NU472 Week 3 EAQ Evolve Elsevier: Women's Health/Disorders & Childbearing Health Promotion

How many milligrams of calcium would the nurse instruct the 30-year-old client to consume during pregnancy? o 1500 mg o 1000 mg o 2500 mg o 2000 mg

o 1000 mg · The adult pregnant client should consume 1000 mg of calcium daily. The nurse would explore her diet to identify good sources of calcium and recommend a calcium supplement if the client cannot obtain the recommended amount of calcium from her diet. 1500 mg, 2500 mg, and 2000 mg are all more than the recommended intake.

The primigravida would be taught by the nurse to anticipate quickening in which week of pregnancy? o 24th week o 20th week o 16th week o 12th week

o 20th week · Most primigravidas feel movement by the 20th week of gestation. The 24th week is very late for the pregnant woman to feel initial movement; lack of movement by the 24th week should be investigated. Multiparas may feel movement by the 16th week; however, most primigravidas feel movement between 18 and 20 weeks. Twelve weeks is too early for movement to be felt.

Which recommendation would the nurse suggest to a menopausal client experiencing insomnia? Select all that apply. o Drink chamomile tea. o Avoid caffeine after dinner. o Restrict liquids in the evening. o Sprinkle lavender oil on a pillow. o Use the bed for sleeping and sex only.

o Drink chamomile tea. o Avoid caffeine after dinner. o Restrict liquids in the evening. o Sprinkle lavender oil on a pillow. o Use the bed for sleeping and sex only. · Insomnia is common during menopause. To help manage sleeping problems, clients would be advised to avoid caffeine and try soothing hot drinks like chamomile tea, limit liquids in the evening, sprinkle lavender oil on their pillow, and reserve the bed for sleeping and sexual intercourse only.

At her first prenatal visit, the client informs the nurse that her last menstrual period started on June 10. Which is her expected date of birth (EDB), according to Naegele's rule? o March 3 o March 10 o March 17 o March 24

o March 17 · The EDB is March 17 of the following year. Using Naegele's rule, subtract 3 months from the first day of the last menstrual period and add 7 days. March 3 and March 10 are too early. March 24 is too late.

The nurse is teaching a family planning class about ovulation and conception. For which period of time would the nurse inform the class that the ovum is capable of being fertilized after ovulation? o 1 to 6 hours o 12 to 18 hours o 24 to 36 hours o 48 to 72 hours

o 24 to 36 hours · The ovum is capable of being fertilized for 24 to 36 hours after ovulation. After this time it travels a variable distance between the fallopian tube and uterus and, if not fertilized, disintegrates and is phagocytized by leukocytes. The other time periods listed are not correct.

Which sign would immediately alert the nurse that the postpartum client 6 hours after delivery is hemorrhaging? o Decrease in pulse rate o Increase in blood pressure o Continuous trickling of blood o Persistent muscle twitching

o Continuous trickling of blood · Trickling of blood indicates continuous bleeding. The pulse will increase, not decrease, with hemorrhage. Blood pressure will decrease, not increase, with hemorrhage. Persistent muscle twitching is not a sign of hemorrhage.

The nurse teaches a pregnant client regarding the necessity for a folic acid supplement. Folic acid taken in the first trimester of pregnancy helps reduce the risk for which neonatal disorder? o Phenylketonuria o Down syndrome o Neural tube defects o Erythroblastosis fetalis

o Neural tube defects · A folic acid supplement (0.4 mg/day) greatly reduces the incidence of fetal neural tube defects. Phenylketonuria is a genetic disorder that cannot be prevented by the action of folic acid. Down syndrome is a genetic disorder that also cannot be prevented by the action of folic acid. Erythroblastosis fetalis is related to the Rh factor and is not prevented by the action of folic acid.

Which information would the nurse provide to the client who is to have a pelvic examination on her first visit to the prenatal clinic? o Papanicolaou (Pap) smears are not done during pregnancy. o Pelvic examinations are needed at each prenatal visit. o An increased amount of white discharge can be anticipated after the pelvic examination. o The uterus will be assessed for growth.

o The uterus will be assessed for growth. · In early pregnancy the uterus is not palpable abdominally and a pelvic examination allows assessment of the size of the uterus to determine if it is appropriately growing in accordance with the gestational age. A Pap smear can be safely done during pregnancy if indicated. Pelvic examinations are typically done at the first prenatal visit and again near the end of pregnancy to assess cervical effacement and dilation. They are done at other times only if needed for a specific assessment related to the client's condition. The pelvic examination would not cause an increased amount of white discharge.

Which intervention would the nurse recommend to relieve symptoms of a yeast infection? o Using a sitz bath o Sleeping in tight leggings o Sitting in a warm bubble bath o Using tampons if she is on her period

o Using a sitz bath · A sitz bath with or without colloidal oatmeal can be very soothing to irritated skin. It is better to sleep without underwear if possible; tight leggings can worsen symptoms. Use of bath salts or bubble bath is not recommended because it can irritate the already swollen skin. If a woman has her period, treatment should continue, and she should avoid using tampons because they can absorb the vaginal medication that may have been prescribed.

Which medication would the nurse question if prescribed for a pregnant client? Select all that apply. o Warfarin o Phenytoin o Isotretinoin o Clavulanate o Methotrexate

o Warfarin o Phenytoin o Isotretinoin o Clavulanate o Methotrexate · Some medications are not safe to take during pregnancy because of the adverse effects to the fetus and/or newborn. Warfarin, phenytoin, isotretinoin, clavulanate, and methotrexate are not safe during pregnancy.

Which complication is a primipara with a second-degree perineal laceration and repair likely to experience during the postpartum period? o Posterior vaginal varicosities o Difficulty voiding spontaneously o Delayed onset of milk production o Maladaptive bonding with the newborn

o Difficulty voiding spontaneously · Voiding may be difficult because of periurethral edema and discomfort. Posterior vaginal varicosities rarely occur in primiparas, even when they are pushing during a prolonged second stage of labor. A second-degree laceration is unrelated to lactation. A second-degree tear is unrelated to bonding and attachment.

Which statement by a pregnant woman after attending a prenatal education session indicates the need for additional teaching? o "During pregnancy it's safe for me to use my regular herbal remedies." o "My doctor will tell me if it's safe for me to take my allergy medications." o "I should avoid all x-rays unless absolutely necessary and tell the technician that I'm pregnant." o "I'm only 18 weeks pregnant, so it's safe for me to go through the airport security check when I go on vacation next month."

o "During pregnancy it's safe for me to use my regular herbal remedies." · Herbal remedies should be evaluated like any other medication to check for safety in pregnancy. All medications, including allergy medications, should be cleared through the health care provider. Radiation from x-rays can be harmful to the fetus. However, the amount of radiation encountered in airport security over the course of a single trip would not pose a risk to the fetus.

Which instruction would the nurse include in the postoperative teaching for a client who has undergone laparoscopic surgery for a benign ovarian tumor? o "Resume usual activities after 12 hours." o "Expect shoulder pain for 12 to 24 hours." o "Douche with povidone-iodine twice a day." o "Report vaginal spotting that occurs during the first 3 days after the surgery."

o "Expect shoulder pain for 12 to 24 hours." · Postoperative teaching should include instructing the client to expect shoulder pain, caused by the insufflated carbon dioxide, which presses on the diaphragm for 12 to 24 hours. This occurs more frequently when the client's head is elevated too soon after surgery. Usual activities should not be resumed until 2 to 3 days after surgery; the client should undertake no heavy lifting or strenuous exercise for 4 to 7 days. There is no need to douche with povidone-iodine after the surgery. Vaginal spotting may occur but is benign. Frank bleeding should be reported.

A client is being discharged after a first-trimester aspiration abortion. Which statement indicates to the nurse that the client has understood the instructions? o "I'll be able to have sex in 4 or 5 days." o "I can switch from sanitary pads to tampons after 24 hours." o "I can expect my menstrual period to start again in 2 to 3 weeks." o "I need to call you if I have to change my pad more than once in 2 hours."

o "I need to call you if I have to change my pad more than once in 2 hours." · Having to change a pad more than once in 2 hours indicates that the bleeding is excessive, and the primary health care provider should be notified. Although instructions vary among primary health care providers, sexual intercourse usually may be resumed in 1 to 3 weeks and tampons are contraindicated for 3 days to 3 weeks. The menstrual period usually resumes in 4 to 6 weeks.

The nurse teaches a postpartum client how to care for her episiotomy at home. Which statement indicates to the nurse that the client understands the priority instruction? o "I should discontinue the anti-inflammatories once I'm home." o "I mustn't climb up or down stairs for at least 3 days after discharge." o "I should discontinue the sitz baths after 3 days." o "I need to continue perineal care after I go to the bathroom until everything is healed."

o "I need to continue perineal care after I go to the bathroom until everything is healed." · Prevention of infection—in this case, perineal care—is the priority. Anti-inflammatory medication such as ibuprofen may be continued. Stair climbing may cause some discomfort but is not detrimental to healing. It is not necessary to stop sitz baths as long as they provide comfort.

After a client has a spontaneous abortion at 12 weeks' gestation, the nurse notes that both she and her partner are visibly upset and crying. Which statement would be a therapeutic response? o "I'll be here if you want to talk." o "Try to relax—it'll speed the healing process." o "With any luck you'll get pregnant again soon." o "It's best that this happened early rather than having the baby die after it was born."

o "I'll be here if you want to talk." · Saying, "I'll be here if you want to talk" gives the client and her partner room to comfort each other while letting them know that the nurse is available; it also gives the couple time and space in which to recognize and accept their feelings of loss. Telling the couple to relax denies their feelings and may cut off communication. Telling the client that she will become pregnant again soon minimizes the couple's grief over this loss and cuts off further communication. Also, an assumption is made that another pregnancy will occur. Telling the client that it is best that the miscarriage happened early rather than having the baby die after it was born is an insensitive statement. Grieving for a loss is not confined to when the loss occurs, either during the pregnancy or after the birth.

Which response would the nurse provide to a client in labor at 32 weeks' gestation who tells the nurse that she and her husband are very concerned because the baby will be born 2 months early? o "You should be concerned. I feel for you." o "If you're concerned, let's talk about it." o "Try not to worry about it; just concentrate on your labor." o "Don't worry; the care of preterm babies has greatly improved."

o "If you're concerned, let's talk about it." · Offering to talk with the client encourages her to verbalize concerns, which serves as an outlet for tension. The nurse would first listen to her concerns and emotions and then offer more specific information to her regarding what she can anticipate. Telling the client that she should be concerned reinforces her fears, and it conveys sympathy, not empathy. Telling the client not to worry about it denies the client's feelings and cuts off communication. Telling the client not to worry because the care of preterm babies has improved denies the client's feelings and represents false reassurance.

A client at 16 weeks' gestation is being treated for Trichomonas vaginalis infection. Which statement best indicates to the nurse that the client has learned measures to prevent a recurrence? o "After having sex I'll insert a vaginal suppository." o "My partner has to get treated before we have sex again." o "I need to urinate immediately after having sexual intercourse." o "Douching immediately after sexual intercourse will help protect me."

o "My partner has to get treated before we have sex again." · The male partner should be treated to prevent the infection from passing back and forth between him and his sexual partner. Inserting a vaginal suppository after having sex is an ineffective remedy and will not prevent a recurrence. The organism is usually present in the partner's urogenital tract; voiding will not prevent a recurrence. A douche is not recommended either during pregnancy or in the nonpregnant state.

While being admitted for a lumpectomy the client begins to cry and says, "I found the lump a few months ago, but I didn't go to the health care provider because of what it could be." How would the nurse reply? o "This has been frightening for you." o "About 80% of breast lumps are benign." o "Cry as long as you like and get it out of your system." o "More than 95% of breast lumps are discovered by the woman herself."

o "This has been frightening for you." · Saying "This has been frightening for you" involves the use of a reflective technique to acknowledge the client's feelings. Providing statistics (such as the percentage of breast lumps that are benign or the percentage that are discovered by the woman) does not acknowledge the client's feelings and may cut off communication. Providing false reassurance that crying will ease her concerns is inappropriate.

Which instruction would the nurse give to the pregnant client with a positive group B streptococcus (GBS) result at 36 weeks' gestation? o "Go straight to the outpatient area of the maternity unit for a nonstress test." o "You'll need to schedule visits twice a week with your health care provider until you deliver." o "Your baby will have to spend at least 3 days in the neonatal intensive care unit because of this infection." o "This information will be in your prenatal record; however, please remind your labor and delivery nurse of this finding."

o "This information will be in your prenatal record; however, please remind your labor and delivery nurse of this finding." · A client who has a positive result on a GBS screening will need to be treated with an intravenous antibiotic, often penicillin or ampicillin, throughout the labor process to help prevent transmission of the infection to the neonate. Vertical transfer of GBS to the neonate during labor is associated with higher rates of neonatal morbidity and mortality. If the newborn was infected with GBS, then care would be provided in a neonatal intensive care unit. There is no need for an increase in the frequency of prenatal visits or nonstress testing as a result of a positive GBS finding.

Which time of the month would the nurse teach premenopausal women to perform breast self-examination? o When ovulation occurs o The first day of every month o The day that the menses begins o About a week after menses ends

o About a week after menses ends · A week after the end of menses, breast engorgement has abated, limiting lumps that may occur because of fluid accumulation. Breast engorgement begins before ovulation and does not subside until several days after menses ends; engorgement interferes with accurate palpation. Inaccurate assessment may result when examinations are performed at different times of the menstrual cycle because accurate comparisons may not be made from month to month.

On a visit to the fertility clinic a couple requests fertility medications because, despite having a 28-day menstrual cycle and temperature readings that demonstrate an ovulatory pattern, the woman has been unable to conceive. Which guidance would the nurse provide to this couple? o A laparoscopy will be scheduled. o An endometrial biopsy will be required. o A fertility medication will be prescribed. o An examination of semen will be needed.

o An examination of semen will be needed. · Because the client has an ovulatory cyclic pattern, the infertility may be a result of a male factor. The partner's semen should be examined before more extensive studies or treatments are begun. Laparoscopy and endometrial biopsy are invasive procedures that may be needed after all noninvasive tests are completed and the cause of the infertility remains undetermined. After all indicated diagnostic procedures are completed, an appropriate fertility medication may be prescribed if it is determined that the medication will enhance the probability of conception.

On the second postpartum day a client mentions that her nipples are becoming sore from breast-feeding. Which is the nurse's initial action in response to this information? o Assess her breast-feeding techniques to identify possible causes. o Provide a nipple shield to keep the infant's mouth off the nipples. o Instruct her to apply warm compresses 10 minutes before she begins to breast-feed. o Explain that she should pump her breasts and give breast milk in a bottle until the soreness subsides.

o Assess her breast-feeding techniques to identify possible causes. · The nurse must first assess the client's breast-feeding practices; nipple soreness may occur when the newborn's mouth is not covering the entire areola. Improper latch is the most common cause of nipple soreness at this time. Providing a nipple shield, having the client apply warm compresses before the feeding, or initiating pumping and bottle feeding of breast milk are not indicated immediately. The cause of the soreness must be determined first and will dictate the choice of intervention.

A 30-year-old woman is scheduled for a total abdominal hysterectomy because of noninvasive endometrial cancer. The nurse anticipates the client may have difficulty adjusting emotionally to this type of surgery. Which concern would be the cause of this anticipated difficulty? o Change in femininity o Body image changes o Diminished sexual desire o Slow recovery

o Change in femininity · Removal of the uterus may produce changes in how some women view themselves sexually because it is a reproductive organ. The young age of this client may contribute to heightened feelings of loss of femininity and reproductive potential. Although body image changes are possible, they are more likely to occur with surgery that involves obvious external changes. The libido of a premenopausal woman will probably not be altered unless she has concerns about sexuality. An otherwise healthy 30-year-old woman should have an uneventful recovery.

The nurse plans to delegate some of the tasks for the discharge of a postpartum client to an unlicensed health care worker. Which activity must be performed by the nurse? o Taking the neonate's picture o Calling to arrange the client's postpartum appointment o Comparing the identification bands of mother and infant o Preparing the discharge packets and distributing them to the parents

o Comparing the identification bands of mother and infant · It is the nurse's professional responsibility to compare the mother's and infant's identification bands one last time before discharge. This ensures that the correct infant is discharged with the mother. Taking the neonate's picture, arranging the client's postpartum appointment, and preparing the discharge packets and distributing them to parents are all within the role of the nursing assistant and may be delegated safely.

A client who recently was told by her primary health care provider that she has extensive terminal metastatic carcinoma of the breast tells the nurse that she believes an error has been made. She states that she does not have breast cancer, and she is not going to die. Which stage of death and dying is the client experiencing? o Anger o Denial o Bargaining o Acceptance

o Denial · The client has difficulty accepting the inevitability of death and is attempting to deny the reality of it. In the anger stage the client strikes out with "Why me?" and "How could God do this?" types of statements. The client is angry at life and still angrier to be removed from it by death. In the bargaining stage the client tries to bargain for more time. The reality of death is no longer denied, but the client attempts to manipulate and extend the remaining time. In the acceptance stage the client accepts the inevitability of death and peacefully awaits it.

Which nursing action would the nurse perform to enhance the beginning of the mother-infant relationship? o Suggesting that the mother choose breast-feeding instead of formula-feeding o Advising the mother to engage in rooming-in with the newborn at the bedside o Encouraging the mother to help out with simple aspects of her newborn's care o Observing the mother-infant interaction unobtrusively to evaluate the relationship

o Encouraging the mother to help out with simple aspects of her newborn's care · Holding, touching, and interacting with the newborn while providing basic care promotes attachment. The nurse's infant feeding preference should not be forced upon the mother. Although rooming-in helps promote attachment, not all women have the physical or emotional ability to provide 24-hour care to the newborn so early in the postpartum period. Early observation is not adequate; full evaluation of the relationship can be achieved only by allowing the mother ample time to interact with her baby.

Which nursing intervention would be used to achieve the cooperation of an extremely anxious pregnant client during her first pelvic examination? o Distracting the client by asking her preference regarding the infant's sex o Assisting the health care practitioner so that the client's examination can be completed quickly o Explaining the procedure and maintaining eye contact while touching the client gently o Encouraging the client to squeeze the nurse's hand, close her eyes, and hold her breath

o Explaining the procedure and maintaining eye contact while touching the client gently · Explaining the procedure and maintaining eye contact while touching the client gently will help the client relax and will lessen discomfort. Distracting the client by asking her preference regarding the sex of her infant may distract the client; however, this will not produce relaxation. The client may become more anxious if the procedure is hurried. Encouraging the client to squeeze the nurse's hand, close her eyes, and hold her breath may make the client more anxious; holding the breath causes tightening of the perineum.

The client in labor is 10 cm dilated and has an urge to push. Which breathing pattern would the nurse encourage the client to use? o Expulsion breathing o Rhythmic chest breathing o Continuous blowing-breathing o Accelerated-decelerated breathing

o Expulsion breathing · Expulsion breathing (pushing) should be encouraged when the cervix is fully dilated. Rhythmic chest breathing is used in the early active phase of labor for relief of discomfort; it is not used to overcome the desire to push. A breathing pattern consisting of continuous blowing can assist in overcoming the urge to push when a client is in transition. Accelerated-decelerated breathing is not effective in overcoming the urge to push.

Which information would the nurse provide to the breast-feeding client asking how human milk compares with cow's milk? o Lactose content is higher in cow's milk than in human milk. o Protein content in human milk is higher than in cow's milk. o Fat in human milk is easier to digest and absorb than the fat in cow's milk. o Immunological and antiallergenic factors found in human milk are now added to cow's milk.

o Fat in human milk is easier to digest and absorb than the fat in cow's milk. · Fat in human milk is easier to digest because of the arrangement of fatty acids on the glycerol molecule. Also, human milk is not heat treated, as is cow's milk when it is pasteurized. The lactose content is higher in human milk. There is less protein in human milk than in cow's milk; however, it is easier for human beings to digest. Human immunological and antiallergenic factors are found only in human milk, not in cow's milk.

Which symptom indicates pelvic inflammatory disease? Select all that apply. o Fever o Elevated erythrocyte sedimentation rate (ESR) o Chronic pelvic pain o Irregular vaginal bleeding o Abnormal vaginal discharge o Bilateral adnexal tenderness

o Fever o Elevated erythrocyte sedimentation rate (ESR) o Chronic pelvic pain o Irregular vaginal bleeding o Abnormal vaginal discharge o Bilateral adnexal tenderness · Fever, elevated ESR and C-reactive protein, chronic pelvic pain, irregular vaginal bleeding, abnormal vaginal discharge, and bilateral adnexal tenderness are all symptoms of pelvic inflammatory disease, an infection of the upper reproductive tract.

Which cause may produce abnormal uterine bleeding? Select all that apply. o Hypothyroidism o Failure to ovulate o Bleeding disorders o Unidentified pregnancy o Use of oral contraceptives o Benign lesions of the uterus

o Hypothyroidism o Failure to ovulate o Bleeding disorders o Unidentified pregnancy o Use of oral contraceptives o Benign lesions of the uterus · Common causes for any type of abnormal uterine bleeding include endocrine disorders like hypothyroidism; failure to ovulate or respond appropriately to ovulation hormones; bleeding disorders; pregnancy complications such as an unidentified pregnancy that is ending in spontaneous abortion; breakthrough bleeding, which may occur in the woman taking oral contraceptives; and lesions of the vagina, cervix, or uterus (benign or malignant).

Which estimated date of birth (EDB) would the nurse calculate if the client states that her last menstrual period began on April 11 and that she also had some spotting on May 8? o January 8 o January 11 o January 18 o February 15

o January 18 · January 18 is the EDB. To use Naegele's rule, subtract 3 months and add 7 days to the first day of the last normal menstrual period, April 11. The spotting is discounted because it was not a normal menstrual period. January 8, January 11, and February 15 are all incorrect calculations.

Which exercise would the nurse teach the pregnant client to increase the tone of the muscles of the pelvic floor? o Pelvic tilt o Half sit-ups o Pelvic rocking o Kegel exercises

o Kegel exercises · Kegel exercises increase the tone of pelvic floor muscles and prepare the area for the second stage of labor. Pelvic tilting alleviates backache and strengthens the abdominal muscles, not the muscles of the pelvic floor. Half sit-ups strengthen the abdominal musculature, not the muscles of the pelvic floor. Pelvic rocking alleviates backache and strengthens abdominal muscles, not the muscles of the pelvic floor.

Which condition in the gynecological history of the client scheduled for hysterectomy causes the nurse to anticipate an abdominal, rather than a vaginal, hysterectomy? o Prolapsed uterus o Large uterine fibroids o Mild dysplasia of the cervical os o Urinary incontinence when coughing

o Large uterine fibroids · Attempting to remove a uterus with large uterine fibroids vaginally can cause trauma, resulting in hemorrhage. Vaginal hysterectomy is indicated for prolapsed uterus, because the uterus is usually collapsed into the vagina. A hysterectomy is not the treatment of choice for mild cervical dysplasia; when a hysterectomy is necessary, the vaginal route is preferred. Urinary incontinence with coughing may be related to stress incontinence, which does not require a hysterectomy.

The day after a hysterectomy, the client asks for sanitary pads because she feels that she is about to begin menstruating. Which information would influence the nurse's response? o Menstruation will not occur because the uterus has been removed. o It will take several weeks before regular menstruation is reestablished. o Abdominal cramping and menstruation are expected after surgery. o The appearance of frank vaginal bleeding is expected after this type of surgery.

o Menstruation will not occur because the uterus has been removed. · Menstruation is shedding of the endometrial lining of the uterus. A woman who has undergone a hysterectomy has had her uterus removed and will no longer menstruate. Abdominal pain is common after a hysterectomy; however, menstruation is impossible after this surgery. Frank bleeding is not expected after a hysterectomy.

Which is correct regarding the safety of caffeinated beverages during pregnancy? Select all that apply. o High intake causes congenital disabilities. o One 12-ounce cup of coffee per day is probably fine. o High consumption is often related to a decrease in birth weight. o Pregnant women should try to abstain from caffeine completely. o Caffeine does not increase the risk for miscarriage, regardless of the amount consumed. o There is no effect of caffeine on the fetus in the third trimester.

o One 12-ounce cup of coffee per day is probably fine. o High consumption is often related to a decrease in birth weight. · One 12-ounce cup of coffee per day is probably fine. A high intake of caffeine is often related to a decrease in birth weight. It does not cause congenital disabilities. All pregnant women do not need to abstain from caffeine completely; this is an individual choice. High intakes of caffeine during pregnancy might increase the risk of miscarriage. It is not true that a woman need not worry about caffeine intake once she has entered the third trimester; the recommendation remains no more than one 12-ounce cup daily.

Which health screening and immunization recommendations are appropriate for a 48-year-old client? Select all that apply. o Pelvic examination annually o Blood cholesterol annually over the age of 45 o Blood pressure at every visit but at least every 2 years o Blood lipids every 5 years if blood cholesterol is within normal limits o Papanicolaou (Pap) and human papillomavirus (HPV) testing unnecessary if three tests are negative after the age of 40 o Measles, mumps, and rubella immunization once if born after 1956 with no evidence of immunity

o Pelvic examination annually o Blood pressure at every visit but at least every 2 years o Blood lipids every 5 years if blood cholesterol is within normal limits o Measles, mumps, and rubella immunization once if born after 1956 with no evidence of immunity · A 48-year old female will need a pelvic examination annually, a blood pressure check at every visit (at least every 2 years), blood lipid measurement every 5 years if blood cholesterol is within normal limits, and the measles, mumps, and rubella immunization once if born after 1956 with no evidence of immunity. Blood cholesterol needs to be done only every 5 years or more often if a client has abnormal levels or risk factors for coronary artery disease. Pap and HPV testing should be done every 5 years between the ages of 30 and 65.

A 47-year-old client comes to the clinic for a Papanicolaou (Pap) smear. She tells the nurse that she has been experiencing hot flashes and that her periods have been occurring at longer, less-regular intervals, with a scanty flow. Which condition would the nurse suspect to be the likely cause of these changes? o Uterine cancer o Lack of estrogen o Early cervical carcinoma o Perimenopause

o Perimenopause · The adaptations described, along with the client's age, suggest that the client is experiencing perimenopausal symptoms, which are normal in the years preceding cessation of menses. Irregular spotting and bleeding occur with uterine cancer and are not associated with the menstrual cycle. Estrogen is reduced, not eliminated, during and after menopause; the adrenal glands produce a small amount of estrogen throughout life. Early cervical cancer is asymptomatic; an irregular bloody vaginal discharge is a late sign of cervical cancer.

A client at 42 weeks' gestation is admitted for a nonstress test. The nurse concludes that this test is being done because of which possible complication related to a prolonged pregnancy? o Polyhydramnios o Placental insufficiency o Postpartum infection o Subclinical gestational diabetes

o Placental insufficiency · Placental function peaks at 37 weeks and declines slowly thereafter; therefore, continuation of the pregnancy past term (42 weeks) places the fetus at risk because of placental insufficiency. Oligohydramnios (decreased amniotic fluid volume), not polyhydramnios (increased amniotic fluid volume), may occur in postterm gestations. A prolonged pregnancy does not present a risk for a postpartum infection. A prolonged pregnancy is unrelated to gestational diabetes.

A primigravida in the first trimester tells the nurse that she has heard that hormones play an important role in pregnancy. Which hormone would the nurse tell the client maintains pregnancy? o Prolactin o Estrogen o Progesterone o Somatotropin

o Progesterone · Produced by the ovaries and placenta, progesterone is a female sex hormone that prepares the endometrium for implantation of the fertilized ovum, maintains pregnancy, and plays a role in the development of the mammary glands. Prolactin is secreted by the anterior lobe of the pituitary gland; it is responsible for initiating and maintaining milk secretion from the mammary glands. Estrogen is a female sex hormone that starts to prepare the endometrium for implantation and promotes development of secondary sex characteristics. Somatotropin is a growth hormone secreted by the anterior pituitary gland.

A client who recently gave birth is transferred to the postpartum unit by the nurse. Which nursing action would the nurse perform to prevent a charge of client abandonment? o Assess the client's condition. o Document the client's condition and the transfer. o Orient the client to the room and explain unit routines. o Report the client's condition to the responsible staff member assuming her care.

o Report the client's condition to the responsible staff member assuming her care. · Because the nurse is responsible for the client's care until another nurse assumes that responsibility, the nurse would report directly to the client's primary nurse. Safe handoffs of clients at the time of transfer are an essential element of client safety. Making an assessment of the client's condition is not enough. Although documentation is important, it is insufficient. Orienting the client to the room and explaining unit routines is insufficient. Although the nurse would carry out these activities, the safe handoff of client care is the essential action at this time.

A pregnant client tells the nurse that she has two toddlers at home and that their father abandoned the family last month and she doesn't know what to do. Which conclusion would the nurse make about the client's emotional state? o She is angry that the father has left. o She feels overwhelmed by the situation. o She is expressing ambivalence about her pregnancy. o She is denying the reality of her pregnancy.

o She feels overwhelmed by the situation. · Because of the difficult home situation, this client is experiencing multiple stressors that could cause difficulty with coping. The client also directly tells the nurse that she doesn't know what to do, suggesting that she is overwhelmed with her situation. There is no information to support the conclusion that the client is angry or that she is ambivalent about the pregnancy. The client is attending the prenatal clinic, which indicates that she is aware of reality and is not in denial.

Which instruction would the nurse provide to a client who would like to learn breast self-examination? o Squeeze the nipples to examine for discharge. o Use the right hand to examine the right breast. o Perform the examination while in a seated position. o Compress breast tissue to the chest wall with the palm to palpate for lumps.

o Squeeze the nipples to examine for discharge. · Serous or bloody discharge from the nipple is pathological and must be reported. The right hand should be used to examine the left breast because this allows the flattened fingers to palpate the entire breast, including the tail (upper, outer quadrant toward the axilla) and axillary area. The examination is best performed while lying down to allow the fingers to more easily to compress the breast tissue. The flat part of the fingers, not the palm or fingertips, should be used for palpation. Although breast self-examination is no longer routinely recommended by the American Cancer Society and other organizations, some clients may wish to learn the technique as part of self-breast awareness, which is recommended.

A 60-year-old woman is admitted for a vaginal hysterectomy and anterior and posterior repair of the vaginal wall. Which symptom would the client be likely to state as a reason that she is having surgery? o Hematuria o Dysmenorrhea o Pain on urination o Stress incontinence

o Stress incontinence · Increased intra-abdominal pressure associated with lifting, coughing, or laughing, in conjunction with a relaxed pelvic musculature and a bladder displaced into the vagina, may result in stress incontinence. Hematuria is usually associated with urinary tract infection, bladder tumor, or renal calculi, not with cystocele or rectocele. Dysmenorrhea is usually associated with pelvic inflammatory disease, endometriosis, or cervical stenosis, not with cystocele or rectocele; the client at age 60 is probably postmenopausal. Pain on urination is usually associated with urinary infection, not with cystocele or rectocele.

Which change should the 39-year-old client scheduled for laparoscopic hysterectomy and bilateral salpingo-oophorectomy be taught to expect after surgery? o Depression o Weight gain o Urine retention o Surgical menopause

o Surgical menopause · When bilateral oophorectomy is performed, both ovaries are excised, eliminating ovarian hormones and initiating menopause. Although depression may occur, it is not expected; if it does occur, intervention is required. There is no physiological reason for weight gain after hysterectomy. Urine retention is not an expected concern, because a urine retention catheter is inserted before surgery and left in place generally for 24 hours, regardless of the type of hysterectomy (e.g., laparoscopic, abdominal, vaginal).

The nurse in the emergency department is assessing a client who has been physically and sexually assaulted. What is the nurse's priority during assessment? o The family's feelings about the attack o The client's feelings of social isolation o The client's ability to cope with the situation o Disturbance in the client's thought processes

o The client's ability to cope with the situation · The situation is so traumatic that the individual may be unable to use past coping behaviors to comprehend what has occurred. Assessing emotions that occur in response to news of the attack will occur later. The client should be the focus of care at this time, not the family. Social isolation is not an immediate concern. Coping skills, not thought processes, are challenged at this time.

The nutrition interview of an adolescent client at 10 weeks' gestation indicates that her dietary intake consists mainly of soft drinks, candy, French fries, and potato chips. Which reason indicates why this diet is inadequate? o The caloric content will result in too great a weight gain. o The ingredients in soft drinks and candy can be teratogenic during early pregnancy. o The salt in this diet will contribute to the development of gestational hypertension. o The nutritional composition of the diet places herself and the fetus at risk.

o The nutritional composition of the diet places herself and the fetus at risk. · The primary problem with the diet is that it does not reflect a healthy balance of foods and nutrients, especially protein; adequate nutrition is necessary for the birth of a healthy full-term infant whose weight is appropriate for gestational age. The adolescent client herself needs a well-balanced diet to meet her own nutritional requirements. The caloric content of these foods may not be high if small amounts are consumed; in addition, this client's weight gain may not be reflective of an adequate weight gain in the developing fetus. No data are available to support the assertion that the ingredients of candy and soft drinks are teratogenic. Unrestricted salt intake does not contribute to the development of gestational hypertension.