Which nonpharmacologic contraceptive method has a failure rate of less than 25%? A. Standard days variation B. Periodic abstinence C. Postovulation D. Coitus interruptus

ANS: A The standard days variation on the calendar method has a failure rate of 12% and is a variation of the calendar rhythm method with a fixed number of days for fertility in each cycle. The periodic abstinence method has a failure rate of 25% or higher. The postovulation method has a failure rate of 25% or higher. The coitus interruptus method has a failure rate of 27% or higher.

25. Which development related to the integumentary system is correct? A. Very fine hairs called lanugo appear at 12 weeks of gestation. B. Eyelashes, eyebrows, and scalp hair appear at 28 weeks of gestation. C. Fingernails and toenails develop at 28 weeks of gestation. D. By 32 weeks, scalp hair becomes apparent.

ANS: A Very fine hairs, called lanugo appear first at 12 weeks of gestational age on the fetus eyebrows and upper lip. By 20 weeks of gestation, lanugo covers the entire body. By 20 weeks of gestation the eyelashes, eyebrows, and scalp hair also begin to grow. By 28 weeks of gestation, the scalp hair is longer than these fine hairs, which is thin and may disappear by term. Fingernails and toenails develop from thickened epidermis, beginning during the 10th week. Fingernails reach the fingertips at 32 weeks of gestation, and the toenails reach the toe tips at 36 weeks of gestation.

Congenital disorders refer to those conditions that are present at birth. These disorders may be inherited and caused by environmental factors or maternal malnutrition. Toxic exposures have the greatest effect on development between 15 and 60 days of gestation. For the nurse to be able to conduct a complete assessment of the newly pregnant client, he or she should be knowledgeable regarding known human teratogens. Which substances might be considered a teratogen? (Select all that apply.) A. Cytomegalovirus (CMV) B. Ionizing radiation C. Hypothermia D. Carbamazepine E. Lead

ANS: A, B, D, E Exposure to radiation and a number of infections may result in profound congenital deformities. These include but are not limited to varicella, rubella, syphilis, parvovirus, CMV, and toxoplasmosis. Certain maternal conditions such as diabetes and phenylketonuria (PKU) may also affect organs and other parts of the embryo during this developmental period. Drugs such as antiseizure medications (e.g., carbamazepine) and some antibiotics, as well as chemicals including lead, mercury, tobacco, and alcohol, may also result in structural and functional abnormalities.

Relating to the fetal circulatory system, which special characteristics allow the fetus to obtain sufficient oxygen from the maternal blood? (Select all that apply.) A. Fetal hemoglobin (Hb) carries 20% to 30% more oxygen than maternal Hb. B. Fetal Hb carries 40% to 50% more oxygen than maternal Hb. C. Hb concentration is 50% higher than that of the mother. D. Fetal heart rate is 110 to 160 beats per minute. E. Fetal heart rate is 160 to 200 beats per minute.

ANS: A, C, D The following three special characteristics enable the fetus to obtain sufficient oxygen from maternal blood: (1) the fetal Hb carries 20% to 30% more oxygen; (2) the concentration is 50% higher than that of the mother; and (3) the fetal heart rate is 110 to 160 beats per minute, a cardiac output that is higher than that of an adult.

Which activities are included in the role of a nurse practicing in the field of genetics? (Select all that apply.) A. Assessing the responses of family members to a genetic disorder B. Performing genetic testing, such as amniocentesis C. Constructing a family pedigree of three or more generations D. Advising a pregnant mother whose fetus has a genetic disorder to have an abortion E. Offering parents information about genetics

ANS: A, C, E Assessing the responses of family members, constructing a family pedigree, and offering parents information about genetics are activities that a genetics nurse would carry out in caring for a family undergoing genetic counseling. Physicians perform amniocentesis, but the nurse may assist in this procedure. Being aware of their own values and beliefs and refraining from attempting to influence the family are important responsibilities for nurses. The nurse must respect the right of the individual or family to make autonomous decisions.

The nurse is reviewing the educational packet provided to a client about tubal ligation. Which information regarding this procedure is important for the nurse to share? (Select all that apply.) A. It is highly unlikely that you will become pregnant after the procedure. B. Tubal ligation is an effective form of 100% permanent sterilization. C. You wont be able to get pregnant. D. Sterilization offers some form of protection against STIs. E. Sterilization offers no protection against STIs. F. Your menstrual cycle will greatly increase after your sterilization.

ANS: A, D A woman is unlikely to become pregnant after tubal ligation. However, sterilization offers no protection against STIs and is not 100% effective. Typically, the menstrual cycle remains the same after a tubal ligation.

A woman who is 16 weeks pregnant asks the nurse, Is it possible to tell by ultrasound if the baby is a boy or girl yet? What is the best answer? A. A babys sex is determined as soon as conception occurs. B. The baby has developed enough to enable us to determine the sex by examining the genitals through an ultrasound scan. C. Boys and girls look alike until approximately 20 weeks after conception, and then they begin to look different. D. It might be possible to determine your babys sex, but the external organs look very similar right now.

ANS: B Although gender is determined at conception, the external genitalia of males and females look similar through the ninth week. By the twelfth week, the external genitalia are distinguishable as male or female.

The musculoskeletal system adapts to the changes that occur throughout the pregnancy. Which musculoskeletal alteration should the client expect? A. Her center of gravity will shift backward. B. She will have increased lordosis. C. She will have increased abdominal muscle tone. D. She will notice decreased mobility of her pelvic joints.

ANS: B An increase in the normal lumbosacral curve (lordosis) develops, and a compensatory curvature in the cervicodorsal region develops to help her maintain balance. The center of gravity shifts forward. She will have decreased abdominal muscle tone and will notice increased mobility of her pelvic joints.

Which statement regarding chromosomal abnormalities is most accurate? A. Chromosomal abnormalities occur in approximately 10% of newborns. B. Abnormalities of number are the leading cause of pregnancy loss. C. Down syndrome is a result of an abnormal chromosomal structure. D. Unbalanced translocation results in a mild abnormality that the child will outgrow.

ANS: B Aneuploidy is an abnormality of number that is also the leading genetic cause of mental retardation. Chromosomal abnormalities occur in fewer than 1% of newborns. Down syndrome is the most common form of a trisomal abnormality, an abnormality of chromosome number (47 chromosomes). Unbalanced translocation is an abnormality of chromosomal structure that often has serious clinical effects.

A 31-year-old woman believes that she may be pregnant. She took an over-the-counter (OTC) pregnancy test 1 week ago after missing her period; the test was positive. During her assessment interview, the nurse inquires about the womans last menstrual period and asks whether she is taking any medications. The client states that she takes medicine for epilepsy. She has been under considerable stress lately at work and has not been sleeping well. Her physical examination does not indicate that she is pregnant. She has an ultrasound scan, which confirms that she is not pregnant. What is the most likely cause of the false-positive pregnancy test result? A. The pregnancy test was taken too early. B. Anticonvulsant medications may cause the false-positive test result. C. The woman has a fibroid tumor. D. She has been under considerable stress and has a hormone imbalance.

ANS: B Anticonvulsants may cause false-positive pregnancy test results. OTC pregnancy tests use enzyme-linked immunosorbent assay (ELISA) technology, which can yield positive results as soon as 4 days after implantation. Implantation occurs 6 to 10 days after conception. If the woman were pregnant, then she would be into her third week at this point (having missed her period 1 week ago). Fibroid tumors do not produce hormones and have no bearing on human chorionic gonadotropin (hCG) pregnancy tests. Although stress may interrupt normal hormone cycles (menstrual cycles), it does not affect hCG levels or produce positive pregnancy test results.

Which statement regarding the structure and function of the placenta is correct? A. Produces nutrients for fetal nutrition B. Secretes both estrogen and progesterone C. Forms a protective, impenetrable barrier to microorganisms such as bacteria and viruses D. Excretes prolactin and insulin

ANS: B As one of its early functions, the placenta acts as an endocrine gland, producing four hormones necessary to maintain the pregnancy and to support the embryo or fetus: human chorionic gonadotropin (hCG), human placental lactogen (hPL), estrogen, and progesterone. The placenta does not produce nutrients. It functions as a means of metabolic exchange between the maternal and fetal blood supplies. Many bacteria and viruses can cross the placental membrane.

Which contraceptive method best protects against STIs and the HIV? A. Periodic abstinence B. Barrier methods C. Hormonal methods D. Same protection with all methods

ANS: B Barrier methods, such as condoms, protect against STIs and the HIV the best of all contraceptive methods. Periodic abstinence and hormonal methods, such as birth control pills, offer no protection against STIs or the HIV

A woman who has a seizure disorder and takes barbiturates and phenytoin sodium daily asks the nurse about the pill as a contraceptive choice. What is the nurses best response? A. Oral contraceptives are a highly effective method, but they have some side effects. B. Your current medications will reduce the effectiveness of the pill. C. Oral contraceptives will reduce the effectiveness of your seizure medication. D. The pill is a good choice for a woman of your age and with your personal history.

ANS: B Because the liver metabolizes oral contraceptives, their effectiveness is reduced when they are simultaneously taken with anticonvulsants. Stating that the pill is an effective birth control method with side effects is a true statement, but this response is not the most appropriate. The anticonvulsant reduces the effectiveness of the pill, not the other way around. Stating that the pill is a good choice for a woman of her age and personal history does not teach the client that the effectiveness of the pill may be reduced because of her anticonvulsant therapy.

Which renal system adaptation is an anticipated anatomic change of pregnancy? A. Increased urinary output makes pregnant women less susceptible to urinary infections. B. Increased bladder sensitivity and then compression of the bladder by the enlarging uterus result in the urge to urinate even when the bladder is almost empty. C. Renal (kidney) function is more efficient when the woman assumes a supine position. D. Using diuretic agents during pregnancy can help keep kidney function regular.

ANS: B Bladder sensitivity and then compression of the bladder by the uterus result in the urge to urinate more often, even when the bladder is almost empty. A number of anatomic changes in pregnancy make a woman more susceptible to urinary tract infections. Renal function is more efficient when the woman lies in the lateral recumbent position and is less efficient when she is supine. Diuretic use during pregnancy can overstress the system and cause problems.

Nurses, certified nurse-midwives, and other advanced practice nurses have the knowledge and expertise to assist women in making informed choices regarding contraception. A multidisciplinary approach should ensure that the womans social, cultural, and interpersonal needs are met. Which action should the nurse first take when meeting with a new client to discuss contraception? A. Obtain data about the frequency of coitus. B. Determine the womans level of knowledge concerning contraception and her commitment to any particular method. C. Assess the womans willingness to touch her genitals and cervical mucus. D. Evaluate the womans contraceptive life plan.

ANS: B Determining the womans level of knowledge concerning contraception and her commitment to any particular method is the primary step of this nursing assessment and necessary before completing the process and moving on to a nursing diagnosis. Once the clients level of knowledge is determined, the nurse can interact with the woman to compare options, reliability, cost, comfort level, protection from STIs, and her partners willingness to participate. Although important, obtaining data about the frequency of coitus is not the first action that the nurse should undertake when completing an assessment. Data should include not only the frequency of coitus but also the number of sexual partners, level of contraceptive involvement, and the partners objections. Assessing the womans willingness to touch herself is a key factor for the nurse to discuss should the client express an interest in using one of the fertility awareness methods of contraception. The nurse must be aware of the clients plan regarding whether she is attempting to prevent conception, delay conception, or conceive.

An unmarried young woman describes her sex life as active and involving many partners. She wants a contraceptive method that is reliable and does not interfere with sex. She requests an intrauterine device (IUD). Which information is most important for the nurse to share? A. The IUD does not interfere with sex. B. The risk of pelvic inflammatory disease will be higher with the IUD. C. The IUD will protect you from sexually transmitted infections. D. Pregnancy rates are high with the IUD.

ANS: B Disadvantages of IUDs include an increased risk of pelvic inflammatory disease (PID) in the first 20 days after insertion, as well as the risks of bacterial vaginosis and uterine perforation. The IUD offers no protection against sexually transmitted infections (STIs) or the human immunodeficiency virus (HIV), as does a barrier method. Because this woman has multiple sex partners, she is at higher risk of developing an STI. Stating that an IUD does not interfere with sex may be correct; however, it is not the most appropriate response. The typical failure rate of the IUD is approximately 1%

A married couple is discussing alternatives for pregnancy prevention and has asked about fertility awareness methods (FAMs). Which response by the nurse is most appropriate? A. Theyre not very effective, and it is very likely that youll get pregnant. B. FAMs can be effective for many couples; however, they require motivation. C. These methods have a few advantages and several health risks. D. You would be much safer going on the pill and not having to worry.

ANS: B FAMs are effective with proper vigilance about ovulatory changes in the body and with adherence to coitus intervals. FAMs are effective if correctly used by a woman with a regular menstrual cycle. The typical failure rate for all FAMs is 24% during the first year of use. FAMs have no associated health risks. The use of birth control has associated health risks. In addition, taking a pill daily requires compliance on the clients part.

Which statement concerning neurologic and sensory development in the fetus is correct? A. Brain waves have been recorded on an electroencephalogram as early as the end of the first trimester (12 weeks of gestation). B. Fetuses respond to sound by 24 weeks of gestation and can be soothed by the sound of the mothers voice. C. Eyes are first receptive to light at 34 to 36 weeks of gestation. D. At term, the fetal brain is at least one third the size of an adult brain.

ANS: B Hearing develops early and is fully developed at birth. Brain waves have been recorded at week 8. Eyes are receptive to light at 28 weeks of gestation. The fetal brain is approximately one fourth the size of an adult brain.

A client is seen at the clinic at 14 weeks of gestation for a follow-up appointment. At which level does the nurse expect to palpate the fundus? A. Nonpalpable above the symphysis at 14 weeks of gestation B. Slightly above the symphysis pubis C. At the level of the umbilicus D. Slightly above the umbilicus

ANS: B In normal pregnancies, the uterus grows at a predictable rate. It may be palpated above the symphysis pubis sometime between the 12th and 14th weeks of pregnancy. As the uterus grows, it may be palpated above the symphysis pubis sometime between the 12th and 14th weeks of pregnancy. At 14 weeks, the uterus is not yet at the level of the umbilicus. The fundus is not palpable above the umbilicus until 22 to 24 weeks of gestation.

The pancreas forms in the foregut during the 5th to 8th week of gestation. A client with poorly controlled gestational diabetes asks the nurse what the effects of her condition will be on the fetus. What is the best response by the nurse? Poorly controlled maternal gestational diabetes will: A. produce fetal hypoglycemia. B. result in a macrocosmic fetus. C. result in a microcosmic fetus. D. enhance lung maturation.

ANS: B Insulin is produced by week 20 of gestation. In the fetus of a mother with uncontrolled diabetes, maternal hypoglycemia produces fetal hypoglycemia and macrocosmia results. Hyperinsulinemia blocks lung maturation, placing the neonate at risk for respiratory distress.

A woman is 15 weeks pregnant with her first baby. She asks how long it will be before she feels the baby move. What is the nurses best answer? A. You should have felt the baby move by now. B. Within the next month, you should start to feel fluttering sensations. C. The baby is moving; however, you cant feel it yet. D. Some babies are quiet, and you dont feel them move.

ANS: B Maternal perception of fetal movement usually begins 16 to 20 weeks after conception. Because this is her first pregnancy, movement is felt toward the later part of the 16- to 20-week time period. Stating, you should have felt the baby move by now is incorrect and may be an alarming statement to the client. Fetal movement should be felt by 16 to 20 weeks. If movement is not felt by the end of that time, then further assessment is necessary.

A newly married couple plans to use the natural family planning method of contraception. Understanding how long an ovum can live after ovulation is important to them. The nurse knows that his or her teaching was effective when the couple responds that an ovum is considered fertile for which period of time? A. 6 to 8 hours B. 24 hours C. 2 to 3 days D. 1 week

ANS: B Most ova remain fertile for approximately 24 hours after ovulation, much longer than 6 to 8 hours. However, ova do not remain fertile for 2 to 3 days or are viable for 1 week. If unfertilized by a sperm after 24 hours, the ovum degenerates and is reabsorbed.

A male client asks the nurse why it is better to purchase condoms that are not lubricated with nonoxynol-9 (a common spermicide). Which response by the nurse is the most accurate? A. The lubricant prevents vaginal irritation. B. Nonoxynol-9 does not provide protection against STIs as originally thought; it has also been linked to an increase in the transmission of the HIV and can cause genital lesions. C. The additional lubrication improves sex. D. Nonoxynol-9 improves penile sensitivity.

ANS: B Nonoxynol-9 does not provide protection against STIs as originally thought; it has also been linked to an increase in the transmission of the HIV and can cause genital lesions. Nonoxynol-9 may cause vaginal irritation, has no effect on the quality of sexual activity, and has no effect on penile sensitivity.

Which statement regarding the probable signs of pregnancy is most accurate? A. Determined by ultrasound B. Observed by the health care provider C. Reported by the client D. Confirmed by diagnostic tests

ANS: B Probable signs are those detected through trained examination. Fetal visualization is a positive sign of pregnancy. Presumptive signs are those reported by the client. The term diagnostic tests is open for interpretation. To actually diagnose pregnancy, one would have to see positive signs of pregnancy.

Which time-based description of a stage of development in pregnancy is correct? A. Viability22 to 37 weeks of gestation since the last menstrual period (assuming a fetal weight greater than 500 g) B. Termpregnancy from the beginning of 38 weeks of gestation to the end of 42 weeks of gestation C. Pretermpregnancy from 20 to 28 weeks of gestation D. Postdatepregnancy that extends beyond 38 weeks of gestation

ANS: B Term is 38 to 42 weeks of gestation. Viability is the ability of the fetus to live outside the uterus before coming to term, or 22 to 24 weeks since the last menstrual period. Preterm is 20 to 37 weeks of gestation. Postdateor postterm is a pregnancy that extends beyond 42 weeks of gestation or what is considered the limit of full term.

Which factor is least likely to influence the decision to undergo genetic testing? A. Anxiety and altered family relationships B. Cost of testing or denial of insurance benefits C. Imperfection of test results D. Ethnic and socioeconomic disparity associated with genetic testing

ANS: B Testing is not 100% accurate and has a high percentage of false-negative results. An individual may not take these results seriously and subsequently fail to have testing completed or to seek necessary follow-up consultation. Anxiety and altered family relationships are often the result of genetic testing. The results of genetic testing may be difficult to keep confidential, and family members may feel pressured to have testing performed. 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. Caucasian middle-class families have greater access to genetic screening; therefore, this population is less at likely to decide against genetic testing.

The lactational amenorrhea method (LAM) of birth control is popular in developing countries and has had limited use in the United States. As breastfeeding rates increase, more women may rely upon this method for birth control. Which information is most important to provide to the client interested in using the LAM for contraception? A. LAM is effective until the infant is 9 months of age. B. This popular method of birth control works best if the mother is exclusively breastfeeding. C. Its typical failure rate is 5%. D. Feeding intervals should be 6 hours during the day.

ANS: B The LAM works best if the mother is exclusively or almost exclusively breastfeeding. Disruption of the breastfeeding pattern increases the risk of pregnancy. After the infant is 6 months of age or menstrual flow has resumed, effectiveness decreases. The typical failure rate is 1% to 2%. Feeding intervals should be no greater than 4 hours during the day and 6 hours at night.

Which benefit regarding FAMs makes it an appealing choice for some women? A. Adherence to strict recordkeeping B. Absence of chemicals and hormones C. Decreased involvement and intimacy of partner D. Increased spontaneity of coitus

ANS: B The absence of chemicals or hormones to alter the natural menstrual flow is extremely important to some women. The strict recordkeeping with FAMs may be difficult and creates a potential risk for failure. These methods require increased involvement by the partner; however, they also reduce the spontaneity of coitus.

A 32-year-old woman is pregnant for the third time. One child was born with cystic fibrosis, and the other child is healthy. The client and her husband wonder what chance this child has of having cystic fibrosis. This type of testing is most commonly known as what? A. Occurrence risk B. Recurrence risk C. Predictive testing D. Predisposition testi

ANS: B The couple already has a child with a genetic disease; therefore, this couple will be given a recurrence risk test. If a couple has not yet had a child but is known to be at risk for having a child with a genetic disease, then an occurrence risk test is administered. Predictive testing clarifies the genetic status of an asymptomatic family member. Predisposition testing differs from presymptomatic testing in that a positive result does not indicate 100% risk of a condition developing.

9. Which statement describes a key finding of the Human Genome Project? A. Humans produce one protein per gene. B. All human beings are 99.9% identical at the deoxyribonucleic acid (DNA) level. C. The Human Genome Project has not yet been able to translate the accumulating raw research into anything medically practical. D. Humans have more genes than other species.

ANS: B The majority of the 0.1% genetic variations are found within and not among populations. Most human genes produce at least three proteins. The projects research has been very valuable in the identification of genes involved in disease and in the development of genetic testing. There are 20,500 genes in the human genome; scientists originally estimated more than 50,000 genes. Human genes are more efficient than the genes in other species, thereby increasing the human genetic complexity.

The maternity nurse is cognizant of what important structure and function of the placenta? A. As the placenta widens, it gradually thins to allow easier passage of air and nutrients. B. As one of its early functions, the placenta acts as an endocrine gland. C. The placenta is able to keep out most potentially toxic substances, such as cigarette smoke, to which the mother is exposed. D. Optimal blood circulation is achieved through the placenta when the woman is lying on her back or standing.

ANS: B The placenta produces four hormones necessary to maintain the pregnancy: hCG, hPL, estrogen, and progesterone. The placenta widens until 20 weeks of gestation and continues to grow thicker. Toxic substances such as nicotine and carbon monoxide readily cross the placenta into the fetus. Optimal circulation occurs when the woman is lying on her side.

Of which physiologic alteration of the uterus during pregnancy is it important for the nurse to alert the patient? A. Lightening occurs near the end of the second trimester as the uterus rises into a different position. B. Womans increased urinary frequency in the first trimester is the result of exaggerated uterine antireflexion caused by softening. C. Braxton Hicks contractions become more painful in the third trimester, particularly if the woman tries to exercise. D. Uterine souffle is the movement of the fetus.

ANS: B The softening of the lower uterine segment is called the Hegar sign. In this position, the uterine fundus presses on the bladder, causing urinary frequency that is a normal change of pregnancy. Lightening occurs in the last 2 weeks of pregnancy, when the fetus descends. Braxton Hicks contractions become more defined in the final trimester but are not painful. Walking or exercise usually causes them to stop. The uterine souffle is the sound made by blood in the uterine arteries; it can be heard with a fetal stethoscope.

Importantly, the nurse must be aware of which information related to the use of IUDs? A. Return to fertility can take several weeks after the device is removed. B. IUDs containing copper can provide an emergency contraception option if inserted within a few days of unprotected intercourse. C. IUDs offer the same protection against STIs as the diaphragm. D. Consent forms are not needed for IUD insertion

ANS: B The woman has up to 5 days to insert the IUD after unprotected sex. The return to fertility is immediate after the removal of the IUD. IUDs offer no protection against STIs. A consent form is required for insertion, as is a negative pregnancy test.

The nurse is providing health education to a pregnant client regarding the cardiovascular system. Which information is correct and important to share? A. A pregnant woman experiencing disturbed cardiac rhythm, such as sinus arrhythmia, requires close medical and obstetric observation no matter how healthy she may appear otherwise. B. Changes in heart size and position and increases in blood volume create auditory changes from 20 weeks of gestation to term. C. Palpitations are twice as likely to occur in twin gestations. D. All of the above changes will likely occur

ANS: B These auscultatory changes should be discernible after 20 weeks of gestation. A healthy woman with no underlying heart disease does not need any therapy. The maternal heart rate increases in the third trimester, but palpitations may not necessarily occur, let alone double. Auditory changes are discernible at 20 weeks of gestation.

A maternal-newborn nurse is caring for a mother who just delivered a baby born with Down syndrome. Which nursing diagnosis would be the most essential in caring for the mother of this infant? A. Disturbed body image B. Interrupted family processes C. Anxiety D. Risk for injury

ANS: B This mother will likely experience a disruption in the family process related to the birth of a baby with an inherited disorder. Therefore, the probable nursing diagnosis for this family is Interrupted family processes. Women commonly experience body image disturbances in the postpartum period; however, this nursing diagnosis is unrelated to giving birth to a child with Down syndrome. The mother will likely have a mix of emotions that may include anxiety, guilt, and denial, but this nursing diagnosis is not the most essential for this family. Risk for injury is not an applicable nursing diagnosis.

A womans obstetric history indicates that she is pregnant for the fourth time, and all of her children from previous pregnancies are living. One was born at 39 weeks of gestation, twins were born at 34 weeks of gestation, and another child was born at 35 weeks of gestation. What is her gravidity and parity using the GTPAL system? a. 3-1-1-1-3 b. 4-1-2-0-4 c. 3-0-3-0-3 d. 4-2-1-0-3

ANS: B Using the GTPAL system, 4-1-2-0-4 is the correct calculation of this womans gravidity and parity. The numbers reflect the womans gravidity and parity information. Her information is calculated as: G reflects the total number of times the woman has been pregnant; she is pregnant for the fourth time. T indicates the number of pregnancies carried to term, not the number of deliveries at term; only one of her pregnancies resulted in a fetus at term. P is the number of pregnancies that resulted in a preterm birth; the woman has had two pregnancies in which she delivered preterm. A signifies whether the woman has had any abortions or miscarriages before the period of viability; she has not. L signifies the number of children born who are currently living; the woman has four children. 3-1-1-1-3 is an incorrect calculation of this womans gravidity and parity; 3-0-3-0-3 is an incorrect calculation of this womans gravidity and parity; and 4-2-1-0-3 is an incorrect calculation of this womans gravidity and parity.

One of the most promising clinical applications of the Human Genome Project has been pharmacogenomic testing (the use of genetic information to guide a clients drug therapy). Which conditions are potential candidates for pharmacogenomic application? (Select all that apply.) A. Fragile X syndrome B. Deep vein thrombosis (DVT) C. Breast cancer D. Myocardial infarction E. Hemophilia

ANS: B, C, D Associations between genetic variation and drug effect have been observed for a number of commonly used drugs. The conditions for which these are applicable include: DVT, breast cancer, and myocardial infarction. Gene therapy has been unsuccessfully used in hemophilia treatment. Fragile X syndrome is the leading cause of intellectual disability and lacks effective treatment of any kind.

Postabortion instructions may differ among providers regarding tampon use and the resumption of intercourse. However, education should be provided regarding serious complications. When should the woman who has undergone an induced abortion be instructed to return to the emergency department? (Select all that apply.) A. Fever higher than 39 C B. Chills C. Foul-smelling vaginal discharge D. Bleeding greater than four pads in 2 hours E. Severe abdominal pain

ANS: B, C, E The client should report to a health care facility for any of the following symptoms: fever higher than 38 C, chills, bleeding more than two saturated pads in 2 hours or heavy bleeding lasting for days, foul-smelling discharge, abdominal tenderness or pain, and cramping or backache.

The client and her partner are considering male sterilization as a form of permanent birth control. While educating the client regarding the risks and benefits of the procedure, which information should the nurse include? (Select all that apply.) A. Sterilization should be performed under general anesthesia. B. Pain, bleeding, and infection are possible complications. C. Pregnancy may still be possible. D. Vasectomy may affect potency. E. Secondary sex characteristics are unaffected.

ANS: B, C, E Vasectomy is the most commonly used procedure for male sterilization and is performed on an outpatient basis under local anesthesia. Pain, bleeding, swelling, and infection are considered complications. Reversal is generally unsuccessful; however, it may take several weeks to months for all sperm to be cleared from the sperm ducts. Another form of contraception is necessary until the sperm counts are zero. Vasectomy has no effect on potency, and secondary sex characteristics are not affected.

Which statement regarding the development of the respiratory system is a high priority for the nurse to understand? A. The respiratory system does not begin developing until after the embryonic stage. B. The infants lungs are considered mature when the L/S ratio is 1:1, at approximately 32 weeks of gestation. C. Maternal hypertension can reduce maternal-placental blood flow, accelerating lung maturity. D. Fetal respiratory movements are not visible on ultrasound scans until at least 16 weeks of gestation.

ANS: C A reduction in placental blood flow stresses the fetus, increases blood levels of corticosteroids, and thus accelerates lung maturity. The development of the respiratory system begins during the embryonic phase and continues into childhood. The infants lungs are considered mature when the L/S ratio is 2:1, at approximately 35 weeks of gestation. Lung movements have been visualized on ultrasound scans at 11 weeks of gestation.

Which client would be an ideal candidate for injectable progestins such as Depo-Provera (DMPA) as a contraceptive choice? A. The ideal candidate for DMPA wants menstrual regularity and predictability. B. The client has a history of thrombotic problems or breast cancer. C. The ideal candidate has difficulty remembering to take oral contraceptives daily. D. The client is homeless or mobile and rarely receives health care.

ANS: C Advantages of DMPA include its contraceptive effectiveness, compared with the effectiveness of combined oral contraceptives, and the requirement of only four injections a year. The disadvantages of injectable progestins are prolonged amenorrhea and uterine bleeding. The use of injectable progestin carries an increased risk of venous thrombosis and thromboembolism. To be effective, DMPA injections must be administered every 11 to 13 weeks. Access to health care is necessary to prevent pregnancy or potential complications.

A new father has just been told that his infant has trisomy 18. Which identifying physical feature is unique to an infant with this genetic disorder? A. Microcephaly and capillary hemangiomas B. Epicanthal folds and a simian crease C. Oblique palpebral fissures and Cri du chat syndrome D. Rocker-bottom feet and clenched hands with overlapping fingers

ANS: D Rocker-bottom feet and clenched hands with overlapping fingers are associated with trisomy 18. Microcephaly and capillary hemangiomas are associated with trisomy 13. Epicanthal folds and a simian crease are associated with trisomy 21 (Down syndrome). Deletion of the short arm of chromosome number 5 is manifested by Cri du chat syndrome.

Some pregnant clients may complain of changes in their voice and impaired hearing. What should the nurse explain to the client concerning these findings? A. Voice changes are caused by decreased estrogen levels. B. Displacement of the diaphragm results in thoracic breathing. C. Voice changes and impaired hearing are due to the results of congestion and swelling of the upper respiratory tract. D. Increased blood volume causes changes in the voice.

ANS: C Although the diaphragm is displaced and the volume of blood is increased, neither causes changes in the voice nor impairs hearing. The key is that estrogen levels increase, not decrease, which causes the upper respiratory tract to become more vascular, which produces swelling and congestion in the nose and ears and therefore voice changes and impaired hearing.

A pregnant woman at 25 weeks of gestation tells the nurse that she dropped a pan last week and her baby jumped at the noise. Which response by the nurse is most accurate? A. That must have been a coincidence; babies cant respond like that. B. The fetus is demonstrating the aural reflex. C. Babies respond to sound starting at approximately 24 weeks of gestation. D. Let me know if it happens again; we need to report that to your midwife.

ANS: C Babies respond to external sound starting at approximately 24 weeks of gestation. Acoustic stimulations can evoke a fetal heart rate response. There is no such thing as an aural reflex. The last statement is inappropriate and may cause undue psychologic alarm to the client.

3. A client who is gravida 2 and 16 weeks of gestation comes in for her prenatal appointment. Her 2-year-old daughter is with her and is wearing a sleeveless top. While interacting with her daughter, you note axillary freckling and several caf-au-lait spots (>2 cm). In reviewing her chart, the nurse should assess for documentation of which genetic disease? A. Tay-Sachs disease B. Galactosemia C. Neurofibromatosis (NF) D. PKU

ANS: C Clinical manifestations of NF may include axillary freckling and caf-au-lait spots. Tay-Sachs disease is an incurable lipid-storage disorder and is not associated with caf-au-lait spots. Galactosemia is an inborn error of metabolism and is also not associated with caf-au-lait spots. PKU is not associated with caf-au-lait spots. A child with PKU would have difficulty manufacturing the liver enzyme phenylalanine.

8. Cancer is now recognized as a genetic disorder that begins with one or more genetic mutations. Which type of cancer is specifically being investigated in this regard? A. Lung cancer B. Liver cancer C. Colorectal cancer D. Oral cancer

ANS: C Colorectal cancer usually results from one or more predisposing genes and is the third leading cause of cancer deaths in women. Although tobacco smoke is a known causative factor for lung cancer, an acquired mutation of an oncogene may also be present. Liver cancer is not being investigated in this regard. Oral cancer may be caused by an inherited mutation of one or more oncogenes.

If consistently and correctly used, which of the barrier methods of contraception has the lowest failure rate? A. Spermicides B. Female condoms C. Male condoms D. Diaphragms

ANS: C For typical users, the failure rate for male condoms may approach 18%. Spermicide failure rates are approximately 28%. The failure rate for female condoms is approximately 21%. The failure rate for diaphragms with spermicides is 12%.

A woman who has just undergone a first-trimester abortion will be using oral contraceptives. To protect against pregnancy, the client should be advised to do what? A. Avoid sexual contact for at least 10 days after starting the pill. B. Use condoms and foam for the first few weeks as a backup. C. Use another method of contraception for 1 week after starting the pill. D. Begin sexual relations once vaginal bleeding has ended.

ANS: C If oral contraceptives are to be started within 3 weeks after an abortion, additional forms of contraception should be used throughout the first week to avoid the risk of pregnancy.

n the acronym BRAIDED, which letter is used to identify the key components of informed consent that the nurse must document? A. B stands for birth control. B. R stands for reproduction. C. A stands for alternatives. D. I stands for ineffective.

ANS: C In the acronym BRAIDED, A stands for alternatives and information about other viable methods. B stands for benefits and information about the advantages of a particular birth control method and its success rates. Rstands for risks and information about the disadvantages of a particular method and its failure rates. I stands for inquiries and the opportunity to ask questions.

A couple has been counseled for genetic anomalies. They ask you, What is karyotyping? Which description is most accurate? A. Karyotyping will reveal if the babys lungs are mature. B. Karyotyping will reveal if the baby will develop normally. C. Karyotyping will provide information about the gender of the baby and the number and structure of the chromosomes. D. Karyotyping will detect any physical deformities the baby has.

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

The nurse is providing education to a client regarding the normal changes of the breasts during pregnancy. Which statement regarding these changes is correct? A. The visibility of blood vessels that form an intertwining blue network indicates full function of the Montgomery tubercles and possibly an infection of the tubercles. B. The mammary glands do not develop until 2 weeks before labor. C. Lactation is inhibited until the estrogen level declines after birth. D. Colostrum is the yellowish oily substance used to lubricate the nipples for breastfeeding.

ANS: C Lactation is inhibited until after birth. The visible blue network of blood vessels is a normal outgrowth of a richer blood supply. The mammary glands are functionally complete by midpregnancy. Colostrum is a creamy white-to-yellow premilk fluid that can be expressed from the nipples before birth.

hCG is an important biochemical marker for pregnancy and therefore the basis for many tests. Which statement regarding hCG is true? A. hCG can be detected as early as weeks after conception. B. hCG levels gradually and uniformly increase throughout pregnancy. C. Significantly lower-than-normal increases in the levels of hCG may indicate a postdate pregnancy. D. Higher-than-normal levels of hCG may indicate an ectopic pregnancy or Down syndrome.

ANS: D Higher hCG levels also could be a sign of a multiple gestation. hCG can be detected as early as 7 to 10 days after conception. The hCG levels fluctuate during pregnancy, peaking, declining, stabilizing, and then increasing again. Abnormally slow increases may indicate impending miscarriage.

The nurse is providing contraceptive instruction to a young couple who are eager to learn. The nurse should be cognizant of which information regarding the natural family planning method? A. The natural family planning method is the same as coitus interruptus or pulling out. B. This contraception method uses the calendar method to align the womans cycle with the natural phases of the moon. C. This practice is the only contraceptive method acceptable to the Roman Catholic Church. D. The natural family planning method relies on barrier methods during the fertility phases.

ANS: C Natural family planning is the only contraceptive practice acceptable to the Roman Catholic Church. Pulling out is not the same as periodic abstinence, another name for natural family planning. The phases of the moon are not part of the calendar method or any method. Natural family planning is another name for periodic abstinence, which is the accepted way to pass safely through the fertility phases without relying on chemical or physical barriers.

Which statement regarding genetic health care is most important to the nurse practicing in this specialty? A. Genetic disorders equally affect people of all socioeconomic backgrounds, races, and ethnic groups. B. Genetic health care is more concerned with populations than individuals. C. Providing emotional support to the family during counseling is the most important of all nursing functions. D. Taking genetic histories is the province of large universities and medical centers.

ANS: C Perhaps the most important of all nursing functions is the ability to provide emotional support. Nurses should be prepared to help with various stress reactions from a couple facing the possibility of a genetic disorder. Although anyone may have a genetic disorder, certain disorders appear more often in certain ethnic and racial groups. Genetic health care is highly individualized because treatments are based on the phenotypic responses of the individual. Individual nurses at any facility can take a genetic history, although larger facilities may have better support services.

Which clinical finding in a primiparous client at 32 weeks of gestation might be an indication of anemia? A. Ptyalism B. Pyrosis C. Pica D. Decreased peristalsis

ANS: C Pica (a desire to eat nonfood substances) is an indication of iron deficiency and should be evaluated. Cravings include ice, clay, and laundry starch. Ptyalism (excessive salivation), pyrosis (heartburn), and decreased peristalsis are normal findings.

The measurement of lecithin in relation to sphingomyelin (lecithin/sphingomyelin [L/S] ratio) is used to determine fetal lung maturity. Which ratio reflects fetal maturity of the lungs? a. 1.4:1 b. 1.8:1 c. 2:1 d. 1:1

ANS: C The L/S ratio indicates a 2:1 ratio of lecithin to sphingomyelin, which is an indicator of fetal lung maturity and occurs at approximately the middle of the third trimester. L/S ratios of 1.4:1, 1.8:1, and 1:1 each indicate immaturity of the fetal lungs.

A womans 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 dont really know when such defects occur. B. It depends on what caused the defect. C. Defects occur between the third and fifth weeks of development. D. They usually occur in the first 2 weeks of development.

ANS: C 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. We dont really know when such defects occur is an inaccurate statement. Regardless of the cause, the heart is vulnerable during its period of developmentin the third to fifth weeks; therefore, the statement, They usually occur in the first 2 weeks of development is inaccurate.

A client arrives for her initial prenatal examination. This is her first child. She asks the nurse, How does my baby get air inside my uterus? What is the correct response by the nurse? A. The babys lungs work in utero to exchange oxygen and carbon dioxide. B. The baby absorbs oxygen from your blood system. C. The placenta provides oxygen to the baby and excretes carbon dioxide into your bloodstream. D. The placenta delivers oxygen-rich blood through the umbilical artery to the babys abdomen.

ANS: C The placenta delivers oxygen-rich blood through the umbilical vein, not the artery, to the fetus and excretes carbon dioxide into the maternal bloodstream. The fetal lungs do not function as respiratory gas exchange in utero. The baby does not simply absorb oxygen from a womans blood system; rather, blood and gas transport occur through the placenta.

At a routine prenatal visit, the nurse explains the development of the fetus to her client. At approximately ____ weeks of gestation, lecithin is forming on the alveolar surfaces, the eyelids open, and the fetus measures approximately 27 cm crown to rump and weighs approximately 1110 g. The client is how many weeks of gestation at todays visit? A. 20 B. 24 C. 28 D. 30

ANS: C These milestones in human development occur at 28 weeks of gestation. These milestones have not occurred by 20 or 24 weeks of gestation but have been reached before 30 weeks of gestation.

A woman will be taking oral contraceptives using a 28-day pack. What advice should the nurse provide to protect this client from an unintended pregnancy? A. Limit sexual contact for one cycle after starting the pill. B. Use condoms and foam instead of the pill for as long as the client takes an antibiotic. C. Take one pill at the same time every day. D. Throw away the pack and use a backup method if two pills are missed during week 1 of her cycle.

ANS: C To maintain adequate hormone levels for contraception and to enhance compliance, clients should take oral contraceptives at the same time each day. If contraceptives are to be started at any time other than during normal menses or within 3 weeks after birth or an abortion, then another method of contraception should be used through the first week to prevent the risk of pregnancy. Taken exactly as directed, oral contraceptives prevent ovulation, and pregnancy cannot occur. No strong pharmacokinetic evidence indicates a link between the use of broad- spectrum antibiotics and altered hormonal levels in oral contraceptive users. If the client misses two pills during week 1, then she should take two pills a day for 2 days and finish the package and use a backup contraceptive method for the next 7 consecutive days.

Which statement is the most complete and accurate description of medical abortions? A. Medical abortions are performed only for maternal health. B. They can be achieved through surgical procedures or with drugs. C. Medical abortions are mostly performed in the second trimester. D. They can be either elective or therapeutic.

ANS: D Medical abortions can be either elective (the womans choice) or therapeutic (for reasons of maternal or fetal health) and are performed through the use of medications rather than surgical procedures. Medical abortions are usually performed in the first trimester.

A father and mother are carriers of phenylketonuria (PKU). Their 2-year-old daughter has the condition. The couple tells the nurse that they are having a second baby. Because their daughter has PKU, they are certain that this baby will not be affected. Which response by the nurse is the most accurate? A. Good planning. You need to take advantage of the odds that are in your favor. B. I think youd better first check with your physician. C. You are both carriers; therefore, each baby has a 25% chance of being affected. D. The ultrasound indicates a boy, and boys are not affected by PKU.

ANS: C Each child conceived by this couple has a one-in-four chance of being affected with the PKU disorder. This couple still has an increased likelihood of having a child with PKU; having one child already with PKU does not guarantee that they will not have another. These parents need to discuss their options with their physician. However, an opportune time has presented itself for the couple to receive correct teaching about inherited genetic risks. No correlation exists between gender and inheritance of the disorder, because PKU is an autosomal recessive disorder.

What is the most basic information that a nurse should be able to share with a client who asks about the process of conception? A. Ova are considered fertile 48 to 72 hours after ovulation. B. Sperm remain viable in the womans reproductive system for an average of 12 to 24 hours. C. Conception is achieved when a sperm successfully penetrates the membrane surrounding the ovum. D. Implantation in the endometrium occurs 6 to 10 days after conception.

ANS: D After implantation, the endometrium is called the decidua. Ova are considered fertile for approximately 24 hours after ovulation. Sperm remain viable in the womans reproductive system for an average of 2 to 3 days. Penetration of the ovum by the sperm is called fertilization. Conception occurs when the zygote, the first cell of the new individual, is formed.

The U.S. Department of Health and Human Services has designated Thanksgiving Day as National Family History Day. The U.S. Surgeon General encourages family members to discuss important family health information while sharing in holiday gatherings. Why is this initiative significant to nurses? A. Few genetic tests are available that identify this information. B. Only physicians should obtain this detailed information. C. Clients cannot accurately complete these histories on their own. D. Family history is the single most cost-effective source for genetic information.

ANS: D Although more than 1000 genetic tests are available, the single most cost-effective piece of genetic information is the family history. Nurses are ideally suited to take the lead in ongoing efforts to recognize the significance of the family history as an important source of genetic information. A computerized tool called My Family Health Portrait is available free of charge (https://familyhistory.hhs.gov/fhh-web/home.action). Other tools designed to help the lay community in completing their family histories are available to the public.

What is the importance of obtaining informed consent for a number of contraceptive methods? A. Contraception is an invasive procedure that requires hospitalization. B. The method may require a surgical procedure to insert a device. C. The contraception method chosen may be unreliable. D. The method chosen has potentially dangerous side effects.

ANS: D Being aware of the potential side effects is important for couples who are making an informed decision about the use of contraceptives. The only contraceptive method that is a surgical procedure and requires hospitalization is sterilization. Some methods have greater efficacy than others, and this efficacy should be included in the teaching.

Which structure is responsible for oxygen and carbon dioxide transport to and from the maternal bloodstream? A. Decidua basalis B. Blastocyst C. Germ layer D. Chorionic villi

ANS: D Chorionic villi are fingerlike projections that develop out of the trophoblast and extend into the blood-filled spaces of the endometrium. The villi obtain oxygen and nutrients from the maternal bloodstream and dispose carbon dioxide and waste products into the maternal blood. The decidua basalis is the portion of the decidua (endometrium) under the blastocyst where the villi attach. The blastocyst is the embryonic development stage after the morula; implantation occurs at this stage. The germ layer is a layer of the blastocyst.

Which statement regarding the term contraceptive failure rate is the most accurate? A. The contraceptive failure rate refers to the percentage of users expected to have an accidental pregnancy over a 5-year span. B. It refers to the minimum rate that must be achieved to receive a government license. C. The contraceptive failure rate increases over time as couples become more careless. D. It varies from couple to couple, depending on the method and the users.

ANS: D Contraceptive effectiveness varies from couple to couple, depending on how well a contraceptive method is used and how well it suits the couple. The contraceptive failure rate measures the likelihood of accidental pregnancy in the first year only. Failure rates decline over time because users gain experience.

A woman who is 8 months pregnant asks the nurse, Does my baby have any antibodies to fight infection? What is the most appropriate response by the nurse? A. Your baby has all the immunoglobulins necessary: immunoglobulin G (IgG), immunoglobulin M (IgM), and immunoglobulin A (IgA). B. Your baby wont receive any antibodies until he is born and you breastfeed him. C. Your baby does not have any antibodies to fight infection. D. Your baby has IgG and IgM.

ANS: D During the third trimester, IgG is the only immunoglobulin that crosses the placenta; it provides passive acquired immunity to specific bacterial toxins. However, the fetus produces IgM by the end of the first trimester. IgA immunoglobulins are not produced by the baby. Therefore, by the third trimester, the fetus has both IgG and IgM. Breastfeeding supplies the newborn infant with IgA.

Which statement most accurately describes dominant genetic disorders? 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.

ANS: D 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. In a dominant disorder, the likelihood of recurrence in subsequent children is 50% (i.e., one-in-two). An autosomal recessive disease carries a one-in-four chance of recurrence. In disorders involving maternal ingestion of drugs, subsequent children would be at risk only if the mother continued to take the drugs; the rate of risk would be difficult to calculate.

Some of the embryos intestines remain within the umbilical cord during the embryonic period. What is the rationale for this development of the gastrointestinal system? A. Umbilical cord is much larger at this time than it will be at the end of pregnancy. B. Intestines begin their development within the umbilical cord. C. Nutrient content of the blood is higher in this location. D. Abdomen is too small to contain all the organs while they are developing.

ANS: D The abdominal contents grow more rapidly than the abdominal cavity; therefore, part of their development takes place in the umbilical cord. By 10 weeks of gestation, the abdomen is large enough to contain them. Intestines begin their development within the umbilical cord but only because the liver and kidneys occupy most of the abdominal cavity. Blood supply is adequate in all areas

A woman is using the basal body temperature (BBT) method of contraception. She calls the clinic and tells the nurse, My period is due in a few days, and my temperature has not gone up. What is the nurses most appropriate response? A. This probably means that youre pregnant. B. Dont worry; its probably nothing. C. Have you been sick this month? D. You probably didn't ovulate during this

ANS: D The absence of a temperature decrease most likely is the result of a lack of ovulation. Pregnancy cannot occur without ovulation, which is being measured using the BBT method. A comment such as, Dont worry; its probably nothing, discredits the clients concerns. Illness is most likely the cause of an increase in BBT.

A client currently uses a diaphragm and spermicide for contraception. She asks the nurse to explain the major differences between the cervical cap and the diaphragm. What is the most appropriate response by the nurse? A. No spermicide is used with the cervical cap, so its less messy. B. The diaphragm can be left in place longer after intercourse. C. Repeated intercourse with the diaphragm is more convenient. D. The cervical cap can be safely used for repeated acts of intercourse without adding more spermicide later.

ANS: D The cervical cap can be inserted hours before sexual intercourse without the need for additional spermicide later. Spermicide should be used inside the cap as an additional chemical barrier. The cervical cap should remain in place for 6 hours after the last act of intercourse. Repeated intercourse with the cervical cap is more convenient because no additional spermicide is needed.

Nurses should be cognizant of what information with regard to the noncontraceptive medical effects of combination oral contraceptives (COCs)? A. COCs can cause TSS if the prescription is wrong. B. Hormonal withdrawal bleeding is usually a little more profuse than in normal menstruation and lasts a week for those who use COCs. C. COCs increase the risk of endometrial and ovarian cancers. D. Effectiveness of COCs can be altered by some over-the-counter medications and herbal supplements.

ANS: D The effectiveness of COCs can be altered by some over-the-counter medications and herbal supplements. TSS can occur in some who use the diaphragm, but it is not a consequence of taking oral contraceptive pills. Hormonal withdrawal bleeding usually is lighter than in normal menstruation and lasts a couple of days. Oral contraceptive pills offer protection against the risk of endometrial and ovarian cancers.