OB Exam 1 Practice Questions

The nurse is caring for a client diagnosed with trichomoniasis. The health care provider has prescribed a single dose of metronidazole. Which information will the nurse provide this client?

"Avoid alcohol consumption for at least 24 hours after you take this medication." Metronidazole is an antibiotic used to treat bacterial infections of the vagina. The HPV vaccine is not required for clients diagnosed with trichomoniasis. The nurse would educate the client that having one sexually transmitted infection (STI) places the client at higher risk for future STIs; however, the client does not have to receive the vaccine. A pregnancy test is not necessary, because metronidazole is safe to take during pregnancy. Clients should not consume alcohol or foods or medicines that contain propylene glycol while taking metronidazole and for at least 1 day after to avoid unpleasant side effects (tachycardia, flushed, nausea, vomiting). The nurse would instruct the client to not crush, chew, or break the extended-release tablet.

A client diagnosed with genital herpes asks the nurse about future sexual experiences. Which response by the nurse is appropriate?

"If you plan to have future sexual relationships, you need to let your partner know of your history prior to intercourse."

The nurse is educating a female client with a history of human papillomavirus (HPV). Which information would the nurse include in the education plan regarding reproductive health?

"You should be sure to receive consistent testing for cervical cancer." Explanation: An infection with HPV is a risk factor for developing cervical cancer. Women with a history of HPV should receive consistent testing/screening for cervical cancer. HPV is a virus; therefore, antibiotics have no effect on the disease. Surgical removal is an option for the genital warts but the virus remains uncured. The diagnosis of HPV is typically seen in young woman.

A pregnant woman is diagnosed with chlamydia and asks the nurse, "How will this infection affect my baby and pregnancy?" Which responses by the nurse are accurate? Select all that apply.

"Your newborn can be infected during birth." "Your newborn may have eye infections from this infection." "Your membranes may rupture earlier than normal."

A woman's prepregnant weight is within the normal range. During her second trimester, the nurse would determine that the woman is gaining the appropriate amount of weight when her weight increases by which amount per week?

1 lb (0.45 kg) Explanation: The recommended weight gain pattern for a woman whose prepregnant weight is within the normal range would be 1 lb (0.45 kg) per week during the second and third trimesters. Underweight women should gain slightly more than 1 lb (0.45 kg) per week. Overweight women should gain about 2/3 lb (0.30 kg) per week.

A urinalysis is done on a client in her third trimester. Which result would be considered abnormal?

2+ Protein in urine Explanation: During pregnancy, there may be a slight amount of glucose found in the urine due to the fact that the kidney tubules are not able to absorb as much glucose as there were before pregnancy. However, there should be minimal protein in the urine. A specific gravity of 1.010 and a straw- like color are both normal findings.

A 17-year-old client arrives for an annual examination and reports no changes since the last exam; however, the nurse assesses a positive Chadwick sign, slightly enlarged uterus, and subsequent positive urine pregnancy test. Which task should the nurse prioritize to assist this client who is denying any possibility that she is pregnant?

Accepting the pregnancy Explanation: Acceptance of pregnancy is multi-factorial, and how the woman responds to the pregnancy is certainly influenced by her age and if the pregnancy was planned. As a teenager, she may not have been trying to get pregnant and may not want to accept the role and experience. Baby and parenthood decisions should all occur later.

The nurse is assigned to clients who are having the following procedures: amniocentesis, fetal nonstress test, chorionic villus sampling, percutaneous umbilical blood sampling, and Doppler assessment of fetal heart rate. For which clients will the nurse ensure that signed informed consent has been given and is in the client's record?

Amniocentesis, chorionic villus sampling, percutaneous umbilical blood sampling Explanation: While the client ultimately consents to all procedures, some require signed documentation of consent within the client's record. An informed consent is needed for an amniocentesis, chorionic villus sampling and a percutaneous umbilical blood sampling due to the invasive nature of the procedures. Both the fetal nonstress test and the Doppler assessment of the fetal heart rate are non-invasive procedures.

A client is receiving ceftriaxone as treatment for gonorrhea. What would be most important for the nurse to emphasize to the client?

Avoid alcohol consumption. Explanation: If alcohol is ingested when taking ceftriaxone, the client can experience a disulfiram-like reaction. Therefore the nurse would need to emphasize avoiding alcohol consumption. Taking the drug on an empty stomach may be appropriate but not the most important consideration. Using a sunscreen would be appropriate if the client was receiving doxycycline or tetracycline. Reporting the appearance of an oral yeast infection would be appropriate for a client receiving tetracycline.

During an exam, the nurse notes that the blood pressure of a client at 22 weeks' gestation is lower, and her heart rate is 12 beats per minute higher than at her last visit. How should the nurse interpret these findings?

Both findings are normal at this point of the pregnancy. Explanation: A pregnant woman will normally experience a decrease in her blood pressure during the second trimester. An increase in the heart rate of 10 to 15 beats per minute on average is also normal, due to the increased blood volume and increased workload of other organ systems. Hormonal changes cause the blood vessels to dilate, leading to a lowering of blood pressure.

A nurse is assessing a pregnant client. The nurse understands that hormonal changes occur during pregnancy. Which hormones would the nurse most likely identify as being inhibited during the pregnancy?

FSH and LH Explanation: During pregnancy, FSH and LH are both inhibited as there is no need to develop a follicle and release an ovum. There is an increase in the secretion of T4 and MSH. There is a decrease in the production of GH and MSH but not an inhibition.

A client in her 39th week of gestation arrives at the maternity clinic stating that earlier in her pregnancy, she experienced shortness of breath. However, for the past few days, she has been able to breathe easily, but she has also begun to experience increased urinary frequency. A nurse is assigned to perform the physical examination of the client. Which observation is most likely?

Fundal height has dropped since the last recording. Explanation: Between 38 and 40 weeks of gestation, the fundal height drops as the fetus begins to descend and engage into the pelvis. Because it pushes against the diaphragm, many women experience shortness of breath. By 40 weeks, the fetal head begins to descend and engage into the pelvis. Although breathing becomes easier because of this descent, the pressure on the urinary bladder now increases, and women experience urinary frequency. The fundus reaches its highest level at the xiphoid process at approximately 36, not 39, weeks. By 20 weeks' gestation, the fundus is at the level of the umbilicus and measures 20 cm. At between 6 and 8 weeks of gestation, the cervix begins to soften (Goodell sign) and the lower uterine segment softens (Hegar's sign).

The nurse is assessing a client who believes she is pregnant. The nurse points out a more definitive assessment is necessary due to which sign being considered a probable sign of pregnancy?

Positive home pregnancy test Explanation: A urine pregnancy test is considered a probable sign of pregnancy as the hCG may be from another source other than pregnancy. Fatigue, amenorrhea, and vomiting are presumptive or possible signs of pregnancy and can also have other causes.

A client in her first trimester reports frequent urination and asks the nurse for suggestions. The nurse should teach the client that the urination is most likely related to which cause?

Pressure on the bladder from the uterus Explanation: Early in pregnancy, the expanding uterus presses on the bladder. During the second trimester there is some relief when the uterus lifts, but the pressure returns again as the fetus continues to grow. Urine concentration does not affect frequency. Fetal urine does not enter the mother's renal system, except through increases in circulatory volume. The glomeruli should not be affected by pregnancy.

A nurse is caring for a client positive for human immunodeficiency virus (HIV). The client is on triple-combination highly active antiretroviral therapy (HAART). What should the nurse include in the teaching plan when educating the client about the treatment? Select all that apply.

Unpleasant side effects such as nausea and diarrhea are common. Provide written materials describing diet, exercise, and medications. Ensure that the client understands the dosing regimen and schedule. The nurse should ensure that the client understands the dosing regimen and schedule. The client should be informed that unpleasant side effects such as nausea and diarrhea are common. The nurse should provide written material describing diet, exercise, and medications to promote compliance and ensure a healthy lifestyle. There is no evidence to suggest that exposure of the fetus to antiretroviral agents during pregnancy is completely safe in the long run. HIV is a lifelong condition, and antiretroviral therapy may delay the onset of AIDS but not prevent it.

A pregnant client in her second trimester informs the nurse that she needs to travel by air the following week. Which precaution should the nurse instruct the client to take during the flight?

Wear support hose. Explanation: The nurse should instruct the client to wear support hose while traveling by air. The nurse should also instruct the client to periodically exercise the legs and ankles, and walk in the aisles if possible. Wearing low-heeled shoes, cotton clothes, or a padded bra will have no effect on the client during the flight.

A client has been admitted with primary syphilis. Which signs or symptoms should the nurse expect to see with this diagnosis?

a painless genital ulcer that appeared about 3 weeks after unprotected sex Explanation: A painless genital ulcer is a symptom of primary syphilis. Macules on the palms and soles after fever are indicative of secondary syphilis, as is patchy hair loss. Wartlike papules are indicative of genital warts.

A nurse is engaged in primary prevention activities for human papillomavirus (HPV). The nurse would be most likely involved with which activity?

administering HPV vaccine Primary prevention is aimed at preventing the disease or condition before it occurs, so giving the HPV vaccine would be a primary prevention activity. If the woman does not receive primary prevention with the vaccine, then secondary prevention would focus on education about the importance of receiving regular Papanicolaou tests and, for women over age 30, including an HPV test to determine whether the woman has a latent high-risk virus that could lead to precancerous cervical changes.

A 24-year-old female presents with vulvar pruritus accompanied by irritation, pain on urination, erythema, and an odorless, thick, acid vaginal discharge. She denies sexual activity during the last six months. Her records show that she has diabetes mellitus and uses oral contraceptives. Which category of antimicrobial medication is most likely to clear her symptoms?

an azole antifungal agent The character of the discharge and the lack of recent sexual activity suggest infection with Candida, which can exist asymptomatically and flare up only if conditions, such as an imbalance in normal vaginal flora resulting from antibiotic treatment, diabetes, or oral contraceptive use, enable the fungus to proliferate. Candidiasis responds well to treatment with azole antifungal agents.

What is the gold standard for herpes simplex virus (HSV) diagnosis?

culture The gold standard for HSV diagnosis is a culture of the lesion. Serology may help determine new versus chronic infection when obtained concurrently with positive culture of the lesion. The other diagnostics may be used for diagnosis of skin disorders, but they would not be used for HSV.

Working at the local health clinic, the nurse recognizes that STIs can often result in pelvic inflammatory disease. When a client with a history of repeat STIs presents to the clinic reporting severe abdominal cramping and bleeding, the immediate concern is to ensure the client does not have:

ectopic pregnancy. Every day, more than one million people are newly infected with STIs that can lead to morbidity, mortality, and an increased risk of human immunodeficiency virus (HIV) acquisition. STIs may contribute to cervical cancer, infertility, ectopic pregnancy, chronic pelvic pain, and death.

A woman is 10 weeks' pregnant and tells the nurse that this pregnancy was unplanned and she has no real family support. The nurse's most therapeutic response would be to:

encourage her to identify someone that she can talk to and share the pregnancy experience. Explanation: A pregnant woman without social support needs to identify someone with whom she can share the experience of pregnancy because social support is a crucial part of adapting to parenthood. Telling her to move home and telling her that she will feel better as the pregnancy progresses do not address the issue of isolation. Also, moving home may not be a possibility for this woman. The nurse should maintain a professional relationship and not commit to a long-term relationship with a client.

A school health nurse is presenting information on sexually transmitted infections (STIs) to a high school class. The nurse feels confident that learning has taken place when the students report:

female adolescents are more susceptible to STIs due to their anatomy. STIs may cause chronic liver diseases and cancer due to hepatitis B (HBV) and C (HCV) infections. Genital cancer is associated with papillomavirus (HPV), and is AIDS caused by HIV. Adolescent males make up more than three-quarters of HIV diagnoses. Many health care providers fail to assess adolescent sexual behavior and STI risks or to screen for asymptomatic infection during clinic visits thus delaying treatments. STIs are not curable. Many female adolescents are more susceptible to STIs due to their anatomy.

A client arrives to the clinic very excited and reporting a positive home pregnancy test. The nurse cautions that the home pregnancy test is considered a probable sign and will assess the client for which sign to confirm pregnancy?

fetal movement felt by examiner Explanation: The positive signs of pregnancy are fetal image on a sonogram, hearing a fetal heart rate, and examiner feeling fetal movement. A pregnancy test has 95% accuracy; however, it may come back as a false positive. Hegar sign is a softening of the uterine isthmus. Chadwick sign may have other causes besides pregnancy.

After teaching a group of students about sexually transmitted infections (STIs), the instructor determines that additional teaching is necessary when the students identify which STI as curable with treatment?

genital herpes Besides AIDS, the five most common STIs are chlamydia, gonorrhea, syphilis, genital herpes, and genital warts. Of these, chlamydia, gonorrhea, and syphilis are easily cured with early and adequate treatment. Genital herpes recurs.

A primary care provider tells a client to return 2 to 3 months after treatment to have a repeat culture done to verify the cure. This prescription would be appropriate for a woman with which condition?

gonorrhea Explanation: Gonococcal infections can be completely eliminated by drug therapy. Genital warts are not curable and are identified by appearance, not culture. Genital herpes is not curable and is identified by the appearance of the lesions or cytologic studies. The diagnosis of syphilis is done using dark-field microscopy or serologic tests.

A client with syphilis did not receive treatment and has now progressed into the tertiary stage of the disorder. Which symptoms would the nurse expect the client to exhibit?

heart disease and inflammation of the aorta, eyes, brain, central nervous system, and skin Explanation: The client with late or tertiary syphilis is noninfectious because the microorganism has invaded the central nervous system (CNS) as well as other organs of the body. Symptoms of tertiary syphilis include heart disease and neurologic disease that slowly destroys the heart, with inflammation of the aorta, eyes, brain, central nervous system, and skin. Symptoms of secondary syphilis include fever, malaise, rash, headache, sore throat, and lymph node enlargement. Ulcerated chancre occurs in the primary stage.

The nurse in the sexual health clinic is obtaining a health history of a client who suffers form heroin use disorder. The client reports chronic flulike symptoms accompanied by pruritis, fatigue, anorexia, and constant upper right quadrant pain. Which sexually transmitted infection would the nurse suspect?

hepatitis A Explanation: Hepatitis A produces flulike symptoms with malaise, skin rashes, fatigue, anorexia, nausea, pruritus, fever, and upper right quadrant pain. Symptoms of hepatitis B are similar to those of hepatitis A, but with less fever and skin rash involvement. Syphilis, herpes simplex, and trichomoniasis do not present with these types of symptoms.

A group of students is reviewing class material on sexually transmitted infections in preparation for a test. The students demonstrate understanding of the material when they identify which cause of condylomata?

human papillomavirus Genital warts or condylomata are caused by the human papilloma virus (HPV). Herpes virus causes genital herpes. Treponema pallidum is the cause of syphilis. Haemophilus ducreyi bacillus is the cause of chancroid.

Which stage or period of syphilis occurs when the infected person has no signs or symptoms of syphilis?

latency A period of latency occurs when the infected person has no signs or symptoms of syphilis. Secondary syphilis occurs when the hematogenous spread of organisms from the original chancre leads to generalized infection. Primary syphilis occurs 2 to 3 weeks after initial inoculation with the organism. Tertiary syphilis presents as a slowly progressive inflammatory disease with the potential to affect multiple organs.

A woman in her third trimester shows the nurse a narrow, brown line that has formed on her abdomen, running from her belly button down to her pubic region. She expresses concern about this and asks the nurse whether it is normal. The nurse explains that this is a normal occurrence of pregnancy and that it results from the release of melanocyte-stimulating hormone from the pituitary, causing the appearance of extra pigmentation on the skin. What is the name of this phenomenon?

linea nigra Explanation: Extra pigmentation generally appears on the abdominal wall because of melanocyte-stimulating hormone from the pituitary. A narrow, brown line (linea nigra) may form, running from the umbilicus to the symphysis pubis and separating the abdomen into right and left halves. The other answers are other changes that occur in the integumentary system during pregnancy, including melasma (darkened or reddened areas on the face - also known as chloasma), diastasis recti (separation of the rectus muscles under the skin), and striae gravidarum (stretch marks; pink or reddish streaks on the sides of the abdominal wall and sometimes on the thighs).

A male client appears in the walk-in clinic and requests treatment for trichomoniasis as his girlfriend was recently diagnosed with it. What medication would the health care provider most likely prescribe?

metronidazole Trichomoniasis is a common vaginal infection with the therapeutic management of metronidazole or tinidazole for both partners. Trichomoniasis is a common, curable sexually transmitted infection (STI) caused by a parasitic protozoa called Trichomonas.

The nurse is teaching a pregnant woman about breastfeeding. The nurse determines that the teaching was successful when the woman identifies which hormone as being released when the newborn sucks at the breast?

oxytocin Explanation: Oxytocin is responsible for milk ejection during breastfeeding. Its secretion is stimulated by stimulation of the breasts via sucking or touching. Secretion of follicle-stimulating hormone is inhibited during pregnancy. The secretion of antidiuretic hormone has no effect on breastfeeding. Cortisol secretion regulates carbohydrate and protein metabolism and is helpful in times of stress.

A woman comes to the clinic reporting her period is late and she is wondering if she is pregnant. Which assessment findings by the nurse would indicate she is exhibiting probable signs of pregnancy? Select all that apply.

positive pregnancy test ballottement softening of the cervix

Which factor in a client's history indicates she is at risk for candidiasis?

use of corticosteroids Small numbers of the fungus Candida albicans are commonly in the vagina. Because corticosteroids decrease host defense, they increase the risk of candidiasis. Pregnancy, not nulliparity, increases the risk of candidiasis. Candidiasis is rare before menarche and after menopause. The use of hormonal contraceptives, not spermicidal jelly, increases the risk of candidiasis.

A client is suspected of having herpes simplex viral infection. The nurse would expect to prepare the client for which diagnostic test to confirm the infection?

viral culture of vesicular fluid Diagnosis of HSV is often based on clinical signs and symptoms and is confirmed by viral culture of fluid from the vesicles. The IgG/IgM antibody testing is frequently done for screening purposes. Papanicolaou (Pap) smears are an insensitive and nonspecific diagnostic test for HSV and should not be relied on for diagnosis. Treponemal testing is used to diagnose syphilis.

The nurse obtains a human chorionic gonadotropin (hCG) level from a woman who thinks that she is pregnant. Which result would the nurse identify as a positive pregnancy result?

32 mIU/mL (32 IU/L) Explanation: An hCG level lower than 5 mIU/mL (5 IU/l) is considered negative for pregnancy, and anything higher than 25 mIU/mL (25 IU/l) is considered positive for pregnancy.

During pregnancy, which situation would interfere with mother-child bonding?

A woman's father has been very ill during the pregnancy. Explanation: Any event during pregnancy that has the potential to reduce the time the woman spends working through the developmental tasks of pregnancy can interfere with bonding.

A pregnant client in her third trimester, lying supine on the examination table, suddenly grows very short of breath and dizzy. Concerned, she asks the nurse what is happening. Which response should the nurse prioritize?

Blood is trapped in the vena cava in a supine position. Explanation: Supine hypotension syndrome, or an interference with blood return to the heart, occurs when the weight of the fetus rests on the vena cava. Cerebral arteries should not be affected. Mean arterial pressure is high enough to maintain perfusion of the uterus in any orientation. The sympathetic nervous system will not be affected by the supine position.

A client presents to the clinic because she thinks she may be pregnant. On examination, the nurse notes that the client's cervix and vaginal mucosa appear a bluish-purple color. The nurse interprets this finding as which sign?

Chadwick sign Explanation: Common probable signs of pregnancy include a bluish-purple coloration of the vaginal mucosa and cervix (Chadwick sign), softening of the lower uterine segment or isthmus (Hegar sign), and softening of the cervix (Goodell sign). There is no such thing as Braxton sign; however, there are the Braxton Hicks contractions, which occur throughout the pregnancy preparing the uterus for delivery.

A client in the first trimester reports having nausea and vomiting, especially in the morning. Which instruction would be most appropriate to help prevent or reduce the client's compliant?

Eat dry crackers or toast before rising. Explanation: The nurse should recommend the client eat dry crackers or toast before rising to prevent nausea and vomiting in the morning. Drinking plenty of fluids at bedtime could cause nocturia. Foods such as cheese should be avoided to prevent constipation. Spicy foods could cause heartburn.

A 41-year-old pregnant woman and her husband are anxiously awaiting the results of various blood tests to evaluate the fetus for potential Down syndrome, neural tube defects, and spina bifida. Client education should include which information?

Further testing will be required to confirm any diagnosis. Explanation: Nursing management related to marker screening tests consists primarily of providing education about the tests. Remind the couple that a definitive diagnosis is not made without further tests such as an amniocentesis. The blood tests are not definitive but only strongly suggest the possibility of a defect. For some conditions there are no treatments. The couple may request a second set, but the health care provider will probably suggest proceeding with the more definitive methods to confirm the diagnosis.

What is the most common viral infection?

Human papillomavirus (HPV)

A pregnant client has been diagnosed with gonorrhea. Which nursing interventions should be performed to prevent gonococcal ophthalmia neonatorum in the baby?

Instill a prophylactic agent in the eyes of the newborn. To prevent gonococcal ophthalmia neonatorum in the baby, the nurse should instill a prophylactic agent in the eyes of the newborn. Cephalosporins are administered to the mother during pregnancy to treat gonorrhea but not to prevent infection in the newborn. Performing a cesarean birth will not prevent gonococcal ophthalmia neonatorum in the newborn. An antiretroviral syrup is administered to the newborn only if the mother is HIV positive and will not help prevent gonococcal ophthalmia neonatorum in the baby.

A client at 34 weeks' gestation has recently been diagnosed with human immunodeficiency virus (HIV). The client asks how HIV would be transmitted to the newborn. Which statement would be the nurse's best response?

It is recommended to formula-feed your newborn as it is transmitted through your breast milk." Explanation: An infected mother can transmit HIV infection to her newborn before or during birth and through breastfeeding. The risk of perinatal transmission of HIV from an infected mother to her newborn is about 25%. This risk falls to less than 1% if the mother receives antiretroviral therapy during pregnancy. HIV can be spread to the infant through breastfeeding. HIV-infected mothers should be counseled to avoid breastfeeding and use formula instead.

The nurse is preparing a presentation for a group of adolescents and young adults about sexually transmitted infections and the use of condoms. Which information will the nurse include?

Leave space at the tip of the condom. The condom should be positioned so there is space (approximately 0.5 in/1.25 cm) at the penis tip to collect the ejaculate without placing undue pressure on the condom. To be effective, a condom must be applied before any penile-vulvar contact as even preejaculation fluid may contain some sperm. To prevent transmission of sexually transmitted infections, condoms or dental dams are recommended for oral sex. It is not recommended to use both a male and female condom together. Only water-soluble lubricants should be used with condoms. Oil-based lubricants, such as body lotion, can weaken the condom making it more likely to tear or break during intercourse.

Which instruction should be given to a woman newly diagnosed with genital herpes?

Limit stress and emotional upset as much as possible. Explanation: Stress, anxiety, and emotional upset seem to predispose a client to recurrent outbreaks of genital herpes. Sexual intercourse should be avoided during outbreaks, and a condom should be used between outbreaks; it is not known whether the virus can be transmitted at this time. During an outbreak, creams and lubricants should be avoided because they may prolong healing. Because a relationship has been found between genital herpes and cervical cancer, a Papanicolaou test is recommended every year.

A client in her second trimester of pregnancy reports discomfort during sexual activity. Which instruction should a nurse provide?

Modify sexual positions to increase comfort. Explanation: The nurse should instruct the client to change sexual positions to increase comfort as the pregnancy progresses. Although the nurse should also encourage her to engage in alternative, noncoital modes of sexual expression, such as cuddling, caressing, and holding, the client need not restrict herself to such alternatives. It is not advisable to perform frequent douching, because this is believed to irritate the vaginal mucosa and predispose the client to infection. Using lubricants or performing stress-relieving and relaxation exercises will not alleviate discomfort during sexual activity.

The public health nurse is teaching young adolescents in a sexual health class the proper use of a condom. Which statements made by the students indicate teaching was successful? Select all that apply.

Only use latex condoms. Place the condom on an erect penis. Store the condoms in a cool, dry place.

During a routine prenatal visit, a pregnant woman reports a white, thick, vaginal discharge. She denies any itching or irritation. Which action would the nurse take next?

Tell the woman that this is entirely normal. Explanation: Vaginal secretions increase during pregnancy and this is considered normal leukorrhea based on the woman's report that she is not experiencing any itching or irritation. There is no evidence indicating the need to notify the health care provider, check for rupture of membranes, or advise her about the need for a culture.

During an examination, a client at 32 weeks' gestation becomes dizzy, lightheaded, and pale while supine. What should the nurse do first?

Turn the client on her left side. Explanation: As the enlarging uterus increases pressure on the inferior vena cava, it compromises venous return, which can cause dizziness, light-headedness, and pallor when the client is supine. The nurse can relieve these symptoms by turning the client on her left side, which relieves pressure on the vena cava and restores venous return. Although they are valuable assessments, fetal heart tone and maternal blood pressure measurements do not correct the problem. Because deep breathing has no effect on venous return, it cannot relieve the client's symptoms.

Which medication is the most effective treatment for trichomoniasis?

etronidazole Explanation: The most effective treatment for trichomoniasis is metronidazole and tinidazole. Penicillin G benzathine is used for syphilis. Doxycycline and azithromycin are used in the treatment of chlamydia.

A client comes to the prenatal clinic for her first visit. Which screening would be most appropriate for the nurse to encourage the client to undergo?

hepatitis B virus Explanation: Nurses should encourage women to undergo hepatitis B screening at their first prenatal visit and repeat screening in the last trimester for women with high-risk behaviors to comply with the U.S. Preventive Services Task Force recommendations.

A client is diagnosed with trichomoniasis infection. The nurse prepares to teach the client about which medication?

metronidazole Oral metronidazole or tinidazole are used to treat trichomoniasis. Penicillin G may be used to treat syphilis. Miconazole and fluconazole are used to treat candidiasis.

A nurse is reviewing the history of a client diagnosed with pelvic inflammatory disease. Which factors would the nurse identify as placing the client at increased risk for this condition? Select all that apply.

multiple sex partners intrauterine contraceptive device inserted 3 weeks ago vaginal douching approximately once a week

Copious amounts of frothy, greenish vaginal discharge would be a symptom of which infection?

trichomoniasis Explanation: The discharge associated with infection caused by Trichomonas organisms is homogenous, greenish gray, watery, and frothy or purulent. The discharge associated with candidiasis is thick, white, and resembles cottage cheese in appearance. The discharge associated with infection due to G. vaginalis is thin and grayish white, with a marked fishy odor. With gonorrhea, vaginal discharge is purulent when present but, in many women, gonorrhea produces no symptoms.

A woman comes to the clinic reporting intense pruritus and a thick curd-like vaginal discharge. On examination, white plaques are observed on the vaginal wall. The nurse suspects which condition?

vulvovaginal candidiasis Explanation: Pruritus accompanied by a thick curd-like vaginal discharge and white plaques on the vaginal wall are characteristic of vulvovaginal candidiasis. Trichomoniasis is characterized by a heavy yellow or green or gray frothy or bubbly discharge. Bacterial vaginosis is characterized by a thin white homogeneous vaginal discharge. Chlamydia is usually manifested by a mucopurulent vaginal discharge.

During a health education session, a teenage client asks the nurse when she should have her first "Pap test." How should the nurse reply?

"When you turn 21 years old." Explanation: Current guidelines recommend that the woman obtain the initial Papanicolaou test at 21 years of age, regardless of when she first has sexual intercourse.

A primigravida at her 12-week prenatal visit expresses concern that she hasn't felt her baby move yet. What is the best response from the nurse?

"You usually cannot feel them until approximately 16 to 20 weeks." Explanation: The first fetal movements felt by the pregnant woman are usually felt between 16 and 20 weeks gestation. Thirteen weeks is too early (fetus is too small), and movements cannot be felt even if the woman lies down and concentrates on them, although the woman should start feeling movements within the next few weeks.

Which change related to the vital signs is expected in pregnant women?

Blood pressure decreases. Explanation: Pulse and temperature often increase, while lung space is decreased in pregnant women. It is common for blood pressure to decrease during pregnancy.

A woman seen in the emergency department is diagnosed with primary syphilis. What finding is most likely?

chancres at the vaginal site Syphilis is divided into four stages: primary, secondary, latency, and tertiary. Primary syphilis is characterized by a chancre at the site of bacterial entry. Foul-smelling discharge would not be noted. Vesicles on the labia are not associated with syphilis. Bleeding from the vagina could be normal menses and does not correlate with syphilis.

Clients who have had PID are prone to which complication?

ectopic pregnancy All clients who have had PID need to be informed of the signs and symptoms of ectopic pregnancy because they are prone to this complication.

A client calls to cancel an appointment for the first prenatal visit after reporting a home pregnancy test is negative. Which instruction should the nurse prioritize?

Keep the appointment. Explanation: Although home pregnancy tests are accurate 95% of the time, they may still have false positives or false negatives, and the client needs to seek prenatal care and confirmation from her health care provider. Diluting the urine, waiting to miss a second period, or eating before the test would have no effect. The tests look for hCG, which is not affected.

A nurse at the health care facility assesses a client at 20 weeks' gestation. The client is healthy and progressing well, without any sign of complications. Where should the nurse expect to measure the fundal height in this client?

at the level of the umbilicus Explanation: In the 20th week of gestation, the nurse should expect to find the fundus at the level of the umbilicus. The nurse should palpate at the top of the symphysis pubis between 10 to 12 weeks' gestation. At 16 weeks' gestation, the fundus should reach halfway between the symphysis pubis and the umbilicus. With a full-term pregnancy, the fundus should reach the xiphoid process.

During a prenatal visit, the nurse inspects the skin of the client's abdomen. Which would the nurse identify as an abnormal finding?

bruising

A nurse is conducting a class for high school students on preventing sexually transmitted infections (STIs). Which information would the nurse emphasize as the sole method for not contracting STIs?

engaging in abstinence Although limiting sexual partners and using condoms can help in preventing STIs, abstinence is the only way to completely avoid contracting STIs. Urinating immediately after intercourse would be ineffective.

A pregnant client at 24 weeks' gestation calls the clinic crying after a prenatal visit, where she had a pelvic exam. She states that she noticed blood on the tissue when she wiped after voiding. What initial statement by the nurse would explain this finding?

The cervix is very vascular during pregnancy, so spotting after a pelvic exam is not unusual. Explanation: Slight bleeding after a pelvic exam in a pregnant woman is common due to the vascularity of her cervix during pregnancy. Suggesting a bleeding disorder is frightening and not substantiated by the data. Bleeding is not a normal finding during pregnancy and losing the mucus plug occurs at the end of pregnancy, just prior to labor.

A pregnant woman who is a vegetarian asks the nurse, "What would you suggest to make sure that I get enough protein in my diet while I am pregnant?" Which food(s) would be appropriate for the nurse to suggest? Select all that apply.

beans lentils nuts

The nurse is teaching the pregnant woman about nutrition for herself and her baby. Which statement by the woman indicates that the teaching was effective?

"I will need to take iron supplementation throughout my pregnancy even if I am not anemic." Explanation: Iron is recommended for all pregnant women because it is almost impossible for the pregnant woman to get what is required from diet alone, especially after 20 weeks' gestation when the requirements of the fetus increase. Pregnant women can get many nutrients from seafood including phosphorus, but there are specific recommendations about types of fish to avoid because of the risk of mercury poisoning. Milk production actually requires higher levels of zinc, which can be obtained from a healthy diet. Calcium requirements do not increase above prepregnancy levels during pregnancy because calcium absorption is enhanced during pregnancy. It can be unsafe for the pregnant woman to eat anything she wants and gain too much weight. A woman who gains too much weight during pregnancy is at risk for delivering a macrosomic baby

The nurse is caring for a client diagnosed with genital herpes who is prescribed acyclovir for treatment. Which statement by the client indicates to the nurse that additional teaching is needed?

"If I forget a dose, it is still important to take it. I can take a double dose if needed." Antiviral drugs like acyclovir are used to treat genital herpes, assist in the prevention of a recurrence, and attempt to suppress the virus. The antiviral drugs do not cure but just control symptoms. If the client misses a dose, the client should take it as soon as possible; however, the client should not take two doses at once. The client should notify the health care provider for directions if this happens. Symptoms may resolve before the entire prescribed amount is taken. If this occurs, it is imperative the client take the remaining medication to prevent developing medication resistance. Common expected side effects include nausea, vomiting, diarrhea, headache, rash, itching, and mild skin pain.

After teaching a group of college-aged students about condom use, the nurse determines that additional teaching is needed when the students make which statement?

"It's okay to use petroleum jelly with a latex condom." Explanation: If external lubricants are used, use only water-based lubricants with latex condoms. Oil-based or petroleum-based lubricants, such as body lotion, massage oil, or cooking oil, can weaken latex condoms. Latex condoms are the best protection from STIs. Condoms are applied before any genital contact because sperm is present in preejactulate fluid. Condoms also should be stored in a cool, dry place away from direct sunlight to prevent deterioration.

A female client with genital herpes is prescribed acyclovir as treatment. After teaching the client about this treatment, which statement by the client indicates effective teaching?

"This drug will help to suppress any symptoms of the infection." Explanation: No cure exists, but antiviral drug therapy helps to reduce or suppress symptoms, shedding, and recurrent episodes. Advances in treatment with acyclovir 400 mg orally three times daily for 7 to 10 days, famciclovir 250 mg orally three times daily for 7 to 10 days, or valacyclovir 1 g orally twice daily for 7 to 10 days have resulted in an improved quality of life for those infected with herpes simplex virus (HSV). However, according to the CDC, these drugs neither eradicate latent virus nor affect the risk, frequency, or severity of recurrences after the drug is discontinued.

A nurse is presenting a program for a local women's group about STIs. When describing the information, the nurse would identify which infection as the most common cause of vaginal discharge?

candidiasis Although vaginal discharge can occur with any STI, genital/vulvovaginal candidiasis is one of the most common causes of vaginal discharge. It is also referred to as yeast, monilial, and a fungal infection. It is not considered an STI because candida is a normal constituent in the vagina and becomes pathogenic only when the vaginal environment becomes altered.

A 20-year-old female comes to the sexual health clinic for follow up related to a positive test for the human papillomavirus (HPV). The client asks the nurse, "Is there anything I can do to get rid of this?" What is the nurse's best response?

"There is currently no medical treatment to cure HPV." It is a lifelong recurrent viral disease treated but not cured with medical treatment. Immunization regimes such as the recombinant human papillomavirus quadrivalent vaccine are for HPV prevention not cure. Cryosurgery will eliminate HPV warts but not cure it. Antibiotics will not be effective for a virus.

A nurse is educating a primigravida client about the expected changes during pregnancy. Which measure will provide anticipatory guidance about pregnancy?

Avoid wearing high heels, especially during late pregnancy. Explanation: The nurse should ask the client to avoid wearing high heels, especially during late pregnancy because the ligaments relax and the pregnant woman's center of gravity changes; thus, she may lose her balance. The client should avoid a hot tub, sauna, whirlpool, or tanning beds during pregnancy as it can adversely affect the fetus resulting in tachycardia. It can also raise the mother's internal temperature. There is also the possible exposure to bacteria which could result in an infection. The nurse should ask the pregnant woman to consume plenty of fiber and water to prevent constipation and hemorrhoids. If she wakes up feeling very hungry, it could help to eat starchy food, such as a baked potato, just before bedtime. If she eats sweets, she will probably have a rapid rise in blood sugar, followed by a sharp drop. Either of these changes can cause uncomfortable symptoms.

What physical changes take place when a woman becomes pregnant? Select all that apply.

Heart rate increases 10 to 15 beats per minute. The areolae become more prominent. Nasal congestion increases due to edema.

In preparing for a prenatal class to discuss the hormonal changes during pregnancy, which information would the nurse most likely include?

Over-the-counter antacids can be used to treat acid reflux with the health care provider's knowledge. Explanation: Elevated progesterone levels cause smooth muscle relaxation, which can result in relaxation of the cardiac sphincter and reflux of the stomach contents into the lower esophagus. OTC antacids will usually relieve the symptoms but should be discussed with the health care provider first. The hormonal changes are necessary for the pregnancy to continue, and the woman will return to her usual nonpregnant hormonal levels after the baby is born. Taking hormonal replacement therapy is not recommended. Using herbs should be done only with the knowledge of the health care practitioner due to the side effects and contraindications of some herbs during pregnancy. Some herbs will cause a spontaneous abortion (miscarriage).

A client in her 29th week of gestation reports dizziness and clamminess when assuming a supine position. During the assessment, the nurse observes there is a marked decrease in the client's blood pressure. Which intervention should the nurse implement to help alleviate this client's condition?

Place the client in the left lateral position. Explanation: The symptoms experienced by the client indicate supine hypotension syndrome. When the pregnant woman assumes a supine position, the expanding uterus exerts pressure on the inferior vena. The nurse should place the client in the left lateral position to correct this syndrome and optimize cardiac output and uterine perfusion. Elevating the client's legs, placing the client in an orthopneic position, or keeping the head of the bed elevated will not help alleviate the client's condition.

A woman is concerned that orgasm will be harmful during pregnancy. Which statement is factual?

Some women experience orgasm intensely during pregnancy. Explanation: Because of pelvic congestion, orgasm may be achieved more readily by pregnant women than nonpregnant women.

The client at 18 weeks' gestation states, "I feel a fluttering sensation, kind of like gas." The nurse understands that the client is describing what occurrence?

quickening Explanation: The fluttering sensation that can be confused with gas is called "quickening." In the 2 weeks leading up to the 20-week mark, she may feel "flutters" that she may confuse with gas. Lightening is the descent of the presenting part of the fetus into the pelvis. Placenta previa is the implantation of the placenta so that it covers part or all of the cervical os. Linea nigra is a hyperpigmented line that appears on the maternal abdomen between the symphysis pubis and top of the fundus.

The nurse is assessing a primigravida woman at a routine prenatal visit. Which assessment finding is reinforcing to the client that she is definitely pregnant?

ultrasound picture of her fetus Explanation: A positive sign of pregnancy is visualization of the fetus by ultrasound at 6+ weeks. Amenorrhea is a presumptive sign and can be caused by a variety of factors. Positive hCG in the blood and uterine growth are both probable signs but can be caused by hydatidiform or tumors.